[Federal Register Volume 67, Number 154 (Friday, August 9, 2002)]
[Proposed Rules]
[Pages 52092-52371]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-20146]



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Part VII





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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42 CFR Part 405 et al.



Medicare Program; Changes to the Hospital Outpatient Prospective 
Payment System and Calendar Year 2003 Payment Rates; and Changes to 
Payment Suspension for Unfiled Cost Reports; Proposed Rule

  Federal Register / Vol. 67, No. 154 / Friday, August 9, 2002 / 
Proposed Rules  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 405, 410 and 419

[CMS-1206-P]
RIN 0938-AL19


Medicare Program; Changes to the Hospital Outpatient Prospective 
Payment System and Calendar Year 2003 Payment Rates; and Changes to 
Payment Suspension for Unfiled Cost Reports

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Proposed rule.

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SUMMARY: This proposed rule would revise the Medicare hospital 
outpatient prospective payment system to implement applicable statutory 
requirements and changes arising from our continuing experience with 
this system. In addition, it would describe proposed changes to the 
amounts and factors used to determine the payment rates for Medicare 
hospital outpatient services paid under the prospective payment system. 
These changes would be applicable to services furnished on or after 
January 1, 2003. In addition, this rule proposes to allow the Secretary 
to suspend Medicare payments ``in whole or in part'' if a provider 
fails to file a timely and acceptable cost report.

DATES: We will consider comments if we receive them at the appropriate 
address, as provided below, no later than 5 p.m. on October 8, 2002.

ADDRESSES: In commenting, please refer to file code CMS-1206-P. Because 
of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission. Mail written comments (one original and 
two copies) to the following address ONLY: Centers for Medicare & 
Medicaid Services, Department of Health and Human Services, Attention: 
CMS-1206-P, P.O. Box 8018, Baltimore, MD 21244-8018.
    Please allow sufficient time for mailed comments to be timely 
received in the event of delivery delays.
    If you prefer, you may deliver (by hand or courier) your written 
comments (one original and two copies) to one of the following 
addresses:

Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., 
Washington, DC 20201, or
Room C5-14-03, 7500 Security Boulevard, Baltimore, MD 21244-1850.

    (Because access to the interior of the HHH Building is not readily 
available to persons without Federal Government identification, 
commenters are encouraged to leave their comments in the CMS drop slots 
located in the main lobby of the building. A stamp-in clock is 
available for persons wishing to retain a proof of filing by stamping 
in and retaining an extra copy of the comments being filed.)
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and could be considered late.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Anita Heygster, (410) 786-0378--
outpatient prospective payment issues; Lana Price, (410) 786-4533--
partial hospitalization and ESRD; Gerald Walters, (410) 786-2070--
payment suspension issues.

SUPPLEMENTARY INFORMATION:
    Inspection of Public Comments: Comments received timely will be 
available for public inspection as they are received, generally 
beginning approximately 3 weeks after publication of a document, at the 
headquarters of the Centers for Medicare & Medicaid Services, 7500 
Security Boulevard, Baltimore, Maryland 21244, Monday through Friday of 
each week from 8:30 a.m. to 4 p.m. To schedule an appointment to view 
public comments, call (410) 786-7197.

Availability of Copies and Electronic Access

    Copies: To order copies of the Federal Register containing this 
document, send your request to: New Orders, Superintendent of 
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of the issue requested and enclose a check or money order payable to 
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number and expiration date. Credit card orders can also be placed by 
calling the order desk at (202) 512-1800 (or toll-free at 1-888-293-
6498) or by faxing to (202) 512-2250. The cost for each copy is $9. As 
an alternative, you can view and photocopy the Federal Register 
document at most libraries designated as Federal Depository Libraries 
and at many other public and academic libraries throughout the country 
that receive the Federal Register.
    This Federal Register document is also available from the Federal 
Register online database through GPO Access, a service of the U.S. 
Government Printing Office. The web site address is: http://www.access.gpo.gov/nara/index.html.
    To assist readers in referencing sections contained in this 
document, we are providing the following table of contents.

Outline of Contents

Comparison of Proposed 2003 Payment Rates to 2002 Payment Rates

I. Background
A. Authority for the Outpatient Prospective Payment System
B. Summary of Rulemaking for the Outpatient Prospective Payment 
System
C. Authority for Payment Suspension for Unfiled Cost Reports
D. Summary of Payment Suspension for Unfiled Cost Reports
II. Proposed Changes to the Ambulatory Payment Classification (APC) 
Groups and Relative Weights
A. Recommendations of the Advisory Panel on APC Groups
    1. Establishment of the Advisory Panel
    2. General Issues Considered by the Advisory Panel
    3. Recommendations of the Advisory Panel and Our Responses
B. Other Changes Affecting the APCs
    1. Limit on Variation of Costs of Services Classified Within a 
Group
    2. Procedures Moved from New Technology APCs to Clinically 
Appropriate APCs
    3. APC Assignment for New Codes Created During 2002
    4. Recalibration of Weights for 2003
    a. Data Issues
    (1) Treatment of ``Multiple Procedure'' Claims
    (2) Calendar Year 2002 Charge Data for Pass-Through Device 
Categories
    b. Description of How Weights Were Calculated for 2003
    5. Procedures That Will Be Paid Only As Inpatient Procedures
C. Partial Hospitalization
III. Transitional Pass-Through and Related Payment Issues
A. Background
B. Discussion of Pro Rata Reduction
C. Expiration of Transitional Pass-Through Payments in Calendar Year 
2003
    1. Devices
    2. Drugs and Biologicals (Including Radiopharmaceuticals, Blood, 
and Blood Products)
    3. Brachytherapy
D. Criteria for New Device Categories
E. Payment for Transitional Pass-Through Drugs and Biologicals for 
Calendar Year 2003
IV. Wage Index Changes for Calendar Year 2003
V. Copayment for Calendar Year 2003
VI. Conversion Factor Update for Calendar Year 2003
VII. Outlier Policy for Calendar Year 2003
VIII. Other Policy Decisions and Proposed Changes
A. Hospital Coding for Evaluation and Management (E/M) Services
B. Observation Services

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C. Payment Policy When A Surgical Procedure on the Inpatient List Is 
Performed on an Emergency Basis
    1. Current Policy
    2. Hospital Concerns
    3. Clarification of Payment Policy
    4. Orders to Admit
D. Status Indicators
E. Other Policy Issues Relating to Pass-Through Device Categories
    1. Reducing Transitional Pass-Through Payments To Offset Costs 
Packaged Into APC Groups
    2. Devices Paid With Multiple Procedures
F. Outpatient Billing for Dialysis
IX. Summary of and Responses to MedPAC Recommendations
X. Summary of Proposed Changes for 2003
A. Changes Required by Statute
B. Additional Changes to OPPS and Payment Suspension Provisons
C. Changes to the Regulations Text
XI. Summary of Proposed Payment Suspension Provisions
XII. Collection of Information Requirements
XIII. Response to Public Comments
XIV. Regulatory Impact Analysis
A. OPPS
    1. General
    2. Changes in this Proposed Rule
    3. Limitations of Our Analysis
    4. Estimated Impacts of this Proposed Rule
    5. Projected Distribution of Outlier Payments
B. Payment Suspension for Unfiled Cost Reports Regulations Text

Addenda

Addendum A--List of Ambulatory Payment Classifications (APCs) with 
Status Indicators, Relative Weights, Payment Rates, and Copayment 
Amounts
Addendum B--Payment Status by HCPCS Code, and Related Information
Addendum C--Hospital Outpatient Payment for Procedures by APC: 
Displayed on Website Only
Addendum D--Payment Status Indicators for the Hospital Outpatient 
Prospective Payment System
Addendum E--CPT Codes That Would Be Paid Only As Inpatient 
Procedures
Addendum H--Wage Index for Urban Areas
Addendum I--Wage Index for Rural Areas
Addendum J--Wage Index for Hospitals That Are Reclassified

Alphabetical List of Acronyms Appearing in the Proposed Rule

ACEP  American College of Emergency Physicians
AMA  American Medical Association
APC  Ambulatory payment classification
AWP  Average wholesale price
BBA  Balanced Budget Act of 1997
BIPA  Medicare, Medicaid, and SCHIP Benefits Improvement and 
Protection Act of 2000
BBRA  Balanced Budget Refinement Act of 1999
CCR  Cost center specific cost-to-charge ratio
CMHC  Community mental health center
CMS  Centers for Medicare & Medicaid Services (Formerly known as the 
Health Care Financing Administration)
CPT  (Physician's) Current Procedural Terminology, Fourth Edition, 
2002, copyrighted by the American Medical Association
CSW  Clinical social worker
CY  Calendar year
DRG  Diagnosis-related group
DSH  Disproportionate Share Hospital
EACH  Essential Access Community Hospital
E/M  Evaluation and management
ERCP  Endoscopic retrograde cholangiopancreatography
ESRD  End-stage renal disease
FACA  Federal Advisory Committee Act
FY  Federal fiscal year
HCPCS  Healthcare Common Procedure Coding System
HIPAA  Health Insurance Portability and Accountability Act of 1996
ICU  Intensive care unit
ICD-9-CM  International Classification of Diseases, Ninth Edition, 
Clinical Modification
IME  Indirect Medical Education
IPPS  (Hospital) inpatient prospective payment system
LTC  Long Term Care
MedPAC  Medicare Payment Advisory Commission
MDH  Medicare Dependent Hospital
MSA  Metropolitan statistical area
NECMA  New England County Metropolitan Area
OCE  Outpatient code editor
OMB  Office of Management and Budget
OPD  (Hospital) outpatient department
OPPS  (Hospital) outpatient prospective payment system
OT  Occupational therapist
PHP  Partial hospitalization program
PPS  Prospective payment system
PPV  Pneumococcal pneumonia (virus)
PRA  Paperwork Reduction Act
RFA  Regulatory Flexibility Act
RRC  Rural Referral Center
RVUs  Relative value units
SCH  Sole Community Hospital
TEFRA  Tax Equity and Fiscal Responsibility Act
USPDI  United States Pharmacopoeia Drug Information
Comparison of Proposed 2003 Payment Rates to 2002 Payment Rates
    The outpatient pass-through provisions of the BBRA and BIPA have 
been exceptionally difficult to implement, arguably the most complex 
and difficult in the history of the Medicare program. In CY 2002, the 
pass-through payments, and the APC rates were calculated on the best 
information available. This was often manufacturer list prices, which 
may not reflect not actual prices paid by hospitals. For CY 2003, far 
more data is available on the actual charges for hospital OPDs, and 
these are reflected in the rates in this proposed rule. In many cases 
these new rates are significantly different from CY 2003 rates, but 
they are based on actual hospital charges, and on far more complete 
data than were the CY 2002 rates. Nevertheless, CMS is actively seeking 
comment on all aspects of these rates, given the significant changes in 
the proposed rule, and the agency is open to making changes, perhaps 
significant, in the final rule based on comments.
    The 2003 payment rates proposed in this proposed rule are, for many 
items and services, significantly higher or lower than the payment 
rates for the same items and services for 2002, particularly for APCs 
which use medical devices, and for APCs for drugs that will no longer 
be eligible for pass-through status in 2003 and paid under separate 
APCs. Some proposed payments for 2003 are far lower than the 2002 
payment amounts (and some are higher).
    For example, as can be seen in Addenda A, the proposed rate for APC 
0108 (Insertion/Replacement/Repair of Cardioverter-Defibrilator Leads) 
shows a dramatic decrease in payment compared to the 2002 rate. This 
reduction for a number of APCs is of concern to us because of the 
potential impact on access to care. We invite public comment and 
suggestions on how to address the potential for adverse impact of these 
proposed changes.
    The proposed 2003 payment rates reflect the use of updated data, as 
required by the statute, in calculating payment rates in accordance 
with the methodologies set forth in the statute and regulations. The 
proposed payment rates reflect mathematical calculations based on the 
latest available program data.
    Our goal in this proposed rule is to explain the methodology and to 
solicit comments on our rate-setting methods and the effect on 
beneficiary access, provider participation and the fiscal integrity of 
the Medicare Trust Fund.
Devices
    We believe that there are several factors that may explain the 
differences between the proposed payment amounts for 2003 and the 
payment amounts for 2002 (some, but not all of which, are significant).
    First, we believe that the payment rates for the device related 
procedures for 2002 may in some cases have been higher than they would 
have been had actual hospital acquisition cost data been available for 
us to use. Specifically, because we lacked hospitals' cost data for 
devices, we used the best data available to us at the time which was 
manufacturer data regarding the hospitals' acquisition costs in 
providing the devices. We assumed that a device would be provided with 
a related procedure and packaged 75 percent of these manufacturer 
estimated

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costs for the devices into the APCs for the procedures.
    The costs that we packaged in for some devices may have been higher 
than actual hospital acquisition costs. The differences between the 
2002 payment rate and the lower 2003 proposed payments are based on our 
data sources. While the 2003 rates are based on 2001 hospital claims 
and the latest available cost report data, the 2002 rates are based on 
manufacturer data for devices. We use charges on the hospital claims 
data to estimate hospital costs. We apply hospital-specific, 
department-specific cost-to-charge ratios (CCRs) from each provider's 
most recently submitted cost report to the charges to develop the 
estimate of costs. In most cases, the provider's most recently 
submitted cost report is from fiscal year 1999. An adjustment factor is 
applied in developing CCRs for cost reports that have not yet been 
settled, so that the CCRs will more closely reflect CCRs from a settled 
cost report.
    Second, there may be problems in the data, particularly for coding 
of devices in 2001. As discussed later in this preamble, devices were 
to be coded using device specific C codes from the start of the OPPS on 
August 1, 2000 until the law changes required that we establish 
category codes by April 1, 2001. We then granted a grace period until 
July 1, 2001, during which we accepted both device specific codes and 
category codes. During a Town Hall meeting with the public on April 5, 
2001, and in other contacts with hospitals (such as the open forum 
calls and visits to hospitals) we have been told that hospitals had 
difficulty in submitting proper HCPCS coding for services and for 
devices once OPPS began and that, in many cases, they did not bill for 
devices for which they should have claimed payment.
    In some cases, hospitals were confused by the change from device 
specific codes to category codes; in other cases, the use of HCPCS 
codes was new and they had a long learning curve to learn how to use 
HCPCS codes. Our initial data analysis suggested that hospitals may not 
have billed for the devices using the device or category codes in all 
cases. If the charges were not on the claim, they would not have been 
picked up for calculation of the median cost for the service and the 
associated device, possibly resulting in a proposed payment rate for 
the APC that is inappropriately low and other rates that are 
inappropriately too high. However, based on our analysis which is 
described later, we believe that hospitals often showed the charges for 
the devices in the applicable revenue centers (such as, supplies) and 
that the charges for the devices often were on the claim, even if the 
HCPCS code was not.
    We welcome public comments regarding these issues for these payment 
changes and proposals regarding how problems with claims data could be 
rectified for development of the final rule.
Drugs
    As discussed later in this preamble, we propose to package the 
costs for lower cost drugs into the payment for the APC in which they 
are used and to pay specialty drugs and high cost drugs under separate 
APCs. Some of the APCs for separately paid drugs also show significant 
reductions in payments compared to the pass-through payments made in 
2002. Several factors may help place these decreases in perspective.
    These changes result largely because the payment method for items 
in transitional pass-through payment status differs significantly from 
other services paid under the OPPS, and as items lose transitional 
pass-through payment status they are subject to a different payment 
method. In particular, a drug in transitional pass-through payment 
status is paid based on 95 percent of the average wholesale price for 
the drug, possibly subject to a uniform reduction.\1\
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    \1\ In 2002, we apply a uniform reduction to the transitional 
pass-through portion of payments for drugs with transitional pass-
through status. As a result, the OPPS now pays hospitals about 72 
percent of AWP for drugs in this status. The uniform reduction, as 
discussed in the March 1, 2002 final rule, is to comply with section 
1833(t)(6)(E) of the Act, which limits the total projected amount of 
transitional pass-through payments for 2002 to 2.5 percent of 
projected total payments under the OPPS in 2002.
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    In contrast, a drug not in transitional pass-through status is paid 
as are other services under the OPPS. The statute provides that 
services (other than transitional pass-through items) be paid on the 
basis of a service-specific relative weight multiplied by a conversion 
factor. The relative weight is determined based on the median hospital 
cost, where the cost on each claim is derived by multiplying the 
submitting hospital's charge by a cost-to-charge ratio (determined from 
the hospital's latest submitted cost report, usually from fiscal year 
1999). We anticipate that a hospital's charges on particular services 
reflect, at least in relative terms, the hospital's resource use in 
providing that service.
    Per the statute, the conversion factor was set at the initiation of 
the system to achieve budget neutrality relative to the prior system; 
it is updated each year by the rate of increase in the hospital market 
basket. This mechanism does reflect changes in input costs from the 
initial base, but the system is not rebased to reflect the absolute 
level of such costs.
    This payment method was not intended to assure that hospitals, even 
on average, are reimbursed costs of particular services. In fact, 
because the conversion factor was calibrated to reflect prior 
reductions in hospital operating and capital costs that were built into 
the baseline for overall program expenditures, the OPPS is not set to 
pay full costs to hospitals.\2\
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    \2\ In fact, because of the effect of prior statutory reductions 
in payments, the OPPS system was calibrated at its initiation to pay 
only about 82 percent of hospital costs in the aggregate.
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    Further, nothing in the payment method prescribed by the statute 
requires or anticipates that hospitals would be reimbursed full costs 
of purchased inputs such as drugs, just as it does not anticipate that 
hospitals would be reimbursed for the full cost of any other services 
they deliver.
    The payment methods are set out in section 1833(t) of the Act. This 
section does not permit continuation of a pass-through payment (at 95 
percent of AWP or some other level) for drugs losing their transitional 
pass-through status. This section permits the Secretary to specify APC 
groupings, and we are proposing in 2003 to continue to pay separately 
for certain drugs that had transitional pass-through status in 2002 and 
that are no longer eligible for pass-through status in 2003. These 
drugs would be in separate APCs, rather than being packaged into other, 
procedure-related APCs; the payment method would be the same relative-
weight payment method used for other APCs.
    The resulting payment rates incorporate the best evidence we have 
regarding what hospitals charged in 2001. They may diverge, however, 
from payment rates based on the AWP, including those in use for 2002. 
As is discussed above, movement from pass-through payment rates to 
relative-weight based payment rates would be expected to lead to 
decreases in payments, even if AWP represented a reliable measure of 
hospital acquisition costs (As discussed above, we use hospital charges 
and hospital-specific, department-specific cost-to-charge ratios to 
estimate hospital costs. In most cases, cost-to-charge ratios are 
derived from 1999 cost reports).
    However, we believe this outcome is also be due to deficiencies in 
AWP as a measure of hospital acquisition costs. AWP is not an accurate 
estimate of what

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providers actually pay for drugs. Studies undertaken over the past 
decade by the Office of the Inspector General, the Department of 
Justice, and the General Accounting Office that compare AWP with actual 
drug acquisition costs have consistently shown that published AWPs 
considerably exceed these costs (See ``MEDICARE Payments for Covered 
Outpatient Drugs Exceed Providers' Costs'', GAO-01-1118). Therefore, it 
is to be expected that the proposed 2003 APC payment rates based on 
median hospital costs for these drugs will be lower than the 2002 
payment rates for the same drugs that are based on AWP. The 
Administration has repeatedly stated its view that AWP inaccurately 
represents actual market pricing. The pass-through system pays based on 
AWP, creating further incentives for artificially high AWP listings. We 
believe the steep reductions in some drug prices reflect these 
incentives, and that the new rates more accurately reflect the actual 
acquisition costs for hospitals pay. Still, we are interested in 
soliciting comments on these costs, and the mechanisms to identify 
them.

I. Background

A. Authority for the Outpatient Prospective Payment System

    When the Medicare statute was originally enacted, Medicare payment 
for hospital outpatient services was based on hospital-specific costs. 
In an effort to ensure that Medicare and its beneficiaries pay 
appropriately for services and to encourage more efficient delivery of 
care, the Congress mandated replacement of the cost-based payment 
methodology with a prospective payment system (PPS). The Balanced 
Budget Act of 1997 (BBA) (Pub. L. 105-33), enacted on August 5, 1997, 
added section 1833(t) to the Social Security Act (the Act) authorizing 
implementation of a PPS for hospital outpatient services. The Balanced 
Budget Refinement Act of 1999 (BBRA) (Pub. L. 106-113), enacted on 
November 29, 1999, made major changes that affected the hospital 
outpatient PPS (OPPS). The Medicare, Medicaid, and SCHIP Benefits 
Improvement and Protection Act of 2000 (BIPA) (Pub. L. 106-554), 
enacted on December 21, 2000, made further changes in the OPPS. The 
OPPS was first implemented for services furnished on or after August 1, 
2000.

B. Summary of Rulemaking for the Outpatient Prospective System

     On September 8, 1998, we published a proposed rule (63 FR 
47552) to establish in regulations a PPS for hospital outpatient 
services, to eliminate the formula-driven overpayment for certain 
hospital outpatient services, and to extend reductions in payment for 
costs of hospital outpatient services. On June 30, 1999, we published a 
correction notice (64 FR 35258) to correct a number of technical and 
typographic errors in the September 1998 proposed rule including the 
proposed amounts and factors used to determine the payment rates.
     On April 7, 2000, we published a final rule with comment 
period (65 FR 18434) that addressed the provisions of the PPS for 
hospital outpatient services scheduled to be effective for services 
furnished on or after July 1, 2000. Under this system, Medicare payment 
for hospital outpatient services included in the PPS is made at a 
predetermined, specific rate. These outpatient services are classified 
according to a list of ambulatory payment classifications (APCs). The 
April 7, 2000 final rule with comment period also established 
requirements for provider departments and provider-based entities and 
prohibited 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 arrangement. In addition, this 
rule extended reductions in payment for costs of hospital outpatient 
services as required by the BBA and amended by the BBRA. Medicare 
regulations governing the hospital OPPS are set forth at 42 CFR part 
419.
     On June 30, 2000, we published a notice (65 FR 40535) 
announcing a delay in implementation of the OPPS from July 1, 2000 to 
August 1, 2000. We implemented the OPPS on August 1, 2000.
     On August 3, 2000, we published an interim final rule with 
comment period (65 FR 47670) that modified criteria that we use to 
determine which medical devices are eligible for transitional pass-
through payments. The August 3, 2000 rule also corrected and clarified 
certain provider-based provisions included in the April 7, 2000 rule.
     On November 13, 2000, we published an interim final rule 
with comment period (65 FR 67798). This rule provided for the annual 
update to the amounts and factors for OPPS payment rates effective for 
services furnished on or after January 1, 2001. We implemented the 2001 
OPPS on January 1, 2001. We also responded to public comments on those 
portions of the April 7, 2000 final rule that implemented related 
provisions of the BBRA and public comments on the August 3, 2000 rule.
     On November 2, 2001, we published a final rule (66 FR 
55857) that announced the Medicare OPPS conversion factor for calendar 
year 2002. In addition, it described the Secretary's estimate of the 
total amount of the transitional pass-through payments for CY 2002 and 
the implementation of a uniform reduction in each of the pass-through 
payments for that year.
     On November 2, 2001, we also published an interim final 
rule with comment period (66 FR 55850) that set forth the criteria the 
Secretary will use to establish new categories of medical devices 
eligible for transitional pass-through payments under Medicare's OPPS.
     On November 30, 2001, we published a final rule (66 FR 
59856) that revised the Medicare OPPS to implement applicable statutory 
requirements, including relevant provisions of BIPA, and changes 
resulting from continuing experience with this system. It addition, it 
described the CY 2002 payment rates for Medicare hospital outpatient 
services paid under the PPS. This final rule also announced a uniform 
reduction of 68.9 percent to be applied to each of the transitional 
pass-through payments for certain categories of medical devices and 
drugs and biologicals.
     On December 31, 2001, we published a final rule (66 FR 
67494) that delayed, until no later than April 1, 2002, the effective 
date of CY 2002 payment rates and the uniform reduction of transitional 
pass-through payments that were announced in the November 30, 2001 
final rule. In addition, this final rule indefinitely delayed certain 
related regulatory provisions.
     On March 1, 2002, we published a final rule (67 FR 9556) 
that corrected technical errors that affected the amounts and factors 
used to determine the payment rates for services paid under the 
Medicare OPPS and corrected the uniform reduction to be applied to 
transitional pass-through payments for CY 2002 as published in the 
November 30, 2001 final rule. These corrections and the regulatory 
provisions that had been delayed became effective on April 1, 2002.

C. Authority for Payment Suspensions for Unfiled Cost Reports

    Authority for the provision regarding payment suspensions for 
unfiled cost reports is contained within the authority for subpart C of 
42 CFR Part 405, that is, sections 1102, 1815, 1833, 1842,

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1866, 1870, 1871, 1879, and 1892 of the Social Security Act (42 U.S.C. 
1302, 1395g, 13951, 1395u, 1395cc, 1395gg, 1395hh, 1395pp, and 1395ccc) 
and 31 U.S.C. 3711.

D. Summary of Payment Suspensions for Unfiled Cost Reports

    This provision is set forth in our existing regulations at 42 CFR 
405.371 as follows:
    Section 405.371 (a) provides that Medicare payments may be 
suspended, in whole or in part, following overpayments determined by 
the Medicare contractor when overpayment exists or when the payments to 
be made may not be correct.
    Section 405.371(b) provides, in relevant part, that a payment 
suspension may proceed only after certain procedural requirements 
contained at Sec. 405.372 are met.
    Existing Sec. 405.371(c) provides for suspension of payment if a 
provider has failed to timely file an acceptable cost report. Payment 
to the provider is immediately suspended until a cost report is filed 
and determined by the intermediary to be acceptable.
    With the increased transition to the prospective payment systems, 
the cost report settlement process has become less determinative of an 
institutional provider's Medicare reimbursement. For instance, in the 
case of an inpatient acute care hospital, the base DRG payment (as 
opposed to any teaching or disproportionate share payments, or pass-
through payments) is determined when a claim is initially adjudicated, 
and does not generally change at the time of cost report settlement. 
Similarly, the APC payment for an outpatient service is also based on 
the claim adjudication. For home health agencies, minimal changes to 
payment are made at the time of cost report settlement, and for skilled 
nursing facilities, the main cost report issues revolve around bad debt 
determinations. In all of these cases, a significant proportion of the 
institution's payments are determined based on the adjudication of 
claims, and do not change at the point of settling the cost report. 
However, the filing of cost reports remains important for settling some 
payments, such as medical education payments, even for providers that 
are fully transitioned to prospective payment systems. Also, cost 
reports for PPS providers are used for determining prospective payment 
rates for future years. For these reasons, tailored payment suspensions 
can still be an effective measure for ensuring that providers comply 
with their obligation to file timely and acceptable cost reports.

II. Proposed Changes to the Ambulatory Payment Classification (APC) 
Groups and Relative Weights

    Under the OPPS, we pay for hospital outpatient services on a rate-
per-service basis that varies according to the APC group to which the 
service is assigned. Each APC weight represents the median hospital 
cost of the services included in that APC relative to the median 
hospital cost of the services included in APC 601, Mid-Level Clinic 
Visits. The APC weights are scaled to APC 601 because a mid-level 
clinic visit is one of the most frequently performed services in the 
outpatient setting.
    Section 1833(t)(9)(A) of the Act requires the Secretary to review 
the components of the OPPS not less often than annually and to revise 
the groups and related payment adjustment factors to take into account 
changes in medical practice, changes in technology, and the addition of 
new services, new cost data, and other relevant information. Section 
1833(t)(9)(A) of the Act requires the Secretary, beginning in 2001, to 
consult with an outside panel of experts when annually reviewing and 
updating the APC groups and the relative payment weights.
    Finally, section 1833(t)(2) of the Act provides that, subject to 
certain exceptions, the items and services within an APC group cannot 
be considered comparable with respect to the use of resources if the 
highest median or mean cost item or service in the group is more than 2 
times greater than the lowest median or mean cost item or service 
within the same group (referred to as the ``2 times rule'').
    We use the median cost of the item or service in implementing this 
provision. The statute authorizes the Secretary to make exceptions to 
the 2 times rule ``in unusual cases, such as low volume items and 
services.''
    The APC groups that we are proposing in this rule as the basis for 
payment in 2003 under the OPPS have been analyzed within this statutory 
framework.

A. Recommendations of the Advisory Panel on APC Groups

1. Establishment of the Advisory Panel
    Section 1833(t)(9)(A) of the Act, requires that we consult with an 
outside panel of experts when annually reviewing and updating the APC 
groups and the relative weights. The Act specifies that the panel will 
act in an advisory capacity. The expert panel, which is to be composed 
of representatives of providers, is to review and advise us about the 
clinical integrity of the APC groups and their weights. The panel is 
not restricted to using our data and may use data collected or 
developed by organizations outside the Department in conducting its 
review.
    On November 21, 2000, the Secretary signed the charter establishing 
an ``Advisory Panel on APC Groups'' (the Panel). The Panel is technical 
in nature and is governed by the provisions of the Federal Advisory 
Committee Act (FACA) as amended (Pub. L. 92-463). To establish the 
Panel, we solicited members in a notice published in the Federal 
Register on December 5, 2000 (65 FR 75943). We received applications 
from more than 115 individuals nominating either themselves or a 
colleague. After carefully reviewing the applications, we chose 15 
highly qualified individuals to serve on the Panel. The first APC Panel 
meeting was held on February 27, February 28, and March 1, 2001 to 
discuss the 2001 APCs in anticipation of the 2002 OPPS.
    We published a notice in the Federal Register on December 14, 2001 
to announce the location and time of the second Panel meeting, a list 
of agenda items, and that the meeting was open to the public. We also 
provided additional information through a press release and on our 
website. We convened the second meeting of the Panel on January 22 
through January 24, 2002.
2. General Issues Considered by the Advisory Panel
    In this section, we summarize the Panel's discussion of a 
recommendation by the Panel's Research Subcommittee concerning the 
format of written submissions and oral presentations to the Panel and 
of several general OPPS payment issues.

Content for Future Presentations to the Panel

    During the 2001 meeting, the Panel heard many different types of 
oral presentations. The Panel members felt that requiring consistency 
for all presentations with regard to format, data submission, and 
general information would assist them in analyzing the submissions and 
presentations and making recommendations. Therefore, during the 2001 
meeting, the Panel recommended the creation of a Research Subcommittee. 
The Research Subcommittee was established during the 2001 meeting and 
had regular conference calls to discuss the development and 
implementation of standards for written submissions and oral 
presentations to the Panel during its meetings. The Research 
Subcommittee also analyzed complex issues (such as the use of multiple 
procedure claims

[[Page 52097]]

data to set APC relative weights) that could not be addressed in the 
time allotted for the annual meeting.
    The Panel began its 2002 meeting by considering the Research 
Subcommittee's recommendation to the Panel on requirements for written 
submissions and oral presentations. The Research Subcommittee 
recommended that all future oral presentations and written submissions 
contain the following:
     Name, address, and telephone number of the proposed 
presenter.
     Financial relationship(s), if any, with any company whose 
products, services, or procedures are under consideration.
     CPT codes involved.
     APC(s) affected.
     Description of the issue.
     Clinical description of the service under discussion, with 
comparison to other services within the APC.
     Description of the resource inputs associated with the 
service under discussion, with a comparison to resource inputs for 
other services within the APC.
     Recommendations and rationale for change.
     Expected outcome of change and potential consequences of 
no change.
    The Panel adopted the Subcommittee s recommendation. Presentations 
for the 2003 meeting must contain, at a minimum, this information.

Inpatient Only List

    At its February 2001 meeting, the Panel discussed the existence of 
the inpatient list. The Panel favored its elimination. At the January 
2002 meeting, Panel members noted that hospitals receive no payment for 
a service performed in an outpatient department that appears on the 
inpatient list, even though the physician performing that service will 
receive payment for his or her services. The Panel believes the 
physician should determine what procedure to perform and that both the 
hospital and the physician should receive payment for the procedure. We 
continue to disagree with the position taken by the Panel regarding the 
inpatient list for reasons that we discuss in detail in the April 7, 
2000 final rule (65 FR 18456).
    Prior to the 2002 Panel meeting, we received requests from hospital 
and surgical associations and societies to remove certain procedures 
from the inpatient list. We reviewed those requests and presented to 
the Panel the requests for which we were unable to make a determination 
based on the information submitted with the request.
    The Panel considered removing the following procedures from the 
inpatient list:

------------------------------------------------------------------------
                 CPT                              Description
------------------------------------------------------------------------
21390                                 Treat eye socket fracture.
27216                                 Treat pelvic ring fracture.
27235                                 Treat thigh fracture.
32201                                 Drain, percut, lung lesion.
33967                                 Insert ia percut device.
47490                                 Incision of gallbladder.
62351                                 Implant spinal canal cath.
64820                                 Remove sympathetic nerves.
92986                                 Revision of aortic valve.
92987                                 Revision of mitral valve.
92990                                 Revision of pulmonary valve.
92997                                 Pul art balloon repr, precut.
92998                                 Pul art balloon repr, precut.
------------------------------------------------------------------------

    The Panel recommended that we solicit comments and additional 
information from hospitals and medical specialty societies that have an 
interest in these procedures. The Panel also recommended that we 
present to them at their 2003 meeting any such comments that we receive 
to assist in their evaluation of whether to recommend removing the 
codes from the inpatient list.
    The Panel did recommend that we remove from the inpatient list CPT 
code 47001, Biopsy of liver, needle; when done for indicated purpose at 
time of other major procedure. Panel members stated that this add-on 
code is being billed with surgical procedures that are payable under 
the OPPS. The Panel noted that coding edits prevent payment for the 
other payable OPPS services if CPT code 47001 is on the claim. We agree 
with the Panel's recommendation and we propose to remove 47001 from the 
inpatient list. We further propose to assign it status indicator ``N'' 
so that costs associated with CPT code 47001 would be packaged into the 
APC payment for the primary procedure performed during the same 
operative session.
    One presenter at the Panel meeting suggested removing CPT codes 
53448, 54411, and 54417 from the inpatient list because he believed 
they were being performed in the outpatient setting. After discussing 
this suggestion, the Panel recommended that these codes remain on the 
inpatient list because they involve removing a prosthesis through an 
infected operative field and cannot be safely and effectively performed 
in the outpatient setting. We agree with the Panel's recommendation, 
and we are not proposing to remove these codes from the inpatient list.
    In section II.B.5 of this preamble, below, we discuss additional 
procedures, which were not considered by the Panel, that we propose to 
remove from the inpatient list. We discuss in detail our reasons for 
proposing these additional changes, and we propose two new criteria 
that we would adopt in the future when evaluating whether to make a 
procedure on the inpatient list payable under the OPPS. Table 6 in 
section II.B.5 lists all the procedures we propose to remove from the 
inpatient list, including those discussed by the Panel. We are 
considering the removal of CPT code 33967, Insertion of intra-aortic 
balloon assist device, percutaneous from the inpatient list, but did 
not include it in Table 6. The Panel considered this code for removal 
from the inpatient list and had concerns about whether performing this 
procedure in an outpatient setting is appropriate. Further, we have not 
been able to confirm that this procedure is being performed on Medicare 
beneficiaries in an outpatient setting. We solicit comments, including 
clinical data and specific case reports, that would support payment for 
CPT 33967 under the OPPS.

Multiple Bills

    During its February 2001 meeting, the Panel received oral testimony 
identifying CMS exclusive use of single procedure claims to set 
relative weights for APCs as a potential problem in setting appropriate 
payment rates for APCs. Therefore, the panel asked its Research 
Subcommittee to work with CMS staff, using the Endoscopic Retrograde 
Cholangiopancreatography (ERCP) code family as a case study, to explore 
the use of multiple procedure claims data for setting relative weights. 
This code family was selected because presenters had suggested that 
when procedures in this family are performed, it is typical to perform 
more than one procedure during a session.
    The Subcommittee reviewed pre-OPPS claims data for these codes, 
paying particular attention to common code combinations and costs per 
procedure and per code combination. After lengthy review, the Panel 
concluded that (1) it could not determine whether findings based on 
review of pre-OPPS data could be extrapolated to post-OPPS claims data; 
(2) the variability in allocation of costs across ERCP line items and 
the existence of claims where the same ERCP code was billed more than 
once indicate that problems exist with the accuracy of facility coding 
for these procedures; and (3) analysis of multiple claims data for ERCP 
may not be applicable to other sets of services.
    The Subcommittee made the following recommendations to the Panel, 
which the Panel approved:

[[Page 52098]]

     We should continue to explore the use of multiple 
procedure claims data for setting payment rates but should continue to 
use only single procedure claims data to determine relative payment 
weights for CY 2003.
     We should work with the APC Panel to explore the use of 
multiple claims data drawn from OPPS claims for services such as 
radiation oncology in time for the next APC Panel meeting.
     We should educate hospitals on appropriate coding and 
billing practices to ensure that claims with multiple procedures are 
properly coded and that costs are properly allocated to each procedure.
    One presenter to the panel suggested a method to increase the 
number of claims that could be considered as single claims. Currently, 
we consider any claim submitted with two or more primary codes (that 
is, a code assigned to an APC for separate payment) to be a multiple 
procedure claim. When these claims contain line items for revenue 
centers without an accompanying Healthcare Common Procedure Coding 
System (HCPCS) code there is no way to determine the appropriate 
primary code with which to package the revenue center. The presenter 
suggested that we consider all claims where every line contains a 
separately payable HCPCS code as a single procedure claim, reasoning 
that on such claims we do not have to determine how and where to 
``package'' line items not identified by a separately payable HCPCS 
code. Where every line item contains a separately payable HCPCS code, 
every cost can easily be allocated to a separately payable HCPCS code 
on the line item and all costs for each HCPCS code can then be 
accurately and completely determined.
    We agree. We describe in section II.B.4 how we determined the 
number of single claims used to set the APC relative weights proposed 
for 2003 using this methodology. We ask for comments on our 
methodology.

Packaging

    We sought the Panel's guidance on whether we should package the 
costs of HCPCS codes for radiologic guidance and radiologic supervision 
and interpretation services whose descriptors require that they only be 
performed in conjunction with a surgical procedure.
    There are a number of reasons why we package the costs of certain 
procedures. For example, ``add-on'' procedures and radiologic guidance 
procedures should never be billed on a claim without the code for an 
associated procedure. A facility should not submit a claim for 
ultrasound guidance for a biopsy unless the claim also includes the 
biopsy procedure, because the guidance is necessary only when a biopsy 
is performed. A claim for a packaged guidance procedure (or a 
supervision and interpretation procedure whose descriptor requires it 
be performed in association with a surgical procedure) would be 
returned to the provider for correction and resubmission.
    Also, we use packaging because billing conventions allow hospitals 
to report costs for certain services using only revenue center codes 
(that is, hospitals are not required to specify HCPCS codes for certain 
services). Packaging allows these costs to be captured in the data used 
to calculate median costs for services with an APC.
    Several presenters to the panel requested that we not package any 
radiologic guidance or supervision and interpretation codes. They 
believe that hospitals will not use codes for which they do not receive 
a separate payment. If that were the case, it would be difficult to 
track utilization for these procedures and make it difficult for 
radiology departments to receive an appropriate payment for their 
services. A few presenters also pointed out that various forms of 
guidance with widely varying costs can be used for a single surgical 
procedure. Therefore, we might unintentionally create an incentive for 
inappropriate care by packaging several guidance procedures with 
varying costs into a single surgical code. Additionally, a manufacturer 
of ultrasound guidance equipment used for placement of radiation fields 
commented that, because guidance is rarely used for this purpose, its 
costs could not be adequately captured by packaging it into a common 
procedure where the vast majority of claims did not use guidance.
    The Panel concluded that, even though we could be setting relative 
weights based on error claims, we should not package additional 
radiologic guidance and supervision and interpretation procedures and 
should continue to explore methodologies that would allow these 
procedures to be recognized for separate payment. The Panel also 
recommended that radiology guidance codes that were in APC 268 for CY 
2001 but that were designated with status indicator ``N'' as packaged 
services in 2002, be restored as separately payable services for CY 
2003. The Panel requested that this topic be placed on the agenda for 
the next Panel meeting.
Add-On Codes
    We presented for the Panel's consideration several options for 
payment of add-on codes, including assignment of status indicator ``N'' 
to package them into the payment for the base procedure. Add-on codes 
described additional procedures performed by the same physician that 
are associated with the primary procedure, and which cannot be billed 
without the primary procedure. Such a methodology would create a 
single, weight averaged payment for the parent procedure and the add-on 
procedure while addressing the problem that any ``single'' claim for an 
add-on procedure is, by definition, an error claim. After thorough 
review, the Panel concluded that we should continue to pay for add-on 
codes separately, setting relative weights with the use of single 
procedure claims in spite of the fact that these were error claims. The 
Panel asked us to continue exploring ways to most appropriately pay for 
these services. They requested that this item also be placed on the 
agenda for the next Panel meeting.
    We propose to accept the recommendations of the APC Panel both for 
packaging radiology guidance and supervision and interpretation codes 
and for payment of add-on codes. We are proposing to pay separately in 
2003 for radiology guidance codes that were paid in APC 268 in CY 2001 
but that were packaged in 2002.
3. Recommendations of the Advisory Panel and Our Responses
    In this section, we consider the Panel's recommendations affecting 
specific APCs. The most recent data available for the Panel to review 
in considering specific APC groupings were the 1999-2000 pre-OPPS 
claims data that were the basis of the CY 2002 relative payment 
weights. The APC titles are shown in this discussion of the APC Panel 
recommendations as they existed when the APC Panel met in January 2002. 
In a few cases the APC titles were changed for the proposed 2003 OPPS 
and therefore some APCs do not have the same title in Addenda A as they 
have in this section.
    As discussed below, the Panel sometimes declined to recommend a 
change in an APC even though the APC violated the 2 times rule. In 
section II.B.1 of this preamble, we discuss our proposals regarding the 
2 times rule based on the CY 2001 data we are using to recalibrate the 
2003 APC relative weights. Section II.B.1 also details the criteria we 
use in deciding to make an exception to the 2 times rule. We asked the 
Panel to review many of the

[[Page 52099]]

exceptions we implemented in 2001 and 2002. We refer to the exceptions 
as ``violations of the 2 times'' rule in the following discussion.

APC 215: Level I Nerve and Muscle Tests
APC 216: Level III Nerve and Muscle Tests
APC 218: Level II Nerve and Muscle Tests

    We presented this agenda item because APC 215 appeared to violate 
the 2 times rule. In order to remedy this violation, we asked the Panel 
to consider the following changes:
     Move CPT codes 95858, 95921, and 95922 from APC 215 to APC 
218.
     Move CPT code 95930 from APC 216 to APC 218.
     Move CPT code 92275 from APC 216 to APC 231.
     Move CPT code 95920 from APC 218 to APC 216.
    A presenter to the Panel who represented a device manufacturer 
noted that the resources used to provide 95921, Autonomic nerve 
function test, are not similar to the resources required for performing 
the procedures in APC 218, where we had suggested moving the device. He 
requested that the code be reassigned to APC 216 where it resided in 
calendar year 2000. Because there were very few claims for the code in 
the 1999 and 2000 data, the Panel voiced concern about making the 
change without sufficient data to support such a move.
    The Panel recommended that the changes we asked them to consider be 
made, that is, to move CPT codes 95921 and 95922 to APC 218. However, 
if the calendar year 2001 data support a move of 95921 to APC 216, the 
Panel recommended that we consider that move.

APC 600: Low Level Clinic Visits
APC 601: Mid Level Clinic Visits
APC 602: High Level Clinic Visits
APC 610: Low Level Emergency Visits
APC 611: Mid Level Emergency Visits
APC 612: High Level Emergency Visits

    The Panel's recommendations related to facility coding for clinic 
and emergency department visits are discussed below, in section VIII.A.

APC 296: Level I Therapeutic Radiologic Procedures
APC 297: Level II Therapeutic Radiologic Procedures
APC 263: Level I Miscellaneous Radiology Procedures
APC 264: Level II Miscellaneous Radiology Procedures

    APCs 296, 263, and 264 appear to violate the 2 times rule. We asked 
the Panel to consider three options for reconfiguring these APCs so 
that they would conform with the 2 times rule.
    Option 1: Create a new APC, Level III Therapeutic Radiology 
Procedures, by moving CPT code 75984 from APC 296 and 74475 from APC 
297. Also, move CPT codes 76101, 70390, and 71060 from APC 263 to APC 
264 and move CPT code 75980 from APC 297 to APC 296.
    Option 2: Move CPT codes 76101, 703690, and 71060 from APC 263 to 
APC 264 and move CPT code 75984 from APC 296 to APC 264. Move CPT code 
75980 from APC 297 to APC 296.
    Option 3: Create a new APC, Level III Miscellaneous Radiology 
Procedures, by moving CPT codes 76080, 7036736, 76101, 70390, 74190, 
and 71060 from APC 263. Move CPT code 74327 from APC 296 to APC 263 and 
move CPT code 75980 from APC 297 to APC 296. APC 264 remains unchanged.
    One presenter to the panel objected to the use of miscellaneous 
APCs in the OPPS. The presenter argued that we are charged with 
creating clinically coherent APCs and that miscellaneous APCs 
contradict the principle of clinical coherence. We noted that in spite 
of considerable effort to do so, we have not been able to incorporate 
the procedures assigned to miscellaneous APCs into other, more 
clinically homogeneous APCs. We asked the presenter to propose a 
configuration for consideration.
    The Panel noted that none of the options that we presented resolve 
all of the 2 times violations. However, the Panel agreed that Option 2 
would create more clinically coherent APCs without creating a new APC 
based on anticipated device costs that would be billed in 2002. In 
addition, the Panel invited the American College of Radiology and other 
interested parties to propose further changes for the Panel's 
consideration next year.
    We propose to accept the Panel's recommendations that option 2 be 
implemented.

APC 230: Level I Eye Tests and Treatments
APC 231: Level III Eye Tests and Treatments
APC 232: Level I Anterior Segment Eye Procedures
APC 233: Level II Anterior Segment Eye Procedures
APC 234: Level III Anterior Segment Eye Procedures
APC 235: Level I Posterior Segment Eye Procedures
APC 236: Level II Posterior Segment Eye Procedures
APC 237: Level III Posterior Segment Eye Procedures
APC 238: Level I Repair and Plastic Eye Procedures
APC 239: Level II Repair and Plastic Eye Procedures
APC 240: Level III Repair and Plastic Eye Procedures
APC 241: Level IV Repair and Plastic Eye Procedures
APC 242: Level V Repair and Plastic Eye Procedures
APC 247: Laser Eye Procedures Except Retinal
APC 248: Laser Retinal Procedures
APC 698: Level II Eye Tests and Treatments
APC 699: Level IV Eye Tests and Treatments

    We asked the Panel to review these APCs to address clinical 
inconsistencies and violations of the 2 times rule. We suggested 
creating a new level for posterior segment eye procedures and other 
changes in order to make the groups more clinically coherent, as 
follows:
     Move CPT codes 65260 and 67218 from APC 237 to 236.
     Create a new APC (Level IV Posterior Segment Eye 
Procedures) by moving CPT codes 67107, 67112, 67040, and 67108 from APC 
237.
     Move CPT codes 67145, 67105, and 67210 from APC 247 to APC 
248.
     Move CPT code 66999 from APC 247 to APC 232.
     Move CPT code 67299 from APC 248 to APC 235.
     Move CPT codes 65855, 66761, and 66821 from APC 248 to APC 
247.
     Move CPT code 67820 from APC 698 to APC 230.
     Move CPT code 67208 from APC 231 to APC 235.
     Move CPT codes 92226, 92284, 65205, 92140 from APC 231 to 
APC 698.
     Move CPT code 92235 from APC 231 to APC 699.
     Move CPT code 68100 from APC 233 to APC 232.
     Move CPT code 65180 from APC 233 to APC 234.
     Create a new APC (Level IV Anterior Segment Eye 
Procedures) by moving CPT codes 66172, 66185, 66180, 66225 from APC 
234.
     Move CPT code 92275 from APC 216 to APC 231.
    No presenters commented on these APCs, and, after brief discussion, 
the Panel recommended concurrence with our suggested changes. We 
propose to accept the Panel's recommendations. We note that when we 
were able to use 2001 claims data to re-evaluate the changes 
recommended by the Panel for these APCs, we found violations of the 2 
times rule in the reconfigured APCs. Nonetheless, we propose to accept 
the

[[Page 52100]]

Panel's recommendations because they result in more clinically coherent 
APCs. We solicit comments on further changes that would address the 
violations of the 2 times rule. We plan to place these APCs on the 
panel's agenda for 2003.

APC 110: Transfusion
APC 111: Blood Product Exchange
APC 112: Apheresis, Photopheresis, and Plasmapheresis

    We presented these APCs to the Panel in 2001 because of their low 
payment rates and concern that our cost data was inaccurate. These APCs 
were on the agenda this year in order to obtain further comment on our 
cost data. We suggested no changes in the structure of these APCs.
    Representatives of two associations made presentations regarding 
these APCs. One recommended that all the plasma derivatives and 
recombinant analogs that currently receive transitional pass-through 
payments be assigned to permanent APCs in 2003, similar to the 
designations of other blood products. The representative of the second 
association supported this recommendation.
    The second presenter also pointed out that, consistent with our 
billing instructions, every claim that a hospital submits for a blood 
transfusion should include codes for both the blood product and the 
transfusion. Therefore, payment for blood and blood products is another 
area affected by the use of single bills in setting payment weights. 
The Panel agreed to look specifically at blood in its work on the 
multiple claims issues.
    The Panel recommended that plasma derivatives be placed in their 
own APCs and classified in the same manner as whole blood products. In 
addition, the Panel observed that hospitals incur additional costs with 
each unit of blood product transfused and, therefore, recommended that 
APC 110 be revised to allow for the costs of additional units of blood 
product and clinical services.
    In section III.C, we discuss our payment proposals for drugs and 
biologicals for which pass-through payments are scheduled to expire in 
2003. Those proposals would affect payment for blood and blood 
products. We propose not to accept the Panel's recommendation to change 
current OPPS payment policy for transfusions. The current payment 
reflects weight averaging over the number of units transfused. 
Therefore, unless a hospital specializes in transfusing multiple units 
of blood, payments for this procedure should be, on average, 
appropriate.
Panel Recommendations to Defer Changes Pending Availability of 2001 
Claims Data
    Regarding the remaining APC groups that are addressed below, the 
Panel recommended that we make no changes until data from claims billed 
in 2001 under the OPPS become available for analysis. The Panel further 
requested that we place the APC groups in this section on the agenda 
for consideration at its meeting in 2003. The changes that we propose 
for the APCs in this section are based upon our review of the 2001 
claims data, which did not become available until March 2002.

APC 203: Level V Nerve Injections
APC 204: Level VI Nerve Injections
APC 206: Level III Nerve Injections
APC 207: Level IV Nerve Injections

    Several presenters to the Panel suggested changes in the 
configuration of these APCs because of concerns that the current 
classifications result in payment rates that are too low relative to 
the resource costs associated with certain procedures in the APCs. 
Several of these APCs include procedures associated with drugs or with 
device categories for which pass-through payments are scheduled to 
expire in 2003. The Panel recommended that we not change the structure 
of these APCs at this time. Because the structure of these APCs was 
substantially changed for 2002, and 2002 cost data was not yet 
available, the Panel felt it would be appropriate to review 2002 cost 
data prior to making further structural changes to these APCs. We 
propose to accept the Panel's recommendation. We will place these APCs 
on the Panel's agenda when 2002 cost data becomes available.

APC 43: Closed Treatment Fracture Finger/Toe/Trunk
APC 44: Closed Treatment Fracture/Dislocation, Except Finger/Toe/Trunk

    On the basis of 1999-2000 claims data, these APCs violate the 2 
times rule. The Panel reviewed these APCs and recommended no changes.
    Our subsequent review of 2001 OPPS cost data shows continuing 
violations of the 2 times rule and that costs within these APCs are 
virtually identical. Therefore, we propose to combine APCs 43 and 44 
into APC 43. The procedures in the consolidated APC are clinically 
homogeneous.


APC 58: Level I Strapping and Cast Application
APC 59: Level II Strapping and Cast Application

    The Panel reviewed these APCs and recommended that no changes be 
made pending analysis of 2001 claims data. The panel did recommend that 
billing instructions be developed on the appropriate use of the codes 
in these APCs. We agree with the Panel's recommendation regarding the 
need for billing instructions, and we expect to develop such 
instructions for hospitals to use in 2003.
    Our subsequent review of 2001 claims data reveals that, in some 
cases, costs for short casts and splints are greater than costs for 
long casts and splints. Moreover, the proposed payments for these two 
APCs, based on 2001 OPPS data, would not differ significantly from each 
other. Therefore, we propose to combine the codes in APC 58 and APC 59 
into a single APC, APC 58. Combining these APCs does not compromise 
clinical homogeneity. The relative weight of the proposed single APC is 
virtually identical to the relative weight of each of the two current 
APCs. We propose to continue to work with hospitals to develop 
appropriate coding for these services and will review the appropriate 
APC structure for these services next year.

APC 279: Level I Angiography and Venography Except Extremity
APC 280: Level II Angiography and Venography Except Extremity

    Without the benefit of 2001 OPPS claims data, it was difficult for 
the Panel to determine whether the apparent violation of the 2 times 
rule in APCs 279 and 280 was attributable to underreporting of 
procedures or inaccurate coding. Therefore, the Panel recommended no 
changes pending the availability of the more recent claims data. After 
subsequently reviewing the 2001 claims data, we propose to move CPT 
codes 75978, Transluminal balloon angioplasty, venous, radiological 
supervision and interpretation, and 75774, Angiography, selective, each 
additional vessel studied after basic examination, radiological 
supervision and interpretation, to new APC 0668. This would resolve 
violations of the 2 times rule and result in clinically coherent APCs.

APC 115: Cannula/Access Device Procedures

    We propose to move CPT code 36860, External Cannula Declotting; 
without balloon catheter, to APC 103, Miscellaneous Vascular 
Procedures. We believe this makes both APC 115 and APC 103 more 
clinically homogeneous and it resolves a violation of the 2 times rule 
in APC 115 that was caused by the presence of CPT code 36860.

APC 93: Vascular Repair/Fistula Construction

[[Page 52101]]

APC 140: Esophageal Dilation without Endoscopy
APC 141: Upper GI Procedures
APC 142: Small Intestine Endoscopy
APC 143: Lower GI Endoscopy
APC 144: Diagnostic Anoscopy
APC 145: Therapeutic Anoscopy
APC 146: Level I Sigmoidoscopy
APC 147: Level II Sigmoidoscopy
APC 148: Level I Anal/Rectal Procedure
APC 149: Level II Anal/Rectal Procedure

    Our subsequent review of 2001 claims data suggests that the cost 
data for APCs 144 and 145 are aberrant. The cost data for these APCs 
yield relative weights and payments that are significantly higher than 
the relative weights for APCs 146 and 147, which consist of similar 
procedures performed through a sigmoidoscope rather than an anoscope. 
As currently arranged, the APC configuration for these services could 
provide a financial incentive for hospitals to perform unnecessary 
anoscopic procedures, either alone or with a sigmoidoscopy. To rectify 
this problem, we propose to move the procedures in APCs 144 and 145 to 
APC 147 with the exception of CPT code 46600, Anoscopy; diagnostic, 
which we propose to assign to APC 340, Minor Ancillary procedures. We 
believe these changes would result in clinically coherent APCs with 
appropriate relative weights and payment rates.

APC 363: Otorhinolaryngologic Function Tests

    Based on 2001 claims data, we propose to move CPT codes 92543, 
92588, 92520, 92546, 92516, 92548, and 92584 to new APC 0660 (Level III 
Otorhinolaryngolgic Function Tests). This change would resolve a 2 
times rule violation and create clinically coherent APCs.

APC 96: Non-Invasive Vascular Studies
APC 265: Level I Diagnostic Ultrasound Except Vascular
APC 266: Level II Diagnostic Ultrasound Except Vascular
APC 267: Vascular Ultrasound
APC 269: Level I Echocardiogram Except Transesophageal
APC 270: Transesophageal Echocardiogram

    The APC Panel recommended making no changes in the configuration of 
these APCs. Several groups made a joint proposal to reconfigure these 
APCs arguing that their proposal resulted in more clinically coherent 
APCs. However, several other presenters commented that the joint 
proposal did not include several physician groups who commonly perform 
these procedures.

    Based on 2001 claims data, we propose to make several changes in 
order to resolve 2 times rule violations and to make these APCs more 
clinically coherent. Specifically, we propose to move CPT code 43499 
from APC 0140 to APC 141; CPT code 93721 from APC 0096 to APC 368; CPT 
code 93740 from APC 0096 to APC 367; CPT code 93888 from APC 0267 to 
APC 266; and CPT code 93931 from APC 0267 to APC 266. We also propose 
to move CPT codes 78627, 76825, and 93320 from APC 0269 to new APC 0671 
to achieve more clinical coherence. We also propose to create new APC 
0670 for intravascular ultrasound and intracardiac echocardiography 
consisting of CPT codes 37250, 37251, 92978, 92979, and 93662.

APC 291: Level I Diagnostic Nuclear Medicine Excluding Myocardial Scans
APC 292: Level II Diagnostic Nuclear Medicine Excluding Myocardial 
Scans

    Subsequent to the APC Panel meeting, we received comments on these 
APCs from the Nuclear Medicine Task Force. After a thorough review of 
that proposal within the context of the 2001 claims data, we propose to 
accept the recommendations of the Nuclear Medicine Task Force, which 
would result in a complete reconfiguration of APCs 290, 291, and 292. 
Although the reconfiguration would create violations of the 2 times 
rule, we agree with the Task Force that the reconfigured APCs are more 
clinically coherent. We note that APCs 290, 291, and 292 as currently 
configured would also violate the 2 times rule. Therefore, we solicit 
comments on the proposed reconfiguration of APCs 290, 291, and 292 and 
on alternative groupings that would achieve clinical coherence without 
violating the 2 times rule.

APC 274: Myleography
APC 179: Urinary Incontinence Procedures
APC 182: Insertion of Penile Prosthesis
APC 19: Level I Excision/Biopsy
APC 20: Level II Excision/Biopsy
APC 21: Level IV Excision/Biopsy
APC 22: Level V Excision/Biopsy
APC 694: Level III Excision/Biopsy

    Based on 2001 claims data, we propose to move several codes from 
APC 19 to APC 20 and several codes from ACP 20 to APC 21. Additionally, 
we propose to move CPT codes 11770, 54105, and 60512 to APC 22. We also 
propose to move CPT code 58999 to APC 191 and CPT code 37799 to APC 35. 
These changes would result in clinically coherent APCs that do not 
violate the 2 times rule.

APC 24: Level I Skin Repair
APC 25: Level II Skin Repair
APC 26: Level III Skin Repair
APC 27: Level IV Skin Repair
APC 686: Level V Skin Repair

    Based on 2001 claims data, we propose to move CPT code 43870 from 
APC 0025 to APC 141; and CPT codes with high costs from APC 26 to APC 
27. We also propose to move the codes remaining in APC 26 to APC 25. 
APC 26 would then be deleted. These changes would result in a more 
compact APC structure without compromising the clinical homogeneity of 
the reconfigured APCs and without violating the 2 times rule. See Table 
1 for codes moving from APC 26 to APC 25 or APC 27.

  Table 1.--HCPCS Codes Proposed To Be Moved From APC 26 into APC 25 or
                                 APC 27
------------------------------------------------------------------------
                  2002 APC 26                   2003 APC 25  2003 APC 27
------------------------------------------------------------------------
11960.........................................  ...........        11960
11970.........................................  ...........        11970
12037.........................................        12037
12047.........................................        12047
12057.........................................        12057
13150.........................................        13150
13160.........................................  ...........        13160
14000.........................................  ...........        14000
14001.........................................  ...........        14001
14020.........................................  ...........        14020
14021.........................................  ...........        14021
14040.........................................  ...........        14040
14041.........................................  ...........        14041
14060.........................................  ...........        14060
14061.........................................  ...........        14061
14300.........................................  ...........        14300
14350.........................................  ...........        14350
15000.........................................        15000
15001.........................................        15001
15050.........................................        15050
15101.........................................  ...........        15101
15120.........................................  ...........        15120
15121.........................................  ...........        15121
15200.........................................  ...........        15200
15201.........................................        15201
15220.........................................  ...........        15220
15221.........................................        15221
15240.........................................  ...........        15240
15241.........................................        15241
15260.........................................  ...........        15260
15261.........................................        15261
15351.........................................  ...........        15351
15400.........................................        15400
15401.........................................        15401
15570.........................................  ...........        15570
15572.........................................  ...........        15572
15574.........................................  ...........        15574
15576.........................................  ...........        15576
15600.........................................  ...........        15600
15610.........................................  ...........        15610
15620.........................................  ...........        15620
15630.........................................  ...........        15630
15650.........................................  ...........        15650
15775.........................................        15775
15776.........................................        15776
15819.........................................        15819
15820.........................................  ...........        15820
15821.........................................  ...........        15821
15822.........................................  ...........        15822
15823.........................................  ...........        15823

[[Page 52102]]

 
15825.........................................  ...........        15825
15826.........................................  ...........        15826
15829.........................................  ...........        15829
15835.........................................        15835
20101.........................................  ...........        20101
20102.........................................  ...........        20102
20910.........................................  ...........        20910
20912.........................................  ...........        20912
20920.........................................  ...........        20920
20922.........................................  ...........        20922
20926.........................................  ...........        20926
23921.........................................        23921
25929.........................................  ...........        25929
33222.........................................  ...........        33222
33223.........................................  ...........        33223
44312.........................................  ...........        44312
44340.........................................  ...........        44340
15580--Code Deleted...........................
15625--Code Deleted...........................
------------------------------------------------------------------------


APC 77: Level I Pulmonary Treatment
APC 78: Level II Pulmonary Treatment
APC 251: Level I ENT Procedures
APC 252: Level II ENT Procedures
APC 253: Level III ENT Procedures
APC 254: Level IV ENT Procedures
APC 256: Level V ENT Procedures

    Based on 2001 claims data, we propose to address violations of the 
2 times rule by moving CPT codes 40812, 42330, and 21015 from APC 0252 
to APC 253 and by moving CPT codes 41120 and 30520 to APC 254.

B. Other Changes Affecting the APCs

1. Limit on Variation of Costs of Services Classified Within a Group
    Section 1833(t)(2) of the Act provides that the items and services 
within an APC 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. However, the statute authorizes 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. No exception may 
be made, however, 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.
    Taking into account the proposed APC changes discussed in relation 
to the APC panel recommendations in this section of this preamble and 
the use of 2001 claims data to calculate the median cost of procedures 
classified to APCs, we reviewed all the APCs to determine which of them 
would not meet the 2 times limit. We use the following criteria when 
deciding whether to make exceptions to the 2 times rule for affected 
APCs:
     Resource homogeneity.
     Clinical homogeneity.
     Hospital concentration.
     Frequency of service (volume).
     Opportunity for upcoding and code fragmentation.
    For a detailed discussion of these criteria, refer to the April 7, 
2000 final rule (65 FR 18457).
    The following table contains APCs that we propose to exempt from 
the 2 times rule based on the criteria cited above. In cases in which 
compliance with the 2 times rule appeared to conflict with a 
recommendation of the APC Advisory Panel, we generally accepted the 
Panel recommendation. This was because Panel recommendations were based 
on explicit consideration of resource use, clinical homogeneity, 
hospital specialization, and the quality of the data used to determine 
payment rates.
    The median cost for hospital outpatient services for these and all 
other APCs can be found at website: http://www.cms.hhs.gov.

                    Table 2.--Table of Exempted Codes
------------------------------------------------------------------------
             NPRM APC                            Description
------------------------------------------------------------------------
0012..............................  Level I Debridement & Destruction
0019..............................  Level I Excision/ Biopsy
0020..............................  Level II Excision/ Biopsy
0025..............................  Level II Skin Repair
0032..............................  Insertion of Central Venous/Arterial
                                     Catheter
0043..............................  Closed Treatment Fracture Finger/Toe/
                                     Trunk
0046..............................  Open/Percutaneous Treatment Fracture
                                     or Dislocation
0058..............................  Level I Strapping and Cast
                                     Application
0074..............................  Level IV Endoscopy Upper Airway
0080..............................  Diagnostic Cardiac Catheterization
0081..............................  Non-Coronary Angioplasty or
                                     Atherectomy
0093..............................  Vascular Repair/Fistula Construction
0097..............................  Cardiac and Ambulatory Blood
                                     Pressure Monitoring
0099..............................  Electrocardiograms
0103..............................  Miscellaneous Vascular Procedures
0105..............................  Revision/Removal of Pacemakers,
                                     AICD, or Vascular
0121..............................  Level I Tube changes and
                                     Repositioning
0140..............................  Esophageal Dilation without
                                     Endoscopy
0147..............................  Level II Sigmoidoscopy
0148..............................  Level I Anal/Rectal Procedure
0155..............................  Level II Anal/Rectal Procedure
0165..............................  Level III Urinary and Anal
                                     Procedures
0170..............................  Dialysis
0179..............................  Urinary Incontinence Procedures
0191..............................  Level I Female Reproductive Proc
0192..............................  Level IV Female Reproductive Proc
0203..............................  Level VI Nerve Injections
0204..............................  Level I Nerve Injections
0207..............................  Level III Nerve Injection
0218..............................  Level II Nerve and Muscle Tests
0225..............................  Implantation of Neurostimulator
                                     Electrodes
0230..............................  Level I Eye Tests & Treatments
0231..............................  Level III Eye Tests & Treatments

[[Page 52103]]

 
0233..............................  Level II Anterior Segment Eye
                                     Procedures
0235..............................  Level I Posterior Segment Eye
                                     Procedures
0238..............................  Level I Repair and Plastic Eye
                                     Procedures
0239..............................  Level II Repair and Plastic Eye
                                     Procedures
0252..............................  Level II ENT Procedures
0260..............................  Level I Plain Film Except Teeth
0274..............................  Myelography
0286..............................  Myocardial Scans
0290..............................  Level I Diagnostic Nuclear Medicine
                                     Excluding Myocardial Scans
0291..............................  Level II Diagnostic Nuclear Medicine
                                     Excluding Myocardial Scans
0294..............................  Level I Therapeutic Nuclear Medicine
0297..............................  Level II Therapeutic Radiologic
                                     Procedures
0303..............................  Treatment Device Construction
0304..............................  Level I Therapeutic Radiation
                                     Treatment Preparation
0330..............................  Dental Procedures
0345..............................  Level I Transfusion Laboratory
                                     Procedures
0354..............................  Administration of Influenza/
                                     Pneumonia Vaccine
0356..............................  Level II Immunizations
0367..............................  Level I Pulmonary Test
0368..............................  Level II Pulmonary Tests
0370..............................  Allergy Tests
0373..............................  Neuropsychological Testing
0600..............................  Low Level Clinic Visits
0602..............................  High Level Clinic Visits
0660..............................  Level III Otorhinolaryngologic
                                     Function Tests
0692..............................  Electronic Analysis of
                                     Neurostimulator Pulse Generators
0694..............................  Mohs Surgery
0698..............................  Level II Eye Tests & Treatments
------------------------------------------------------------------------

2. Procedures Moved From New Technology APCs to Clinically Appropriate 
APCs
    In the November 30, 2001 final rule, we made final our proposal to 
change the period of time during which a service may be paid under a 
new technology APC (66 FR 59903), initially established in the April 7, 
2000 final rule. That is, beginning in 2002, we will retain a service 
within a new technology APC group until we have acquired adequate data 
that allow us to assign the service to a clinically appropriate APC. 
This policy allows us to move a service from a new technology APC in 
less than 2 years if sufficient data are available, and it also allows 
us to retain a service in a new technology APC for more than 3 years if 
sufficient data upon which to base a decision for reassignment have not 
been collected.
    Effective in 2003, we propose to move several procedures from new 
technology APCs to clinical APCs. Those procedures and the clinical 
APCs to which we propose to assign the procedures for payment in 2003 
are identified in Table 3. Based upon our review of the 2001 OPPS 
claims data, we believe we have sufficient information upon which to 
base assignment of these procedures to clinical APCs. In making this 
determination, we reviewed both single and multiple procedure claims. 
We compared median cost data for the new technology procedures with 
median cost data for procedures that are clinically similar and for 
which we would expect costs to be similar. We also compared median cost 
data for the new technology procedures with median cost data for 
clinically related procedures, such as different methods of treating 
prostatic hypertrophy, where expected median costs were lower or higher 
than those of the new technology procedure. In some cases we propose 
classification of a new technology procedure in an APC with procedures 
that are similar both clinically and in terms of resource consumption. 
In other cases, we propose to create a new APC for a new technology 
procedure because we do not believe any of the existing APCs contain 
procedures that are clinically similar and similar in terms of resource 
consumption. We solicit comments on our proposed reassignment of the 
new technology procedures listed in Table 3.

       Table 3.--Proposed Changes in HCPCS Assignments From New Technology APCs to Procedure APCs for 2003
----------------------------------------------------------------------------------------------------------------
      HCPCS             Description             2002 SI           2003 SI          2002 APC          2003 APC
----------------------------------------------------------------------------------------------------------------
19103...........  Bx breast percut w/      S                 T                 0710              0658
                   device.
33282...........  Implant pat-active ht    S                 S                 0710              0680
                   record.
36550...........  Declot vascular device.  T                 T                 0972              0677
53850...........  Prostatic microwave      T                 T                 0982              0675
                   thermotx.
53852...........  Prostatic rf thermotx..  T                 T                 0982              0675
55873...........  Cryoablate prostate....  T                 T                 0982              0674
76075...........  Dual energy x-ray study  S                 S                 0707              0288
76076...........  Dual energy x-ray study  S                 S                 0707              0665
77520...........  Proton trmt, simple w/o  S                 S                 0710              0664
                   comp.
77522...........  Proton trmt, simple w/   S                 S                 0710              0664
                   comp.
77523...........  Proton trmt,             S                 S                 0712              0664
                   intermediate.

[[Page 52104]]

 
77525...........  Proton treatment,        S                 S                 0712              0664
                   complex.
92586...........  Auditor evoke potent,    S                 S                 0707              0218
                   limit.
95965...........  Meg, spontaneous.......  T                 S                 0972              0717
95966...........  Meg, evoked, single....  T                 S                 0972              0714
95967...........  Meg, evoked, each addl.  T                 S                 0972              0712
C1300...........  Hyperbaric oxygen......  S                 S                 0707              0659
C9708...........  Preview Tx Planning      T                 T                 0975              0973
                   Software.
G0125...........  PET img WhBD sgl pulm    T                 S                 0976              0667
                   ring.
G0166...........  Extrnl counterpulse,     T                 T                 0972              0678
                   per tx.
G0168...........  Wound closure by         T                 X                 0970              0340
                   adhesive.
G0173...........  Stereo radoisurgery,     S                 S                 0721              0663
                   complete.
G0204...........  Diagnostic mammography   S                 S                 0707              0669
                   digital.
G0206...........  Diagnostic mammography   S                 S                 0707              0669
                   digital.
G0210...........  PET img whbd ring        S                 S                 0714              0667
                   dxlung ca.
G0211...........  PET img whbd ring init   S                 S                 0714              0667
                   lung.
G0212...........  PET img whbd ring        S                 S                 0714              0667
                   restag lun.
G0213...........  PET img whbd ring dx     S                 S                 0714              0667
                   colorec.
G0214...........  PET img whbd ring init   S                 S                 0714              0667
                   colre.
G0215...........  PET img whbd restag col  S                 S                 0714              0667
G0216...........  PET img whbd ring dx     S                 S                 0714              0667
                   melanom.
G0217...........  PET img whbd ring init   S                 S                 0714              0667
                   melan.
G0218...........  PET img whbd ring        S                 S                 0714              0667
                   restag mel.
G0220...........  PET img whbd ring dx     S                 S                 0714              0667
                   lymphom.
G0221...........  PET img whbd ring init   S                 S                 0714              0667
                   lymph.
G0222...........  PET img whbd ring resta  S                 S                 0714              0667
                   lymp.
G0223...........  PET img whbd reg ring    S                 S                 0714              0667
                   dx hea.
G0224...........  PET img whbd reg ring    S                 S                 0714              0667
                   ini hea.
G0225...........  PET img whbd ring        S                 S                 0714              0667
                   restag hea.
G0226...........  PET img whbd dx esophag  S                 S                 0714              0667
G0227...........  PET img whbd ring ini    S                 S                 0714              0667
                   esopha.
G0228...........  PET img whbd ring restg  S                 S                 0714              0667
                   esop.
G0229...........  PET img metabolic brain  S                 S                 0714              0667
                   ring.
G0230...........  PET myocard viability    S                 S                 0714              0667
                   ring.
G0231...........  PET WhBD colorec; gamma  S                 S                 0714              0667
                   cam.
G0232...........  PET WhBD lymphoma;       S                 S                 0714              0667
                   gamma cam.
G0233...........  PET WhBD melanoma;       S                 S                 0714              0667
                   gamma cam.
G0234...........  PET WhBD pulm nod,       S                 S                 0714              0667
                   gamma cam.
----------------------------------------------------------------------------------------------------------------

3. APC Assignment for New Codes Created During 2002
    During CY 2002 we created several HCPCS codes to describe services 
newly covered by Medicare and payable under the hospital OPPS. While we 
have assigned these services to APCs for CY 2002, the assignments are 
open to public comment in this proposed rule. In this proposed rule, we 
solicit comment on the APC assignment of these services. In addition, 
in this proposed rule, we are proposing the creation of several new 
HCPCS codes and APC assignments with an effective date of January 1, 
2003. Table 4 below includes new procedural HCPCS codes either created 
for implementation in July 2002, which we intend to implement in 
October 2002, or which we propose to implement January 2003.
    Table 4 does not include new codes for drugs and devices for which 
we established or intend to establish pass-through payment eligibility 
in July or October 2002. Furthermore, neither the new procedural HCPCS 
nor the new pass-through codes intended as of this publication for 
implementation beginning October 2002 or later are included in Addendum 
B of this proposed rule.

                          Table 4.--New G Codes for 2002 and Proposed G Codes for 2003
----------------------------------------------------------------------------------------------------------------
                                                                                             Proposed effective
        Code               Long descriptor               APC                   SI                   date
----------------------------------------------------------------------------------------------------------------
G0245...............  Initial physician         0600................  V...................  7/01/02
                       evaluation of a
                       diabetic patient with
                       diabetic sensory
                       neuropathy resulting in
                       a loss of protective
                       sensation (LOPS) which
                       must include the
                       procedure used to
                       diagnose LOPS; a
                       patient history; and a
                       physician examination
                       that consists of at
                       least the following
                       elements--* * *.
G0246...............  Follow-up physician       0600................  V...................  7/01/02
                       evaluation of a
                       diabetic patient with
                       diabetic sensory
                       neuropathy resulting in
                       a loss of protective
                       sensation (LOPS) which
                       must include the
                       procedure used to
                       diagnose LOPS; a
                       patient history; and a
                       physician examination
                       that includes--* * *.
G0247...............  Routine foot care by a    0009................  T...................  7/01/02
                       physician of a diabetic
                       patient with diabetic
                       sensory neuropathy
                       resulting in a loss of
                       protective sensation
                       (LOPS) to include if
                       present at least the
                       following--* * *.

[[Page 52105]]

 
G0248...............  Demonstration, at         0708................  S...................  7/01/02
                       initial use, of home
                       INR monitoring for a
                       patient with mechanical
                       heart valve(s) who
                       meets Medicare coverage
                       criteria, under the
                       direction of a
                       physician; includes:
                       demonstration use and
                       care of the INR
                       monitor, obtaining at
                       least one blood sample
                       provision of
                       instructions for
                       reporting home INR test
                       results and
                       documentation of a
                       patient's ability to
                       perform testing.
G0249...............  Provision of test         0708................  S...................  7/01/02
                       material and equipment
                       for home INR monitoring
                       to patient wih
                       mechanical heart
                       valve(s) who meets
                       Medicare coverage
                       criteria. Includes
                       provision of materials
                       for use in the home and
                       reporting of test
                       results to physician;
                       per 4 tests.
G0250...............  Physician review/         N/A.................  E...................  7/01/02
                       interpretation and
                       patient management of
                       home INR test for
                       patient with mechanical
                       heart valve(s) who
                       meets other coverage
                       criteria; per 4 tests
                       (does not require face-
                       to-face service).
G0AAA...............  PET imaging for initial   N/A.................  E...................  10/01/02
                       diagnosis of breast
                       cancer and/or surgical
                       planning for breast
                       cancer (for example,
                       initial staging of
                       axillary lymph nodes),
                       not covered by
                       Medicare..
G0BBB...............  PET imaging for breast    0285................  S...................  10/01/02
                       cancer, full and
                       partial-ring PET
                       scanners only, staging/
                       restaging after or
                       prior to course of
                       treatment.
G0CCC...............  PET imaging for breast    0285................  S...................  10/01/02
                       cancer, full and
                       partial-ring PET
                       scanners only,
                       evaluation of response
                       to treatment, performed
                       during course of
                       treatment.
G0DDD...............  Current Perception        N/A.................  E...................  10/01/02
                       Threshold/Sensory Nerve
                       Conduction Test, (SNCT)
                       per limb, any nerve..
G0EEE...............  Intravenous infusion(s)   0340................  X...................  10/01/02
                       during separately
                       payable observation
                       stay, Per observation
                       stay (must be reported
                       with G0244).
G0FFF...............  Bone marrow aspiration    0003................  T...................  1/01/03
                       and biopsy performed
                       through a single
                       incision during a
                       single session.
G0GGG...............  Unscheduled or emergency  0170................  S...................  1/01/03
                       treatment for dialysis
                       for ESRD patient in the
                       outpatient department
                       of a hospital that does
                       not have a certified
                       ESRD facility.
G0HHH...............  Injection procedure for   N/A.................  N...................  1/01/03
                       sacroiliac joint;
                       arthrography.
G0JJJ...............  Injection procedure for   0204................  T...................  1/01/03
                       sacroiliac joint;
                       provision of
                       anesthetic, steroid,
                       and/or other
                       therapeutic agent.
G0KKK...............  Prostate brachytherapy,   0684................  T...................  1/01/03
                       including transperineal
                       placement of needles or
                       catheters into the
                       prostate, cystoscopy,
                       and interstitial
                       radiation source
                       application..
G0LLL...............  Initial nursing           N...................  N...................  1/01/03
                       assessment of patient
                       directly admitted to
                       observation with
                       diagnosis of congestive
                       heart failure, chest
                       pain or asthma..
G0MMM...............  Initial nursing           0706................  S...................  1/01/03
                       assessment of patient
                       directly admitted to
                       observation with
                       diagnosis other than
                       congestive heart
                       failure, chest pain or
                       asthma..
G0NNN...............  Transcatheter placement   0656................  T...................  01/01/03
                       of a drug eluting
                       intracoronary stent(s),
                       percutaneous, with or
                       without other
                       therapeutic
                       intervention, any
                       method; single vessel..
G0OOO...............  Transcatheter placement   0656................  T...................  01/01/03
                       of a drug eluting
                       intracoronary stent(s),
                       percutaneous, with or
                       without other
                       therapeutic
                       intervention, any
                       method; each additional
                       vessel..
----------------------------------------------------------------------------------------------------------------

HCPCS Codes Created During CY 2002
    The G codes G0245 through G0250 were created to implement payment 
for newly covered Medicare services due to national coverage 
determinations. The G codes G0AAA-G0DDD will be established October 1, 
2002 as a result of national coverage policies that will be effective 
October 1, 2002. These codes were created to accurately describe the 
services covered, to ensure they were reported correctly, to track 
their utilization, and to establish payment. We solicit comments on the 
APC assignment of these services. The codes describing evaluation and 
management services were assigned to clinic visit APCs containing 
similar services, and the codes describing procedural services were 
assigned to new technology APCs or to APCs containing procedures 
requiring similar resource consumption. Because G0250 is a professional 
service furnished by a physician, it is not payable under OPPS.
    We expect to implement HCPCS code G0EEE (Intravenous Infusion(s) 
During Separately Payable Observation Stay) effective October 1, 2002 
to describe infusion therapy given during a separately payable 
observation stay. This code is discussed in detail in section VIII.B of 
this proposed rule. We have assigned it to APC 0340. We believe APC 
0340 appropriately accounts for the resources used for infusion during 
observation. This is because we believe that Q0081, which represents 
the same service as G0EEE, is typically billed with an APC that has a 
higher relative weight, therefore making APC 0120 payable at 50 percent 
of its payment rate.
HCPCS Codes Proposed in This Rule for January 1, 2003
    We are proposing the creation of several new HCPCS codes for 2003 
in order to address issues that have come to our attention, to describe 
new technology procedures, to implement policy proposals discussed in 
this rule, and to allow more appropriate reporting of procedures 
currently described by CPT (HCPCS Level I) codes.
    (1) G0FFF--Bone Marrow Aspiration and Biopsy Services--we are 
proposing to create this code to describe bone marrow aspiration and 
biopsy performed through the same incision. We propose to place this 
code in APC 0003. This code also appears in the proposed rule for the 
physician fee schedule, published in the June 28, 2002 issue of the 
Federal Register (67

[[Page 52106]]

FR 43846). This code would facilitate proper reporting of this 
procedure.
    (2) G0GGG--Unscheduled and Emergency Treatment for ESRD Patients--
we are proposing this code in order to facilitate payment for dialysis 
provided to ESRD patients in the outpatient department of a hospital 
that does not have a certified ESRD facility. This code is described in 
detail in section VIII.G of this proposed rule.
    (3) G0HHH and G0JJJ--Sacroiliac Joint Injections--we are proposing 
to create these two codes to replace CPT code 27096, Injection 
procedure for sacroiliac joint, arthrography and/or anesthetic steroid. 
CPT code 27096 describes two distinct procedures requiring different 
resource consumption. Moreover, our policy of packaging injection 
procedures required packaging of this procedure even when it was used 
to report injection of a steroid or anesthetic. In these cases, it was 
appropriately billed without another procedure and should have been 
payable. Therefore, in order to facilitate appropriate reporting and 
payment for the procedures described by CPT code 27096, we propose to 
create G0HHH, Injection procedure for sacroiliac joint, arthrography, 
and G0JJJ, Injection procedure for sacroiliac joint, provision of 
anesthetic and/or steroid. G0HHH would be given status indicator N, and 
G0JJJ would be assigned to APC 0204.
    (4) G0KKK--Prostate Brachytherapy--we are proposing this code to 
implement our policy decision discussed in section III.C.3 of this 
proposed rule.
    (5) G0LLL and G0MMM--Observation Care--we are proposing to create 
these codes to describe observation care provided to a patient who is 
directly admitted from a physician's office to a hospital for 
observation care. These codes are discussed in detail in section VIII.B 
of this rule.
    (6) G0NNN, G0OOO; Drug Eluting Stents--

Drug-Eluting Stents

    Drug-eluting coronary artery stents (referred to as ``drug-eluting 
stents'' in the discussion that follows) have been developed to combat 
the problem of restenosis of blood vessels previously treated for 
stenosis. The drug is coated on a stent with a special polymer, and 
after the stent is placed in the vessel, the drug is slowly released 
into the vessel wall tissue over a period of 30 to 45 days. The drug 
coating on the stent is intended to prevent the build-up of scar tissue 
that can narrow the reopened artery. The FDA has not yet approved this 
technology for general use. We understand the earliest date that a 
decision from the FDA is anticipated is late 2002.
    We received an application to establish a new medical device 
category eligible for transitional pass-through payment under the OPPS 
for drug-eluting stents from a manufacturer of these stents. In the 
application for the new device category, the manufacturer asserts that 
drug-eluting stents meet the criteria for establishing a new device 
category that were set forth in the November 2, 2001 Federal Register. 
Specifically, the manufacturer believes a new device category is 
appropriate because drug-eluting stents meet the cost significance 
thresholds for a new device category, and they provide substantial 
therapeutic benefit to Medicare beneficiaries compared to other 
available therapies for coronary atherosclerosis.
    Based on our review of the application as well as other information 
pertaining to drug-eluting stents, we determined that drug-eluting 
stents are described by an existing pass-through device category. As we 
discuss in section III.D of this preamble, section 
1833(t)(6)(B)(ii)(IV) of the Act requires that a new category must 
include medical devices for which no existing category, or one 
previously in effect, is appropriate. In the program memorandum that we 
issued to our contractors on March 22, 2001 (Transmittal A-01-41) with 
instructions for the implementation of category codes for use in making 
transitional pass-through payments for devices, we established two 
categories that describe and could be used to bill for drug-eluting 
stents: HCPCS code C1874, Stent, coated/covered, with delivery system, 
and HCPCS code C1875, Stent, coated/covered, without delivery system. 
These two categories were based on devices that previously qualified 
for transitional pass-through payment on an item-specific basis. 
Although these two device categories are among those that will sunset 
after December 31, 2002, as we discuss in section III.C of this 
preamble, the fact that they exist precludes the establishment of a new 
device category for drug-eluting stents.
    Payment for drug-eluting stents is not allowed under the OPPS until 
they receive FDA approval for general use. If the drug-eluting stents 
are approved for general use by the FDA, payment would be packaged into 
the APC payment for the procedures with which the stents are used. The 
cost of drug-eluting stents would be incorporated within the APC 
relative payment weights when we recalibrate the payment weights in CY 
2005 using CY 2003 claims data.
    In considering how we would pay for drug eluting stents under OPPS 
we thought carefully about how the payment should relate to payment for 
these stents under IPPS. Section 533 of BIPA added sections 
1886(d)(5)(K) and (d)(5)(L) to the Act (as implemented by Sec. 42 CFR 
412.87 and 412.88 ) to reduce the time needed under the hospital 
inpatient PPS for the DRG system to recognize the higher costs of new 
technologies that meet certain criteria. Drug-eluting stents did not 
meet the inpatient PPS new technology cost threshold criterion in the 
May 9, 2002 proposed rule to update the hospital inpatient PPS for FY 
2003. Therefore, in that proposed rule, we listed a new ICD-9 procedure 
code 36.07 (Insertion of drug-eluting coronary artery stent(s)) that 
would be effective for use October 1, 2002. We also proposed to add 
ICD-9 code 00.55 (Insertion of drug-eluting noncoronary artery stent) 
(67 FR 31630). To be consistent with our prior practice of assigning 
new technology to the same DRGs to which its predecessor technologies 
were assigned, we proposed in the May 9 inpatient PPS proposed rule to 
assign inpatient cases involving ICD-9 code 36.07 to DRG 517 
(Percutaneous Cardiovascular Procedure with Coronary Artery Stent 
without AMI).
    However, comments to the May 9, 2002 proposed IPPS rule and our own 
further consideration of this issue persuaded us that a different 
approach was needed for the IPPS given the preliminary evidence that 
drug-eluting stents could prove potentially to be transformational 
technology in the treatment of coronary artery disease. While this 
technology is not yet approved for general use by FDA, commenters to 
the May 9 hospital inpatient PPS proposed rule reported that drug-
eluting stents have shown promise to significantly advance the 
treatment of coronary artery disease, and they encouraged CMS to 
consider the available data to determine the most appropriate DRG 
payment. Commenters supported reassignment of the new procedure codes 
for drug-eluting stent insertions to higher paying DRGs or, if 
necessary, the modification of all affected DRGs, once verifiable data 
on the costs associated with drug-eluting stents become available.
    Many of the commenters who supported higher payment under the 
inpatient PPS for this technology were clinical practitioners and 
hospitals, who expressed great anticipation for the potential benefits 
of this technology. In addition, commenters referred to the likelihood 
that, once approved, patients would demand to have these new drug-

[[Page 52107]]

eluting stents, putting tremendous financial strain on hospitals.
    Commenters to the proposed rule for the inpatient PPS for FY 2003 
also argued there should be long-term cost savings to the Medicare 
program and the health system generally from this technology after 
approval by the FDA. Specifically, if dramatically fewer patients 
require restenting, savings will result from fewer repeat angioplasty 
procedures. And, to the extent bypass surgeries are reduced, savings 
would result from that outcome as well.
    In responding to these commenters in the inpatient final rule 
published in the Federal Register on August 1, 2002 (67 FR 50003), we 
noted that, although the FDA has not yet approved this technology for 
general use, public presentation of the results from recent clinical 
trials have found virtually no in-stent restenosis in patients treated 
with the drug-eluting stent. Therefore, we recognize the potentially 
significant impact this technology may conceivably have on the 
treatment of coronary artery blockages.
    We are concerned that, if the FDA does approve this technology and 
the predictions of its rapid, widespread use are accurate, significant 
strain on hospital financial resources would result. In particular, we 
are concerned that the higher costs of this technology would create 
undue financial hardships for hospitals due to the high volume of stent 
cases and the fact that a large proportion of these cases could involve 
the new technology soon after FDA approval. Therefore, in the final 
rule for the FY 2003 inpatient PPS, we implemented an unprecedented 
approach in response to the unique circumstances surrounding the 
potential breakthrough nature of this technology and we created two new 
DRGs to reflect cases involving the insertion of a drug-eluting 
coronary artery stent. We discuss in detail in the final inpatient PPS 
rule our rationale for establishing these DRGs (67 FR 50003-50005).
    Although the clinical trials for drug-eluting stents are being 
conducted on hospital inpatients, our 2001 hospital outpatient claims 
data included nearly 18,000 claims for procedures utilizing other types 
of coronary stents in the hospital outpatient setting. Every indication 
points to a steady increase in the future volume of coronary stent 
procedures performed on an outpatient basis. The same concerns that we 
express above about the impact of the advent of drug-eluting stents on 
hospital resources apply to procedures performed in the outpatient 
setting as well as the inpatient setting. We created these new DRGs for 
drug-eluting stents to ensure and promote beneficiary access to the 
best care possible by ensuring that our payment system keeps pace with 
what we believe will be a growing volume of coronary stent procedures 
if FDA approves drug-eluting coronary artery stents. We want to ensure 
that the costs of drug-eluting stents will be recognized sufficiently 
quickly to ensure beneficiary access in the outpatient setting over the 
2 years that it will take for the costs of these devices to appear in 
the Medicare data on which we will base Medicare payments for them.
    Drug-eluting stents may have been commercially marketed for 2 years 
by the time cost data for stent insertion procedures performed in CY 
2003 are incorporated into the APC relative weights under the OPPS for 
CY 2005. Therefore, as we have done under the inpatient PPS for FY 2003 
under these exceptional circumstances, we propose to deviate from our 
standard OPPS payment methodology to ensure consistent payment for 
drug-eluting stents in both the inpatient and outpatient settings; to 
ensure that hospital resources are not negatively affected by a sudden 
surge in demand for this new technology if FDA approval is received; 
and, to ensure that Medicare payment does not impede beneficiary access 
to what appears to be a potentially landmark advance in the treatment 
of coronary disease. Consistent with the special approach we 
implemented in the inpatient PPS final rule, we propose to create two 
new HCPCS codes and a new APC that may be used to pay for the insertion 
of coronary artery drug-eluting stents under the OPPS, to be effective 
if these stents receive FDA approval for general use. Of course, as 
with other new procedures, FDA approval does not mean that Medicare 
will always cover the approved item. Medicare coverage depends upon 
whether an item or service is medically necessary to treat illness or 
injury as determined by Medicare contractors based on the specifics of 
individual cases.
    The new HCPCS codes that we propose are as follows: G0NNN--
Transcatheter placement of a drug eluting intracoronary stent(s), 
percutaneous, with or without other therapeutic intervention, any 
method; single vessel G0OOO--Transcatheter placement of a drug eluting 
intracoronary stent(s), percutaneous, with or without other therapeutic 
intervention, any method; each additional vessel.
    We propose to assign G0NNN and G0OOO to new APC 0656, Transcatheter 
Placement of Drug-Eluting Coronary Stents, with a status indicator of 
T.
    To establish a payment amount for the proposed new APC, we propose 
to apply the same assumptions that we used in establishing the weights 
for DRG 526 (Percutaneous Cardiovascular Procedure with Drug-Eluting 
Stent with AMI) and DRG 527 (Percutaneous Cardiovascular Procedure With 
Drug-Eluting Stent Without AMI) as described in the final rule 
implementing the FY 2003 inpatient PPS. That is, based on prices in 
countries where drug-eluting stents are currently being used, 
manufacturer information and information furnished in response to the 
May 9, 2002 IPPS proposed rule, and the average price of currently 
available stents, we assume a price differential of approximately 
$1,200. Using an average of 1.5 stents per procedure, we propose to add 
$1,200 to the median costs established for APC 0104 based on 2001 
claims data. We would then calculate a relative payment weight and 
payment rate for APC 0656 in accordance with the methodology that we 
discuss in section II.B. of this preamble. By taking this approach, we 
believe that payment for drug-eluting stents would be balanced between 
the OPPS and the inpatient PPS, minimizing the incentive to use payment 
as the basis for determining where to furnish this new technology.
    We are taking the extraordinary temporary measure of establishing 
this APC and pricing it as we propose only because we have been advised 
by experts that these stents can be expected to revolutionize the 
provision of coronary care and can be expected to supplant use of 
existing stents. While the statute contemplates the difficulties of 
setting OPPS payments for new devices by providing the transitional 
pass-through mechanism, that mechanism does not work in this 
circumstance since these devices fall into a previously existing device 
category and do not meet the test for inclusion in new technology APCs. 
However, the law permits us to take into account changes in technology 
and the addition of new factors (See section 1833(t)(9)(A)) of the Act. 
In this case, we think the impact of this new technology will be so 
great compared to other new technologies that, to ensure beneficiary 
access to state-of-the-art medical care, we believe that we need to 
create new codes and a separate APC, paid based on the best information 
currently available, to ensure adequate payment to providers and access 
to care during the first 2 years of the device's existence. To 
undertake this methodology in other cases, we would

[[Page 52108]]

have to be similarly convinced that the technology would not qualify 
for pass-through payment nor new technology APC payment, that it will 
revolutionize the provision of care and that it will replace an 
existing technology. As indicated previously, this payment mechanism 
would be a temporary one that would exist only until 2005, at which 
point we would have sufficient data to determine how to pay for these 
devices under the standard OPPS methodology for setting payment 
amounts.
    We propose to implement payment under APC 0656 effective April 1, 
2003, consistent with the effective date for implementation of the 
drug-eluting DRGs under the OPPS and contingent upon FDA approval by 
that date. If the FDA grants approval prior to April 1, 2003, hospitals 
would be paid for insertion of coronary artery drug-eluting stents 
under APC 104.
    We are proposing to establish the new HCPCS codes and APC group for 
coronary artery drug-eluting stents to allow close tracking of the 
utilization and costs associated with these services. Once we obtain 
adequate cost data for coronary artery drug-eluting stents, we propose 
to incorporate these data into the current CPT codes for coronary stent 
placement. We invite comments on this proposed methodology for 
recognizing the additional costs of drug-eluting stents under the OPPS.
    It is important to emphasize that we anticipate that the vast 
majority of new technologies in the future will continue to be 
routinely incorporated into the existing DRGs or through the new 
technology add-on payments under the inpatient PPS. Similarly, we 
expect in the future to continue to make payment under the OPPS for the 
vast majority of new technologies through the existing provisions for 
transitional pass-through payments for new devices, drugs, and 
biologicals and through new technology APCs.
4. Recalibration of APC Weights for 2003
    Section 1833(t)(9)(A) of the Act requires that the Secretary review 
and revise the relative payment weights for APCs at least annually, 
beginning in 2001 for application in 2002. In the April 7, 2000 final 
rule (65 FR 18482), we explained in detail how we calculated the 
relative payment weights that were implemented on August 1, 2000 for 
each APC group. Except for some reweighting due to APC changes, these 
relative weights continued to be in effect for 2001. (See the November 
13, 2000 interim final rule (65 FR 67824 to 67827).)
    To recalibrate the relative APC weights for services furnished on 
or after January 1, 2003 and before January 1, 2004, we are proposing 
to use the same basic methodology that we described in the April 7, 
2000 final rule. That is, we would recalibrate the weights based on 
claims and cost report data for outpatient services. We propose to use 
the most recent available data to construct the database for 
calculating APC group weights. For the purpose of recalibrating APC 
relative weights for 2003, the most recent available claims data are 
the approximately 110 million final action claims for hospital 
outpatient department services furnished on or after January 1, 2001 
and before January 1, 2002 and processed through March 2002. Many of 
these 110 million claims were for services that are not paid under OPPS 
(such as, clinical laboratory tests). We matched the claims that are 
paid under OPPS to the most recent cost report filed by the individual 
hospitals represented in our claims data. The APC relative weights 
would continue to be based on the median hospital costs for services in 
the APC groups.
a. Data Issues
(1) Treatment of ``Multiple Procedure'' Claims
    We have received many requests (through an April Town Hall meeting 
and other sources of contact with the public) asking that we ensure 
that the data from claims that contain charges for multiple procedures 
are included in the data from which we calculate the 2003 relative 
payment weights. They believe that relying solely on single procedure 
claims to recalibrate APC weights fails to take into account data for 
many frequently performed procedures, particularly those commonly 
performed in combination with other procedures.
    We agree that optimally, it is desirable to use the data from as 
many claims as possible to recalibrate the relative payment weights, 
including those with multiple procedures. We identified certain 
multiple procedure claims that could be treated as single procedure 
claims, enabling us to greatly increase the number of services used to 
develop the APC payment weights for 2003. However, several inherent 
features of multiple bill claims prevented us from using all of them to 
recalibrate the payment weights. We discuss these obstacles below.
    There are four scenarios that occur when multiple procedures are 
billed on a claim that result in our being unable to use all of those 
claims to recalibrate the APC weights. In each case, the underlying 
problem is that there are charges on the claim that we are unable to 
correctly associate with the HCPCS codes for the procedures on the 
claim (that is, payable HCPCS codes). In general, we are unable to 
determine with confidence what portion of those charges should be 
packaged into the charges for each of the procedures on the claim. The 
different scenarios that we describe below may occur singly or in 
combination on the same claim.
    In the first scenario, costs associated with outpatient hospital 
services are reported in revenue centers that cannot be associated with 
individual HCPCS codes because they are ancillary and supportive of 
some or all services furnished to the beneficiary. We do not require 
that hospitals assign a HCPCS code to each revenue center and charge or 
that they split the charges within revenue centers by HCPCS code 
because they advise us that they are unable to account for costs in 
this manner. In addition, to collect and report this information would 
be burdensome and costly.
    Where there is only one HCPCS code for a procedure on the claim, we 
can assign supporting charges in revenue centers to the single HCPCS 
code. However, when there are two or more HCPCS codes for procedures on 
the claim, we have no basis for allocating appropriately the ancillary 
charges reported under revenue centers to the HCPCS codes for 
separately payable procedures. For example, a claim containing HCPCS 
codes for a visit and a surgical procedure may show charges under the 
revenue center for family clinic (517) for the visit and under 
operating room (360) for the surgery. But in addition, the claim could 
show charges under the following revenue centers without assigning a 
HCPCS code to the revenue center: recovery room (710), charge A for 
sterile supplies (272), charge B for sterile supplies (272), anesthesia 
(370), and pharmacy (250). If only a single HCPCS code was billed, we 
could sum the charges shown under the ancillary revenue centers and 
attribute those charges to the HCPCS code for the single HCPCS code 
that was billed. However, because there is more than one separately 
payable code on the claim (clinic visit and surgery), we do not know 
which charge for sterile supplies should be mapped to the visit and 
which should be assigned to the surgery. Similarly, there is nothing on 
the claim to indicate whether the total pharmacy charge is associated 
with the surgery or with the clinic visit, or split between them. For 
this type of multiple procedure claim, we have chosen to

[[Page 52109]]

exclude the claim from the pool of charges used to calculate median APC 
costs rather than risk assigning the ancillary revenue center charges 
incorrectly. This type of multiple procedure claim, often much more 
complex than this example, accounts for a significant portion of the 
multiple procedure claims that we are unable to use to recalibrate 
payment weights.
    In the second scenario, we are unable to correctly assign to 
procedures the charges for HCPCS codes that we package into other 
procedures. HCPCS codes with status indicator ``N'' are not paid 
separately. Rather, the payment for these packaged items or services is 
recognized in the payment for a service or services billed on the same 
claim for which there is an APC payment rate. In calculating the median 
costs, we have to know where to incorporate the charges shown for the 
HCPCS code with status indicator ``N.'' When a packaged HCPCS codes is 
on a claim that also bills for more than one primary procedure (that 
is, procedures for which we make separate payment), we do not know with 
which of the procedures the charges for the packaged HCPCS code should 
be associated, or whether the charges for the packaged HCPCS code 
should be apportioned on some basis among the multiple primary 
procedures.
    In the third scenario, in the case of multiple surgical procedures, 
our billing instructions permit hospitals to show charges for only one 
surgical procedure code although they report more than one surgical 
HCPCS code. Specifically, this billing convention has long been 
permitted in Medicare Intermediary Manual section 3626.4B3 and was 
reconfirmed by Medicare Transmittal A-01-50, which was issued on April 
12, 2001 (http://www.hcfa.gov/pubforms/transmit/A0150.pdf) in response 
to hospital requests that we clarify whether they were required to 
create and report charges for each HCPCS code for each surgical service 
billed on a claim. We believe that to report charges for each HCPCS 
code for surgical services would have imposed an additional accounting 
and billing burden on hospitals that had not previously existed. This 
would have been in addition to the changes to the claims format and 
instructions that hospitals had recently made to accommodate OPPS and 
our other initiatives. As in the case of the ancillary services billed 
under revenue centers, the charges for each HCPCS code for the surgery 
were not needed to ensure that correct payment was made on the claim 
(since payment was made based on the code's APC assignment and not on 
reported charges).
    However, because hospitals are permitted to report operating room 
charges for only one of the multiple surgical procedures on a claim, we 
are unable to identify a valid means of apportioning the operating room 
charges to the other procedures that were performed. We are not aware 
of any research on comparative hospital outpatient department (OPD) 
resource consumption by HCPCS codes that would indicate how to 
apportion a total charge among the individual codes on the claim. 
Moreover, these multiple surgical procedure claims frequently have 
problems similar to those discussed above in scenario one. Therefore, 
we are unable to use data from multiple surgery claims that are 
submitted in this form to calculate APC median costs.
    In the fourth scenario are claims with multiple units of the same 
HCPCS code billed with charges in revenue centers or packaged HCPCS 
codes. In this case, we cannot determine the appropriate distribution 
of charges on the claim between the first and subsequent units of the 
HCPCS code. To approximate the charges that would occur if single 
rather than multiple units of the HCPCS code were billed, we would have 
to inflate the charges for the second and subsequent units of the 
service, which would eliminate the impact of the efficiencies that we 
believe occur when second and subsequent units of a procedure are 
performed. There are no data to suggest an appropriate factor to 
apportion charges for the second and subsequent units.
    We considered several methods of apportioning charges from revenue 
centers and packaged HCPCS codes to enable us to use charge data from 
multiple procedure claims in the calculation of APC weights, but none 
of these methods was sufficient to yield cost data that we could be 
assured were valid. Specifically, we considered dividing the total 
charges in a revenue center or for a packaged HCPCS code by the number 
of payable HCPCS codes for multiple procedures on the claim. In the 
example of a claim for a visit code and a surgical code with the 
revenue center for sterile supplies billed twice on the same claim, we 
would sum the charges for sterile supplies, divide the sum by 2, and 
add the resulting divided charges for sterile supplies to the charges 
for each HCPCS code. The single pharmacy charge would be divided by 2, 
and half of the pharmacy charge would be added to each HCPCS code. We 
rejected this approach because of concern about whether it is likely to 
be sufficiently accurate to serve as a reasonable means of apportioning 
charges.
    We also considered apportioning the charges among the codes based 
on physician work relative value units (RVUs) because time is a major 
factor in the establishment of physician work RVUs under the Medicare 
fee schedule for physician services. Time may be reflective of the 
comparative amount of resources used by the hospital for different 
surgical procedures, particularly charges for operating rooms, recovery 
rooms, and observation rooms. However, physician work RVUs also depend 
in part on the intensity and difficulty of the work of a physician in 
providing a service and would therefore not necessarily reflect 
accurately the relative resources a hospital would expend for the same 
procedure. Moreover, we do not believe that time appropriately reflects 
the use of resources such as pharmacy and supplies.
    We then considered apportioning the charges among the codes based 
on physician nonfacility practice expense RVUs because practice expense 
RVUs reflect relative resource utilization for these services. However, 
we have no evidence that the relative practice expenses of physicians 
correlate with the resources that a hospital would use for the same 
service. Moreover, physician practice expenses are minimal for the many 
services typically furnished in a facility rather than the physician's 
office. For these services, the practice expense RVU reflects only 
minimal expenses for services, such as the physician's billing costs. 
They are, therefore, an inadequate proxy for the facility costs, such 
as supplies, drugs, equipment, nursing services, and overhead costs 
incurred by hospitals.
    In summary, we concluded that the inherent drawbacks of these 
methodologies would outweigh any potential advantages accrued from the 
resulting increase in data used to calculate APC median costs. Without 
evidence to the contrary, we believe that applying these arbitrary 
methods of apportioning costs to multiple procedure claims would yield 
results that are less reliable and valid than continuing to rely on 
single procedure claims in calculating APC median costs.
    We solicit public comment on the methods we considered for 
apportioning the total charges to individual HCPCS codes as described 
above. We also invite suggestions of other alternative means of 
apportioning the total costs on multiple procedure claims to the HCPCS 
codes for the procedures so that we can use more data from multiple 
procedure claims in the 2004 update of the OPPS.
    We also solicit information on existing studies that would provide

[[Page 52110]]

comparative hospital outpatient resource inputs by HCPCS code. In 
addition, we welcome suggestions for studies that we might undertake 
either to determine the relative value of OPD resources by HCPCS code 
or to provide a valid means of apportioning the charges among HCPCS 
codes when multiple surgical procedures are billed on the same claim 
with a single total charge for all services.
    Further, we ask for comments on the feasibility of requiring 
hospitals to apportion all charges currently shown in revenue centers 
to the HCPCS codes billed so that we could use all multiple services 
claims in the calculation of the relative weights. For example, where 
the patient received multiple surgeries on the same day or received a 
visit and a procedure on the same day, the hospital would have to 
create a charge for each billable HCPCS code and that charge would have 
to encompass all charges for OR, recovery room, pharmacy, supplies, 
etc. that were relevant to that code. No charges would be billed under 
revenue centers alone or with packaged HCPCS codes (that is, HCPCS 
codes having a status indicator of N) since all charges would be 
reported under associated payable HCPCS codes. There would have to be 
corollary changes in completion of the cost report. Also, because 
hospitals must have a uniform charge structure, providers would need to 
charge all other payers and private pay patients in the same manner as 
they would be required to charge Medicare.
    We are particularly interested in the views of hospitals and 
billing experts weighing the burden that could be created by these 
changes in billing rules relative to the potential benefit of 
calculating more precise OPPS payment rates that incorporate data from 
multiple procedure claims.
    Finally, we solicit information regarding the extent to which 
efficiencies are realized when multiple services are furnished during 
the same visit or operative session. We currently discount the APC 
payment for the second and subsequent procedures performed during a 
single encounter by 50 percent in the expectation that the same 
efficiencies of service that are demonstrated to exist in the provision 
of physician services also exist in the provision of outpatient 
hospital services. In general, when a second or subsequent service is 
performed at the same time as an initial service, we believe that the 
combined resource costs associated with operating room time, recovery 
room time, anesthesia, supplies, and other services are less than if 
the procedures were performed separately. However, we are interested in 
empirical data regarding the extent to which these efficiencies of 
resource consumption actually occur.
(2) Calendar Year 2002 Charge Data for Pass-Through Device Categories
    HCPCS coding for medical devices that qualified for transitional 
pass-through payment for services furnished in 2001 occurred in two 
different ways. (A detailed discussion of the provisions authorizing 
transitional pass-through payments for certain medical devices and 
drugs and biologicals can be found in section III of this preamble.) 
From August 1, 2000 until April 1, 2001, claims for medical devices 
that were paid on a pass-through basis were coded using device specific 
codes that were often manufacturer specific. BBRA required that, 
effective April 1, 2001, claims for medical devices eligible for 
transitional pass-through payment were to be billed using codes that 
applied to categories of devices. We issued the applicable category 
codes in Program Memoranda, Transmittals A-01-40 and A-01-41. We posted 
them on our web site at http://www.hcfa.gov/pubforms/transmit/A0140.pdf 
and http://www.hcfa.gov/pubforms/transmit/A0141.pdf, respectively. The 
change to the use of category codes, rather than device specific codes, 
simplified coding and also expanded the number of devices that were 
eligible for transitional pass-through payment. The expansion occurred 
because devices that fit the categories but that had previously not met 
the criteria for transitional pass-through payments could now be billed 
for a transitional pass-through payment.
    Moreover, in recognition of the impact of the change on hospital 
billing and in recognition of the short time between the passage of 
legislation (December 14, 2000) and the effective date for the new 
codes (April 1, 2001), we gave hospitals a 90-day grace period during 
which they could bill using either the device specific codes they had 
previously been using or the new category codes. For this reason, only 
services furnished on or after July 1, 2001 were required to be billed 
using the new device category codes.
    We have been advised that during the period in which the 2001 OPPS 
was in effect, hospitals may not have billed properly for devices 
eligible for transitional pass-through payments. We understand that the 
changes in billing format and systems for implementation of the OPPS 
compounded the problems of billing using the device specific codes 
during the first 9 months of the OPPS. We have been informed that these 
problems were further compounded by the creation and requirement to use 
category codes on and after April 1, 2001. In general, we have been 
advised that hospitals may have been underpaid for transitional pass-
through devices (because they did not bill separately for them and 
therefore did not get the pass-through payment) and that our data will 
not correctly show the charges associated with the devices (because the 
devices were not coded with device category codes on the claim).
    We agree that where hospitals failed to show the code for the 
transitional pass-through device (whether the device specific code or 
the category code as applicable), they will not have received payment 
for the device as a transitional pass-through device. For many years, 
there have been processes in place for hospitals to submit adjustment 
bills so they can receive payment for all applicable services they 
furnished if they subsequently determine that their original bills were 
deficient. Notwithstanding, there is no method by which we can infer a 
charge on a claim for a service that is not billed by the hospital.
    Regarding the impact of the absence of coding for devices on the 
data from claims submitted for July 2001 and later, we looked at the 
claims data for a sample of services for which we thought there should 
have been a device category billed because of the nature of the 
procedure (for example, insertion of a pacemaker). We found that there 
were many instances when a device category code was not billed when we 
would have expected it. However, we found that when we summed the 
charges for revenue centers with the charges for the procedure on 
claims where no category code was reported and compared those totals 
with the sum of charges from claims where both a device category code 
and the associated procedure code were billed, the results were very 
similar. From this analysis, we conclude that in many cases, 
particularly during the first half of the calendar year, hospitals 
included charges for transitional pass-through devices in the revenue 
center for supplies. Therefore, we believe cost data for transitional 
pass-through devices are contained in the charges of most claims, even 
where they are not separately identified by the code for the device 
category, which should have been reported.
    We believe that this absence of category codes in the claims data 
and our data analysis, and the issues surrounding multiple procedure 
claims argue strongly for packaging the cost of these devices into the 
payment for the procedures with which they were used and to then create 
weights for

[[Page 52111]]

procedures for the 2003 OPPS. Incorrect device coding could lead to 
skewed weights for the retired transitional pass-through devices, if we 
were to establish individual APCs for the expired device categories.
    We believe that packaging the charges billed under the revenue 
centers into the charges for the procedures before setting the weights 
for the APCs will allow us to capture all of the cost data for services 
in which devices were used which will result in the most valid payment 
for the APC. This approach assures that the payment rate for the 
procedure includes accurate payment for the devices used in the 
procedure. Further discussion of our proposal to package payment for 
sunsetting transitional pass-through devices is contained in section 
III.C of this preamble.
b. Description of How Weights Were Calculated for 2003
    The methodology we followed to calculate the APC relative payment 
weights proposed for CY 2003 is as follows:
     We excluded from the data approximately 15 million claims 
for those bill and claim types that would not be paid under the OPPS 
(for example, bill type 72X for dialysis services for patients with 
end-stage renal disease (ESRD)).
     Using the most recent available cost report from each 
hospital, we converted billed charges to costs and aggregated them to 
the procedure or visit level first by identifying the cost-to-charge 
ratio specific to each hospital's cost centers (``cost center specific 
cost-to-charge ratios'' or CCRs) and then by matching the CCRs to 
revenue centers used on the hospital's 2001 outpatient bills. The CCRs 
include operating and capital costs but exclude items paid on a 
reasonable cost basis.
     We eliminated from the hospital CCR data 301 hospitals 
that we identified as having reported charges on their cost reports 
that were not actual charges (for example, a uniform charge applied to 
all services).
     We calculated the geometric mean of the total operating 
CCRs of hospitals remaining in the CCR data. We removed from the CCR 
data 67 hospitals whose total operating CCR exceeded the geometric mean 
by more than 3 standard deviations.
     We excluded from our data approximately 3 million claims 
submitted by the hospitals that we removed or trimmed from the hospital 
CCR data.
     We eliminated 1.2 million claims from hospitals located in 
Maryland, Guam, and the U.S. Virgin Islands.
     We matched revenue centers from the remaining universe of 
approximately 92.2 million claims to CCRs hospitals.
     We separated the 92.2 million claims that we had matched 
with a cost report into the following three distinct groups: (1) 
single-procedure claims, (2) multiple-procedure claims, and (3) claims 
on which we could not identify at least one OPPS covered service. 
Single-procedure claims are those that include 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 include more than one HCPCS code that could be mapped to an APC. 
Dividing the claims in this manner yielded approximately 30.4 million 
single-procedure claims and 20.1 million multiple-procedure claims. 
Approximately 41.5 million claims without at least one covered OPPS 
service were set aside.
    We converted 10.7 million multiple-procedure claims to single-
procedure claims using the following criteria: (1) If a multiple-
procedure claim contained lines with a HCPCS code in the pathology 
series (that is, CPT 80000 series of codes), we treated each of those 
lines as a single claim. (2) For multiple procedure claims with a 
packaged HCPCS code (status indicator ``N'') on the claim, we ignored 
line items for chest X-rays (HCPCS codes 71010 and/or 71020) and/or 
EKGs (HCPCS code 93005) on these claims. If only one procedure (other 
than HCPCS codes 71010, 71020, and 93005) existed on the claim, we 
treated it as a single-procedure claim. (3) If the claim had no 
packaged HCPCS codes and if there were no packaged revenue centers on 
the claim, we treated each line with a procedure as a single claim if 
the line item was billed as a single unit. (4) If the claim had no 
packaged HCPCS codes on the claim but had packaged revenue centers for 
the procedure, we ignored the line item for chest X-rays and/or EKG 
codes (as identified above) and if only one HCPCS code remained, we 
treated the claim as a single procedure claim. We created an additional 
31.3 million single-procedure bills through this process, which enabled 
us to use these data from multiple-procedure claims in calculation of 
the APC relative payment weights.
     To calculate median costs for services within an APC, we 
used only single-procedure bills and those multiple procedure bills 
that we converted into single claims. If a claim had a single code with 
a zero charge (that would have been considered a single-procedure 
claim), we did not use it. As we discussed in section II.B.4.a.(1) of 
this preamble, we did not use multiple-procedure claims that billed 
more than one separately payable HCPCS code with charges for packaged 
items and services such as anesthesia, recovery room, or supplies that 
could not be reliably allocated or apportioned among the primary HCPCS 
codes on the claim. We have not yet developed what we regard as an 
acceptable method of using multiple-procedure bills to recalibrate APC 
weights that minimizes the risk of improperly assigning charges to the 
wrong procedure or visit.
     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 an appropriate cost center 
did not exist for a given hospital, we crosswalked the revenue center 
to a secondary cost center when possible, or used 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 the OPPS (for example, laboratory, 
ambulance, and therapy services). We included all charges associated 
with HCPCS codes that are designated as packaged services (that is, 
HCPCS codes with the status indicator of ``N'').
     To calculate per-service costs, we used the charges shown 
in revenue centers that contained items integral to performing the 
service. We observed the packaging provisions set forth in the April 7, 
2000 final rule with comment period that were in effect during 2001 (65 
FR 18484). For instance, in calculating the cost of a surgical 
procedure, 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 organs. To 
determine medical visit costs, we included charges for items such as 
medical and surgical supplies, drugs, and observation in those 
instances where they are still packaged. Table 5 lists packaged 
services by revenue center that we are proposing to use to calculate 
per-service costs for outpatient services furnished in 2003.

[[Page 52112]]



               Table 5.--Packaged Services by Revenue Code
------------------------------------------------------------------------
           Revenue code                          Description
------------------------------------------------------------------------
                                 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
274...............................  PROSTHETIC/ORTHOTIC DEVICES
275...............................  PACEMAKER DRUG
276...............................  INTRAOCULAR LENS SOURCE DRUG
278...............................  OTHER IMPLANTS
279...............................  OTHER M&S SUPPLIES
280...............................  ONCOLOGY
289...............................  OTHER ONCOLOGY
290...............................  DURABLE MEDICAL EQUIPMENT
370...............................  ANESTHESIA
379...............................  OTHER ANESTHESIA
390...............................  BLOOD STORAGE AND PROCESSING
399...............................  OTHER BLOOD STORAGE AND PROCESSING
560...............................  MEDICAL SOCIAL SERVICES
569...............................  OTHER MEDICAL SOCIAL SERVICES
624...............................  INVESTIGATIONAL DEVICE (IDE)
630...............................  DRUGS REQUIRING SPECIFIC
                                     IDENTIFICATION, GENERAL CLASS
631...............................  SINGLE SOURCE
632...............................  MULTIPLE
633...............................  RESTRICTIVE PRESCRIPTION
700...............................  CAST ROOM
709...............................  OTHER CAST ROOM
710...............................  RECOVERY ROOM
719...............................  OTHER RECOVERY ROOM
720...............................  LABOR ROOM
721...............................  LABOR
762...............................  OBSERVATION ROOM
810...............................  ORGAN ACQUISITION
819...............................  OTHER ORGAN ACQUISITION
------------------------------------------------------------------------
                              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
560...............................  MEDICAL SOCIAL SERVICES
569...............................  OTHER MEDICAL SOCIAL SERVICES
630...............................  DRUGS REQUIRING SPECIFIC
                                     IDENTIFICATION, GENERAL CLASS
631...............................  SINGLE SOURCE DRUG
632...............................  MULTIPLE SOURCE DRUG
633...............................  RESTRICTIVE PRESCRIPTION
637...............................  SELF-ADMINISTERED DRUG (INSULIN
                                     ADMIN. IN EMERGENCY DIABETIC COMA
700...............................  CAST ROOM
709...............................  OTHER CAST ROOM
762...............................  OBSERVATION ROOM
 
942...............................  EDUCATION/TRAINING
------------------------------------------------------------------------
                            Other Diagnostic
------------------------------------------------------------------------
254...............................  PHARMACY INCIDENT TO OTHER
                                     DIAGNOSTIC
280...............................  ONCOLOGY
289...............................  OTHER ONCOLOGY

[[Page 52113]]

 
372...............................  ANESTHESIA INCIDENT TO OTHER
                                     DIAGNOSTIC
560...............................  MEDICAL SOCIAL SERVICES
569...............................  OTHER MEDICAL SOCIAL SERVICES
622...............................  SUPPLIES INCIDENT TO OTHER
                                     DIAGNOSTIC
624...............................  INVESTIGATIONAL DEVICE (IDE)
710...............................  RECOVERY ROOM
719...............................  OTHER RECOVERY ROOM
762...............................  OBSERVATION ROOM
------------------------------------------------------------------------
                                Radiology
------------------------------------------------------------------------
255...............................  PHARMACY INCIDENT TO RADIOLOGY
280...............................  ONCOLOGY
289...............................  OTHER ONCOLOGY
371...............................  ANESTHESIA INCIDENT TO RADIOLOGY
560...............................  MEDICAL SOCIAL SERVICES
569...............................  OTHER MEDICAL SOCIAL SERVICES
621...............................  SUPPLIES INCIDENT TO RADIOLOGY
624...............................  INVESTIGATIONAL DEVICE (IDE)
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
560...............................  MEDICAL SOCIAL SERVICES
569...............................  OTHER MEDICAL SOCIAL SERVICES
630...............................  DRUGS REQUIRING SPECIFIC
                                     IDENTIFICATION, GENERAL CLASS
631...............................  SINGLE SOURCE DRUG
632...............................  MULTIPLE SOURCE DRUG
633...............................  RESTRICTIVE PRESCRIPTION
762...............................  OBSERVATION ROOM
942...............................  EDUCATION/TRAINING
------------------------------------------------------------------------

     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 proposed FY 2003 hospital inpatient 
prospective payment system (IPPS) wage index published in the Federal 
Register on May 9, 2002 (67 FR 31602). We used 60 percent to represent 
our estimate of that portion of costs attributable, on average, to 
labor. We have used this estimate since the inception of the OPPS and 
continue to believe that it is appropriate. See 65 FR 18496, the April 
7, 2000 final rule for a complete description of how we derived this 
percentage.
     We summed the standardized labor-related cost and the 
nonlabor-related cost component for each billed item to derive the 
total standardized cost for each procedure or medical visit.
     We removed extremely unusual costs that appeared to be 
errors in the data using a trimming methodology analogous to what we 
use in calculating the diagnosis-related group (DRG) weights for the 
hospital IPPS. That is, we eliminated any bills with costs outside of 3 
standard deviations from the geometric mean.
     After trimming the procedure and visit level costs, we 
mapped each procedure or visit cost to its assigned APC, including, to 
the extent possible, the proposed APC changes described in section II.A 
of this preamble.
     We calculated the median cost for each APC.
     Using the median APC costs, we calculated the relative 
payment weights for each APC. As in prior years, we scaled all the 
relative payment weights to APC 0601, Mid-level clinic visit, because 
it is one of the most frequently performed services in the hospital 
outpatient setting. This approach is consistent with that used in 
developing relative value units for the Medicare physician fee 
schedule. We assigned APC 0601 a relative payment weight of 1.00 and 
divided the median cost for each APC by the median cost for APC 0601 to 
derive the relative payment weight for each APC. Using 2001 data, the 
median cost for APC 0601 is $56.77.
    Section 1833(t)(9)(B) of the Act requires that APC reclassification 
and recalibration changes and wage index changes be made in a manner 
that assures that aggregate payments under the OPPS for 2003 are 
neither greater

[[Page 52114]]

than nor less than the aggregate payments that would have been made 
without the changes. To comply with this requirement concerning the APC 
changes, we compared aggregate payments using the CY 2002 relative 
weights to aggregate payments using the CY 2003 proposed weights. Based 
on this comparison, we are proposing to make an adjustment of 1.04227 
to the weights. The weights that we are proposing for 2003, which 
incorporate the recalibration adjustments explained in this section, 
are listed in Addendum A and Addendum B.
5. Procedures That Will Be Paid Only As Inpatient Procedures
    Before implementation of the OPPS, Medicare paid reasonable costs 
for services provided in the outpatient department. The claims 
submitted were subject to medical review by the fiscal intermediaries 
to determine the appropriateness of providing certain services in the 
outpatient setting. We did not specify in regulations those services 
that were appropriate to provide only in the inpatient setting and 
that, therefore, should be payable only when provided in that setting.
    Section 1833(t)(1)(B)(i) of the Act gives the Secretary broad 
authority to determine the services to be covered and paid for under 
the OPPS. In the April 7, 2000 final rule, we identified procedures 
that are typically provided only in an inpatient setting and, 
therefore, would not be paid by Medicare under the OPPS (65 FR 18455). 
These procedures comprise what is referred to as the ``inpatient 
list.'' The inpatient list specifies those services that are only paid 
when provided in an inpatient setting. These are services that require 
inpatient care because of the nature of the procedure, the need for at 
least 24 hours of postoperative recovery time or monitoring before the 
patient can be safely discharged, or the underlying physical condition 
of the patient. As we discussed in the April 7, 2000 and the November 
30, 2001 final rules, we use the following criteria when reviewing 
procedures to determine whether or not they should be moved from the 
inpatient list and assigned to an APC group for payment under the OPPS:
     Most outpatient departments are equipped to provide the 
services to the Medicare population.
     The simplest procedure described by the code may be 
performed in most outpatient departments.
     The procedure is related to codes we have already moved 
off the inpatient list.
    We update the inpatient list as often as quarterly through program 
memoranda to reflect current advances in medical practice. We last 
updated the inpatient list in the November 30, 2001 final rule. As we 
discuss in section II.A.2, above, the APC Panel at its January 2002 
meeting reviewed certain procedures on the inpatient list for which we 
had received requests that they be made payable under the OPPS. The 
Panel recommended that we solicit comments and further information 
about all these procedures except for CPT code 47001, which they 
recommended be removed from the inpatient list (see section II.A.2 
above for a discussion of this and the other codes that the Panel 
considered for removal from the inpatient list). These procedures are 
included in Table 6, with the exception of CPT code 33967, which we are 
not proposing to pay for under the OPPS for reasons that we explain in 
section II.A.2.
    In preparing this proposed rule to update the OPPS for CY 2003, we 
compared procedures with status indicator ``C'' (status indicator ``C'' 
is assigned to inpatient procedures that are not payable under the 
OPPS) to the list of procedures that are currently on the ambulatory 
surgical center (ASC) list of approved procedures, to procedures that 
we proposed to add to the ASC list in a proposed rule published in the 
Federal Register on June 12, 1998 (63 FR 32291), and to procedures 
recommended for addition to the ASC list by commenters in response to 
the June 12, 1998 proposed rule. We found that there are procedures on 
the current ASC list, or procedures proposed for addition to the ASC 
list, or procedures recommended by commenters for addition to the ASC 
list that are assigned status indicator ``C'' under the OPPS. A review 
of 2001 physician claims data also revealed that physicians are 
performing some of these ``C'' status indicator procedures on Medicare 
beneficiaries on an outpatient basis. We concluded that it was 
appropriate to propose removal of procedures from the OPPS inpatient 
list that are being performed on an outpatient basis and/or that we had 
determined could be safely and appropriately performed on a Medicare 
beneficiary in an ASC under the applicable ASC rules that are set forth 
in 42 CFR 416.22. We believe that our payment policies for surgical 
procedures provided in an outpatient hospital setting and in the ASC 
setting should be consistent to the extent possible within the 
limitations imposed by statutory or regulatory requirements. So, we 
propose to add the following criteria for use in reviewing procedures 
to determine whether they should be removed from the inpatient list and 
assigned to an APC group for payment under the OPPS:
     We have determined that the procedure is being performed 
in numerous hospitals on an outpatient basis; or
     We have determined that the procedure can be appropriately 
and safely performed in an ASC and is on the list of approved ASC 
procedures or proposed by us for addition to the ASC list.
    In addition to the procedures considered by the APC Panel for 
removal from the inpatient list, Table 6 includes the procedures that 
we are proposing to be removed from the inpatient list for payment 
under the OPPS. We applied the criteria discussed above in order to be 
consistent with the ASC list of approved procedures, and with 
utilization data that indicate the procedures are being performed on an 
outpatient basis. We solicit comments on whether the procedures in 
Table 6 should be paid under the OPPS. We also solicit comments on the 
APC assignment that we propose for these procedures in the event we 
determine in the final rule, based on comments, that these procedures 
would be payable under the OPPS in 2003. We ask that commenters 
recommending reclassification of a procedure to an APC include evidence 
(preferably from peer-reviewed medical literature) that the procedure 
is being performed on an outpatient basis in a safe and effective 
manner.
    Following our review of the comments that we receive about the 
procedures in Table 6, we propose either to assign a CPT code to an APC 
for payment under the OPPS or, if the comments do not provide 
sufficient information and data to enable us to make a decision, to 
present the comments to the APC Panel at its 2003 meeting.

[[Page 52115]]



           Table 6.--Procedures on the Inpatient List Proposed for Payment Under the OPPS in CY 2003.
----------------------------------------------------------------------------------------------------------------
         CPT code            Proposed status indicator         Proposed APC                 Description
----------------------------------------------------------------------------------------------------------------
21390                       T                           0256                       OPEN TREATMENT OF ORBITAL
                                                                                    FLOOR BLOWOUT FRACTURE;
                                                                                    PERIORBITAL APPROACH, WITH
                                                                                    ALLOPLASTIC OR OTHER
                                                                                    IMPLANT.
22100                       T                           0208                       PARTIAL EXCISION OF POSTERIOR
                                                                                    VERTEBRAL COMPONENT (EG,
                                                                                    SPINOUS PROCESS, LAMINA OR
                                                                                    FACET) FOR INTRINSIC BONY
                                                                                    LESION, SINGLE VERTEBRAL
                                                                                    SEGMENT; CERVICAL.
22101                       T                           0208                       PARTIAL EXCISION OF POSTERIOR
                                                                                    VERTEBRAL COMPONENT (EG,
                                                                                    SPINOUS PROCESS, LAMINA OR
                                                                                    FACET) FOR INTRINSIC BONY
                                                                                    LESION, SINGLE VERTEBRAL
                                                                                    SEGMENT; THORACIC.
22102                       T                           0208                       PARTIAL EXCISION OF POSTERIOR
                                                                                    VERTEBRAL COMPONENT (EG,
                                                                                    SPINOUS PROCESS, LAMINA OR
                                                                                    FACET) FOR INTRINSIC BONY
                                                                                    LESION, SINGLE VERTEBRAL
                                                                                    SEGMENT; LUMBAR.
22103                       T                           0208                       PARTIAL EXCISION OF POSTERIOR
                                                                                    VERTEBRAL COMPONENT (EG,
                                                                                    SPINOUS PROCESS, LAMINA OR
                                                                                    FACET) FOR INTRINSIC BONY
                                                                                    LESION, SINGLE VERTEBRAL
                                                                                    SEGMENT; EACH ADDITIONAL
                                                                                    SEGMENT (LIST SEPARATELY IN
                                                                                    ADDITION TO CODE FOR PRIMARY
                                                                                    PROCEDURE).
23035                       T                           0049                       INCISION, BONE CORTEX (EG,
                                                                                    OSTEOMYELITIS OR BONE
                                                                                    ABSCESS), SHOULDER AREA.
23125                       T                           0051                       CLAVICULECTOMY; TOTAL.
23195                       T                           0050                       RESECTION, HUMERAL HEAD.
23395                       T                           0051                       MUSCLE TRANSFER, ANY TYPE,
                                                                                    SHOULDER OR UPPER ARM;
                                                                                    SINGLE.
23397                       T                           0052                       MUSCLE TRANSFER, ANY TYPE,
                                                                                    SHOULDER OR UPPER ARM;
                                                                                    MULTIPLE.
23400                       T                           0050                       SCAPULOPEXY (EG, SPRENGELS
                                                                                    DEFORMITY OR FOR PARALYSIS).
24150                       T                           0052                       RADICAL RESECTION FOR TUMOR,
                                                                                    SHAFT OR DISTAL HUMERUS;.
24151                       T                           0052                       RADICAL RESECTION FOR TUMOR,
                                                                                    SHAFT OR DISTAL HUMERUS;
                                                                                    WITH AUTOGRAFT (INCLUDES
                                                                                    OBTAINING GRAFT).
24152                       T                           0052                       RADICAL RESECTION FOR TUMOR,
                                                                                    RADIAL HEAD OR NECK;.
24153                       T                           0052                       RADICAL RESECTION FOR TUMOR,
                                                                                    RADIAL HEAD OR NECK; WITH
                                                                                    AUTOGRAFT (INCLUDES
                                                                                    OBTAINING GRAFT).
25170                       T                           0052                       RADICAL RESECTION FOR TUMOR,
                                                                                    RADIUS OR ULNA.
25390                       T                           0050                       OSTEOPLASTY, RADIUS OR ULNA;
                                                                                    SHORTENING.
25391                       T                           0051                       OSTEOPLASTY, RADIUS OR ULNA;
                                                                                    LENGTHENING WITH AUTOGRAFT.
25392                       T                           0050                       OSTEOPLASTY, RADIUS AND ULNA;
                                                                                    SHORTENING (EXCLUDING
                                                                                    64876).
25393                       T                           0051                       OSTEOPLASTY, RADIUS AND ULNA;
                                                                                    LENGTHENING WITH AUTOGRAFT.
25420                       T                           0051                       REPAIR OF NONUNION OR
                                                                                    MALUNION, RADIUS AND ULNA;
                                                                                    WITH AUTOGRAFT (INCLUDES
                                                                                    OBTAINING GRAFT).
27035                       T                           0052                       DENERVATION, HIP JOINT,
                                                                                    INTRAPELVIC OR EXTRAPELVIC
                                                                                    INTRA-ARTICULAR BRANCHES OF
                                                                                    SCIATIC, FEMORAL, OR
                                                                                    OBTURATOR NERVES.
27216                       T                           0050                       PERCUTANEOUS SKELETAL
                                                                                    FIXATION OF POSTERIOR PELVIC
                                                                                    RING FRACTURE AND/OR
                                                                                    DISLOCATION (INCLUDES ILIUM,
                                                                                    SACROILIAC JOINT AND/OR
                                                                                    SACRUM).
27235                       T                           0050                       PERCUTANEOUS SKELETAL
                                                                                    FIXATION OF FEMORAL
                                                                                    FRACTURE, PROXIMAL END,
                                                                                    NECK, UNDISPLACED, MILDLY
                                                                                    DISPLACED, OR IMPACTED
                                                                                    FRACTURE.
31582                       T                           0256                       LARYNGOPLASTY; FOR LARYNGEAL
                                                                                    STENOSIS, WITH GRAFT OR CORE
                                                                                    MOLD, INCLUDING TRACHEOTOMY.
31785                       T                           0254                       EXCISION OF TRACHEAL TUMOR OR
                                                                                    CARCINOMA; CERVICAL.
32201                       T                           0070                       PNEUMONOSTOMY; WITH
                                                                                    PERCUTANEOUS DRAINAGE OF
                                                                                    ABSCESS OR CYST.
38700                       T                           0113                       SUPRAHYOID LYMPHADENECTOMY.
42842                       T                           0254                       RADICAL RESECTION OF TONSIL,
                                                                                    TONSILLAR PILLARS, AND/OR
                                                                                    RETROMOLAR TRIGONE; WITHOUT
                                                                                    CLOSURE.
43030                       T                           0253                       CRICOPHARYNGEAL MYOTOMY.
47490                       T                           0152                       PERCUTANEOUS CHOLECYSTOSTOMY.
47001                       N                           .........................  BIOPSY OF LIVER, NEEDLE; WHEN
                                                                                    DONE FOR INDICATED PURPOSE
                                                                                    AT TIME OF OTHER MAJOR
                                                                                    PROCEDURE.
62351                       T                           0208                       IMPLANTATION, REVISION OR
                                                                                    REPOSITIONING OF TUNNELED
                                                                                    INTRATHECAL OR EPIDURAL
                                                                                    CATHETER, FOR LONG-TERM
                                                                                    MEDICATION ADMINISTRATION
                                                                                    VIA AN EXTERNAL PUMP OR
                                                                                    IMPLANTABLE RESERVOIR/
                                                                                    INFUSION PUMP; WITH
                                                                                    LAMINECTOMY.
64820                       T                           0220                       SYMPATHECTOMY; DIGITAL
                                                                                    ARTERIES, EACH DIGIT.
69150                       T                           0252                       RADICAL EXCISIONS EXTERNAL
                                                                                    AUDITORY CANAL LESION;
                                                                                    WITHOUT NECK DISSECTION.
69502                       T                           0254                       MASTOIDECTOMY; COMPLETE.
92986                       T                           0083                       PERCUTANEOUS BALLOON
                                                                                    VALVULOPLASTY; AORTIC VALVE.
92987                       T                           0083                       PERCUTANEOUS BALLOON
                                                                                    VALVULOPLASTY; MITRAL VALVE.
92990                       T                           0083                       PERCUTANEOUS BALLOON
                                                                                    VALVULOPLASTY; PULMONARY
                                                                                    VALVE.
92997                       T                           0081                       PERCUTANEOUS TRANSLUMINAL
                                                                                    PULMONARY ARTERY BALLOON
                                                                                    ANGIOPLASTY; SINGLE VESSEL.
92998                       T                           0081                       PERCUTANEOUS TRANSLUMINAL
                                                                                    PULMONARY ARTERY BALLOON
                                                                                    ANGIOPLASTY; EACH ADDITIONAL
                                                                                    VESSEL (LIST SEPARATELY IN
                                                                                    ADDITION TO CODE FOR PRIMARY
                                                                                    PROCEDURE)
----------------------------------------------------------------------------------------------------------------


[[Page 52116]]

C. Partial Hospitalization

Payment Methodology
    As we discussed in the April 7, 2000 OPPS final rule (65 FR 18452), 
partial hospitalization is an intensive outpatient program of 
psychiatric services provided to patients in the place of inpatient 
care. A partial hospitalization program (PHP) may be provided by a 
hospital to its outpatients or by a Medicare-certified community mental 
health center (CMHC). Payment to providers under the OPPS for PHPs 
represents the provider's overhead costs associated with the program. 
Because a day of care is the unit that defines the structure and 
scheduling of partial hospitalization services, effective for services 
furnished on or after August 1, 2000, we established a per diem payment 
methodology for the PHP 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. We 
were unable to use CMHC data in computing the per diem because up until 
April 1, 2000, CMHCs were not required to report HCPCS codes. In 
addition, 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 and the most 
recent available cost report data. This analysis resulted in a per diem 
payment of $202.19 effective August 1, 2000. This amount was updated 
effective January 1, 2001 and April 1, 2002 to $206.82 and $212.27.
    Although we did not use CMHC data in establishing the initial APC 
for partial hospitalization (or in the updates made since then), in the 
April 7, 2000 final rule we made a commitment to analyze future data 
from hospitals and CMHCs to determine if refinements to the per diem 
are warranted. Based on our review of 2001 claims data submitted under 
the OPPS, we have developed a payment rate for partial hospitalization 
following the same methodology used to establish all the APC payment 
amounts. However, because a day of care is the unit for PHP services, 
we computed the median cost of furnishing a day of partial 
hospitalization. Other than the unit of service being a day of care, 
the method we used to determine median costs for PHP is no different 
than that used for all other APCs as described in other sections of 
this proposed rule. The CY 2003 proposed payment rate for the partial 
hospitalization APC is $256.96 per day, of which $51.39 is the 
beneficiary's coinsurance.
    We used calendar year 2001 bills from both hospitals and CMHCs. We 
used data from all the hospital bills reporting condition code 41, 
which identifies the claim as partial hospitalization. Since section 
1866(e)(2) of the Act specifies that a CMHC is a provider of service 
``* * * only with respect to the furnishing of partial hospitalization 
services * * *,'' we used all bills from CMHCs. We used cost-to-charge 
ratios from the most recently available hospital and CMHC cost reports 
to develop costs from line item charges reported on bills. Since 
hospitals and CMHCs are now required to report line item dates of 
service on claims, we used that data to refine our estimates of line 
item costs.
    We then computed per diem costs by summing the line item costs on 
each bill and dividing by the number of days on each bill. Using this 
method of determining costs, preliminary per diem cost estimates for 
CMHCs were much higher than expected, in many cases more than twice the 
average per diem for inpatient psychiatric care and more than three 
times the hospital median PHP per diem cost. The data strongly suggests 
that the costs were reported incorrectly. We believe that the data are 
unusable without adjustment.
    Closer examination of the CMHC cost report data showed that costs 
from CMHC finalized cost reports were considerably lower than costs 
from ``as submitted'' CMHC cost reports. To account for the difference 
between settled and as-filed cost report data, we computed the ratio of 
total final costs to total as-filed costs over a 3-year period (FYs 
1998-2000) and calculated an average adjustment factor which we applied 
to the costs on each claim. The adjusted costs were summed, then 
divided by the number of days on that bill.
Treatment of Professional Services Under PHP
    Section 410.43 describes the conditions and exclusions of partial 
hospitalization services. That section lists the services that are 
separately covered and not paid as partial hospitalization services. 
The list includes--
     Physician services that meet the requirements of 42 CFR 
415.102(a) for payment on a fee schedule basis;
     Physician assistant services, as defined in section 
1861(s)(2)(K)(i) of the Act;
     Nurse practitioner and clinical nurse specialist services, 
as defined in section 1861(s)(2)(K)(ii) of the Act;
     Qualified psychologist services, as defined in section 
1861(ii) of the Act; and
     Services furnished to SNF residents as defined in 42 CFR 
411.15(p).
    Based on this section, in the April 7, 2000 OPPS rule, we stated 
that the APC for partial hospitalization 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 Medicare payment is made to the provider. Before implementation 
of the OPPS, the services of CSWs and OTs in a PHP were billed by the 
hospitals to the fiscal intermediaries and paid on a reasonable cost 
basis.
    We have looked carefully at the differences between the cost 
experiences of CMHCs and of hospitals with respect to PHP services, as 
well as how payment is made for other hospital outpatient psychiatric 
services, to identify areas where improvements can be made in OPPS. One 
of the areas in which we identified discrepancies was in the coverage 
of CSW services. The way in which CSW services are currently billed and 
paid depends upon the circumstances under which CSW services are 
provided. In some settings, payment for CSW services is part of a 
bundled payment. In other settings, separate payment for CSW services 
is made.
    Generally, CSW services furnished to hospital outpatients are 
bundled, which means that only the hospital may bill for such services. 
However, payment for CSW professional services furnished to hospital 
outpatients is made under the physician fee schedule. Therefore, the 
hospital outpatient department bills separately the Part B carrier for 
CSW services furnished to outpatients who are not in a PHP. CSW 
professional services are paid at 75 percent of the clinical 
psychologist fee schedule.
    However, when CSWs furnish services to hospital outpatients or a 
CMHC under a partial hospitalization program, hospitals may not bill 
separately for the services of a CSW. Instead, for coverage and payment 
purposes, the services are recognized as partial hospitalization 
services. Partial hospitalization services are billed by hospitals and 
CMHCs to the fiscal intermediaries and paid the OPPS PHP APC per diem 
amount.
    The different methodologies for payment of CSW services has proven 
both confusing and burdensome for hospitals because they must implement 
separate billing schemes for CSW services depending upon whether an

[[Page 52117]]

individual outpatient is admitted to a PHP program or to any other 
hospital outpatient psychiatric program. We believe that these 
challenges have resulted in incorrect reporting by hospitals which has 
led to an under-representation of CSW services in the OPPS PHP APC per 
diem amount.
    To facilitate proper billing and to ensure comparable reporting of 
costs by hospitals and CMHCs, we are proposing to allow separate 
payment for CSW services furnished in CMHCs. This means that both 
hospitals and CMHCs will bill the carrier for CSW services furnished to 
PHP patients. Therefore, we are proposing to amend Sec. 410.43(b) to 
add clinical social worker services that meet the requirements of 
section 1861(hh)(2) of the Act to the list of professional services not 
considered to be PHP services. We believe this change will allow CSW 
services to be more appropriately reflected in both settings as part of 
PHPs.

III. Transitional Pass-Through and Related Payment Issues

A. Background

    Section 1833(t)(6) of the Act provides for temporary additional 
payments or ``transitional pass-through payments'' for certain medical 
devices, drugs, and biologicals. As originally enacted by the BBRA, 
this provision required the Secretary to make additional payments to 
hospitals for current orphan drugs, as designated under section 526 of 
the Federal Food, Drug, and Cosmetic Act, Pub. L. 107-186; current 
drugs, biologic agents, and brachytherapy devices used for the 
treatment of cancer; and current radiopharmaceutical drugs and 
biological products.
    For those drugs, biologicals, and devices referred to as 
``current,'' the transitional pass-through payment began on the first 
date the hospital OPPS was implemented (before enactment of the 
Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act 
(BIPA), Pub. L. 106-554, enacted December 21, 2000).
    Transitional pass-through payments are also required for certain 
``new'' medical devices, drugs, and biological agents that were not 
being paid for as a hospital outpatient service as of December 31, 1996 
and whose cost is ``not insignificant'' in relation to the OPPS payment 
for the procedures or services associated with the new device, drug, or 
biological. Under the statute, transitional pass-through payments are 
to be made for at least 2 years but not more than 3 years.
    Section 1833(t)(6)(B)(i) of the Act required that we establish by 
April 1, 2001, initial categories to be used for purposes of 
determining which medical devices are eligible for transitional pass-
through payments. Section 1833(t)(6)(B)(i)(II) of the Act explicitly 
authorized us to establish initial categories by program memorandum. On 
March 22, 2001, we issued two Program Memoranda, Transmittals A-01-40 
and A-01-41 that established the initial categories. We posted them on 
our web site at http://www.hcfa.gov/pubforms/transmit/A0140.pdf and 
http://www.hcfa.gov/pubforms/transmit/A0141.pdf, respectively.
    Transmittal A-01-41 includes a list of the initial device 
categories and a crosswalk of all the item-specific codes for 
individual devices that were approved for transitional pass-through 
payments as of January 21, 2001 to the initial category code by which 
the device is to be billed beginning April 1, 2001. Items eligible for 
transitional pass-through payments are generally coded using a Level II 
HCPCS code with an alpha prefix of ``C.'' Pass-through device 
categories are identified by status indicator ``H'' and pass-through 
drugs and biologicals are identified by status indicator ``G.'' 
Subsequently, we added two additional categories and made 
clarifications to some of the categories' long descriptors found in 
transmittal A-01-73. A current list of device category codes in effect 
as of July 1, 2002 can be found in Transmittal A-02-050, which was 
issued on June 17, 2002. This Program Memorandum can be accessed on our 
web site at http://www.hcfa.gov. The list is also included in this 
preamble in Table 7.
    Section 1833(t)(6)(B)(ii) of the Act also requires us to establish, 
through rulemaking, criteria that will be used to create additional 
device categories. The criteria for new categories are the subject of a 
separate interim final rule with comment period that we published in 
the Federal Register on November 2, 2001 (66 FR 55850). We will respond 
to public comments on that interim final rule in the final rule that 
implements the 2003 OPPS update.
    Transitional pass-through categories are for devices only; they do 
not apply to drugs or biologicals. The regulations at Sec. 419.64 
governing transitional pass-through payments for eligible drugs and 
biologicals are unaffected by the creation of categories.
    The process to apply for transitional pass-through payment for 
eligible drugs and biological agents or for additional device 
categories can be found on respective pages on our web site at http://www.hcfa.gov. If we revise the application instructions in any way, we 
will post the revisions on our web site and submit the changes for 
approval by the Office of Management and Budget (OMB) under the 
Paperwork Reduction Act (PRA). Notification of new drug, biological, or 
device category application processes are generally posted on the OPPS 
web site at http://www.hcfa.gov/Medicare/hopsmain.html.

B. Discussion of Pro Rata Reduction

    Section 1833(t)(6)(E) of the Act limits the total projected amount 
of transitional pass-through payments for a given year to an 
``applicable percentage'' of projected total payments under the 
hospital OPPS. For a year before 2004, the applicable percentage is 2.5 
percent; for 2004 and subsequent years, we specify the applicable 
percentage up to 2.0 percent. If we estimate before the beginning of 
the calendar year that the total amount of pass-through payments in 
that year would exceed the applicable percentage, section 
1833(t)(6)(E)(iii) of the Act requires a (prospective) uniform 
reduction in the amount of each of the transitional pass-through 
payments made in that year to ensure that the limit is not exceeded. We 
make an estimate of pass-through spending to determine not only whether 
payment exceeds the applicable percentage but also to determine the 
appropriate reduction to the conversion factor.
    We will make an estimate of pass-through spending in 2003 using the 
methodology described below. Making an estimate of pass-though spending 
in 2003 entails estimating spending for two groups of items. The first 
group consists of those items for which we have claims data (that is, 
items that were eligible in 2001 and that will continue to be eligible 
in 2003). The second group consists of those items for which we have no 
direct claims data (that is, items that became or will become eligible 
in 2002 and will retain pass-through status and items that will be 
newly eligible beginning in 2003).
    To estimate 2003 pass-through spending for device categories in the 
first group, we will use volume and hospital cost (derived from charges 
on claims using cost-to-charge ratios) information from 2001 claims 
data. This information will be projected forward to 2003 levels using 
appropriate inflation and utilization factors. For existing categories 
with no claims data in 2001 that are or will be active in 2002, we will 
follow the method described in the November 2, 2001 final rule (66 FR 
55857). We will use price information from manufacturers and volume 
estimates from claims related to procedures that use the devices in 
question. This information will be

[[Page 52118]]

projected forward to 2003 using appropriate inflation and utilization 
factors to estimate 2003 pass-through spending for this group of 
categories. For categories that become eligible in 2003, we will use 
the same method as described for categories that are newly active in 
2002. Any new categories for 2003 will be announced after the 
publication of this proposed rule but prior to the publication of the 
final rule. Therefore the estimate of pass-through spending will 
incorporate pass-through spending for categories made effective January 
1, 2003.
    To estimate 2003 pass-through spending for drugs, biologicals, and 
radiopharmaceuticals, in the first group, we will use volume data from 
2001 claims and the average wholesale price (AWP) as published in the 
July 2002 Red Book. This information will be projected forward to 2003 
using the appropriate utilization factor. (Because 2003 payment rates 
for pass-through drugs will be based on the July 2002 AWPs, we do not 
apply an inflation factor.) The pass-through amount for drugs, 
biologicals, and radiopharmaceuticals is the difference between the 
payment rate (that is, 95 percent of the AWP) and the amount that would 
have been included in the payment rate of its associated APC had the 
drug, biological, or radiopharmaceutical been packaged. Section V.E. 
describes this methodology. To estimate pass-through spending for drugs 
in this group, for each drug we will multiply the drug's estimated 
utilization times the pass-through amount (for example, the difference 
between 95 percent of AWP for the drug and the amount included in the 
payment rate for its associated APC). For most drugs, the pass-through 
amount will be based on the weighted average ratios described in 
Section IV.E. However some drugs may fall into two other classes. The 
first class includes a drug that is new and for which there are no 
previously existing costs in an associated APC. For such a drug, we 
propose that the pass-through amount would be 95 percent of the AWP 
(because there are no previously existing costs in an associated APC) 
and there will be no copayment (because there are no previously 
existing costs in an APC on which to base a copayment). The second 
class includes a drug that is new and is a substitute for only one drug 
whose cost is recognized in the OPPS through an unpackaged APC. For 
drugs in this second class, we propose that the pass-through amount 
would be the difference between 95 percent of the AWP for the pass-
through drug and the payment rate for the comparable dose of the 
associated drug's APC. The copayment would be based on the payment rate 
of its associated APC.
    For existing drugs, biologicals, and radiopharmaceuticals for which 
we have no claims data in 2001 and which are active or will be active 
in 2002 as well as for drugs, biologicals, and radiopharmaceuticals, we 
will derive volume estimates from information submitted by 
manufacturers as well as other sources (such as, peer-reviewed clinical 
studies) and the AWP as published in the July 2002 Red Book. This 
information will be projected forward to 2003 using the appropriate 
utilization factor. Again, because 2003 payment rates for pass-through 
drugs will be based on the July 2002 AWP, we do not apply an inflation 
factor. To estimate pass-through spending for drugs in this group, for 
each drug we will multiply the drug's estimated utilization times the 
pass-through amount. For most drugs, these amounts will be based on the 
weighted average ratios described in Section IV.E. However some drugs 
may fall into two other classes. The first class includes a drug that 
is new and has no previously existing costs included in an associated 
APC. For such a drug, we propose that the pass-through amount would be 
95 percent of the AWP (because there are no previously existing costs 
included in an APC) and there would be no copayment (because there are 
no previously existing costs in an APC on which to base a copayment). 
The table below shows two such drugs, Y-90 Zevalin and IN-111 Zevalin. 
The second class includes a drug that is new and is a substitute for 
only one drug that is recognized in the OPPS, through an unpackaged 
APC. The table below shows one such drug, Darbepoetin alfa, which is a 
new substitute of epoetin. For drugs in this second class, the pass-
through amount will be the difference between 95 percent of the AWP for 
the pass-through drug and the payment rate for the comparable dose of 
the associated drug's APC. The copayment will be based on the payment 
rate of its associated APC. For drugs, biologicals, and 
radiopharmaceuticals that may receive pass-through status effective 
January 1, 2003, we will use the same methodology as described for 
drugs, biologicals, and radiopharmaceuticals that received pass-through 
status in 2002. Any new pass-through drugs, biologicals, and 
radiopharmaceuticals effective beginning in 2003 will be announced 
after the publication of this proposed rule but prior to the 
publication of the final rule. Therefore the estimate of pass-through 
spending will incorporate pass-through spending for these drugs, 
biologicals, and radiopharmaceuticals made effective January 1, 2003.
    Finally, we will incorporate an estimate of pass-through spending 
for items that become eligible later in 2003 (that is, April 1, 2003; 
July 1, 2003; and October 1, 2003) based on estimates for items that 
will become eligible for pass-through status January 1, 2003. 
Specifically, we will assume a proportionate amount of spending for 
items that become eligible later in the year while making an adjustment 
to account for the fact that items made eligible later in the year will 
not have received pass-through payments for the entire year.
    After using the methodologies described above to determine 
projected 2003 pass-through spending for the groups of devices, drugs, 
biologicals, and radiopharmaceuticals described above, we would 
calculate total projected 2003 pass-through spending as a percentage of 
the total (that is, Medicare and beneficiary payments) projected 
payments under OPPS to determine if the pro rata reduction would be 
required.
    Below is a table showing our current estimate of 2003 pass-through 
spending based on information available at the time this table was 
developed. We are uncertain whether pass-through spending in 2003 will 
exceed $457 million or 2.5 percent of total OPPS spending. We have not 
yet completed the estimate of pass-through spending for a number of 
drugs. In particular, we are in the process of obtaining additional 
information about the utilization volume for several pass-through 
drugs. We invite comments on the methodology described above as well as 
the assumptions shown in the table below including anticipated 
utilization and utilization not yet determined. More information 
regarding the assumptions used to create these estimates is available 
at http://cms.hhs.gov/regulations/regnotices.asp.

[[Page 52119]]



                                                                        Table X.
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                          2003 Pass-
                                                                                   2002         2001       through     2003 estimated   2003 anticipated
               HCPC                   APC            DRUG, biological            payment    utilization    payment       utilization      pass-through
                                                                                   rate                    portion                           payment
--------------------------------------------------------------------------------------------------------------------------------------------------------
 
                                                         Existing Pass-through Drugs/Biologicals
--------------------------------------------------------------------------------------------------------------------------------------------------------
A9700.............................     9016  Echocardiography Contrast*......      $118.75      300,000       $34.44           368,686    $12,696,607.35
C1774.............................      734  Darbepoetin alfa, 1 mcg.........         4.74      6136252         1.37         7,541,157     10,366,074.10
C1058.............................     1058  TC 99M oxidronate, per vial.....        36.74        4,000        10.65             4,916         52,375.96
C1064.............................     1064  I-131 cap, each add mCi.........         5.86        4,575         1.88             5,622        485,208.00
C1065.............................     1065  I-131 sol, each add mCi.........        15.81        4,575         5.06             5,622      1,309,068.00
C1775.............................     1775  FDG, per dose (4-40 mCi/ml).....       475.00       30,000       137.75            36,869      5,078,642.94
J9219.............................     7051  Leuprolide acetate implant......     5,399.80           66     1,565.94                81        127,014.83
J9017.............................     9012  Arsenic Trioxide................        23.75  ...........         6.89               TBD  To be determined
J7517.............................     9015  Mycophenolate mofetil...........         2.40  ...........         0.70               TBD  To be determined
J0587.............................     9018  Botulinum toxin type B..........         8.79  ...........         2.55               TBD  To be determined
C9019.............................     9019  Caspofugen acetate, 5 mg........        34.20  ...........         9.92               TBD  To be determined
C9110.............................     9110  Alemtuzumab, per 10mg/ml........       486.88  ...........       141.20               517         72,997.92
C9111.............................     9111  Inj. Bivalrudin, 250 mg vial....       397.81  ...........       115.36               TBD  To be determined
C9112.............................     9112  Perflutren lipid micro, 2ml.....       148.20      300,000        42.98           368,686     15,845,365.98
C9113.............................     9113  Inj Pantoprazole sodium, vial...        22.80  ...........         6.61               TBD  To be determined
C9114.............................     9114  Nesiritide, per 1.5 mg vial.....       433.20  ...........       125.63               TBD  To be determined
C9115.............................     9115  Zoledronic acid, 2 mg...........       406.78  ...........       117.97               TBD  To be determined
C9200.............................     9200  Orcel, per 36 cm2...............     1,135.25  ...........       329.22               TBD  To be determined
C9201.............................     9201  Dermagraft, per 37.5 sq cm......       577.60  ...........       167.50               TBD  To be determined
--------------------------------------------------------------------------------------------------------------------------------------------------------
 
                                                  Pass-through Drugs/Biologicals Effective October 2002
--------------------------------------------------------------------------------------------------------------------------------------------------------
C9116.............................     9116  Ertapenem sodium................        36.24  ...........        10.51               TBD  To be determined
C9117.............................     9117  Y-90 Zevalin....................    19,181.44  ...........    19,181.44             9,000    172,632,960.00
C9118.............................     9118  IN-111 Zevalin..................     2,769.65  ...........     2,769.65             9,000     24,926,850.00
C9119.............................     9119  Pegfilgrastim...................     2,802.50  ...........     2,367.13            85,258    201,815,396.40
--------------------------------------------------------------------------------------------------------------------------------------------------------
 
                                                                  Pass-through Devices
--------------------------------------------------------------------------------------------------------------------------------------------------------
C1765.............................     1754  Adhesion barrier................  ...........          256  ...........               261         20,011.00
C1783.............................     1783  Ocular implant, aqueous drainage  ...........         2000  ...........              2042      1,327,300.00
C1888.............................     1888  Endovascular, non-cardiac.......  ...........          184  ...........               188        136,300.00
C1900.............................     1900  Lead, left ventricular..........  ...........         1000  ...........              1021      2,042,000.00
C2618.............................     2618  Probe, cryoablation.............  ...........         1120  ...........              1144        531,106.00
--------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 52120]]

C. Expiration of Transitional Pass-Through Payments in Calendar Year 
2003

1. Devices
    Section 1833(t)(6)(B)(iii) of the Act requires that a category of 
devices be eligible for transitional pass-through payments for at least 
2, but not more than 3, years. This period begins with the first date 
on which a transitional pass-through payment is made for any medical 
device that is described by the category. We propose that 95 device 
categories currently in effect will expire effective January 1, 2003. 
Our proposed payment methodology for devices that have been paid by 
means of pass-through categories, but for which pass-through status 
will expire effective January 1, 2003, is discussed in the section 
below.
    Although the device category codes became effective on April 1, 
2001, many of the item-specific C-codes for pass-through devices that 
were crosswalked to the new category codes were approved for pass-
through payment in CY 2000, or as of January 1, 2001. (The crosswalk 
for item-specific C-codes to category codes was issued in Transmittals 
A-01-41 and A-01-97, cited in section III.A.) To establish the 
expiration date for the category codes listed in Table 7, we determined 
when item-specific devices that are described by the categories were 
first made effective for pass-through payment before the implementation 
of device categories. These dates are listed in Table 7 in the column 
entitled ``Date First Populated.'' We propose to base the expiration 
date for a device category on the earliest effective date of pass-
through status for any device that populates that category. Thus, the 
95 categories for devices that will have been eligible for pass-through 
payments for at least 2 years as of December 31, 2002 would not be 
eligible for pass-through payments effective January 1, 2003.
    Below is Table 7, which includes a comprehensive list of all pass-
through device categories effective on or before July 1, 2002 with the 
date that devices described by the category first became effective for 
payment under the pass-through provisions and their respective proposed 
expiration dates.

                 Table 7.--List of Pass-through Device Categories With Proposed Expiration Dates
----------------------------------------------------------------------------------------------------------------
                     HCPCS codes       Category long descriptor    Date first populated       Expiration date
----------------------------------------------------------------------------------------------------------------
1..............  C1883..............  Adaptor/extension, pacing   8/1/00................  12/31/02
                                       lead or neurostimulator
                                       lead (implantable).
2..............  C1765..............  Adhesion barrier..........  10/01/00-3/31/01; 7/1/  12/31/03
                                                                   01.
3..............  C1713..............  Anchor/screw for opposing   8/1/00................  12/31/02
                                       bone-to-bone or soft
                                       tissue-to-bone
                                       (implantable).
4..............  C1715..............  Brachytherapy needle......  8/1/00................  12/31/02
5..............  C1716..............  Brachytherapy seed, Gold    10/1/00...............  12/31/02
                                       198.
6..............  C1717..............  Brachytherapy seed, High    1/1/01................  12/31/02
                                       Dose Rate Iridium 192.
7..............  C1718..............  Brachytherapy seed, Iodine  8/1/00................  12/31/02
                                       125.
8..............  C1719..............  Brachytherapy seed, Non-    10/1/00...............  12/31/02
                                       High Dose Rate Iridium
                                       192.
9..............  C1720..............  Brachytherapy seed,         8/1/00................  12/31/02
                                       Palladium 103.
10.............  C2616..............  Brachytherapy seed,         1/1/01................  12/31/02
                                       Yttrium-90.
11.............  C1721..............  Cardioverter-               8/1/00................  12/31/02
                                       defibrillator, dual
                                       chamber (implantable).
12.............  C1882..............  Cardioverter-               8/1/00................  12/31/02
                                       defibrillator, other than
                                       single or dual chamber
                                       (implantable).
13.............  C1722..............  Cardioverter-               8/1/00................  12/31/02
                                       defibrillator, single
                                       chamber (implantable).
14.............  C1888..............  Catheter, ablation, non-    7/1/02................  12/31/04
                                       cardiac, endovascular
                                       (implantable).
15.............  C1726..............  Catheter, balloon           8/1/00................  12/31/02
                                       dilatation, non-vascular.
16.............  C1727..............  Catheter, balloon tissue    8/1/00................  12/31/02
                                       dissector, non-vascular
                                       (insertable).
17.............  C1728..............  Catheter, brachytherapy     1/1/01................  12/31/02
                                       seed administration.
18.............  C1729..............  Catheter, drainage........  10/1/00...............  12/31/02
19.............  C1730..............  Catheter,                   8/1/00................  12/31/02
                                       electrophysiology,
                                       diagnostic, other than 3D
                                       mapping (19 or fewer
                                       electrodes).
20.............  C1731..............  Catheter,                   8/1/00................  12/31/02
                                       electrophysiology,
                                       diagnostic, other than 3D
                                       mapping (20 or more
                                       electrodes).
21.............  C1732..............  Catheter,                   8/1/00................  12/31/02
                                       electrophysiology,
                                       diagnostic/ablation, 3D
                                       or vector mapping.
22.............  C1733..............  Catheter,                   8/1/00................  12/31/02
                                       electrophysiology,
                                       diagnostic/ablation,
                                       other than 3D or vector
                                       mapping, other than cool-
                                       tip.
23.............  C2630..............  Catheter,                   10/1/00...............  12/31/02
                                       electrophysiology,
                                       diagnostic/ablation,
                                       other than 3D or vector
                                       mapping, cool-tip.
24.............  C1887..............  Catheter, guiding (may      8/1/00................  12/31/02
                                       include infusion/
                                       perfusion capability).
25.............  C1750..............  Catheter, hemodialysis/     8/1/00................  12/31/02
                                       peritoneal, long-term.
26.............  C1752..............  Catheter, hemodialysis/     8/1/00................  12/31/02
                                       peritoneal, short-term.
27.............  C1751..............  Catheter, infusion,         8/1/00................  12/31/02
                                       inserted peripherally,
                                       centrally or midline
                                       (other than hemodialysis).
28.............  C1759..............  Catheter, intracardiac      8/1/00................  12/31/02
                                       echocardiography.
29.............  C1754..............  Catheter, intradiscal.....  10/1/00...............  12/31/02
30.............  C1755..............  Catheter, intraspinal.....  8/1/00................  12/31/02
31.............  C1753..............  Catheter, intravascular     8/1/00................  12/31/02
                                       ultrasound.
32.............  C2628..............  Catheter, occlusion.......  10/1/00...............  12/31/02
33.............  C1756..............  Catheter, pacing,           10/1/00...............  12/31/02
                                       transesophageal.
34.............  C2627..............  Catheter, suprapubic/       10/1/00...............  12/31/02
                                       cystoscopic.
35.............  C1757..............  Catheter, thrombectomy/     8/1/00................  12/31/02
                                       embolectomy.
36.............  C1885..............  Catheter, transluminal      10/1/00...............  12/31/02
                                       angioplasty, laser.
37.............  C1725..............  Catheter, transluminal      8/1/00................  12/31/02
                                       angioplasty, non-laser
                                       (may include guidance,
                                       infusion/perfusion
                                       capability).
38.............  C1714..............  Catheter, transluminal      8/1/00................  12/31/02
                                       atherectomy, directional.
39.............  C1724..............  Catheter, transluminal      8/1/00................  12/31/02
                                       atherectomy, rotational.
40.............  C1758..............  Catheter, ureteral........  10/1/00...............  12/31/02
41.............  C1760..............  Closure device, vascular    8/1/00................  12/31/02
                                       (implantable/insertable).
42.............  L8614..............  Cochlear implant system...  8/1/00................  12/31/02
43.............  C1762..............  Connective tissue, human    8/1/00................  12/31/02
                                       (includes fascia lata).

[[Page 52121]]

 
44.............  C1763..............  Connective tissue, non-     10/1/00...............  12/31/02
                                       human (includes
                                       synthetic).
45.............  C1881..............  Dialysis access system      8/1/00................  12/31/02
                                       (implantable).
46.............  C1764..............  Event recorder, cardiac     8/1/00................  12/31/02
                                       (implantable).
47.............  C1767..............  Generator, neurostimulator  8/1/00................  12/31/02
                                       (implantable).
48.............  C1768..............  Graft, vascular...........  1/1/01................  12/31/02
49.............  C1769..............  Guide wire................  8/1/00................  12/31/02
50.............  C1770..............  Imaging coil, magnetic      1/1/01................  12/31/02
                                       resonance (insertable).
51.............  C1891..............  Infusion pump, non-         8/1/00................  12/31/02
                                       programmable, permanent
                                       (implantable).
52.............  C2626..............  Infusion pump, non-         1/1/01................  12/31/02
                                       programmable, temporary
                                       (implantable).
53.............  C1772..............  Infusion pump,              10/1/00...............  12/31/02
                                       programmable
                                       (implantable).
54.............  C1893..............  Introducer/sheath,          10/1/00...............  12/31/02
                                       guiding, intracardiac
                                       electrophysiological,
                                       fixed-curve, other than
                                       peel-away.
55.............  C1766..............  Introducer/sheath,          1/1/01................  12/31/02
                                       guiding, intracardiac
                                       electrophysiological,
                                       steerable, other than
                                       peel-away.
56.............  C1892..............  Introducer/sheath,          1/1/01................  12/31/02
                                       guiding, intracardiac
                                       electrophysiological,
                                       fixed-curve, peel-away.
57.............  C1894..............  Introducer/sheath, other    8/1/00................  12/31/02
                                       than guiding, other than
                                       intracardiac
                                       electrophysiological, non-
                                       laser.
58.............  C2629..............  Introducer/sheath, other    1/1/01................  12/31/02
                                       than guiding, other than
                                       intracardiac
                                       electrophysiological,
                                       laser.
59.............  C1776..............  Joint device (implantable)  10/1/00...............  12/31/02
60.............  C1895..............  Lead, cardioverter-         8/1/00................  12/31/02
                                       defibrillator,
                                       endocardial dual coil
                                       (implantable).
61.............  C1777..............  Lead, cardioverter-         8/1/00................  12/31/02
                                       defibrillator,
                                       endocardial single coil
                                       (implantable).
62.............  C1896..............  Lead, cardioverter-         8/1/00................  12/31/02
                                       defibrillator, other than
                                       endocardial single or
                                       dual coil (implantable).
63.............  C1900..............  Lead, left ventricular      7/1/02................  12/31/04
                                       coronary venous system.
64.............  C1778..............  Lead, neurostimulator       8/1/00................  12/31/02
                                       (implantable).
65.............  C1897..............  Lead, neurostimulator test  8/1/00................  12/31/02
                                       kit (implantable).
66.............  C1898..............  Lead, pacemaker, other      8/1/00................  12/31/02
                                       than transvenous VDD
                                       single pass.
67.............  C1779..............  Lead, pacemaker,            8/1/00................  12/31/02
                                       transvenous VDD single
                                       pass.
68.............  C1899..............  Lead, pacemaker/            1/1/01................  12/31/02
                                       cardioverter-
                                       defibrillator combination
                                       (implantable).
69.............  C1780..............  Lens, intraocular (new      8/1/00................  12/31/02
                                       technology).
70.............  C1878..............  Material for vocal cord     10/1/00...............  12/31/02
                                       medialization, synthetic
                                       (implantable).
71.............  C1781..............  Mesh (implantable)........  8/1/00................  12/31/02
72.............  C1782..............  Morcellator...............  8/1/00................  12/31/02
73.............  C1784..............  Ocular device,              1/1/01................  12/31/02
                                       intraoperative, detached
                                       retina.
74.............  C1783..............  Ocular implant, aqueous     7/1/02................  12/31/04
                                       drainage assist device.
75.............  C2619..............  Pacemaker, dual chamber,    8/1/00................  12/31/02
                                       non rate-responsive
                                       (implantable).
76.............  C1785..............  Pacemaker, dual chamber,    8/1/00................  12/31/02
                                       rate-responsive
                                       (implantable).
77.............  C2621..............  Pacemaker, other than       1/1/01................  12/31/02
                                       single or dual chamber
                                       (implantable).
78.............  C2620..............  Pacemaker, single chamber,  8/1/00................  12/31/02
                                       non rate-responsive
                                       (implantable).
79.............  C1786..............  Pacemaker, single chamber,  8/1/00................  12/31/02
                                       rate-responsive
                                       (implantable).
80.............  C1787..............  Patient programmer,         8/1/00................  12/31/02
                                       neurostimulator.
81.............  C1788..............  Port, indwelling            8/1/00................  12/31/02
                                       (implantable).
82.............  C2618..............  Probe, cryoablation.......  4/1/01................  12/31/03
83.............  C1789..............  Prosthesis, breast          10/1/00...............  12/31/02
                                       (implantable).
84.............  C1813..............  Prosthesis, penile,         8/1/00................  12/31/02
                                       inflatable.
85.............  C2622..............  Prosthesis, penile, non-    10/1/01...............  12/31/02
                                       inflatable.
86.............  C1815..............  Prosthesis, urinary         10/1/00...............  12/31/02
                                       sphincter (implantable).
87.............  C1816..............  Receiver and/or             8/1/00................  12/31/02
                                       transmitter,
                                       neurostimulator
                                       (implantable).
88.............  C1771..............  Repair device, urinary,     10/1/00...............  12/31/02
                                       incontinence, with sling
                                       graft.
89.............  C2631..............  Repair device, urinary,     8/1/00................  12/31/02
                                       incontinence, without
                                       sling graft.
90.............  C1773..............  Retrieval device,           1/1/01................  12/31/02
                                       insertable.
91.............  C2615..............  Sealant, pulmonary, liquid  1/1/01................  12/31/02
                                       (Implantable).
92.............  C1817..............  Septal defect implant       8/1/00................  12/31/02
                                       system, intracardiac.
93.............  C1874..............  Stent, coated/covered,      8/1/00................  12/31/02
                                       with delivery system.
94.............  C1875..............  Stent, coated/covered,      8/1/00................  12/31/02
                                       without delivery system.
95.............  C2625..............  Stent, non-coronary,        10/1/00...............  12/31/02
                                       temporary, with delivery
                                       system.
96.............  C2617..............  Stent, non-coronary,        10/1/00...............  12/31/02
                                       temporary, without
                                       delivery system.
97.............  C1876..............  Stent, non-coated/non-      8/1/00................  12/31/02
                                       covered, with delivery
                                       system.
98.............  C1877..............  Stent, non-coated/non-      8/1/00................  12/31/02
                                       covered, without delivery
                                       system.
99.............  C1879..............  Tissue marker               8/1/00................  12/31/02
                                       (implantable).
100............  C1880..............  Vena cava filter..........  1/1/01................  12/31/02
----------------------------------------------------------------------------------------------------------------

    We considered a number of options on how to pay for devices after 
their pass-through payment status expires effective January 1, 2003. We 
held a Town Hall Meeting on April 5, 2002, to solicit recommendations 
on how to pay for drugs, biologicals, and devices once their 
eligibility for transitional pass-through payments expires in 
accordance with the time limits set by the statute. Interested parties 
representing hospitals, physician specialty groups, device and drug 
manufacturers and trade associations, and other organizations presented 
their views on these issues.
    We have carefully considered all the comments, concerns, and 
recommendations submitted to us regarding payment for devices and drugs 
and biologicals that would no

[[Page 52122]]

longer be eligible for pass-through payments in 2003. One consideration 
under the OPPS is the need to enable beneficiary access to new, and 
often costly, medical technology. We have also had to assess the extent 
to which the most recently available data that are the basis for 
prospectively setting payment rates for services within the APC system 
adequately reflect the costs incurred by hospitals to furnish this new 
technology. Having considered these factors, we propose to package the 
costs of medical devices no longer eligible for pass-through payment in 
2003 into the costs of the procedures with which the devices were 
billed in 2001. (Our proposal to pay for pass-through drugs and 
biologicals whose pass-through status expires in 2003 is discussed 
below, in section III.C.2.)
    The methodology that we propose to use to package pass-through 
device costs is consistent with the methodology for packaging that we 
describe in section II.B.4.b. That is, to calculate the total cost for 
a service on a per-service basis, we included all charges billed with 
the service in a revenue center in addition to packaged HCPCS codes 
with status indicator ``N.'' We also packaged the 2001 charges for 
devices that will cease to be eligible for pass-through payment in 2003 
into the changes for the HCPCS codes with which the devices were 
billed. We relied on the hospitals to correctly code their bills for 
all costs, including pass-through devices, using HCPCS codes and 
revenue centers as appropriate to describe the services that they 
furnished.
    We discuss in section II.B.4.a.(2), issues related to coding and 
billing for pass-through devices in 2001 and how our analysis of the 
claims data suggests that in some instances charges for devices were 
billed in revenue centers and in other instances with a device-specific 
or device category ``C'' code. We did not want to lose the device costs 
billed by hospitals through revenue centers in developing our relative 
weights for APCs, yet we were unable to separate the device costs from 
other costs included in the revenue centers. This problem is resolved 
by our proposal to package the costs of both the device ``C'' codes and 
the billed revenue centers, whichever appears on the claim. We are 
confident that this method will allow us to capture all device related 
costs billed by hospitals.
    We customarily allow a grace period for HCPCS codes that are 
scheduled for deletion. When we allow a grace period for deleted codes, 
we permit deleted codes to continue to be billed and paid for 90 days 
after the effective date of the changes that require their deletion. 
However, we propose to not allow a grace period for expiring pass-
through codes because permitting a grace period would result in pass-
through payment for the items for which we propose to cease pass-
through payment effective with services furnished on or after January 
1, 2003. Effective for services furnished on or after January 1, 2003, 
hospitals would submit charges for all surgically inserted devices in 
the supply, implant, or device revenue center that most appropriately 
describes the implant. Device costs will thus be packaged into and 
reflected in the costs for the procedure with which they are 
associated. Therefore, effective for services furnished on or after 
January 1, 2003, we propose to reject line items containing a ``C'' 
code for a device category scheduled to expire effective January 1, 
2003.
2. Drugs and Biologicals (Including Radiopharmaceuticals, Blood, and 
Blood Products)
    Under the OPPS, we currently pay for drugs and biologicals, 
including radiopharmaceuticals, blood, and blood products, in one of 
three ways: packaged payment, separate APCs and transitional pass-
through payment.
Packaged Payment
    As we explained in the April 7, 2000 final rule, we generally 
package the cost of drugs and biologicals into the APC payment rate for 
the primary procedure or treatment with which the drugs are usually 
furnished (65 FR 18450). Hospitals do not receive separate payment from 
Medicare for packaged items and supplies, and hospitals may not bill 
beneficiaries separately for any such packaged items and supplies whose 
costs are recognized and paid for within the national OPPS payment rate 
for the associated procedure or service. (Transmittal A-01-133, a 
Program Memorandum issued to Intermediaries on November 20, 2001, 
explains in greater detail the rules regarding separate payment for 
packaged services). Hospitals bill for costs directly related and 
integral to performing a procedure or furnishing a service using a 
revenue center or packaged HCPCS code (status indicator ``N''). As 
discussed earlier in section II.B.4.a(2), we list the packaged 
services, by revenue center, that we use to calculate per-service 
costs.
    As specified in the regulations at Sec. 419.2(b), costs directly 
related and integral to performing a procedure or furnishing a service 
on an outpatient basis are included in the determination of OPPS 
payment rates for the procedure or service. For example, sedatives 
administered to patients while they are in the preoperative area being 
prepared for a procedure are supplies that are integral to being able 
to perform the procedure. Similarly, mydriatic drops instilled into the 
eye to dilate the pupils, anti-inflammatory drops, antibiotic 
ointments, and ocular hypotensives that are administered to the patient 
immediately before, during, or following an ophthalmic procedure are 
considered an integral part of the procedure without which the 
procedure could not be performed. The costs of these items are packaged 
into and reflected within the OPPS payment rate for the procedure. 
Likewise, barium or low osmolar contrast media are supplies that are 
integral to a diagnostic imaging procedure as is the topical solution 
used with photodynamic therapy furnished at the hospital to treat non-
hyperkeratotic actinic keratosis lesions of the face or scalp. Local 
anesthetics such as marcaine, lidocaine (with or without epinephrine) 
and antibiotic ointments such as bacitracin, placed on a wound or 
surgical incision at the completion of a procedure, are other examples. 
The hospital furnishes these items while the patient is in the hospital 
and registered as an outpatient for the purpose of receiving a therapy, 
treatment, procedure, or service. These and other such supplies may be 
furnished pre-operatively, while the patient is being prepared for a 
procedure; intra-operatively, while the procedure is being performed; 
or post-operatively, while the patient is in the recovery area prior to 
discharge. Or, these items may be part of an E/M service furnished 
during a clinic visit or in the emergency department. All of these 
supplies are directly related and integral to the performance of a 
separately payable therapy, treatment, procedure, or service with which 
they are furnished. Therefore, we do not generally recognize them as 
separately payable services. We package their cost into the cost of the 
primary procedure, and we pay for them as part of the APC payment.
Separate APCs for Drugs Not Eligible for Transitional Pass-Through 
Payment
    There are certain new technology drugs and biologicals that are not 
eligible for transitional pass-through payments but for which we have 
made separate payment. Beginning with the April 7, 2000 rule (65 FR 
18476), we created separate new technology APCs for these drugs and 
biologicals as well as devices. For example, we did not package into 
the emergency room visit APCs the various drugs classified as tissue 
plasminogen activators (TPAs)

[[Page 52123]]

and other thrombolytic agents that are used to treat patients with 
myocardial infarctions. We also did not package the costs of certain 
vaccines into the payment for visits or procedures. Rather, we created 
temporary individual APC groups for these drugs to allow separate 
payment so as not to discourage their use where appropriate. In the 
case of blood and blood products, wide variations in patient 
requirements convinced us that we should pay for these items separately 
rather than packaging their costs into the procedural APCs. Moreover, 
the Secretary's Advisory Council on Blood Safety and Access recommended 
that blood and blood products be paid separately to ensure that there 
were no incentives that would be inconsistent with the promotion of 
blood safety and access.
    In the case of the other drugs and vaccines that we did not package 
into payment for visits or procedures, we paid separately for them 
because we wanted to avoid creating an incentive to cease providing 
these drugs when they were medically indicated.
    We based the payment rate for the APCs for these drugs and 
biologicals on median hospital acquisition costs. To determine the 
hospital acquisition cost for the drugs, we imputed a cost using the 
same ratios of drug acquisition cost to AWP that we discuss below in 
connection with calculating acquisition costs for transitional pass-
through drug payments. That is, we multiplied the AWP for the drug by 
the applicable ratio (sole or multisource drug) based on data collected 
in an external survey of hospital drug acquisition costs.
    We set beneficiary copayment amounts for these drug and biological 
APCs at 20 percent of the imputed acquisition cost. In 2003 we will use 
status indicator ``K'' to denote the APCs for drugs and biologicals 
(including blood and blood products) and certain brachytherapy seeds 
that are paid separately from and in addition to the procedure or 
treatment with which they are associated but that are not eligible for 
transitional pass-through payment.
Transitional Pass-Through Payments for Eligible Drugs and Biologicals
    BBRA provided for special transitional pass-through payments for a 
period of 2 to 3 years for the following drugs and biologicals (pass-
through payments for devices are addressed in section III.C.1 of this 
proposed rule):
     Current orphan drugs, as designated under section 526 of 
the Federal Food, Drug, and Cosmetic Act.
     Current drugs and biologic agents used for treatment of 
cancer.
     Current radiopharmaceutical drugs and biological products.
     New drugs and biological agents.
    In this context, ``current'' refers to those items for which 
hospital outpatient payment was being made on August 1, 2000, the date 
on which the OPPS was implemented. A ``new'' drug or biological is a 
product that is not paid under the OPPS as a ``current'' drug or 
biological, was not paid as a hospital outpatient service before 
January 1, 1997, and for which the cost is not insignificant in 
relation to the payment for the APC with which it is associated.
    Section 1833(t)(6)(D)(i) of the Act sets the payment rate for pass-
through eligible drugs as the amount by which the amount determined 
under section 1842(o) of the Act, that is, 95 percent of the applicable 
average wholesale price (AWP), exceeds the difference between 95 
percent of the applicable AWP and the portion of the otherwise 
applicable fee schedule amount (that is, the APC payment rate) that the 
Secretary determines is associated with the drug or biological. 
Therefore, in order to determine the pass-through payment amount, we 
first had to determine the cost that was packaged for the drug or 
biological within its related APC. In order to determine this amount, 
we used data on hospital acquisition costs for drugs from a survey that 
is described more fully in the April 7, 2000 and the November 30, 2001 
final rules. The ratio of hospital acquisition cost, on average, to AWP 
that we used is as follows:
     For sole-source drugs, the ratio of acquisition cost to 
AWP equals 0.68.
     For multisource drugs, the ratio of acquisition cost to 
AWP equals 0.61.
     For multisource drugs with generic competitors, the ratio 
of acquisition cost to AWP equals 0.43.
    Section 1833(t)(6)(C)(i) of the Act specifies that the duration of 
transitional pass-through payments for current drugs and biologicals 
must be no less than 2 years nor any longer than 3 years beginning on 
the date that the OPPS is implemented. Therefore, the latest date for 
which current drugs that have been in transitional pass-through status 
since August 1, 2000 will be eligible for transitional pass-through 
payments is July 31, 2003. We propose to remove these drugs from 
transitional pass-through status effective January 1, 2003 because the 
law gives us the discretion to do so and because we generally implement 
annual OPPS updates on January 1 of each year. We would be in violation 
of the law if we were to not remove these drugs and biologicals from 
transitional pass through status before August 2, 2003. The next new 
OPPS that will go into place will not be effective until January 1, 
2004, at which time, the statute's 3-year limit on pass-through 
payments for these drugs would have been exceeded. We further propose 
to remove from transitional pass-through status, beginning January 1, 
2003, those drugs for which transitional pass-through payments were 
made effective on or prior to January 1, 2001 because the law gives us 
the discretion to do so and we believe that, to the extent possible, 
payments should be made under the OPPS, without pass-through payment, 
when the law permits, as it does in this case.
    As explained above, our policy has been to package payment for 
drugs and biologicals into the payment for the procedure or service to 
which the drug is integral and directly related. In general, packaging 
the costs of items and services into the payment for the primary 
procedure or service with which it is associated encourages hospital 
efficiencies and also enables hospitals to manage their resources with 
maximum flexibility. Packaging costs into a single aggregate payment 
for a service procedure or episode of care is a fundamental principle 
that distinguishes a prospective payment system from a fee schedule. 
Our proposal to package the costs of devices that we discuss in section 
III.C.1 of this preamble is based on this principle. As we refine the 
OPPS in the future, we intend to continue to package, to the maximum 
possible extent, the costs of any items and services that are furnished 
with an outpatient procedure or service into the APC payment for 
services with which it is billed.
    Notwithstanding our commitment to package as many costs as 
possible, we are aware of concerns that were presented at the April 5, 
2002 Town Hall meeting and that have been brought to our attention by 
various interested parties, that packaging payments for certain drugs, 
especially those that are particularly expensive or rarely used, might 
result in insufficient payments to hospitals, which could adversely 
affect beneficiary access to medically necessary services.
    The options that we considered included packaging the costs of all 
drugs and biologicals, both those with status indicator ``K'' in 2002 
and those that would no longer receive pass-through payments in 2003, 
or continuing to make separate payment for both categories of drugs and 
biologicals through separate APCs. After careful consideration of the 
various options for 2003, we propose to package the cost of many drugs 
for which separate payment is made currently. But

[[Page 52124]]

we also propose to continue making separate payment for orphan drugs 
(as defined below), blood and blood products, vaccines that are paid 
under a benefit separate from the outpatient hospital benefit (that is, 
influenza, pneumococcal pneumonia, and hepatitis B), and certain higher 
cost drugs as explained below. The payment rates for those drugs for 
which we would make separate payment in 2003 would be an APC payment 
rate based on a relative weight calculated in the same way that 
relative weights for procedural APCs are calculated.
Orphan Drugs
    We recognize that orphan drugs that are used solely for an orphan 
condition or conditions are generally expensive and, by definition, are 
rarely used. We believe that if the cost of these drugs were packaged 
into the payment for an associated procedure or visit, the payment for 
the procedure might be insufficient to compensate a hospital for the 
typically high cost of this special type of drug. Therefore, we propose 
to establish separate APCs to pay for those orphan drugs that are used 
solely for orphan conditions.
    To identify the orphan drugs for which we would continue to make 
separate payment, we applied the following criteria:
     The drug must be designated as an orphan drug by FDA and 
approved by FDA for the orphan condition.
     The current United States Pharmacopoeia Drug Information 
(USPDI) shows that the drug had neither an approved use for other than 
an orphan condition nor an off label use for conditions other than the 
orphan condition. There are three orphan drugs that are used solely for 
orphan conditions for which we propose to make separate payment: J0205 
Alglucerase injection (APC 0900); J0256 Alpha 1 proteinase inhibitor 
(APC 0901); and J09300 Gemtuzumab ozogamicin (APC 9004).
Blood and Blood Products
    From the onset of the OPPS, we have made separate payment for blood 
and blood products either in APCs with status indicator ``K'' or as 
pass-through drugs and biologicals with status indicator ``G'' rather 
than packaging them into payment for the procedures with which they 
were administered. As we explained in the April 7, 2000 final rule (65 
FR 18449), the high degree of variability in blood use among patients 
could result in payment inequities if the costs of blood and blood 
products were packaged with their administration. We also want to 
ensure that costs associated with blood safety testing are fully 
recognized. The safety of the nation's blood supply continues to be 
among the highest priorities of the Secretary's council on Blood Safety 
and Access. Therefore, we propose to continue to pay separately for 
blood and blood products.
Vaccines Covered Under a Benefit Other Than OPPS
    Outpatient hospital departments administer large numbers of the 
vaccines for influenza (flu), pneumococcal pneumonia (PPV), and 
hepatitis B, typically by participating in immunization programs 
encouraged by the Secretary because these vaccinations greatly reduce 
death and illness in vulnerable populations. In recent years, the 
availability and cost of the vaccines (particularly the flu vaccine) 
have varied considerably. We want to avoid creating any disincentives 
to provide these important preventative services that might result from 
packaging their costs into those of primary procedures, visits, or 
administration codes. Therefore, we propose to pay for these vaccines 
under OPPS through the establishment of separate APCs.
Higher Cost Drugs
    While our preferred policy is to package the cost of drugs and 
other items into the cost of the procedures with which they are 
associated, we are concerned that beneficiary access to care may be 
affected by packaging certain higher cost drugs. For this reason, we 
propose to allow payment under separate APCs for high cost drugs for an 
additional year while we further study various payment options. 
Specifically, we propose to pay separately for drugs for which the 
median cost per line (cost per unit multiplied by the number of units 
billed on the claim) exceeded $150, as determined below.
    To establish a reasonable threshold for determining which drugs we 
would pay under separate APCs rather than through packaging, we 
calculated the median cost per unit using 2001 claims data for each of 
the drugs for which transitional pass-through payment ceases January 1, 
2003 and for those additional drugs that we have paid separately 
(status indicator ``K'') since the outset of OPPS. We excluded from 
these calculations the orphan drugs, vaccines, and blood and blood 
products discussed above. The unit median represents the cost per 
single unit dose of the drug as described by its HCPCS code. Because 
many drugs are used and billed in multiple unit doses, we then 
multiplied the median cost per unit for the drug by the average number 
of units that were billed per line. The average number of units per 
drug equals the total units divided by the total number of times the 
drug was billed. This calculation gave us an approximate median cost 
per line for the drug. We viewed this as being the approximate cost per 
administration because we believed that a single administration of a 
drug was billed as a single line item on a claim and that the correct 
number of units was placed in the ``units'' field of the claim form. We 
then arrayed the median cost per line in ascending order and examined 
the distribution. A natural break occurs at $150 per line, the midpoint 
of a $10 span between the drug immediately above and below the $150 
point. Within the array, approximately 61 percent of the drugs fall 
below the $150 point and 39 percent of the array are above the point. 
Among the drugs that we propose to package are some 
radiopharmaceuticals, vaccines, anesthetics, and anticancer agents. 
After including the costs of packaged drugs in the services with which 
they were provided, we noted that the median costs of those services 
increased. For example, based on 2001 data, APC 117, Chemotherapy 
Administration by Infusion Only, showed a median cost before packaging 
of $129.53 and showed a median cost after packaging of $210.36. 
Similarly, APC 118, Chemotherapy administration by both infusion and 
another technique, showed a median cost before packaging of $136.00 and 
a median cost after packaging of $309.65. We believe that this 
appropriately represents the cost of packaged drugs on a per 
administration basis. However, in particular, we solicit comments that 
address specific alternative protocols we might use when several 
packaged drugs whose total cost significantly exceeds the applicable 
APC payment amount may be administered to a patient on the same day 
(for example, multiple agent cancer chemotherapy).
    We request comments on the factors we considered in determining 
which drugs to package in 2003. We are particularly interested in 
comments with respect to the exclusion of high cost drugs from 
packaging. We are continuing to analyze the effect of our drug 
packaging proposal to assess whether the $150 threshold should be 
adjusted to avoid significant overpayments or underpayments for the 
base APCs relative to the median costs of the individual drugs packaged 
into the APCs. Depending on this analysis, we may revise our threshold 
or criteria for packaging in the final rule for 2003.

[[Page 52125]]

We expect to further consider each of these exclusions for packaging 
when we develop our proposals for the 2004 OPPS.
    Although we expect to expand packaging of drugs to package payment 
for more drugs into the APC for the services with which they are 
billed, we are, nonetheless, requesting comments on alternatives to 
packaging. One example of an alternative approach is to use different 
criteria from those we propose in this proposed rule to identify the 
drugs to package into procedure APCs and the drugs to pay separately. 
We could package all drugs for which the median cost was less than $500 
or alternatively package drugs for which the median cost was less than 
$100. Another alternative approach would be to create APCs for groups 
of drugs based on their costs. Under such an approach we could group 
drugs with costs between $0 and $100 and pay at the mid-point--$50. The 
next group could consist of drugs with a median cost between $100 and 
$250 and pay at the mid-point--$175. This approach would be similar to 
that employed for new technology services. Another approach would be to 
create separate APCs for each drug. Under this approach we would create 
a separate APC for each drug (regardless of its median cost) and use 
its relative weight to calculate a payment rate for the drug. We 
welcome a full discussion of the alternatives as we determine the best 
way to ensure that hospitals are paid appropriately for the drugs they 
administer to the Medicare beneficiaries whom they treat in their 
outpatient departments.
    Table 8 lists drugs and biologicals for which separate payment is 
currently being made in 2002 with either status indicator ``K'' or 
``G'' and whose costs we propose to package in 2003. Drugs that we 
propose to pay for separately in 2003 are designated in Addendum B by 
status indicator ``K'' or ``G.''.

      Table 8.--Drugs and Biologicals Separately Payable in CY 2002
------------------------------------------------------------------------
               HCPCS                          Short description
------------------------------------------------------------------------
90296.............................  Diphtheria antitoxin
90375.............................  Rabies ig, im/sc
90376.............................  Rabies ig, heat treated
90378.............................  Rsv ig, im, 50mg
90379.............................  Rsv ig, iv
90385.............................  Rh ig, minidose, im
90389.............................  Tetanus ig, im
90393.............................  Vaccina ig, im
90396.............................  Varicella-zoster ig, im
90471.............................  Immunization admin
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
90645.............................  Hib vaccine, hboc, im
90646.............................  Hib vaccine, prp-d, im
90647.............................  Hib vaccine, prp-omp, im
90648.............................  Hib vaccine, prp-t, im
90665.............................  Lyme disease vaccine, im
90675.............................  Rabies vaccine, im
90676.............................  Rabies vaccine, id
90680.............................  Rotovirus vaccine, oral
90690.............................  Typhoid vaccine, oral
90691.............................  Typhoid vaccine, im
90692.............................  Typhoid vaccine, h-p, sc/id
90700.............................  Dtap vaccine, im
90701.............................  Dtp vaccine, im
90702.............................  Dt vaccine  7, im
90703.............................  Tetanus vaccine, im
90704.............................  Mumps vaccine, sc
90705.............................  Measles vaccine, sc
90706.............................  Rubella vaccine, sc
90707.............................  Mmr vaccine, sc
90708.............................  Measles-rubella vaccine, sc
90710.............................  Mmrv vaccine, sc
90712.............................  Oral poliovirus vaccine
90713.............................  Poliovirus, ipv, sc
90716.............................  Chicken pox vaccine, sc
90717.............................  Yellow fever vaccine, sc
90718.............................  Td vaccine > 7, im
90719.............................  Diphtheria vaccine, im
90720.............................  Dtp/hib vaccine, im
90721.............................  Dtap/hib vaccine, im
90725.............................  Cholera vaccine, injectable
90727.............................  Plague vaccine, im
90733.............................  Meningococcal vaccine, sc
90735.............................  Encephalitis vaccine, sc
90749.............................  Vaccine toxoid
A4642.............................  Satumomab pendetide per dose

[[Page 52126]]

 
A9500.............................  Technetium TC 99m sestamibi
A9502.............................  Technetium TC99M tetrofosmin
A9503.............................  Technetium TC 99m medronate
A9504.............................  Technetium tc 99m apcitide
A9505.............................  Thallous chloride TL 201/mci
A9508.............................  Iobenguane sulfate I-131
A9510.............................  Technetium TC99m Disofenin
A9700.............................  Echocardiography Contrast
C1066.............................  IN 111 satumomab pendetide
C1079.............................  CO 57/58 per 0.5 uCi
C1087.............................  I-123 per 100 uCi
C1094.............................  TC99Malbumin aggr, per 1.0 mCi
C1097.............................  TC 99M MEBROFENIN, PER Vial
C1098.............................  TC 99M PENTETATE, PER Vial
C1099.............................  TC 99M PYROPHOSPHATE, PER Via
C1166.............................  CYTARABINE LIPOSOMAL, 10 mg
C1188.............................  I-131 cap, per 1-5 mCi
C1200.............................  TC 99M Sodium Glucoheptonat
C1201.............................  TC 99M SUCCIMER, PER Vial
C1202.............................  TC 99M SULFUR COLLOID, Vial
J2020.............................  Linezolid inj, 200mg
J7525.............................  Tacrolimus inj, per 5 mg
C9007.............................  Baclofen Intrathecal kit-1am
C9008.............................  Baclofen Refill Kit-500mcg
J0706.............................  Caffeine Citrate, inj, 1ml
C9100.............................  Iodinated I-131 Albumin
C9102.............................  51 Na Chromate, 50 mCi
C9103.............................  Na Iothalamate I-125, 10 uCi
J0150.............................  Injection adenosine 6 MG
J0350.............................  Injection anistreplase 30 u
J0640.............................  Leucovorin calcium injection
J0706.............................  Caffeine Citrate, inj, per 5 mg
J1245.............................  Dipyridamole injection
J1260.............................  Dolasetron mesylate
J1325.............................  Epoprostenol injection
J1327.............................  Eptifibatide injection
J1436.............................  Etidronate disodium inj
J1438.............................  Etanercept injection
J1565.............................  RSV-ivig
J1570.............................  Ganciclovir sodium injection
J1620.............................  Gonadorelin hydroch/ 100 mcg
J1626.............................  Granisetron HCl injection
J1670.............................  Tetanus immune globulin inj
J1830.............................  Interferon beta-1b / .25 MG
J2260.............................  Inj milrinone lactate / 5 ML
J2275.............................  Morphine sulfate injection
J2405.............................  Ondansetron hcl injection
J2765.............................  Metoclopramide hcl injection
J2770.............................  Quinupristin/dalfopristin
J2820.............................  Sargramostim injection
J2995.............................  Inj streptokinase /250000 IU
J2997.............................  Alteplase recombinant
J3010.............................  Fentanyl citrate injeciton
J3280.............................  Thiethylperazine maleate inj
J3365.............................  Urokinase 250,000 IU inj
J7310.............................  Ganciclovir long act implant
J7316.............................  Sodium hyaluronate injection, per 5
                                     mg
J7500.............................  Azathioprine oral 50 mg
J7501.............................  Azathioprine parenteral
J7506.............................  Prednisone oral
J7516.............................  Cyclosporin parenteral 250 mg
J8510.............................  Oral busulfan
J8530.............................  Cyclophosphamide oral 25 MG
J8600.............................  Melphalan oral 2 MG
J8610.............................  Methotrexate oral 2.5 MG
J9000.............................  Doxorubic hcl 10 MG vl chemo
J9020.............................  Asparaginase injection
J9031.............................  Bcg live intravesical vac
J9050.............................  Carmus bischl nitro inj
J9070.............................  Cyclophosphamide 100 MG inj
J9093.............................  Cyclophosphamide lyophilized
J9100.............................  Cytarabine hcl 100 MG inj

[[Page 52127]]

 
J9120.............................  Dactinomycin actinomycin d
J9130.............................  Dacarbazine 10 MG inj
J9181.............................  Etoposide 10 MG inj
J9190.............................  Fluorouracil injection
J9212.............................  Interferon alfacon-1
J9213.............................  Interferon alfa-2a inj
J9214.............................  Interferon alfa-2b inj
J9215.............................  Interferon alfa-n3 inj
J9230.............................  Mechlorethamine hcl inj
J9250.............................  Methotrexate sodium inj
J9270.............................  Plicamycin (mithramycin) inj
J9320.............................  Streptozocin injection
J9340.............................  Thiotepa injection
J9360.............................  Vinblastine sulfate inj
J9370.............................  Vincristine sulfate 1 MG inj
Q0163.............................  Diphenhydramine HCl 50 mg
Q0164.............................  Prochlorperazine maleate 5 mg
Q0166.............................  Granisetron HCl 1 mg oral
Q0167.............................  Dronabinol 2.5 mg oral
Q0169.............................  Promethazine HCl 12.5 mg oral
Q0171.............................  Chlorpromazine HCl 10 mg oral
Q0173.............................  Trimethobenzamide HCl 250 mg
Q0174.............................  Thiethylperazine maleate 10 mg
Q0175.............................  Perphenazine 4 mg oral
Q0177.............................  Hydroxyzine pamoate 25 mg
Q0179.............................  Ondansetron HCl 8 mg oral
Q0180.............................  Dolasetron mesylate oral
Q2002.............................  Elliotts b solution per ml
Q2003.............................  Aprotinin, 10,000 kiu
Q2004.............................  Bladder calculi irrig sol
Q2007.............................  Ethanolamine oleate 100 mg
Q2008.............................  Fomepizole, 15 mg
Q2009.............................  Fosphenytoin, 50 mg
Q2010.............................  Glatiramer acetate, per dose
Q2013.............................  Pentastarch 10% solution
Q2014.............................  Sermorelin acetate, 0.5 mg
J2940.............................  Somatrem injection
Q2018.............................  Urofollitropin, 75 iu
Q2021.............................  Lepirudin
Q3002.............................  Gallium ga 67
Q3004.............................  Xenon xe 133
Q3005.............................  Technetium tc99m mertiatide
Q3006.............................  Technetium tc99m glucepatate
Q3007.............................  Sodium phosphate p32
Q3009.............................  Technetium tc99m oxidronate
Q3010.............................  Technetium tc99m labeledrbcs
------------------------------------------------------------------------

3. Brachytherapy
    Section 1833(t)(6) of the Act requires us to establish transitional 
pass-through payments for devices of brachytherapy. As of August 1, 
2000, we established item-specific device codes including codes for 
brachytherapy seeds, needles, and catheters. Effective April 1, 2001, 
we established category codes for brachytherapy seeds on a per seed 
basis (one for each isotope), brachytherapy needles on a per needle 
basis, and brachytherapy catheters on a per catheter basis. Because 
initial payment was made for a device in each of these categories in 
August 2000, we propose that these categories (and the transitional 
pass-through payments) will be discontinued as of January 1, 2003. 
Furthermore, as discussed above, we propose that there will be no grace 
period for billing these category codes.
    We received comments, both in writing and at the April 2002 Town 
Hall meeting, recommending that we continue to make separate payment 
for brachytherapy seeds. The basis for this recommendation is that the 
number of brachytherapy seeds implanted per procedure is variable. 
These commenters stated that the number and type of seeds implanted in 
a given patient depends on the type of tumor, its size, extent, and 
biology, and the amount of radioactivity contained in each seed. For 
example, a given type of cancer may be treated by implanting seeds of 
different isotopes (for example, iodine or palladium) depending on its 
biological characteristics. Further, depending on the size of the 
tumor, the number of implanted seeds that may be required to 
effectively treat the cancer is quite variable (for example, from 25 to 
100 seeds). In addition, implantable seeds may be manufactured with 
different amounts of radioactivity, and it may be preferable to implant 
fewer seeds with higher activity in some cases while in other cases it 
may be preferable to implant a larger number of seeds with lower 
activity. To further complicate the matter, the HCPCS codes used to 
report implantation of brachytherapy seeds are not tumor-specific. 
Instead, they are defined based on the number of sources, that is, the 
number of seeds or ribbons used in the procedure. This means that the 
treatment of many different tumors requiring implantation of widely

[[Page 52128]]

varying numbers of seeds is described by a single HCPCS code. 
Therefore, it has been argued that given the costs of seeds and the 
variety of treatments described by a single HCPCS code, the cost of 
brachytherapy billed under a single HCPCS code could vary by as much as 
$3,000.
    In determining whether to package seeds into their associated 
procedures, we considered all these factors as well as our claims data. 
Consistent with our proposed policy for other device costs and the cost 
of many drugs, as well as with the principles of a prospective payment 
system, our preferred policy is to package the cost of brachytherapy 
devices into their associated procedures. For 2003, in the case of 
remote afterloading high intensity brachytherapy and prostate 
brachytherapy, which we discuss below, we propose to package the costs 
into payment for the procedures with which they are billed.
    For other uses of brachytherapy, we propose to defer packaging of 
brachytherapy seeds for at least 1 year. In those cases, when paying 
separately in 2003 for brachytherapy seeds, we propose to continue 
payment on a per seed basis. The payment amount would be based on the 
median cost of brachytherapy seeds, per seed, as determined from our 
claims data.
    We solicit comments on methodologies we might use to package all 
brachytherapy seeds beginning in CY 2004. For example, creation of 
tumor-specific brachytherapy HCPCS codes would reduce the variability 
in seed implantation costs associated with the current HCPCS codes used 
for seed implantation.
    As stated above, beginning January 1, 2003, we propose to package 
payment for brachytherapy seeds into the payment for the following two 
types of brachytherapy services:
Remote Afterloading High Intensity Brachytherapy.
    Participants in the April 5, 2002 Town Hall meeting expressed 
concern about packaging single use brachytherapy seeds into payment for 
procedures.
    Remote afterloading high intensity brachytherapy treatment does not 
involve implantation of seeds. Instead, it utilizes a single 
radioactive ``source'' of high dose iridium with a 90-day life span. 
This single source is purchased and used multiple times in multiple 
patients over its life. One or more temporary catheters are inserted 
into the area requiring treatment, and the radioactive source is 
briefly inserted into each catheter and then removed. Because the 
source never comes in direct contact with the patient, it may be used 
for multiple patients. We note that the cost of the radioactive source, 
per procedure, is the same irrespective of how many catheters are 
inserted into the patient. Further, because the number of treatments 
administered with a single source over a 90-day period may vary and 
because the cost of the source is fixed, it is difficult if not 
impossible to determine a per ``treatment'' cost for the source. 
Moreover, we believe that the costs of this type of source should be 
amortized over the life of the source. Therefore, each hospital 
administering this type of therapy should include a charge (which is 
hospital-specific) for the radiation source in the charge for the 
procedure. Therefore, we propose to package the costs associated with 
high dose iridium into the HCPCS codes used to describe this procedure. 
Those codes are: 77781, 77782, 77783, and 77784.
Prostate Brachytherapy
    The preponderance of brachytherapy claims under OPPS to date is for 
prostate brachytherapy. Brachytherapy is administered in several other 
organ systems, but the claims volume for non-prostate brachytherapy is 
very small, and hence our base of information on which to make payment 
decisions is slim. Furthermore, prostate brachytherapy uses only two 
isotopes, which are similar in cost, while brachytherapy on other 
organs involves a variety of isotopes with greater variation in cost. 
Consequently, we believe it would be prudent to wait for further 
experience to develop before proceeding to package non-prostate 
brachytherapy seeds.
    A number of commenters at the April 5, 2002, Town Hall Meeting and 
elsewhere have stressed to us their views that brachytherapy seeds 
should remain unpackaged. The principle argument put forth in favor of 
this approach is that the number of seeds used is highly variable 
across patients. We do not find this argument compelling. Payments in 
the OPPS, as in other prospective payment systems, are based on 
averages. We expect hospitals, in general, to be able to accommodate 
variation across patients in resource costs of services paid in a 
particular payment cell. The degree of variation should be immaterial 
as long as the payment is appropriate for a typical case, the hospital 
treats a caseload the resource use of which approximates a typical 
distribution, and the number of cases treated by a hospital is 
sufficiently large to overcome peculiarities in resource use that might 
be observed with a very small number of cases. We believe the service 
volume at hospitals providing prostate brachytherapy is likely to be 
large enough for a payment reflecting average use of seeds to be 
appropriate.
    Additionally, appropriate payment for prostate brachytherapy has 
been of concern to many commenters since implementation of the OPPS 
because facilities must use multiple HCPCS codes on a single claim to 
accurately describe the entire procedure. Because we determine APC 
relative weights using single procedure claims, commenters have argued 
that payments for prostate brachytherapy are, in part, based on error 
claims, resulting in underpayment for this important service. We agree 
that basing the relative weights for APCs reported for prostate 
brachytherapy services on only the small number of claims related to 
this service that are single procedure claims may be problematic. To 
increase the number of claims we could use to develop the proposed 2003 
relative payment weights for prostate brachytherapy, we began by 
identifying all claims billed in 2001 for prostate brachytherapy. That 
is, we identified all claims that contained a line item for HCPCS code 
77778, Interstitial radiation source application; complex, and HCPCS 
code 55859, Transperineal placement of needles or catheters into 
prostate for interstitial radioelement application, with or without 
cystoscopy. We discovered more than 12,000 claims that met these 
specifications, suggesting that most of the procedures coded under 
HCPCS code 77778 were for prostate brachytherapy. Unfortunately, closer 
analysis of these claims revealed that hospitals do not report prostate 
brachytherapy using a uniform combination of codes. Of the more than 
12,000 claims for prostate brachytherapy that we identified in the 2001 
claims data, no single combination of HCPCS codes occurred more than 25 
times.
    Therefore, in order to facilitate tracking of this service, we 
propose to establish a G code for hospital use only that will 
specifically identify prostate brachytherapy. We propose as the 
descriptor for this G code the following: ``Prostate brachytherapy, 
including transperineal placement of needles or catheters into the 
prostate, cystoscopy, and interstitial radiation source application.'' 
This G code would be used by hospitals instead of HCPCS codes 55859 and 
77778 to bill for prostate brachytherapy. Hospitals would continue to 
use HCPCS codes 55859 and 77778 when reporting services other than 
prostate brachytherapy. We would also instruct hospitals to continue to

[[Page 52129]]

report separately other services provided in conjunction with prostate 
brachytherapy, such as dosimetry and ultrasound guidance. These 
additional services would be paid according to the APC payment rate 
established by our usual methodology.
    This G code will allow us to package brachytherapy seeds into the 
procedures for administering prostate brachytherapy while permitting us 
to pay separately for brachytherapy seeds which are administered for 
other procedures. Therefore, we propose to package the costs of the 
brachytherapy seeds, catheters, and needles into the payment for the 
prostate brachytherapy G code. In order to develop a payment amount for 
this G code, we used all claims where both HCPCS codes 55859 and 77778 
appeared. We packaged all revenue centers and appropriate HCPCS codes, 
that is, HCPCS with status indicator ``N.'' We then determined median 
costs of the line items for HCPCS codes 55859 and 77778 and added the 
two. Next, we packaged the costs of all C codes, whether an item-
specific or a device category code, into the payment amount. We propose 
to assign APC 0684 with status indicator ``T.'' We believe the payment 
rate proposed for this G code appropriately reflects the costs of the 
procedures, the brachytherapy seeds, and any other devices associated 
with these procedures. We solicit comments on this proposal.
Packaging of Other Device Costs Associated with Brachytherapy
    We propose to package the costs of brachytherapy needles and 
catheters with whichever procedures they are reported, similar to our 
proposal for packaging the costs of other devices that will no longer 
be eligible for a transitional pass-through payment in 2003. Because 
the HCPCS code descriptors for brachytherapy are based on the number of 
catheters or needles used, we believe the costs of these devices would 
be appropriately reflected within the costs of the associated 
procedure.

D. Criteria for New Device Categories

    Section 1833(t)(6)(B)(ii) of the Act, as amended by BIPA, required 
us to establish criteria by July 1, 2001 that will be used to create 
additional device categories to be used in determining eligibility of a 
device for pass-through payments. This provision requires that no 
medical device be described by more than one category. In addition, the 
criteria must include a test of whether the average cost of devices 
that would be included in a category is ``not insignificant'' in 
relation to the APC payment amount for the associated service.
    On November 2, 2001, we published in the Federal Register an 
interim final rule (66 FR 55850) that set forth the criteria for 
establishing new (that is, additional) categories of medical devices 
eligible for transitional pass-through payments under the hospital 
outpatient PPS as required by section 1833(t)(6)(B)(ii) of the Act. The 
provisions relating to transitional pass-through payments for eligible 
drugs and biologicals remained unchanged and were not addressed in the 
November 2001 interim final rule (except for a change relating to 
contrast agents as provided in section 430 of BIPA). We received 
several public comments regarding our criteria published in the 
November 2001 interim final rule. We will respond to these public 
comments in the final rule for the OPPS for 2003.
    In the November 2, 2001 interim final rule, we implemented new 
Sec. 419.66(c), which establishes the criteria for establishing a new 
device category. We propose to make a technical correction to 
Sec. 419.66(c)(1), which establishes one of those criteria. 
Specifically, we discuss in the November 2, 2001 interim final rule the 
criterion that a new category must describe devices that demonstrate 
substantial improvement in medical benefits for Medicare beneficiaries 
compared to the benefits obtained by devices in previously established 
(that is, previously existing) categories or other available 
treatments, as described in regulations at new Sec. 419.66(c)(1) (66 FR 
55852). Section 1833(t)(6)(B)(ii)(IV) of the Act requires that a new 
category must include medical devices for which no existing category, 
or one previously in effect, is appropriate. In the November 2, 2001 
IFC, we addressed in the preamble the requirement that no category 
previously in effect could describe a new category (66 FR 55852), but 
we did not conform the regulations text to this requirement. Therefore, 
we propose to correct Sec. 419.66(c)(1) to read as follows:
    (1) CMS determines that a device to be included in the category is 
not described by any of the existing categories or by any category 
previously in effect, and was not being paid for as an outpatient 
service as of December 31, 1996.

E. Payment for Transitional Pass-Through Drugs and Biologicals for 
Calendar Year 2003

    As discussed in the November 13, 2000 interim final rule (65 FR 
67809) and the November 30, 2001 final rule (66 FR 59895), we update 
the payment rates for pass-through drugs on an annual basis. Therefore, 
as we have done for prior updates, we propose to update the APC rates 
for drugs that are eligible for pass-through payments in 2003 using the 
most recent version of the Red Book, the July 2002 version in this 
case. The updated rates effective January 1, 2003 would remain in 
effect until we implement the next annual update in 2004, when we would 
again update the AWPs for any pass-through drugs based on the latest 
quarterly version of the Red Book. This retains the update of pass-
through drug prices on the same calendar year schedule as the other 
annual OPPS updates.
    As described in our final rule of November 30, 2001 (66 FR 59894), 
in order to establish the applicable beneficiary copayment amount and 
the pass-through payment amount, we must determine the cost of the 
pass-through eligible drug or biological that would have been included 
in the payment rate for its associated APC had the drug or biological 
been packaged. We used hospital acquisition costs as a proxy for the 
amount that would have been packaged, based on data from an external 
survey of hospital drug costs (see the April 7, 2000 final rule (65 FR 
18481)). That survey concluded that--
     For drugs available through only one source drugs, the 
ratio of acquisition cost to AWP equals 0.68;
     For multisource drugs, the ratio of acquisition cost to 
AWP equals 0.6l;
     For drugs with generic competitors, the ratio is 0.43.
    As we stated in our final rule of November 30, 2001 (66 FR 59896), 
we considered the use of the study-derived ratios of drug costs to AWP 
to be an interim measure until we could obtain data on hospital costs 
from claims. We stated that we anticipated having this data to use in 
setting payment rates for 2003.
    As described elsewhere in this preamble, we used 2001 claims data 
to calculate a median cost per unit of drug for each drug for which we 
are currently paying separately. We compared the median per unit cost 
of each drug to the AWP to determine a ratio of acquisition cost to 
AWP. Using the total units billed for each drug, we then calculated a 
weighted average for each of the above three categories of drugs. These 
calculations resulted in the following weighted average ratios:
     For sole-source drugs, the ratio of cost to AWP equals 
71.0 percent.
     For multisource drugs, the ratio of cost to AWP equals 
68.0 percent.
     For drugs with generic competitors, the ratio of cost to 
AWP equals 46.0 percent.

[[Page 52130]]

    We propose to use these percentages for determining the applicable 
beneficiary copayment amount and the pass-through payment amount for 
drugs eligible for pass-through payment in 2003.
    We propose to use these percentages for determining the applicable 
beneficiary copayment amount and the pass-through payment amount for 
most drugs eligible for pass-through payment in 2003. However some 
drugs may fall into two other classes. The first class includes a drug 
that is new and for which no cost is yet included in an associated APC. 
For such a drug, because there is no cost for the drug yet included in 
an associated APC, the pass-through amount will be 95 percent of the 
AWP and there would be no copayment. The second class includes a drug 
that is new and is a substitute for only one drug that is recognized in 
the OPPS through an unpackaged APC. For drugs in this second class, the 
pass-through amount would be the difference between 95 percent of the 
AWP for the pass-through drug and the payment rate for the comparable 
dose of the associated drug's APC. The copayment would be based on the 
payment rate of its associated APC. We believe that using this 
methodology will yield a more accurate payment rate.
    We have received questions with respect to our definition of 
multisource drugs. In determining whether a drug is available from 
multiple sources, we consider repackagers to be among the sources. This 
is consistent with the findings of the survey cited above which 
indicated a lower ratio of acquisition cost to AWP from multiple 
sources including repackagers.
    We note that determining that a drug is eligible for a pass-through 
payment or assigning a status indicator ``K'' to a drug or biological 
(indicating that the drugs or biologicals is paid based on a separate 
APC rate) indicates only the method by which the drug or biological is 
paid if it is covered by the Medicare program. It does not represent a 
determination that the drug is covered by the Medicare program. For 
example, Medicare contractors must determine whether the drug or 
biological is: (1) reasonable and necessary to treat the beneficiary's 
conditions; and (2) excluded from payment because it is usually self-
administered by the patient.

IV. Wage Index Changes for Calendar Year 2003

    Section 1833(t)(2)(D) of the Act requires that we determine a wage 
adjustment factor to adjust for geographic wage differences, in a 
budget neutral manner, that portion of the OPPS payment rate and 
copayment amount that is attributable to labor and labor-related costs.
    We used the proposed Federal fiscal year (FY) 2003 hospital 
inpatient PPS wage index to make wage adjustments in determining the 
proposed payment rates set forth in this proposed rule. The proposed FY 
2003 hospital inpatient wage index published in the May 9, 2002 Federal 
Register (67 FR 31431) is reprinted in this proposed rule as Addendum 
H--Wage Index for Urban Areas; Addendum I--Wage Index for Rural Areas; 
and Addendum J--Wage Index for Hospitals That Are Reclassified. We 
propose to use the final FY 2003 hospital inpatient wage index to 
calculate the payment rates and coinsurance amounts that we will 
publish in the final rule implementing the OPPS for CY 2003.

V. Copayment for Calendar Year 2003

    Section 1833(t)(8)(C)(ii) of the Act accelerates the reduction of 
beneficiary copayment amounts, providing that, for services furnished 
on or after April 1, 2001 and before January 1, 2002, the national 
unadjusted coinsurance for an APC cannot exceed 57 percent of the APC 
payment rate. The statute provides that the national unadjusted 
coinsurance for an APC cannot exceed 55 percent in 2002 and 2003. The 
statute provides for further reductions in future years so that the 
national unadjusted coinsurance for an APC cannot exceed 55 percent of 
the APC payment rate in 2002 and 2003, 50 percent in 2004, 45 percent 
in 2005, and 40 percent in 2006 and thereafter.
    For 2003, we determined copayment amounts for new and revised APCs 
using the same methodology that we implemented for 2002 (see the 
November 30, 2001 final at 66 FR 59888). See Addendum B for proposed 
national unadjusted copayments for 2003. Our regulations at Sec. 419.41 
conform to this provision of the Act.

VI. Conversion Factor Update for Calendar Year 2003

    Section 1833(t)(3)(C)(ii) of the Act requires us to update the 
conversion factor used to determine payment rates under the OPPS on an 
annual basis. Section 1833(t)(3)(C)(iv) of the Act provides that for 
2003, the update is equal to the hospital inpatient market basket 
percentage increase applicable to hospital discharges under section 
1886(b)(3)(B)(iii) of the Act.
    The most recent forecast of the hospital market basket increase for 
FY 2003 is 3.5 percent. To set the proposed OPPS conversion factor for 
2003, we increased the 2002 conversion factor of $50.904 (the figure 
from the March 1, 2002 final rule (67 FR 9556)) by 3.5 percent.
    In accordance with section 1833(t)(9)(B) of the Act, we further 
adjusted the proposed conversion factor for 2003 to ensure that the 
revisions we are proposing to update by means of the wage index are 
made on a budget-neutral basis. We calculated a budget neutrality 
factor of .98715 for wage index changes by comparing total payments 
from our simulation model using the proposed FY 2003 hospital inpatient 
PPS wage index values to those payments using the current (FY 2002) 
wage index values.
    The increase factor of 3.5 percent for 2003 and the required wage 
index budget neutrality adjustment of .98715 result in a proposed 
conversion factor for 2003 of 52.009.

VII. Outlier Policy for Calendar Year 2003

    For OPPS services furnished between August 1, 2000 and April 1, 
2002, we calculated outlier payments in the aggregate for all OPPS 
services that appear on a bill in accordance with section 1833(t)(5)(D) 
of the Act. In the November 30, 2001 final rule (66 FR 59856, 59888), 
we specified that beginning with 2002, we will calculate outlier 
payments based on each individual OPPS service. We revised the 
aggregate method that we had used to calculate outlier payments and 
began to determine outliers on a service-by-service basis.
    As explained in the April 7, 2000 final rule (65 FR 18498), we set 
a target for outlier payments at 2.0 percent of total payments. For 
purposes of simulating payments to calculate outlier thresholds, we 
propose to continue to set the target for outlier payments at 2.0 
percent, as we did for CYs 2001 and 2002. For 2002, the outlier 
threshold is met when costs of furnishing a service or procedure exceed 
3.5 times the APC payment amount, and the current outlier payment 
percentage is 50 percent of the amount of costs in excess of the 
threshold. Based on our simulations for 2003, we propose to set the 
threshold for 2003 at 2.75 times the APC payment amounts, and the 
proposed 2003 payment percentage applicable to costs over the threshold 
at 50 percent.

[[Page 52131]]

VIII. Other Policy Decisions and Proposed Changes

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

Background
    Currently, facilities code clinic and emergency department visits 
using the same current procedural terminology (CPT) codes as 
physicians. For both clinic and emergency department visits, there are 
five levels of care. While there is only one set of codes for emergency 
visits, clinic visits are differentiated by new patient, established 
patient, and consultation visits. CPT codes 99201 through 99205 are 
used for new patients, CPT codes 99211 through 99215 are used for 
established patients, and CPT codes 99281 through 99285 for emergency 
patients.
    Physicians determine the proper code for reporting their services 
by referring to CPT descriptors and our documentation guidelines. The 
descriptors and guidelines are helpful to physicians because they 
reference taking a history, performing an examination, and making 
medical decisions. The lower levels of service (for example, CPT codes 
99201, 99211, and 99281) are used for shorter visits and for patients 
with uncomplicated problems, and the higher levels of service (for 
example, CPT codes 99205, 99215, and 99285) are used for longer visits 
and patients with complex problems.
    These codes were defined to reflect the activities of physicians. 
It is generally agreed, however, that they do not describe well the 
range and mix of services provided by facilities to clinic and 
emergency patients (for example, ongoing nursing care, preparation for 
diagnostic tests, and patient education).
    Before the implementation of the OPPS, facilities were paid on the 
basis of charges reduced to costs. In that system, because use of a 
correct HCPCS code did not influence payment, there was little 
incentive to correctly report the level of service. In fact, many 
facilities reported all clinic and emergency visits with the lowest 
level of service (for example, CPT codes 99211, 99201, and 99281) 
simply to minimize administrative burden (for example, charge-masters 
might include only one level of service).
    This situation changed with the implementation of the OPPS. The 
OPPS requires correct reporting of services using HCPCS codes as a 
prerequisite to payment. For emergency and clinic visits, the OPPS 
distinguishes three levels of service for payment purposes. These are 
referred to as ``low-level,'' ``mid-level,'' and ``high-level'' 
emergency or clinic visits. Low-level clinic and emergency visits 
include CPT codes for level one and two services (for example, CPT 
codes 99201, 99211, and 99281), mid-level visits include level three 
services (for example, CPT codes 99203, 99213, and 99283), and high-
level visits include level four and five services (for example, CPT 
codes 99205, 99215, and 99285). Payment rates for low-level visits are 
less than for mid-level visits, which are less than rates for high-
level visits.
    In the April 7, 2000 final rule (65 FR 18434), we stated that to 
pay hospitals properly, it was important that emergency and clinic 
visits be coded properly. To facilitate proper coding, we required each 
hospital to create an internal set of guidelines to determine what 
level of visit to report for each patient. We stated in the rule, that 
if hospitals set up these guidelines and follow them, they would be in 
compliance with OPPS coding requirements for the visits. Furthermore, 
we announced that we would be reviewing this issue and planned to set 
national guidelines for coding clinic and emergency visits in the 
future. In the August 24, 2001 proposed rule (66 FR 44672), we asked 
for public comments regarding national guidelines for hospital coding 
of emergency and clinic visits. We also announced that we would compile 
these comments and present them to our APC Panel at the January 2002 
meeting. We also announced that we planned to propose uniform national 
facility coding guidelines in the proposed rule for the 2003 OPPS.
    During its January 2002 meeting, the APC Panel reviewed written 
comments, heard oral testimony, discussed the issue, and made 
recommendations concerning establishment of facility coding guidelines 
for emergency and clinic visits. Among those who submitted oral and 
written comments to us and to the Panel were national hospital 
organizations, national physician organizations, hospital systems, 
individual hospitals, coding organizations, and consultants.
Discussion
    We set forth below, by issue, a summary of the comments we 
received:
     The need for national coding guidelines.
    Except for the American Medical Association (AMA) and one other 
physician organization, commenters unanimously agreed that national 
guidelines for facility coding of emergency and clinic visits were 
required. Furthermore, most commenters requested that we establish 
these guidelines as soon as possible, but, in any event, not later than 
January 2003. Among the reasons cited were the following:
    + The need for facilities to comply with the requirements of the 
Health Insurance Portability and Accountability Act (HIPAA), no later 
than October 16, 2003 (October 16, 2002 for those entities that do not 
obtain a one-year extension). Commenters expressed concern that use of 
CPT E/M codes with different reporting rules when used by facilities 
(as opposed to use by physicians) would violate HIPAA requirements.
    + The need for facilities to set up effective audit and compliance 
programs.
    + The need to minimize confusion on the part of coders.
    + The need to minimize inaccurate payments.
    + The need to prevent gaming of the system by facilities.
    The AMA recommended that we wait for the CPT Editorial Panel to 
develop coding guidelines for hospitals to assure that coding 
guidelines will be minimally burdensome to hospitals.
     The need to establish principles against which facility E/
M coding guidelines would be measured. Commenters unanimously agreed 
that any set of coding guidelines for facilities would have to satisfy 
a uniform set of basic principles to be acceptable to, and accepted by, 
hospitals. These include the following:
    + Coding guidelines for emergency and clinic visits should be based 
on emergency department or clinic facility resource use, not physician 
resource use.
    + Coding guidelines should be clear, facilitate accurate payment, 
be usable for compliance purposes and audits, and meet HIPAA 
requirements.
    + Coding guidelines should only require documentation that is 
clinically necessary for patient care. Preferably, coding guidelines 
should be based on current hospital documentation requirements.
    + Coding guidelines should not facilitate upcoding or gaming.
    We would add one other requirement to these principles: The 
distribution of codes should result in a normal curve. Documentation 
guidelines should facilitate this result.
     Current use of hospital coding guidelines is inconsistent 
and much more prevalent in the emergency department.
    Several commenters noted that many hospitals have developed their 
own coding guidelines but that no specific

[[Page 52132]]

set of guidelines is in widespread use at the present time. These 
commenters noted that guidelines have been used much more in the 
emergency department setting than in the clinic setting. They also 
noted that only one set of guidelines has undergone any sort of 
testing. These are the facility coding guidelines for emergency 
departments, developed and copyrighted by the American College of 
Emergency Physicians (ACEP). Unfortunately, the testing was not done by 
protocol, no quantitative data were collected, and only a small number 
of facilities participated.
     Development of two sets of guidelines: one for emergency 
department visits and one for clinic visits.
    Several commenters noted that the types and intensity of hospital 
resources used for emergency department visits were significantly 
different from the types and intensity of resources used for clinic 
visits. These commenters recommended that we adopt different guidelines 
for emergency department and clinic visits.
     The need to develop new descriptors and codes for facility 
emergency and clinic visits.
    Commenters unanimously agreed that the current CPT descriptors for 
E/M services were not only inappropriate for facility coding of 
emergency and clinic visits but also were confusing and misleading to 
both facility coders and our reviewers. Commenters stated that patients 
whose complexity level was low in terms of physician work could 
frequently require highly intensive and complex facility services (for 
example, patients with gastroenteritis who require intravenous fluids, 
patients in motor vehicle accidents who require multiple X-rays, or 
patients with congestive heart failure or diabetes who require 
extensive education). In these cases, lack of agreement between 
physician and hospital coding would be clinically appropriate but could 
be the source of an investigation given the current code descriptors 
and hospital reporting guidelines. Commenters were also concerned that 
internal hospital-specific coding guidelines could vary greatly because 
the current CPT descriptors exclude any reference to facility services 
and, therefore, are highly susceptible to individual interpretation. A 
third concern was HIPAA compliance. Commenters believe that development 
by individual hospitals of a second set of descriptors that the 
hospital uses when reporting E/M codes could violate HIPAA 
requirements. These commenters believe that when HIPAA is first 
implemented on October 16, 2002 (October 16, 2003 for those entities 
that obtain a one-year extension), Healthcare Common Procedure Coding 
System (HCPCS) codes must be used uniformly by all providers. Two sets 
of descriptors for a single set of codes would require that different 
providers (that is, physicians and hospitals) use the codes 
differently. Based on these concerns, all commenters recommended that 
we develop, on an interim basis, HCPCS codes for emergency and clinic 
visits with descriptors specific for hospital coding.
     Maintenance of five levels of service.
    Although a few commenters were not certain that facilities needed 
to differentiate among five levels of service, they believe that 
reducing the number of levels of service, even if clinically 
appropriate, would cause significant confusion among coders and 
reviewers. Therefore, they recommended maintaining five levels of 
service on an interim basis until more data on this issue can be 
obtained.
     Recommendations concerning adoption of specific 
guidelines.
    Commenters recommended four basic types of guidelines for adoption.
    1. Guidelines based on the number or type of staff interventions. 
Under this model, the level of service reported would be based on the 
number and/or type of interventions performed by nursing or ancillary 
staff. In the intervention model, baseline care (including 
registration, triage, initial nursing assessment, periodic vital signs 
as appropriate, simple discharge instructions, and exam room set up/
clean up) and possibly a single minor intervention (for example, suture 
removal, rapid strep test, visual acuity) would be reported by the 
lowest level of service. Higher levels of service would be reported as 
the number and/or complexity of staff interventions increased.
    The most commonly recommended intervention-based guidelines were 
the facility-coding guidelines developed by ACEP. The ACEP model uses 
examples of interventions to illustrate appropriate coding. Coders 
extrapolate from these examples to determine the correct level of 
service to report. The ACEP model uses the type of intervention rather 
than the number of interventions to determine the appropriate level of 
service. This means that the single most complex intervention 
determines the level of service whether it was the only service 
provided (in addition to baseline care), whether other similarly 
complex interventions were also provided, or whether other 
interventions of less complexity were also provided. The intervention 
model is based on emergency/clinic resource use, is simple, reflects 
the care given to the patient, and does not require additional facility 
documentation. However, we are concerned that the intervention model 
may provide an incentive to provide unnecessary services and that it is 
susceptible to upcoding. Furthermore, the ACEP model requires 
extrapolation from a set of examples that could make it prone to 
variability across hospitals.
    2. Guidelines based on the time staff spent with the patient. Under 
this model, the level of service would be determined based on the 
amount of time hospital staff spent with the patient. The underlying 
assumption is that staff time spent with the patient is an appropriate 
proxy for total facility resource consumption. In this model, if only 
baseline care (as described above) were provided a Level 1 service 
would be reported. Higher levels of service would be reported based on 
increments of staff time beyond baseline care (for example, Level 2 
would be reported for 11 to 20 minutes beyond baseline care, and Level 
3 would be reported for 21 to 30 minutes beyond baseline care). This 
model is simple, it correlates with total facility resource use, and it 
would provide an objective standard for all hospitals to follow. 
However, extra, potentially burdensome, documentation (that is, 
documentation of staff time that is not normally required for clinical 
care) would be necessary, there would be an incentive to work slowly or 
use less efficient personnel, and there would be significant potential 
for upcoding and gaming.
    3. Guidelines based on a point system where a certain number of 
points is assigned to each staff intervention based on the time, 
intensity, and staff type required for the intervention. In this model, 
points or weights are assigned to each facility service and/or 
intervention provided to a patient in the clinic or emergency 
department. The level of service is determined by the sum of the points 
for all services/interventions provided. Commenters recommended various 
approaches to a point system including point systems that assigned 
points based on the amount of staff time spent with the patient, the 
number of activities performed during the emergency department or 
clinic visit, and a combination of patient condition and activities 
performed. A point system would correlate with facility resource 
consumption and provide an objective standard. However, a point system 
could present significant burdens for hospitals in terms of requiring 
extra, clinically unnecessary, documentation. Point systems are

[[Page 52133]]

extremely complex, would probably require dedicated staff to monitor 
and maintain, and would be susceptible to upcoding and gaming.
    4. Guidelines based on patient complexity. Several variations were 
recommended including assignment of level of service based on ICD-9-CM 
(International Classification of Diseases, Ninth Edition, Clinical 
Modification) diagnosis codes, assignment of level of service based on 
complexity of medical decision making, or assignment of level of 
service based on presenting complaint or medical problem. The premise 
for these systems is that many emergency departments follow established 
protocols based on patients presenting complaints and diagnoses. 
Therefore, assigning a level of service based on patient diagnosis 
should correlate with facility resource consumption. These systems 
require the use of a coding ``grid,'' which lists more than 100 
examples of patient conditions and diagnosis and assigns a level of 
service to each example. When a patient has a condition that does not 
appear on the grid, the coder must extrapolate from the grid to the 
individual patient. These systems are extremely complex, demand 
significant interpretive work on the part of a coder (who may not have 
clinical experience), and are subject to variability across hospitals. 
No clinically unnecessary documentation would be required but, because 
the system is based on diagnosis, there is a significant potential for 
upcoding and gaming.
APC Panel Recommendations
    The APC Panel reviewed the comments that we received, reviewed 
background material we prepared, and heard oral testimony. Most 
commenters recommended that we adopt the ACEP guidelines. However, one 
organization representing cancer centers stated that the most 
appropriate proxy for facility resource consumption in cancer care is 
staff time and asked that we consider basing our guidelines on staff 
time. Commenters agreed that we needed to address this problem in the 
proposed rule for CY 2003. They also agreed that to address potential 
HIPAA compliance issues, we should develop new HCPCS codes for facility 
visits; and that we should maintain five levels of service for 
emergency and clinic visits until data are available to show that only 
three levels of service are required to ensure accurate payments. 
Commenters also agreed that, for the same level of service, clinic 
resource consumption should be similar for new, established, and 
consultation patients. Therefore, we need only create a single set of 
five codes for clinic visits.
    After a thorough discussion, the APC technical panel made the 
following recommendations:
    1. Propose and make final facility coding guidelines for E/M 
services for calendar year 2003.
    2. Create a series of G codes with appropriate descriptors for 
facility E/M services.
    3. Maintain a single set of codes, with five levels of service, for 
emergency department visits.
    4. Develop a single set of codes, with five levels of service, for 
clinic visits. The Panel specifically recommended that we not 
differentiate among visit types (for example, new, established, and 
consultation visits) for the purposes of facility coding of clinic 
visits.
    5. Adopt the ACEP facility coding guidelines as the national 
guidelines for facility coding of emergency department visits.
    6. Develop guidelines for clinic visits that are modeled on the 
ACEP guidelines but are appropriate for clinic visits.
    7. Implement these guidelines as interim and continue to work with 
appropriate organizations and stakeholders to develop final guidelines.
Proposal
    We have reviewed the written comments, the oral testimony before 
the APC Panel, and the Panel's recommendations. We agree that facility 
coding guidelines should be implemented as soon as possible. We are 
particularly concerned that facilities be able to comply with HIPAA 
requirements. We have worked, and will continue to work, on this issue, 
with hospitals, organizations representing hospitals, physicians, and 
organizations representing physicians. We note that the AMA CPT 
Editorial Panel is not currently considering the issue of facility 
coding guidelines for clinic visits and that the earliest any CPT 
guidelines could be implemented would be in January 2004. Additionally, 
consistent with the intent of the outpatient prospective payment 
system, we want to ensure that reporting of hospital emergency and 
clinic visits is resource based.
    After careful review and consideration of written comments, oral 
testimony and the APC Panel's recommendations, we propose the following 
(for implementation no earlier than January 2004):
    1. To develop five G codes to describe emergency department 
services: GXXX1--Level 1 Facility Emergency Services, GXXX2--Level 2 
Facility Emergency Services, GXXX3--Level 3 Facility Emergency 
Services, GXXX4-- Level 4 Facility Emergency Services, and GXXX5--Level 
5 Facility Emergency Services.
    2. To develop five G codes to describe clinic visits: GXXX6--Level 
1 Facility Clinic Services, GXXX7--Level 2 Facility Clinic Services, 
GXXX8--Level 3 Facility Clinic Services, GXXX9--Level 4 Facility Clinic 
Services, and GXXX10--Level 5 Facility Clinic Services.
    3. To replace CPT Visit Codes with the 10 new G codes for OPPS 
payment purposes.
    4. To establish separate documentation guidelines for emergency 
visits and clinic visits.
    With regard to the documentation guidelines, our primary concerns 
are to make appropriate payment for medically necessary care, to 
minimize the information collection and reporting burden on facilities, 
and to minimize any incentive to provide unnecessary or low quality 
care. We realize that many facilities use complaint or diagnosis driven 
care protocols and that current documentation standards do not include 
documentation of staff time or the complexity of diagnostic and 
therapeutic services provided. Therefore, in the interest of 
facilitating the delivery of medically necessary care in a clinically 
appropriate way, we believe that the potential drawbacks of each of the 
recommended sets of guidelines outweigh the potential benefits of 
creating uniformity and reproducibility. For example, any documentation 
system requiring counting or quantification of resource use has the 
potential to be burdensome, require clinically unnecessary 
documentation, and be susceptible to upcoding and gaming. Documentation 
systems using coding grids or a series of clinical examples for each 
level of service are subject to interpretation, may induce variability, 
may be overly complex and burdensome, and may result in disagreements 
with medical reviewers. We are also concerned that all the proposed 
guidelines allow counting of separately paid services (for example, 
intravenous infusion, x-ray, EKG, lab tests, etc.) as ``interventions'' 
or ``staff time'' in determining a level of service. We believe that, 
within the constraints of clinical care and management protocols, the 
level of service for emergency and clinic visits should be determined 
by resource consumption that is not otherwise separately payable.
    To address these concerns, in addition to reviewing written 
comments, oral comments, and the APC

[[Page 52134]]

Panel recommendations, we have also reviewed the current distribution 
of paid emergency and clinic visit codes in the OPPS. With regard to 
emergency visits, we have observed that well over 50 percent of the 
visits are considered ``multiple procedure claims'' because the claim 
includes services such as diagnostic tests (for example, EKGs, x-rays) 
or therapeutic interventions (for example, intravenous infusions). The 
distribution of all emergency services is in a bell-shaped curve with a 
slight left shift because there are more claims for CPT codes 99281 and 
99282 than for CPT codes 99284 and 99285. This pattern of coding is 
significantly different from physician billing for emergency services, 
which is skewed and peaks at CPT code 99284. We also note that the 
median costs for successive levels of emergency visits show an expected 
increase across APCs.
    With regard to clinic visits, we have observed that more than 50 
percent of the services are considered ``single claims'' meaning that 
they are billed without any other significant procedures such as 
diagnostic tests or therapeutic interventions. We also note that the 
distribution of clinic visits is skewed with the majority being low-
level clinic visits. This distribution is consistent with pre-OPPS 
billing patterns where many facilities billed all clinic visits as low 
level visits. However, the median costs for different levels of clinic 
services, while similar within an APC, do not show the expected 
increase across the clinic visit APCs.
    Based on our review, on the current distribution of coding for 
emergency and clinic visits, and on our understanding that hospitals 
set charges for services based on the resources used to provide those 
services, we believe that an incremental approach to developing and 
implementing documentation guidelines for emergency and clinic visits 
is appropriate. As hospitals become more familiar with the OPPS and 
with the need to differentiate emergency and clinic visits based on 
resource consumption, we will continue to review the advantages and 
disadvantages of detailed, uniform documentation guidelines. We plan to 
begin the development of uniform guidelines over the next year. If we 
are ready, we would propose the guidelines for comments in our Federal 
Register document for the calendar year 2004 update. For calendar year 
2003, we propose the following new codes:
Emergency Visits
    Our data indicate that, in general, hospitals under the OPPS are 
reporting emergency visits appropriately. We believe that insofar as 
hospitals have existing guidelines for determining the level of 
emergency service, those guidelines reflect facility resource 
consumption. Therefore, we propose that GXXX1--Level 1 Facility 
Emergency Services be reported when facilities deliver, and document, 
basic emergency department services. These services include 
registration, triage, initial nursing assessment, minimal monitoring in 
the emergency department (for example, one additional set of vital 
signs), minimal diagnostic and therapeutic services (for example, rapid 
strep test, urine dipstick), nursing discharge (including brief home 
instructions), and exam room set up/clean up. We would expect that 
these services would be delivered to patients who present with minor 
problems of low acuity.
    With regard to GXXX2 through GXXX5, we propose to require that 
facilities develop internal documentation guidelines based on hospital 
resource consumption (for example, staff time). These guidelines must 
be appropriate for the type of services provided in the hospital and 
must also clearly differentiate the relative resource consumption for 
each level of service so that a medical reviewer can easily infer the 
type, complexity, and medical necessity of the services provided and 
validate the level of service reported. Because there is great 
variability in available facility resources, staff, and clinical 
protocols among facilities, we do not believe that it is advisable to 
require a single set of guidelines for all facilities. Instead, we 
believe it is appropriate for each facility to develop its own 
documentation guidelines that take into account the facility's clinical 
protocols, available facility resources, and staff types. As stated 
above, we are not proposing any specific requirements with regard to 
the basis of these guidelines. However, the guidelines must be tied to 
actual resource consumption in the emergency department such as number 
and type of staff interventions, staff time, clinical examples, or 
patient acuity. We also propose to require that facilities have 
documentation guidelines available for review upon request. The 
guidelines must emphasize relative resource consumption and must not, 
to the extent possible, set minimal requirements as a basis for 
determining the level of service (for example, require 30 minutes of 
staff time or five staff interventions to bill a Level 3 emergency 
visit).
    If made final, these requirements would be interim. We will work 
with interested parties to revise these requirements and would propose 
any revision to these requirements in a future proposed rule.
Clinic Visits
    The current distribution of codes for clinic visits may be due to a 
facility's continued use of pre-OPPS coding policies for clinic visits. 
We believe that over time facilities will become as experienced 
differentiating levels of clinic visits as they are at differentiating 
levels of emergency visits. Therefore, we propose a set of guidelines 
for clinic visits that parallels the requirements for emergency visits. 
We propose that GXXX6--Level 1 Facility Clinic Services, be reported 
when facilities deliver, and document, basic clinic services. These 
services include registration, triage, initial nursing assessment, 
minimal monitoring in the clinic (for example, one additional set of 
vital signs), minimal diagnostic and therapeutic services (for example, 
rapid strep test, urine dipstick), nursing discharge (including brief 
home instructions), and exam room set up/clean up. Our proposal for 
GXXX7 through GXXX10 is the same as for GXXX2 through GXXX5 except that 
the facility-specific guidelines must be tied to actual resource 
consumption in the clinic such as number and type of staff 
intervention, staff time, clinical examples, or patient acuity. The 
guidelines must also differentiate the relative resource consumption in 
the clinic for each level of service sufficiently so that a medical 
reviewer could easily infer the type, complexity, and medical necessity 
of the services provided to validate the level of service provided.
    This proposal, if made final, would also be interim while we work 
with interested parties to revise the requirements. Any revision would 
be proposed in a future proposed rule.
    We propose to make final, in the 2003 OPPS final rule, changes in 
coding for clinic and emergency department visits and requirements 
related to the development of documentation guidelines for the new 
codes. However, we propose to implement the new codes and documentation 
guidelines no earlier than January 1, 2004. This will give hospitals 
time to develop documentation guidelines for the new codes and prepare 
their internal billing systems to accommodate the changes. We will 
continue to work with hospitals throughout CY 2003 as they develop the

[[Page 52135]]

documentation guidelines. We solicit comments on this proposal overall 
as well as the specific components of the proposal.

B. Observation Services

Coding and Billing Instructions
    On November 30, 2001, we published a final rule updating changes to 
the OPPS for 2002. We implemented provisions that allow separate 
payment for observation services under certain conditions. That is, a 
hospital may bill for a separate APC payment (APC 0339) for observation 
services for patients with diagnoses of chest pain, asthma, or 
congestive heart failure when certain criteria are met. The criteria 
discussed in the November 30, 2001 final rule and as corrected in the 
March 1, 2002 final rule are also explained in detail in section XI of 
a Program Memorandum to intermediaries issued on March 28, 2002 
(Transmittal A-02-026). Payment for HCPCS code G0244, observation care 
provided by a facility to a patient with congestive heart failure, 
chest pain or asthma, minimum eight hours, maximum 48 hours, was 
effective for services furnished on or after April 1, 2002.
    Section XI of Transmittal A-02-026 that was issued on March 28, 
2002 provides additional billing and coding instructions and 
requirements that flow from the basic criteria that we implemented in 
the November 30, 2001 and the March 1, 2002 final rules. Although we do 
not address them explicitly in the final rules, the additional 
instructions and requirements in Transmittal A-02-026 were developed to 
implement the basic observation criteria within the programming logic 
of the outpatient code editor (OCE), which is used to process claims 
submitted by hospitals for payment under the OPPS. For example, in the 
November 30, 2001 final rule, we state that an emergency department 
visit (APC 0610, 0611, or 0612) or a clinic visit (APC 0600, 0601, or 
0602) must be billed in conjunction with each bill for observation 
services (66 FR 59879). In section XI of Transmittal A-02-026, we state 
that an Evaluation and Management (E/M) code (referred to, incorrectly, 
in Transmittal A-02-026 as an ``Emergency Management'' code), for the 
emergency room, clinic visit, or critical care is required to be billed 
on the day before or the day that the patient is admitted to 
observation. That is, unless one of the CPT codes assigned to APCs 
0600, 0601, 0602, 0610, 0611, 0612, or 0620 is billed on the day before 
or the day that the patient is admitted to observation, separate 
payment for G0244 is not allowed. The codes assigned to these APCs are 
categorized by CPT as E/M codes. Although we did not include APC 0620, 
Critical Care, among the APCs that must be billed in order to receive 
separate payment for observation services, we added it in the program 
memorandum because critical care is an E/M service which can be 
furnished in a clinic or an emergency department. Critical care may 
appropriately precede admission to observation for chest pain, asthma, 
or congestive heart failure. We clarify in Transmittal A-02-026 that 
both the associated E/M code and G0244 are paid separately if the 
observation criteria are met. We also specify that the E/M code 
associated with observation must be billed on the same claim as the 
observation service.
    Similarly, in the November 30, 2001 and the March 1, 2002 final 
rules, we require that certain diagnostic tests be performed in order 
to bill for separate payment for observation services. In Transmittal 
A-02-026, in section XI.B.2, we list the diagnostic tests that the OCE 
looks for on a bill for G0244. This list, which amplifies what we 
published in the November 30, 2001 and March 1, 2002 final rules, is 
incomplete and should read as follows to reflect the current OCE logic 
that is applied to claims for G0244:
     For chest pain, at least two sets of cardiac enzymes 
[either two CPK (82550, 82552, or 82553), or two troponin (84484 or 
84512)], and two sequential electrocardiograms (93005);
     For asthma, a peak expiratory flow rate (94010) or pulse 
oximetry (94760, 94761, or 94762);
     For congestive heart failure, a chest x-ray (71010, 71020, 
or 71030) and an electrocardiogram (93005) and pulse oximetry (94760, 
94761, or 94762).

     Note: Pulse oximetry codes 94760, 94761, and 94762 are 
treated as packaged services under the OPPS. Although as packaged 
codes no separate payment is made for these codes, hospitals must 
separately report the HCPCS code and a charge for pulse oximetry in 
order to establish that observation services for congestive heart 
failure and asthma diagnoses meet the criteria for separate payment.

    Transmittal A-02-026 also provides specific coding instructions 
that hospitals must use when billing for observation services that do 
not meet the criteria for separate payment under APC 0339. In addition, 
Transmittal A-02-026 addresses the use of modifier ``25 with the E/M 
code billed with G0244.
Direct Admissions to Observation
    Since implementation of the provision for separate payment for 
observation services under APC 0339, a number of hospitals, hospital 
associations, and other interested parties have asked if separate 
payment for observation services would be allowed for a patient with 
chest pain, asthma, or congestive heart failure who is admitted 
directly into observation by order of the patient's physician but 
without having received critical care or E/M services in a hospital 
clinic or the emergency department on the day before or the day of 
admission to observation. We have responded during monthly CMS hospital 
open forum calls that, consistent with the criteria in the November 30, 
2001 final rule, effective for services furnished on or after April 1, 
2002, separate payment for observation services requires that an 
admission to observation be made by order of a physician in a hospital 
clinic or in a hospital emergency department. If a patient is directly 
admitted to observation but without an associated E/M service 
(including critical care) shown on the same bill, the hospital should 
bill observation services using revenue code 762 alone or revenue code 
762 with one of the HCPCS codes for packaged observation services (CPT 
codes 99218, 99219, 99220, 99234, 99235, or 99236).
    A related question has arisen in connection with a policy 
interpretation that was posted as a response to a ``Frequently Asked 
Question'' (FAQ) on our web site on September 12, 2000. The FAQ 
follows:
    ``Q.97: If a patient is admitted from the physician's office to the 
observation room, will there be no reimbursement?''
    ``A.97: Since observation is a packaged service, payment cannot be 
made if it is the only OPPS service on a claim. However, we believe 
that the ``admission'' of a patient to observation involves a low-level 
visit billed by the hospital, as well as whatever office visit the 
physician who arranged for the admission billed. Thus, when a patient 
arrives for observation arranged for by a physician in the community 
(that is, ``direct admit to observation''), and is not seen or assessed 
by a hospital-based physician, the hospital may bill a low-level visit 
code. This low-level visit code will capture the baseline nursing 
assessment, the creation of a medical record, the recording and 
initiation of telephone orders, etc. This visit may be coded only once 
during the period of observation. The observation charges should be 
shown in revenue code 762. The number of hours the patient was in

[[Page 52136]]

observation status should be shown in the units field. Payment for 
those services is packaged into the APC for the visit. Other services 
performed in connection with observation, such as lab, radiology, etc., 
should be billed for as well * * *''
    We have been asked to clarify whether or not the low-level visit 
code suggested in the FAQ for patients directly admitted for 
observation services would satisfy the requirement that a line item for 
a hospital emergency visit, hospital clinic visit, or critical care 
appear on the same bill as HCPCS code G0244. Our response is that when 
we established the final criteria effective for services furnished on 
or after April 1, 2002, we did not contemplate that the low-level visit 
described in the FAQ would satisfy the requirement for the E/M code 
that a hospital must bill to show a hospital clinic visit or hospital 
emergency department visit was performed before observation services 
for asthma, congestive heart failure, or chest pain to bill and receive 
payment for G0244 under APC 0339.
    In light of these questions, we have reviewed the criteria for 
separate payment for observation services under APC 0339, and we 
propose to modify the criteria and coding for observation services 
furnished on or after January 1, 2003. Specifically, we propose to 
create two new codes. These additional codes would allow us to collect 
data on the extent to which patients are directly admitted to hospital 
observation services without an associated hospital clinic visit or 
emergency department visit. The proposed codes are as follows:
    G0LLL--Initial nursing assessment of patient directly admitted to 
observation with diagnosis of congestive heart failure, chest pain, or 
asthma.
    G0MMM--Initial nursing assessment of patient directly admitted to 
observation with diagnosis other than congestive heart failure, chest 
pain, or asthma.
    If a hospital directly admits to observation from a physician's 
office a patient with a diagnosis of congestive heart failure, asthma, 
or chest pain, we propose to require that G0LLL be billed with G0244. 
The current requirement that the hospital bill an emergency department 
visit (APC 0600, 0601, or 0602) or a clinic visit (APC 0610, 0611, or 
0612) or a critical care service (APC 0620) in order to receive 
separate payment for observation services for patients not admitted 
directly from a physician's office would remain in effect. However, 
because the initial nursing assessment is part of any observation 
service, we propose not to make separate payment for G0LLL. Rather, we 
propose to assign status indicator ``N'' to G0LLL, to designate that 
charges submitted with G0LLL would be packaged into the costs 
associated with APC 0339. If G0LLL is billed, we would require that the 
medical record show that the patient was admitted directly from a 
physician's office for purposes of evaluating and treating chest pain, 
asthma, or congestive heart failure.
    G0MMM describes the initial nursing assessment of a patient 
directly admitted to observation with a diagnosis other than chest 
pain, asthma, or congestive heart failure. We propose to assign G0MMM 
for payment under APC 0706, New Technology--Level I. We propose to 
require hospitals to bill G0MMM instead of the low level clinic visit 
referred to in the FAQ above to describe the initial nursing assessment 
of a patient directly admitted to observation with a diagnosis other 
than chest pain, asthma, or congestive heart failure. Separate payment 
would not be made for observation services billed with G0MMM. Rather, 
when billing G0MMM, hospitals would be required to use revenue code 762 
alone or revenue code 762 with one of the HCPCS codes for packaged 
observation services (99218, 99219, 99220, 99234, 992335, or 99236). We 
propose to create G0MMM to establish a separately payable code into 
which costs for observation care for patients directly admitted for 
diagnoses other than asthma, chest pain, or congestive heart failure 
can be packaged and recognized.
    We would use billing data for G0LLL and G0MMM in reviewing the 
provisions for payment of observation services in future updates of the 
OPPS. We invite comment on the extent to which these codes address the 
concerns that have been raised in connection with patients who are 
directly admitted to observation services.
Billing Intravenous Infusions With Observation
    Based on questions and concerns raised by hospitals since 
implementation of payment for APC 0339 effective April 1, 2002, we have 
also reviewed the current status of billing intravenous infusions with 
observation. Several hospitals have noted that claims for G0244 when 
billed with intravenous infusion services reported with HCPCS code 
Q0084 are denied because of the ``T'' status indicator assigned to 
HCPCS code Q0084. Our current payment rules for G0244 require that 
G0244 be denied if a service with status indicator ``T'' is performed 
the day before, the day of, or the day after observation care. Because 
patients in observation may require intravenous infusions of fluid, we 
propose to create code G0EEE, Intravenous infusion during separately 
payable observation stay, per observation, payable under APC 0340 with 
status indicator ``X.'' When observation services that otherwise meet 
the billing requirements for separate payment under APC 0339 include an 
intravenous infusion administered as part of the observation care, 
G0EEE would be used to report the infusion service. We include 
instructions on the use of G0EEE in the program memorandum issued to 
implement OPPS coding changes for the October 1, 2002 OCE. We solicit 
comment on the use of this code.
    We discuss this and other new Level II HCPCS codes proposed for 
payment under the OPPS in section II.B.3 of this preamble. We instruct 
hospitals to use G0EEE only when billing for payment under APC 0339. 
G0EEE includes placement of the IV access and should not be billed with 
CPT code 36000.
Annual Update of ICD-9 Diagnosis Codes
    To receive payment for G0244, we require hospitals to bill 
specified ICD-9-CM diagnosis code(s). Because ICD-9-CM codes are 
updated effective October 1 of each year, we propose to issue by 
Program Memorandum any changes in the diagnosis codes required for 
payment of G0244 resulting from the ICD-9-CM annual update.
    In the March 1, 2002 final rule (67 FR 9559) and in Transmittal A-
02-026 issued on March 28, 2002, we listed the diagnosis codes required 
in order for separate payment of observation services under APC 0339 to 
be made for patients with congestive heart failure. We added by program 
memorandum the following new ICD-9-CM codes to the list of allowed 
diagnosis codes for separate payment for observation of patients with 
congestive heart failure, effective for services furnished on or after 
October 1, 2002:

428.20  unspecified systolic heart failure
428.21  acute systolic heart failure
428.22  chronic systolic heart failure
428.23  acute on chronic systolic heart failure
428.30  unspecified diastolic heart failure
428.31  acute diastolic heart failure
428.32  chronic diastolic heart failure
428.33  acute on chronic diastolic heart failure
428.40  unspecified combined systolic and diastolic heart failure
428.41  acute combined systolic and diastolic heart failure

[[Page 52137]]

428.42  chronic combined systolic and diastolic heart failure
428.43  acute on chronic combined systolic and diastolic heart failure

    We invite comment on the addition of these diagnosis codes to the 
criteria for separate payment for observation services under APC 0339.

C. Payment Policy When a Surgical Procedure on the Inpatient List Is 
Performed on an Emergency Basis

    As we state in section II.B.5 of this preamble, the inpatient list 
specifies those services that are only paid when provided in an 
inpatient setting. The inpatient list proposed for 2003 is printed as 
Addendum E. In Addendum B, status indicator C designates a HCPCS code 
that is on the inpatient list.
    Over the past year, some hospitals and hospital associations have 
asked how a hospital could receive Medicare payment for a procedure on 
the inpatient list that had to be performed to resuscitate or stabilize 
a patient with an emergent, life-threatening condition who was 
transferred or died before being admitted as an inpatient. We reviewed 
within the context of our current policy the cases brought to our 
attention for which payment under the OPPS was denied because a 
procedure with status indicator C was on the bill. Based on that 
review, we propose to clarify our policy regarding Medicare payment 
when a procedure with status indicator C is performed under certain 
life-threatening, emergent conditions. We solicit comments on the 
extent to which the payment policy described below addresses hospitals' 
concerns. These comments would be most helpful if they are supported by 
specific examples of cases when hospitals have, in these instances, 
submitted bills for a procedure with OPPS status indicator C that were 
not paid.
1. Current Policy
    In the April 7, 2000 final rule (65 FR 18451), in response to 
comments about the appropriate level of payment for patients who die in 
the emergency department, we set forth the following guidelines for 
fiscal intermediaries to use in determining how to make payment when a 
patient dies in the emergency department or is sent directly to surgery 
and dies there.
     If the patient dies in the emergency department, make 
payment under the outpatient PPS for services furnished.
     If the emergency department 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 emergency department services.
    The OPPS outpatient code editor (OCE) currently has an edit in 
place that generates a ``line item denial'' for a line on a claim that 
has a status indicator C. A line item denial means that the claim can 
be processed for payment but with some line items denied for payment. A 
line item denial can be appealed under the provisions of section 1869 
of the Act. The OCE includes another edit that denies all other line 
items furnished on the same day as a line item with a status indicator 
C. The rationale for this edit is that all line items for services 
furnished on the same date as the procedure with status indicator C 
would be considered inpatient services and paid under the appropriate 
DRG.
    As part of the definition of line item denial in the program 
memorandum that we issue quarterly to update the OCE specifications 
(for example, see Program Memorandum/Intermediaries, Transmittal A-02-
052, June 18, 2002, which is available on our website at http://www.hcfa.gov/pubforms/transmit/A02052.pdf), we state that a line item 
denial cannot be resubmitted except for an emergency room visit in 
which a patient dies during a procedure that is categorized as an 
inpatient procedure: ``Under such circumstances, the claim can be 
resubmitted as an inpatient claim.''
    In Addendum D of the March 1, 2002 final rule, we designate payment 
status indicator ``C'' as follows: ``Admit patient; bill as 
inpatient.''
2. Hospital Concerns
    Hospitals have requested clarification regarding billing and 
payment in certain situations that our current policy does not seem to 
explicitly address. The following scenarios synthesize cases described 
by hospitals for which they have encountered problems when billing for 
a procedure with status indicator C.
    Scenario A: A procedure assigned status indicator C under the OPPS 
is performed to resuscitate or stabilize a beneficiary who appears with 
or suddenly develops a life-threatening condition. The patient dies 
during surgery or postoperatively before being admitted.
    Scenario B: An elective or emergent surgical procedure payable 
under the OPPS is being performed. Because of sudden, unexpected intra-
operative complications, the physician must alter the surgical 
procedure and perform a procedure with OPPS status indicator C. The 
patient dies during the operation before he or she is admitted as an 
inpatient.
    Scenario C: A procedure with status indicator C is performed to 
resuscitate or stabilize a beneficiary who appears with or suddenly 
develops a life-threatening condition. After the procedure, the patient 
is transferred to another facility for postoperative care.
3. Clarification of Payment Policy
    We propose the following policy for fiscal intermediaries and 
providers to use in determining the appropriate Medicare payment in 
cases such as those described in the section above.
    A procedure assigned status indicator C under the OPPS is never 
payable under the OPPS. Therefore, for a hospital to receive payment 
when a procedure with OPPS status indicator C is performed and: (1) the 
patient dies during or after the procedure, before being admitted, or 
(2) the patient survives the procedure and is transferred following the 
procedure, the patient's medical record must contain all of the 
following information:
     Either orders to admit written by the physician 
responsible for the patient's care at the hospital to which the patient 
was to be admitted, the hospital following the procedure for the 
purpose of receiving inpatient hospital services and occupying an 
inpatient bed, or written orders to admit and transfer the patient to 
another hospital following the procedure.
     Documentation that the reported HCPCS code for the 
surgical procedure with OPPS payment status indicator C (such as CPT 
code 61345) was actually performed.
     Documentation that the reported surgical procedure with 
status indicator C was medically necessary.
     If the patient is admitted and subsequently transferred to 
another facility, documentation that the transfer was medically 
necessary, such as the patient requiring postoperative treatment 
unavailable at the transferring facility.
    Because these services would be paid according to the appropriate 
DRG or per diem (see below), all services that were furnished before 
admission that would otherwise be payable under the OPPS would be paid 
in accordance with the

[[Page 52138]]

provisions of section 3610.3 of the Medicare Intermediary Manual (``3-
day rule'') and section 415.6 of the Medicare Hospital Manual.
    In the case of a patient who dies during performance of a procedure 
with OPPS status indicator C before being admitted, the hospital would 
submit a claim for all services provided, including a line item for the 
status indicator C procedure. The claim would be rejected for payment 
under the OPPS and returned to the hospital. The hospital would 
resubmit the claim for payment as an inpatient stay under the 
appropriate DRG.
    In the case of a patient who is admitted and transferred, the 
transferring hospital would be paid a per diem DRG rate if all the 
above conditions are met. (We propose to revise section 3610.5 of the 
Medicare Intermediary Manual accordingly.)
    Note that a physician's order to admit a patient to an observation 
bed following a procedure designated with OPPS status indicator C would 
not constitute an inpatient admission and, therefore, would not qualify 
the procedure with status indicator C for payment. In this instance, 
the only allowable Medicare payment would be for a code payable under 
APC 0610, 0611, or 0612 if those services were provided. Payment would 
not be allowed for either the procedure with status indicator C or for 
any ancillary services furnished on the same date.
4. Orders To Admit
    Some hospitals have raised questions about the timing of a 
physician's order to admit a patient. The requirements for the 
authenticating physician orders and the standards for medical record 
keeping fall outside the scope of this proposed rule and OPPS payment 
policy. The payment guidelines proposed above are to assist hospitals 
and contractors in determining how to bill and pay for services 
appropriately under Medicare. The patient's admission status, as 
documented by the medical records, determines what Medicare payment is 
appropriate. Medical record keeping and documentation requirements are 
addressed in the Medicare hospital conditions of participation at 
Sec. 482.24, and are governed by applicable State law and State 
licensing rules and hospital accreditation standards.

D. Status Indicators

    The status indicators we assign to HCPCS codes and APCs under the 
OPPS have an important role in payment for services under the OPPS 
because they indicate if a service represented by a HCPCS code is 
payable under the OPPS or another payment system and also if particular 
OPPS policies apply to the code. We are providing our proposed status 
indicator assignments for APCs in Addendum A, HCPCS codes in Addendum 
B, and definitions of the status indicators in Addendum D.
    The OPPS is based on HCPCS codes for medical and other health 
services. These codes are used for a wide variety of payment systems 
under Medicare, including, but not limited to, the Medicare fee 
schedule for physician services, the Medicare fee schedule for durable 
medical equipment and prosthetic devices, and the Medicare clinical 
laboratory fee schedule. For purposes of making payment under the OPPS, 
we need a way to signal the claims processing system which HCPCS codes 
are paid under the OPPS and those codes to which particular OPPS 
payment policies apply. We accomplish this identification in the OPPS 
through the establishment of a system of status indicators with 
specific meanings. Addendum D defines the meaning of each status 
indicator for purposes of the OPPS.
    We assign one and only one status indicator to each APC and to each 
HCPCS code. Each HCPCS code that is assigned to an APC has the same 
status indicator as the APC to which it is assigned.
    Specifically, in 2003, we propose to use the status indicators in 
the following manner:
     We use A to indicate services that are paid under some 
payment method other than OPPS, such as the Durable medical equipment, 
prosthetics, orthotics, and supplies (DMEPOS) fee schedule or the 
physician fee schedule. Some but not all of these other payment systems 
are identified in Addendum D.
     We use ``C'' to indicate inpatient services that are not 
payable under the OPPS.
     We use ``D'' to indicate a code that was deleted effective 
with the beginning of the calendar year.
     We use ``E'' to indicate services for which payment is not 
allowed under the OPPS or that are not covered by Medicare.
     We use ``F'' to indicate acquisition of corneal tissue, 
which is paid at reasonable cost.
     We use ``G'' to indicate drugs and biologicals that are 
paid under OPPS transitional pass-through rules.
     We use ``H'' to indicate devices that are paid under OPPS 
transitional pass-through rules.
     We use ``K'' to indicate drugs and biologicals (including 
blood and blood products) and certain brachytherapy seeds that are paid 
in separate APCs under the OPPS, but that are not paid under OPPS 
transitional pass-through rules.
     We use ``N'' to indicate services that are paid under the 
OPPS for which payment is packaged into another service or APC group.
     We use ``P'' to indicate services that are paid under the 
OPPS but only in partial hospitalization programs.
     We use ``S'' to indicate significant procedures that are 
paid under OPPS but to which the multiple procedure reduction does not 
apply.
     We use ``T'' to indicate significant services that are 
paid under the OPPS and to which the multiple procedure payment 
discount under OPPS applies.
     We use ``V'' to indicate medical visits (including clinic 
or emergency department visits) that are paid under the OPPS.
     We use ``X'' to indicate ancillary services that are paid 
under the OPPS.
    The software that controls Medicare payment looks to the status 
indicators attached to the HCPCS codes and APCs for direction in the 
processing of the claim. Therefore, the assignment of the status 
indicators has significance for the payment of services. We sometimes 
change these indicators in the course of a year through Program 
Memoranda. Moreover, indicators are established for new codes that we 
establish in the middle of the year, either as a result of a national 
coverage decision or otherwise. A status indicator, as well as an APC, 
must be assigned so that payment can be made for the service identified 
by the new code.
    We are proposing the status indicators identified for each HCPCS 
code and each APC in Addenda A and B and are requesting comments on the 
appropriateness of the indicators we have assigned.

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

1. Reducing Transitional Pass-Through Payments To Offset Costs Packaged 
Into APC Groups
    In the November 30, 2001 final rule, we explain the methodology we 
used to estimate the portion of each APC rate that could reasonably be 
attributed to the cost of associated devices that are eligible for 
pass-through payments (66 FR 59904). Effective with implementation of 
the 2002 OPPS update on April 1, 2002, we deduct from the pass-through 
payments for those devices an amount that offsets the portion of the 
otherwise applicable APC payment amount that we determined is 
associated with the device, as required

[[Page 52139]]

by section 1833(t)(6)(D)(ii) of the Act. In the March 1, 2002 final 
rule, we published the applicable offset amounts for 2002, which we had 
recalculated to reflect certain device cost assignments that were 
corrected in the same final rule (67 FR 9557).
    For the 2003 OPPS update, we propose to estimate the portion of 
each APC rate that could reasonably be attributed to the cost of an 
associated pass-through device that is eligible for pass-through 
payment using claims data for services furnished between July 1, 2001 
through December 31, 2001. We propose to use only the last 6 months of 
2001 claims data because bills for pass-through devices submitted 
during this time period would use only device category codes, allowing 
a more consistent analysis than would result were we to include pre-
July 1 claims that might still show item-specific codes for pass-
through devices. Using these claims, we would calculate a median cost 
for every APC without packaging the costs of associated C-codes for 
device categories that were billed with the APC. We would then 
calculate a median cost for every APC with the costs of associated C-
codes for device categories that were billed with the APC packaged into 
the median. Comparing the median APC cost minus device packaging by the 
median APC cost including device packaging would allow us to determine 
the percentage of the median APC cost that is attributable to 
associated pass-through devices. By applying these percentages to the 
median APC cost, we would determine the applicable offset amount. Table 
9 shows the offsets that we propose be applied in 2003 to each APC that 
contains device costs. APCs were included for offsets if their device 
costs comprised at least 1 percent of the APC's costs. (However, if any 
APC's calculated offset had been less than 1 dollar, that APC and 
offset would not have been included.)

                Table 9.--Proposed Offsets To Be Applied for Each APC That Contains Device Costs
----------------------------------------------------------------------------------------------------------------
                                                                                                  Device related
                                                                                                    cost to be
                                                                                    APC percent     subtracted
                  APC                                  Description                 attributed to    from pass-
                                                                                      devices         through
                                                                                                      payment
----------------------------------------------------------------------------------------------------------------
0032..................................  Insertion of Central Venous/Arterial                6.12          $22.73
                                         Catheter.
0046..................................  Open/Percutaneous Treatment Fracture or             1.06           16.00
                                         Dislocation.
0048..................................  Arthroplasty with Prosthesis............            5.78          111.02
0051..................................  Level III Musculoskeletal Procedures                1.24           21.95
                                         Except Hand and Foot.
0052..................................  Level IV Musculoskeletal Procedures                 3.05           67.21
                                         Except Hand and Foot.
0080..................................  Diagnostic Cardiac Catheterization......            4.36           80.82
0081..................................  Non-Coronary Angioplasty or Atherectomy.            7.29           86.03
0082..................................  Coronary Atherectomy....................           47.58        1,866.34
0083..................................  Coronary Angioplasty and Percutaneous              20.08          499.51
                                         Valvuloplasty.
0085..................................  Level II Electrophysiologic Evaluation..           10.22          168.87
0086..................................  Ablate Heart Dysrhythm Focus............           20.36          462.74
0087..................................  Cardiac Electrophysiologic Recording/              15.19           45.90
                                         Mapping.
0088..................................  Thrombectomy............................            4.08           72.06
0089..................................  Insertion/Replacement of Permanent                 68.56        3,883.80
                                         Pacemaker and Electrodes.
0090..................................  Insertion/Replacement of Pacemaker Pulse           64.17        2,574.81
                                         Generator.
0091..................................  Level II Vascular Ligation..............            1.75           24.60
0093..................................  Vascular Repair/Fistula Construction....            1.63           22.29
0104..................................  Transcatheter Placement of Intracoronary           40.26        1,522.67
                                         Stents.
0105..................................  Revision/Removal of Pacemakers, AICD, or            5.79           57.64
                                         Vascular.
0106..................................  Insertion/Replacement/Repair of                    18.05          274.40
                                         Pacemaker and/or Electrodes.
0107..................................  Insertion of Cardioverter-Defibrillator.           83.18        7,852.32
0108..................................  Insertion/Replacement/Repair of                    82.11        9,936.93
                                         Cardioverter-Defibrillator Leads.
0109..................................  Removal of Implanted Devices............            1.70            6.79
0115..................................  Cannula/Access Device Procedures........            7.22           88.17
0119..................................  Implantation of Devices.................           13.61          183.19
0122..................................  Level II Tube changes and Repositioning.            2.21            4.47
0124..................................  Revision of Implanted Infusion Pump.....            9.82          119.87
0142..................................  Small Intestine Endoscopy...............            1.03            4.40
0151..................................  Endoscopic Retrograde Cholangio-                    2.71           25.69
                                         Pancreatography (ERCP).
0152..................................  Percutaneous Abdominal and Biliary                  9.96           32.01
                                         Procedures.
0153..................................  Peritoneal and Abdominal Procedures.....            1.69           22.84
0154..................................  Hernia/Hydrocele Procedures.............            2.66           37.33
0167..................................  Level III Urethral Procedures...........           11.54          162.95
0168..................................  Level II Urethral Procedures............            5.20           65.18
0179..................................  Urinary Incontinence Procedures.........           34.30        1,449.96
0182..................................  Insertion of Penile Prosthesis..........           42.39        1,847.50
0202..................................  Level VIII Female Reproductive Proc.....           10.67          216.92
0222..................................  Implantation of Neurological Device.....           65.75        4,806.58
0223..................................  Implantation of Pain Management Device..           11.54          121.84
0225..................................  Implantation of Neurostimulator                    33.33          770.87
                                         Electrodes.
0226..................................  Implantation of Drug Infusion Reservoir.           70.33        1,616.75
0227..................................  Implantation of Drug Infusion Device....           75.38        5,019.34
0229..................................  Transcatherter Placement of                        46.89        1,194.96
                                         Intravascular Shunts.
0245..................................  Level I Cataract Procedures without IOL             3.24           24.25
                                         Insert.
0246..................................  Cataract Procedures with IOL Insert.....            1.20           14.72
0259..................................  Level III ENT Procedures................           75.29       11,396.81
0279..................................  Level II Angiography and Venography                 1.56            6.82
                                         except Extremity.
0280..................................  Level III Angiography and Venography                5.02           40.49
                                         except Extremity.
0281..................................  Venography of Extremity.................            1.39            3.78

[[Page 52140]]

 
0297..................................  Level II Therapeutic Radiologic                     1.91            7.75
                                         Procedures.
0656..................................  Transcatheter placement of drug eluting            54.15         2668.28
                                         stents.
0670..................................  Intravenous and Intracardiac Ultrasound.           51.03          392.26
0680..................................  Insertion of Patient Activated Event               68.48        1,850.24
                                         Recorders.
0681..................................  Knee Arthroplasty.......................           64.57        5,310.69
0684..................................  Prostate Brachytherapy..................           67.49         3631.89
0686..................................  Level III Skin Repair...................            4.00           23.51
0687..................................  Revision/Removal of Neurostimulator                 1.50           15.21
                                         Electrodes.
0688..................................  Revision/Removal of Neurostimulator                22.15          352.28
                                         Pulse Generator Receiver.
0693..................................  Level II Breast Reconstruction..........            1.00           20.44
0981..................................  New Technology--Level XII ($2000--$2500)           13.32          299.70
----------------------------------------------------------------------------------------------------------------

2. Devices Paid With Multiple Procedures
    As explained above, under section 1833(t)(6)(D)(ii) of the Act, the 
amount of additional payment for a device eligible for pass-through 
payment is the amount by which the hospital's cost exceeds the portion 
of the otherwise applicable APC payment amount that the Secretary 
determines is associated with the device. Thus, for devices eligible 
for pass-through payment, we reduce the pass-through payment amount by 
the cost attributable to the device that is already packaged into the 
APC payment for an associated procedure. For 2002, we developed offset 
amounts, for 59 APCs (March 1, 2002 final rule, 67 FR 9556 through 
9557, Table 1).
    In our November 30, 2001 final rule (66 FR 59856), we articulated a 
policy regarding the calculation of the offsets for device costs 
already reflected in APCs in cases where the payment for the associated 
APC is reduced due to the multiple procedure discount. The policy was 
in response to several commenting parties that recommended that we 
apply the multiple procedure discount only to the non-device-related 
portion of the APC payment amount (66 FR 59906).
    We agreed with the commenters that the full pass-through offset 
should not be applied when the APC payment is subject to the multiple 
procedure discount of 50 percent.
    The purpose of the offset is to ensure that the OPPS is not making 
double payments for any portion of the cost associated with the use of 
the pass-through item. We stated in the November 30, 2001 rule that the 
offset should reflect that portion of the cost for the pass-through 
device actually reflected in the payment that is received for the 
associated APC. We consequently ruled that the most straightforward 
methodology for applying this principle is to reduce the amount of the 
offset amount by 50 percent whenever the multiple procedure discount 
applies to the associated APC. This discounting of the offset is 
applied in 2002 to bills subject to multiple procedure discounting that 
also include devices eligible for pass-through payment.
    The significant number of device categories that are expiring in 
2003 combined with our proposal to package 100 percent of device costs 
into their associated APCs has prompted us to revisit the current 
policy of reducing offsets for pass-through devices in instances when 
multiple procedure discounts are applied to procedures associated with 
pass-through device categories. In order to determine the impact of 
multiple procedure discounting on APCs with full packaging of device 
costs, we reviewed the median costs of all APCs after incorporation of 
device costs and arrayed them in order of descending median cost. We 
also determined the contribution (in absolute dollars and as a 
percentage) of device costs to the median costs of each APC. We did 
this by examining claims submitted during the last 6 months of 2001 
during which only device category codes were used to bill for pass-
through devices because those were the only claims where we could 
specifically identify the contribution of device costs to the cost of 
each APC.
    We then determined which APCs containing devices would be billed 
together. For example, the APC for insertion of a pacemaker would not 
be billed with the APC for insertion of neurostimulator electrodes, 
whereas the APC for coronary stent placement might be billed with the 
APC for coronary angioplasty. We next determined, based on median cost 
data, which device containing APCs would be subject to the 50 percent 
multiple procedure reduction. After identifying these APCs, we applied 
a 50 percent reduction to arrive at a discounted payment amount. We 
then reviewed the contribution of device costs to the discounted APC 
both as a percentage and in absolute dollars to determine if applying 
the 50 percent reduction would result in underpayment for the service. 
We determined that the reduced payment was adequate to pay both for the 
devices incorporated into the APC and for the procedure cost in the 
context of performing multiple procedures. We obtained the same results 
even when we overstated device costs in our model by 5 or 10 percent to 
offset concerns expressed by some manufacturers and physicians that 
hospital charges for transitional pass-through devices may be 
understated.
    To illustrate this analysis, assume APCs 0104 and 0083 are billed 
together. The median cost of APC 0104 is $3,960 with 40 percent of the 
cost attributable to devices. The median cost of APC 0083 is $2,605 
with 20 percent of its cost attributable to devices. Under our existing 
multiple procedure discount payment rules, APC 0104 would be paid at 
100 percent, and APC 0083 would be paid at 50 percent. This means that 
payment for APC 0083 would be $1,302 of which $520 (20 percent of 
$2,605) is attributable to devices. We believe this total payment 
accounts for the costs of the devices and the costs of the procedure 
when it is performed in conjunction with APC 0104.
    We note that almost all APCs with high device costs (such as 
insertion of pacemakers, insertion of cardioverter-defibrillators, 
insertion of infusion pumps and neurostimulator electrodes) would never 
be subject to a multiple procedure discount. They have the highest 
relative weights in the OPPS,

[[Page 52141]]

and we would not expect these procedures to be performed during the 
same operative session with a higher paying procedure with status 
indicator ``T.'' Therefore, we propose to continue our current policy 
of multiple procedure discounting. That is, when two or more APCS with 
status indicator ``T'' are billed together we propose to pay 100 
percent for the highest cost APC and 50 percent for all other APCs with 
status indicator ``T.'' We propose not to adjust these payments to 
account for device costs in the APCs.

F. Outpatient Billing For Dialysis

    Currently, hospitals are unable to bill for dialysis treatments 
furnished to End-Stage Renal Disease (ESRD) patients on an outpatient 
basis, unless the hospital also has a certified hospital-based ESRD 
facility. As a result of this policy, there has been an increase in 
denials by the PROs for inappropriate hospital admissions.
    When ESRD patients come to the hospital for a medical emergency or 
for problems with their access sites, they typically miss their 
regularly scheduled dialysis appointments. If the ESRD patient's usual 
facility is unable to reschedule the dialysis treatment, the 
beneficiary has to wait until the next scheduled dialysis appointment. 
CMS is concerned that by maintaining this policy, beneficiaries may be 
receiving interrupted care because there will be unnecessary lapses in 
treatment. The ESRD patient should not be prevented from receiving her 
or his normal dialysis because he or she experienced another unrelated 
medical situation. Therefore, we propose to allow payment for dialysis 
treatments for ESRD patients in the outpatient department of a hospital 
in specific situations. Payment would be limited to unscheduled 
dialysis for ESRD patients in exceptional circumstances. Outpatient 
dialysis for acute patients would not be included in this payment 
mechanism.
    We propose to limit this payment to medical situations in which the 
ESRD patient cannot obtain her or his regularly scheduled dialysis 
treatment at a certified ESRD facility. Situations that we propose to 
allow are limited to: (1) dialysis performed following or in connection 
with a vascular access procedure; (2) dialysis performed following 
treatment for an unrelated medical emergency. For example, if a patient 
goes to the emergency room for chest pains and misses a regularly 
scheduled dialysis treatment that cannot be rescheduled, we would allow 
the hospital to provide and bill Medicare for the dialysis treatment; 
and (3) emergency dialysis--Currently, the only mechanism available for 
payment in this situation is through an inpatient admission. We will 
maintain our policy that routine treatments in non-ESRD certified 
hospitals would not be payable under OPPS.
    We believe it is important to make this change in policy for two 
reasons: (1) to ensure that hospital outpatient departments are paid 
for providing this much needed service; and (2) to prevent dialysis 
patients from receiving interrupted care. Non-ESRD certified hospital 
outpatient facilities would bill Medicare using a new G code, G0GGG, 
``Unscheduled or emergency treatment for dialysis for ESRD patient in 
the outpatient department of a hospital that does not have a certified 
ESRD facility.'' We propose that this new code will have status 
indicator ``S'' and be assigned to APC 0170. Payment would be roughly 
equivalent to the reimbursement rate for acute dialysis. We propose to 
implement this change effective January 1, 2003. Effective January 1, 
2003, this would be the only way for non-ESRD certified hospital 
outpatient facilities to bill Medicare and be paid for providing 
outpatient dialysis to ESRD beneficiaries.
    CMS will be monitoring the use of this new code to ensure that (1) 
certified dialysis facilities are not incorrectly using this code; and 
(2) the same dialysis patient is not repeatedly using this code, which 
would indicate routine dialysis treatment.
    When ESRD patients receive outpatient dialysis in non-ESRD 
certified hospital outpatient facilities, the patient's home facility 
would be responsible for obtaining and reviewing the patient's medical 
records to ensure that appropriate care was provided in the hospital 
and that modifications are made, if necessary, to the patient's plan of 
care upon her or his return to the facility. This ensures continuity of 
care for the patient.

IX. Summary of and Responses to MedPAC Recommendations

    The Medicare Payment Advisory Commission (MedPAC) in its March 2002 
Report to the Congress: ``Medicare Payment Policy,'' makes a number of 
recommendations relating to the OPPS. This section provides responses 
to those recommendations.
    Recommendation: For calendar year 2003, the Secretary should 
increase the payment rates for services covered by the OPPS by the rate 
of increase in the hospital market basket.
    Response: Section 1833(t)(3)(C)(ii) of the Act requires the 
Secretary to update the conversion factor annually. Under section 
1833(t)(3)(C)(iv) of the Act, the update is equal to the hospital 
market basket percentage increase applicable under the hospital 
inpatient PPS, minus one percentage point for the years 2000 and 2002. 
The Secretary has the authority under section 1833(t)(3)(C)(iv) of the 
Act to substitute a market basket that is specific to hospital 
outpatient services. In the September 8, 1998 proposed rule on the 
OPPS, we indicated that we were considering the option of developing an 
outpatient-specific market basket and invited comments on possible 
sources of data suitable for constructing one (63 FR 47579). We 
received no comments in response to this invitation, and we therefore 
announced in the April 7, 2000 final rule that we would update the 
conversion factor by the hospital inpatient market basket increase, 
minus one percentage point, for the years 2000, 2001, and 2002 (65 FR 
18502). (As required by section 401(c) of the BIPA, we made payment 
adjustments effective April 1, 2001 under a special payment rule that 
had the effect of providing a full market basket update in 2001.) For 
2003, we propose to increase payment rates by the rate of increase in 
the hospital market basket.
    Recommendation: The Congress should--
     Replace hospital-specific payments for pass-through 
devices with national rates.
     Give the Secretary authority to consider alternatives to 
average wholesale price (AWP) when determining payments for pass-
through drugs and biologicals.
    Response: Regarding the pricing of transitional pass-through 
devices, we share the Commission's concern that the current methodology 
provides incentives for hospitals to inflate charges for transitional 
pass-through devices to increase payments. However, we believe that 
alternative approaches are not necessarily superior. Further, the 
salience of this problem should be much less in the future.
    At present, the payment for a transitional pass-through device is 
set, on a claim-by-claim basis, relative to the hospital's charge for 
that device. The charge is reduced to a measure of cost by application 
of a hospital-specific cost-to-charge ratio, and a subtraction is made 
to reflect the portion of device costs already recognized in the 
payment for the associated procedure APC. This procedure means that a 
higher charge by a hospital will result in a higher payment from 
Medicare. The Commission notes that this method embodies an incentive 
for hospitals, perhaps prompted by manufacturers, to increase charges 
as a means of

[[Page 52142]]

increasing payments. The Commission is concerned that this situation 
may lead to excessive payments and may bias the charges used to revise, 
from year to year, relative weights in the OPPS.
    In fact, the extent to which hospitals raising their charges on 
devices is problematic depends on the outcomes. In general, we 
anticipate that hospital charge structures, on average, reflect their 
costs; this assumption helps support the use of charge data to revise 
relative weights in hospital prospective payment systems. Accordingly, 
whether payments to hospitals for transitional pass-through devices 
might be considered excessive depends on whether hospitals inflate 
charges beyond the levels appropriate to recover their costs. Whether 
their behavior leads to biases in charge data depends on whether they 
set charges on transitional pass-through devices significantly 
differently than on other services.
    Moving to a fee schedule for transitional pass-through devices 
would remove the particular incentive problem that the Commission 
noted, which we agree would be desirable. However, the establishment of 
appropriate national rates would then become the focus. In the absence 
of field data on actual costs, we will be inevitably reliant on 
information that manufacturers provide. At present, manufacturers are 
asked for information about prices on applications for pass-through 
status. Anecdotal information suggests this information is not fully 
reliable as a measure of what hospitals actually pay.
    The Commission's report discusses the possibility of CMS setting 
the rate for a device based on analysis of the manufacturer's costs, 
including an appropriate rate of return on equity. This approach would 
confront a number of accounting, legal, and operational difficulties.
     First, it would take some time to complete the analysis 
for a new product, which could significantly delay establishment of a 
rate. The rate that would be used in the meantime, or whether billing 
would be permitted at all, would be open to question.
     Second, it appears that large firms with multiple product 
lines supply most devices, which would make determining the costs of a 
particular device difficult. This problem would be compounded when 
multiple enterprises are involved in bringing a product to market, 
which is not uncommon in the device industry, where invention and 
initial development may occur in one firm and final development, 
manufacturing, and marketing in another.
     Third, the government generally does not have access to 
manufacturers cost information. While legal authority could be 
enhanced, manufacturers would face incentives that raise questions 
about the reliability of information provided, and the need for 
government accounting and auditing resources would be high.
     Fourth, as the Commission's report notes, an appropriate 
rate of return on equity would have to be established.
     Fifth, devices are now paid, under BIPA, on the basis of 
categories. As a result, if a manufacturer brings to market a product 
that fits the description of a category, hospitals can bill for that 
manufacturer's product without any change in coding or notification of 
CMS. Consequently, we do not know what specific devices are actually 
being billed in these categories, or who manufactures them. Whatever 
rate might be established on the basis of an initial application for a 
category would presumably be based on the applicant's costs. Later 
entrants might have significantly different cost structures, but this 
information would not come into account unless a more elaborate process 
was implemented to include it.
    Finally, whether a rate set in this fashion would pay less or more 
than the current method is unclear. The current method is based on 
actual experience in the field, and it will reflect, though perhaps 
somewhat tenuously, whatever competitive market pressures exist. Any 
method that we use aimed at ensuring a more reliable price could yield 
a price that is too high, since it will not reflect market activity. 
Whether a rate set by ex ante analysis of this sort would produce 
superior results does not appear obvious.
    The Commission's report also mentions the possibility of using 
competitive bidding to set rates for transitional pass-through devices. 
While competitive bidding appears attractive as a means of setting a 
market-related price, it has not proven an easy process for Medicare to 
implement. Competitive bidding seems best suited for established 
products with multiple suppliers. However, transitional pass-through 
devices are by definition new to the market and will frequently have 
only one manufacturer, at least at the start of the 2 to 3 year 
transitional pass-through period. Even in those instances in which this 
technique would be possible, it involves a fair amount of 
administrative resources and time, and using it to establish a rate 
that will be used at the most for 3 years does not appear to be an 
effective use of resources.
    Both of the suggestions discussed above reflect procedures that 
involve relatively high overhead on the part of CMS and of other 
actors. It is not obvious whether either would produce results that are 
superior to those derived from the present method. While they would 
change incentives on hospitals, incentives of manufacturers would still 
be a source of concern. We agree with the Commission that further 
investigation would be necessary to determine a feasible alternative to 
cost-based pass-through payments.
    In considering the advantages of various approaches, it is 
important to keep the size of the problem in mind, especially when 
contemplating procedures for setting rates that would involve 
substantial administrative resources. As of July 1, 2002, the OPPS pays 
for 100 categories of devices. As is explained in section III.C of this 
preamble, we are proposing that 95 categories will lose pass-through 
status and be retired as of January 1, 2003.\3\ Since the initial 
categories were established in April 2001, we have added only three 
categories. While several applications are pending, given the 
extensiveness of the existing categories, it appears likely that the 
number of new categories to be established in future years will be 
small.\4\ The likely volume of claims represented by these new 
categories is of course speculative, but it also does not seem likely 
to be large relative to the size of the OPPS system. As discussed 
below, we developed criteria for the establishment of new categories 
that were specifically intended to limit future pass-through payments 
to devices that provide a substantial clinical improvement.
---------------------------------------------------------------------------

    \3\ In accord with the BBRA amendment that established the pass-
through payment methodology, items are only eligible for pass-
through payments for 2 to 3 years. After expiration of pass-through 
status, payments for devices described by these categories will be 
packaged into APC payments for the procedures with which they are 
used.
    \4\ If a new device arrives on the market that would have fit in 
a category formerly in use but subsequently retired, it will not be 
eligible for pass-through payment.
---------------------------------------------------------------------------

    Considering that the identified alternatives do not appear to be 
manifestly superior to the current system but do involve significantly 
more administrative resources, and given the anticipated small volume 
of transitional pass-through devices in the future, we think on balance 
it would be best to let more experience develop with the current system 
before making significant changes to the current method.
    However, we agree that it would be desirable to give the Secretary 
authority

[[Page 52143]]

to use alternatives to AWP when determining payments for pass-through 
drugs and biologicals. At present, total payment for these items is 
governed by the general rule (section 1842(o) of the Act) for Medicare 
pricing of drugs, which requires they be paid at 95 percent of AWP. 
This rule also covers most drugs delivered ``incident to'' physicians' 
services in physicians' offices and elsewhere. The Congress is at 
present considering various changes to the AWP as the basis for 
Medicare payment for drugs, and if a change is adopted to this 
standard, it may be an appropriate standard for transitional pass-
through drugs and biologicals as well.
    Recommendation: The Secretary should do the following:
     Ensure additional payments are made only for new or 
substantially improved technologies that are expensive in relation to 
the applicable ambulatory payment classification rate.
     Avoid basing national rates only on reported costs.
     Ensure that the same broad principles guide payments for 
new technologies in the inpatient and outpatient payment systems.
    Response: We agree that additional payments should be limited to 
items that have the greatest merit and that have high costs not well 
captured in the existing payment structure. The Commission notes that 
limiting the number of transitional pass-through items limits the 
burdens on hospitals and us; reduces the likelihood of exceeding the 
statutory cap on aggregate pass-through payment, necessitating a 
uniform reduction in transitional pass-through payments; and limits the 
redistribution of funds across hospitals that are low versus high users 
of transitional pass-through items. We agree with these points. On 
November 2, 2001, we published an interim final rule with comment 
period in the Federal Register (66 FR 55850 to 55857) that set forth 
criteria we will use to evaluate whether to establish new categories of 
devices in the future. These criteria include tests of whether a device 
is new, whether it represents a substantial medical improvement for 
Medicare beneficiaries, and whether its costs are high relative to the 
payments that would otherwise be made.
    Section 1833(t)(6)(D) of the Act prescribes the method for setting 
payment for transitional pass-through drugs and devices. The issue of 
possible alternatives is discussed above.
    We agree that the same principles should govern payments for new 
technologies in the inpatient and outpatient prospective payment 
systems. Criteria governing extra new technology payments in the IPPS 
were established in a final rule published in the Federal Register (66 
FR 46902 to 46925) on September 7, 2001. The criteria have the same 
general form as those for the OPPS. They differ in some particulars, 
largely traceable to the difference of the two payment systems. In 
particular, the IPPS system pays on the basis of an episode of care. As 
a result, the bundle of payment is generally larger and hospitals are 
better able to absorb minor cost differences. Considering the impact of 
new technology on all costs of the episode is also pertinent. 
Consequently, the criteria for special payment for inpatient new 
technologies require examination of the net effect on costs of the 
entire episode (not just the added costs of a new technology), and the 
relative cost standard we established is somewhat more stringent than 
for the OPPS. We believe it is premature to judge whether it will make 
sense to make these criteria even closer in the future, as the 
Commission's discussion suggests.

X. Summary of Proposed Changes for 2003

A. Changes Required by Statute

    We are proposing the following changes to implement statutory 
requirements:
     Add APCs, delete APCs, and modify the composition of some 
existing APCs.
     Recalibrate the relative payment weights of the APCs.
     Update the conversion factor and the wage index.
     Revise the APC payment amounts to reflect the APC 
reclassifications, the recalibration of payment weights, and the other 
required updates and adjustments.
     Cease transitional pass-through payments for drugs and 
biologicals (including blood and blood products) and devices (including 
brachytherapy), that will, on January 1, 2003, have been paid under 
transitional pass-through methodology for at least 2 years.

B. Additional Changes to OPPS and Payment Suspension Provisions

    We are proposing the following additional changes to the OPPS and 
Payment Suspension Provisions:
     Creation of new evaluation and management service codes 
for outpatient clinic and emergency department encounters for 
implementation no earlier than January 1, 2004.
     Changes to the list of services that we do not pay in 
outpatient departments because we define them as ``inpatient only'' 
procedures.
     Changes to our policy of nonpayment for procedures on the 
``inpatient only'' list in special cases involving death or transfer 
before inpatient admission.
     Changes to our policy governing observation in cases of 
direct admission to observation.
     Changes to status indicators for HCPCS codes.
     Changes to our policies governing dialysis for ESRD 
patients and regarding partial hospitalization.
    In addition, we are making changes to payment suspension policies.

C. Changes to the Regulations Text

    A. We propose to make the following changes to our regulations:
     Amend Sec. 410.43(b) to add clinical social worker 
services (for the diagnosis and treatment of mental illnesses) that 
meet the requirements of section 1861(hh)(2) of the Act to the 
specified professional services that are separately covered and not 
paid as partial hospitalization services.
     Amend Sec. 419.66(c)(1) to specify that we must establish 
a new category for a medical device if it is not described by any 
category previously in effect as well as an existing category.

XI. Summary of Proposed Payment Suspension Provisions

    In this rule, we propose to revise Sec. 405.371 (c) to specify that 
we may suspend Medicare payments ``in whole or in part'' if a provider 
has failed to timely file an acceptable cost report. This provision is 
consistent with the existing provisions in Sec. 405.371(a) governing 
the suspension of Medicare payments ``in whole or in part'' under 
certain conditions. We believe the Medicare program would benefit 
because immediate complete payment suspension can be disruptive to 
providers and may negatively affect the care of Medicare patients.

XII. Collection of Information Requirements

    Under the Paperwork Reduction Act of 1995, we are required to 
provide 60-day notice in the Federal Register and solicit public 
comment before a collection of information requirement is submitted to 
the Office of Management and Budget (OMB) for review and approval. In 
order to fairly evaluate whether an information collection should be 
approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act 
of 1995 requires that we solicit comment on the following issues:

[[Page 52144]]

     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.
    This rule does not impose information collection and recordkeeping 
requirements. Consequently, it need not be reviewed by the Office of 
Management and Budget under the authority of the Paperwork Reduction 
Act of 1995.

XIII. Response to Public Comments

    Because of the large number of items of correspondence we normally 
receive on a proposed rule, we are not able to acknowledge or respond 
to them individually. However, in preparing the final rule, we will 
consider all comments concerning the provisions of this proposed rule 
that we receive by the date and time specified in the DATES section of 
this preamble and respond to those comments in the preamble to that 
rule.

XIV. Regulatory Impact Analysis

    The regulatory impact analysis for this proposed rule consists of 
an impact analysis for the OPPS provisions and a regulatory impact 
statement for the provision for payment suspension for unfiled cost 
reports.

A. OPPS

1. General
    We have examined the impacts of this proposed rule as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review) 
and the Regulatory Flexibility Act (RFA) (September 16, 1980 Pub. L. 
96-354). Executive Order 12866 directs agencies to assess all costs and 
benefits of available regulatory alternatives and, if regulation is 
necessary, to select regulatory approaches that maximize net benefits 
(including potential economic, environmental, public health and safety 
effects, distributive impacts, and equity). A regulatory impact 
analysis (RIA) must be prepared for major rules with economically 
significant effects ($100 million or more annually).
    We estimate the effects of the provisions that would be implemented 
by this proposed rule would result in expenditures exceeding $100 
million in any 1 year. We estimate the total increase (from changes in 
the proposed rule as well as enrollment, utilization, and case mix 
changes) in expenditures under the OPPS for CY 2003 compared to CY 2002 
to be approximately $1.372 billion. Therefore, this proposed rule is an 
economically significant rule under Executive Order 12866, and a major 
rule under 5 U.S.C. 804(2).
    The RFA requires agencies to determine whether a rule will have a 
significant economic impact on a substantial number of small entities. 
For purposes of the RFA, small entities include small businesses, 
nonprofit organizations and government agencies. Most hospitals and 
most other providers and suppliers are small entities, either by 
nonprofit status or by having revenues of $6 to $29 million or less in 
any 1 year (see 65 FR 69432).
    For purposes of the RFA we have determined that approximately 37 
percent of hospitals and 98 percent of mental health practitioners 
would be considered small entities according to the Small Business 
Administration (SBA) size standards. We do not have data available to 
calculate the percentages of entities in the pharmaceutical preparation 
manufacturing, biological products, or medical instrument industries. 
For the pharmaceutical preparation manufacturing industry (NAICS 
325412), the size standard is 750 or fewer employees and $67.6 billion 
in annual sales (1997 business census). For biological products (except 
diagnostic) (NAICS 325414) $5.7 billion and medical instruments (NAICS 
339112), with $18.5 billion in annual sales, the standard is 50 or 
fewer employees (see the standards web site at http://www.sba.gov/regulations/siccodes/). Individuals and States are not included in the 
definition of a small entity.
    In addition, section 1102(b) of the Act requires us to prepare a 
regulatory impact analysis if a rule may have a significant impact on 
the operations of a substantial number of small rural hospitals. This 
analysis must conform to the provisions of section 603 of the RFA. With 
the exception of hospitals located in certain New England counties, for 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside of a Metropolitan 
Statistical Area (MSA) and has fewer than 100 beds (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 OPPS, we classify these hospitals as urban 
hospitals. We believe that the changes in this proposed rule would 
affect both a substantial number of rural hospitals as well as other 
classes of hospitals and that the effects on some may be significant. 
Therefore, we conclude that this proposed rule has a significant impact 
on a substantial number of small entities. However, the statute 
provides for small rural hospitals (of less than 100 beds) to be held 
harmless by the law and to continue to be paid at cost; therefore this 
proposed rule has no impact on them.
Unfunded Mandates
    Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L. 
104-4) also requires that agencies assess anticipated costs and 
benefits before issuing any rule that may result in an expenditure in 
any 1 year by State, local, or tribal governments, in the aggregate, or 
by the private sector, of $110 million. This proposed rule would not 
mandate any requirements for State, local, or tribal governments. This 
proposed rule imposes no unfunded mandates on the private sector.
Federalism
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it publishes a proposed rule (and subsequent 
final rule) that imposes substantial direct costs on State and local 
governments, preempts State law, or otherwise has Federalism 
implications.
    We have examined this proposed rule in accordance with Executive 
Order 13132, Federalism, and have determined that it will not have an 
impact on the rights, roles, and responsibilities of State, local or 
tribal governments. The impact analysis (see table 10) shows that 
payments to governmental hospitals (including State, local and tribal 
governmental hospitals) would increase by 5 percent under the proposed 
rule.

2. Changes in this Proposed Rule

    We are proposing several changes to the OPPS that are required by 
the statute. We are required under section 1833(t)(3)(C)(ii) of the Act 
to update annually the conversion factor used to determine the APC 
payment rates. We are also required under section 1833(t)(9)(A) of the 
Act to revise, not less often than annually, the wage index and other 
adjustments. In addition, we must review the clinical integrity of 
payment groups and weights at least annually. Accordingly, in this 
proposed rule, we are updating the conversion factor and the wage index 
adjustment for hospital outpatient services furnished beginning January 
1, 2003 as

[[Page 52145]]

we discuss in sections VI and IV, respectively, of this preamble. We 
are also proposing revisions to the relative APC payment weights based 
on claims data from January 1, 2001 through December 31, 2001. Finally, 
we are proposing to remove 95 devices and more than 200 drugs and 
biologicals from pass-through payment status.
    Under this proposed rule, the change to the conversion factor as 
provided by statute would increase total OPPS payments by 3.5 percent 
in 2003. The changes to the wage index and to the APC weights (which 
incorporates the cessation of pass-through payments for many drugs and 
devices) do not increase OPPS payments because the OPPS is budget 
neutral. However, the wage index and APC weight changes do change the 
distribution of payments within the budget neutral system as shown in 
Table 10 and described in more detail in this section.
Alternatives Considered
    Alternatives to the changes we propose and the reason that we did 
not choose to propose them are discussed throughout this proposed rule. 
Below we discuss options we considered when analyzing methodologies to 
appropriately recognize the costs of former pass-through items. For a 
more detailed discussion, see section III.C.1 regarding the expiration 
of pass-through payment for devices and section III.C.2 regarding the 
expiration of pass-through payment for drugs and biologicals.
Payment for Categories of Devices
    We considered establishing separate APCs for categories of devices 
and paying for them separately. We did not propose this option because 
we believe that to the extent possible, hospital payment for procedures 
and visits should include all of the costs required to provide the 
procedures and visits.
    A second option we considered involved (1) packaging some 
categories of devices into the procedures with which they were billed 
in 2001 and (2) paying the rest through separate APCs (as discussed in 
section III.C.). We did not propose this option because we believe that 
devices are routinely used in the services for which they are needed 
and therefore are consistently paid at the cost of providing the 
service. Furthermore, criteria that would provide a basis for some 
devices to be packaged and for others to be paid separately would have 
to be developed and approved, thereby further complicating an already 
complex payment system.
Payment for Drugs and Biologicals
    We considered continuing to make separate payment for all drugs and 
biologicals through separate APCs. We did not propose to pay separately 
for all drugs through separate APCs because we believe that, to the 
extent possible, hospital payment for services should include all of 
the costs of the services. We believe that drugs should be packaged 
with the services in which they are furnished except when we determine 
that there is a valid reason to do otherwise. However, we recognize 
that (unlike the stability that exists with device usage with the 
applicable procedures) the use of drugs may vary widely depending upon 
patient and disease characteristics. Therefore, packaging payment for 
all drugs may, in some cases, provide inadequate payment for the 
services furnished. Where a hospital has a disproportionate share of 
patients who need greater amounts of expensive drugs, underpayment for 
the drugs needed by these patients could result in cessation of needed 
services. For the first year that we are ceasing transitional pass-
through payment for drugs, we decided to proceed cautiously by 
proposing to pay separately for drugs when the cost per encounter was 
more than $150 or when special characteristics existed (for example, 
orphan drugs, blood products).
    We also considered packaging the costs of all drugs into the cost 
of the associated procedures with which they were billed in 2001. We 
did not package all payment for drugs into the payment for the 
procedures because, while this packaging is ultimately our goal, we 
believe, for the reasons indicated above, that we need to proceed 
cautiously to ensure that we do not inadvertently threaten access to 
needed care.
Conclusion
    It is clear that the changes in this proposed rule would affect 
both a substantial number of rural hospitals as well as other classes 
of hospitals, and the effects on some may be significant. Therefore, 
the discussion below, in combination with the rest of this proposed 
rule, constitutes a regulatory impact analysis.
    The OPPS rates proposed for CY 2003 would have, overall, a positive 
effect for every category of hospital with the exception of children's 
hospitals, which are held harmless under the OPPS. The changes in the 
OPPS proposed for 2003 would result in an overall 3.5 percent increase 
in Medicare payments to hospitals, exclusive of outlier and 
transitional pass-through payments and transitional corridor payments. 
As described in the preamble, budget neutrality adjustments are made to 
the conversion factor and the weights to assure that the revisions in 
the wage index, APC groups, and relative weights do not affect 
aggregate payments. The impact of the wage and recalibration changes 
does vary somewhat by hospital group. Estimates of these impacts are 
displayed on Table 10.
    The overall projected increase in payments for urban hospitals is 
slightly lower (2.5 percent) than the average increase for all 
hospitals (3.5 percent) while the increase for rural hospitals is 
significantly greater (7.6 percent) than the average increase. Rural 
hospitals gain 2.3 percent from the wage index change, and also gain 
1.6 percent from APC changes. A discussion of the distribution of 
outlier payments that we project under this proposed rule can be found 
under section D below. Table 11 presents the outlier distribution that 
we expect to see under this proposed rule.

3. Limitations of Our Analysis

    The distributional impacts represent the projected effects of the 
proposed policy changes, as well as statutory changes effective for 
2003, on various hospital groups. We estimate the effects of individual 
policy changes by estimating payments per service while holding all 
other payment policies constant. We use the best data available but do 
not attempt to predict behavioral responses to our policy changes. In 
addition, we do not make adjustments for future changes in variables 
such as service volume, service mix, or number of encounters.

4. Estimated Impacts of This Proposed Rule on Hospitals

    The OPPS is a budget neutral payment system under which the 
increase to the total payments made under OPPS is limited by the 
increase to the conversion factor set under the methodology in the 
statute. The impact tables show the redistributive effects of the wage 
index and APC changes. In some cases, under this proposed rule, 
hospitals would receive more total payment than in 2002 while in other 
cases they would receive less total payment than they received in 2002. 
The impact of this proposed rule would depend on a number of factors, 
most significant of which are the mix of services furnished by a 
hospital (for example, how the APCs for the hospital's most frequently 
furnished services would change) and the impact of the wage index 
changes on the hospital.
    Column 4 in Table 10 represents the full impact on each hospital 
group of all

[[Page 52146]]

the changes for 2003. Columns 2 and 3 in the table reflect the 
independent effects of the proposed change in the wage index and the 
APC reclassification and recalibration changes, respectively. We 
excluded critical access hospitals (CAHs) from the analysis of the 
impact of the proposed 2003 OPPS rates that is summarized in Table 10. 
For that reason, the total number of hospitals included in Table 10 
(4,551) is lower than in previous years. CAHs are excluded from the 
OPPS.
    In general, the wage index changes favor rural hospitals, 
particularly the largest in bed size and volume. The only rural 
hospitals that would experience a negative impact due to wage index 
changes are those in Puerto Rico, a decrease of 2.8 percent. 
Conversely, the urban hospitals are generally negatively affected by 
wage index changes, with the largest decreases occurring in those with 
300-499 beds (-0.7 percent) and those in the Middle Atlantic (-1.3 
percent), Pacific (-.09 percent) and Puerto Rico Regions (-1.8 
percent). However, this effect is somewhat lessened by the distribution 
of outlier payments as discussed in more detail below.
    The APC reclassification and recalibration changes also favor rural 
hospitals and have a negative effect on urban hospitals in excess of 
200 beds. Specifically, urban hospitals with 200-299 beds (-0.5 percent 
decrease), urban hospitals with 300-499 beds (-2.0 percent decrease) 
and urban hospitals in excess of 500 beds (a -1.9 percent decrease) all 
show a decrease attributed to APC recalibration. We believe this occurs 
as a result of our folding 75 percent of estimated pass-through device 
costs into APC payments in the 2002 OPPS. Specifically, a comparison of 
the relative payment weights proposed for 2003, as listed in Addendum 
A, with the final 2002 relative payment weights in the March 1, 2002 
final rule shows a decrease in the weights for certain APCs in 2002 
that included a fold-in of 75 percent of estimated pass-through device 
costs. We relied on cost information supplied by device manufacturers 
in estimating the device costs to be folded in when calculating the 
median APC costs for the 2002 OPPS, whereas the proposed 2003 relative 
payment weights are based on actual hospital charges and utilization 
under the OPPS as reported by hospitals. We believe this downward 
tendency in the payment weights for APCs that include device costs, 
based on actual hospital experience, accounts in part for the lower 
positive effect of the proposed 2003 rates on urban hospitals and on 
teaching hospitals, which tend to perform a higher number of procedures 
involving costly new technology devices, in contrast with an increased 
positive effect in 2003 on rural and non-teaching hospitals, which tend 
to furnish a higher volume of clinic and preventive services than 
procedures associated with expensive new technology devices.
    In both urban and rural areas, hospitals that provide a lower 
volume of outpatient services are projected to receive a larger 
increase in payments than higher volume hospitals. In rural areas, 
hospitals with volumes of fewer than 5000 services are projected to 
experience a significant increase in payments (8.1 percent). The less 
favorable impact for the high volume urban hospitals is attributable to 
both wage index and APC changes. For example, urban hospitals providing 
more than 42,999 services are projected to gain a combined 1.6 percent 
due to these changes.
    Major teaching hospitals are projected to experience a smaller 
increase in payments (1.7 percent) than the aggregate for all hospitals 
(3.5 percent) due to negative impacts of the wage index (-0.5 percent) 
and recalibration (-1.2 percent). Hospitals with less intensive 
teaching programs are projected to experience an overall increase (2.0 
percent) that is smaller than the average for all hospitals. There is 
little difference in impact among hospitals with that serve low-income 
patients.

             Table 10.--Impact of Changes for CY 2003 Hospital Outpatient Prospective Payment System
[Percent change in total payment to hospitals (program and beneficiary); does not include the effects of outlier
                  and transitional pass-through payments or of transitional corridor payments.]
----------------------------------------------------------------------------------------------------------------
                                                               Number of     New wage       APC      All CY 2003
                                                               hospitals    index \2\   changes)\3\  changes \4\
                                                                \1\ (1)        (2)          (3)          (4)
----------------------------------------------------------------------------------------------------------------
ALL HOSPITALS..............................................         4,551          0.0          0.0          3.5
NON-TEFRA HOSPITALS........................................         4,002          0.0         -0.1          3.4
URBAN HOSPS................................................         2,429         -0.6         -0.5          2.5
    LARGE URBAN (GT 1 MILL.)...............................         1,398         -0.7         -0.1          2.6
    OTHER URBAN (LE 1 MILL.)...............................         1,031         -0.4         -0.9          2.2
RURAL HOSPS................................................         1,573          2.3          1.6          7.6
BEDS (URBAN):
    0-99 BEDS..............................................           554         -0.3          3.1          6.4
    100-199 BEDS...........................................           882         -0.6          1.4          4.3
    200-299 BEDS...........................................           488         -0.6         -0.5          2.3
    300-499 BEDS...........................................           364         -0.7         -2.0          0.7
    500+ BEDS..............................................           141         -0.3         -1.9          1.3
BEDS (RURAL):
    0-49 BEDS..............................................           754          0.4          2.9          7.0
    50-99 BEDS.............................................           479          1.5          2.3          7.6
    100-149 BEDS...........................................           201          2.4          1.5          7.6
    150-199 BEDS...........................................            73          5.5          0.1          9.5
    200+ BEDS..............................................            66          3.3          0.0          7.0
VOLUME (URBAN):
    LT 5,000...............................................           188          0.9          6.5         10.9
    5,000-10,999...........................................           305         -0.8          5.1          7.9
    11,000-20,999..........................................           472         -0.7          2.6          5.5
    21,000-42,999..........................................           657         -0.8          0.3          3.0
    GT 42,999..............................................           807         -0.5         -1.4          1.6
VOLUME (RURAL):
    LT 5,000...............................................           326          0.2          4.2          8.1
    5,000-10,999...........................................           446          0.6          4.4          8.7

[[Page 52147]]

 
    11,000-20,999..........................................           373          1.3          2.7          7.7
    21,000-42,999..........................................           290          1.9          1.4          6.9
    GT 42,999..............................................           138          4.3         -0.2          7.8
REGION (URBAN):
    NEW ENGLAND............................................           127         -0.6          0.6          3.4
    MIDDLE ATLANTIC........................................           372         -1.3          0.2          2.3
    SOUTH ATLANTIC.........................................           370         -0.2         -0.1          3.2
    EAST NORTH CENT........................................           413         -0.7         -1.4          1.4
    EAST SOUTH CENT........................................           153         -0.6         -1.0          1.9
    WEST NORTH CENT........................................           172         -0.3         -1.6          1.6
    WEST SOUTH CENT........................................           293          0.5         -0.7          3.3
    MOUNTAIN...............................................           122         -0.4         -1.1          1.9
    PACIFIC................................................           368         -0.9          0.6          3.1
    PUERTO RICO............................................            39         -1.8          4.7          6.4
REGION (RURAL):
    NEW ENGLAND............................................            40          1.6          1.3          6.5
    MIDDLE ATLANTIC........................................            63          2.2          1.3          7.2
    SOUTH ATLANTIC.........................................           226          2.6          2.1          8.4
    EAST NORTH CENT........................................           213          1.2         -0.2          4.6
    EAST SOUTH CENT........................................           232          2.3          2.6          8.7
    WEST NORTH CENT........................................           271          2.0          0.9          6.6
    WEST SOUTH CENT........................................           278          1.8          3.2          8.8
    MOUNTAIN...............................................           141          4.1          1.3          9.2
    PACIFIC................................................           104          5.6          2.7         12.1
    PUERTO RICO............................................             5         -2.8         10.4         11.1
TEACHING STATUS:
    NON-TEACHING...........................................         2,935          0.4          1.1          5.0
    MINOR..................................................           782         -0.4         -1.1          2.0
    MAJOR..................................................           284         -0.5         -1.2          1.7
DSH PATIENT PERCENT:
     0.....................................................            11          4.9         10.1         19.4
    GT 0-0.10..............................................           982         -0.2         -0.4          3.0
    0.10-0.16..............................................           873          0.7         -0.8          3.4
    0.16-0.23..............................................           767         -0.6         -0.3          2.6
    0.23-0.35..............................................           756         -0.2          0.1          3.4
    GE 0.35................................................           613         -0.1          2.2          5.8
URBAN IME/DSH:
    IME & DSH..............................................           982         -0.7         -1.2          1.6
    IME/NO DSH.............................................             0          0.0          0.0          0.0
    NO IME/DSH.............................................         1,441         -0.4          0.7          3.8
    NO IME/NO DSH..........................................             6          5.4          9.8         19.7
RURAL HOSP. TYPES:
    NO SPECIAL STATUS......................................           610          0.7          2.7          7.1
    RRC....................................................           167          4.2          0.2          8.2
    SCH/EACH...............................................           507          1.5          2.7          7.8
    MDH....................................................           199          0.8          2.1          6.6
    SCH AND RRC............................................            75          4.0          0.5          8.2
TYPE OF OWNERSHIP:
    VOLUNTARY..............................................         2,440         -0.1         -0.4          3.1
    PROPRIETARY............................................           707         -0.6          0.9          3.8
    GOVERNMENT.............................................           855          0.7          0.7          5.0
SPECIALTY HOSPITALS:
    EYE AND EAR............................................            13         -1.4         11.5         13.7
    TRAUMA.................................................           153         -0.3         -1.5          1.6
    CANCER.................................................            10          0.5         -3.9          0.2
TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES):
    REHAB..................................................           166         10.3          2.8         16.9
    PSYCH..................................................           198          0.1         15.9         20.1
    LTC....................................................           143          1.3         15.9         20.4
    CHILDREN...............................................            42         -1.4         -2.8        -0.9
----------------------------------------------------------------------------------------------------------------
Note: For CY 2003, under the OPPS transitional corridor policy, the following categories of hospitals are held
  harmless compared to their 1996 payment margin for these services: cancer and children's hospitals and rural
  hospitals with 100 or fewer beds.
\1\ Some data necessary to classify hospitals by category were missing; thus, the total number of hospitals in
  each category may not equal the national total.
\2\ This column shows the impact of updating the wage index used to calculate payment by applying the proposed
  FY 2003 hospital inpatient wage index after geographic reclassification by the Medicare Geographic
  Classification Review Board. The hospital inpatient proposed rule for FY 2003 was published in the Federal
  Register on May 9, 2002.
\3\ This column shows the impact of changes resulting from the reclassification of HCPCS codes among APC groups
  and the recalibration of APC weights based on 2001 hospital claims data.

[[Page 52148]]

 
\4\ This column shows changes in total payment from CY 2002 to CY 2003, excluding outlier and pass-through
  payments. It incorporates all of the changes reflected in columns 2 and 3. In addition, it shows the impact of
  the proposed CY 2003 payment update. The sum of the columns may be different from the percentage changes shown
  here due to rounding.

    As stated elsewhere in this preamble, we propose to allocate 2 
percent of the estimated 2003 expenditures to outlier payments. In 
Table 11 below, we provide a distribution by percentage of the total 
projected outlier payments for the categories of hospitals that we show 
in the impact table (Table 10).
    We project, based on the mix of services for the hospitals that 
will be paid under the OPPS in 2003, that most hospitals will receive 
outlier payments. It appears that, with the exception of some smaller 
bed hospitals, all Tax Equity & Fiscal Responsibility Act of 1982 
(TEFRA) hospitals can be expected to receive outlier payments. This is 
because TEFRA hospitals provide an atypical mix of specialty services 
(which account for less than 1 percent of total OPPS payment before 
consideration of outliers). A greater percentage of non-TEFRA hospitals 
are not projected to receive outlier payments.
    The anticipated outlier payments for urban hospitals can be 
expected to ameliorate the impact of the wage index and APC changes on 
payments to urban hospitals.

     Table 11.--Distribution of Outlier Payments for CY 2003 Hospital Outpatient Prospective Payment System
----------------------------------------------------------------------------------------------------------------
                                                                                                      Percent of
                                                               Number of    Percent of   Number of      total
                                                                 hosps     total hosps   hosps with    outlier
                                                                                          outliers     payments
----------------------------------------------------------------------------------------------------------------
ALL HOSPITALS...............................................        4,551       100.00        4,306       100.00
NON-TEFRA HOSPITALS.........................................        4,002        88.00        3,987        99.40
URBAN HOSPS.................................................        2,429        53.40        2,420        83.20
    LARGE URBAN (GT 1 MILL.)................................        1,398        30.80        1,396        55.20
    OTHER URBAN (LE 1 MILL.)................................        1,031        22.60        1,024        28.00
RURAL HOSPS.................................................        1,573        34.60        1,567        16.00
BEDS (URBAN):
    0-99 BEDS...............................................          554        12.20          550         6.80
    100-199 BEDS............................................          882        19.40          877        18.20
    200-299 BEDS............................................          488        10.80          488        16.20
    300-499 BEDS............................................          364         8.00          364        21.00
    500+ BEDS...............................................          141         3.00          141        21.00
BEDS (RURAL):
    0-49 BEDS...............................................          754        16.60          751         4.20
    50-99 BEDS..............................................          479        10.60          477         5.00
    100-149 BEDS............................................          201         4.40          200         2.60
    150-199 BEDS............................................           73         1.60           73         2.00
    200+ BEDS...............................................           66         1.40           66         2.40
VOLUME (URBAN):
    LT 5,000................................................          188         4.20          180         1.00
    5,000-10,999............................................          310         6.80          309         2.80
    11,000-20,999...........................................          467        10.20          467         7.00
    21,000-42,999...........................................          659        14.40          659        15.80
    GT 42,999...............................................          805        17.60          805        56.60
VOLUME (RURAL):
    LT 5,000................................................          326         7.20          321         1.00
    5,000-10,999............................................          447         9.80          446         2.60
    11,000-20,999...........................................          372         8.20          372         3.80
    21,000-42,999...........................................          290         6.40          290         4.20
    GT 42,999...............................................          138         3.00          138         4.40
REGION (URBAN):
    NEW ENGLAND.............................................          127         2.80          126         6.20
    MIDDLE ATLANTIC.........................................          372         8.20          371        22.80
    SOUTH ATLANTIC..........................................          370         8.20          369        11.00
    EAST NORTH CENT.........................................          413         9.00          409        15.60
    EAST SOUTH CENT.........................................          153         3.40          152         3.40
    WEST NORTH CENT.........................................          172         3.80          172         4.40
    WEST SOUTH CENT.........................................          293         6.40          292         8.20
    MOUNTAIN................................................          122         2.60          122         3.00
    PACIFIC.................................................          368         8.00          368         8.60
    PUERTO RICO.............................................           39         0.80           39         0.20
REGION (RURAL):
    NEW ENGLAND.............................................           40         0.80           40         1.00
    MIDDLE ATLANTIC.........................................           63         1.40           63         1.00
    SOUTH ATLANTIC..........................................          226         5.00          223         3.00
    EAST NORTH CENT.........................................          213         4.60          212         3.00
    EAST SOUTH CENT.........................................          232         5.00          232         1.60
    WEST NORTH CENT.........................................          271         6.00          270         2.40
    WEST SOUTH CENT.........................................          278         6.20          278         1.60
    MOUNTAIN................................................          141         3.00          141         1.40
    PACIFIC.................................................          104         2.20          103         1.20
    PUERTO RICO.............................................            5         0.20            5         0.00
TEACHING STATUS:
    NON-TEACHING............................................        2,935        64.40        2,920        39.80

[[Page 52149]]

 
    MINOR...................................................          782        17.20          782        27.20
    MAJOR...................................................          284         6.20          284        32.20
DSH PATIENT PERCENT:
    0.......................................................           11         0.20           10         0.00
    GT 0--0.10..............................................          982        21.60          978        24.80
    0.10--0.16..............................................          873        19.20          873        19.40
    0.16--0.23..............................................          767        16.80          765        17.60
    0.23--0.35..............................................          756        16.60          753        20.00
    GE 0.35.................................................          613        13.40          608        17.40
URBAN IME/DSH:
    IME & DSH...............................................          982        21.60          982        57.20
    IME/NO DSH..............................................            0         0.00            0         0.00
    NO IME/DSH..............................................        1,441        31.60        1,433        26.00
    NO IME/NO DSH...........................................            6         0.20            5         0.00
RURAL HOSP. TYPES:
    NO SPECIAL STATUS.......................................          621        13.60          617         5.20
    RRC.....................................................          167         3.60          166         4.00
    SCH/EACH................................................          511        11.20          511         4.40
    MDH.....................................................          199         4.40          198         1.00
    SCH AND RRC.............................................           75         1.60           75         1.40
TYPE OF OWNERSHIP:
    VOLUNTARY...............................................        2,440        53.60        2,435        73.60
    PROPRIETARY.............................................          707        15.60          702        10.40
    GOVERNMENT..............................................          855        18.80          850        15.20
SPECIALTY HOSPITALS:
    EYE AND EAR.............................................           13         0.20           13         0.20
    TRAUMA..................................................          153         3.40          153        15.00
    CANCER..................................................           10         0.20           10         3.80
TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES):
    REHAB...................................................          166         3.60          113         0.20
    PSYCH...................................................          198         4.40           65         0.20
    LTC.....................................................          143         3.20          100         0.20
    CHILDREN................................................           42         1.00           41         0.20
----------------------------------------------------------------------------------------------------------------

5. Estimated Impacts of This Proposed Rule on Beneficiaries
    For services for which the beneficiary pays a coinsurance of 20 
percent of the payment rate, the beneficiary share of payment would 
increase for services for which OPPS payments would rise and would 
decrease for services for which OPPS payments would fall. For example 
for a mid level office visit (APC 0601), the minimum unadjusted 
copayment in 2002 was $9.67; under this proposed rule, the minimum 
unadjusted copayment would be $10.82 because the OPPS payment for the 
service would increase under this proposed rule. For some services 
(those services for which a national unadjusted copayment amount is 
shown in Addendum B), however, the beneficiary copayment is frozen 
based on historic data and would not change, therefore not presenting 
any potential impact on beneficiaries.
    However, in all cases, the statute limits beneficiary liability for 
copayment for a service to the inpatient hospital deductible for the 
applicable year. This amount was $812 for 2002, but is not yet 
determined for 2003. In general, the impact of this proposed rule on 
beneficiaries would vary based on the service the beneficiary receives 
and whether the copayment for the service is one that is frozen under 
the OPPS.

B. Payment Suspension for Unfiled Cost Reports

Overall Impact
    We have examined the impacts of this proposed rule as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review), 
the Regulatory Flexibility Act (RFA) (September 16, 1980, Pub. L. 96-
354), section 1102(b) of the Social Security Act, the Unfunded Mandates 
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132. (A 
description of each of these requirements is stated above in section 
XIV.A.1.) We have determined that the proposed payment suspension 
provision does not have an economic impact on Medicare payments or 
other payments to providers. We are proposing to allow the Secretary 
flexibility in payment suspensions, but we are not altering the final 
payment determination in any way. With the implementation of the 
various prospective payment systems, the majority of the payment to 
providers is based on the PPS methodology and not on the cost report. 
Suspending all payments because the cost report is not timely filed 
negatively affects providers. Providing the Secretary with flexibility 
in payment suspension can lessen the financial impact on providers. For 
these reasons, we are not preparing analyses for either the RFA or 
section 1102(b) of the Act because we have determined, and we certify, 
that this rule would not have a significant economic impact on a 
substantial number of small entities or a significant impact on the 
operations of a substantial number of small rural hospitals. Under the 
requirement for Unfunded Mandates, this proposed rule will not have an 
economic effect on State, local, or tribal governments, in the 
aggregate, or on the private sector.
Anticipated Effects
    1. Effects on providers that file cost reports. The majority of 
providers that file cost reports comply with the timeliness provisions 
and will be unaffected by this proposed regulation.

[[Page 52150]]

In FY 2000, collectively 16 percent of hospitals, skilled nursing 
facilities, and home health agencies filed late cost reports. Of this 
16 percent, 65 percent of those were only 1 day late. Currently, when a 
provider fails to file an acceptable cost report, the provider is 
placed on a complete payment suspension. Under this provision, for 
those providers who do not file timely, an immediate payment suspension 
less than the total suspension currently required might be imposed if 
the Secretary deemed it appropriate, which would allow the provider to 
more easily continue operations while completing and submitting the 
acceptable cost report.
    2. Effects on other providers. The payment suspension provision 
does not affect other providers.
    3. Effects on the Medicare Program. The provision would allow the 
Secretary to more effectively manage the Medicare program by imposing 
other than complete payment suspension when it is appropriate to do so. 
The Medicare program benefits because immediate complete payment 
suspension can be disruptive to providers and may negatively affect the 
care of Medicare patients. There are no costs to the Medicare program 
to doing so, because when the cost report is submitted, the suspended 
payments are returned to the provider.
    4. Effects on Beneficiaries. We have determined that this provision 
has a potentially positive impact on beneficiaries. Under this proposed 
provision the Secretary will have the discretion to impose less than 
100 percent payment suspension when a provider fails to timely file an 
acceptable cost report. Doing so will lessen the financial burden on 
the provider and thereby allow it to provide adequate services to its 
patient population as it works to complete and file an acceptable cost 
report.
Alternatives Considered
    We considered not revising existing Sec. 405.371(c) to provide that 
payment suspension could be ``in whole or in part''. However, we did 
not choose this option because we believe the Secretary should have the 
discretion to impose partial payment suspensions when circumstances 
warrant in order to more effectively manage the Medicare program.
Conclusion
    In conclusion, we have determined that the proposed payment 
suspension provision does not have an economic impact on Medicare 
payments.
Federalism
    Since this regulation does not impose any costs on State or local 
governments, it will not have an effect on State or local governments. 
State or local governments will have no roles or responsibilities 
associated with this provision.
    In accordance with the provisions of Executive Order 12866, this 
regulation was reviewed by the Office of Management and Budget.

List of Subjects

42 CFR Part 405

    Administrative practice and procedure, Health facilities, Health 
professions, Kidney diseases, Medicare, Reporting and recordkeeping 
requirements, Rural areas, X-rays.

42 CFR Part 410

    Health facilities, Health professions, Kidney diseases, 
Laboratories, Medicare, Reporting and recordkeeping requirements, Rural 
areas, X-rays.

42 CFR Part 419

    Hospitals, Medicare, Reporting and recordkeeping requirements.
    For the reasons set forth in the preamble, the Centers for Medicare 
& Medicaid Services proposes to amend 42 CFR chapter IV as follows:

PART 405--FEDERAL HEALTH INSURANCE FOR THE AGED AND DISABLED

Subpart C--Suspension of Payment, Recovery of Overpayments, and 
Repayment of Scholarships and Loans

    1. The authority citation for subpart C continues to read as 
follows:

    Authority: Secs. 1102, 1815, 1833, 1842, 1866, 1870, 1871, 1879, 
and 1892 of the Social Security Act (42 U.S.C. 1302, 1395g, 1395l, 
1395u, 1395cc, 1395gg, 1395hh, 1395pp, and 1395ccc) and 31 U.S.C. 
3711.

    2.Section 405.371(c) is revised to read as follows:


Sec. 405.371  Suspension, offset and recoupment of Medicare payments to 
providers and suppliers of services.

* * * * *
    (c) Suspension of payment in the case of unfiled cost reports. If a 
provider has failed to timely file an acceptable cost report, payment 
to the provider is immediately suspended in whole or in part until a 
cost report is filed and determined by the intermediary to be 
acceptable. In the case of an unfiled cost report, the provisions of 
Sec. 405.372 do not apply. (See Sec. 405.372(a)(2) concerning failure 
to furnish other information.)

PART 410--SUPPLEMENTARY MEDICAL INSURANCE (SMI) BENEFITS

    1.The authority citation continues to read as follows:

    Authority: Secs. 1102 and 1871 of the Social Security Act (42 
U.S.C. 1302 and 1395hh).

    2. In 410.43 republish the introductory text of paragraph (b), and 
add a new paragraph (b)(6) 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:
* * * * *
    (6) Clinical social worker services that meet the requirements of 
section 1861(hh)(2) of the Act.

PART 419--PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT 
DEPARTMENT SERVICES

    1. The authority citation continues to read as follows:

    Authority: Secs. 1102, 1833(t), and 1871 of the Social Security 
Act (42 U.S.C. 1302, 1395l(t), and 1395hh).


Sec. 419.66  [Amended]

    2. In Sec. 419.66, paragraph (c)(1) is amended by adding the phrase 
``or by any category previously in effect'' after ``categories'' and 
before ``and'.


Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
    Dated: July 31, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
    Approved: August 5, 2002.
Tommy G. Thompson,
Secretary.
BILLING CODE 4120-01-P

[[Page 52151]]



Addendum A.--List of Ambulatory Payment Classifications (APCs) With Status Indicators, Relative Weights, Payment
                                 Rates, and Copayment Amounts Calendar Year 2003
----------------------------------------------------------------------------------------------------------------
                                                                                           National     Minimum
         APC               Group title         Status indicator    Relative     Payment   unadjusted  unadjusted
                                                                    weight       rate      copayment   copayment
----------------------------------------------------------------------------------------------------------------
0620................  Critical Care........  S                         10.25     $533.09     $150.55     $106.62
0656................  Transcatheter          T                         90.90   $4,927.70  ..........     $985.54
                       Placement of Drug-
                       Eluting Coronary
                       Stents.
0657................  Placement of Tissue    S                          1.38      $71.77  ..........      $14.35
                       Clips.
0658................  Percutaneous Breast    T                          5.57     $289.69  ..........      $57.94
                       Biopsies.
----------------------------------------------------------------------------------------------------------------


Addendum A.--List of Ambulatory Payment Classifications (APCs) with Status Indicators, Relative Weights, Payment
                                 Rates, and Copayment Amounts Calendar Year 2003
----------------------------------------------------------------------------------------------------------------
                                                                                        National       Minimum
       APC             Group title           Status         Relative    Payment rate   unadjusted    unadjusted
                                            indicator        weight                     copayment     copayment
----------------------------------------------------------------------------------------------------------------
0001.............  Level I              S                         0.43        $22.36         $7.88         $4.47
                    Photochemotherapy.
0002.............  Fine needle Biopsy/  T                         0.63        $32.77         $8.52         $6.55
                    Aspiration.
0003.............  Bone Marrow Biopsy/  T                         1.24        $64.49        $27.08        $12.90
                    Aspiration.
0004.............  Level I Needle       T                         1.63        $84.77        $22.04        $16.95
                    Biopsy/Aspiration
                    Except Bone Marrow.
0005.............  Level II Needle      T                         3.02       $157.07        $69.11        $31.41
                    Biopsy /Aspiration
                    Except Bone Marrow.
0006.............  Level I Incision &   T                         1.89        $98.30        $25.56        $19.66
                    Drainage.
0007.............  Level II Incision &  T                         9.44       $490.96       $103.10        $98.19
                    Drainage.
0008.............  Level III Incision   T                        16.32       $848.79  ............       $169.76
                    and Drainage.
0009.............  Nail Procedures....  T                         0.68        $35.37         $8.34         $7.07
0010.............  Level I Destruction  T                         0.70        $36.41        $10.56         $7.28
                    of Lesion.
0011.............  Level II             T                         1.93       $100.38        $27.88        $20.08
                    Destruction of
                    Lesion.
0012.............  Level I Debridement  T                         0.76        $39.53        $10.67         $7.91
                    & Destruction.
0013.............  Level II             T                         1.10        $57.21        $14.30        $11.44
                    Debridement &
                    Destruction.
0015.............  Level III            T                         1.43        $74.37        $18.59        $14.87
                    Debridement &
                    Destruction.
0016.............  Level IV             T                         2.57       $133.66        $56.14        $26.73
                    Debridement &
                    Destruction.
0017.............  Level VI             T                        16.46       $856.07       $227.84       $171.21
                    Debridement &
                    Destruction.
0018.............  Biopsy of Skin/      T                         0.92        $47.85        $15.79         $9.57
                    Puncture of Lesion.
0019.............  Level I Excision/    T                         3.94       $204.92        $75.82        $40.98
                    Biopsy.
0020.............  Level II Excision/   T                         7.36       $382.79       $114.84        $76.56
                    Biopsy.
0021.............  Level III Excision/  T                        14.58       $758.29       $227.49       $151.66
                    Biopsy.
0022.............  Level IV Excision/   T                        18.10       $941.36       $367.13       $188.27
                    Biopsy.
0023.............  Exploration          T                         2.38       $123.78        $40.37        $24.76
                    Penetrating Wound.
0024.............  Level I Skin Repair  T                         2.00       $104.02        $37.45        $20.80
0025.............  Level II Skin        T                         5.89       $306.33       $116.41        $61.27
                    Repair.
0027.............  Level IV Skin        T                        15.73       $818.10       $343.60       $163.62
                    Repair.
0028.............  Level I Breast       T                        17.44       $907.04       $303.74       $181.41
                    Surgery.
0029.............  Level II Breast      T                        29.89     $1,554.55       $632.64       $310.91
                    Surgery.
0030.............  Level III Breast     T                        40.23     $2,092.32       $763.55       $418.46
                    Surgery.
0032.............  Insertion of         T                         7.14       $371.34  ............        $74.27
                    Central Venous/
                    Arterial Catheter.
0033.............  Partial              P                         4.96       $257.96  ............        $51.59
                    Hospitalization.
0035.............  Placement of         T                         0.24        $12.48         $3.74         $2.50
                    Arterial or
                    Central Venous
                    Catheter.
0041.............  Level I Arthroscopy  T                        27.58     $1,434.41       $580.06       $286.88
0042.............  Level II             T                        43.24     $2,248.87       $804.74       $449.77
                    Arthroscopy.
0043.............  Closed Treatment     T                         1.68        $87.38  ............        $17.48
                    Fracture Finger/
                    Toe/Trunk.
0045.............  Bone/Joint           T                        13.47       $700.56       $280.22       $140.11
                    Manipulation Under
                    Anesthesia.
0046.............  Open/Percutaneous    T                        29.03     $1,509.82       $535.76       $301.96
                    Treatment Fracture
                    or Dislocation.
0047.............  Arthroplasty         T                        29.59     $1,538.95       $537.03       $307.79
                    without Prosthesis.
0048.............  Arthroplasty with    T                        36.93     $1,920.69       $633.83       $384.14
                    Prosthesis.
0049.............  Level I              T                        19.45     $1,011.58  ............       $202.32
                    Musculoskeletal
                    Procedures Except
                    Hand and Foot.
0050.............  Level II             T                        23.60     $1,227.41  ............       $245.48
                    Musculoskeletal
                    Procedures Except
                    Hand and Foot.
0051.............  Level III            T                        34.03     $1,769.87  ............       $353.97
                    Musculoskeletal
                    Procedures Except
                    Hand and Foot.
0052.............  Level IV             T                        42.37     $2,203.62  ............       $440.72
                    Musculoskeletal
                    Procedures Except
                    Hand and Foot.
0053.............  Level I Hand         T                        14.76       $767.65       $253.49       $153.53
                    Musculoskeletal
                    Procedures.
0054.............  Level II Hand        T                        23.50     $1,222.21       $472.33       $244.44
                    Musculoskeletal
                    Procedures.
0055.............  Level I Foot         T                        18.28       $950.72       $355.34       $190.14
                    Musculoskeletal
                    Procedures.
0056.............  Level II Foot        T                        22.94     $1,193.09       $405.81       $238.62
                    Musculoskeletal
                    Procedures.
0057.............  Bunion Procedures..  T                        23.87     $1,241.45       $496.58       $248.29
0058.............  Level I Strapping    S                         1.09        $56.69        $14.74        $11.34
                    and Cast
                    Application.
0060.............  Manipulation         S                         0.36        $18.72  ............         $3.74
                    Therapy.

[[Page 52152]]

 
0068.............  CPAP Initiation....  S                         1.59        $82.69        $45.48        $16.54
0069.............  Thoracoscopy.......  T                        29.51     $1,534.79       $591.64       $306.96
0070.............  Thoracentesis/       T                         3.30       $171.63  ............        $34.33
                    Lavage Procedures.
0071.............  Level I Endoscopy    T                         1.01        $52.53        $14.18        $10.51
                    Upper Airway.
0072.............  Level II Endoscopy   T                         1.66        $86.33        $37.99        $17.27
                    Upper Airway.
0073.............  Level III Endoscopy  T                         3.63       $188.79        $74.14        $37.76
                    Upper Airway.
0074.............  Level IV Endoscopy   T                        12.84       $667.80       $295.70       $133.56
                    Upper Airway.
0075.............  Level V Endoscopy    T                        20.41     $1,061.50       $445.92       $212.30
                    Upper Airway.
0076.............  Endoscopy Lower      T                         9.30       $483.68       $189.92        $96.74
                    Airway.
0077.............  Level I Pulmonary    S                         0.26        $13.52         $7.44         $2.70
                    Treatment.
0078.............  Level II Pulmonary   S                         0.68        $35.37        $15.21         $7.07
                    Treatment.
0079.............  Ventilation          S                         1.63        $84.77        $16.80        $16.95
                    Initiation and
                    Management.
0080.............  Diagnostic Cardiac   T                        35.64     $1,853.60       $838.92       $370.72
                    Catheterization.
0081.............  Non-Coronary         T                        22.69     $1,180.08  ............       $236.02
                    Angioplasty or
                    Atherectomy.
0082.............  Coronary             T                        75.42     $3,922.52     $1,137.53       $784.50
                    Atherectomy.
0083.............  Coronary             T                        47.83     $2,487.59  ............       $497.52
                    Angioplasty and
                    Percutaneous
                    Valvuloplasty.
0084.............  Level I              S                         9.60       $499.29  ............        $99.86
                    Electrophysiologic
                    Evaluation.
0085.............  Level II             T                        31.77     $1,652.33       $363.51       $330.47
                    Electrophysiologic
                    Evaluation.
0086.............  Ablate Heart         T                        43.70     $2,272.79       $772.75       $454.56
                    Dysrhythm Focus.
0087.............  Cardiac              T                         5.81       $302.17  ............        $60.43
                    Electrophysiologic
                    Recording/Mapping.
0088.............  Thrombectomy.......  T                        33.96     $1,766.23       $678.68       $353.25
0089.............  Insertion/           T                       108.92     $5,664.82     $1,642.80     $1,132.96
                    Replacement of
                    Permanent
                    Pacemaker and
                    Electrodes.
0090.............  Insertion/           T                        77.15     $4,012.49     $1,444.50       $802.50
                    Replacement of
                    Pacemaker Pulse
                    Generator.
0091.............  Level II Vascular    T                        27.03     $1,405.80       $348.23       $281.16
                    Ligation.
0092.............  Level I Vascular     T                        24.97     $1,298.66       $505.37       $259.73
                    Ligation.
0093.............  Vascular Repair/     T                        26.29     $1,367.32       $277.34       $273.46
                    Fistula
                    Construction.
0094.............  Level I              S                         2.68       $139.38        $47.39        $27.88
                    Resuscitation and
                    Cardioversion.
0095.............  Cardiac              S                         0.66        $34.33        $16.73         $6.87
                    Rehabilitation.
0096.............  Non-Invasive         S                         1.82        $94.66        $48.15        $18.93
                    Vascular Studies.
0097.............  Cardiac and          X                         0.84        $43.69        $23.80         $8.74
                    Ambulatory Blood
                    Pressure
                    Monitoring.
0098.............  Injection of         T                         1.90        $98.82        $20.88        $19.76
                    Sclerosing
                    Solution.
0099.............  Electrocardiograms.  S                         0.38        $19.76  ............         $3.95
0100.............  Stress Tests and     X                         1.34        $69.69        $38.33        $13.94
                    Continuous ECG.
0101.............  Tilt Table           S                         4.40       $228.84       $105.27        $45.77
                    Evaluation.
0103.............  Miscellaneous        T                        11.26       $585.62       $210.82       $117.12
                    Vascular
                    Procedures.
0104.............  Transcatheter        T                        72.72     $3,782.09  ............       $756.42
                    Placement of
                    Intracoronary
                    Stents.
0105.............  Revision/Removal of  T                        19.14       $995.45       $370.40       $199.09
                    Pacemakers, AICD,
                    or Vascular.
0106.............  Insertion/           T                        29.23     $1,520.22       $410.46       $304.04
                    Replacement/Repair
                    of Pacemaker and/
                    or Electrodes.
0107.............  Insertion of         T                       181.51     $9,440.15     $2,076.83     $1,888.03
                    Cardioverter-
                    Defibrillator.
0108.............  Insertion/           T                       232.69    $12,101.97  ............     $2,420.39
                    Replacement/Repair
                    of Cardioverter-
                    Defibrillator
                    Leads.
0109.............  Removal of           T                         7.68       $399.43       $131.49        $79.89
                    Implanted Devices.
0110.............  Transfusion........  S                         4.04       $210.12  ............        $42.02
0111.............  Blood Product        S                        13.60       $707.32       $198.05       $141.46
                    Exchange.
0112.............  Apheresis,           S                        39.40     $2,049.15       $612.47       $409.83
                    Photopheresis, and
                    Plasmapheresis.
0113.............  Excision Lymphatic   T                        19.75     $1,027.18  ............       $205.44
                    System.
0114.............  Thyroid/             T                        37.55     $1,952.94       $507.76       $390.59
                    Lymphadenectomy
                    Procedures.
0115.............  Cannula/Access       T                        23.48     $1,221.17       $439.62       $244.23
                    Device Procedures.
0116.............  Chemotherapy         S                         0.85        $44.21  ............         $8.84
                    Administration by
                    Other Technique
                    Except Infusion.
0117.............  Chemotherapy         S                         3.87       $201.27        $52.33        $40.25
                    Administration by
                    Infusion Only.
0118.............  Chemotherapy         S                         5.68       $295.41        $72.03        $59.08
                    Administration by
                    Both Infusion and
                    Other Technique.
0119.............  Implantation of      T                        25.88     $1,345.99  ............       $269.20
                    Devices.
0120.............  Infusion Therapy     T                         1.81        $94.14        $25.42        $18.83
                    Except
                    Chemotherapy.
0121.............  Level I Tube         T                         2.17       $112.86        $45.14        $22.57
                    changes and
                    Repositioning.
0122.............  Level II Tube        T                         3.89       $202.32        $46.53        $40.46
                    changes and
                    Repositioning.
0123.............  Bone Marrow          S                         4.86       $252.76  ............        $50.55
                    Harvesting and
                    Bone Marrow/Stem
                    Cell Transplant.
0124.............  Revision of          T                        23.47     $1,220.65  ............       $244.13
                    Implanted Infusion
                    Pump.
0125.............  Refilling of         T                         1.73        $89.98  ............        $18.00
                    Infusion Pump.
0130.............  Level I Laparoscopy  T                        31.99     $1,663.77       $659.53       $332.75
0131.............  Level II             T                        42.44     $2,207.26     $1,001.89       $441.45
                    Laparoscopy.
0132.............  Level III            T                        57.95     $3,013.92     $1,239.22       $602.78
                    Laparoscopy.
0140.............  Esophageal Dilation  T                         5.84       $303.73       $107.24        $60.75
                    without Endoscopy.

[[Page 52153]]

 
0141.............  Upper GI Procedures  T                         7.82       $406.71       $150.48        $81.34
0142.............  Small Intestine      T                         8.21       $426.99       $152.78        $85.40
                    Endoscopy.
0143.............  Lower GI Endoscopy.  T                         8.37       $435.32       $186.06        $87.06
0146.............  Level I              T                         3.47       $180.47        $64.40        $36.09
                    Sigmoidoscopy.
0147.............  Level II             T                         7.30       $379.67        $83.53        $75.93
                    Sigmoidoscopy.
0148.............  Level I Anal/Rectal  T                         3.61       $187.75        $67.59        $37.55
                    Procedure.
0149.............  Level III Anal/      T                        16.91       $879.47       $293.06       $175.89
                    Rectal Procedure.
0150.............  Level IV Anal/       T                        22.02     $1,145.24       $437.12       $229.05
                    Rectal Procedure.
0151.............  Endoscopic           T                        18.23       $948.12       $245.46       $189.62
                    Retrograde
                    Cholangio-
                    Pancreatography
                    (ERCP).
0152.............  Percutaneous         T                         6.18       $321.42        $80.36        $64.28
                    Abdominal and
                    Biliary Procedures.
0153.............  Peritoneal and       T                        25.99     $1,351.71       $540.68       $270.34
                    Abdominal
                    Procedures.
0154.............  Hernia/Hydrocele     T                        26.98     $1,403.20       $491.12       $280.64
                    Procedures.
0155.............  Level II Anal/       T                        10.05       $522.69       $188.17       $104.54
                    Rectal Procedure.
0156.............  Level II Urinary     T                         3.10       $161.23        $48.37        $32.25
                    and Anal
                    Procedures.
0157.............  Colorectal Cancer    S                         2.73       $141.98        $22.19        $28.40
                    Screening: Barium
                    Enema.
0158.............  Colorectal Cancer    T                         7.56       $393.19  ............        $98.30
                    Screening:
                    Colonoscopy.
0159.............  Colorectal Cancer    S                         2.48       $128.98  ............        $32.25
                    Screening:
                    Flexible
                    Sigmoidoscopy.
0160.............  Level I              T                         6.44       $334.94       $105.06        $66.99
                    Cystourethroscopy
                    and other
                    Genitourinary
                    Procedures.
0161.............  Level II             T                        16.03       $833.70       $249.36       $166.74
                    Cystourethroscopy
                    and other
                    Genitourinary
                    Procedures.
0162.............  Level III            T                        21.50     $1,118.19  ............       $223.64
                    Cystourethroscopy
                    and other
                    Genitourinary
                    Procedures.
0163.............  Level IV             T                        24.77     $1,288.26  ............       $257.65
                    Cystourethroscopy
                    and other
                    Genitourinary
                    Procedures.
0164.............  Level I Urinary and  T                         1.18        $61.37        $18.41        $12.27
                    Anal Procedures.
0165.............  Level III Urinary    T                        12.62       $656.35  ............       $131.27
                    and Anal
                    Procedures.
0166.............  Level I Urethral     T                        15.63       $812.90       $218.73       $162.58
                    Procedures.
0167.............  Level III Urethral   T                        27.15     $1,412.04       $555.84       $282.41
                    Procedures.
0168.............  Level II Urethral    T                        24.10     $1,253.42       $405.60       $250.68
                    Procedures.
0169.............  Lithotripsy........  T                        46.44     $2,415.30     $1,115.69       $483.06
0170.............  Dialysis...........  S                         4.79       $249.12  ............        $49.82
0179.............  Urinary              T                        81.28     $4,227.29     $1,817.73       $845.46
                    Incontinence
                    Procedures.
0180.............  Circumcision.......  T                        18.95       $985.57       $304.87       $197.11
0181.............  Penile Procedures..  T                        29.88     $1,554.03       $621.82       $310.81
0182.............  Insertion of Penile  T                        83.80     $4,358.35     $1,438.26       $871.67
                    Prosthesis.
0183.............  Testes/Epididymis    T                        22.19     $1,154.08       $448.94       $230.82
                    Procedures.
0184.............  Prostate Biopsy....  T                         3.66       $190.35        $95.18        $38.07
0187.............  Miscellaneous        X                         4.19       $217.92        $94.96        $43.58
                    Placement/
                    Repositioning.
0188.............  Level II Female      T                         1.12        $58.25        $11.95        $11.65
                    Reproductive Proc.
0189.............  Level III Female     T                         1.63        $84.77        $18.60        $16.95
                    Reproductive Proc.
0190.............  Surgical             T                        20.06     $1,043.30       $424.28       $208.66
                    Hysteroscopy.
0191.............  Level I Female       T                         0.22        $11.44         $3.32         $2.29
                    Reproductive Proc.
0192.............  Level IV Female      T                         2.94       $152.91        $42.81        $30.58
                    Reproductive Proc.
0193.............  Level V Female       T                        14.57       $757.77       $171.13       $151.55
                    Reproductive Proc.
0194.............  Level VI Female      T                        18.88       $981.93       $397.84       $196.39
                    Reproductive Proc.
0195.............  Level VII Female     T                        24.37     $1,267.46       $483.80       $253.49
                    Reproductive Proc.
0196.............  Dilation and         T                        16.32       $848.79       $338.23       $169.76
                    Curettage.
0197.............  Infertility          T                         1.19        $61.89        $24.76        $12.38
                    Procedures.
0198.............  Pregnancy and        T                         1.33        $69.17        $32.92        $13.83
                    Neonatal Care
                    Procedures.
0199.............  Vaginal Delivery...  T                         5.69       $295.93        $72.98        $59.19
0200.............  Therapeutic          T                        14.49       $753.61       $307.83       $150.72
                    Abortion.
0201.............  Spontaneous          T                        15.84       $823.82       $329.65       $164.76
                    Abortion.
0202.............  Level VIII Female    T                        39.09     $2,033.03       $996.18       $406.61
                    Reproductive Proc.
0203.............  Level IV Nerve       T                        10.96       $570.02       $256.51       $114.00
                    Injections.
0204.............  Level I Nerve        T                         2.13       $110.78        $42.10        $22.16
                    Injections.
0206.............  Level II Nerve       T                         4.89       $254.32        $75.55        $50.86
                    Injections.
0207.............  Level III Nerve      T                         5.97       $310.49       $123.69        $62.10
                    Injections.
0208.............  Laminotomies and     T                        39.95     $2,077.76  ............       $415.55
                    Laminectomies.
0209.............  Extended EEG         S                        12.09       $628.79       $280.58       $125.76
                    Studies and Sleep
                    Studies, Level II.
0212.............  Nervous System       T                         3.53       $183.59        $84.45        $36.72
                    Injections.
0213.............  Extended EEG         S                         3.38       $175.79        $70.41        $35.16
                    Studies and Sleep
                    Studies, Level I.
0214.............  Electroencephalogra  S                         2.37       $123.26        $61.63        $24.65
                    m.
0215.............  Level I Nerve and    S                         0.60        $31.21  ............         $6.24
                    Muscle Tests.
0216.............  Level III Nerve and  S                         3.06       $159.15        $71.62        $31.83
                    Muscle Tests.
0218.............  Level II Nerve and   S                         1.06        $55.13  ............        $11.03
                    Muscle Tests.
0220.............  Level I Nerve        T                        16.66       $866.47  ............       $173.29
                    Procedures.
0221.............  Level II Nerve       T                        25.35     $1,318.43       $463.62       $263.69
                    Procedures.

[[Page 52154]]

 
0222.............  Implantation of      T                       140.56     $7,310.39  ............     $1,462.08
                    Neurological
                    Device.
0223.............  Implantation of      T                        20.30     $1,055.78  ............       $211.16
                    Pain Management
                    Device.
0224.............  Implantation of      T                        39.14     $2,035.63       $453.41       $407.13
                    Reservoir/Pump/
                    Shunt.
0225.............  Implantation of      T                        44.47     $2,312.84  ............       $462.57
                    Neurostimulator
                    Electrodes.
0226.............  Implantation of      T                        44.20     $2,298.80  ............       $459.76
                    Drug Infusion
                    Reservoir.
0227.............  Implantation of      T                       128.03     $6,658.71  ............     $1,331.74
                    Drug Infusion
                    Device.
0228.............  Creation of Lumbar   T                        55.05     $2,863.10       $696.46       $572.62
                    Subarachnoid Shunt.
0229.............  Transcatherter       T                        49.00     $2,548.44       $662.59       $509.69
                    Placement of
                    Intravascular
                    Shunts.
0230.............  Level I Eye Tests &  S                         0.78        $40.57        $15.82         $8.11
                    Treatments.
0231.............  Level III Eye Tests  S                         2.24       $116.50        $52.43        $23.30
                    & Treatments.
0232.............  Level I Anterior     T                         4.91       $255.36       $112.36        $51.07
                    Segment Eye
                    Procedures.
0233.............  Level II Anterior    T                        13.43       $698.48       $266.33       $139.70
                    Segment Eye
                    Procedures.
0234.............  Level III Anterior   T                        21.45     $1,115.59       $535.48       $223.12
                    Segment Eye
                    Procedures.
0235.............  Level I Posterior    T                         5.62       $292.29        $81.84        $58.46
                    Segment Eye
                    Procedures.
0236.............  Level II Posterior   T                        20.62     $1,072.43  ............       $214.49
                    Segment Eye
                    Procedures.
0237.............  Level III Posterior  T                        35.09     $1,825.00       $818.54       $365.00
                    Segment Eye
                    Procedures.
0238.............  Level I Repair and   T                         3.04       $158.11        $58.96        $31.62
                    Plastic Eye
                    Procedures.
0239.............  Level II Repair and  T                         6.91       $359.38       $115.94        $71.88
                    Plastic Eye
                    Procedures.
0240.............  Level III Repair     T                        16.99       $883.63       $315.31       $176.73
                    and Plastic Eye
                    Procedures.
0241.............  Level IV Repair and  T                        21.89     $1,138.48       $384.47       $227.70
                    Plastic Eye
                    Procedures.
0242.............  Level V Repair and   T                        28.87     $1,501.50       $597.36       $300.30
                    Plastic Eye
                    Procedures.
0243.............  Strabismus/Muscle    T                        20.94     $1,089.07       $431.39       $217.81
                    Procedures.
0244.............  Corneal Transplant.  T                        38.14     $1,983.62       $851.42       $396.72
0245.............  Level I Cataract     T                        14.39       $748.41       $251.21       $149.68
                    Procedures without
                    IOL Insert.
0246.............  Cataract Procedures  T                        23.59     $1,226.89       $495.96       $245.38
                    with IOL Insert.
0247.............  Laser Eye            T                         4.97       $258.48       $108.56        $51.70
                    Procedures Except
                    Retinal.
0248.............  Laser Retinal        T                         4.44       $230.92        $96.99        $46.18
                    Procedures.
0249.............  Level II Cataract    T                        27.75     $1,443.25       $524.67       $288.65
                    Procedures without
                    IOL Insert.
0250.............  Nasal Cauterization/ T                         1.68        $87.38        $30.58        $17.48
                    Packing.
0251.............  Level I ENT          T                         1.92        $99.86  ............        $19.97
                    Procedures.
0252.............  Level II ENT         T                         6.27       $326.10       $114.24        $65.22
                    Procedures.
0253.............  Level III ENT        T                        14.79       $769.21       $284.61       $153.84
                    Procedures.
0254.............  Level IV ENT         T                        21.89     $1,138.48       $352.93       $227.70
                    Procedures.
0256.............  Level V ENT          T                        35.51     $1,846.84  ............       $369.37
                    Procedures.
0258.............  Tonsil and Adenoid   T                        21.15     $1,099.99       $437.25       $220.00
                    Procedures.
0259.............  Level VI ENT         T                       291.05    $15,137.22     $7,417.24     $3,027.44
                    Procedures.
0260.............  Level I Plain Film   X                         0.81        $42.13        $23.17         $8.43
                    Except Teeth.
0261.............  Level II Plain Film  X                         1.37        $71.25        $34.15        $14.25
                    Except Teeth
                    Including Bone
                    Density
                    Measurement.
0262.............  Plain Film of Teeth  X                         0.60        $31.21        $10.30         $6.24
0263.............  Level I              X                         1.99       $103.50        $45.54        $20.70
                    Miscellaneous
                    Radiology
                    Procedures.
0264.............  Level II             X                         2.75       $143.02        $77.23        $28.60
                    Miscellaneous
                    Radiology
                    Procedures.
0265.............  Level I Diagnostic   S                         1.04        $54.09        $29.75        $10.82
                    Ultrasound Except
                    Vascular.
0266.............  Level II Diagnostic  S                         1.70        $88.42        $48.63        $17.68
                    Ultrasound Except
                    Vascular.
0267.............  Level III            S                         2.58       $134.18        $65.52        $26.84
                    Diagnostic
                    Ultrasound Except
                    Vascular.
0268.............  Ultrasound Guidance  S                         1.48        $76.97  ............        $15.39
                    Procedures.
0269.............  Level III            S                         3.42       $177.87        $92.49        $35.57
                    Echocardiogram
                    Except
                    Transesophageal.
0270.............  Transesophageal      S                         5.65       $293.85       $146.79        $58.77
                    Echocardiogram.
0271.............  Mammography........  S                         0.69        $35.89        $16.80         $7.18
0272.............  Level I Fluoroscopy  X                         1.38        $71.77        $38.64        $14.35
0274.............  Myelography........  S                         3.21       $166.95        $80.14        $33.39
0275.............  Arthrography.......  S                         3.09       $160.71        $69.09        $32.14
0276.............  Level I Digestive    S                         1.69        $87.90        $41.72        $17.58
                    Radiology.
0277.............  Level II Digestive   S                         2.50       $130.02        $60.47        $26.00
                    Radiology.
0278.............  Diagnostic           S                         2.65       $137.82        $66.07        $27.56
                    Urography.
0279.............  Level II             S                         8.41       $437.40       $174.57        $87.48
                    Angiography and
                    Venography except
                    Extremity.
0280.............  Level III            S                        15.51       $806.66       $353.85       $161.33
                    Angiography and
                    Venography except
                    Extremity.
0281.............  Venography of        S                         5.23       $272.01       $115.16        $54.40
                    Extremity.
0282.............  Miscellaneous        S                         1.76        $91.54        $44.51        $18.31
                    Computerized Axial
                    Tomography.
0283.............  Computerized Axial   S                         4.75       $247.04  ............        $49.41
                    Tomography with
                    Contrast Material.
0284.............  Magnetic Resonance   S                         7.74       $402.55       $201.02        $80.51
                    Imaging and
                    Magnetic Resonance
                    Angiography with
                    Contrast Material.
0285.............  Myocardial Positron  S                        16.73       $870.11       $374.15       $174.02
                    Emission
                    Tomography (PET).
0286.............  Myocardial Scans...  S                         6.94       $360.94       $198.52        $72.19
0287.............  Complex Venography.  S                         7.13       $370.82       $114.51        $74.16
0288.............  Bone Density:Axial   S                         1.38        $71.77  ............        $14.35
                    Skeleton.

[[Page 52155]]

 
0289.............  Needle Localization  X                         1.84        $95.70        $44.80        $19.14
                    for Breast Biopsy.
0290.............  Level I Diagnostic   S                         2.16       $112.34        $56.17        $22.47
                    Nuclear Medicine
                    Excluding
                    Myocardial Scans.
0291.............  Level II Diagnostic  S                         4.19       $217.92       $108.96        $43.58
                    Nuclear Medicine
                    Excluding
                    Myocardial Scans.
0292.............  Level III            S                         4.53       $235.60       $117.80        $47.12
                    Diagnostic Nuclear
                    Medicine Excluding
                    Myocardial Scans.
0294.............  Level II             S                         4.45       $231.44       $127.29        $46.29
                    Therapeutic
                    Nuclear Medicine.
0295.............  Level I Therapeutic  S                         3.86       $200.75       $110.41        $40.15
                    Nuclear Medicine.
0296.............  Level I Therapeutic  S                         2.12       $110.26        $52.92        $22.05
                    Radiologic
                    Procedures.
0297.............  Level II             S                         7.80       $405.67       $172.51        $81.13
                    Therapeutic
                    Radiologic
                    Procedures.
0299.............  Miscellaneous        S                         6.20       $322.46  ............        $64.49
                    Radiation
                    Treatment.
0300.............  Level I Radiation    S                         1.53        $79.57  ............        $15.91
                    Therapy.
0301.............  Level II Radiation   S                         2.22       $115.46  ............        $23.09
                    Therapy.
0302.............  Level III Radiation  S                        10.17       $528.93       $200.99       $105.79
                    Therapy.
0303.............  Treatment Device     X                         2.93       $152.39        $68.58        $30.48
                    Construction.
0304.............  Level I Therapeutic  X                         1.69        $87.90        $41.52        $17.58
                    Radiation
                    Treatment
                    Preparation.
0305.............  Level II             X                         3.87       $201.27        $91.38        $40.25
                    Therapeutic
                    Radiation
                    Treatment
                    Preparation.
0310.............  Level III            X                        14.38       $747.89       $339.05       $149.58
                    Therapeutic
                    Radiation
                    Treatment
                    Preparation.
0312.............  Radioelement         S                         4.23       $220.00  ............        $44.00
                    Applications.
0313.............  Brachytherapy......  S                        13.80       $717.72  ............       $143.54
0314.............  Hyperthermic         S                         4.24       $220.52       $101.77        $44.10
                    Therapies.
0320.............  Electroconvulsive    S                         4.46       $231.96        $80.06        $46.39
                    Therapy.
0321.............  Biofeedback and      S                         1.27        $66.05        $21.78        $13.21
                    Other Training.
0322.............  Brief Individual     S                         1.44        $74.89        $12.40        $14.98
                    Psychotherapy.
0323.............  Extended Individual  S                         1.95       $101.42        $21.26        $20.28
                    Psychotherapy.
0324.............  Family               S                         2.71       $140.94  ............        $28.19
                    Psychotherapy.
0325.............  Group Psychotherapy  S                         1.55        $80.61        $18.27        $16.12
0330.............  Dental Procedures..  S                         0.64        $33.29  ............         $6.66
0332.............  Computerized Axial   S                         3.62       $188.27        $91.27        $37.65
                    Tomography and
                    Computerized
                    Angiography
                    without Contrast
                    Material.
0333.............  Computerized Axial   S                         5.69       $295.93       $146.98        $59.19
                    Tomography and
                    Computerized Angio
                    w/o Contrast
                    Material followed
                    by Contrast.
0335.............  Magnetic Resonance   S                         6.46       $335.98       $151.46        $67.20
                    Imaging,
                    Miscellaneous.
0336.............  Magnetic Resonance   S                         7.01       $364.58       $176.94        $72.92
                    Imaging and
                    Magnetic Resonance
                    Angiography
                    without Contrast.
0337.............  MRI and Magnetic     S                         9.86       $512.81       $240.77       $102.56
                    Resonance
                    Angiography
                    without Contrast
                    Material followed
                    by Contrast
                    Material.
0339.............  Observation........  S                         7.60       $395.27  ............        $79.05
0340.............  Minor Ancillary      X                         0.66        $34.33  ............         $6.87
                    Procedures.
0341.............  Skin Tests and       X                         0.16         $8.32         $3.08         $1.66
                    Miscellaneous Red
                    Blood Cell Tests.
0342.............  Level I Pathology..  X                         0.23        $11.96         $5.88         $2.39
0343.............  Level II Pathology.  X                         0.47        $24.44        $13.20         $4.89
0344.............  Level III Pathology  X                         0.66        $34.33        $18.54         $6.87
0345.............  Level I Transfusion  X                         0.19         $9.88         $3.06         $1.98
                    Laboratory
                    Procedures.
0346.............  Level II             X                         0.42        $21.84         $5.46         $4.37
                    Transfusion
                    Laboratory
                    Procedures.
0347.............  Level III            X                         0.98        $50.97        $12.74        $10.19
                    Transfusion
                    Laboratory
                    Procedures.
0348.............  Fertility            X                         0.83        $43.17  ............         $8.63
                    Laboratory
                    Procedures.
0352.............  Level I Injections.  X                         0.14         $7.28  ............         $1.46
0353.............  Level II Allergy     X                         0.43        $22.36  ............         $4.47
                    Injections.
0354.............  Administration of    K                         0.09         $4.68  ............  ............
                    Influenza/
                    Pneumonia Vaccine.
0355.............  Level I              K                         0.24        $12.48  ............         $2.50
                    Immunizations.
0356.............  Level II             K                         0.69        $35.89  ............         $7.18
                    Immunizations.
0359.............  Level II Injections  X                         0.83        $43.17  ............         $8.63
0360.............  Level I Alimentary   X                         1.65        $85.81        $42.91        $17.16
                    Tests.
0361.............  Level II Alimentary  X                         3.55       $184.63        $83.23        $36.93
                    Tests.
0362.............  Level III            X                         2.83       $147.19  ............        $29.44
                    Otorhinolaryngolog
                    ic Function Tests.
0363.............  Level I              X                         0.76        $39.53        $14.63         $7.91
                    Otorhinolaryngolog
                    ic Function Tests.
0364.............  Level I Audiometry.  X                         0.45        $23.40         $9.13         $4.68
0365.............  Level II Audiometry  X                         1.31        $68.13        $20.16        $13.63
0367.............  Level I Pulmonary    X                         0.60        $31.21        $15.61         $6.24
                    Test.
0368.............  Level II Pulmonary   X                         0.96        $49.93        $24.97         $9.99
                    Tests.
0369.............  Level III Pulmonary  X                         2.39       $124.30        $41.02        $24.86
                    Tests.
0370.............  Allergy Tests......  X                         0.74        $38.49        $11.16         $7.70
0371.............  Level I Allergy      X                         0.50        $26.00  ............         $5.20
                    Injections.
0372.............  Therapeutic          X                         0.56        $29.13        $10.09         $5.83
                    Phlebotomy.
0373.............  Neuropsychological   X                         2.37       $123.26  ............        $24.65
                    Testing.
0374.............  Monitoring           X                         1.20        $62.41  ............        $12.48
                    Psychiatric Drugs.

[[Page 52156]]

 
0600.............  Low Level Clinic     V                         0.91        $47.33  ............         $9.47
                    Visits.
0601.............  Mid Level Clinic     V                         1.04        $54.09  ............        $10.82
                    Visits.
0602.............  High Level Clinic    V                         1.57        $81.65  ............        $16.33
                    Visits.
0610.............  Low Level Emergency  V                         1.49        $77.49        $19.57        $15.50
                    Visits.
0611.............  Mid Level Emergency  V                         2.66       $138.34        $36.47        $27.67
                    Visits.
0612.............  High Level           V                         4.53       $235.60        $54.14        $47.12
                    Emergency Visits.
0620.............  Critical Care......  S                        10.25       $533.09       $150.55       $106.62
0656.............  Transcatheter        T                        90.90     $4,927.70  ............       $985.54
                    Placement of Drug-
                    Eluting Coronary
                    Stents.
0657.............  Placement of Tissue  S                         1.38        $71.77  ............        $14.35
                    Clips.
0658.............  Percutaneous Breast  T                         5.57       $289.69  ............        $57.94
                    Biopsies.
0659.............  Hyperbaric Oxygen..  S                         3.12       $162.27  ............        $32.45
0660.............  Level II             X                         1.65        $85.81        $31.75        $17.16
                    Otorhinolaryngolog
                    ic Function Tests.
0661.............  Level IV Pathology.  X                         3.46       $179.95        $98.97        $35.99
0662.............  CT Angiography.....  S                         5.96       $309.97       $170.48        $61.99
0663.............  Stereoteactic        S                        63.69     $3,312.45  ............       $662.49
                    Radiosurgery.
0664.............  Proton Beam          S                        11.03       $573.66  ............       $114.73
                    Radiation Therapy.
0665.............  Bone                 S                         0.73        $37.97  ............         $7.59
                    Density:Appendicul
                    arSkeleton.
0666.............  Myocardial Add-on    S                         1.59        $82.69        $45.48        $16.54
                    Scans.
0667.............  Nonmyocardial        S                        18.68       $971.53  ............       $194.31
                    Positron Emission
                    Tomography (PET).
0668.............  Level I Angiography  S                         5.36       $278.77       $122.66        $55.75
                    and Venography
                    except Extremity.
0669.............  Digital Mammography  S                         0.95        $49.41  ............         $9.88
0670.............  Intravenous and      S                        14.78       $768.69       $276.73       $153.74
                    Intracardiac
                    Ultrasound.
0671.............  Level II             S                         1.68        $87.38        $45.44        $17.48
                    Echocardiogram
                    Except
                    Transesophageal.
0672.............  Level IV Posterior   T                        39.95     $2,077.76     $1,038.88       $415.55
                    Segment Procedures.
0673.............  Level IV Anterior    T                        27.47     $1,428.69       $685.77       $285.74
                    Segment Eye
                    Procedures.
0674.............  Prostate             T                        69.25     $3,601.62  ............       $720.32
                    Cryoablation.
0675.............  Prostatic            T                        51.57     $2,682.10  ............       $536.42
                    Thermotherapy.
0676.............  Level II             T                         4.62       $240.28        $64.88        $48.06
                    Transcatheter
                    Thrombolysis.
0677.............  Level I              T                         2.80       $145.63  ............        $29.13
                    Transcatheter
                    Thrombolysis.
0678.............  External             T                         2.55       $132.62  ............        $26.52
                    Counterpulsation.
0679.............  Level II             S                         5.70       $296.45       $100.79        $59.29
                    Resuscitation and
                    Cardioversion.
0680.............  Insertion of         S                        51.95     $2,701.87  ............       $540.37
                    Patient Activated
                    Event Recorders.
0681.............  Knee Arthroplasty..  T                       158.14     $8,224.70     $3,289.88     $1,644.94
0682.............  Level V Debridement  T                         6.74       $350.54       $161.25        $70.11
                    & Destruction.
0683.............  Level II             S                         2.11       $109.74        $39.51        $21.95
                    Photochemotherapy.
0684.............  Prostate             T                       103.47     $5,381.37  ............     $1,076.27
                    Brachytherapy.
0685.............  Level III Needle     T                         4.47       $232.48       $102.29        $46.50
                    Biopsy/Aspiration
                    Except Bone Marrow.
0686.............  Level III Skin       T                        11.30       $587.70       $270.34       $117.54
                    Repair.
0687.............  Revision/Removal of  T                        19.50     $1,014.18       $466.52       $202.84
                    Neurostimulator
                    Electrodes.
0688.............  Revision/Removal of  T                        30.58     $1,590.44       $779.32       $318.09
                    Neurostimulator
                    Pulse Generator
                    Receiver.
0689.............  Electronic Analysis  S                         0.60        $31.21        $12.03         $6.24
                    of Cardioverter-
                    defibrillators.
0690.............  Electronic Analysis  S                         0.45        $23.40        $10.63         $4.68
                    of Pacemakers and
                    other Cardiac
                    Devices.
0691.............  Electronic Analysis  S                         3.14       $163.31        $89.02        $32.66
                    of Programmable
                    Shunts/Pumps.
0692.............  Electronic Analysis  S                         0.85        $44.21        $24.32         $8.84
                    of Neurostimulator
                    Pulse Generators.
0693.............  Level II Breast      T                        39.30     $2,043.95       $798.17       $408.79
                    Reconstruction.
0694.............  Mohs Surgery.......  T                         3.90       $202.84        $81.14        $40.57
0695.............  Level VII            T                        19.65     $1,021.98       $266.59       $204.40
                    Debridement &
                    Destruction.
0697.............  Level I              S                         1.51        $78.53        $40.84        $15.71
                    Echocardiogram
                    Except
                    Transesophageal.
0698.............  Level II Eye Tests   S                         1.01        $52.53        $20.49        $10.51
                    & Treatments.
0699.............  Level IV Eye Tests   T                         2.37       $123.26        $55.47        $24.65
                    & Treatment.
0701.............  SR 89 chloride, per  K                         6.43       $334.42  ............        $66.88
                    mCi.
0702.............  SM 153 lexidronam,   K                        15.02       $781.18  ............       $156.24
                    50 mCi.
0706.............  New Technology -     S                 ............        $25.00  ............         $5.00
                    Level I ($0 - $50).
0707.............  New Technology -     S                 ............        $75.00  ............        $15.00
                    Level II ($50 -
                    $100).
0708.............  New Technology -     S                 ............       $150.00  ............        $30.00
                    Level III ($100 -
                    $200).
0709.............  New Technology -     S                 ............       $250.00  ............        $50.00
                    Level IV ($200 -
                    $300).
0710.............  New Technology -     S                 ............       $400.00  ............        $80.00
                    Level V ($300 -
                    $500).
0711.............  New Technology -     S                 ............       $625.00  ............       $125.00
                    Level VI ($500 -
                    $750).
0712.............  New Technology -     S                 ............       $875.00  ............       $175.00
                    Level VII ($750 -
                    $1000).
0713.............  New Technology -     S                 ............     $1,125.00  ............       $225.00
                    Level VIII ($1000 -
                     $1250).
0714.............  New Technology -     S                 ............     $1,375.00  ............       $275.00
                    Level IX ($1250 -
                    $1500).
0715.............  New Technology -     S                 ............     $1,625.00  ............       $325.00
                    Level X ($1500 -
                    $1750).
0716.............  New Technology -     S                 ............     $1,875.00  ............       $375.00
                    Level XI ($1750 -
                    $2000).

[[Page 52157]]

 
0717.............  New Technology -     S                 ............     $2,250.00  ............       $450.00
                    Level XII ($2000 -
                    $2500).
0718.............  New Technology -     S                 ............     $2,750.00  ............       $550.00
                    Level XIII ($2500 -
                     $3000).
0719.............  New Technology-      S                 ............     $3,250.00  ............       $650.00
                    Level XIV ($3000-
                    $3500).
0720.............  New Technology -     S                 ............     $4,250.00  ............       $850.00
                    Level XV ($3500 -
                    $5000).
0721.............  New Technology -     S                 ............     $5,500.00  ............     $1,100.00
                    Level XVI ($5000 -
                    $6000).
0726.............  Dexrazoxane hcl      K                         2.40       $124.82  ............        $24.96
                    injection, 250 mg.
0728.............  Filgrastim 300 mcg   K                         2.24       $116.50  ............        $23.30
                    injection.
0730.............  Pamidronate          K                         3.46       $179.95  ............        $35.99
                    disodium , 30 mg.
0732.............  Mesna injection 200  K                         0.55        $28.60  ............         $5.72
                    mg.
0733.............  Non esrd epoetin     K                         0.19         $9.88  ............         $1.98
                    alpha inj, 1000 u.
0734.............  Darbepoetin alfa, 1  G                 ............         $4.74  ............          $.68
                    mcg.
0800.............  Leuprolide acetate,  K                         4.15       $215.84  ............        $43.17
                    3.75 mg.
0802.............  Etoposide oral 50    K                         0.54        $28.08  ............         $5.62
                    mg.
0807.............  Aldesleukin/single   K                         6.09       $316.73  ............        $63.35
                    use vial.
0810.............  Goserelin acetate    K                         5.94       $308.93  ............        $61.79
                    implant 3.6 mg.
0811.............  Carboplatin          K                         1.58        $82.17  ............        $16.43
                    injection 50 mg.
0813.............  Cisplatin 10 mg      K                         0.47        $24.44  ............         $4.89
                    injection.
0820.............  Daunorubicin 10 mg.  K                         2.27       $118.06  ............        $23.61
0821.............  Daunorubicin         K                         3.17       $164.87  ............        $32.97
                    citrate liposom 10
                    mg.
0822.............  Diethylstilbestrol   K                         2.21       $114.94  ............        $22.99
                    injection 250 mg.
0823.............  Docetaxel, 20 mg...  K                         4.01       $208.56  ............        $41.71
0827.............  Floxuridine          K                         2.42       $125.86  ............        $25.17
                    injection 500 mg.
0828.............  Gemcitabine HCL 200  K                         1.49        $77.49  ............        $15.50
                    mg.
0830.............  Irinotecan           K                         1.86        $96.74  ............        $19.35
                    injection 20 mg.
0831.............  Ifosfomide           K                         2.06       $107.14  ............        $21.43
                    injection 1 gm.
0832.............  Idarubicin hcl       K                         4.57       $237.68  ............        $47.54
                    injection 5 mg.
0838.............  Interferon gamma 1-  K                         2.49       $129.50  ............        $25.90
                    b inj, 3 million u.
0840.............  Melphalan hydrochl   K                         4.09       $212.72  ............        $42.54
                    50 mg.
0842.............  Fludarabine          K                         3.30       $171.63  ............        $34.33
                    phosphate inj 50
                    mg.
0843.............  Pegaspargase, singl  K                         2.38       $123.78  ............        $24.76
                    dose vial.
0844.............  Pentostatin          K                        21.32     $1,108.83  ............       $221.77
                    injection, 10 mg.
0849.............  Rituximab, 100 mg..  K                         5.71       $296.97  ............        $59.39
0852.............  Topotecan, 4 mg....  K                         7.61       $395.79  ............        $79.16
0855.............  Vinorelbine          K                         1.10        $57.21  ............        $11.44
                    tartrate, 10 mg.
0856.............  Porfimer sodium, 75  K                        26.35     $1,370.44  ............       $274.09
                    mg.
0857.............  Bleomycin sulfate    K                         3.10       $161.23  ............        $32.25
                    injection 15 u.
0858.............  Cladribine, 1mg....  K                         0.84        $43.69  ............         $8.74
0861.............  Leuprolide acetate   K                         0.84        $43.69  ............         $8.74
                    injection 1 mg.
0862.............  Mitomycin 5 mg inj.  K                         1.18        $61.37  ............        $12.27
0863.............  Paclitaxel           K                         2.50       $130.02  ............        $26.00
                    injection, 30 mg.
0864.............  Mitoxantrone hcl, 5  K                         3.02       $157.07  ............        $31.41
                    mg.
0884.............  Rho d immune         K                         0.70        $36.41  ............         $7.28
                    globulin inj, 1
                    dose pkg.
0888.............  Cyclosporine oral    K                         0.04         $2.08  ............          $.42
                    100 mg.
0890.............  Lymphocyte immune    K                         3.64       $189.31  ............        $37.86
                    globulin 250 mg.
0891.............  Tacrolimus oral per  K                         0.02         $1.04  ............          $.21
                    1 mg.
0900.............  Alglucerase          K                         0.53        $27.56  ............         $5.51
                    injection, per 10
                    u.
0901.............  Alpha 1 proteinase   K                         0.02         $1.04  ............          $.21
                    inhibitor, 10 mg.
0902.............  Botulinum toxin a,   K                         0.05         $2.60  ............          $.52
                    per unit.
0903.............  Cytomegalovirus imm  K                         0.34        $17.68  ............         $3.54
                    IV/vial.
0905.............  Immune globulin 500  K                         0.45        $23.40  ............         $4.68
                    mg.
0909.............  Interferon beta-1a,  K                         2.77       $144.06  ............        $28.81
                    33 mcg.
0916.............  Injection            K                         0.05         $2.60  ............          $.52
                    imiglucerase /unit.
0925.............  Factor viii per iu.  K                         0.01          $.52  ............          $.10
0926.............  Factor VIII          K                         0.02         $1.04  ............          $.21
                    (porcine) per iu.
0927.............  Factor viii          K                         0.01          $.52  ............          $.10
                    recombinant per iu.
0928.............  Factor ix complex    K                         0.01          $.52  ............          $.10
                    per iu.
0929.............  Anti-inhibitor per   K                         0.01          $.52  ............          $.10
                    iu.
0930.............  Antithrombin iii     K                         0.01          $.52  ............          $.10
                    injection per iu.
0931.............  Factor IX non-       K                         0.01          $.52  ............          $.10
                    recombinant, per
                    iu.
0932.............  Factor IX            K                         0.03         $1.56  ............          $.31
                    recombinant, per
                    iu.
0949.............  Plasma, Pooled       K                         1.26        $65.53  ............        $13.11
                    Multiple Donor,
                    Solvent/Detergent
                    T.
0950.............  Blood (Whole) For    K                         1.25        $65.01  ............        $13.00
                    Transfusion.
0952.............  Cryoprecipitate....  K                         0.53        $27.56  ............         $5.51
0954.............  RBC leukocytes       K                         1.59        $82.69  ............        $16.54
                    reduced.
0955.............  Plasma, Fresh        K                         0.71        $36.93  ............         $7.39
                    Frozen.
0956.............  Plasma Protein       K                         1.94       $100.90  ............        $20.18
                    Fraction.
0957.............  Platelet             K                         0.67        $34.85  ............         $6.97
                    Concentrate.
0958.............  Platelet Rich        K                         1.12        $58.25  ............        $11.65
                    Plasma.
0959.............  Red Blood Cells....  K                         1.12        $58.25  ............        $11.65

[[Page 52158]]

 
0960.............  Washed Red Blood     K                         1.42        $73.85  ............        $14.77
                    Cells.
0961.............  Infusion, Albumin    K                         0.47        $24.44  ............         $4.89
                    (Human) 5%, 50 ml.
0963.............  Albumin (human),     K                         2.37       $123.26  ............        $24.65
                    5%, 250 ml.
0964.............  Albumin (human),     K                         0.50        $26.00  ............         $5.20
                    25%, 20 ml.
0965.............  Albumin (human),     K                         1.25        $65.01  ............        $13.00
                    25%, 50ml.
0966.............  Plasmaprotein        K                         9.71       $505.01  ............       $101.00
                    fract,5%,250ml.
0970.............  New Technology -     T                 ............        $25.00  ............         $5.00
                    Level I ($0 - $50).
0971.............  New Technology -     T                 ............        $75.00  ............        $15.00
                    Level II ($50 -
                    $100).
0972.............  New Technology -     T                 ............       $150.00  ............        $30.00
                    Level III ($100 -
                    $200).
0973.............  New Technology -     T                 ............       $250.00  ............        $50.00
                    Level IV ($200 -
                    $300).
0974.............  New Technology -     T                 ............       $400.00  ............        $80.00
                    Level V ($300 -
                    $500).
0975.............  New Technology -     T                 ............       $625.00  ............       $125.00
                    Level VI ($500 -
                    $750).
0976.............  New Technology -     T                 ............       $875.00  ............       $175.00
                    Level VII ($750 -
                    $1000).
0977.............  New Technology -     T                 ............     $1,125.00  ............       $225.00
                    Level VIII ($1000 -
                     $1250).
0978.............  New Technology -     T                 ............     $1,375.00  ............       $275.00
                    Level IX ($1250 -
                    $1500).
0979.............  New Technology -     T                 ............     $1,625.00  ............       $325.00
                    Level X ($1500 -
                    $1750).
0980.............  New Technology -     T                 ............     $1,875.00  ............       $375.00
                    Level XI ($1750 -
                    $2000).
0981.............  New Technology -     T                 ............     $2,250.00  ............       $450.00
                    Level XII ($2000 -
                    $2500).
0982.............  New Technology -     T                 ............     $2,750.00  ............       $550.00
                    Level XIII ($2500 -
                     $3000).
0983.............  New Technology-      T                 ............     $3,250.00  ............       $650.00
                    Level XIV ($3000-
                    $3500).
0984.............  New Technology -     T                 ............     $4,250.00  ............       $850.00
                    Level XV ($3500 -
                    $5000).
0985.............  New Technology -     T                 ............     $5,500.00  ............     $1,100.00
                    Level XVI ($5000 -
                    $6000).
1009.............  Cryoprecip reduced   K                         0.66        $34.33  ............         $6.87
                    plasma.
1010.............  Blood, L/R, CMV-neg  K                         1.67        $86.86  ............        $17.37
1011.............  Platelets, HLA-m, L/ K                         6.03       $313.61  ............        $62.72
                    R, unit.
1013.............  Platelet             K                         0.91        $47.33  ............         $9.47
                    concentrate, L/R,
                    unit.
1016.............  Blood, L/R, froz/    K                         1.09        $56.69  ............        $11.34
                    deglycerol/washed.
1017.............  Platelets, aph/      K                         4.78       $248.60  ............        $49.72
                    pher, L/R, CMV-
                    neg, unit.
1018.............  Blood, L/R,          K                         1.90        $98.82  ............        $19.76
                    irradiated.
1019.............  Platelets, aph/      K                         6.93       $360.42  ............        $72.08
                    pher, L/R,
                    irradiated, unit.
1058.............  TC 99M oxidronate,   G                 ............        $36.74  ............         $5.26
                    per vial.
1059.............  Cultured             K                        43.64     $2,269.67  ............       $453.93
                    chondrocytes
                    implnt.
1064.............  I-131 cap, each add  G                 ............         $5.86  ............          $.75
                    mCi.
1065.............  I-131 sol, each add  G                 ............        $15.81  ............         $2.03
                    mCi.
1084.............  Denileukin           K                        13.94       $725.01  ............       $145.00
                    diftitox, 300 MCG.
1086.............  Temozolomide,oral 5  K                         0.05         $2.60  ............          $.52
                    mg.
1091.............  IN 111               K                         4.36       $226.76  ............        $45.35
                    Oxyquinoline, per
                    .5 mCi.
1092.............  IN 111 Pentetate,    K                         4.78       $248.60  ............        $49.72
                    per 0.5 mCi.
1095.............  Technetium TC 99M    K                         0.25        $13.00  ............         $2.60
                    Depreotide.
1096.............  TC 99M Exametazime,  K                         3.35       $174.23  ............        $34.85
                    per dose.
1122.............  TC 99M arcitumomab,  K                         8.33       $433.23  ............        $86.65
                    per vial.
1167.............  Epirubicin hcl, 2    K                         0.32        $16.64  ............         $3.33
                    mg.
1178.............  Busulfan IV, 6 mg..  K                         0.53        $27.56  ............         $5.51
1203.............  Verteporfin for      K                        16.26       $845.67  ............       $169.13
                    injection.
1207.............  Octreotide acetate   K                         1.22        $63.45  ............        $12.69
                    depot 1mg.
1305.............  Apligraf...........  K                        12.47       $648.55  ............       $129.71
1348.............  I-131 sol, per 1-6   K                         0.19         $9.88  ............         $1.98
                    mCi.
1409.............  Factor viia          K                        13.53       $703.68  ............       $140.74
                    recombinant, per
                    1.2 mg.
1604.............  IN 111 capromab      K                         5.91       $307.37  ............        $61.47
                    pendetide, per
                    dose.
1605.............  Abciximab            K                         5.82       $302.69  ............        $60.54
                    injection, 10 mg.
1609.............  Rho(D) immune        K                         0.22        $11.44  ............         $2.29
                    globulin h, sd,
                    100 iu.
1611.............  Hylan G-F 20         K                         2.43       $126.38  ............        $25.28
                    injection, 16 mg.
1612.............  Daclizumab,          K                         3.77       $196.07  ............        $39.21
                    parenteral, 25 mg.
1613.............  Trastuzumab, 10 mg.  K                         0.66        $34.33  ............         $6.87
1614.............  Valrubicin, 200 mg.  K                         2.04       $106.10  ............        $21.22
1615.............  Basiliximab, 20 mg.  K                         9.64       $501.37  ............       $100.27
1618.............  Vonwillebrandfactrc  K                         0.01          $.52  ............          $.10
                    mplx, per iu.
1620.............  Technetium tc99m     K                         2.80       $145.63  ............        $29.13
                    bicisate.
1625.............  Indium 111-in        K                         4.57       $237.68  ............        $47.54
                    pentetreotide.
1628.............  Chromic phosphate    K                         1.35        $70.21  ............        $14.04
                    p32.
1716.............  Brachytx seed, Gold  K                         0.35        $18.20  ............         $3.64
                    198.
1718.............  Brachytx seed,       K                         0.64        $33.29  ............         $6.66
                    Iodine 125.
1719.............  Brachytxseed, Non-   K                         0.57        $29.65  ............         $5.93
                    HDR Ir-192.
1720.............  Brachytx seed,       K                         0.89        $46.29  ............         $9.26
                    Palladium 103.
1765.............  Adhesion barrier...  H                 ............  ............  ............  ............
1775.............  FDG, per dose (4-40  G                 ............       $475.00  ............        $68.00
                    mCi/ml).
1783.............  Ocular implant,      H                 ............  ............  ............  ............
                    aqueous drainage
                    assist device.
1888.............  Catheter, ablation,  H                 ............  ............  ............  ............
                    non-cardiac,
                    endovascular
                    (implantable.

[[Page 52159]]

 
1900.............  Lead, left           H                 ............  ............  ............  ............
                    ventricular
                    coronary venous
                    system.
2618.............  Probe, cryoablation  H                 ............  ............  ............  ............
7000.............  Amifostine, 500 mg.  K                         4.46       $231.96  ............        $46.39
7001.............  Amphotericin B       K                         2.05       $106.62  ............        $21.32
                    lipid complex, 50
                    mg.
7011.............  Oprelvekin           K                         2.52       $131.06  ............        $26.21
                    injection, 5 mg.
7024.............  Corticorelin ovine   K                         4.62       $240.28  ............        $48.06
                    triflutat.
7025.............  Digoxin immune FAB   K                         2.77       $144.06  ............        $28.81
                    (ovine).
7030.............  Hemin, per 1 mg....  K                         0.01          $.52  ............          $.10
7031.............  Octreotide acetate   K                         0.90        $46.81  ............         $9.36
                    injection.
7034.............  Somatropin           K                         0.78        $40.57  ............         $8.11
                    injection.
7035.............  Teniposide, 50 mg..  K                         1.24        $64.49  ............        $12.90
7038.............  Muromonab-CD3, 5 mg  K                         4.43       $230.40  ............        $46.08
7041.............  Tirofiban            K                         4.82       $250.68  ............        $50.14
                    hydrochloride 12.5
                    mg.
7042.............  Capecitabine, oral,  K                         0.03         $1.56  ............          $.31
                    150 mg.
7043.............  Infliximab           K                         0.74        $38.49  ............         $7.70
                    injection 10 mg.
7045.............  Trimetrexate         K                         1.23        $63.97  ............        $12.79
                    glucoronate.
7046.............  Doxorubicin hcl      K                         4.54       $236.12  ............        $47.22
                    liposome inj 10 mg.
7049.............  Filgrastim 480 mcg   K                         3.37       $175.27  ............        $35.05
                    injection.
7051.............  Leuprolide acetate   G                 ............     $5,399.80  ............       $773.02
                    implant, 65 mg.
9002.............  Tenecteplase, 50mg/  K                        25.46     $1,324.15  ............       $264.83
                    vial.
9003.............  Palivizumab, per     K                         9.34       $485.76  ............        $97.15
                    50mg.
9004.............  Gemtuzumab           K                         1.05        $54.61  ............        $10.92
                    ozogamicin inj,5mg.
9005.............  Reteplase injection  K                        10.84       $563.78  ............       $112.76
9009.............  Baclofen refill kit  K                         0.79        $41.09  ............         $8.22
                    - per 2000 mcg.
9010.............  Baclofen refill kit  K                         0.95        $49.41  ............         $9.88
                    - per 4000 mcg.
9012.............  Arsenic Trioxide...  G                 ............        $23.75  ............         $3.40
9015.............  Mycophenolate        G                 ............         $2.40  ............          $.34
                    mofetil oral 250
                    mg.
9016.............  Echocardiography     G                 ............       $118.75  ............        $17.00
                    contrast.
9018.............  Botulinum tox B,     G                 ............         $8.79  ............         $1.26
                    per 100 u.
9019.............  Caspofungin          G                 ............        $34.20  ............         $4.90
                    acetate, 5 mg.
9020.............  Sirolimus tablet, 1  K                         0.05         $2.60  ............          $.52
                    mg.
9104.............  Anti-thymocycte      K                         1.97       $102.46  ............        $20.49
                    globulin rabbit.
9105.............  Hep B imm glob, per  K                         1.58        $82.17  ............        $16.43
                    1 ml.
9106.............  Sirolimus, 1 mg....  K                         0.05         $2.60  ............          $.52
9108.............  Thyrotropin alfa,    K                         8.79       $457.16  ............        $91.43
                    per 1.1 mg.
9109.............  Tirofliban hcl, per  K                         2.32       $120.66  ............        $24.13
                    6.25 mg.
9110.............  Alemtuzumab, per ml  G                 ............       $486.88  ............        $69.70
9111.............  Inj, bivalirudin,    G                 ............       $397.81  ............        $56.95
                    per 250mg vial.
9112.............  Perflutren lipid     G                 ............       $148.20  ............        $21.22
                    micro, per 2ml.
9113.............  Inj pantoprazole     G                 ............        $22.80  ............         $3.26
                    sodium, vial.
9114.............  Nesiritide, per 1.5  G                 ............       $433.20  ............        $62.02
                    mg vial.
9115.............  Inj, zoledronic      G                 ............       $406.78  ............        $58.23
                    acid, per 2 mg.
9200.............  Orcel, per 36 cm2..  G                 ............     $1,135.25  ............       $162.52
9201.............  Dermagraft, per      G                 ............       $577.60  ............        $82.69
                    37.5 sq cm.
9217.............  Leuprolide acetate   K                         6.30       $327.66  ............        $65.53
                    suspnsion, 7.5 mg.
9500.............  Platelets,           K                         0.92        $47.85  ............         $9.57
                    irradiated.
9501.............  Platelets, pheresis  K                         5.10       $265.25  ............        $53.05
9502.............  Platelet pheresis    K                         1.99       $103.50  ............        $20.70
                    irradiated.
9503.............  Fresh frozen         K                         0.77        $40.05  ............         $8.01
                    plasma, ea unit.
9504.............  RBC deglycerolized.  K                         1.91        $99.34  ............        $19.87
9505.............  RBC irradiated.....  K                         1.82        $94.66  ............        $18.93
9506.............  Granulocytes,        K                         0.45        $23.40  ............         $4.68
                    pheresis.
----------------------------------------------------------------------------------------------------------------

    --------------------
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 52159]]



                                  Addendum B.--Payment Status by HCPCS Code and Related Information Calender Year 2003
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                National       Minimum
         CPT/HCPCS              Status  indicator              Description               APC        Relative       Payment     unadjusted    unadjusted
                                                                                                     weight         rate        copayment     copayment
--------------------------------------------------------------------------------------------------------------------------------------------------------
0002T.....................  C                          Endovas repr abdo ao         ............  ............  ............  ............  ............
                                                        aneurys.
0003T.....................  S                          Cervicography..............          0706  ............        $25.00  ............         $5.00
0005T.....................  C                          Perc cath stent/brain cv     ............  ............  ............  ............  ............
                                                        art.
0006T.....................  C                          Perc cath stent/brain cv     ............  ............  ............  ............  ............
                                                        art.

[[Page 52160]]

 
0007T.....................  C                          Perc cath stent/brain cv     ............  ............  ............  ............  ............
                                                        art.
0008T.....................  E                          Upper gi endoscopy w/suture  ............  ............  ............  ............  ............
0009T.....................  T                          Endometrial cryoablation...          0980  ............     $1,875.00  ............       $375.00
00100.....................  N                          Anesth, salivary gland.....  ............  ............  ............  ............  ............
00102.....................  N                          Anesth, repair of cleft lip  ............  ............  ............  ............  ............
00103.....................  N                          Anesth, blepharoplasty.....  ............  ............  ............  ............  ............
00104.....................  N                          Anesth, electroshock.......  ............  ............  ............  ............  ............
0010T.....................  A                          Tb test, gamma interferon..  ............  ............  ............  ............  ............
00120.....................  N                          Anesth, ear surgery........  ............  ............  ............  ............  ............
00124.....................  N                          Anesth, ear exam...........  ............  ............  ............  ............  ............
00126.....................  N                          Anesth, tympanotomy........  ............  ............  ............  ............  ............
0012T.....................  T                          Osteochondral knee                   0041         27.58     $1,434.41       $580.06       $286.88
                                                        autograft.
0013T.....................  T                          Osteochondral knee                   0041         27.58     $1,434.41       $580.06       $286.88
                                                        allograft.
00140.....................  N                          Anesth, procedures on eye..  ............  ............  ............  ............  ............
00142.....................  N                          Anesth, lens surgery.......  ............  ............  ............  ............  ............
00144.....................  N                          Anesth, corneal transplant.  ............  ............  ............  ............  ............
00145.....................  N                          Anesth, vitreoretinal surg.  ............  ............  ............  ............  ............
00147.....................  N                          Anesth, iridectomy.........  ............  ............  ............  ............  ............
00148.....................  N                          Anesth, eye exam...........  ............  ............  ............  ............  ............
0014T.....................  T                          Meniscal transplant, knee..          0041         27.58     $1,434.41       $580.06       $286.88
00160.....................  N                          Anesth, nose/sinus surgery.  ............  ............  ............  ............  ............
00162.....................  N                          Anesth, nose/sinus surgery.  ............  ............  ............  ............  ............
00164.....................  N                          Anesth, biopsy of nose.....  ............  ............  ............  ............  ............
0016T.....................  E                          Thermotx choroid vasc        ............  ............  ............  ............  ............
                                                        lesion.
00170.....................  N                          Anesth, procedure on mouth.  ............  ............  ............  ............  ............
00172.....................  N                          Anesth, cleft palate repair  ............  ............  ............  ............  ............
00174.....................  C                          Anesth, pharyngeal surgery.  ............  ............  ............  ............  ............
00176.....................  C                          Anesth, pharyngeal surgery.  ............  ............  ............  ............  ............
0017T.....................  E                          Photocoagulat macular        ............  ............  ............  ............  ............
                                                        drusen.
0018T.....................  S                          Transcranial magnetic                0215          0.60        $31.21  ............         $6.24
                                                        stimul.
00190.....................  N                          Anesth, face/skull bone      ............  ............  ............  ............  ............
                                                        surg.
00192.....................  C                          Anesth, facial bone surgery  ............  ............  ............  ............  ............
0019T.....................  A                          Extracorp shock wave tx, ms  ............  ............  ............  ............  ............
0020T.....................  A                          Extracorp shock wave tx, ft  ............  ............  ............  ............  ............
00210.....................  N                          Anesth, open head surgery..  ............  ............  ............  ............  ............
00212.....................  N                          Anesth, skull drainage.....  ............  ............  ............  ............  ............
00214.....................  C                          Anesth, skull drainage.....  ............  ............  ............  ............  ............
00215.....................  C                          Anesth, skull repair/fract.  ............  ............  ............  ............  ............
00216.....................  N                          Anesth, head vessel surgery  ............  ............  ............  ............  ............
00218.....................  N                          Anesth, special head         ............  ............  ............  ............  ............
                                                        surgery.
0021T.....................  C                          Fetal oximetry, trnsvag/     ............  ............  ............  ............  ............
                                                        cerv.
00220.....................  N                          Anesth, intrcrn nerve......  ............  ............  ............  ............  ............
00222.....................  N                          Anesth, head nerve surgery.  ............  ............  ............  ............  ............
0023T.....................  A                          Phenotype drug test, hiv 1.  ............  ............  ............  ............  ............
0024T.....................  C                          Transcath cardiac reduction  ............  ............  ............  ............  ............
0025T.....................  S                          Ultrasonic pachymetry......          0230          0.78        $40.57        $15.82         $8.11
0026T.....................  A                          Measure remnant              ............  ............  ............  ............  ............
                                                        lipoproteins.
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  ............  ............  ............  ............  ............

[[Page 52161]]

 
00524.....................  C                          Anesth, chest drainage.....  ............  ............  ............  ............  ............
00528.....................  N                          Anesth, chest partition      ............  ............  ............  ............  ............
                                                        view.
00530.....................  N                          Anesth, pacemaker insertion  ............  ............  ............  ............  ............
00532.....................  N                          Anesth, vascular access....  ............  ............  ............  ............  ............
00534.....................  N                          Anesth, cardioverter/defib.  ............  ............  ............  ............  ............
00537.....................  N                          Anesth, cardiac electrophys  ............  ............  ............  ............  ............
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.
00550.....................  N                          Anesth, sternal debridement  ............  ............  ............  ............  ............
00560.....................  C                          Anesth, open heart surgery.  ............  ............  ............  ............  ............
00562.....................  C                          Anesth, open heart surgery.  ............  ............  ............  ............  ............
00563.....................  N                          Anesth, heart proc w/pump..  ............  ............  ............  ............  ............
00566.....................  N                          Anesth, cabg w/o pump......  ............  ............  ............  ............  ............
00580.....................  C                          Anesth heart/lung            ............  ............  ............  ............  ............
                                                        transplant.
00600.....................  N                          Anesth, spine, cord surgery  ............  ............  ............  ............  ............
00604.....................  C                          Anesth, sitting procedure..  ............  ............  ............  ............  ............
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  ............  ............  ............  ............  ............
00635.....................  N                          Anesth, lumbar puncture....  ............  ............  ............  ............  ............
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, hemorr/excise liver  ............  ............  ............  ............  ............
00794.....................  C                          Anesth, pancreas removal...  ............  ............  ............  ............  ............
00796.....................  C                          Anesth, for liver            ............  ............  ............  ............  ............
                                                        transplant.
00797.....................  N                          Anesth, surgery for obesity  ............  ............  ............  ............  ............
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..  ............  ............  ............  ............  ............
00851.....................  N                          Anesth, tubal ligation.....  ............  ............  ............  ............  ............
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..  ............  ............  ............  ............  ............
00869.....................  N                          Anesth, vasectomy..........  ............  ............  ............  ............  ............
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  ............  ............  ............  ............  ............
00902.....................  N                          Anesth, anorectal surgery..  ............  ............  ............  ............  ............
00904.....................  C                          Anesth, perineal surgery...  ............  ............  ............  ............  ............

[[Page 52162]]

 
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, surg on vag/urethal  ............  ............  ............  ............  ............
00944.....................  C                          Anesth, vaginal              ............  ............  ............  ............  ............
                                                        hysterectomy.
00948.....................  N                          Anesth, repair of cervix...  ............  ............  ............  ............  ............
00950.....................  N                          Anesth, vaginal endoscopy..  ............  ............  ............  ............  ............
00952.....................  N                          Anesth, hysteroscope/graph.  ............  ............  ............  ............  ............
01112.....................  N                          Anesth, bone aspirate/bx...  ............  ............  ............  ............  ............
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, hip arthroplasty...  ............  ............  ............  ............  ............
01215.....................  N                          Anesth, revise hip repair..  ............  ............  ............  ............  ............
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, knee arthroplasty..  ............  ............  ............  ............  ............
01404.....................  C                          Anesth, amputation at knee.  ............  ............  ............  ............  ............
01420.....................  N                          Anesth, knee joint casting.  ............  ............  ............  ............  ............
01430.....................  N                          Anesth, knee veins surgery.  ............  ............  ............  ............  ............
01432.....................  N                          Anesth, knee vessel surg...  ............  ............  ............  ............  ............
01440.....................  N                          Anesth, knee arteries surg.  ............  ............  ............  ............  ............
01442.....................  C                          Anesth, knee artery surg...  ............  ............  ............  ............  ............
01444.....................  C                          Anesth, knee artery repair.  ............  ............  ............  ............  ............
01462.....................  N                          Anesth, lower leg procedure  ............  ............  ............  ............  ............
01464.....................  N                          Anesth, ankle arthroscopy..  ............  ............  ............  ............  ............
01470.....................  N                          Anesth, lower leg surgery..  ............  ............  ............  ............  ............

[[Page 52163]]

 
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.....................  N                          Anesth, uppr arm             ............  ............  ............  ............  ............
                                                        embolectomy.
01780.....................  N                          Anesth, upper arm vein surg  ............  ............  ............  ............  ............
01782.....................  N                          Anesth, uppr arm vein        ............  ............  ............  ............  ............
                                                        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.....................  N                          Anesth, lwr arm embolectomy  ............  ............  ............  ............  ............
01844.....................  N                          Anesth, vascular shunt surg  ............  ............  ............  ............  ............
01850.....................  N                          Anesth, lower arm vein surg  ............  ............  ............  ............  ............
01852.....................  N                          Anesth, lwr arm vein repair  ............  ............  ............  ............  ............
01860.....................  N                          Anesth, lower arm casting..  ............  ............  ............  ............  ............
01905.....................  N                          Anes, spine inject, x-ray/   ............  ............  ............  ............  ............
                                                        re.
01916.....................  N                          Anesth, dx arteriography...  ............  ............  ............  ............  ............
01920.....................  N                          Anesth, catheterize heart..  ............  ............  ............  ............  ............
01922.....................  N                          Anesth, cat or MRI scan....  ............  ............  ............  ............  ............
01924.....................  N                          Anes, ther interven rad,     ............  ............  ............  ............  ............
                                                        art.
01925.....................  N                          Anes, ther interven rad,     ............  ............  ............  ............  ............
                                                        car.
01926.....................  N                          Anes, tx interv rad hrt/     ............  ............  ............  ............  ............
                                                        cran.
01930.....................  N                          Anes, ther interven rad,     ............  ............  ............  ............  ............
                                                        vei.
01931.....................  N                          Anes, ther interven rad,     ............  ............  ............  ............  ............
                                                        tip.
01932.....................  N                          Anes, tx interv rad, th      ............  ............  ............  ............  ............
                                                        vein.
01933.....................  N                          Anes, tx interv rad, cran v  ............  ............  ............  ............  ............
01951.....................  N                          Anesth, burn, less 4         ............  ............  ............  ............  ............
                                                        percent.
01952.....................  N                          Anesth, burn, 4-9 percent..  ............  ............  ............  ............  ............
01953.....................  N                          Anesth, burn, each 9         ............  ............  ............  ............  ............
                                                        percent.

[[Page 52164]]

 
01960.....................  N                          Anesth, vaginal delivery...  ............  ............  ............  ............  ............
01961.....................  N                          Anesth, cs delivery........  ............  ............  ............  ............  ............
01962.....................  N                          Anesth, emer hysterectomy..  ............  ............  ............  ............  ............
01963.....................  N                          Anesth, cs hysterectomy....  ............  ............  ............  ............  ............
01964.....................  N                          Anesth, abortion procedures  ............  ............  ............  ............  ............
01967.....................  N                          Anesth/analg, vag delivery.  ............  ............  ............  ............  ............
01968.....................  N                          Anes/analg cs deliver add-   ............  ............  ............  ............  ............
                                                        on.
01969.....................  N                          Anesth/analg cs hyst add-on  ............  ............  ............  ............  ............
01990.....................  C                          Support for organ donor....  ............  ............  ............  ............  ............
01995.....................  N                          Regional anesthesia limb...  ............  ............  ............  ............  ............
01996.....................  N                          Manage daily drug therapy..  ............  ............  ............  ............  ............
01999.....................  N                          Unlisted anesth procedure..  ............  ............  ............  ............  ............
10021.....................  T                          Fna w/o image..............          0002          0.63        $32.77         $8.52         $6.55
10022.....................  T                          Fna w/image................          0002          0.63        $32.77         $8.52         $6.55
10040.....................  T                          Acne surgery...............          0010          0.70        $36.41        $10.56         $7.28
10060.....................  T                          Drainage of skin abscess...          0006          1.89        $98.30        $25.56        $19.66
10061.....................  T                          Drainage of skin abscess...          0006          1.89        $98.30        $25.56        $19.66
10080.....................  T                          Drainage of pilonidal cyst.          0006          1.89        $98.30        $25.56        $19.66
10081.....................  T                          Drainage of pilonidal cyst.          0007          9.44       $490.96       $103.10        $98.19
10120.....................  T                          Remove foreign body........          0006          1.89        $98.30        $25.56        $19.66
10121.....................  T                          Remove foreign body........          0021         14.58       $758.29       $227.49       $151.66
10140.....................  T                          Drainage of hematoma/fluid.          0007          9.44       $490.96       $103.10        $98.19
10160.....................  T                          Puncture drainage of lesion          0018          0.92        $47.85        $15.79         $9.57
10180.....................  T                          Complex drainage, wound....          0007          9.44       $490.96       $103.10        $98.19
11000.....................  T                          Debride infected skin......          0015          1.43        $74.37        $18.59        $14.87
11001.....................  T                          Debride infected skin add-           0013          1.10        $57.21        $14.30        $11.44
                                                        on.
11010.....................  T                          Debride skin, fx...........          0022         18.10       $941.36       $367.13       $188.27
11011.....................  T                          Debride skin/muscle, fx....          0022         18.10       $941.36       $367.13       $188.27
11012.....................  T                          Debride skin/muscle/bone,            0022         18.10       $941.36       $367.13       $188.27
                                                        fx.
11040.....................  T                          Debride skin, partial......          0015          1.43        $74.37        $18.59        $14.87
11041.....................  T                          Debride skin, full.........          0015          1.43        $74.37        $18.59        $14.87
11042.....................  T                          Debride skin/tissue........          0016          2.57       $133.66        $56.14        $26.73
11043.....................  T                          Debride tissue/muscle......          0016          2.57       $133.66        $56.14        $26.73
11044.....................  T                          Debride tissue/muscle/bone.          0682          6.74       $350.54       $161.25        $70.11
11055.....................  T                          Trim skin lesion...........          0012          0.76        $39.53        $10.67         $7.91
11056.....................  T                          Trim skin lesions, 2 to 4..          0012          0.76        $39.53        $10.67         $7.91
11057.....................  T                          Trim skin lesions, over 4..          0012          0.76        $39.53        $10.67         $7.91
11100.....................  T                          Biopsy of skin lesion......          0018          0.92        $47.85        $15.79         $9.57
11101.....................  T                          Biopsy, skin add-on........          0018          0.92        $47.85        $15.79         $9.57
11200.....................  T                          Removal of skin tags.......          0013          1.10        $57.21        $14.30        $11.44
11201.....................  T                          Remove skin tags add-on....          0015          1.43        $74.37        $18.59        $14.87
11300.....................  T                          Shave skin lesion..........          0012          0.76        $39.53        $10.67         $7.91
11301.....................  T                          Shave skin lesion..........          0012          0.76        $39.53        $10.67         $7.91
11302.....................  T                          Shave skin lesion..........          0013          1.10        $57.21        $14.30        $11.44
11303.....................  T                          Shave skin lesion..........          0015          1.43        $74.37        $18.59        $14.87
11305.....................  T                          Shave skin lesion..........          0013          1.10        $57.21        $14.30        $11.44
11306.....................  T                          Shave skin lesion..........          0013          1.10        $57.21        $14.30        $11.44
11307.....................  T                          Shave skin lesion..........          0013          1.10        $57.21        $14.30        $11.44
11308.....................  T                          Shave skin lesion..........          0013          1.10        $57.21        $14.30        $11.44
11310.....................  T                          Shave skin lesion..........          0013          1.10        $57.21        $14.30        $11.44
11311.....................  T                          Shave skin lesion..........          0013          1.10        $57.21        $14.30        $11.44
11312.....................  T                          Shave skin lesion..........          0013          1.10        $57.21        $14.30        $11.44
11313.....................  T                          Shave skin lesion..........          0016          2.57       $133.66        $56.14        $26.73
11400.....................  T                          Removal of skin lesion.....          0019          3.94       $204.92        $75.82        $40.98
11401.....................  T                          Removal of skin lesion.....          0019          3.94       $204.92        $75.82        $40.98
11402.....................  T                          Removal of skin lesion.....          0019          3.94       $204.92        $75.82        $40.98
11403.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11404.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11406.....................  T                          Removal of skin lesion.....          0021         14.58       $758.29       $227.49       $151.66
11420.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11421.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11422.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11423.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11424.....................  T                          Removal of skin lesion.....          0021         14.58       $758.29       $227.49       $151.66
11426.....................  T                          Removal of skin lesion.....          0022         18.10       $941.36       $367.13       $188.27
11440.....................  T                          Removal of skin lesion.....          0019          3.94       $204.92        $75.82        $40.98

[[Page 52165]]

 
11441.....................  T                          Removal of skin lesion.....          0019          3.94       $204.92        $75.82        $40.98
11442.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11443.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11444.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11446.....................  T                          Removal of skin lesion.....          0022         18.10       $941.36       $367.13       $188.27
11450.....................  T                          Removal, sweat gland lesion          0022         18.10       $941.36       $367.13       $188.27
11451.....................  T                          Removal, sweat gland lesion          0022         18.10       $941.36       $367.13       $188.27
11462.....................  T                          Removal, sweat gland lesion          0022         18.10       $941.36       $367.13       $188.27
11463.....................  T                          Removal, sweat gland lesion          0022         18.10       $941.36       $367.13       $188.27
11470.....................  T                          Removal, sweat gland lesion          0022         18.10       $941.36       $367.13       $188.27
11471.....................  T                          Removal, sweat gland lesion          0022         18.10       $941.36       $367.13       $188.27
11600.....................  T                          Removal of skin lesion.....          0019          3.94       $204.92        $75.82        $40.98
11601.....................  T                          Removal of skin lesion.....          0019          3.94       $204.92        $75.82        $40.98
11602.....................  T                          Removal of skin lesion.....          0019          3.94       $204.92        $75.82        $40.98
11603.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11604.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11606.....................  T                          Removal of skin lesion.....          0021         14.58       $758.29       $227.49       $151.66
11620.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11621.....................  T                          Removal of skin lesion.....          0019          3.94       $204.92        $75.82        $40.98
11622.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11623.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11624.....................  T                          Removal of skin lesion.....          0021         14.58       $758.29       $227.49       $151.66
11626.....................  T                          Removal of skin lesion.....          0022         18.10       $941.36       $367.13       $188.27
11640.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11641.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11642.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11643.....................  T                          Removal of skin lesion.....          0020          7.36       $382.79       $114.84        $76.56
11644.....................  T                          Removal of skin lesion.....          0021         14.58       $758.29       $227.49       $151.66
11646.....................  T                          Removal of skin lesion.....          0022         18.10       $941.36       $367.13       $188.27
11719.....................  T                          Trim nail(s)...............          0009          0.68        $35.37         $8.34         $7.07
11720.....................  T                          Debride nail, 1-5..........          0009          0.68        $35.37         $8.34         $7.07
11721.....................  T                          Debride nail, 6 or more....          0009          0.68        $35.37         $8.34         $7.07
11730.....................  T                          Removal of nail plate......          0013          1.10        $57.21        $14.30        $11.44
11732.....................  T                          Remove nail plate, add-on..          0012          0.76        $39.53        $10.67         $7.91
11740.....................  T                          Drain blood from under nail          0009          0.68        $35.37         $8.34         $7.07
11750.....................  T                          Removal of nail bed........          0019          3.94       $204.92        $75.82        $40.98
11752.....................  T                          Remove nail bed/finger tip.          0022         18.10       $941.36       $367.13       $188.27
11755.....................  T                          Biopsy, nail unit..........          0019          3.94       $204.92        $75.82        $40.98
11760.....................  T                          Repair of nail bed.........          0024          2.00       $104.02        $37.45        $20.80
11762.....................  T                          Reconstruction of nail bed.          0024          2.00       $104.02        $37.45        $20.80
11765.....................  T                          Excision of nail fold, toe.          0015          1.43        $74.37        $18.59        $14.87
11770.....................  T                          Removal of pilonidal lesion          0022         18.10       $941.36       $367.13       $188.27
11771.....................  T                          Removal of pilonidal lesion          0022         18.10       $941.36       $367.13       $188.27
11772.....................  T                          Removal of pilonidal lesion          0022         18.10       $941.36       $367.13       $188.27
11900.....................  T                          Injection into skin lesions          0012          0.76        $39.53        $10.67         $7.91
11901.....................  T                          Added skin lesions                   0012          0.76        $39.53        $10.67         $7.91
                                                        injection.
11920.....................  T                          Correct skin color defects.          0024          2.00       $104.02        $37.45        $20.80
11921.....................  T                          Correct skin color defects.          0024          2.00       $104.02        $37.45        $20.80
11922.....................  T                          Correct skin color defects.          0024          2.00       $104.02        $37.45        $20.80
11950.....................  T                          Therapy for contour defects          0024          2.00       $104.02        $37.45        $20.80
11951.....................  T                          Therapy for contour defects          0024          2.00       $104.02        $37.45        $20.80
11952.....................  T                          Therapy for contour defects          0024          2.00       $104.02        $37.45        $20.80
11954.....................  T                          Therapy for contour defects          0024          2.00       $104.02        $37.45        $20.80
11960.....................  T                          Insert tissue expander(s)..          0027         15.73       $818.10       $343.60       $163.62
11970.....................  T                          Replace tissue expander....          0027         15.73       $818.10       $343.60       $163.62
11971.....................  T                          Remove tissue expander(s)..          0022         18.10       $941.36       $367.13       $188.27
11975.....................  E                          Insert contraceptive cap...  ............  ............  ............  ............  ............
11976.....................  T                          Removal of contraceptive             0019          3.94       $204.92        $75.82        $40.98
                                                        cap.
11977.....................  E                          Removal/reinsert contra cap  ............  ............  ............  ............  ............
11980.....................  X                          Implant hormone pellet(s)..          0340          0.66        $34.33  ............         $6.87
11981.....................  X                          Insert drug implant device.          0340          0.66        $34.33  ............         $6.87
11982.....................  X                          Remove drug implant device.          0340          0.66        $34.33  ............         $6.87
11983.....................  X                          Remove/insert drug implant.          0340          0.66        $34.33  ............         $6.87
12001.....................  T                          Repair superficial wound(s)          0024          2.00       $104.02        $37.45        $20.80
12002.....................  T                          Repair superficial wound(s)          0024          2.00       $104.02        $37.45        $20.80
12004.....................  T                          Repair superficial wound(s)          0024          2.00       $104.02        $37.45        $20.80

[[Page 52166]]

 
12005.....................  T                          Repair superficial wound(s)          0024          2.00       $104.02        $37.45        $20.80
12006.....................  T                          Repair superficial wound(s)          0024          2.00       $104.02        $37.45        $20.80
12007.....................  T                          Repair superficial wound(s)          0024          2.00       $104.02        $37.45        $20.80
12011.....................  T                          Repair superficial wound(s)          0024          2.00       $104.02        $37.45        $20.80
12013.....................  T                          Repair superficial wound(s)          0024          2.00       $104.02        $37.45        $20.80
12014.....................  T                          Repair superficial wound(s)          0024          2.00       $104.02        $37.45        $20.80
12015.....................  T                          Repair superficial wound(s)          0024          2.00       $104.02        $37.45        $20.80
12016.....................  T                          Repair superficial wound(s)          0024          2.00       $104.02        $37.45        $20.80
12017.....................  T                          Repair superficial wound(s)          0024          2.00       $104.02        $37.45        $20.80
12018.....................  T                          Repair superficial wound(s)          0024          2.00       $104.02        $37.45        $20.80
12020.....................  T                          Closure of split wound.....          0024          2.00       $104.02        $37.45        $20.80
12021.....................  T                          Closure of split wound.....          0024          2.00       $104.02        $37.45        $20.80
12031.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12032.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12034.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12035.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12036.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12037.....................  T                          Layer closure of wound(s)..          0025          5.89       $306.33       $116.41        $61.27
12041.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12042.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12044.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12045.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12046.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12047.....................  T                          Layer closure of wound(s)..          0025          5.89       $306.33       $116.41        $61.27
12051.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12052.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12053.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12054.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12055.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12056.....................  T                          Layer closure of wound(s)..          0024          2.00       $104.02        $37.45        $20.80
12057.....................  T                          Layer closure of wound(s)..          0025          5.89       $306.33       $116.41        $61.27
13100.....................  T                          Repair of wound or lesion..          0025          5.89       $306.33       $116.41        $61.27
13101.....................  T                          Repair of wound or lesion..          0025          5.89       $306.33       $116.41        $61.27
13102.....................  T                          Repair wound/lesion add-on.          0024          2.00       $104.02        $37.45        $20.80
13120.....................  T                          Repair of wound or lesion..          0024          2.00       $104.02        $37.45        $20.80
13121.....................  T                          Repair of wound or lesion..          0024          2.00       $104.02        $37.45        $20.80
13122.....................  T                          Repair wound/lesion add-on.          0024          2.00       $104.02        $37.45        $20.80
13131.....................  T                          Repair of wound or lesion..          0024          2.00       $104.02        $37.45        $20.80
13132.....................  T                          Repair of wound or lesion..          0024          2.00       $104.02        $37.45        $20.80
13133.....................  T                          Repair wound/lesion add-on.          0024          2.00       $104.02        $37.45        $20.80
13150.....................  T                          Repair of wound or lesion..          0025          5.89       $306.33       $116.41        $61.27
13151.....................  T                          Repair of wound or lesion..          0024          2.00       $104.02        $37.45        $20.80
13152.....................  T                          Repair of wound or lesion..          0025          5.89       $306.33       $116.41        $61.27
13153.....................  T                          Repair wound/lesion add-on.          0024          2.00       $104.02        $37.45        $20.80
13160.....................  T                          Late closure of wound......          0027         15.73       $818.10       $343.60       $163.62
14000.....................  T                          Skin tissue rearrangement..          0027         15.73       $818.10       $343.60       $163.62
14001.....................  T                          Skin tissue rearrangement..          0027         15.73       $818.10       $343.60       $163.62
14020.....................  T                          Skin tissue rearrangement..          0027         15.73       $818.10       $343.60       $163.62
14021.....................  T                          Skin tissue rearrangement..          0027         15.73       $818.10       $343.60       $163.62
14040.....................  T                          Skin tissue rearrangement..          0027         15.73       $818.10       $343.60       $163.62
14041.....................  T                          Skin tissue rearrangement..          0027         15.73       $818.10       $343.60       $163.62
14060.....................  T                          Skin tissue rearrangement..          0027         15.73       $818.10       $343.60       $163.62
14061.....................  T                          Skin tissue rearrangement..          0027         15.73       $818.10       $343.60       $163.62
14300.....................  T                          Skin tissue rearrangement..          0027         15.73       $818.10       $343.60       $163.62
14350.....................  T                          Skin tissue rearrangement..          0027         15.73       $818.10       $343.60       $163.62
15000.....................  T                          Skin graft.................          0025          5.89       $306.33       $116.41        $61.27
15001.....................  T                          Skin graft add-on..........          0025          5.89       $306.33       $116.41        $61.27
15050.....................  T                          Skin pinch graft...........          0025          5.89       $306.33       $116.41        $61.27
15100.....................  T                          Skin split graft...........          0027         15.73       $818.10       $343.60       $163.62
15101.....................  T                          Skin split graft add-on....          0027         15.73       $818.10       $343.60       $163.62
15120.....................  T                          Skin split graft...........          0027         15.73       $818.10       $343.60       $163.62
15121.....................  T                          Skin split graft add-on....          0027         15.73       $818.10       $343.60       $163.62
15200.....................  T                          Skin full graft............          0027         15.73       $818.10       $343.60       $163.62
15201.....................  T                          Skin full graft add-on.....          0025          5.89       $306.33       $116.41        $61.27
15220.....................  T                          Skin full graft............          0027         15.73       $818.10       $343.60       $163.62
15221.....................  T                          Skin full graft add-on.....          0025          5.89       $306.33       $116.41        $61.27

[[Page 52167]]

 
15240.....................  T                          Skin full graft............          0027         15.73       $818.10       $343.60       $163.62
15241.....................  T                          Skin full graft add-on.....          0025          5.89       $306.33       $116.41        $61.27
15260.....................  T                          Skin full graft............          0027         15.73       $818.10       $343.60       $163.62
15261.....................  T                          Skin full graft add-on.....          0025          5.89       $306.33       $116.41        $61.27
15342.....................  T                          Cultured skin graft, 25 cm.          0025          5.89       $306.33       $116.41        $61.27
15343.....................  T                          Culture skn graft addl 25            0024          2.00       $104.02        $37.45        $20.80
                                                        cm.
15350.....................  T                          Skin homograft.............          0686         11.30       $587.70       $270.34       $117.54
15351.....................  T                          Skin homograft add-on......          0027         15.73       $818.10       $343.60       $163.62
15400.....................  T                          Skin heterograft...........          0025          5.89       $306.33       $116.41        $61.27
15401.....................  T                          Skin heterograft add-on....          0025          5.89       $306.33       $116.41        $61.27
15570.....................  T                          Form skin pedicle flap.....          0027         15.73       $818.10       $343.60       $163.62
15572.....................  T                          Form skin pedicle flap.....          0027         15.73       $818.10       $343.60       $163.62
15574.....................  T                          Form skin pedicle flap.....          0027         15.73       $818.10       $343.60       $163.62
15576.....................  T                          Form skin pedicle flap.....          0027         15.73       $818.10       $343.60       $163.62
15600.....................  T                          Skin graft.................          0027         15.73       $818.10       $343.60       $163.62
15610.....................  T                          Skin graft.................          0027         15.73       $818.10       $343.60       $163.62
15620.....................  T                          Skin graft.................          0027         15.73       $818.10       $343.60       $163.62
15630.....................  T                          Skin graft.................          0027         15.73       $818.10       $343.60       $163.62
15650.....................  T                          Transfer skin pedicle flap.          0027         15.73       $818.10       $343.60       $163.62
15732.....................  T                          Muscle-skin graft, head/             0027         15.73       $818.10       $343.60       $163.62
                                                        neck.
15734.....................  T                          Muscle-skin graft, trunk...          0027         15.73       $818.10       $343.60       $163.62
15736.....................  T                          Muscle-skin graft, arm.....          0027         15.73       $818.10       $343.60       $163.62
15738.....................  T                          Muscle-skin graft, leg.....          0027         15.73       $818.10       $343.60       $163.62
15740.....................  T                          Island pedicle flap graft..          0027         15.73       $818.10       $343.60       $163.62
15750.....................  T                          Neurovascular pedicle graft          0027         15.73       $818.10       $343.60       $163.62
15756.....................  C                          Free muscle flap, microvasc  ............  ............  ............  ............  ............
15757.....................  C                          Free skin flap, microvasc..  ............  ............  ............  ............  ............
15758.....................  C                          Free fascial flap,           ............  ............  ............  ............  ............
                                                        microvasc.
15760.....................  T                          Composite skin graft.......          0027         15.73       $818.10       $343.60       $163.62
15770.....................  T                          Derma-fat-fascia graft.....          0027         15.73       $818.10       $343.60       $163.62
15775.....................  T                          Hair transplant punch                0025          5.89       $306.33       $116.41        $61.27
                                                        grafts.
15776.....................  T                          Hair transplant punch                0025          5.89       $306.33       $116.41        $61.27
                                                        grafts.
15780.....................  T                          Abrasion treatment of skin.          0022         18.10       $941.36       $367.13       $188.27
15781.....................  T                          Abrasion treatment of skin.          0022         18.10       $941.36       $367.13       $188.27
15782.....................  T                          Abrasion treatment of skin.          0022         18.10       $941.36       $367.13       $188.27
15783.....................  T                          Abrasion treatment of skin.          0016          2.57       $133.66        $56.14        $26.73
15786.....................  T                          Abrasion, lesion, single...          0013          1.10        $57.21        $14.30        $11.44
15787.....................  T                          Abrasion, lesions, add-on..          0013          1.10        $57.21        $14.30        $11.44
15788.....................  T                          Chemical peel, face,                 0012          0.76        $39.53        $10.67         $7.91
                                                        epiderm.
15789.....................  T                          Chemical peel, face, dermal          0015          1.43        $74.37        $18.59        $14.87
15792.....................  T                          Chemical peel, nonfacial...          0012          0.76        $39.53        $10.67         $7.91
15793.....................  T                          Chemical peel, nonfacial...          0013          1.10        $57.21        $14.30        $11.44
15810.....................  T                          Salabrasion................          0016          2.57       $133.66        $56.14        $26.73
15811.....................  T                          Salabrasion................          0016          2.57       $133.66        $56.14        $26.73
15819.....................  T                          Plastic surgery, neck......          0025          5.89       $306.33       $116.41        $61.27
15820.....................  T                          Revision of lower eyelid...          0027         15.73       $818.10       $343.60       $163.62
15821.....................  T                          Revision of lower eyelid...          0027         15.73       $818.10       $343.60       $163.62
15822.....................  T                          Revision of upper eyelid...          0027         15.73       $818.10       $343.60       $163.62
15823.....................  T                          Revision of upper eyelid...          0027         15.73       $818.10       $343.60       $163.62
15824.....................  T                          Removal of forehead                  0027         15.73       $818.10       $343.60       $163.62
                                                        wrinkles.
15825.....................  T                          Removal of neck wrinkles...          0027         15.73       $818.10       $343.60       $163.62
15826.....................  T                          Removal of brow wrinkles...          0027         15.73       $818.10       $343.60       $163.62
15828.....................  T                          Removal of face wrinkles...          0027         15.73       $818.10       $343.60       $163.62
15829.....................  T                          Removal of skin wrinkles...          0027         15.73       $818.10       $343.60       $163.62
15831.....................  T                          Excise excessive skin                0022         18.10       $941.36       $367.13       $188.27
                                                        tissue.
15832.....................  T                          Excise excessive skin                0022         18.10       $941.36       $367.13       $188.27
                                                        tissue.
15833.....................  T                          Excise excessive skin                0022         18.10       $941.36       $367.13       $188.27
                                                        tissue.
15834.....................  T                          Excise excessive skin                0022         18.10       $941.36       $367.13       $188.27
                                                        tissue.
15835.....................  T                          Excise excessive skin                0025          5.89       $306.33       $116.41        $61.27
                                                        tissue.
15836.....................  T                          Excise excessive skin                0020          7.36       $382.79       $114.84        $76.56
                                                        tissue.
15837.....................  T                          Excise excessive skin                0020          7.36       $382.79       $114.84        $76.56
                                                        tissue.
15838.....................  T                          Excise excessive skin                0020          7.36       $382.79       $114.84        $76.56
                                                        tissue.
15839.....................  T                          Excise excessive skin                0020          7.36       $382.79       $114.84        $76.56
                                                        tissue.
15840.....................  T                          Graft for face nerve palsy.          0027         15.73       $818.10       $343.60       $163.62
15841.....................  T                          Graft for face nerve palsy.          0027         15.73       $818.10       $343.60       $163.62
15842.....................  T                          Flap for face nerve palsy..          0027         15.73       $818.10       $343.60       $163.62

[[Page 52168]]

 
15845.....................  T                          Skin and muscle repair,              0027         15.73       $818.10       $343.60       $163.62
                                                        face.
15850.....................  T                          Removal of sutures.........          0016          2.57       $133.66        $56.14        $26.73
15851.....................  T                          Removal of sutures.........          0013          1.10        $57.21        $14.30        $11.44
15852.....................  X                          Dressing change,not for              0340          0.66        $34.33  ............         $6.87
                                                        burn.
15860.....................  S                          Test for blood flow in               0706  ............        $25.00  ............         $5.00
                                                        graft.
15876.....................  T                          Suction assisted lipectomy.          0027         15.73       $818.10       $343.60       $163.62
15877.....................  T                          Suction assisted lipectomy.          0027         15.73       $818.10       $343.60       $163.62
15878.....................  T                          Suction assisted lipectomy.          0027         15.73       $818.10       $343.60       $163.62
15879.....................  T                          Suction assisted lipectomy.          0027         15.73       $818.10       $343.60       $163.62
15920.....................  T                          Removal of tail bone ulcer.          0022         18.10       $941.36       $367.13       $188.27
15922.....................  T                          Removal of tail bone ulcer.          0027         15.73       $818.10       $343.60       $163.62
15931.....................  T                          Remove sacrum pressure sore          0022         18.10       $941.36       $367.13       $188.27
15933.....................  T                          Remove sacrum pressure sore          0022         18.10       $941.36       $367.13       $188.27
15934.....................  T                          Remove sacrum pressure sore          0027         15.73       $818.10       $343.60       $163.62
15935.....................  T                          Remove sacrum pressure sore          0027         15.73       $818.10       $343.60       $163.62
15936.....................  T                          Remove sacrum pressure sore          0027         15.73       $818.10       $343.60       $163.62
15937.....................  T                          Remove sacrum pressure sore          0027         15.73       $818.10       $343.60       $163.62
15940.....................  T                          Remove hip pressure sore...          0022         18.10       $941.36       $367.13       $188.27
15941.....................  T                          Remove hip pressure sore...          0022         18.10       $941.36       $367.13       $188.27
15944.....................  T                          Remove hip pressure sore...          0027         15.73       $818.10       $343.60       $163.62
15945.....................  T                          Remove hip pressure sore...          0027         15.73       $818.10       $343.60       $163.62
15946.....................  T                          Remove hip pressure sore...          0027         15.73       $818.10       $343.60       $163.62
15950.....................  T                          Remove thigh pressure sore.          0022         18.10       $941.36       $367.13       $188.27
15951.....................  T                          Remove thigh pressure sore.          0022         18.10       $941.36       $367.13       $188.27
15952.....................  T                          Remove thigh pressure sore.          0027         15.73       $818.10       $343.60       $163.62
15953.....................  T                          Remove thigh pressure sore.          0027         15.73       $818.10       $343.60       $163.62
15956.....................  T                          Remove thigh pressure sore.          0027         15.73       $818.10       $343.60       $163.62
15958.....................  T                          Remove thigh pressure sore.          0027         15.73       $818.10       $343.60       $163.62
15999.....................  T                          Removal of pressure sore...          0022         18.10       $941.36       $367.13       $188.27
16000.....................  T                          Initial treatment of                 0013          1.10        $57.21        $14.30        $11.44
                                                        burn(s).
16010.....................  T                          Treatment of burn(s).......          0016          2.57       $133.66        $56.14        $26.73
16015.....................  T                          Treatment of burn(s).......          0017         16.46       $856.07       $227.84       $171.21
16020.....................  T                          Treatment of burn(s).......          0013          1.10        $57.21        $14.30        $11.44
16025.....................  T                          Treatment of burn(s).......          0013          1.10        $57.21        $14.30        $11.44
16030.....................  T                          Treatment of burn(s).......          0015          1.43        $74.37        $18.59        $14.87
16035.....................  C                          Incision of burn scab,       ............  ............  ............  ............  ............
                                                        initi.
16036.....................  C                          Incise burn scab, addl       ............  ............  ............  ............  ............
                                                        incis.
17000.....................  T                          Detroy benign/premal lesion          0010          0.70        $36.41        $10.56         $7.28
17003.....................  T                          Destroy lesions, 2-14......          0010          0.70        $36.41        $10.56         $7.28
17004.....................  T                          Destroy lesions, 15 or more          0011          1.93       $100.38        $27.88        $20.08
17106.....................  T                          Destruction of skin lesions          0011          1.93       $100.38        $27.88        $20.08
17107.....................  T                          Destruction of skin lesions          0011          1.93       $100.38        $27.88        $20.08
17108.....................  T                          Destruction of skin lesions          0011          1.93       $100.38        $27.88        $20.08
17110.....................  T                          Destruct lesion, 1-14......          0010          0.70        $36.41        $10.56         $7.28
17111.....................  T                          Destruct lesion, 15 or more          0011          1.93       $100.38        $27.88        $20.08
17250.....................  T                          Chemical cautery, tissue...          0013          1.10        $57.21        $14.30        $11.44
17260.....................  T                          Destruction of skin lesions          0015          1.43        $74.37        $18.59        $14.87
17261.....................  T                          Destruction of skin lesions          0015          1.43        $74.37        $18.59        $14.87
17262.....................  T                          Destruction of skin lesions          0015          1.43        $74.37        $18.59        $14.87
17263.....................  T                          Destruction of skin lesions          0015          1.43        $74.37        $18.59        $14.87
17264.....................  T                          Destruction of skin lesions          0015          1.43        $74.37        $18.59        $14.87
17266.....................  T                          Destruction of skin lesions          0016          2.57       $133.66        $56.14        $26.73
17270.....................  T                          Destruction of skin lesions          0015          1.43        $74.37        $18.59        $14.87
17271.....................  T                          Destruction of skin lesions          0012          0.76        $39.53        $10.67         $7.91
17272.....................  T                          Destruction of skin lesions          0015          1.43        $74.37        $18.59        $14.87
17273.....................  T                          Destruction of skin lesions          0015          1.43        $74.37        $18.59        $14.87
17274.....................  T                          Destruction of skin lesions          0016          2.57       $133.66        $56.14        $26.73
17276.....................  T                          Destruction of skin lesions          0016          2.57       $133.66        $56.14        $26.73
17280.....................  T                          Destruction of skin lesions          0015          1.43        $74.37        $18.59        $14.87
17281.....................  T                          Destruction of skin lesions          0015          1.43        $74.37        $18.59        $14.87
17282.....................  T                          Destruction of skin lesions          0015          1.43        $74.37        $18.59        $14.87
17283.....................  T                          Destruction of skin lesions          0015          1.43        $74.37        $18.59        $14.87
17284.....................  T                          Destruction of skin lesions          0016          2.57       $133.66        $56.14        $26.73
17286.....................  T                          Destruction of skin lesions          0015          1.43        $74.37        $18.59        $14.87
17304.....................  T                          Chemosurgery of skin lesion          0694          3.90       $202.84        $81.14        $40.57
17305.....................  T                          2nd stage chemosurgery.....          0694          3.90       $202.84        $81.14        $40.57

[[Page 52169]]

 
17306.....................  T                          3rd stage chemosurgery.....          0694          3.90       $202.84        $81.14        $40.57
17307.....................  T                          Followup skin lesion                 0694          3.90       $202.84        $81.14        $40.57
                                                        therapy.
17310.....................  T                          Extensive skin chemosurgery          0694          3.90       $202.84        $81.14        $40.57
17340.....................  T                          Cryotherapy of skin........          0012          0.76        $39.53        $10.67         $7.91
17360.....................  T                          Skin peel therapy..........          0012          0.76        $39.53        $10.67         $7.91
17380.....................  T                          Hair removal by                      0012          0.76        $39.53        $10.67         $7.91
                                                        electrolysis.
17999.....................  T                          Skin tissue procedure......          0006          1.89        $98.30        $25.56        $19.66
19000.....................  T                          Drainage of breast lesion..          0004          1.63        $84.77        $22.04        $16.95
19001.....................  T                          Drain breast lesion add-on.          0004          1.63        $84.77        $22.04        $16.95
19020.....................  T                          Incision of breast lesion..          0008         16.32       $848.79  ............       $169.76
19030.....................  N                          Injection for breast x-ray.  ............  ............  ............  ............  ............
19100.....................  T                          Bx breast percut w/o image.          0005          3.02       $157.07        $69.11        $31.41
19101.....................  T                          Biopsy of breast, open.....          0028         17.44       $907.04       $303.74       $181.41
19102.....................  T                          Bx breast percut w/image...          0005          3.02       $157.07        $69.11        $31.41
19103.....................  T                          Bx breast percut w/device..          0658          5.57       $289.69  ............        $57.94
19110.....................  T                          Nipple exploration.........          0028         17.44       $907.04       $303.74       $181.41
19112.....................  T                          Excise breast duct fistula.          0028         17.44       $907.04       $303.74       $181.41
19120.....................  T                          Removal of breast lesion...          0028         17.44       $907.04       $303.74       $181.41
19125.....................  T                          Excision, breast lesion....          0028         17.44       $907.04       $303.74       $181.41
19126.....................  T                          Excision, addl breast                0028         17.44       $907.04       $303.74       $181.41
                                                        lesion.
19140.....................  T                          Removal of breast tissue...          0028         17.44       $907.04       $303.74       $181.41
19160.....................  T                          Removal of breast tissue...          0028         17.44       $907.04       $303.74       $181.41
19162.....................  T                          Remove breast tissue, nodes          0693         39.30     $2,043.95       $798.17       $408.79
19180.....................  T                          Removal of breast..........          0029         29.89     $1,554.55       $632.64       $310.91
19182.....................  T                          Removal of breast..........          0029         29.89     $1,554.55       $632.64       $310.91
19200.....................  C                          Removal of breast..........  ............  ............  ............  ............  ............
19220.....................  C                          Removal of breast..........  ............  ............  ............  ............  ............
19240.....................  T                          Removal of breast..........          0030         40.23     $2,092.32       $763.55       $418.46
19260.....................  T                          Removal of chest wall                0021         14.58       $758.29       $227.49       $151.66
                                                        lesion.
19271.....................  C                          Revision of chest wall.....  ............  ............  ............  ............  ............
19272.....................  C                          Extensive chest wall         ............  ............  ............  ............  ............
                                                        surgery.
19290.....................  N                          Place needle wire, breast..  ............  ............  ............  ............  ............
19291.....................  N                          Place needle wire, breast..  ............  ............  ............  ............  ............
19295.....................  S                          Place breast clip, percut..          0657          1.38        $71.77  ............        $14.35
19316.....................  T                          Suspension of breast.......          0029         29.89     $1,554.55       $632.64       $310.91
19318.....................  T                          Reduction of large breast..          0693         39.30     $2,043.95       $798.17       $408.79
19324.....................  T                          Enlarge breast.............          0693         39.30     $2,043.95       $798.17       $408.79
19325.....................  T                          Enlarge breast with implant          0693         39.30     $2,043.95       $798.17       $408.79
19328.....................  T                          Removal of breast implant..          0029         29.89     $1,554.55       $632.64       $310.91
19330.....................  T                          Removal of implant material          0029         29.89     $1,554.55       $632.64       $310.91
19340.....................  T                          Immediate breast prosthesis          0030         40.23     $2,092.32       $763.55       $418.46
19342.....................  T                          Delayed breast prosthesis..          0693         39.30     $2,043.95       $798.17       $408.79
19350.....................  T                          Breast reconstruction......          0029         29.89     $1,554.55       $632.64       $310.91
19355.....................  T                          Correct inverted nipple(s).          0029         29.89     $1,554.55       $632.64       $310.91
19357.....................  T                          Breast reconstruction......          0693         39.30     $2,043.95       $798.17       $408.79
19361.....................  C                          Breast reconstruction......  ............  ............  ............  ............  ............
19364.....................  C                          Breast reconstruction......  ............  ............  ............  ............  ............
19366.....................  T                          Breast reconstruction......          0029         29.89     $1,554.55       $632.64       $310.91
19367.....................  C                          Breast reconstruction......  ............  ............  ............  ............  ............
19368.....................  C                          Breast reconstruction......  ............  ............  ............  ............  ............
19369.....................  C                          Breast reconstruction......  ............  ............  ............  ............  ............
19370.....................  T                          Surgery of breast capsule..          0029         29.89     $1,554.55       $632.64       $310.91
19371.....................  T                          Removal of breast capsule..          0029         29.89     $1,554.55       $632.64       $310.91
19380.....................  T                          Revise breast                        0030         40.23     $2,092.32       $763.55       $418.46
                                                        reconstruction.
19396.....................  T                          Design custom breast                 0029         29.89     $1,554.55       $632.64       $310.91
                                                        implant.
19499.....................  T                          Breast surgery procedure...          0028         17.44       $907.04       $303.74       $181.41
20000.....................  T                          Incision of abscess........          0006          1.89        $98.30        $25.56        $19.66
20005.....................  T                          Incision of deep abscess...          0049         19.45     $1,011.58  ............       $202.32
20100.....................  T                          Explore wound, neck........          0023          2.38       $123.78        $40.37        $24.76
20101.....................  T                          Explore wound, chest.......          0027         15.73       $818.10       $343.60       $163.62
20102.....................  T                          Explore wound, abdomen.....          0027         15.73       $818.10       $343.60       $163.62
20103.....................  T                          Explore wound, extremity...          0023          2.38       $123.78        $40.37        $24.76
20150.....................  T                          Excise epiphyseal bar......          0051         34.03     $1,769.87  ............       $353.97
20200.....................  T                          Muscle biopsy..............          0021         14.58       $758.29       $227.49       $151.66
20205.....................  T                          Deep muscle biopsy.........          0021         14.58       $758.29       $227.49       $151.66
20206.....................  T                          Needle biopsy, muscle......          0005          3.02       $157.07        $69.11        $31.41

[[Page 52170]]

 
20220.....................  T                          Bone biopsy, trocar/needle.          0019          3.94       $204.92        $75.82        $40.98
20225.....................  T                          Bone biopsy, trocar/needle.          0019          3.94       $204.92        $75.82        $40.98
20240.....................  T                          Bone biopsy, excisional....          0022         18.10       $941.36       $367.13       $188.27
20245.....................  T                          Bone biopsy, excisional....          0022         18.10       $941.36       $367.13       $188.27
20250.....................  T                          Open bone biopsy...........          0049         19.45     $1,011.58  ............       $202.32
20251.....................  T                          Open bone biopsy...........          0049         19.45     $1,011.58  ............       $202.32
20500.....................  T                          Injection of sinus tract...          0251          1.92        $99.86  ............        $19.97
20501.....................  N                          Inject sinus tract for x-    ............  ............  ............  ............  ............
                                                        ray.
20520.....................  T                          Removal of foreign body....          0019          3.94       $204.92        $75.82        $40.98
20525.....................  T                          Removal of foreign body....          0022         18.10       $941.36       $367.13       $188.27
20526.....................  T                          Ther injection carpal                0204          2.13       $110.78        $42.10        $22.16
                                                        tunnel.
20550.....................  T                          Inject tendon/ligament/cyst          0204          2.13       $110.78        $42.10        $22.16
20551.....................  T                          Inject tendon origin/insert          0204          2.13       $110.78        $42.10        $22.16
20552.....................  T                          Inject trigger point, 1 or           0204          2.13       $110.78        $42.10        $22.16
                                                        2.
20553.....................  T                          Inject trigger points, > 3.          0204          2.13       $110.78        $42.10        $22.16
20600.....................  T                          Drain/inject, joint/bursa..          0204          2.13       $110.78        $42.10        $22.16
20605.....................  T                          Drain/inject, joint/bursa..          0204          2.13       $110.78        $42.10        $22.16
20610.....................  T                          Drain/inject, joint/bursa..          0204          2.13       $110.78        $42.10        $22.16
20615.....................  T                          Treatment of bone cyst.....          0004          1.63        $84.77        $22.04        $16.95
20650.....................  T                          Insert and remove bone pin.          0049         19.45     $1,011.58  ............       $202.32
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.....................  X                          Removal of fixation device.          0340          0.66        $34.33  ............         $6.87
20670.....................  T                          Removal of support implant.          0021         14.58       $758.29       $227.49       $151.66
20680.....................  T                          Removal of support implant.          0022         18.10       $941.36       $367.13       $188.27
20690.....................  T                          Apply bone fixation device.          0050         23.60     $1,227.41  ............       $245.48
20692.....................  T                          Apply bone fixation device.          0050         23.60     $1,227.41  ............       $245.48
20693.....................  T                          Adjust bone fixation device          0049         19.45     $1,011.58  ............       $202.32
20694.....................  T                          Remove bone fixation device          0049         19.45     $1,011.58  ............       $202.32
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         23.60     $1,227.41  ............       $245.48
20902.....................  T                          Removal of bone for graft..          0050         23.60     $1,227.41  ............       $245.48
20910.....................  T                          Remove cartilage for graft.          0027         15.73       $818.10       $343.60       $163.62
20912.....................  T                          Remove cartilage for graft.          0027         15.73       $818.10       $343.60       $163.62
20920.....................  T                          Removal of fascia for graft          0027         15.73       $818.10       $343.60       $163.62
20922.....................  T                          Removal of fascia for graft          0027         15.73       $818.10       $343.60       $163.62
20924.....................  T                          Removal of tendon for graft          0050         23.60     $1,227.41  ............       $245.48
20926.....................  T                          Removal of tissue for graft          0027         15.73       $818.10       $343.60       $163.62
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.....          0006          1.89        $98.30        $25.56        $19.66
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         19.45     $1,011.58  ............       $202.32
20979.....................  A                          Us bone stimulation........  ............  ............  ............  ............  ............
20999.....................  T                          Musculoskeletal surgery....          0049         19.45     $1,011.58  ............       $202.32

[[Page 52171]]

 
21010.....................  T                          Incision of jaw joint......          0254         21.89     $1,138.48       $352.93       $227.70
21015.....................  T                          Resection of facial tumor..          0253         14.79       $769.21       $284.61       $153.84
21025.....................  T                          Excision of bone, lower jaw          0256         35.51     $1,846.84  ............       $369.37
21026.....................  T                          Excision of facial bone(s).          0256         35.51     $1,846.84  ............       $369.37
21029.....................  T                          Contour of face bone lesion          0256         35.51     $1,846.84  ............       $369.37
21030.....................  T                          Removal of face bone lesion          0254         21.89     $1,138.48       $352.93       $227.70
21031.....................  T                          Remove exostosis, mandible.          0254         21.89     $1,138.48       $352.93       $227.70
21032.....................  T                          Remove exostosis, maxilla..          0254         21.89     $1,138.48       $352.93       $227.70
21034.....................  T                          Removal of face bone lesion          0256         35.51     $1,846.84  ............       $369.37
21040.....................  T                          Removal of jaw bone lesion.          0254         21.89     $1,138.48       $352.93       $227.70
21041.....................  T                          Removal of jaw bone lesion.          0256         35.51     $1,846.84  ............       $369.37
21044.....................  T                          Removal of jaw bone lesion.          0256         35.51     $1,846.84  ............       $369.37
21045.....................  C                          Extensive jaw surgery......  ............  ............  ............  ............  ............
21050.....................  T                          Removal of jaw joint.......          0256         35.51     $1,846.84  ............       $369.37
21060.....................  T                          Remove jaw joint cartilage.          0256         35.51     $1,846.84  ............       $369.37
21070.....................  T                          Remove coronoid process....          0256         35.51     $1,846.84  ............       $369.37
21076.....................  T                          Prepare face/oral                    0254         21.89     $1,138.48       $352.93       $227.70
                                                        prosthesis.
21077.....................  T                          Prepare face/oral                    0256         35.51     $1,846.84  ............       $369.37
                                                        prosthesis.
21079.....................  T                          Prepare face/oral                    0256         35.51     $1,846.84  ............       $369.37
                                                        prosthesis.
21080.....................  T                          Prepare face/oral                    0256         35.51     $1,846.84  ............       $369.37
                                                        prosthesis.
21081.....................  T                          Prepare face/oral                    0256         35.51     $1,846.84  ............       $369.37
                                                        prosthesis.
21082.....................  T                          Prepare face/oral                    0256         35.51     $1,846.84  ............       $369.37
                                                        prosthesis.
21083.....................  T                          Prepare face/oral                    0256         35.51     $1,846.84  ............       $369.37
                                                        prosthesis.
21084.....................  T                          Prepare face/oral                    0256         35.51     $1,846.84  ............       $369.37
                                                        prosthesis.
21085.....................  T                          Prepare face/oral                    0253         14.79       $769.21       $284.61       $153.84
                                                        prosthesis.
21086.....................  T                          Prepare face/oral                    0256         35.51     $1,846.84  ............       $369.37
                                                        prosthesis.
21087.....................  T                          Prepare face/oral                    0256         35.51     $1,846.84  ............       $369.37
                                                        prosthesis.
21088.....................  T                          Prepare face/oral                    0256         35.51     $1,846.84  ............       $369.37
                                                        prosthesis.
21089.....................  T                          Prepare face/oral                    0253         14.79       $769.21       $284.61       $153.84
                                                        prosthesis.
21100.....................  T                          Maxillofacial fixation.....          0256         35.51     $1,846.84  ............       $369.37
21110.....................  T                          Interdental fixation.......          0252          6.27       $326.10       $114.24        $65.22
21116.....................  N                          Injection, jaw joint x-ray.  ............  ............  ............  ............  ............
21120.....................  T                          Reconstruction of chin.....          0254         21.89     $1,138.48       $352.93       $227.70
21121.....................  T                          Reconstruction of chin.....          0254         21.89     $1,138.48       $352.93       $227.70
21122.....................  T                          Reconstruction of chin.....          0254         21.89     $1,138.48       $352.93       $227.70
21123.....................  T                          Reconstruction of chin.....          0254         21.89     $1,138.48       $352.93       $227.70
21125.....................  T                          Augmentation, lower jaw              0254         21.89     $1,138.48       $352.93       $227.70
                                                        bone.
21127.....................  T                          Augmentation, lower jaw              0256         35.51     $1,846.84  ............       $369.37
                                                        bone.
21137.....................  T                          Reduction of forehead......          0254         21.89     $1,138.48       $352.93       $227.70
21138.....................  T                          Reduction of forehead......          0256         35.51     $1,846.84  ............       $369.37
21139.....................  T                          Reduction of forehead......          0256         35.51     $1,846.84  ............       $369.37
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         21.89     $1,138.48       $352.93       $227.70
21182.....................  C                          Reconstruct cranial bone...  ............  ............  ............  ............  ............
21183.....................  C                          Reconstruct cranial bone...  ............  ............  ............  ............  ............
21184.....................  C                          Reconstruct cranial bone...  ............  ............  ............  ............  ............
21188.....................  C                          Reconstruction of midface..  ............  ............  ............  ............  ............
21193.....................  C                          Reconst lwr jaw w/o graft..  ............  ............  ............  ............  ............
21194.....................  C                          Reconst lwr jaw w/graft....  ............  ............  ............  ............  ............
21195.....................  C                          Reconst lwr jaw w/o          ............  ............  ............  ............  ............
                                                        fixation.
21196.....................  C                          Reconst lwr jaw w/fixation.  ............  ............  ............  ............  ............

[[Page 52172]]

 
21198.....................  T                          Reconstr lwr jaw segment...          0256         35.51     $1,846.84  ............       $369.37
21199.....................  T                          Reconstr lwr jaw w/advance.          0256         35.51     $1,846.84  ............       $369.37
21206.....................  T                          Reconstruct upper jaw bone.          0256         35.51     $1,846.84  ............       $369.37
21208.....................  T                          Augmentation of facial               0256         35.51     $1,846.84  ............       $369.37
                                                        bones.
21209.....................  T                          Reduction of facial bones..          0256         35.51     $1,846.84  ............       $369.37
21210.....................  T                          Face bone graft............          0256         35.51     $1,846.84  ............       $369.37
21215.....................  T                          Lower jaw bone graft.......          0256         35.51     $1,846.84  ............       $369.37
21230.....................  T                          Rib cartilage graft........          0256         35.51     $1,846.84  ............       $369.37
21235.....................  T                          Ear cartilage graft........          0254         21.89     $1,138.48       $352.93       $227.70
21240.....................  T                          Reconstruction of jaw joint          0256         35.51     $1,846.84  ............       $369.37
21242.....................  T                          Reconstruction of jaw joint          0256         35.51     $1,846.84  ............       $369.37
21243.....................  T                          Reconstruction of jaw joint          0256         35.51     $1,846.84  ............       $369.37
21244.....................  T                          Reconstruction of lower jaw          0256         35.51     $1,846.84  ............       $369.37
21245.....................  T                          Reconstruction of jaw......          0256         35.51     $1,846.84  ............       $369.37
21246.....................  T                          Reconstruction of jaw......          0256         35.51     $1,846.84  ............       $369.37
21247.....................  C                          Reconstruct lower jaw bone.  ............  ............  ............  ............  ............
21248.....................  T                          Reconstruction of jaw......          0256         35.51     $1,846.84  ............       $369.37
21249.....................  T                          Reconstruction of jaw......          0256         35.51     $1,846.84  ............       $369.37
21255.....................  C                          Reconstruct lower jaw bone.  ............  ............  ............  ............  ............
21256.....................  C                          Reconstruction of orbit....  ............  ............  ............  ............  ............
21260.....................  T                          Revise eye sockets.........          0256         35.51     $1,846.84  ............       $369.37
21261.....................  T                          Revise eye sockets.........          0256         35.51     $1,846.84  ............       $369.37
21263.....................  T                          Revise eye sockets.........          0256         35.51     $1,846.84  ............       $369.37
21267.....................  T                          Revise eye sockets.........          0256         35.51     $1,846.84  ............       $369.37
21268.....................  C                          Revise eye sockets.........  ............  ............  ............  ............  ............
21270.....................  T                          Augmentation, cheek bone...          0256         35.51     $1,846.84  ............       $369.37
21275.....................  T                          Revision, orbitofacial               0256         35.51     $1,846.84  ............       $369.37
                                                        bones.
21280.....................  T                          Revision of eyelid.........          0256         35.51     $1,846.84  ............       $369.37
21282.....................  T                          Revision of eyelid.........          0253         14.79       $769.21       $284.61       $153.84
21295.....................  T                          Revision of jaw muscle/bone          0252          6.27       $326.10       $114.24        $65.22
21296.....................  T                          Revision of jaw muscle/bone          0254         21.89     $1,138.48       $352.93       $227.70
21299.....................  T                          Cranio/maxillofacial                 0253         14.79       $769.21       $284.61       $153.84
                                                        surgery.
21300.....................  T                          Treatment of skull fracture          0253         14.79       $769.21       $284.61       $153.84
21310.....................  X                          Treatment of nose fracture.          0340          0.66        $34.33  ............         $6.87
21315.....................  X                          Treatment of nose fracture.          0340          0.66        $34.33  ............         $6.87
21320.....................  X                          Treatment of nose fracture.          0340          0.66        $34.33  ............         $6.87
21325.....................  T                          Treatment of nose fracture.          0254         21.89     $1,138.48       $352.93       $227.70
21330.....................  T                          Treatment of nose fracture.          0254         21.89     $1,138.48       $352.93       $227.70
21335.....................  T                          Treatment of nose fracture.          0254         21.89     $1,138.48       $352.93       $227.70
21336.....................  T                          Treat nasal septal fracture          0046         29.03     $1,509.82       $535.76       $301.96
21337.....................  T                          Treat nasal septal fracture          0253         14.79       $769.21       $284.61       $153.84
21338.....................  T                          Treat nasoethmoid fracture.          0254         21.89     $1,138.48       $352.93       $227.70
21339.....................  T                          Treat nasoethmoid fracture.          0254         21.89     $1,138.48       $352.93       $227.70
21340.....................  T                          Treatment of nose fracture.          0256         35.51     $1,846.84  ............       $369.37
21343.....................  C                          Treatment of sinus fracture  ............  ............  ............  ............  ............
21344.....................  C                          Treatment of sinus fracture  ............  ............  ............  ............  ............
21345.....................  T                          Treat nose/jaw fracture....          0254         21.89     $1,138.48       $352.93       $227.70
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         35.51     $1,846.84  ............       $369.37
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.....................  T                          Treat eye socket fracture..          0256         35.51     $1,846.84  ............       $369.37
21395.....................  C                          Treat eye socket fracture..  ............  ............  ............  ............  ............
21400.....................  T                          Treat eye socket fracture..          0252          6.27       $326.10       $114.24        $65.22
21401.....................  T                          Treat eye socket fracture..          0253         14.79       $769.21       $284.61       $153.84
21406.....................  T                          Treat eye socket fracture..          0256         35.51     $1,846.84  ............       $369.37
21407.....................  T                          Treat eye socket fracture..          0256         35.51     $1,846.84  ............       $369.37
21408.....................  C                          Treat eye socket fracture..  ............  ............  ............  ............  ............
21421.....................  T                          Treat mouth roof fracture..          0254         21.89     $1,138.48       $352.93       $227.70

[[Page 52173]]

 
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          0254         21.89     $1,138.48       $352.93       $227.70
21445.....................  T                          Treat dental ridge fracture          0254         21.89     $1,138.48       $352.93       $227.70
21450.....................  T                          Treat lower jaw fracture...          0251          1.92        $99.86  ............        $19.97
21451.....................  T                          Treat lower jaw fracture...          0252          6.27       $326.10       $114.24        $65.22
21452.....................  T                          Treat lower jaw fracture...          0253         14.79       $769.21       $284.61       $153.84
21453.....................  T                          Treat lower jaw fracture...          0256         35.51     $1,846.84  ............       $369.37
21454.....................  T                          Treat lower jaw fracture...          0254         21.89     $1,138.48       $352.93       $227.70
21461.....................  T                          Treat lower jaw fracture...          0256         35.51     $1,846.84  ............       $369.37
21462.....................  T                          Treat lower jaw fracture...          0256         35.51     $1,846.84  ............       $369.37
21465.....................  T                          Treat lower jaw fracture...          0256         35.51     $1,846.84  ............       $369.37
21470.....................  T                          Treat lower jaw fracture...          0256         35.51     $1,846.84  ............       $369.37
21480.....................  T                          Reset dislocated jaw.......          0251          1.92        $99.86  ............        $19.97
21485.....................  T                          Reset dislocated jaw.......          0253         14.79       $769.21       $284.61       $153.84
21490.....................  T                          Repair dislocated jaw......          0256         35.51     $1,846.84  ............       $369.37
21493.....................  T                          Treat hyoid bone fracture..          0252          6.27       $326.10       $114.24        $65.22
21494.....................  T                          Treat hyoid bone fracture..          0252          6.27       $326.10       $114.24        $65.22
21495.....................  C                          Treat hyoid bone fracture..  ............  ............  ............  ............  ............
21497.....................  T                          Interdental wiring.........          0253         14.79       $769.21       $284.61       $153.84
21499.....................  T                          Head surgery procedure.....          0253         14.79       $769.21       $284.61       $153.84
21501.....................  T                          Drain neck/chest lesion....          0008         16.32       $848.79  ............       $169.76
21502.....................  T                          Drain chest lesion.........          0049         19.45     $1,011.58  ............       $202.32
21510.....................  C                          Drainage of bone lesion....  ............  ............  ............  ............  ............
21550.....................  T                          Biopsy of neck/chest.......          0021         14.58       $758.29       $227.49       $151.66
21555.....................  T                          Remove lesion, neck/chest..          0022         18.10       $941.36       $367.13       $188.27
21556.....................  T                          Remove lesion, neck/chest..          0022         18.10       $941.36       $367.13       $188.27
21557.....................  C                          Remove tumor, neck/chest...  ............  ............  ............  ............  ............
21600.....................  T                          Partial removal of rib.....          0050         23.60     $1,227.41  ............       $245.48
21610.....................  T                          Partial removal of rib.....          0050         23.60     $1,227.41  ............       $245.48
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....          0049         19.45     $1,011.58  ............       $202.32
21705.....................  C                          Revision of neck muscle/rib  ............  ............  ............  ............  ............
21720.....................  T                          Revision of neck muscle....          0049         19.45     $1,011.58  ............       $202.32
21725.....................  T                          Revision of neck muscle....          0006          1.89        $98.30        $25.56        $19.66
21740.....................  C                          Reconstruction of sternum..  ............  ............  ............  ............  ............
21750.....................  C                          Repair of sternum            ............  ............  ............  ............  ............
                                                        separation.
21800.....................  T                          Treatment of rib fracture..          0043          1.68        $87.38  ............        $17.48
21805.....................  T                          Treatment of rib fracture..          0046         29.03     $1,509.82       $535.76       $301.96
21810.....................  C                          Treatment of rib             ............  ............  ............  ............  ............
                                                        fracture(s).
21820.....................  T                          Treat sternum fracture.....          0043          1.68        $87.38  ............        $17.48
21825.....................  C                          Treat sternum fracture.....  ............  ............  ............  ............  ............
21899.....................  T                          Neck/chest surgery                   0252          6.27       $326.10       $114.24        $65.22
                                                        procedure.
21920.....................  T                          Biopsy soft tissue of back.          0020          7.36       $382.79       $114.84        $76.56
21925.....................  T                          Biopsy soft tissue of back.          0022         18.10       $941.36       $367.13       $188.27
21930.....................  T                          Remove lesion, back or               0022         18.10       $941.36       $367.13       $188.27
                                                        flank.
21935.....................  T                          Remove tumor, back.........          0022         18.10       $941.36       $367.13       $188.27
22100.....................  T                          Remove part of neck                  0208         39.95     $2,077.76  ............       $415.55
                                                        vertebra.
22101.....................  T                          Remove part, thorax                  0208         39.95     $2,077.76  ............       $415.55
                                                        vertebra.
22102.....................  T                          Remove part, lumbar                  0208         39.95     $2,077.76  ............       $415.55
                                                        vertebra.
22103.....................  T                          Remove extra spine segment.          0208         39.95     $2,077.76  ............       $415.55
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.....  ............  ............  ............  ............  ............

[[Page 52174]]

 
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                  0043          1.68        $87.38  ............        $17.48
                                                        fracture.
22310.....................  T                          Treat spine fracture.......          0043          1.68        $87.38  ............        $17.48
22315.....................  T                          Treat spine fracture.......          0043          1.68        $87.38  ............        $17.48
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         13.47       $700.56       $280.22       $140.11
22520.....................  T                          Percut vertebroplasty thor.          0050         23.60     $1,227.41  ............       $245.48
22521.....................  T                          Percut vertebroplasty lumb.          0050         23.60     $1,227.41  ............       $245.48
22522.....................  T                          Percut vertebroplasty addl.          0050         23.60     $1,227.41  ............       $245.48
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.
22899.....................  T                          Spine surgery procedure....          0043          1.68        $87.38  ............        $17.48
22900.....................  T                          Remove abdominal wall                0022         18.10       $941.36       $367.13       $188.27
                                                        lesion.
22999.....................  T                          Abdomen surgery procedure..          0022         18.10       $941.36       $367.13       $188.27
23000.....................  T                          Removal of calcium deposits          0021         14.58       $758.29       $227.49       $151.66
23020.....................  T                          Release shoulder joint.....          0051         34.03     $1,769.87  ............       $353.97
23030.....................  T                          Drain shoulder lesion......          0008         16.32       $848.79  ............       $169.76
23031.....................  T                          Drain shoulder bursa.......          0008         16.32       $848.79  ............       $169.76
23035.....................  T                          Drain shoulder bone lesion.          0049         19.45     $1,011.58  ............       $202.32
23040.....................  T                          Exploratory shoulder                 0050         23.60     $1,227.41  ............       $245.48
                                                        surgery.
23044.....................  T                          Exploratory shoulder                 0050         23.60     $1,227.41  ............       $245.48
                                                        surgery.

[[Page 52175]]

 
23065.....................  T                          Biopsy shoulder tissues....          0021         14.58       $758.29       $227.49       $151.66
23066.....................  T                          Biopsy shoulder tissues....          0022         18.10       $941.36       $367.13       $188.27
23075.....................  T                          Removal of shoulder lesion.          0021         14.58       $758.29       $227.49       $151.66
23076.....................  T                          Removal of shoulder lesion.          0022         18.10       $941.36       $367.13       $188.27
23077.....................  T                          Remove tumor of shoulder...          0022         18.10       $941.36       $367.13       $188.27
23100.....................  T                          Biopsy of shoulder joint...          0049         19.45     $1,011.58  ............       $202.32
23101.....................  T                          Shoulder joint surgery.....          0050         23.60     $1,227.41  ............       $245.48
23105.....................  T                          Remove shoulder joint                0050         23.60     $1,227.41  ............       $245.48
                                                        lining.
23106.....................  T                          Incision of collarbone               0050         23.60     $1,227.41  ............       $245.48
                                                        joint.
23107.....................  T                          Explore treat shoulder               0050         23.60     $1,227.41  ............       $245.48
                                                        joint.
23120.....................  T                          Partial removal, collar              0051         34.03     $1,769.87  ............       $353.97
                                                        bone.
23125.....................  T                          Removal of collar bone.....          0051         34.03     $1,769.87  ............       $353.97
23130.....................  T                          Remove shoulder bone, part.          0051         34.03     $1,769.87  ............       $353.97
23140.....................  T                          Removal of bone lesion.....          0049         19.45     $1,011.58  ............       $202.32
23145.....................  T                          Removal of bone lesion.....          0050         23.60     $1,227.41  ............       $245.48
23146.....................  T                          Removal of bone lesion.....          0050         23.60     $1,227.41  ............       $245.48
23150.....................  T                          Removal of humerus lesion..          0050         23.60     $1,227.41  ............       $245.48
23155.....................  T                          Removal of humerus lesion..          0050         23.60     $1,227.41  ............       $245.48
23156.....................  T                          Removal of humerus lesion..          0050         23.60     $1,227.41  ............       $245.48
23170.....................  T                          Remove collar bone lesion..          0050         23.60     $1,227.41  ............       $245.48
23172.....................  T                          Remove shoulder blade                0050         23.60     $1,227.41  ............       $245.48
                                                        lesion.
23174.....................  T                          Remove humerus lesion......          0050         23.60     $1,227.41  ............       $245.48
23180.....................  T                          Remove collar bone lesion..          0050         23.60     $1,227.41  ............       $245.48
23182.....................  T                          Remove shoulder blade                0050         23.60     $1,227.41  ............       $245.48
                                                        lesion.
23184.....................  T                          Remove humerus lesion......          0050         23.60     $1,227.41  ............       $245.48
23190.....................  T                          Partial removal of scapula.          0050         23.60     $1,227.41  ............       $245.48
23195.....................  T                          Removal of head of humerus.          0050         23.60     $1,227.41  ............       $245.48
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.  ............  ............  ............  ............  ............
23330.....................  T                          Remove shoulder foreign              0020          7.36       $382.79       $114.84        $76.56
                                                        body.
23331.....................  T                          Remove shoulder foreign              0022         18.10       $941.36       $367.13       $188.27
                                                        body.
23332.....................  C                          Remove shoulder foreign      ............  ............  ............  ............  ............
                                                        body.
23350.....................  N                          Injection for shoulder x-    ............  ............  ............  ............  ............
                                                        ray.
23395.....................  T                          Muscle transfer,shoulder/            0051         34.03     $1,769.87  ............       $353.97
                                                        arm.
23397.....................  T                          Muscle transfers...........          0052         42.37     $2,203.62  ............       $440.72
23400.....................  T                          Fixation of shoulder blade.          0050         23.60     $1,227.41  ............       $245.48
23405.....................  T                          Incision of tendon & muscle          0050         23.60     $1,227.41  ............       $245.48
23406.....................  T                          Incise tendon(s) &                   0050         23.60     $1,227.41  ............       $245.48
                                                        muscle(s).
23410.....................  T                          Repair of tendon(s)........          0052         42.37     $2,203.62  ............       $440.72
23412.....................  T                          Repair of tendon(s)........          0052         42.37     $2,203.62  ............       $440.72
23415.....................  T                          Release of shoulder                  0051         34.03     $1,769.87  ............       $353.97
                                                        ligament.
23420.....................  T                          Repair of shoulder.........          0052         42.37     $2,203.62  ............       $440.72
23430.....................  T                          Repair biceps tendon.......          0052         42.37     $2,203.62  ............       $440.72
23440.....................  T                          Remove/transplant tendon...          0052         42.37     $2,203.62  ............       $440.72
23450.....................  T                          Repair shoulder capsule....          0052         42.37     $2,203.62  ............       $440.72
23455.....................  T                          Repair shoulder capsule....          0052         42.37     $2,203.62  ............       $440.72
23460.....................  T                          Repair shoulder capsule....          0052         42.37     $2,203.62  ............       $440.72
23462.....................  T                          Repair shoulder capsule....          0052         42.37     $2,203.62  ............       $440.72
23465.....................  T                          Repair shoulder capsule....          0052         42.37     $2,203.62  ............       $440.72
23466.....................  T                          Repair shoulder capsule....          0052         42.37     $2,203.62  ............       $440.72
23470.....................  T                          Reconstruct shoulder joint.          0048         36.93     $1,920.69       $633.83       $384.14
23472.....................  C                          Reconstruct shoulder joint.  ............  ............  ............  ............  ............
23480.....................  T                          Revision of collar bone....          0051         34.03     $1,769.87  ............       $353.97
23485.....................  T                          Revision of collar bone....          0051         34.03     $1,769.87  ............       $353.97
23490.....................  T                          Reinforce clavicle.........          0051         34.03     $1,769.87  ............       $353.97
23491.....................  T                          Reinforce shoulder bones...          0051         34.03     $1,769.87  ............       $353.97
23500.....................  T                          Treat clavicle fracture....          0043          1.68        $87.38  ............        $17.48
23505.....................  T                          Treat clavicle fracture....          0043          1.68        $87.38  ............        $17.48
23515.....................  T                          Treat clavicle fracture....          0046         29.03     $1,509.82       $535.76       $301.96
23520.....................  T                          Treat clavicle dislocation.          0043          1.68        $87.38  ............        $17.48
23525.....................  T                          Treat clavicle dislocation.          0043          1.68        $87.38  ............        $17.48
23530.....................  T                          Treat clavicle dislocation.          0046         29.03     $1,509.82       $535.76       $301.96
23532.....................  T                          Treat clavicle dislocation.          0046         29.03     $1,509.82       $535.76       $301.96

[[Page 52176]]

 
23540.....................  T                          Treat clavicle dislocation.          0043          1.68        $87.38  ............        $17.48
23545.....................  T                          Treat clavicle dislocation.          0043          1.68        $87.38  ............        $17.48
23550.....................  T                          Treat clavicle dislocation.          0046         29.03     $1,509.82       $535.76       $301.96
23552.....................  T                          Treat clavicle dislocation.          0046         29.03     $1,509.82       $535.76       $301.96
23570.....................  T                          Treat shoulder blade fx....          0043          1.68        $87.38  ............        $17.48
23575.....................  T                          Treat shoulder blade fx....          0043          1.68        $87.38  ............        $17.48
23585.....................  T                          Treat scapula fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
23600.....................  T                          Treat humerus fracture.....          0043          1.68        $87.38  ............        $17.48
23605.....................  T                          Treat humerus fracture.....          0043          1.68        $87.38  ............        $17.48
23615.....................  T                          Treat humerus fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
23616.....................  T                          Treat humerus fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
23620.....................  T                          Treat humerus fracture.....          0043          1.68        $87.38  ............        $17.48
23625.....................  T                          Treat humerus fracture.....          0043          1.68        $87.38  ............        $17.48
23630.....................  T                          Treat humerus fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
23650.....................  T                          Treat shoulder dislocation.          0043          1.68        $87.38  ............        $17.48
23655.....................  T                          Treat shoulder dislocation.          0045         13.47       $700.56       $280.22       $140.11
23660.....................  T                          Treat shoulder dislocation.          0046         29.03     $1,509.82       $535.76       $301.96
23665.....................  T                          Treat dislocation/fracture.          0043          1.68        $87.38  ............        $17.48
23670.....................  T                          Treat dislocation/fracture.          0046         29.03     $1,509.82       $535.76       $301.96
23675.....................  T                          Treat dislocation/fracture.          0043          1.68        $87.38  ............        $17.48
23680.....................  T                          Treat dislocation/fracture.          0046         29.03     $1,509.82       $535.76       $301.96
23700.....................  T                          Fixation of shoulder.......          0045         13.47       $700.56       $280.22       $140.11
23800.....................  T                          Fusion of shoulder joint...          0051         34.03     $1,769.87  ............       $353.97
23802.....................  T                          Fusion of shoulder joint...          0051         34.03     $1,769.87  ............       $353.97
23900.....................  C                          Amputation of arm & girdle.  ............  ............  ............  ............  ............
23920.....................  C                          Amputation at shoulder       ............  ............  ............  ............  ............
                                                        joint.
23921.....................  T                          Amputation follow-up                 0025          5.89       $306.33       $116.41        $61.27
                                                        surgery.
23929.....................  T                          Shoulder surgery procedure.          0043          1.68        $87.38  ............        $17.48
23930.....................  T                          Drainage of arm lesion.....          0008         16.32       $848.79  ............       $169.76
23931.....................  T                          Drainage of arm bursa......          0006          1.89        $98.30        $25.56        $19.66
23935.....................  T                          Drain arm/elbow bone lesion          0049         19.45     $1,011.58  ............       $202.32
24000.....................  T                          Exploratory elbow surgery..          0050         23.60     $1,227.41  ............       $245.48
24006.....................  T                          Release elbow joint........          0050         23.60     $1,227.41  ............       $245.48
24065.....................  T                          Biopsy arm/elbow soft                0021         14.58       $758.29       $227.49       $151.66
                                                        tissue.
24066.....................  T                          Biopsy arm/elbow soft                0021         14.58       $758.29       $227.49       $151.66
                                                        tissue.
24075.....................  T                          Remove arm/elbow lesion....          0021         14.58       $758.29       $227.49       $151.66
24076.....................  T                          Remove arm/elbow lesion....          0022         18.10       $941.36       $367.13       $188.27
24077.....................  T                          Remove tumor of arm/elbow..          0022         18.10       $941.36       $367.13       $188.27
24100.....................  T                          Biopsy elbow joint lining..          0049         19.45     $1,011.58  ............       $202.32
24101.....................  T                          Explore/treat elbow joint..          0050         23.60     $1,227.41  ............       $245.48
24102.....................  T                          Remove elbow joint lining..          0050         23.60     $1,227.41  ............       $245.48
24105.....................  T                          Removal of elbow bursa.....          0049         19.45     $1,011.58  ............       $202.32
24110.....................  T                          Remove humerus lesion......          0049         19.45     $1,011.58  ............       $202.32
24115.....................  T                          Remove/graft bone lesion...          0050         23.60     $1,227.41  ............       $245.48
24116.....................  T                          Remove/graft bone lesion...          0050         23.60     $1,227.41  ............       $245.48
24120.....................  T                          Remove elbow lesion........          0049         19.45     $1,011.58  ............       $202.32
24125.....................  T                          Remove/graft bone lesion...          0050         23.60     $1,227.41  ............       $245.48
24126.....................  T                          Remove/graft bone lesion...          0050         23.60     $1,227.41  ............       $245.48
24130.....................  T                          Removal of head of radius..          0050         23.60     $1,227.41  ............       $245.48
24134.....................  T                          Removal of arm bone lesion.          0050         23.60     $1,227.41  ............       $245.48
24136.....................  T                          Remove radius bone lesion..          0050         23.60     $1,227.41  ............       $245.48
24138.....................  T                          Remove elbow bone lesion...          0050         23.60     $1,227.41  ............       $245.48
24140.....................  T                          Partial removal of arm bone          0050         23.60     $1,227.41  ............       $245.48
24145.....................  T                          Partial removal of radius..          0050         23.60     $1,227.41  ............       $245.48
24147.....................  T                          Partial removal of elbow...          0050         23.60     $1,227.41  ............       $245.48
24149.....................  C                          Radical resection of elbow.  ............  ............  ............  ............  ............
24150.....................  T                          Extensive humerus surgery..          0052         42.37     $2,203.62  ............       $440.72
24151.....................  T                          Extensive humerus surgery..          0052         42.37     $2,203.62  ............       $440.72
24152.....................  T                          Extensive radius surgery...          0052         42.37     $2,203.62  ............       $440.72
24153.....................  T                          Extensive radius surgery...          0052         42.37     $2,203.62  ............       $440.72
24155.....................  T                          Removal of elbow joint.....          0051         34.03     $1,769.87  ............       $353.97
24160.....................  T                          Remove elbow joint implant.          0050         23.60     $1,227.41  ............       $245.48
24164.....................  T                          Remove radius head implant.          0050         23.60     $1,227.41  ............       $245.48
24200.....................  T                          Removal of arm foreign body          0019          3.94       $204.92        $75.82        $40.98
24201.....................  T                          Removal of arm foreign body          0021         14.58       $758.29       $227.49       $151.66
24220.....................  N                          Injection for elbow x-ray..  ............  ............  ............  ............  ............

[[Page 52177]]

 
24300.....................  T                          Manipulate elbow w/anesth..          0045         13.47       $700.56       $280.22       $140.11
24301.....................  T                          Muscle/tendon transfer.....          0050         23.60     $1,227.41  ............       $245.48
24305.....................  T                          Arm tendon lengthening.....          0050         23.60     $1,227.41  ............       $245.48
24310.....................  T                          Revision of arm tendon.....          0049         19.45     $1,011.58  ............       $202.32
24320.....................  T                          Repair of arm tendon.......          0051         34.03     $1,769.87  ............       $353.97
24330.....................  T                          Revision of arm muscles....          0051         34.03     $1,769.87  ............       $353.97
24331.....................  T                          Revision of arm muscles....          0051         34.03     $1,769.87  ............       $353.97
24332.....................  T                          Tenolysis, triceps.........          0049         19.45     $1,011.58  ............       $202.32
24340.....................  T                          Repair of biceps tendon....          0051         34.03     $1,769.87  ............       $353.97
24341.....................  T                          Repair arm tendon/muscle...          0051         34.03     $1,769.87  ............       $353.97
24342.....................  T                          Repair of ruptured tendon..          0051         34.03     $1,769.87  ............       $353.97
24343.....................  T                          Repr elbow lat ligmnt w/             0050         23.60     $1,227.41  ............       $245.48
                                                        tiss.
24344.....................  T                          Reconstruct elbow lat                0051         34.03     $1,769.87  ............       $353.97
                                                        ligmnt.
24345.....................  T                          Repr elbw med ligmnt w/tiss          0050         23.60     $1,227.41  ............       $245.48
24346.....................  T                          Reconstruct elbow med                0051         34.03     $1,769.87  ............       $353.97
                                                        ligmnt.
24350.....................  T                          Repair of tennis elbow.....          0050         23.60     $1,227.41  ............       $245.48
24351.....................  T                          Repair of tennis elbow.....          0050         23.60     $1,227.41  ............       $245.48
24352.....................  T                          Repair of tennis elbow.....          0050         23.60     $1,227.41  ............       $245.48
24354.....................  T                          Repair of tennis elbow.....          0050         23.60     $1,227.41  ............       $245.48
24356.....................  T                          Revision of tennis elbow...          0050         23.60     $1,227.41  ............       $245.48
24360.....................  T                          Reconstruct elbow joint....          0047         29.59     $1,538.95       $537.03       $307.79
24361.....................  T                          Reconstruct elbow joint....          0048         36.93     $1,920.69       $633.83       $384.14
24362.....................  T                          Reconstruct elbow joint....          0048         36.93     $1,920.69       $633.83       $384.14
24363.....................  T                          Replace elbow joint........          0048         36.93     $1,920.69       $633.83       $384.14
24365.....................  T                          Reconstruct head of radius.          0047         29.59     $1,538.95       $537.03       $307.79
24366.....................  T                          Reconstruct head of radius.          0048         36.93     $1,920.69       $633.83       $384.14
24400.....................  T                          Revision of humerus........          0050         23.60     $1,227.41  ............       $245.48
24410.....................  T                          Revision of humerus........          0050         23.60     $1,227.41  ............       $245.48
24420.....................  T                          Revision of humerus........          0051         34.03     $1,769.87  ............       $353.97
24430.....................  T                          Repair of humerus..........          0051         34.03     $1,769.87  ............       $353.97
24435.....................  T                          Repair humerus with graft..          0051         34.03     $1,769.87  ............       $353.97
24470.....................  T                          Revision of elbow joint....          0051         34.03     $1,769.87  ............       $353.97
24495.....................  T                          Decompression of forearm...          0050         23.60     $1,227.41  ............       $245.48
24498.....................  T                          Reinforce humerus..........          0051         34.03     $1,769.87  ............       $353.97
24500.....................  T                          Treat humerus fracture.....          0043          1.68        $87.38  ............        $17.48
24505.....................  T                          Treat humerus fracture.....          0043          1.68        $87.38  ............        $17.48
24515.....................  T                          Treat humerus fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
24516.....................  T                          Treat humerus fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
24530.....................  T                          Treat humerus fracture.....          0043          1.68        $87.38  ............        $17.48
24535.....................  T                          Treat humerus fracture.....          0043          1.68        $87.38  ............        $17.48
24538.....................  T                          Treat humerus fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
24545.....................  T                          Treat humerus fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
24546.....................  T                          Treat humerus fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
24560.....................  T                          Treat humerus fracture.....          0043          1.68        $87.38  ............        $17.48
24565.....................  T                          Treat humerus fracture.....          0043          1.68        $87.38  ............        $17.48
24566.....................  T                          Treat humerus fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
24575.....................  T                          Treat humerus fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
24576.....................  T                          Treat humerus fracture.....          0043          1.68        $87.38  ............        $17.48
24577.....................  T                          Treat humerus fracture.....          0043          1.68        $87.38  ............        $17.48
24579.....................  T                          Treat humerus fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
24582.....................  T                          Treat humerus fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
24586.....................  T                          Treat elbow fracture.......          0046         29.03     $1,509.82       $535.76       $301.96
24587.....................  T                          Treat elbow fracture.......          0046         29.03     $1,509.82       $535.76       $301.96
24600.....................  T                          Treat elbow dislocation....          0043          1.68        $87.38  ............        $17.48
24605.....................  T                          Treat elbow dislocation....          0045         13.47       $700.56       $280.22       $140.11
24615.....................  T                          Treat elbow dislocation....          0046         29.03     $1,509.82       $535.76       $301.96
24620.....................  T                          Treat elbow fracture.......          0043          1.68        $87.38  ............        $17.48
24635.....................  T                          Treat elbow fracture.......          0046         29.03     $1,509.82       $535.76       $301.96
24640.....................  T                          Treat elbow dislocation....          0043          1.68        $87.38  ............        $17.48
24650.....................  T                          Treat radius fracture......          0043          1.68        $87.38  ............        $17.48
24655.....................  T                          Treat radius fracture......          0043          1.68        $87.38  ............        $17.48
24665.....................  T                          Treat radius fracture......          0046         29.03     $1,509.82       $535.76       $301.96
24666.....................  T                          Treat radius fracture......          0046         29.03     $1,509.82       $535.76       $301.96
24670.....................  T                          Treat ulnar fracture.......          0043          1.68        $87.38  ............        $17.48
24675.....................  T                          Treat ulnar fracture.......          0043          1.68        $87.38  ............        $17.48
24685.....................  T                          Treat ulnar fracture.......          0046         29.03     $1,509.82       $535.76       $301.96

[[Page 52178]]

 
24800.....................  T                          Fusion of elbow joint......          0051         34.03     $1,769.87  ............       $353.97
24802.....................  T                          Fusion/graft of elbow joint          0051         34.03     $1,769.87  ............       $353.97
24900.....................  C                          Amputation of upper arm....  ............  ............  ............  ............  ............
24920.....................  C                          Amputation of upper arm....  ............  ............  ............  ............  ............
24925.....................  T                          Amputation follow-up                 0049         19.45     $1,011.58  ............       $202.32
                                                        surgery.
24930.....................  C                          Amputation follow-up         ............  ............  ............  ............  ............
                                                        surgery.
24931.....................  C                          Amputate upper arm &         ............  ............  ............  ............  ............
                                                        implant.
24935.....................  T                          Revision of amputation.....          0052         42.37     $2,203.62  ............       $440.72
24940.....................  C                          Revision of upper arm......  ............  ............  ............  ............  ............
24999.....................  T                          Upper arm/elbow surgery....          0043          1.68        $87.38  ............        $17.48
25000.....................  T                          Incision of tendon sheath..          0049         19.45     $1,011.58  ............       $202.32
25001.....................  T                          Incise flexor carpi                  0049         19.45     $1,011.58  ............       $202.32
                                                        radialis.
25020.....................  T                          Decompress forearm 1 space.          0049         19.45     $1,011.58  ............       $202.32
25023.....................  T                          Decompress forearm 1 space.          0050         23.60     $1,227.41  ............       $245.48
25024.....................  T                          Decompress forearm 2 spaces          0050         23.60     $1,227.41  ............       $245.48
25025.....................  T                          Decompress forarm 2 spaces.          0050         23.60     $1,227.41  ............       $245.48
25028.....................  T                          Drainage of forearm lesion.          0049         19.45     $1,011.58  ............       $202.32
25031.....................  T                          Drainage of forearm bursa..          0049         19.45     $1,011.58  ............       $202.32
25035.....................  T                          Treat forearm bone lesion..          0049         19.45     $1,011.58  ............       $202.32
25040.....................  T                          Explore/treat wrist joint..          0050         23.60     $1,227.41  ............       $245.48
25065.....................  T                          Biopsy forearm soft tissues          0021         14.58       $758.29       $227.49       $151.66
25066.....................  T                          Biopsy forearm soft tissues          0022         18.10       $941.36       $367.13       $188.27
25075.....................  T                          Remove forearm lesion                0021         14.58       $758.29       $227.49       $151.66
                                                        subcut.
25076.....................  T                          Remove forearm lesion deep.          0022         18.10       $941.36       $367.13       $188.27
25077.....................  T                          Remove tumor, forearm/wrist          0022         18.10       $941.36       $367.13       $188.27
25085.....................  T                          Incision of wrist capsule..          0049         19.45     $1,011.58  ............       $202.32
25100.....................  T                          Biopsy of wrist joint......          0049         19.45     $1,011.58  ............       $202.32
25101.....................  T                          Explore/treat wrist joint..          0050         23.60     $1,227.41  ............       $245.48
25105.....................  T                          Remove wrist joint lining..          0050         23.60     $1,227.41  ............       $245.48
25107.....................  T                          Remove wrist joint                   0050         23.60     $1,227.41  ............       $245.48
                                                        cartilage.
25110.....................  T                          Remove wrist tendon lesion.          0049         19.45     $1,011.58  ............       $202.32
25111.....................  T                          Remove wrist tendon lesion.          0053         14.76       $767.65       $253.49       $153.53
25112.....................  T                          Reremove wrist tendon                0053         14.76       $767.65       $253.49       $153.53
                                                        lesion.
25115.....................  T                          Remove wrist/forearm lesion          0049         19.45     $1,011.58  ............       $202.32
25116.....................  T                          Remove wrist/forearm lesion          0049         19.45     $1,011.58  ............       $202.32
25118.....................  T                          Excise wrist tendon sheath.          0050         23.60     $1,227.41  ............       $245.48
25119.....................  T                          Partial removal of ulna....          0050         23.60     $1,227.41  ............       $245.48
25120.....................  T                          Removal of forearm lesion..          0050         23.60     $1,227.41  ............       $245.48
25125.....................  T                          Remove/graft forearm lesion          0050         23.60     $1,227.41  ............       $245.48
25126.....................  T                          Remove/graft forearm lesion          0050         23.60     $1,227.41  ............       $245.48
25130.....................  T                          Removal of wrist lesion....          0050         23.60     $1,227.41  ............       $245.48
25135.....................  T                          Remove & graft wrist lesion          0050         23.60     $1,227.41  ............       $245.48
25136.....................  T                          Remove & graft wrist lesion          0050         23.60     $1,227.41  ............       $245.48
25145.....................  T                          Remove forearm bone lesion.          0050         23.60     $1,227.41  ............       $245.48
25150.....................  T                          Partial removal of ulna....          0050         23.60     $1,227.41  ............       $245.48
25151.....................  T                          Partial removal of radius..          0050         23.60     $1,227.41  ............       $245.48
25170.....................  T                          Extensive forearm surgery..          0052         42.37     $2,203.62  ............       $440.72
25210.....................  T                          Removal of wrist bone......          0054         23.50     $1,222.21       $472.33       $244.44
25215.....................  T                          Removal of wrist bones.....          0054         23.50     $1,222.21       $472.33       $244.44
25230.....................  T                          Partial removal of radius..          0050         23.60     $1,227.41  ............       $245.48
25240.....................  T                          Partial removal of ulna....          0050         23.60     $1,227.41  ............       $245.48
25246.....................  N                          Injection for wrist x-ray..  ............  ............  ............  ............  ............
25248.....................  T                          Remove forearm foreign body          0049         19.45     $1,011.58  ............       $202.32
25250.....................  T                          Removal of wrist prosthesis          0050         23.60     $1,227.41  ............       $245.48
25251.....................  T                          Removal of wrist prosthesis          0050         23.60     $1,227.41  ............       $245.48
25259.....................  T                          Manipulate wrist w/anesthes          0043          1.68        $87.38  ............        $17.48
25260.....................  T                          Repair forearm tendon/               0050         23.60     $1,227.41  ............       $245.48
                                                        muscle.
25263.....................  T                          Repair forearm tendon/               0050         23.60     $1,227.41  ............       $245.48
                                                        muscle.
25265.....................  T                          Repair forearm tendon/               0050         23.60     $1,227.41  ............       $245.48
                                                        muscle.
25270.....................  T                          Repair forearm tendon/               0050         23.60     $1,227.41  ............       $245.48
                                                        muscle.
25272.....................  T                          Repair forearm tendon/               0050         23.60     $1,227.41  ............       $245.48
                                                        muscle.
25274.....................  T                          Repair forearm tendon/               0050         23.60     $1,227.41  ............       $245.48
                                                        muscle.
25275.....................  T                          Repair forearm tendon                0050         23.60     $1,227.41  ............       $245.48
                                                        sheath.
25280.....................  T                          Revise wrist/forearm tendon          0050         23.60     $1,227.41  ............       $245.48
25290.....................  T                          Incise wrist/forearm tendon          0050         23.60     $1,227.41  ............       $245.48
25295.....................  T                          Release wrist/forearm                0049         19.45     $1,011.58  ............       $202.32
                                                        tendon.

[[Page 52179]]

 
25300.....................  T                          Fusion of tendons at wrist.          0050         23.60     $1,227.41  ............       $245.48
25301.....................  T                          Fusion of tendons at wrist.          0050         23.60     $1,227.41  ............       $245.48
25310.....................  T                          Transplant forearm tendon..          0051         34.03     $1,769.87  ............       $353.97
25312.....................  T                          Transplant forearm tendon..          0051         34.03     $1,769.87  ............       $353.97
25315.....................  T                          Revise palsy hand tendon(s)          0051         34.03     $1,769.87  ............       $353.97
25316.....................  T                          Revise palsy hand tendon(s)          0051         34.03     $1,769.87  ............       $353.97
25320.....................  T                          Repair/revise wrist joint..          0051         34.03     $1,769.87  ............       $353.97
25332.....................  T                          Revise wrist joint.........          0047         29.59     $1,538.95       $537.03       $307.79
25335.....................  T                          Realignment of hand........          0051         34.03     $1,769.87  ............       $353.97
25337.....................  T                          Reconstruct ulna/radioulnar          0051         34.03     $1,769.87  ............       $353.97
25350.....................  T                          Revision of radius.........          0051         34.03     $1,769.87  ............       $353.97
25355.....................  T                          Revision of radius.........          0051         34.03     $1,769.87  ............       $353.97
25360.....................  T                          Revision of ulna...........          0050         23.60     $1,227.41  ............       $245.48
25365.....................  T                          Revise radius & ulna.......          0050         23.60     $1,227.41  ............       $245.48
25370.....................  T                          Revise radius or ulna......          0051         34.03     $1,769.87  ............       $353.97
25375.....................  T                          Revise radius & ulna.......          0051         34.03     $1,769.87  ............       $353.97
25390.....................  T                          Shorten radius or ulna.....          0050         23.60     $1,227.41  ............       $245.48
25391.....................  T                          Lengthen radius or ulna....          0051         34.03     $1,769.87  ............       $353.97
25392.....................  T                          Shorten radius & ulna......          0050         23.60     $1,227.41  ............       $245.48
25393.....................  T                          Lengthen radius & ulna.....          0051         34.03     $1,769.87  ............       $353.97
25394.....................  T                          Repair carpal bone, shorten          0053         14.76       $767.65       $253.49       $153.53
25400.....................  T                          Repair radius or ulna......          0050         23.60     $1,227.41  ............       $245.48
25405.....................  T                          Repair/graft radius or ulna          0050         23.60     $1,227.41  ............       $245.48
25415.....................  T                          Repair radius & ulna.......          0050         23.60     $1,227.41  ............       $245.48
25420.....................  T                          Repair/graft radius & ulna.          0051         34.03     $1,769.87  ............       $353.97
25425.....................  T                          Repair/graft radius or ulna          0051         34.03     $1,769.87  ............       $353.97
25426.....................  T                          Repair/graft radius & ulna.          0051         34.03     $1,769.87  ............       $353.97
25430.....................  T                          Vasc graft into carpal bone          0054         23.50     $1,222.21       $472.33       $244.44
25431.....................  T                          Repair nonunion carpal bone          0054         23.50     $1,222.21       $472.33       $244.44
25440.....................  T                          Repair/graft wrist bone....          0051         34.03     $1,769.87  ............       $353.97
25441.....................  T                          Reconstruct wrist joint....          0048         36.93     $1,920.69       $633.83       $384.14
25442.....................  T                          Reconstruct wrist joint....          0048         36.93     $1,920.69       $633.83       $384.14
25443.....................  T                          Reconstruct wrist joint....          0048         36.93     $1,920.69       $633.83       $384.14
25444.....................  T                          Reconstruct wrist joint....          0048         36.93     $1,920.69       $633.83       $384.14
25445.....................  T                          Reconstruct wrist joint....          0048         36.93     $1,920.69       $633.83       $384.14
25446.....................  T                          Wrist replacement..........          0048         36.93     $1,920.69       $633.83       $384.14
25447.....................  T                          Repair wrist joint(s)......          0047         29.59     $1,538.95       $537.03       $307.79
25449.....................  T                          Remove wrist joint implant.          0047         29.59     $1,538.95       $537.03       $307.79
25450.....................  T                          Revision of wrist joint....          0051         34.03     $1,769.87  ............       $353.97
25455.....................  T                          Revision of wrist joint....          0051         34.03     $1,769.87  ............       $353.97
25490.....................  T                          Reinforce radius...........          0051         34.03     $1,769.87  ............       $353.97
25491.....................  T                          Reinforce ulna.............          0051         34.03     $1,769.87  ............       $353.97
25492.....................  T                          Reinforce radius and ulna..          0051         34.03     $1,769.87  ............       $353.97
25500.....................  T                          Treat fracture of radius...          0043          1.68        $87.38  ............        $17.48
25505.....................  T                          Treat fracture of radius...          0043          1.68        $87.38  ............        $17.48
25515.....................  T                          Treat fracture of radius...          0046         29.03     $1,509.82       $535.76       $301.96
25520.....................  T                          Treat fracture of radius...          0043          1.68        $87.38  ............        $17.48
25525.....................  T                          Treat fracture of radius...          0046         29.03     $1,509.82       $535.76       $301.96
25526.....................  T                          Treat fracture of radius...          0046         29.03     $1,509.82       $535.76       $301.96
25530.....................  T                          Treat fracture of ulna.....          0043          1.68        $87.38  ............        $17.48
25535.....................  T                          Treat fracture of ulna.....          0043          1.68        $87.38  ............        $17.48
25545.....................  T                          Treat fracture of ulna.....          0046         29.03     $1,509.82       $535.76       $301.96
25560.....................  T                          Treat fracture radius &              0043          1.68        $87.38  ............        $17.48
                                                        ulna.
25565.....................  T                          Treat fracture radius &              0043          1.68        $87.38  ............        $17.48
                                                        ulna.
25574.....................  T                          Treat fracture radius &              0046         29.03     $1,509.82       $535.76       $301.96
                                                        ulna.
25575.....................  T                          Treat fracture radius/ulna.          0046         29.03     $1,509.82       $535.76       $301.96
25600.....................  T                          Treat fracture radius/ulna.          0043          1.68        $87.38  ............        $17.48
25605.....................  T                          Treat fracture radius/ulna.          0043          1.68        $87.38  ............        $17.48
25611.....................  T                          Treat fracture radius/ulna.          0046         29.03     $1,509.82       $535.76       $301.96
25620.....................  T                          Treat fracture radius/ulna.          0046         29.03     $1,509.82       $535.76       $301.96
25622.....................  T                          Treat wrist bone fracture..          0043          1.68        $87.38  ............        $17.48
25624.....................  T                          Treat wrist bone fracture..          0043          1.68        $87.38  ............        $17.48
25628.....................  T                          Treat wrist bone fracture..          0046         29.03     $1,509.82       $535.76       $301.96
25630.....................  T                          Treat wrist bone fracture..          0043          1.68        $87.38  ............        $17.48
25635.....................  T                          Treat wrist bone fracture..          0043          1.68        $87.38  ............        $17.48
25645.....................  T                          Treat wrist bone fracture..          0046         29.03     $1,509.82       $535.76       $301.96

[[Page 52180]]

 
25650.....................  T                          Treat wrist bone fracture..          0043          1.68        $87.38  ............        $17.48
25651.....................  T                          Pin ulnar styloid fracture.          0046         29.03     $1,509.82       $535.76       $301.96
25652.....................  T                          Treat fracture ulnar                 0046         29.03     $1,509.82       $535.76       $301.96
                                                        styloid.
25660.....................  T                          Treat wrist dislocation....          0043          1.68        $87.38  ............        $17.48
25670.....................  T                          Treat wrist dislocation....          0046         29.03     $1,509.82       $535.76       $301.96
25671.....................  T                          Pin radioulnar dislocation.          0046         29.03     $1,509.82       $535.76       $301.96
25675.....................  T                          Treat wrist dislocation....          0043          1.68        $87.38  ............        $17.48
25676.....................  T                          Treat wrist dislocation....          0046         29.03     $1,509.82       $535.76       $301.96
25680.....................  T                          Treat wrist fracture.......          0043          1.68        $87.38  ............        $17.48
25685.....................  T                          Treat wrist fracture.......          0046         29.03     $1,509.82       $535.76       $301.96
25690.....................  T                          Treat wrist dislocation....          0043          1.68        $87.38  ............        $17.48
25695.....................  T                          Treat wrist dislocation....          0046         29.03     $1,509.82       $535.76       $301.96
25800.....................  T                          Fusion of wrist joint......          0051         34.03     $1,769.87  ............       $353.97
25805.....................  T                          Fusion/graft of wrist joint          0051         34.03     $1,769.87  ............       $353.97
25810.....................  T                          Fusion/graft of wrist joint          0051         34.03     $1,769.87  ............       $353.97
25820.....................  T                          Fusion of hand bones.......          0053         14.76       $767.65       $253.49       $153.53
25825.....................  T                          Fuse hand bones with graft.          0054         23.50     $1,222.21       $472.33       $244.44
25830.....................  T                          Fusion, radioulnar jnt/ulna          0051         34.03     $1,769.87  ............       $353.97
25900.....................  C                          Amputation of forearm......  ............  ............  ............  ............  ............
25905.....................  C                          Amputation of forearm......  ............  ............  ............  ............  ............
25907.....................  T                          Amputation follow-up                 0049         19.45     $1,011.58  ............       $202.32
                                                        surgery.
25909.....................  C                          Amputation follow-up         ............  ............  ............  ............  ............
                                                        surgery.
25915.....................  C                          Amputation of forearm......  ............  ............  ............  ............  ............
25920.....................  C                          Amputate hand at wrist.....  ............  ............  ............  ............  ............
25922.....................  T                          Amputate hand at wrist.....          0049         19.45     $1,011.58  ............       $202.32
25924.....................  C                          Amputation follow-up         ............  ............  ............  ............  ............
                                                        surgery.
25927.....................  C                          Amputation of hand.........  ............  ............  ............  ............  ............
25929.....................  T                          Amputation follow-up                 0027         15.73       $818.10       $343.60       $163.62
                                                        surgery.
25931.....................  C                          Amputation follow-up         ............  ............  ............  ............  ............
                                                        surgery.
25999.....................  T                          Forearm or wrist surgery...          0043          1.68        $87.38  ............        $17.48
26010.....................  T                          Drainage of finger abscess.          0006          1.89        $98.30        $25.56        $19.66
26011.....................  T                          Drainage of finger abscess.          0007          9.44       $490.96       $103.10        $98.19
26020.....................  T                          Drain hand tendon sheath...          0053         14.76       $767.65       $253.49       $153.53
26025.....................  T                          Drainage of palm bursa.....          0053         14.76       $767.65       $253.49       $153.53
26030.....................  T                          Drainage of palm bursa(s)..          0053         14.76       $767.65       $253.49       $153.53
26034.....................  T                          Treat hand bone lesion.....          0053         14.76       $767.65       $253.49       $153.53
26035.....................  T                          Decompress fingers/hand....          0053         14.76       $767.65       $253.49       $153.53
26037.....................  T                          Decompress fingers/hand....          0053         14.76       $767.65       $253.49       $153.53
26040.....................  T                          Release palm contracture...          0054         23.50     $1,222.21       $472.33       $244.44
26045.....................  T                          Release palm contracture...          0054         23.50     $1,222.21       $472.33       $244.44
26055.....................  T                          Incise finger tendon sheath          0053         14.76       $767.65       $253.49       $153.53
26060.....................  T                          Incision of finger tendon..          0053         14.76       $767.65       $253.49       $153.53
26070.....................  T                          Explore/treat hand joint...          0053         14.76       $767.65       $253.49       $153.53
26075.....................  T                          Explore/treat finger joint.          0053         14.76       $767.65       $253.49       $153.53
26080.....................  T                          Explore/treat finger joint.          0053         14.76       $767.65       $253.49       $153.53
26100.....................  T                          Biopsy hand joint lining...          0053         14.76       $767.65       $253.49       $153.53
26105.....................  T                          Biopsy finger joint lining.          0053         14.76       $767.65       $253.49       $153.53
26110.....................  T                          Biopsy finger joint lining.          0053         14.76       $767.65       $253.49       $153.53
26115.....................  T                          Remove hand lesion subcut..          0022         18.10       $941.36       $367.13       $188.27
26116.....................  T                          Remove hand lesion, deep...          0022         18.10       $941.36       $367.13       $188.27
26117.....................  T                          Remove tumor, hand/finger..          0022         18.10       $941.36       $367.13       $188.27
26121.....................  T                          Release palm contracture...          0054         23.50     $1,222.21       $472.33       $244.44
26123.....................  T                          Release palm contracture...          0054         23.50     $1,222.21       $472.33       $244.44
26125.....................  T                          Release palm contracture...          0054         23.50     $1,222.21       $472.33       $244.44
26130.....................  T                          Remove wrist joint lining..          0053         14.76       $767.65       $253.49       $153.53
26135.....................  T                          Revise finger joint, each..          0054         23.50     $1,222.21       $472.33       $244.44
26140.....................  T                          Revise finger joint, each..          0053         14.76       $767.65       $253.49       $153.53
26145.....................  T                          Tendon excision, palm/               0053         14.76       $767.65       $253.49       $153.53
                                                        finger.
26160.....................  T                          Remove tendon sheath lesion          0053         14.76       $767.65       $253.49       $153.53
26170.....................  T                          Removal of palm tendon,              0053         14.76       $767.65       $253.49       $153.53
                                                        each.
26180.....................  T                          Removal of finger tendon...          0053         14.76       $767.65       $253.49       $153.53
26185.....................  T                          Remove finger bone.........          0053         14.76       $767.65       $253.49       $153.53
26200.....................  T                          Remove hand bone lesion....          0053         14.76       $767.65       $253.49       $153.53
26205.....................  T                          Remove/graft bone lesion...          0054         23.50     $1,222.21       $472.33       $244.44
26210.....................  T                          Removal of finger lesion...          0053         14.76       $767.65       $253.49       $153.53
26215.....................  T                          Remove/graft finger lesion.          0053         14.76       $767.65       $253.49       $153.53

[[Page 52181]]

 
26230.....................  T                          Partial removal of hand              0053         14.76       $767.65       $253.49       $153.53
                                                        bone.
26235.....................  T                          Partial removal, finger              0053         14.76       $767.65       $253.49       $153.53
                                                        bone.
26236.....................  T                          Partial removal, finger              0053         14.76       $767.65       $253.49       $153.53
                                                        bone.
26250.....................  T                          Extensive hand surgery.....          0053         14.76       $767.65       $253.49       $153.53
26255.....................  T                          Extensive hand surgery.....          0054         23.50     $1,222.21       $472.33       $244.44
26260.....................  T                          Extensive finger surgery...          0053         14.76       $767.65       $253.49       $153.53
26261.....................  T                          Extensive finger surgery...          0053         14.76       $767.65       $253.49       $153.53
26262.....................  T                          Partial removal of finger..          0053         14.76       $767.65       $253.49       $153.53
26320.....................  T                          Removal of implant from              0021         14.58       $758.29       $227.49       $151.66
                                                        hand.
26340.....................  T                          Manipulate finger w/anesth.          0043          1.68        $87.38  ............        $17.48
26350.....................  T                          Repair finger/hand tendon..          0054         23.50     $1,222.21       $472.33       $244.44
26352.....................  T                          Repair/graft hand tendon...          0054         23.50     $1,222.21       $472.33       $244.44
26356.....................  T                          Repair finger/hand tendon..          0054         23.50     $1,222.21       $472.33       $244.44
26357.....................  T                          Repair finger/hand tendon..          0054         23.50     $1,222.21       $472.33       $244.44
26358.....................  T                          Repair/graft hand tendon...          0054         23.50     $1,222.21       $472.33       $244.44
26370.....................  T                          Repair finger/hand tendon..          0054         23.50     $1,222.21       $472.33       $244.44
26372.....................  T                          Repair/graft hand tendon...          0054         23.50     $1,222.21       $472.33       $244.44
26373.....................  T                          Repair finger/hand tendon..          0054         23.50     $1,222.21       $472.33       $244.44
26390.....................  T                          Revise hand/finger tendon..          0054         23.50     $1,222.21       $472.33       $244.44
26392.....................  T                          Repair/graft hand tendon...          0054         23.50     $1,222.21       $472.33       $244.44
26410.....................  T                          Repair hand tendon.........          0053         14.76       $767.65       $253.49       $153.53
26412.....................  T                          Repair/graft hand tendon...          0054         23.50     $1,222.21       $472.33       $244.44
26415.....................  T                          Excision, hand/finger                0054         23.50     $1,222.21       $472.33       $244.44
                                                        tendon.
26416.....................  T                          Graft hand or finger tendon          0054         23.50     $1,222.21       $472.33       $244.44
26418.....................  T                          Repair finger tendon.......          0053         14.76       $767.65       $253.49       $153.53
26420.....................  T                          Repair/graft finger tendon.          0054         23.50     $1,222.21       $472.33       $244.44
26426.....................  T                          Repair finger/hand tendon..          0054         23.50     $1,222.21       $472.33       $244.44
26428.....................  T                          Repair/graft finger tendon.          0054         23.50     $1,222.21       $472.33       $244.44
26432.....................  T                          Repair finger tendon.......          0053         14.76       $767.65       $253.49       $153.53
26433.....................  T                          Repair finger tendon.......          0053         14.76       $767.65       $253.49       $153.53
26434.....................  T                          Repair/graft finger tendon.          0054         23.50     $1,222.21       $472.33       $244.44
26437.....................  T                          Realignment of tendons.....          0053         14.76       $767.65       $253.49       $153.53
26440.....................  T                          Release palm/finger tendon.          0053         14.76       $767.65       $253.49       $153.53
26442.....................  T                          Release palm & finger                0054         23.50     $1,222.21       $472.33       $244.44
                                                        tendon.
26445.....................  T                          Release hand/finger tendon.          0053         14.76       $767.65       $253.49       $153.53
26449.....................  T                          Release forearm/hand tendon          0054         23.50     $1,222.21       $472.33       $244.44
26450.....................  T                          Incision of palm tendon....          0053         14.76       $767.65       $253.49       $153.53
26455.....................  T                          Incision of finger tendon..          0053         14.76       $767.65       $253.49       $153.53
26460.....................  T                          Incise hand/finger tendon..          0053         14.76       $767.65       $253.49       $153.53
26471.....................  T                          Fusion of finger tendons...          0053         14.76       $767.65       $253.49       $153.53
26474.....................  T                          Fusion of finger tendons...          0053         14.76       $767.65       $253.49       $153.53
26476.....................  T                          Tendon lengthening.........          0053         14.76       $767.65       $253.49       $153.53
26477.....................  T                          Tendon shortening..........          0053         14.76       $767.65       $253.49       $153.53
26478.....................  T                          Lengthening of hand tendon.          0053         14.76       $767.65       $253.49       $153.53
26479.....................  T                          Shortening of hand tendon..          0053         14.76       $767.65       $253.49       $153.53
26480.....................  T                          Transplant hand tendon.....          0054         23.50     $1,222.21       $472.33       $244.44
26483.....................  T                          Transplant/graft hand                0054         23.50     $1,222.21       $472.33       $244.44
                                                        tendon.
26485.....................  T                          Transplant palm tendon.....          0054         23.50     $1,222.21       $472.33       $244.44
26489.....................  T                          Transplant/graft palm                0054         23.50     $1,222.21       $472.33       $244.44
                                                        tendon.
26490.....................  T                          Revise thumb tendon........          0054         23.50     $1,222.21       $472.33       $244.44
26492.....................  T                          Tendon transfer with graft.          0054         23.50     $1,222.21       $472.33       $244.44
26494.....................  T                          Hand tendon/muscle transfer          0054         23.50     $1,222.21       $472.33       $244.44
26496.....................  T                          Revise thumb tendon........          0054         23.50     $1,222.21       $472.33       $244.44
26497.....................  T                          Finger tendon transfer.....          0054         23.50     $1,222.21       $472.33       $244.44
26498.....................  T                          Finger tendon transfer.....          0054         23.50     $1,222.21       $472.33       $244.44
26499.....................  T                          Revision of finger.........          0054         23.50     $1,222.21       $472.33       $244.44
26500.....................  T                          Hand tendon reconstruction.          0053         14.76       $767.65       $253.49       $153.53
26502.....................  T                          Hand tendon reconstruction.          0054         23.50     $1,222.21       $472.33       $244.44
26504.....................  T                          Hand tendon reconstruction.          0054         23.50     $1,222.21       $472.33       $244.44
26508.....................  T                          Release thumb contracture..          0053         14.76       $767.65       $253.49       $153.53
26510.....................  T                          Thumb tendon transfer......          0054         23.50     $1,222.21       $472.33       $244.44
26516.....................  T                          Fusion of knuckle joint....          0054         23.50     $1,222.21       $472.33       $244.44
26517.....................  T                          Fusion of knuckle joints...          0054         23.50     $1,222.21       $472.33       $244.44
26518.....................  T                          Fusion of knuckle joints...          0054         23.50     $1,222.21       $472.33       $244.44
26520.....................  T                          Release knuckle contracture          0053         14.76       $767.65       $253.49       $153.53
26525.....................  T                          Release finger contracture.          0053         14.76       $767.65       $253.49       $153.53

[[Page 52182]]

 
26530.....................  T                          Revise knuckle joint.......          0047         29.59     $1,538.95       $537.03       $307.79
26531.....................  T                          Revise knuckle with implant          0048         36.93     $1,920.69       $633.83       $384.14
26535.....................  T                          Revise finger joint........          0047         29.59     $1,538.95       $537.03       $307.79
26536.....................  T                          Revise/implant finger joint          0048         36.93     $1,920.69       $633.83       $384.14
26540.....................  T                          Repair hand joint..........          0053         14.76       $767.65       $253.49       $153.53
26541.....................  T                          Repair hand joint with               0054         23.50     $1,222.21       $472.33       $244.44
                                                        graft.
26542.....................  T                          Repair hand joint with               0053         14.76       $767.65       $253.49       $153.53
                                                        graft.
26545.....................  T                          Reconstruct finger joint...          0054         23.50     $1,222.21       $472.33       $244.44
26546.....................  T                          Repair nonunion hand.......          0054         23.50     $1,222.21       $472.33       $244.44
26548.....................  T                          Reconstruct finger joint...          0054         23.50     $1,222.21       $472.33       $244.44
26550.....................  T                          Construct thumb replacement          0054         23.50     $1,222.21       $472.33       $244.44
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         23.50     $1,222.21       $472.33       $244.44
26556.....................  C                          Toe joint transfer.........  ............  ............  ............  ............  ............
26560.....................  T                          Repair of web finger.......          0053         14.76       $767.65       $253.49       $153.53
26561.....................  T                          Repair of web finger.......          0054         23.50     $1,222.21       $472.33       $244.44
26562.....................  T                          Repair of web finger.......          0054         23.50     $1,222.21       $472.33       $244.44
26565.....................  T                          Correct metacarpal flaw....          0054         23.50     $1,222.21       $472.33       $244.44
26567.....................  T                          Correct finger deformity...          0054         23.50     $1,222.21       $472.33       $244.44
26568.....................  T                          Lengthen metacarpal/finger.          0054         23.50     $1,222.21       $472.33       $244.44
26580.....................  T                          Repair hand deformity......          0054         23.50     $1,222.21       $472.33       $244.44
26587.....................  T                          Reconstruct extra finger...          0053         14.76       $767.65       $253.49       $153.53
26590.....................  T                          Repair finger deformity....          0054         23.50     $1,222.21       $472.33       $244.44
26591.....................  T                          Repair muscles of hand.....          0054         23.50     $1,222.21       $472.33       $244.44
26593.....................  T                          Release muscles of hand....          0053         14.76       $767.65       $253.49       $153.53
26596.....................  T                          Excision constricting                0054         23.50     $1,222.21       $472.33       $244.44
                                                        tissue.
26600.....................  T                          Treat metacarpal fracture..          0043          1.68        $87.38  ............        $17.48
26605.....................  T                          Treat metacarpal fracture..          0043          1.68        $87.38  ............        $17.48
26607.....................  T                          Treat metacarpal fracture..          0043          1.68        $87.38  ............        $17.48
26608.....................  T                          Treat metacarpal fracture..          0046         29.03     $1,509.82       $535.76       $301.96
26615.....................  T                          Treat metacarpal fracture..          0046         29.03     $1,509.82       $535.76       $301.96
26641.....................  T                          Treat thumb dislocation....          0043          1.68        $87.38  ............        $17.48
26645.....................  T                          Treat thumb fracture.......          0043          1.68        $87.38  ............        $17.48
26650.....................  T                          Treat thumb fracture.......          0046         29.03     $1,509.82       $535.76       $301.96
26665.....................  T                          Treat thumb fracture.......          0046         29.03     $1,509.82       $535.76       $301.96
26670.....................  T                          Treat hand dislocation.....          0043          1.68        $87.38  ............        $17.48
26675.....................  T                          Treat hand dislocation.....          0043          1.68        $87.38  ............        $17.48
26676.....................  T                          Pin hand dislocation.......          0046         29.03     $1,509.82       $535.76       $301.96
26685.....................  T                          Treat hand dislocation.....          0046         29.03     $1,509.82       $535.76       $301.96
26686.....................  T                          Treat hand dislocation.....          0046         29.03     $1,509.82       $535.76       $301.96
26700.....................  T                          Treat knuckle dislocation..          0043          1.68        $87.38  ............        $17.48
26705.....................  T                          Treat knuckle dislocation..          0043          1.68        $87.38  ............        $17.48
26706.....................  T                          Pin knuckle dislocation....          0043          1.68        $87.38  ............        $17.48
26715.....................  T                          Treat knuckle dislocation..          0046         29.03     $1,509.82       $535.76       $301.96
26720.....................  T                          Treat finger fracture, each          0043          1.68        $87.38  ............        $17.48
26725.....................  T                          Treat finger fracture, each          0043          1.68        $87.38  ............        $17.48
26727.....................  T                          Treat finger fracture, each          0046         29.03     $1,509.82       $535.76       $301.96
26735.....................  T                          Treat finger fracture, each          0046         29.03     $1,509.82       $535.76       $301.96
26740.....................  T                          Treat finger fracture, each          0043          1.68        $87.38  ............        $17.48
26742.....................  T                          Treat finger fracture, each          0043          1.68        $87.38  ............        $17.48
26746.....................  T                          Treat finger fracture, each          0046         29.03     $1,509.82       $535.76       $301.96
26750.....................  T                          Treat finger fracture, each          0043          1.68        $87.38  ............        $17.48
26755.....................  T                          Treat finger fracture, each          0043          1.68        $87.38  ............        $17.48
26756.....................  T                          Pin finger fracture, each..          0046         29.03     $1,509.82       $535.76       $301.96
26765.....................  T                          Treat finger fracture, each          0046         29.03     $1,509.82       $535.76       $301.96
26770.....................  T                          Treat finger dislocation...          0043          1.68        $87.38  ............        $17.48
26775.....................  T                          Treat finger dislocation...          0045         13.47       $700.56       $280.22       $140.11
26776.....................  T                          Pin finger dislocation.....          0046         29.03     $1,509.82       $535.76       $301.96
26785.....................  T                          Treat finger dislocation...          0046         29.03     $1,509.82       $535.76       $301.96
26820.....................  T                          Thumb fusion with graft....          0054         23.50     $1,222.21       $472.33       $244.44
26841.....................  T                          Fusion of thumb............          0054         23.50     $1,222.21       $472.33       $244.44
26842.....................  T                          Thumb fusion with graft....          0054         23.50     $1,222.21       $472.33       $244.44
26843.....................  T                          Fusion of hand joint.......          0054         23.50     $1,222.21       $472.33       $244.44
26844.....................  T                          Fusion/graft of hand joint.          0054         23.50     $1,222.21       $472.33       $244.44

[[Page 52183]]

 
26850.....................  T                          Fusion of knuckle..........          0054         23.50     $1,222.21       $472.33       $244.44
26852.....................  T                          Fusion of knuckle with               0054         23.50     $1,222.21       $472.33       $244.44
                                                        graft.
26860.....................  T                          Fusion of finger joint.....          0054         23.50     $1,222.21       $472.33       $244.44
26861.....................  T                          Fusion of finger jnt, add-           0054         23.50     $1,222.21       $472.33       $244.44
                                                        on.
26862.....................  T                          Fusion/graft of finger               0054         23.50     $1,222.21       $472.33       $244.44
                                                        joint.
26863.....................  T                          Fuse/graft added joint.....          0054         23.50     $1,222.21       $472.33       $244.44
26910.....................  T                          Amputate metacarpal bone...          0054         23.50     $1,222.21       $472.33       $244.44
26951.....................  T                          Amputation of finger/thumb.          0053         14.76       $767.65       $253.49       $153.53
26952.....................  T                          Amputation of finger/thumb.          0053         14.76       $767.65       $253.49       $153.53
26989.....................  T                          Hand/finger surgery........          0043          1.68        $87.38  ............        $17.48
26990.....................  T                          Drainage of pelvis lesion..          0049         19.45     $1,011.58  ............       $202.32
26991.....................  T                          Drainage of pelvis bursa...          0049         19.45     $1,011.58  ............       $202.32
26992.....................  C                          Drainage of bone lesion....  ............  ............  ............  ............  ............
27000.....................  T                          Incision of hip tendon.....          0049         19.45     $1,011.58  ............       $202.32
27001.....................  T                          Incision of hip tendon.....          0050         23.60     $1,227.41  ............       $245.48
27003.....................  T                          Incision of hip tendon.....          0050         23.60     $1,227.41  ............       $245.48
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         34.03     $1,769.87  ............       $353.97
27035.....................  T                          Denervation of hip joint...          0052         42.37     $2,203.62  ............       $440.72
27036.....................  C                          Excision of hip joint/       ............  ............  ............  ............  ............
                                                        muscle.
27040.....................  T                          Biopsy of soft tissues.....          0021         14.58       $758.29       $227.49       $151.66
27041.....................  T                          Biopsy of soft tissues.....          0022         18.10       $941.36       $367.13       $188.27
27047.....................  T                          Remove hip/pelvis lesion...          0022         18.10       $941.36       $367.13       $188.27
27048.....................  T                          Remove hip/pelvis lesion...          0022         18.10       $941.36       $367.13       $188.27
27049.....................  T                          Remove tumor, hip/pelvis...          0022         18.10       $941.36       $367.13       $188.27
27050.....................  T                          Biopsy of sacroiliac joint.          0049         19.45     $1,011.58  ............       $202.32
27052.....................  T                          Biopsy of hip joint........          0049         19.45     $1,011.58  ............       $202.32
27054.....................  C                          Removal of hip joint lining  ............  ............  ............  ............  ............
27060.....................  T                          Removal of ischial bursa...          0049         19.45     $1,011.58  ............       $202.32
27062.....................  T                          Remove femur lesion/bursa..          0049         19.45     $1,011.58  ............       $202.32
27065.....................  T                          Removal of hip bone lesion.          0049         19.45     $1,011.58  ............       $202.32
27066.....................  T                          Removal of hip bone lesion.          0050         23.60     $1,227.41  ............       $245.48
27067.....................  T                          Remove/graft hip bone                0050         23.60     $1,227.41  ............       $245.48
                                                        lesion.
27070.....................  C                          Partial removal of hip bone  ............  ............  ............  ............  ............
27071.....................  C                          Partial removal of hip bone  ............  ............  ............  ............  ............
27075.....................  C                          Extensive hip surgery......  ............  ............  ............  ............  ............
27076.....................  C                          Extensive hip surgery......  ............  ............  ............  ............  ............
27077.....................  C                          Extensive hip surgery......  ............  ............  ............  ............  ............
27078.....................  C                          Extensive hip surgery......  ............  ............  ............  ............  ............
27079.....................  C                          Extensive hip surgery......  ............  ............  ............  ............  ............
27080.....................  T                          Removal of tail bone.......          0050         23.60     $1,227.41  ............       $245.48
27086.....................  T                          Remove hip foreign body....          0020          7.36       $382.79       $114.84        $76.56
27087.....................  T                          Remove hip foreign body....          0049         19.45     $1,011.58  ............       $202.32
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         23.60     $1,227.41  ............       $245.48
27098.....................  T                          Transfer tendon to pelvis..          0050         23.60     $1,227.41  ............       $245.48
27100.....................  T                          Transfer of abdominal                0051         34.03     $1,769.87  ............       $353.97
                                                        muscle.
27105.....................  T                          Transfer of spinal muscle..          0051         34.03     $1,769.87  ............       $353.97
27110.....................  T                          Transfer of iliopsoas                0051         34.03     $1,769.87  ............       $353.97
                                                        muscle.
27111.....................  T                          Transfer of iliopsoas                0051         34.03     $1,769.87  ............       $353.97
                                                        muscle.
27120.....................  C                          Reconstruction of hip        ............  ............  ............  ............  ............
                                                        socket.
27122.....................  C                          Reconstruction of hip        ............  ............  ............  ............  ............
                                                        socket.
27125.....................  C                          Partial hip replacement....  ............  ............  ............  ............  ............
27130.....................  C                          Total hip arthroplasty.....  ............  ............  ............  ............  ............
27132.....................  C                          Total hip arthroplasty.....  ............  ............  ............  ............  ............
27134.....................  C                          Revise hip joint             ............  ............  ............  ............  ............
                                                        replacement.
27137.....................  C                          Revise hip joint             ............  ............  ............  ............  ............
                                                        replacement.
27138.....................  C                          Revise hip joint             ............  ............  ............  ............  ............
                                                        replacement.
27140.....................  C                          Transplant femur ridge.....  ............  ............  ............  ............  ............

[[Page 52184]]

 
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.          0043          1.68        $87.38  ............        $17.48
27194.....................  T                          Treat pelvic ring fracture.          0045         13.47       $700.56       $280.22       $140.11
27200.....................  T                          Treat tail bone fracture...          0043          1.68        $87.38  ............        $17.48
27202.....................  T                          Treat tail bone fracture...          0046         29.03     $1,509.82       $535.76       $301.96
27215.....................  C                          Treat pelvic fracture(s)...  ............  ............  ............  ............  ............
27216.....................  T                          Treat pelvic ring fracture.          0050         23.60     $1,227.41  ............       $245.48
27217.....................  C                          Treat pelvic ring fracture.  ............  ............  ............  ............  ............
27218.....................  C                          Treat pelvic ring fracture.  ............  ............  ............  ............  ............
27220.....................  T                          Treat hip socket fracture..          0043          1.68        $87.38  ............        $17.48
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.......          0043          1.68        $87.38  ............        $17.48
27232.....................  C                          Treat thigh fracture.......  ............  ............  ............  ............  ............
27235.....................  T                          Treat thigh fracture.......          0050         23.60     $1,227.41  ............       $245.48
27236.....................  C                          Treat thigh fracture.......  ............  ............  ............  ............  ............
27238.....................  T                          Treat thigh fracture.......          0043          1.68        $87.38  ............        $17.48
27240.....................  C                          Treat thigh fracture.......  ............  ............  ............  ............  ............
27244.....................  C                          Treat thigh fracture.......  ............  ............  ............  ............  ............
27245.....................  C                          Treat thigh fracture.......  ............  ............  ............  ............  ............
27246.....................  T                          Treat thigh fracture.......          0043          1.68        $87.38  ............        $17.48
27248.....................  C                          Treat thigh fracture.......  ............  ............  ............  ............  ............
27250.....................  T                          Treat hip dislocation......          0043          1.68        $87.38  ............        $17.48
27252.....................  T                          Treat hip dislocation......          0045         13.47       $700.56       $280.22       $140.11
27253.....................  C                          Treat hip dislocation......  ............  ............  ............  ............  ............
27254.....................  C                          Treat hip dislocation......  ............  ............  ............  ............  ............
27256.....................  T                          Treat hip dislocation......          0043          1.68        $87.38  ............        $17.48
27257.....................  T                          Treat hip dislocation......          0045         13.47       $700.56       $280.22       $140.11
27258.....................  C                          Treat hip dislocation......  ............  ............  ............  ............  ............
27259.....................  C                          Treat hip dislocation......  ............  ............  ............  ............  ............
27265.....................  T                          Treat hip dislocation......          0043          1.68        $87.38  ............        $17.48
27266.....................  T                          Treat hip dislocation......          0045         13.47       $700.56       $280.22       $140.11
27275.....................  T                          Manipulation of hip joint..          0045         13.47       $700.56       $280.22       $140.11
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          1.68        $87.38  ............        $17.48
27301.....................  T                          Drain thigh/knee lesion....          0008         16.32       $848.79  ............       $169.76
27303.....................  C                          Drainage of bone lesion....  ............  ............  ............  ............  ............
27305.....................  T                          Incise thigh tendon &                0049         19.45     $1,011.58  ............       $202.32
                                                        fascia.
27306.....................  T                          Incision of thigh tendon...          0049         19.45     $1,011.58  ............       $202.32
27307.....................  T                          Incision of thigh tendons..          0049         19.45     $1,011.58  ............       $202.32
27310.....................  T                          Exploration of knee joint..          0050         23.60     $1,227.41  ............       $245.48
27315.....................  T                          Partial removal, thigh               0220         16.66       $866.47  ............       $173.29
                                                        nerve.
27320.....................  T                          Partial removal, thigh               0220         16.66       $866.47  ............       $173.29
                                                        nerve.
27323.....................  T                          Biopsy, thigh soft tissues.          0021         14.58       $758.29       $227.49       $151.66

[[Page 52185]]

 
27324.....................  T                          Biopsy, thigh soft tissues.          0022         18.10       $941.36       $367.13       $188.27
27327.....................  T                          Removal of thigh lesion....          0022         18.10       $941.36       $367.13       $188.27
27328.....................  T                          Removal of thigh lesion....          0022         18.10       $941.36       $367.13       $188.27
27329.....................  T                          Remove tumor, thigh/knee...          0022         18.10       $941.36       $367.13       $188.27
27330.....................  T                          Biopsy, knee joint lining..          0050         23.60     $1,227.41  ............       $245.48
27331.....................  T                          Explore/treat knee joint...          0050         23.60     $1,227.41  ............       $245.48
27332.....................  T                          Removal of knee cartilage..          0050         23.60     $1,227.41  ............       $245.48
27333.....................  T                          Removal of knee cartilage..          0050         23.60     $1,227.41  ............       $245.48
27334.....................  T                          Remove knee joint lining...          0050         23.60     $1,227.41  ............       $245.48
27335.....................  T                          Remove knee joint lining...          0050         23.60     $1,227.41  ............       $245.48
27340.....................  T                          Removal of kneecap bursa...          0049         19.45     $1,011.58  ............       $202.32
27345.....................  T                          Removal of knee cyst.......          0049         19.45     $1,011.58  ............       $202.32
27347.....................  T                          Remove knee cyst...........          0049         19.45     $1,011.58  ............       $202.32
27350.....................  T                          Removal of kneecap.........          0050         23.60     $1,227.41  ............       $245.48
27355.....................  T                          Remove femur lesion........          0050         23.60     $1,227.41  ............       $245.48
27356.....................  T                          Remove femur lesion/graft..          0050         23.60     $1,227.41  ............       $245.48
27357.....................  T                          Remove femur lesion/graft..          0050         23.60     $1,227.41  ............       $245.48
27358.....................  T                          Remove femur lesion/                 0050         23.60     $1,227.41  ............       $245.48
                                                        fixation.
27360.....................  T                          Partial removal, leg                 0050         23.60     $1,227.41  ............       $245.48
                                                        bone(s).
27365.....................  C                          Extensive leg surgery......  ............  ............  ............  ............  ............
27370.....................  N                          Injection for knee x-ray...  ............  ............  ............  ............  ............
27372.....................  T                          Removal of foreign body....          0022         18.10       $941.36       $367.13       $188.27
27380.....................  T                          Repair of kneecap tendon...          0049         19.45     $1,011.58  ............       $202.32
27381.....................  T                          Repair/graft kneecap tendon          0049         19.45     $1,011.58  ............       $202.32
27385.....................  T                          Repair of thigh muscle.....          0049         19.45     $1,011.58  ............       $202.32
27386.....................  T                          Repair/graft of thigh                0049         19.45     $1,011.58  ............       $202.32
                                                        muscle.
27390.....................  T                          Incision of thigh tendon...          0049         19.45     $1,011.58  ............       $202.32
27391.....................  T                          Incision of thigh tendons..          0049         19.45     $1,011.58  ............       $202.32
27392.....................  T                          Incision of thigh tendons..          0049         19.45     $1,011.58  ............       $202.32
27393.....................  T                          Lengthening of thigh tendon          0050         23.60     $1,227.41  ............       $245.48
27394.....................  T                          Lengthening of thigh                 0050         23.60     $1,227.41  ............       $245.48
                                                        tendons.
27395.....................  T                          Lengthening of thigh                 0051         34.03     $1,769.87  ............       $353.97
                                                        tendons.
27396.....................  T                          Transplant of thigh tendon.          0050         23.60     $1,227.41  ............       $245.48
27397.....................  T                          Transplants of thigh                 0051         34.03     $1,769.87  ............       $353.97
                                                        tendons.
27400.....................  T                          Revise thigh muscles/                0051         34.03     $1,769.87  ............       $353.97
                                                        tendons.
27403.....................  T                          Repair of knee cartilage...          0050         23.60     $1,227.41  ............       $245.48
27405.....................  T                          Repair of knee ligament....          0051         34.03     $1,769.87  ............       $353.97
27407.....................  T                          Repair of knee ligament....          0051         34.03     $1,769.87  ............       $353.97
27409.....................  T                          Repair of knee ligaments...          0051         34.03     $1,769.87  ............       $353.97
27418.....................  T                          Repair degenerated kneecap.          0051         34.03     $1,769.87  ............       $353.97
27420.....................  T                          Revision of unstable                 0051         34.03     $1,769.87  ............       $353.97
                                                        kneecap.
27422.....................  T                          Revision of unstable                 0051         34.03     $1,769.87  ............       $353.97
                                                        kneecap.
27424.....................  T                          Revision/removal of kneecap          0051         34.03     $1,769.87  ............       $353.97
27425.....................  T                          Lateral retinacular release          0050         23.60     $1,227.41  ............       $245.48
27427.....................  T                          Reconstruction, knee.......          0052         42.37     $2,203.62  ............       $440.72
27428.....................  T                          Reconstruction, knee.......          0052         42.37     $2,203.62  ............       $440.72
27429.....................  T                          Reconstruction, knee.......          0052         42.37     $2,203.62  ............       $440.72
27430.....................  T                          Revision of thigh muscles..          0051         34.03     $1,769.87  ............       $353.97
27435.....................  T                          Incision of knee joint.....          0051         34.03     $1,769.87  ............       $353.97
27437.....................  T                          Revise kneecap.............          0047         29.59     $1,538.95       $537.03       $307.79
27438.....................  T                          Revise kneecap with implant          0048         36.93     $1,920.69       $633.83       $384.14
27440.....................  T                          Revision of knee joint.....          0047         29.59     $1,538.95       $537.03       $307.79
27441.....................  T                          Revision of knee joint.....          0047         29.59     $1,538.95       $537.03       $307.79
27442.....................  T                          Revision of knee joint.....          0047         29.59     $1,538.95       $537.03       $307.79
27443.....................  T                          Revision of knee joint.....          0047         29.59     $1,538.95       $537.03       $307.79
27445.....................  C                          Revision of knee joint.....  ............  ............  ............  ............  ............
27446.....................  T                          Revision of knee joint.....          0681        158.14     $8,224.70     $3,289.88     $1,644.94
27447.....................  C                          Total knee arthroplasty....  ............  ............  ............  ............  ............
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....  ............  ............  ............  ............  ............

[[Page 52186]]

 
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         19.45     $1,011.58  ............       $202.32
27497.....................  T                          Decompression of thigh/knee          0049         19.45     $1,011.58  ............       $202.32
27498.....................  T                          Decompression of thigh/knee          0049         19.45     $1,011.58  ............       $202.32
27499.....................  T                          Decompression of thigh/knee          0049         19.45     $1,011.58  ............       $202.32
27500.....................  T                          Treatment of thigh fracture          0043          1.68        $87.38  ............        $17.48
27501.....................  T                          Treatment of thigh fracture          0043          1.68        $87.38  ............        $17.48
27502.....................  T                          Treatment of thigh fracture          0043          1.68        $87.38  ............        $17.48
27503.....................  T                          Treatment of thigh fracture          0043          1.68        $87.38  ............        $17.48
27506.....................  C                          Treatment of thigh fracture  ............  ............  ............  ............  ............
27507.....................  C                          Treatment of thigh fracture  ............  ............  ............  ............  ............
27508.....................  T                          Treatment of thigh fracture          0043          1.68        $87.38  ............        $17.48
27509.....................  T                          Treatment of thigh fracture          0046         29.03     $1,509.82       $535.76       $301.96
27510.....................  T                          Treatment of thigh fracture          0043          1.68        $87.38  ............        $17.48
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          0043          1.68        $87.38  ............        $17.48
27517.....................  T                          Treat thigh fx growth plate          0043          1.68        $87.38  ............        $17.48
27519.....................  C                          Treat thigh fx growth plate  ............  ............  ............  ............  ............
27520.....................  T                          Treat kneecap fracture.....          0043          1.68        $87.38  ............        $17.48
27524.....................  T                          Treat kneecap fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
27530.....................  T                          Treat knee fracture........          0043          1.68        $87.38  ............        $17.48
27532.....................  T                          Treat knee fracture........          0043          1.68        $87.38  ............        $17.48
27535.....................  C                          Treat knee fracture........  ............  ............  ............  ............  ............
27536.....................  C                          Treat knee fracture........  ............  ............  ............  ............  ............
27538.....................  T                          Treat knee fracture(s).....          0043          1.68        $87.38  ............        $17.48
27540.....................  C                          Treat knee fracture........  ............  ............  ............  ............  ............
27550.....................  T                          Treat knee dislocation.....          0043          1.68        $87.38  ............        $17.48
27552.....................  T                          Treat knee dislocation.....          0045         13.47       $700.56       $280.22       $140.11
27556.....................  C                          Treat knee dislocation.....  ............  ............  ............  ............  ............
27557.....................  C                          Treat knee dislocation.....  ............  ............  ............  ............  ............
27558.....................  C                          Treat knee dislocation.....  ............  ............  ............  ............  ............
27560.....................  T                          Treat kneecap dislocation..          0043          1.68        $87.38  ............        $17.48
27562.....................  T                          Treat kneecap dislocation..          0045         13.47       $700.56       $280.22       $140.11
27566.....................  T                          Treat kneecap dislocation..          0046         29.03     $1,509.82       $535.76       $301.96
27570.....................  T                          Fixation of knee joint.....          0045         13.47       $700.56       $280.22       $140.11
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                 0049         19.45     $1,011.58  ............       $202.32
                                                        surgery.
27596.....................  C                          Amputation follow-up         ............  ............  ............  ............  ............
                                                        surgery.
27598.....................  C                          Amputate lower leg at knee.  ............  ............  ............  ............  ............
27599.....................  T                          Leg surgery procedure......          0043          1.68        $87.38  ............        $17.48
27600.....................  T                          Decompression of lower leg.          0049         19.45     $1,011.58  ............       $202.32
27601.....................  T                          Decompression of lower leg.          0049         19.45     $1,011.58  ............       $202.32
27602.....................  T                          Decompression of lower leg.          0049         19.45     $1,011.58  ............       $202.32
27603.....................  T                          Drain lower leg lesion.....          0008         16.32       $848.79  ............       $169.76
27604.....................  T                          Drain lower leg bursa......          0049         19.45     $1,011.58  ............       $202.32
27605.....................  T                          Incision of achilles tendon          0055         18.28       $950.72       $355.34       $190.14
27606.....................  T                          Incision of achilles tendon          0049         19.45     $1,011.58  ............       $202.32
27607.....................  T                          Treat lower leg bone lesion          0049         19.45     $1,011.58  ............       $202.32
27610.....................  T                          Explore/treat ankle joint..          0050         23.60     $1,227.41  ............       $245.48
27612.....................  T                          Exploration of ankle joint.          0050         23.60     $1,227.41  ............       $245.48
27613.....................  T                          Biopsy lower leg soft                0020          7.36       $382.79       $114.84        $76.56
                                                        tissue.
27614.....................  T                          Biopsy lower leg soft                0022         18.10       $941.36       $367.13       $188.27
                                                        tissue.

[[Page 52187]]

 
27615.....................  T                          Remove tumor, lower leg....          0046         29.03     $1,509.82       $535.76       $301.96
27618.....................  T                          Remove lower leg lesion....          0021         14.58       $758.29       $227.49       $151.66
27619.....................  T                          Remove lower leg lesion....          0022         18.10       $941.36       $367.13       $188.27
27620.....................  T                          Explore/treat ankle joint..          0050         23.60     $1,227.41  ............       $245.48
27625.....................  T                          Remove ankle joint lining..          0050         23.60     $1,227.41  ............       $245.48
27626.....................  T                          Remove ankle joint lining..          0050         23.60     $1,227.41  ............       $245.48
27630.....................  T                          Removal of tendon lesion...          0049         19.45     $1,011.58  ............       $202.32
27635.....................  T                          Remove lower leg bone                0050         23.60     $1,227.41  ............       $245.48
                                                        lesion.
27637.....................  T                          Remove/graft leg bone                0050         23.60     $1,227.41  ............       $245.48
                                                        lesion.
27638.....................  T                          Remove/graft leg bone                0050         23.60     $1,227.41  ............       $245.48
                                                        lesion.
27640.....................  T                          Partial removal of tibia...          0051         34.03     $1,769.87  ............       $353.97
27641.....................  T                          Partial removal of fibula..          0050         23.60     $1,227.41  ............       $245.48
27645.....................  C                          Extensive lower leg surgery  ............  ............  ............  ............  ............
27646.....................  C                          Extensive lower leg surgery  ............  ............  ............  ............  ............
27647.....................  T                          Extensive ankle/heel                 0051         34.03     $1,769.87  ............       $353.97
                                                        surgery.
27648.....................  N                          Injection for ankle x-ray..  ............  ............  ............  ............  ............
27650.....................  T                          Repair achilles tendon.....          0051         34.03     $1,769.87  ............       $353.97
27652.....................  T                          Repair/graft achilles                0051         34.03     $1,769.87  ............       $353.97
                                                        tendon.
27654.....................  T                          Repair of achilles tendon..          0051         34.03     $1,769.87  ............       $353.97
27656.....................  T                          Repair leg fascia defect...          0049         19.45     $1,011.58  ............       $202.32
27658.....................  T                          Repair of leg tendon, each.          0049         19.45     $1,011.58  ............       $202.32
27659.....................  T                          Repair of leg tendon, each.          0049         19.45     $1,011.58  ............       $202.32
27664.....................  T                          Repair of leg tendon, each.          0049         19.45     $1,011.58  ............       $202.32
27665.....................  T                          Repair of leg tendon, each.          0050         23.60     $1,227.41  ............       $245.48
27675.....................  T                          Repair lower leg tendons...          0049         19.45     $1,011.58  ............       $202.32
27676.....................  T                          Repair lower leg tendons...          0050         23.60     $1,227.41  ............       $245.48
27680.....................  T                          Release of lower leg tendon          0050         23.60     $1,227.41  ............       $245.48
27681.....................  T                          Release of lower leg                 0050         23.60     $1,227.41  ............       $245.48
                                                        tendons.
27685.....................  T                          Revision of lower leg                0050         23.60     $1,227.41  ............       $245.48
                                                        tendon.
27686.....................  T                          Revise lower leg tendons...          0050         23.60     $1,227.41  ............       $245.48
27687.....................  T                          Revision of calf tendon....          0050         23.60     $1,227.41  ............       $245.48
27690.....................  T                          Revise lower leg tendon....          0051         34.03     $1,769.87  ............       $353.97
27691.....................  T                          Revise lower leg tendon....          0051         34.03     $1,769.87  ............       $353.97
27692.....................  T                          Revise additional leg                0051         34.03     $1,769.87  ............       $353.97
                                                        tendon.
27695.....................  T                          Repair of ankle ligament...          0050         23.60     $1,227.41  ............       $245.48
27696.....................  T                          Repair of ankle ligaments..          0050         23.60     $1,227.41  ............       $245.48
27698.....................  T                          Repair of ankle ligament...          0050         23.60     $1,227.41  ............       $245.48
27700.....................  T                          Revision of ankle joint....          0047         29.59     $1,538.95       $537.03       $307.79
27702.....................  C                          Reconstruct ankle joint....  ............  ............  ............  ............  ............
27703.....................  C                          Reconstruction, ankle joint  ............  ............  ............  ............  ............
27704.....................  T                          Removal of ankle implant...          0049         19.45     $1,011.58  ............       $202.32
27705.....................  T                          Incision of tibia..........          0051         34.03     $1,769.87  ............       $353.97
27707.....................  T                          Incision of fibula.........          0049         19.45     $1,011.58  ............       $202.32
27709.....................  T                          Incision of tibia & fibula.          0050         23.60     $1,227.41  ............       $245.48
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         23.60     $1,227.41  ............       $245.48
27732.....................  T                          Repair of fibula epiphysis.          0050         23.60     $1,227.41  ............       $245.48
27734.....................  T                          Repair lower leg epiphyses.          0050         23.60     $1,227.41  ............       $245.48
27740.....................  T                          Repair of leg epiphyses....          0050         23.60     $1,227.41  ............       $245.48
27742.....................  T                          Repair of leg epiphyses....          0051         34.03     $1,769.87  ............       $353.97
27745.....................  T                          Reinforce tibia............          0051         34.03     $1,769.87  ............       $353.97
27750.....................  T                          Treatment of tibia fracture          0043          1.68        $87.38  ............        $17.48
27752.....................  T                          Treatment of tibia fracture          0043          1.68        $87.38  ............        $17.48
27756.....................  T                          Treatment of tibia fracture          0046         29.03     $1,509.82       $535.76       $301.96
27758.....................  T                          Treatment of tibia fracture          0046         29.03     $1,509.82       $535.76       $301.96
27759.....................  T                          Treatment of tibia fracture          0046         29.03     $1,509.82       $535.76       $301.96
27760.....................  T                          Treatment of ankle fracture          0043          1.68        $87.38  ............        $17.48
27762.....................  T                          Treatment of ankle fracture          0043          1.68        $87.38  ............        $17.48
27766.....................  T                          Treatment of ankle fracture          0046         29.03     $1,509.82       $535.76       $301.96
27780.....................  T                          Treatment of fibula                  0043          1.68        $87.38  ............        $17.48
                                                        fracture.

[[Page 52188]]

 
27781.....................  T                          Treatment of fibula                  0043          1.68        $87.38  ............        $17.48
                                                        fracture.
27784.....................  T                          Treatment of fibula                  0046         29.03     $1,509.82       $535.76       $301.96
                                                        fracture.
27786.....................  T                          Treatment of ankle fracture          0043          1.68        $87.38  ............        $17.48
27788.....................  T                          Treatment of ankle fracture          0043          1.68        $87.38  ............        $17.48
27792.....................  T                          Treatment of ankle fracture          0046         29.03     $1,509.82       $535.76       $301.96
27808.....................  T                          Treatment of ankle fracture          0043          1.68        $87.38  ............        $17.48
27810.....................  T                          Treatment of ankle fracture          0043          1.68        $87.38  ............        $17.48
27814.....................  T                          Treatment of ankle fracture          0046         29.03     $1,509.82       $535.76       $301.96
27816.....................  T                          Treatment of ankle fracture          0043          1.68        $87.38  ............        $17.48
27818.....................  T                          Treatment of ankle fracture          0043          1.68        $87.38  ............        $17.48
27822.....................  T                          Treatment of ankle fracture          0046         29.03     $1,509.82       $535.76       $301.96
27823.....................  T                          Treatment of ankle fracture          0046         29.03     $1,509.82       $535.76       $301.96
27824.....................  T                          Treat lower leg fracture...          0043          1.68        $87.38  ............        $17.48
27825.....................  T                          Treat lower leg fracture...          0043          1.68        $87.38  ............        $17.48
27826.....................  T                          Treat lower leg fracture...          0046         29.03     $1,509.82       $535.76       $301.96
27827.....................  T                          Treat lower leg fracture...          0046         29.03     $1,509.82       $535.76       $301.96
27828.....................  T                          Treat lower leg fracture...          0046         29.03     $1,509.82       $535.76       $301.96
27829.....................  T                          Treat lower leg joint......          0046         29.03     $1,509.82       $535.76       $301.96
27830.....................  T                          Treat lower leg dislocation          0043          1.68        $87.38  ............        $17.48
27831.....................  T                          Treat lower leg dislocation          0043          1.68        $87.38  ............        $17.48
27832.....................  T                          Treat lower leg dislocation          0046         29.03     $1,509.82       $535.76       $301.96
27840.....................  T                          Treat ankle dislocation....          0043          1.68        $87.38  ............        $17.48
27842.....................  T                          Treat ankle dislocation....          0045         13.47       $700.56       $280.22       $140.11
27846.....................  T                          Treat ankle dislocation....          0046         29.03     $1,509.82       $535.76       $301.96
27848.....................  T                          Treat ankle dislocation....          0046         29.03     $1,509.82       $535.76       $301.96
27860.....................  T                          Fixation of ankle joint....          0045         13.47       $700.56       $280.22       $140.11
27870.....................  T                          Fusion of ankle joint......          0051         34.03     $1,769.87  ............       $353.97
27871.....................  T                          Fusion of tibiofibular               0051         34.03     $1,769.87  ............       $353.97
                                                        joint.
27880.....................  C                          Amputation of lower leg....  ............  ............  ............  ............  ............
27881.....................  C                          Amputation of lower leg....  ............  ............  ............  ............  ............
27882.....................  C                          Amputation of lower leg....  ............  ............  ............  ............  ............
27884.....................  T                          Amputation follow-up                 0049         19.45     $1,011.58  ............       $202.32
                                                        surgery.
27886.....................  C                          Amputation follow-up         ............  ............  ............  ............  ............
                                                        surgery.
27888.....................  C                          Amputation of foot at ankle  ............  ............  ............  ............  ............
27889.....................  T                          Amputation of foot at ankle          0050         23.60     $1,227.41  ............       $245.48
27892.....................  T                          Decompression of leg.......          0049         19.45     $1,011.58  ............       $202.32
27893.....................  T                          Decompression of leg.......          0049         19.45     $1,011.58  ............       $202.32
27894.....................  T                          Decompression of leg.......          0049         19.45     $1,011.58  ............       $202.32
27899.....................  T                          Leg/ankle surgery procedure          0043          1.68        $87.38  ............        $17.48
28001.....................  T                          Drainage of bursa of foot..          0008         16.32       $848.79  ............       $169.76
28002.....................  T                          Treatment of foot infection          0049         19.45     $1,011.58  ............       $202.32
28003.....................  T                          Treatment of foot infection          0049         19.45     $1,011.58  ............       $202.32
28005.....................  T                          Treat foot bone lesion.....          0055         18.28       $950.72       $355.34       $190.14
28008.....................  T                          Incision of foot fascia....          0055         18.28       $950.72       $355.34       $190.14
28010.....................  T                          Incision of toe tendon.....          0055         18.28       $950.72       $355.34       $190.14
28011.....................  T                          Incision of toe tendons....          0055         18.28       $950.72       $355.34       $190.14
28020.....................  T                          Exploration of foot joint..          0055         18.28       $950.72       $355.34       $190.14
28022.....................  T                          Exploration of foot joint..          0055         18.28       $950.72       $355.34       $190.14
28024.....................  T                          Exploration of toe joint...          0055         18.28       $950.72       $355.34       $190.14
28030.....................  T                          Removal of foot nerve......          0220         16.66       $866.47  ............       $173.29
28035.....................  T                          Decompression of tibia               0220         16.66       $866.47  ............       $173.29
                                                        nerve.
28043.....................  T                          Excision of foot lesion....          0021         14.58       $758.29       $227.49       $151.66
28045.....................  T                          Excision of foot lesion....          0055         18.28       $950.72       $355.34       $190.14
28046.....................  T                          Resection of tumor, foot...          0055         18.28       $950.72       $355.34       $190.14
28050.....................  T                          Biopsy of foot joint lining          0055         18.28       $950.72       $355.34       $190.14
28052.....................  T                          Biopsy of foot joint lining          0055         18.28       $950.72       $355.34       $190.14
28054.....................  T                          Biopsy of toe joint lining.          0055         18.28       $950.72       $355.34       $190.14
28060.....................  T                          Partial removal, foot                0056         22.94     $1,193.09       $405.81       $238.62
                                                        fascia.
28062.....................  T                          Removal of foot fascia.....          0056         22.94     $1,193.09       $405.81       $238.62
28070.....................  T                          Removal of foot joint                0056         22.94     $1,193.09       $405.81       $238.62
                                                        lining.
28072.....................  T                          Removal of foot joint                0056         22.94     $1,193.09       $405.81       $238.62
                                                        lining.
28080.....................  T                          Removal of foot lesion.....          0055         18.28       $950.72       $355.34       $190.14
28086.....................  T                          Excise foot tendon sheath..          0055         18.28       $950.72       $355.34       $190.14
28088.....................  T                          Excise foot tendon sheath..          0055         18.28       $950.72       $355.34       $190.14
28090.....................  T                          Removal of foot lesion.....          0055         18.28       $950.72       $355.34       $190.14
28092.....................  T                          Removal of toe lesions.....          0055         18.28       $950.72       $355.34       $190.14

[[Page 52189]]

 
28100.....................  T                          Removal of ankle/heel                0055         18.28       $950.72       $355.34       $190.14
                                                        lesion.
28102.....................  T                          Remove/graft foot lesion...          0056         22.94     $1,193.09       $405.81       $238.62
28103.....................  T                          Remove/graft foot lesion...          0056         22.94     $1,193.09       $405.81       $238.62
28104.....................  T                          Removal of foot lesion.....          0055         18.28       $950.72       $355.34       $190.14
28106.....................  T                          Remove/graft foot lesion...          0056         22.94     $1,193.09       $405.81       $238.62
28107.....................  T                          Remove/graft foot lesion...          0056         22.94     $1,193.09       $405.81       $238.62
28108.....................  T                          Removal of toe lesions.....          0055         18.28       $950.72       $355.34       $190.14
28110.....................  T                          Part removal of metatarsal.          0056         22.94     $1,193.09       $405.81       $238.62
28111.....................  T                          Part removal of metatarsal.          0055         18.28       $950.72       $355.34       $190.14
28112.....................  T                          Part removal of metatarsal.          0055         18.28       $950.72       $355.34       $190.14
28113.....................  T                          Part removal of metatarsal.          0055         18.28       $950.72       $355.34       $190.14
28114.....................  T                          Removal of metatarsal heads          0055         18.28       $950.72       $355.34       $190.14
28116.....................  T                          Revision of foot...........          0055         18.28       $950.72       $355.34       $190.14
28118.....................  T                          Removal of heel bone.......          0055         18.28       $950.72       $355.34       $190.14
28119.....................  T                          Removal of heel spur.......          0055         18.28       $950.72       $355.34       $190.14
28120.....................  T                          Part removal of ankle/heel.          0055         18.28       $950.72       $355.34       $190.14
28122.....................  T                          Partial removal of foot              0055         18.28       $950.72       $355.34       $190.14
                                                        bone.
28124.....................  T                          Partial removal of toe.....          0055         18.28       $950.72       $355.34       $190.14
28126.....................  T                          Partial removal of toe.....          0055         18.28       $950.72       $355.34       $190.14
28130.....................  T                          Removal of ankle bone......          0055         18.28       $950.72       $355.34       $190.14
28140.....................  T                          Removal of metatarsal......          0055         18.28       $950.72       $355.34       $190.14
28150.....................  T                          Removal of toe.............          0055         18.28       $950.72       $355.34       $190.14
28153.....................  T                          Partial removal of toe.....          0055         18.28       $950.72       $355.34       $190.14
28160.....................  T                          Partial removal of toe.....          0055         18.28       $950.72       $355.34       $190.14
28171.....................  T                          Extensive foot surgery.....          0055         18.28       $950.72       $355.34       $190.14
28173.....................  T                          Extensive foot surgery.....          0055         18.28       $950.72       $355.34       $190.14
28175.....................  T                          Extensive foot surgery.....          0055         18.28       $950.72       $355.34       $190.14
28190.....................  T                          Removal of foot foreign              0019          3.94       $204.92        $75.82        $40.98
                                                        body.
28192.....................  T                          Removal of foot foreign              0021         14.58       $758.29       $227.49       $151.66
                                                        body.
28193.....................  T                          Removal of foot foreign              0021         14.58       $758.29       $227.49       $151.66
                                                        body.
28200.....................  T                          Repair of foot tendon......          0055         18.28       $950.72       $355.34       $190.14
28202.....................  T                          Repair/graft of foot tendon          0056         22.94     $1,193.09       $405.81       $238.62
28208.....................  T                          Repair of foot tendon......          0055         18.28       $950.72       $355.34       $190.14
28210.....................  T                          Repair/graft of foot tendon          0055         18.28       $950.72       $355.34       $190.14
28220.....................  T                          Release of foot tendon.....          0055         18.28       $950.72       $355.34       $190.14
28222.....................  T                          Release of foot tendons....          0055         18.28       $950.72       $355.34       $190.14
28225.....................  T                          Release of foot tendon.....          0055         18.28       $950.72       $355.34       $190.14
28226.....................  T                          Release of foot tendons....          0055         18.28       $950.72       $355.34       $190.14
28230.....................  T                          Incision of foot tendon(s).          0055         18.28       $950.72       $355.34       $190.14
28232.....................  T                          Incision of toe tendon.....          0055         18.28       $950.72       $355.34       $190.14
28234.....................  T                          Incision of foot tendon....          0055         18.28       $950.72       $355.34       $190.14
28238.....................  T                          Revision of foot tendon....          0056         22.94     $1,193.09       $405.81       $238.62
28240.....................  T                          Release of big toe.........          0055         18.28       $950.72       $355.34       $190.14
28250.....................  T                          Revision of foot fascia....          0056         22.94     $1,193.09       $405.81       $238.62
28260.....................  T                          Release of midfoot joint...          0056         22.94     $1,193.09       $405.81       $238.62
28261.....................  T                          Revision of foot tendon....          0056         22.94     $1,193.09       $405.81       $238.62
28262.....................  T                          Revision of foot and ankle.          0056         22.94     $1,193.09       $405.81       $238.62
28264.....................  T                          Release of midfoot joint...          0056         22.94     $1,193.09       $405.81       $238.62
28270.....................  T                          Release of foot contracture          0055         18.28       $950.72       $355.34       $190.14
28272.....................  T                          Release of toe joint, each.          0055         18.28       $950.72       $355.34       $190.14
28280.....................  T                          Fusion of toes.............          0055         18.28       $950.72       $355.34       $190.14
28285.....................  T                          Repair of hammertoe........          0055         18.28       $950.72       $355.34       $190.14
28286.....................  T                          Repair of hammertoe........          0055         18.28       $950.72       $355.34       $190.14
28288.....................  T                          Partial removal of foot              0056         22.94     $1,193.09       $405.81       $238.62
                                                        bone.
28289.....................  T                          Repair hallux rigidus......          0056         22.94     $1,193.09       $405.81       $238.62
28290.....................  T                          Correction of bunion.......          0056         22.94     $1,193.09       $405.81       $238.62
28292.....................  T                          Correction of bunion.......          0057         23.87     $1,241.45       $496.58       $248.29
28293.....................  T                          Correction of bunion.......          0057         23.87     $1,241.45       $496.58       $248.29
28294.....................  T                          Correction of bunion.......          0056         22.94     $1,193.09       $405.81       $238.62
28296.....................  T                          Correction of bunion.......          0056         22.94     $1,193.09       $405.81       $238.62
28297.....................  T                          Correction of bunion.......          0057         23.87     $1,241.45       $496.58       $248.29
28298.....................  T                          Correction of bunion.......          0056         22.94     $1,193.09       $405.81       $238.62
28299.....................  T                          Correction of bunion.......          0057         23.87     $1,241.45       $496.58       $248.29
28300.....................  T                          Incision of heel bone......          0056         22.94     $1,193.09       $405.81       $238.62
28302.....................  T                          Incision of ankle bone.....          0056         22.94     $1,193.09       $405.81       $238.62
28304.....................  T                          Incision of midfoot bones..          0056         22.94     $1,193.09       $405.81       $238.62

[[Page 52190]]

 
28305.....................  T                          Incise/graft midfoot bones.          0056         22.94     $1,193.09       $405.81       $238.62
28306.....................  T                          Incision of metatarsal.....          0056         22.94     $1,193.09       $405.81       $238.62
28307.....................  T                          Incision of metatarsal.....          0056         22.94     $1,193.09       $405.81       $238.62
28308.....................  T                          Incision of metatarsal.....          0056         22.94     $1,193.09       $405.81       $238.62
28309.....................  T                          Incision of metatarsals....          0056         22.94     $1,193.09       $405.81       $238.62
28310.....................  T                          Revision of big toe........          0055         18.28       $950.72       $355.34       $190.14
28312.....................  T                          Revision of toe............          0055         18.28       $950.72       $355.34       $190.14
28313.....................  T                          Repair deformity of toe....          0055         18.28       $950.72       $355.34       $190.14
28315.....................  T                          Removal of sesamoid bone...          0055         18.28       $950.72       $355.34       $190.14
28320.....................  T                          Repair of foot bones.......          0056         22.94     $1,193.09       $405.81       $238.62
28322.....................  T                          Repair of metatarsals......          0056         22.94     $1,193.09       $405.81       $238.62
28340.....................  T                          Resect enlarged toe tissue.          0055         18.28       $950.72       $355.34       $190.14
28341.....................  T                          Resect enlarged toe........          0055         18.28       $950.72       $355.34       $190.14
28344.....................  T                          Repair extra toe(s)........          0056         22.94     $1,193.09       $405.81       $238.62
28345.....................  T                          Repair webbed toe(s).......          0056         22.94     $1,193.09       $405.81       $238.62
28360.....................  T                          Reconstruct cleft foot.....          0056         22.94     $1,193.09       $405.81       $238.62
28400.....................  T                          Treatment of heel fracture.          0043          1.68        $87.38  ............        $17.48
28405.....................  T                          Treatment of heel fracture.          0043          1.68        $87.38  ............        $17.48
28406.....................  T                          Treatment of heel fracture.          0046         29.03     $1,509.82       $535.76       $301.96
28415.....................  T                          Treat heel fracture........          0046         29.03     $1,509.82       $535.76       $301.96
28420.....................  T                          Treat/graft heel fracture..          0046         29.03     $1,509.82       $535.76       $301.96
28430.....................  T                          Treatment of ankle fracture          0043          1.68        $87.38  ............        $17.48
28435.....................  T                          Treatment of ankle fracture          0043          1.68        $87.38  ............        $17.48
28436.....................  T                          Treatment of ankle fracture          0046         29.03     $1,509.82       $535.76       $301.96
28445.....................  T                          Treat ankle fracture.......          0046         29.03     $1,509.82       $535.76       $301.96
28450.....................  T                          Treat midfoot fracture,              0043          1.68        $87.38  ............        $17.48
                                                        each.
28455.....................  T                          Treat midfoot fracture,              0043          1.68        $87.38  ............        $17.48
                                                        each.
28456.....................  T                          Treat midfoot fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
28465.....................  T                          Treat midfoot fracture,              0046         29.03     $1,509.82       $535.76       $301.96
                                                        each.
28470.....................  T                          Treat metatarsal fracture..          0043          1.68        $87.38  ............        $17.48
28475.....................  T                          Treat metatarsal fracture..          0043          1.68        $87.38  ............        $17.48
28476.....................  T                          Treat metatarsal fracture..          0046         29.03     $1,509.82       $535.76       $301.96
28485.....................  T                          Treat metatarsal fracture..          0046         29.03     $1,509.82       $535.76       $301.96
28490.....................  T                          Treat big toe fracture.....          0043          1.68        $87.38  ............        $17.48
28495.....................  T                          Treat big toe fracture.....          0043          1.68        $87.38  ............        $17.48
28496.....................  T                          Treat big toe fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
28505.....................  T                          Treat big toe fracture.....          0046         29.03     $1,509.82       $535.76       $301.96
28510.....................  T                          Treatment of toe fracture..          0043          1.68        $87.38  ............        $17.48
28515.....................  T                          Treatment of toe fracture..          0043          1.68        $87.38  ............        $17.48
28525.....................  T                          Treat toe fracture.........          0046         29.03     $1,509.82       $535.76       $301.96
28530.....................  T                          Treat sesamoid bone                  0043          1.68        $87.38  ............        $17.48
                                                        fracture.
28531.....................  T                          Treat sesamoid bone                  0046         29.03     $1,509.82       $535.76       $301.96
                                                        fracture.
28540.....................  T                          Treat foot dislocation.....          0043          1.68        $87.38  ............        $17.48
28545.....................  T                          Treat foot dislocation.....          0045         13.47       $700.56       $280.22       $140.11
28546.....................  T                          Treat foot dislocation.....          0046         29.03     $1,509.82       $535.76       $301.96
28555.....................  T                          Repair foot dislocation....          0046         29.03     $1,509.82       $535.76       $301.96
28570.....................  T                          Treat foot dislocation.....          0043          1.68        $87.38  ............        $17.48
28575.....................  T                          Treat foot dislocation.....          0043          1.68        $87.38  ............        $17.48
28576.....................  T                          Treat foot dislocation.....          0046         29.03     $1,509.82       $535.76       $301.96
28585.....................  T                          Repair foot dislocation....          0046         29.03     $1,509.82       $535.76       $301.96
28600.....................  T                          Treat foot dislocation.....          0043          1.68        $87.38  ............        $17.48
28605.....................  T                          Treat foot dislocation.....          0043          1.68        $87.38  ............        $17.48
28606.....................  T                          Treat foot dislocation.....          0046         29.03     $1,509.82       $535.76       $301.96
28615.....................  T                          Repair foot dislocation....          0046         29.03     $1,509.82       $535.76       $301.96
28630.....................  T                          Treat toe dislocation......          0043          1.68        $87.38  ............        $17.48
28635.....................  T                          Treat toe dislocation......          0045         13.47       $700.56       $280.22       $140.11
28636.....................  T                          Treat toe dislocation......          0046         29.03     $1,509.82       $535.76       $301.96
28645.....................  T                          Repair toe dislocation.....          0046         29.03     $1,509.82       $535.76       $301.96
28660.....................  T                          Treat toe dislocation......          0043          1.68        $87.38  ............        $17.48
28665.....................  T                          Treat toe dislocation......          0045         13.47       $700.56       $280.22       $140.11
28666.....................  T                          Treat toe dislocation......          0046         29.03     $1,509.82       $535.76       $301.96
28675.....................  T                          Repair of toe dislocation..          0046         29.03     $1,509.82       $535.76       $301.96
28705.....................  T                          Fusion of foot bones.......          0056         22.94     $1,193.09       $405.81       $238.62
28715.....................  T                          Fusion of foot bones.......          0056         22.94     $1,193.09       $405.81       $238.62
28725.....................  T                          Fusion of foot bones.......          0056         22.94     $1,193.09       $405.81       $238.62
28730.....................  T                          Fusion of foot bones.......          0056         22.94     $1,193.09       $405.81       $238.62

[[Page 52191]]

 
28735.....................  T                          Fusion of foot bones.......          0056         22.94     $1,193.09       $405.81       $238.62
28737.....................  T                          Revision of foot bones.....          0055         18.28       $950.72       $355.34       $190.14
28740.....................  T                          Fusion of foot bones.......          0056         22.94     $1,193.09       $405.81       $238.62
28750.....................  T                          Fusion of big toe joint....          0055         18.28       $950.72       $355.34       $190.14
28755.....................  T                          Fusion of big toe joint....          0055         18.28       $950.72       $355.34       $190.14
28760.....................  T                          Fusion of big toe joint....          0056         22.94     $1,193.09       $405.81       $238.62
28800.....................  C                          Amputation of midfoot......  ............  ............  ............  ............  ............
28805.....................  C                          Amputation thru metatarsal.  ............  ............  ............  ............  ............
28810.....................  T                          Amputation toe & metatarsal          0055         18.28       $950.72       $355.34       $190.14
28820.....................  T                          Amputation of toe..........          0055         18.28       $950.72       $355.34       $190.14
28825.....................  T                          Partial amputation of toe..          0055         18.28       $950.72       $355.34       $190.14
28899.....................  T                          Foot/toes surgery procedure          0043          1.68        $87.38  ............        $17.48
29000.....................  S                          Application of body cast...          0058          1.09        $56.69        $14.74        $11.34
29010.....................  S                          Application of body cast...          0058          1.09        $56.69        $14.74        $11.34
29015.....................  S                          Application of body cast...          0058          1.09        $56.69        $14.74        $11.34
29020.....................  S                          Application of body cast...          0058          1.09        $56.69        $14.74        $11.34
29025.....................  S                          Application of body cast...          0058          1.09        $56.69        $14.74        $11.34
29035.....................  S                          Application of body cast...          0058          1.09        $56.69        $14.74        $11.34
29040.....................  S                          Application of body cast...          0058          1.09        $56.69        $14.74        $11.34
29044.....................  S                          Application of body cast...          0058          1.09        $56.69        $14.74        $11.34
29046.....................  S                          Application of body cast...          0058          1.09        $56.69        $14.74        $11.34
29049.....................  S                          Application of figure eight          0058          1.09        $56.69        $14.74        $11.34
29055.....................  S                          Application of shoulder              0058          1.09        $56.69        $14.74        $11.34
                                                        cast.
29058.....................  S                          Application of shoulder              0058          1.09        $56.69        $14.74        $11.34
                                                        cast.
29065.....................  S                          Application of long arm              0058          1.09        $56.69        $14.74        $11.34
                                                        cast.
29075.....................  S                          Application of forearm cast          0058          1.09        $56.69        $14.74        $11.34
29085.....................  S                          Apply hand/wrist cast......          0058          1.09        $56.69        $14.74        $11.34
29086.....................  S                          Apply finger cast..........          0058          1.09        $56.69        $14.74        $11.34
29105.....................  S                          Apply long arm splint......          0058          1.09        $56.69        $14.74        $11.34
29125.....................  S                          Apply forearm splint.......          0058          1.09        $56.69        $14.74        $11.34
29126.....................  S                          Apply forearm splint.......          0058          1.09        $56.69        $14.74        $11.34
29130.....................  S                          Application of finger                0058          1.09        $56.69        $14.74        $11.34
                                                        splint.
29131.....................  S                          Application of finger                0058          1.09        $56.69        $14.74        $11.34
                                                        splint.
29200.....................  S                          Strapping of chest.........          0058          1.09        $56.69        $14.74        $11.34
29220.....................  S                          Strapping of low back......          0058          1.09        $56.69        $14.74        $11.34
29240.....................  S                          Strapping of shoulder......          0058          1.09        $56.69        $14.74        $11.34
29260.....................  S                          Strapping of elbow or wrist          0058          1.09        $56.69        $14.74        $11.34
29280.....................  S                          Strapping of hand or finger          0058          1.09        $56.69        $14.74        $11.34
29305.....................  S                          Application of hip cast....          0058          1.09        $56.69        $14.74        $11.34
29325.....................  S                          Application of hip casts...          0058          1.09        $56.69        $14.74        $11.34
29345.....................  S                          Application of long leg              0058          1.09        $56.69        $14.74        $11.34
                                                        cast.
29355.....................  S                          Application of long leg              0058          1.09        $56.69        $14.74        $11.34
                                                        cast.
29358.....................  S                          Apply long leg cast brace..          0058          1.09        $56.69        $14.74        $11.34
29365.....................  S                          Application of long leg              0058          1.09        $56.69        $14.74        $11.34
                                                        cast.
29405.....................  S                          Apply short leg cast.......          0058          1.09        $56.69        $14.74        $11.34
29425.....................  S                          Apply short leg cast.......          0058          1.09        $56.69        $14.74        $11.34
29435.....................  S                          Apply short leg cast.......          0058          1.09        $56.69        $14.74        $11.34
29440.....................  S                          Addition of walker to cast.          0058          1.09        $56.69        $14.74        $11.34
29445.....................  S                          Apply rigid leg cast.......          0058          1.09        $56.69        $14.74        $11.34
29450.....................  S                          Application of leg cast....          0058          1.09        $56.69        $14.74        $11.34
29505.....................  S                          Application, long leg                0058          1.09        $56.69        $14.74        $11.34
                                                        splint.
29515.....................  S                          Application lower leg                0058          1.09        $56.69        $14.74        $11.34
                                                        splint.
29520.....................  S                          Strapping of hip...........          0058          1.09        $56.69        $14.74        $11.34
29530.....................  S                          Strapping of knee..........          0058          1.09        $56.69        $14.74        $11.34
29540.....................  S                          Strapping of ankle.........          0058          1.09        $56.69        $14.74        $11.34
29550.....................  S                          Strapping of toes..........          0058          1.09        $56.69        $14.74        $11.34
29580.....................  S                          Application of paste boot..          0058          1.09        $56.69        $14.74        $11.34
29590.....................  S                          Application of foot splint.          0058          1.09        $56.69        $14.74        $11.34
29700.....................  S                          Removal/revision of cast...          0058          1.09        $56.69        $14.74        $11.34
29705.....................  S                          Removal/revision of cast...          0058          1.09        $56.69        $14.74        $11.34
29710.....................  S                          Removal/revision of cast...          0058          1.09        $56.69        $14.74        $11.34
29715.....................  S                          Removal/revision of cast...          0058          1.09        $56.69        $14.74        $11.34
29720.....................  S                          Repair of body cast........          0058          1.09        $56.69        $14.74        $11.34
29730.....................  S                          Windowing of cast..........          0058          1.09        $56.69        $14.74        $11.34
29740.....................  S                          Wedging of cast............          0058          1.09        $56.69        $14.74        $11.34
29750.....................  S                          Wedging of clubfoot cast...          0058          1.09        $56.69        $14.74        $11.34

[[Page 52192]]

 
29799.....................  S                          Casting/strapping procedure          0058          1.09        $56.69        $14.74        $11.34
29800.....................  T                          Jaw arthroscopy/surgery....          0041         27.58     $1,434.41       $580.06       $286.88
29804.....................  T                          Jaw arthroscopy/surgery....          0041         27.58     $1,434.41       $580.06       $286.88
29805.....................  T                          Shoulder arthroscopy, dx...          0041         27.58     $1,434.41       $580.06       $286.88
29806.....................  T                          Shoulder arthroscopy/                0041         27.58     $1,434.41       $580.06       $286.88
                                                        surgery.
29807.....................  T                          Shoulder arthroscopy/                0041         27.58     $1,434.41       $580.06       $286.88
                                                        surgery.
29819.....................  T                          Shoulder arthroscopy/                0041         27.58     $1,434.41       $580.06       $286.88
                                                        surgery.
29820.....................  T                          Shoulder arthroscopy/                0041         27.58     $1,434.41       $580.06       $286.88
                                                        surgery.
29821.....................  T                          Shoulder arthroscopy/                0041         27.58     $1,434.41       $580.06       $286.88
                                                        surgery.
29822.....................  T                          Shoulder arthroscopy/                0041         27.58     $1,434.41       $580.06       $286.88
                                                        surgery.
29823.....................  T                          Shoulder arthroscopy/                0041         27.58     $1,434.41       $580.06       $286.88
                                                        surgery.
29824.....................  T                          Shoulder arthroscopy/                0041         27.58     $1,434.41       $580.06       $286.88
                                                        surgery.
29825.....................  T                          Shoulder arthroscopy/                0041         27.58     $1,434.41       $580.06       $286.88
                                                        surgery.
29826.....................  T                          Shoulder arthroscopy/                0042         43.24     $2,248.87       $804.74       $449.77
                                                        surgery.
29830.....................  T                          Elbow arthroscopy..........          0041         27.58     $1,434.41       $580.06       $286.88
29834.....................  T                          Elbow arthroscopy/surgery..          0041         27.58     $1,434.41       $580.06       $286.88
29835.....................  T                          Elbow arthroscopy/surgery..          0042         43.24     $2,248.87       $804.74       $449.77
29836.....................  T                          Elbow arthroscopy/surgery..          0042         43.24     $2,248.87       $804.74       $449.77
29837.....................  T                          Elbow arthroscopy/surgery..          0041         27.58     $1,434.41       $580.06       $286.88
29838.....................  T                          Elbow arthroscopy/surgery..          0041         27.58     $1,434.41       $580.06       $286.88
29840.....................  T                          Wrist arthroscopy..........          0041         27.58     $1,434.41       $580.06       $286.88
29843.....................  T                          Wrist arthroscopy/surgery..          0041         27.58     $1,434.41       $580.06       $286.88
29844.....................  T                          Wrist arthroscopy/surgery..          0041         27.58     $1,434.41       $580.06       $286.88
29845.....................  T                          Wrist arthroscopy/surgery..          0041         27.58     $1,434.41       $580.06       $286.88
29846.....................  T                          Wrist arthroscopy/surgery..          0041         27.58     $1,434.41       $580.06       $286.88
29847.....................  T                          Wrist arthroscopy/surgery..          0041         27.58     $1,434.41       $580.06       $286.88
29848.....................  T                          Wrist endoscopy/surgery....          0041         27.58     $1,434.41       $580.06       $286.88
29850.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29851.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29855.....................  T                          Tibial arthroscopy/surgery.          0042         43.24     $2,248.87       $804.74       $449.77
29856.....................  T                          Tibial arthroscopy/surgery.          0041         27.58     $1,434.41       $580.06       $286.88
29860.....................  T                          Hip arthroscopy, dx........          0041         27.58     $1,434.41       $580.06       $286.88
29861.....................  T                          Hip arthroscopy/surgery....          0041         27.58     $1,434.41       $580.06       $286.88
29862.....................  T                          Hip arthroscopy/surgery....          0042         43.24     $2,248.87       $804.74       $449.77
29863.....................  T                          Hip arthroscopy/surgery....          0042         43.24     $2,248.87       $804.74       $449.77
29870.....................  T                          Knee arthroscopy, dx.......          0041         27.58     $1,434.41       $580.06       $286.88
29871.....................  T                          Knee arthroscopy/drainage..          0041         27.58     $1,434.41       $580.06       $286.88
29874.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29875.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29876.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29877.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29879.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29880.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29881.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29882.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29883.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29884.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29885.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29886.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29887.....................  T                          Knee arthroscopy/surgery...          0041         27.58     $1,434.41       $580.06       $286.88
29888.....................  T                          Knee arthroscopy/surgery...          0042         43.24     $2,248.87       $804.74       $449.77
29889.....................  T                          Knee arthroscopy/surgery...          0042         43.24     $2,248.87       $804.74       $449.77
29891.....................  T                          Ankle arthroscopy/surgery..          0041         27.58     $1,434.41       $580.06       $286.88
29892.....................  T                          Ankle arthroscopy/surgery..          0041         27.58     $1,434.41       $580.06       $286.88
29893.....................  T                          Scope, plantar fasciotomy..          0055         18.28       $950.72       $355.34       $190.14
29894.....................  T                          Ankle arthroscopy/surgery..          0041         27.58     $1,434.41       $580.06       $286.88
29895.....................  T                          Ankle arthroscopy/surgery..          0041         27.58     $1,434.41       $580.06       $286.88
29897.....................  T                          Ankle arthroscopy/surgery..          0041         27.58     $1,434.41       $580.06       $286.88
29898.....................  T                          Ankle arthroscopy/surgery..          0041         27.58     $1,434.41       $580.06       $286.88
29900.....................  T                          Mcp joint arthroscopy, dx..          0053         14.76       $767.65       $253.49       $153.53
29901.....................  T                          Mcp joint arthroscopy, surg          0053         14.76       $767.65       $253.49       $153.53
29902.....................  T                          Mcp joint arthroscopy, surg          0053         14.76       $767.65       $253.49       $153.53
29999.....................  T                          Arthroscopy of joint.......          0041         27.58     $1,434.41       $580.06       $286.88
30000.....................  T                          Drainage of nose lesion....          0251          1.92        $99.86  ............        $19.97
30020.....................  T                          Drainage of nose lesion....          0251          1.92        $99.86  ............        $19.97
30100.....................  T                          Intranasal biopsy..........          0252          6.27       $326.10       $114.24        $65.22

[[Page 52193]]

 
30110.....................  T                          Removal of nose polyp(s)...          0253         14.79       $769.21       $284.61       $153.84
30115.....................  T                          Removal of nose polyp(s)...          0253         14.79       $769.21       $284.61       $153.84
30117.....................  T                          Removal of intranasal                0253         14.79       $769.21       $284.61       $153.84
                                                        lesion.
30118.....................  T                          Removal of intranasal                0254         21.89     $1,138.48       $352.93       $227.70
                                                        lesion.
30120.....................  T                          Revision of nose...........          0253         14.79       $769.21       $284.61       $153.84
30124.....................  T                          Removal of nose lesion.....          0252          6.27       $326.10       $114.24        $65.22
30125.....................  T                          Removal of nose lesion.....          0256         35.51     $1,846.84  ............       $369.37
30130.....................  T                          Removal of turbinate bones.          0253         14.79       $769.21       $284.61       $153.84
30140.....................  T                          Removal of turbinate bones.          0254         21.89     $1,138.48       $352.93       $227.70
30150.....................  T                          Partial removal of nose....          0256         35.51     $1,846.84  ............       $369.37
30160.....................  T                          Removal of nose............          0256         35.51     $1,846.84  ............       $369.37
30200.....................  T                          Injection treatment of nose          0253         14.79       $769.21       $284.61       $153.84
30210.....................  T                          Nasal sinus therapy........          0252          6.27       $326.10       $114.24        $65.22
30220.....................  T                          Insert nasal septal button.          0252          6.27       $326.10       $114.24        $65.22
30300.....................  X                          Remove nasal foreign body..          0340          0.66        $34.33  ............         $6.87
30310.....................  T                          Remove nasal foreign body..          0253         14.79       $769.21       $284.61       $153.84
30320.....................  T                          Remove nasal foreign body..          0253         14.79       $769.21       $284.61       $153.84
30400.....................  T                          Reconstruction of nose.....          0256         35.51     $1,846.84  ............       $369.37
30410.....................  T                          Reconstruction of nose.....          0256         35.51     $1,846.84  ............       $369.37
30420.....................  T                          Reconstruction of nose.....          0256         35.51     $1,846.84  ............       $369.37
30430.....................  T                          Revision of nose...........          0254         21.89     $1,138.48       $352.93       $227.70
30435.....................  T                          Revision of nose...........          0256         35.51     $1,846.84  ............       $369.37
30450.....................  T                          Revision of nose...........          0256         35.51     $1,846.84  ............       $369.37
30460.....................  T                          Revision of nose...........          0256         35.51     $1,846.84  ............       $369.37
30462.....................  T                          Revision of nose...........          0256         35.51     $1,846.84  ............       $369.37
30465.....................  T                          Repair nasal stenosis......          0256         35.51     $1,846.84  ............       $369.37
30520.....................  T                          Repair of nasal septum.....          0254         21.89     $1,138.48       $352.93       $227.70
30540.....................  T                          Repair nasal defect........          0256         35.51     $1,846.84  ............       $369.37
30545.....................  T                          Repair nasal defect........          0256         35.51     $1,846.84  ............       $369.37
30560.....................  T                          Release of nasal adhesions.          0251          1.92        $99.86  ............        $19.97
30580.....................  T                          Repair upper jaw fistula...          0256         35.51     $1,846.84  ............       $369.37
30600.....................  T                          Repair mouth/nose fistula..          0256         35.51     $1,846.84  ............       $369.37
30620.....................  T                          Intranasal reconstruction..          0256         35.51     $1,846.84  ............       $369.37
30630.....................  T                          Repair nasal septum defect.          0254         21.89     $1,138.48       $352.93       $227.70
30801.....................  T                          Cauterization, inner nose..          0252          6.27       $326.10       $114.24        $65.22
30802.....................  T                          Cauterization, inner nose..          0253         14.79       $769.21       $284.61       $153.84
30901.....................  T                          Control of nosebleed.......          0250          1.68        $87.38        $30.58        $17.48
30903.....................  T                          Control of nosebleed.......          0250          1.68        $87.38        $30.58        $17.48
30905.....................  T                          Control of nosebleed.......          0250          1.68        $87.38        $30.58        $17.48
30906.....................  T                          Repeat control of nosebleed          0250          1.68        $87.38        $30.58        $17.48
30915.....................  T                          Ligation, nasal sinus                0091         27.03     $1,405.80       $348.23       $281.16
                                                        artery.
30920.....................  T                          Ligation, upper jaw artery.          0092         24.97     $1,298.66       $505.37       $259.73
30930.....................  T                          Therapy, fracture of nose..          0253         14.79       $769.21       $284.61       $153.84
30999.....................  T                          Nasal surgery procedure....          0251          1.92        $99.86  ............        $19.97
31000.....................  T                          Irrigation, maxillary sinus          0251          1.92        $99.86  ............        $19.97
31002.....................  T                          Irrigation, sphenoid sinus.          0252          6.27       $326.10       $114.24        $65.22
31020.....................  T                          Exploration, maxillary               0254         21.89     $1,138.48       $352.93       $227.70
                                                        sinus.
31030.....................  T                          Exploration, maxillary               0256         35.51     $1,846.84  ............       $369.37
                                                        sinus.
31032.....................  T                          Explore sinus,remove polyps          0256         35.51     $1,846.84  ............       $369.37
31040.....................  T                          Exploration behind upper             0254         21.89     $1,138.48       $352.93       $227.70
                                                        jaw.
31050.....................  T                          Exploration, sphenoid sinus          0256         35.51     $1,846.84  ............       $369.37
31051.....................  T                          Sphenoid sinus surgery.....          0256         35.51     $1,846.84  ............       $369.37
31070.....................  T                          Exploration of frontal               0254         21.89     $1,138.48       $352.93       $227.70
                                                        sinus.
31075.....................  T                          Exploration of frontal               0256         35.51     $1,846.84  ............       $369.37
                                                        sinus.
31080.....................  T                          Removal of frontal sinus...          0256         35.51     $1,846.84  ............       $369.37
31081.....................  T                          Removal of frontal sinus...          0256         35.51     $1,846.84  ............       $369.37
31084.....................  T                          Removal of frontal sinus...          0256         35.51     $1,846.84  ............       $369.37
31085.....................  T                          Removal of frontal sinus...          0256         35.51     $1,846.84  ............       $369.37
31086.....................  T                          Removal of frontal sinus...          0256         35.51     $1,846.84  ............       $369.37
31087.....................  T                          Removal of frontal sinus...          0256         35.51     $1,846.84  ............       $369.37
31090.....................  T                          Exploration of sinuses.....          0256         35.51     $1,846.84  ............       $369.37
31200.....................  T                          Removal of ethmoid sinus...          0256         35.51     $1,846.84  ............       $369.37
31201.....................  T                          Removal of ethmoid sinus...          0256         35.51     $1,846.84  ............       $369.37
31205.....................  T                          Removal of ethmoid sinus...          0256         35.51     $1,846.84  ............       $369.37
31225.....................  C                          Removal of upper jaw.......  ............  ............  ............  ............  ............
31230.....................  C                          Removal of upper jaw.......  ............  ............  ............  ............  ............

[[Page 52194]]

 
31231.....................  T                          Nasal endoscopy, dx........          0071          1.01        $52.53        $14.18        $10.51
31233.....................  T                          Nasal/sinus endoscopy, dx..          0072          1.66        $86.33        $37.99        $17.27
31235.....................  T                          Nasal/sinus endoscopy, dx..          0074         12.84       $667.80       $295.70       $133.56
31237.....................  T                          Nasal/sinus endoscopy, surg          0075         20.41     $1,061.50       $445.92       $212.30
31238.....................  T                          Nasal/sinus endoscopy, surg          0074         12.84       $667.80       $295.70       $133.56
31239.....................  T                          Nasal/sinus endoscopy, surg          0075         20.41     $1,061.50       $445.92       $212.30
31240.....................  T                          Nasal/sinus endoscopy, surg          0074         12.84       $667.80       $295.70       $133.56
31254.....................  T                          Revision of ethmoid sinus..          0075         20.41     $1,061.50       $445.92       $212.30
31255.....................  T                          Removal of ethmoid sinus...          0075         20.41     $1,061.50       $445.92       $212.30
31256.....................  T                          Exploration maxillary sinus          0075         20.41     $1,061.50       $445.92       $212.30
31267.....................  T                          Endoscopy, maxillary sinus.          0075         20.41     $1,061.50       $445.92       $212.30
31276.....................  T                          Sinus endoscopy, surgical..          0075         20.41     $1,061.50       $445.92       $212.30
31287.....................  T                          Nasal/sinus endoscopy, surg          0075         20.41     $1,061.50       $445.92       $212.30
31288.....................  T                          Nasal/sinus endoscopy, surg          0075         20.41     $1,061.50       $445.92       $212.30
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          6.27       $326.10       $114.24        $65.22
31300.....................  T                          Removal of larynx lesion...          0256         35.51     $1,846.84  ............       $369.37
31320.....................  T                          Diagnostic incision, larynx          0256         35.51     $1,846.84  ............       $369.37
31360.....................  C                          Removal of larynx..........  ............  ............  ............  ............  ............
31365.....................  C                          Removal of larynx..........  ............  ............  ............  ............  ............
31367.....................  C                          Partial removal of larynx..  ............  ............  ............  ............  ............
31368.....................  C                          Partial removal of larynx..  ............  ............  ............  ............  ............
31370.....................  C                          Partial removal of larynx..  ............  ............  ............  ............  ............
31375.....................  C                          Partial removal of larynx..  ............  ............  ............  ............  ............
31380.....................  C                          Partial removal of larynx..  ............  ............  ............  ............  ............
31382.....................  C                          Partial removal of larynx..  ............  ............  ............  ............  ............
31390.....................  C                          Removal of larynx & pharynx  ............  ............  ............  ............  ............
31395.....................  C                          Reconstruct larynx &         ............  ............  ............  ............  ............
                                                        pharynx.
31400.....................  T                          Revision of larynx.........          0256         35.51     $1,846.84  ............       $369.37
31420.....................  T                          Removal of epiglottis......          0256         35.51     $1,846.84  ............       $369.37
31500.....................  S                          Insert emergency airway....          0094          2.68       $139.38        $47.39        $27.88
31502.....................  T                          Change of windpipe airway..          0121          2.17       $112.86        $45.14        $22.57
31505.....................  T                          Diagnostic laryngoscopy....          0072          1.66        $86.33        $37.99        $17.27
31510.....................  T                          Laryngoscopy with biopsy...          0074         12.84       $667.80       $295.70       $133.56
31511.....................  T                          Remove foreign body, larynx          0072          1.66        $86.33        $37.99        $17.27
31512.....................  T                          Removal of larynx lesion...          0074         12.84       $667.80       $295.70       $133.56
31513.....................  T                          Injection into vocal cord..          0072          1.66        $86.33        $37.99        $17.27
31515.....................  T                          Laryngoscopy for aspiration          0074         12.84       $667.80       $295.70       $133.56
31520.....................  T                          Diagnostic laryngoscopy....          0072          1.66        $86.33        $37.99        $17.27
31525.....................  T                          Diagnostic laryngoscopy....          0074         12.84       $667.80       $295.70       $133.56
31526.....................  T                          Diagnostic laryngoscopy....          0075         20.41     $1,061.50       $445.92       $212.30
31527.....................  T                          Laryngoscopy for treatment.          0075         20.41     $1,061.50       $445.92       $212.30
31528.....................  T                          Laryngoscopy and dilation..          0074         12.84       $667.80       $295.70       $133.56
31529.....................  T                          Laryngoscopy and dilation..          0074         12.84       $667.80       $295.70       $133.56
31530.....................  T                          Operative laryngoscopy.....          0075         20.41     $1,061.50       $445.92       $212.30
31531.....................  T                          Operative laryngoscopy.....          0075         20.41     $1,061.50       $445.92       $212.30
31535.....................  T                          Operative laryngoscopy.....          0075         20.41     $1,061.50       $445.92       $212.30
31536.....................  T                          Operative laryngoscopy.....          0075         20.41     $1,061.50       $445.92       $212.30
31540.....................  T                          Operative laryngoscopy.....          0075         20.41     $1,061.50       $445.92       $212.30
31541.....................  T                          Operative laryngoscopy.....          0075         20.41     $1,061.50       $445.92       $212.30
31560.....................  T                          Operative laryngoscopy.....          0075         20.41     $1,061.50       $445.92       $212.30
31561.....................  T                          Operative laryngoscopy.....          0075         20.41     $1,061.50       $445.92       $212.30
31570.....................  T                          Laryngoscopy with injection          0074         12.84       $667.80       $295.70       $133.56
31571.....................  T                          Laryngoscopy with injection          0075         20.41     $1,061.50       $445.92       $212.30
31575.....................  T                          Diagnostic laryngoscopy....          0071          1.01        $52.53        $14.18        $10.51
31576.....................  T                          Laryngoscopy with biopsy...          0075         20.41     $1,061.50       $445.92       $212.30
31577.....................  T                          Remove foreign body, larynx          0073          3.63       $188.79        $74.14        $37.76
31578.....................  T                          Removal of larynx lesion...          0075         20.41     $1,061.50       $445.92       $212.30
31579.....................  T                          Diagnostic laryngoscopy....          0073          3.63       $188.79        $74.14        $37.76
31580.....................  T                          Revision of larynx.........          0256         35.51     $1,846.84  ............       $369.37
31582.....................  T                          Revision of larynx.........          0256         35.51     $1,846.84  ............       $369.37
31584.....................  C                          Treat larynx fracture......  ............  ............  ............  ............  ............

[[Page 52195]]

 
31585.....................  T                          Treat larynx fracture......          0253         14.79       $769.21       $284.61       $153.84
31586.....................  T                          Treat larynx fracture......          0256         35.51     $1,846.84  ............       $369.37
31587.....................  C                          Revision of larynx.........  ............  ............  ............  ............  ............
31588.....................  T                          Revision of larynx.........          0256         35.51     $1,846.84  ............       $369.37
31590.....................  T                          Reinnervate larynx.........          0256         35.51     $1,846.84  ............       $369.37
31595.....................  T                          Larynx nerve surgery.......          0256         35.51     $1,846.84  ............       $369.37
31599.....................  T                          Larynx surgery procedure...          0254         21.89     $1,138.48       $352.93       $227.70
31600.....................  T                          Incision of windpipe.......          0254         21.89     $1,138.48       $352.93       $227.70
31601.....................  T                          Incision of windpipe.......          0254         21.89     $1,138.48       $352.93       $227.70
31603.....................  T                          Incision of windpipe.......          0252          6.27       $326.10       $114.24        $65.22
31605.....................  T                          Incision of windpipe.......          0253         14.79       $769.21       $284.61       $153.84
31610.....................  T                          Incision of windpipe.......          0254         21.89     $1,138.48       $352.93       $227.70
31611.....................  T                          Surgery/speech prosthesis..          0254         21.89     $1,138.48       $352.93       $227.70
31612.....................  T                          Puncture/clear windpipe....          0254         21.89     $1,138.48       $352.93       $227.70
31613.....................  T                          Repair windpipe opening....          0254         21.89     $1,138.48       $352.93       $227.70
31614.....................  T                          Repair windpipe opening....          0256         35.51     $1,846.84  ............       $369.37
31615.....................  T                          Visualization of windpipe..          0076          9.30       $483.68       $189.92        $96.74
31622.....................  T                          Dx bronchoscope/wash.......          0076          9.30       $483.68       $189.92        $96.74
31623.....................  T                          Dx bronchoscope/brush......          0076          9.30       $483.68       $189.92        $96.74
31624.....................  T                          Dx bronchoscope/lavage.....          0076          9.30       $483.68       $189.92        $96.74
31625.....................  T                          Bronchoscopy with biopsy...          0076          9.30       $483.68       $189.92        $96.74
31628.....................  T                          Bronchoscopy with biopsy...          0076          9.30       $483.68       $189.92        $96.74
31629.....................  T                          Bronchoscopy with biopsy...          0076          9.30       $483.68       $189.92        $96.74
31630.....................  T                          Bronchoscopy with repair...          0076          9.30       $483.68       $189.92        $96.74
31631.....................  T                          Bronchoscopy with dilation.          0076          9.30       $483.68       $189.92        $96.74
31635.....................  T                          Remove foreign body, airway          0076          9.30       $483.68       $189.92        $96.74
31640.....................  T                          Bronchoscopy & remove                0076          9.30       $483.68       $189.92        $96.74
                                                        lesion.
31641.....................  T                          Bronchoscopy, treat                  0076          9.30       $483.68       $189.92        $96.74
                                                        blockage.
31643.....................  T                          Diag bronchoscope/catheter.          0076          9.30       $483.68       $189.92        $96.74
31645.....................  T                          Bronchoscopy, clear airways          0076          9.30       $483.68       $189.92        $96.74
31646.....................  T                          Bronchoscopy, reclear                0076          9.30       $483.68       $189.92        $96.74
                                                        airway.
31656.....................  T                          Bronchoscopy, inj for xray.          0076          9.30       $483.68       $189.92        $96.74
31700.....................  T                          Insertion of airway                  0072          1.66        $86.33        $37.99        $17.27
                                                        catheter.
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          3.63       $188.79        $74.14        $37.76
31720.....................  T                          Clearance of airways.......          0072          1.66        $86.33        $37.99        $17.27
31725.....................  C                          Clearance of airways.......  ............  ............  ............  ............  ............
31730.....................  T                          Intro, windpipe wire/tube..          0073          3.63       $188.79        $74.14        $37.76
31750.....................  T                          Repair of windpipe.........          0256         35.51     $1,846.84  ............       $369.37
31755.....................  T                          Repair of windpipe.........          0256         35.51     $1,846.84  ............       $369.37
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.....................  T                          Remove windpipe lesion.....          0254         21.89     $1,138.48       $352.93       $227.70
31786.....................  C                          Remove windpipe lesion.....  ............  ............  ............  ............  ............
31800.....................  C                          Repair of windpipe injury..  ............  ............  ............  ............  ............
31805.....................  C                          Repair of windpipe injury..  ............  ............  ............  ............  ............
31820.....................  T                          Closure of windpipe lesion.          0253         14.79       $769.21       $284.61       $153.84
31825.....................  T                          Repair of windpipe defect..          0254         21.89     $1,138.48       $352.93       $227.70
31830.....................  T                          Revise windpipe scar.......          0254         21.89     $1,138.48       $352.93       $227.70
31899.....................  T                          Airways surgical procedure.          0076          9.30       $483.68       $189.92        $96.74
32000.....................  T                          Drainage of chest..........          0070          3.30       $171.63  ............        $34.33
32002.....................  T                          Treatment of collapsed lung          0070          3.30       $171.63  ............        $34.33
32005.....................  T                          Treat lung lining                    0070          3.30       $171.63  ............        $34.33
                                                        chemically.
32020.....................  T                          Insertion of chest tube....          0070          3.30       $171.63  ............        $34.33
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....  ............  ............  ............  ............  ............

[[Page 52196]]

 
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.....................  T                          Drain, percut, lung lesion.          0070          3.30       $171.63  ............        $34.33
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          3.02       $157.07        $69.11        $31.41
32402.....................  C                          Open biopsy chest lining...  ............  ............  ............  ............  ............
32405.....................  T                          Biopsy, lung or mediastinum          0685          4.47       $232.48       $102.29        $46.50
32420.....................  T                          Puncture/clear lung........          0070          3.30       $171.63  ............        $34.33
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...          0069         29.51     $1,534.79       $591.64       $306.96
32602.....................  T                          Thoracoscopy, diagnostic...          0069         29.51     $1,534.79       $591.64       $306.96
32603.....................  T                          Thoracoscopy, diagnostic...          0069         29.51     $1,534.79       $591.64       $306.96
32604.....................  T                          Thoracoscopy, diagnostic...          0069         29.51     $1,534.79       $591.64       $306.96
32605.....................  T                          Thoracoscopy, diagnostic...          0069         29.51     $1,534.79       $591.64       $306.96
32606.....................  T                          Thoracoscopy, diagnostic...          0069         29.51     $1,534.79       $591.64       $306.96
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.  ............  ............  ............  ............  ............

[[Page 52197]]

 
32940.....................  C                          Revision of lung...........  ............  ............  ............  ............  ............
32960.....................  T                          Therapeutic pneumothorax...          0070          3.30       $171.63  ............        $34.33
32997.....................  C                          Total lung lavage..........  ............  ............  ............  ............  ............
32999.....................  T                          Chest surgery procedure....          0070          3.30       $171.63  ............        $34.33
33010.....................  T                          Drainage of heart sac......          0070          3.30       $171.63  ............        $34.33
33011.....................  T                          Repeat drainage of heart             0070          3.30       $171.63  ............        $34.33
                                                        sac.
33015.....................  C                          Incision of heart sac......  ............  ............  ............  ............  ............
33020.....................  C                          Incision of heart sac......  ............  ............  ............  ............  ............
33025.....................  C                          Incision of heart sac......  ............  ............  ............  ............  ............
33030.....................  C                          Partial removal of heart     ............  ............  ............  ............  ............
                                                        sac.
33031.....................  C                          Partial removal of heart     ............  ............  ............  ............  ............
                                                        sac.
33050.....................  C                          Removal of heart sac lesion  ............  ............  ............  ............  ............
33120.....................  C                          Removal of heart lesion....  ............  ............  ............  ............  ............
33130.....................  C                          Removal of heart lesion....  ............  ............  ............  ............  ............
33140.....................  C                          Heart revascularize (tmr)..  ............  ............  ............  ............  ............
33141.....................  C                          Heart tmr w/other procedure  ............  ............  ............  ............  ............
33200.....................  C                          Insertion of heart           ............  ............  ............  ............  ............
                                                        pacemaker.
33201.....................  C                          Insertion of heart           ............  ............  ............  ............  ............
                                                        pacemaker.
33206.....................  T                          Insertion of heart                   0089        108.92     $5,664.82     $1,642.80     $1,132.96
                                                        pacemaker.
33207.....................  T                          Insertion of heart                   0089        108.92     $5,664.82     $1,642.80     $1,132.96
                                                        pacemaker.
33208.....................  T                          Insertion of heart                   0089        108.92     $5,664.82     $1,642.80     $1,132.96
                                                        pacemaker.
33210.....................  T                          Insertion of heart                   0106         29.23     $1,520.22       $410.46       $304.04
                                                        electrode.
33211.....................  T                          Insertion of heart                   0106         29.23     $1,520.22       $410.46       $304.04
                                                        electrode.
33212.....................  T                          Insertion of pulse                   0090         77.15     $4,012.49     $1,444.50       $802.50
                                                        generator.
33213.....................  T                          Insertion of pulse                   0090         77.15     $4,012.49     $1,444.50       $802.50
                                                        generator.
33214.....................  T                          Upgrade of pacemaker system          0089        108.92     $5,664.82     $1,642.80     $1,132.96
33216.....................  T                          Revise eltrd pacing-defib..          0106         29.23     $1,520.22       $410.46       $304.04
33217.....................  T                          Revise eltrd pacing-defib..          0106         29.23     $1,520.22       $410.46       $304.04
33218.....................  T                          Revise eltrd pacing-defib..          0106         29.23     $1,520.22       $410.46       $304.04
33220.....................  T                          Revise eltrd pacing-defib..          0106         29.23     $1,520.22       $410.46       $304.04
33222.....................  T                          Revise pocket, pacemaker...          0027         15.73       $818.10       $343.60       $163.62
33223.....................  T                          Revise pocket, pacing-defib          0027         15.73       $818.10       $343.60       $163.62
33233.....................  T                          Removal of pacemaker system          0105         19.14       $995.45       $370.40       $199.09
33234.....................  T                          Removal of pacemaker system          0105         19.14       $995.45       $370.40       $199.09
33235.....................  T                          Removal pacemaker electrode          0105         19.14       $995.45       $370.40       $199.09
33236.....................  C                          Remove electrode/            ............  ............  ............  ............  ............
                                                        thoracotomy.
33237.....................  C                          Remove electrode/            ............  ............  ............  ............  ............
                                                        thoracotomy.
33238.....................  C                          Remove electrode/            ............  ............  ............  ............  ............
                                                        thoracotomy.
33240.....................  T                          Insert pulse generator.....          0107        181.51     $9,440.15     $2,076.83     $1,888.03
33241.....................  T                          Remove pulse generator.....          0105         19.14       $995.45       $370.40       $199.09
33243.....................  C                          Remove eltrd/thoracotomy...  ............  ............  ............  ............  ............
33244.....................  T                          Remove eltrd, transven.....          0105         19.14       $995.45       $370.40       $199.09
33245.....................  C                          Insert epic eltrd pace-      ............  ............  ............  ............  ............
                                                        defib.
33246.....................  C                          Insert epic eltrd/generator  ............  ............  ............  ............  ............
33249.....................  T                          Eltrd/insert pace-defib....          0108        232.69    $12,101.97  ............     $2,420.39
33250.....................  C                          Ablate heart dysrhythm       ............  ............  ............  ............  ............
                                                        focus.
33251.....................  C                          Ablate heart dysrhythm       ............  ............  ............  ............  ............
                                                        focus.
33253.....................  C                          Reconstruct atria..........  ............  ............  ............  ............  ............
33261.....................  C                          Ablate heart dysrhythm       ............  ............  ............  ............  ............
                                                        focus.
33282.....................  S                          Implant pat-active ht                0680         51.95     $2,701.87  ............       $540.37
                                                        record.
33284.....................  T                          Remove pat-active ht record          0109          7.68       $399.43       $131.49        $79.89
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  ............  ............  ............  ............  ............

[[Page 52198]]

 
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, modified fontan....  ............  ............  ............  ............  ............
33617.....................  C                          Repair single ventricle....  ............  ............  ............  ............  ............
33619.....................  C                          Repair single ventricle....  ............  ............  ............  ............  ............
33641.....................  C                          Repair heart septum defect.  ............  ............  ............  ............  ............

[[Page 52199]]

 
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..  ............  ............  ............  ............  ............

[[Page 52200]]

 
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  ............  ............  ............  ............  ............
33967.....................  C                          Insert ia percut device....  ............  ............  ............  ............  ............
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..  ............  ............  ............  ............  ............
33979.....................  C                          Insert intracorporeal        ............  ............  ............  ............  ............
                                                        device.
33980.....................  C                          Remove intracorporeal        ............  ............  ............  ............  ............
                                                        device.
33999.....................  T                          Cardiac surgery procedure..          0070          3.30       $171.63  ............        $34.33
34001.....................  C                          Removal of artery clot.....  ............  ............  ............  ............  ............
34051.....................  C                          Removal of artery clot.....  ............  ............  ............  ............  ............
34101.....................  T                          Removal of artery clot.....          0088         33.96     $1,766.23       $678.68       $353.25
34111.....................  T                          Removal of arm artery clot.          0088         33.96     $1,766.23       $678.68       $353.25
34151.....................  C                          Removal of artery clot.....  ............  ............  ............  ............  ............
34201.....................  T                          Removal of artery clot.....          0088         33.96     $1,766.23       $678.68       $353.25
34203.....................  T                          Removal of leg artery clot.          0088         33.96     $1,766.23       $678.68       $353.25
34401.....................  C                          Removal of vein clot.......  ............  ............  ............  ............  ............
34421.....................  T                          Removal of vein clot.......          0088         33.96     $1,766.23       $678.68       $353.25
34451.....................  C                          Removal of vein clot.......  ............  ............  ............  ............  ............
34471.....................  T                          Removal of vein clot.......          0088         33.96     $1,766.23       $678.68       $353.25
34490.....................  T                          Removal of vein clot.......          0088         33.96     $1,766.23       $678.68       $353.25
34501.....................  T                          Repair valve, femoral vein.          0088         33.96     $1,766.23       $678.68       $353.25
34502.....................  C                          Reconstruct vena cava......  ............  ............  ............  ............  ............
34510.....................  T                          Transposition of vein valve          0088         33.96     $1,766.23       $678.68       $353.25
34520.....................  T                          Cross-over vein graft......          0088         33.96     $1,766.23       $678.68       $353.25
34530.....................  T                          Leg vein fusion............          0088         33.96     $1,766.23       $678.68       $353.25
34800.....................  C                          Endovasc abdo repair w/tube  ............  ............  ............  ............  ............
34802.....................  C                          Endovasc abdo repr w/device  ............  ............  ............  ............  ............
34804.....................  C                          Endovasc abdo repr w/device  ............  ............  ............  ............  ............
34808.....................  C                          Endovasc abdo occlud device  ............  ............  ............  ............  ............
34812.....................  C                          Xpose for endoprosth,        ............  ............  ............  ............  ............
                                                        aortic.
34813.....................  C                          Xpose for endoprosth,        ............  ............  ............  ............  ............
                                                        femorl.
34820.....................  C                          Xpose for endoprosth, iliac  ............  ............  ............  ............  ............
34825.....................  C                          Endovasc extend prosth,      ............  ............  ............  ............  ............
                                                        init.
34826.....................  C                          Endovasc exten prosth, addl  ............  ............  ............  ............  ............
34830.....................  C                          Open aortic tube prosth      ............  ............  ............  ............  ............
                                                        repr.
34831.....................  C                          Open aortoiliac prosth repr  ............  ............  ............  ............  ............
34832.....................  C                          Open aortofemor prosth repr  ............  ............  ............  ............  ............
35001.....................  C                          Repair defect of artery....  ............  ............  ............  ............  ............
35002.....................  C                          Repair artery rupture, neck  ............  ............  ............  ............  ............
35005.....................  C                          Repair defect of artery....  ............  ............  ............  ............  ............
35011.....................  T                          Repair defect of artery....          0093         26.29     $1,367.32       $277.34       $273.46
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....  ............  ............  ............  ............  ............

[[Page 52201]]

 
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.          0093         26.29     $1,367.32       $277.34       $273.46
35182.....................  C                          Repair blood vessel lesion.  ............  ............  ............  ............  ............
35184.....................  T                          Repair blood vessel lesion.          0093         26.29     $1,367.32       $277.34       $273.46
35188.....................  T                          Repair blood vessel lesion.          0088         33.96     $1,766.23       $678.68       $353.25
35189.....................  C                          Repair blood vessel lesion.  ............  ............  ............  ............  ............
35190.....................  T                          Repair blood vessel lesion.          0093         26.29     $1,367.32       $277.34       $273.46
35201.....................  T                          Repair blood vessel lesion.          0093         26.29     $1,367.32       $277.34       $273.46
35206.....................  T                          Repair blood vessel lesion.          0093         26.29     $1,367.32       $277.34       $273.46
35207.....................  T                          Repair blood vessel lesion.          0088         33.96     $1,766.23       $678.68       $353.25
35211.....................  C                          Repair blood vessel lesion.  ............  ............  ............  ............  ............
35216.....................  C                          Repair blood vessel lesion.  ............  ............  ............  ............  ............
35221.....................  C                          Repair blood vessel lesion.  ............  ............  ............  ............  ............
35226.....................  T                          Repair blood vessel lesion.          0093         26.29     $1,367.32       $277.34       $273.46
35231.....................  T                          Repair blood vessel lesion.          0093         26.29     $1,367.32       $277.34       $273.46
35236.....................  T                          Repair blood vessel lesion.          0093         26.29     $1,367.32       $277.34       $273.46
35241.....................  C                          Repair blood vessel lesion.  ............  ............  ............  ............  ............
35246.....................  C                          Repair blood vessel lesion.  ............  ............  ............  ............  ............
35251.....................  C                          Repair blood vessel lesion.  ............  ............  ............  ............  ............
35256.....................  T                          Repair blood vessel lesion.          0093         26.29     $1,367.32       $277.34       $273.46
35261.....................  T                          Repair blood vessel lesion.          0093         26.29     $1,367.32       $277.34       $273.46
35266.....................  T                          Repair blood vessel lesion.          0093         26.29     $1,367.32       $277.34       $273.46
35271.....................  C                          Repair blood vessel lesion.  ............  ............  ............  ............  ............
35276.....................  C                          Repair blood vessel lesion.  ............  ............  ............  ............  ............
35281.....................  C                          Repair blood vessel lesion.  ............  ............  ............  ............  ............
35286.....................  T                          Repair blood vessel lesion.          0093         26.29     $1,367.32       $277.34       $273.46
35301.....................  C                          Rechanneling of artery.....  ............  ............  ............  ............  ............
35311.....................  C                          Rechanneling of artery.....  ............  ............  ............  ............  ............
35321.....................  T                          Rechanneling of artery.....          0093         26.29     $1,367.32       $277.34       $273.46
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.....................  T                          Repair arterial blockage...          0081         22.69     $1,180.08  ............       $236.02
35459.....................  T                          Repair arterial blockage...          0081         22.69     $1,180.08  ............       $236.02
35460.....................  T                          Repair venous blockage.....          0081         22.69     $1,180.08  ............       $236.02
35470.....................  T                          Repair arterial blockage...          0081         22.69     $1,180.08  ............       $236.02
35471.....................  T                          Repair arterial blockage...          0081         22.69     $1,180.08  ............       $236.02
35472.....................  T                          Repair arterial blockage...          0081         22.69     $1,180.08  ............       $236.02
35473.....................  T                          Repair arterial blockage...          0081         22.69     $1,180.08  ............       $236.02
35474.....................  T                          Repair arterial blockage...          0081         22.69     $1,180.08  ............       $236.02
35475.....................  T                          Repair arterial blockage...          0081         22.69     $1,180.08  ............       $236.02
35476.....................  T                          Repair venous blockage.....          0081         22.69     $1,180.08  ............       $236.02
35480.....................  C                          Atherectomy, open..........  ............  ............  ............  ............  ............
35481.....................  C                          Atherectomy, open..........  ............  ............  ............  ............  ............
35482.....................  C                          Atherectomy, open..........  ............  ............  ............  ............  ............
35483.....................  C                          Atherectomy, open..........  ............  ............  ............  ............  ............

[[Page 52202]]

 
35484.....................  T                          Atherectomy, open..........          0081         22.69     $1,180.08  ............       $236.02
35485.....................  T                          Atherectomy, open..........          0081         22.69     $1,180.08  ............       $236.02
35490.....................  T                          Atherectomy, percutaneous..          0081         22.69     $1,180.08  ............       $236.02
35491.....................  T                          Atherectomy, percutaneous..          0081         22.69     $1,180.08  ............       $236.02
35492.....................  T                          Atherectomy, percutaneous..          0081         22.69     $1,180.08  ............       $236.02
35493.....................  T                          Atherectomy, percutaneous..          0081         22.69     $1,180.08  ............       $236.02
35494.....................  T                          Atherectomy, percutaneous..          0081         22.69     $1,180.08  ............       $236.02
35495.....................  T                          Atherectomy, percutaneous..          0081         22.69     $1,180.08  ............       $236.02
35500.....................  T                          Harvest vein for bypass....          0081         22.69     $1,180.08  ............       $236.02
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..........  ............  ............  ............  ............  ............
35600.....................  C                          Harvest artery for cabg....  ............  ............  ............  ............  ............
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........  ............  ............  ............  ............  ............
35647.....................  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.....  ............  ............  ............  ............  ............

[[Page 52203]]

 
35685.....................  T                          Bypass graft patency/patch.          0093         26.29     $1,367.32       $277.34       $273.46
35686.....................  T                          Bypass graft/av fist                 0093         26.29     $1,367.32       $277.34       $273.46
                                                        patency.
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.....................  T                          Exploration of artery/vein.          0115         23.48     $1,221.17       $439.62       $244.23
35800.....................  C                          Explore neck vessels.......  ............  ............  ............  ............  ............
35820.....................  C                          Explore chest vessels......  ............  ............  ............  ............  ............
35840.....................  C                          Explore abdominal vessels..  ............  ............  ............  ............  ............
35860.....................  T                          Explore limb vessels.......          0093         26.29     $1,367.32       $277.34       $273.46
35870.....................  C                          Repair vessel graft defect.  ............  ............  ............  ............  ............
35875.....................  T                          Removal of clot in graft...          0088         33.96     $1,766.23       $678.68       $353.25
35876.....................  T                          Removal of clot in graft...          0088         33.96     $1,766.23       $678.68       $353.25
35879.....................  T                          Revise graft w/vein........          0088         33.96     $1,766.23       $678.68       $353.25
35881.....................  T                          Revise graft w/vein........          0088         33.96     $1,766.23       $678.68       $353.25
35901.....................  C                          Excision, graft, neck......  ............  ............  ............  ............  ............
35903.....................  T                          Excision, graft, extremity.          0115         23.48     $1,221.17       $439.62       $244.23
35905.....................  C                          Excision, graft, thorax....  ............  ............  ............  ............  ............
35907.....................  C                          Excision, graft, abdomen...  ............  ............  ............  ............  ............
36000.....................  N                          Place needle in vein.......  ............  ............  ............  ............  ............
36002.....................  S                          Pseudoaneurysm injection             0267          2.58       $134.18        $65.52        $26.84
                                                        trt.
36005.....................  N                          Injection ext 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.          0119         25.88     $1,345.99  ............       $269.20
36261.....................  T                          Revision of infusion pump..          0124         23.47     $1,220.65  ............       $244.13
36262.....................  T                          Removal of infusion pump...          0109          7.68       $399.43       $131.49        $79.89
36299.....................  N                          Vessel injection procedure.  ............  ............  ............  ............  ............
36400.....................  N                          Drawing blood..............  ............  ............  ............  ............  ............
36405.....................  N                          Drawing blood..............  ............  ............  ............  ............  ............
36406.....................  N                          Drawing blood..............  ............  ............  ............  ............  ............
36410.....................  N                          Drawing blood..............  ............  ............  ............  ............  ............
36415.....................  E                          Drawing blood..............  ............  ............  ............  ............  ............
36420.....................  T                          Establish access to vein...          0035          0.24        $12.48         $3.74         $2.50
36425.....................  T                          Establish access to vein...          0035          0.24        $12.48         $3.74         $2.50
36430.....................  S                          Blood transfusion service..          0110          4.04       $210.12  ............        $42.02
36440.....................  S                          Blood transfusion service..          0110          4.04       $210.12  ............        $42.02
36450.....................  S                          Exchange transfusion                 0110          4.04       $210.12  ............        $42.02
                                                        service.
36455.....................  S                          Exchange transfusion                 0110          4.04       $210.12  ............        $42.02
                                                        service.
36460.....................  S                          Transfusion service, fetal.          0110          4.04       $210.12  ............        $42.02
36468.....................  T                          Injection(s), spider veins.          0098          1.90        $98.82        $20.88        $19.76
36469.....................  T                          Injection(s), spider veins.          0098          1.90        $98.82        $20.88        $19.76
36470.....................  T                          Injection therapy of vein..          0098          1.90        $98.82        $20.88        $19.76

[[Page 52204]]

 
36471.....................  T                          Injection therapy of veins.          0098          1.90        $98.82        $20.88        $19.76
36481.....................  N                          Insertion of catheter, vein  ............  ............  ............  ............  ............
36488.....................  T                          Insertion of catheter, vein          0032          7.14       $371.34  ............        $74.27
36489.....................  T                          Insertion of catheter, vein          0032          7.14       $371.34  ............        $74.27
36490.....................  T                          Insertion of catheter, vein          0032          7.14       $371.34  ............        $74.27
36491.....................  T                          Insertion of catheter, vein          0032          7.14       $371.34  ............        $74.27
36493.....................  X                          Repositioning of cvc.......          0187          4.19       $217.92        $94.96        $43.58
36500.....................  N                          Insertion of catheter, vein  ............  ............  ............  ............  ............
36510.....................  C                          Insertion of catheter, vein  ............  ............  ............  ............  ............
36520.....................  S                          Plasma and/or cell exchange          0111         13.60       $707.32       $198.05       $141.46
36521.....................  S                          Apheresis w/ adsorp/                 0112         39.40     $2,049.15       $612.47       $409.83
                                                        reinfuse.
36522.....................  S                          Photopheresis..............          0112         39.40     $2,049.15       $612.47       $409.83
36530.....................  T                          Insertion of infusion pump.          0119         25.88     $1,345.99  ............       $269.20
36531.....................  T                          Revision of infusion pump..          0124         23.47     $1,220.65  ............       $244.13
36532.....................  T                          Removal of infusion pump...          0109          7.68       $399.43       $131.49        $79.89
36533.....................  T                          Insertion of access device.          0115         23.48     $1,221.17       $439.62       $244.23
36534.....................  T                          Revision of access device..          0109          7.68       $399.43       $131.49        $79.89
36535.....................  T                          Removal of access device...          0109          7.68       $399.43       $131.49        $79.89
36540.....................  N                          Collect blood venous device  ............  ............  ............  ............  ............
36550.....................  T                          Declot vascular device.....          0677          2.80       $145.63  ............        $29.13
36600.....................  N                          Withdrawal of arterial       ............  ............  ............  ............  ............
                                                        blood.
36620.....................  N                          Insertion catheter, artery.  ............  ............  ............  ............  ............
36625.....................  N                          Insertion catheter, artery.  ............  ............  ............  ............  ............
36640.....................  T                          Insertion catheter, artery.          0032          7.14       $371.34  ............        $74.27
36660.....................  C                          Insertion catheter, artery.  ............  ............  ............  ............  ............
36680.....................  T                          Insert needle, bone cavity.          0120          1.81        $94.14        $25.42        $18.83
36800.....................  T                          Insertion of cannula.......          0115         23.48     $1,221.17       $439.62       $244.23
36810.....................  T                          Insertion of cannula.......          0115         23.48     $1,221.17       $439.62       $244.23
36815.....................  T                          Insertion of cannula.......          0115         23.48     $1,221.17       $439.62       $244.23
36819.....................  T                          Av fusion/uppr arm vein....          0088         33.96     $1,766.23       $678.68       $353.25
36820.....................  T                          Av fusion/forearm vein.....          0088         33.96     $1,766.23       $678.68       $353.25
36821.....................  T                          Av fusion direct any site..          0088         33.96     $1,766.23       $678.68       $353.25
36822.....................  C                          Insertion of cannula(s)....  ............  ............  ............  ............  ............
36823.....................  C                          Insertion of cannula(s)....  ............  ............  ............  ............  ............
36825.....................  T                          Artery-vein graft..........          0088         33.96     $1,766.23       $678.68       $353.25
36830.....................  T                          Artery-vein graft..........          0088         33.96     $1,766.23       $678.68       $353.25
36831.....................  T                          Open thrombect av fistula..          0088         33.96     $1,766.23       $678.68       $353.25
36832.....................  T                          Av fistula revision, open..          0088         33.96     $1,766.23       $678.68       $353.25
36833.....................  T                          Av fistula revision........          0088         33.96     $1,766.23       $678.68       $353.25
36834.....................  T                          Repair A-V aneurysm........          0088         33.96     $1,766.23       $678.68       $353.25
36835.....................  T                          Artery to vein shunt.......          0115         23.48     $1,221.17       $439.62       $244.23
36860.....................  T                          External cannula declotting          0103         11.26       $585.62       $210.82       $117.12
36861.....................  T                          Cannula declotting.........          0115         23.48     $1,221.17       $439.62       $244.23
36870.....................  T                          Percut thrombect av fistula          0093         26.29     $1,367.32       $277.34       $273.46
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.....................  T                          Transcatheter biopsy.......          0685          4.47       $232.48       $102.29        $46.50
37201.....................  T                          Transcatheter therapy                0676          4.62       $240.28        $64.88        $48.06
                                                        infuse.
37202.....................  T                          Transcatheter therapy                0677          2.80       $145.63  ............        $29.13
                                                        infuse.
37203.....................  T                          Transcatheter retrieval....          0103         11.26       $585.62       $210.82       $117.12
37204.....................  T                          Transcatheter occlusion....          0115         23.48     $1,221.17       $439.62       $244.23
37205.....................  T                          Transcatheter stent........          0229         49.00     $2,548.44       $662.59       $509.69
37206.....................  T                          Transcatheter stent add-on.          0229         49.00     $2,548.44       $662.59       $509.69
37207.....................  T                          Transcatheter stent........          0229         49.00     $2,548.44       $662.59       $509.69
37208.....................  T                          Transcatheter stent add-on.          0229         49.00     $2,548.44       $662.59       $509.69
37209.....................  T                          Exchange arterial catheter.          0103         11.26       $585.62       $210.82       $117.12
37250.....................  S                          Iv us first vessel add-on..          0670         14.78       $768.69       $276.73       $153.74
37251.....................  S                          Iv us each add vessel add-           0670         14.78       $768.69       $276.73       $153.74
                                                        on.
37565.....................  T                          Ligation of neck vein......          0093         26.29     $1,367.32       $277.34       $273.46
37600.....................  T                          Ligation of neck artery....          0093         26.29     $1,367.32       $277.34       $273.46
37605.....................  T                          Ligation of neck artery....          0091         27.03     $1,405.80       $348.23       $281.16
37606.....................  T                          Ligation of neck artery....          0091         27.03     $1,405.80       $348.23       $281.16

[[Page 52205]]

 
37607.....................  T                          Ligation of a-v fistula....          0092         24.97     $1,298.66       $505.37       $259.73
37609.....................  T                          Temporal artery procedure..          0021         14.58       $758.29       $227.49       $151.66
37615.....................  T                          Ligation of neck artery....          0091         27.03     $1,405.80       $348.23       $281.16
37616.....................  C                          Ligation of chest artery...  ............  ............  ............  ............  ............
37617.....................  C                          Ligation of abdomen artery.  ............  ............  ............  ............  ............
37618.....................  C                          Ligation of extremity        ............  ............  ............  ............  ............
                                                        artery.
37620.....................  T                          Revision of major vein.....          0091         27.03     $1,405.80       $348.23       $281.16
37650.....................  T                          Revision of major vein.....          0091         27.03     $1,405.80       $348.23       $281.16
37660.....................  C                          Revision of major vein.....  ............  ............  ............  ............  ............
37700.....................  T                          Revise leg vein............          0091         27.03     $1,405.80       $348.23       $281.16
37720.....................  T                          Removal of leg vein........          0092         24.97     $1,298.66       $505.37       $259.73
37730.....................  T                          Removal of leg veins.......          0092         24.97     $1,298.66       $505.37       $259.73
37735.....................  T                          Removal of leg veins/lesion          0092         24.97     $1,298.66       $505.37       $259.73
37760.....................  T                          Revision of leg veins......          0091         27.03     $1,405.80       $348.23       $281.16
37780.....................  T                          Revision of leg vein.......          0091         27.03     $1,405.80       $348.23       $281.16
37785.....................  T                          Revise secondary varicosity          0091         27.03     $1,405.80       $348.23       $281.16
37788.....................  C                          Revascularization, penis...  ............  ............  ............  ............  ............
37790.....................  T                          Penile venous occlusion....          0181         29.88     $1,554.03       $621.82       $310.81
37799.....................  T                          Vascular surgery procedure.          0035          0.24        $12.48         $3.74         $2.50
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         42.44     $2,207.26     $1,001.89       $441.45
38129.....................  T                          Laparoscope proc, spleen...          0130         31.99     $1,663.77       $659.53       $332.75
38200.....................  N                          Injection for spleen x-ray.  ............  ............  ............  ............  ............
38220.....................  T                          Bone marrow aspiration.....          0003          1.24        $64.49        $27.08        $12.90
38221.....................  T                          Bone marrow biopsy.........          0003          1.24        $64.49        $27.08        $12.90
38230.....................  S                          Bone marrow collection.....          0123          4.86       $252.76  ............        $50.55
38231.....................  S                          Stem cell collection.......          0111         13.60       $707.32       $198.05       $141.46
38240.....................  S                          Bone marrow/stem transplant          0123          4.86       $252.76  ............        $50.55
38241.....................  S                          Bone marrow/stem transplant          0123          4.86       $252.76  ............        $50.55
38300.....................  T                          Drainage, lymph node lesion          0008         16.32       $848.79  ............       $169.76
38305.....................  T                          Drainage, lymph node lesion          0008         16.32       $848.79  ............       $169.76
38308.....................  T                          Incision of lymph channels.          0113         19.75     $1,027.18  ............       $205.44
38380.....................  C                          Thoracic duct procedure....  ............  ............  ............  ............  ............
38381.....................  C                          Thoracic duct procedure....  ............  ............  ............  ............  ............
38382.....................  C                          Thoracic duct procedure....  ............  ............  ............  ............  ............
38500.....................  T                          Biopsy/removal, lymph nodes          0113         19.75     $1,027.18  ............       $205.44
38505.....................  T                          Needle biopsy, lymph nodes.          0005          3.02       $157.07        $69.11        $31.41
38510.....................  T                          Biopsy/removal, lymph nodes          0113         19.75     $1,027.18  ............       $205.44
38520.....................  T                          Biopsy/removal, lymph nodes          0113         19.75     $1,027.18  ............       $205.44
38525.....................  T                          Biopsy/removal, lymph nodes          0113         19.75     $1,027.18  ............       $205.44
38530.....................  T                          Biopsy/removal, lymph nodes          0113         19.75     $1,027.18  ............       $205.44
38542.....................  T                          Explore deep node(s), neck.          0114         37.55     $1,952.94       $507.76       $390.59
38550.....................  T                          Removal, neck/armpit lesion          0113         19.75     $1,027.18  ............       $205.44
38555.....................  T                          Removal, neck/armpit lesion          0113         19.75     $1,027.18  ............       $205.44
38562.....................  C                          Removal, pelvic lymph nodes  ............  ............  ............  ............  ............
38564.....................  C                          Removal, abdomen lymph       ............  ............  ............  ............  ............
                                                        nodes.
38570.....................  T                          Laparoscopy, lymph node              0131         42.44     $2,207.26     $1,001.89       $441.45
                                                        biop.
38571.....................  T                          Laparoscopy,                         0132         57.95     $3,013.92     $1,239.22       $602.78
                                                        lymphadenectomy.
38572.....................  T                          Laparoscopy,                         0131         42.44     $2,207.26     $1,001.89       $441.45
                                                        lymphadenectomy.
38589.....................  T                          Laparoscope proc, lymphatic          0130         31.99     $1,663.77       $659.53       $332.75
38700.....................  T                          Removal of lymph nodes,              0113         19.75     $1,027.18  ............       $205.44
                                                        neck.
38720.....................  T                          Removal of lymph nodes,              0113         19.75     $1,027.18  ............       $205.44
                                                        neck.
38724.....................  C                          Removal of lymph nodes,      ............  ............  ............  ............  ............
                                                        neck.
38740.....................  T                          Remove armpit lymph nodes..          0114         37.55     $1,952.94       $507.76       $390.59
38745.....................  T                          Remove armpit lymph nodes..          0114         37.55     $1,952.94       $507.76       $390.59
38746.....................  C                          Remove thoracic lymph nodes  ............  ............  ............  ............  ............
38747.....................  C                          Remove abdominal lymph       ............  ............  ............  ............  ............
                                                        nodes.
38760.....................  T                          Remove groin lymph nodes...          0113         19.75     $1,027.18  ............       $205.44
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.....  ............  ............  ............  ............  ............

[[Page 52206]]

 
38794.....................  N                          Access thoracic lymph duct.  ............  ............  ............  ............  ............
38999.....................  S                          Blood/lymph system                   0110          4.04       $210.12  ............        $42.02
                                                        procedure.
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.....          0069         29.51     $1,534.79       $591.64       $306.96
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..............          0251          1.92        $99.86  ............        $19.97
40500.....................  T                          Partial excision of lip....          0253         14.79       $769.21       $284.61       $153.84
40510.....................  T                          Partial excision of lip....          0254         21.89     $1,138.48       $352.93       $227.70
40520.....................  T                          Partial excision of lip....          0253         14.79       $769.21       $284.61       $153.84
40525.....................  T                          Reconstruct lip with flap..          0254         21.89     $1,138.48       $352.93       $227.70
40527.....................  T                          Reconstruct lip with flap..          0254         21.89     $1,138.48       $352.93       $227.70
40530.....................  T                          Partial removal of lip.....          0254         21.89     $1,138.48       $352.93       $227.70
40650.....................  T                          Repair lip.................          0252          6.27       $326.10       $114.24        $65.22
40652.....................  T                          Repair lip.................          0252          6.27       $326.10       $114.24        $65.22
40654.....................  T                          Repair lip.................          0252          6.27       $326.10       $114.24        $65.22
40700.....................  T                          Repair cleft lip/nasal.....          0256         35.51     $1,846.84  ............       $369.37
40701.....................  T                          Repair cleft lip/nasal.....          0256         35.51     $1,846.84  ............       $369.37
40702.....................  T                          Repair cleft lip/nasal.....          0256         35.51     $1,846.84  ............       $369.37
40720.....................  T                          Repair cleft lip/nasal.....          0256         35.51     $1,846.84  ............       $369.37
40761.....................  T                          Repair cleft lip/nasal.....          0256         35.51     $1,846.84  ............       $369.37
40799.....................  T                          Lip surgery procedure......          0253         14.79       $769.21       $284.61       $153.84
40800.....................  T                          Drainage of mouth lesion...          0251          1.92        $99.86  ............        $19.97
40801.....................  T                          Drainage of mouth lesion...          0252          6.27       $326.10       $114.24        $65.22
40804.....................  X                          Removal, foreign body,               0340          0.66        $34.33  ............         $6.87
                                                        mouth.
40805.....................  T                          Removal, foreign body,               0252          6.27       $326.10       $114.24        $65.22
                                                        mouth.
40806.....................  T                          Incision of lip fold.......          0251          1.92        $99.86  ............        $19.97
40808.....................  T                          Biopsy of mouth lesion.....          0251          1.92        $99.86  ............        $19.97
40810.....................  T                          Excision of mouth lesion...          0253         14.79       $769.21       $284.61       $153.84
40812.....................  T                          Excise/repair mouth lesion.          0253         14.79       $769.21       $284.61       $153.84
40814.....................  T                          Excise/repair mouth lesion.          0253         14.79       $769.21       $284.61       $153.84
40816.....................  T                          Excision of mouth lesion...          0254         21.89     $1,138.48       $352.93       $227.70
40818.....................  T                          Excise oral mucosa for               0251          1.92        $99.86  ............        $19.97
                                                        graft.
40819.....................  T                          Excise lip or cheek fold...          0252          6.27       $326.10       $114.24        $65.22
40820.....................  T                          Treatment of mouth lesion..          0253         14.79       $769.21       $284.61       $153.84
40830.....................  T                          Repair mouth laceration....          0251          1.92        $99.86  ............        $19.97
40831.....................  T                          Repair mouth laceration....          0252          6.27       $326.10       $114.24        $65.22
40840.....................  T                          Reconstruction of mouth....          0254         21.89     $1,138.48       $352.93       $227.70
40842.....................  T                          Reconstruction of mouth....          0254         21.89     $1,138.48       $352.93       $227.70
40843.....................  T                          Reconstruction of mouth....          0254         21.89     $1,138.48       $352.93       $227.70
40844.....................  T                          Reconstruction of mouth....          0256         35.51     $1,846.84  ............       $369.37
40845.....................  T                          Reconstruction of mouth....          0256         35.51     $1,846.84  ............       $369.37
40899.....................  T                          Mouth surgery procedure....          0252          6.27       $326.10       $114.24        $65.22
41000.....................  T                          Drainage of mouth lesion...          0253         14.79       $769.21       $284.61       $153.84
41005.....................  T                          Drainage of mouth lesion...          0251          1.92        $99.86  ............        $19.97
41006.....................  T                          Drainage of mouth lesion...          0254         21.89     $1,138.48       $352.93       $227.70
41007.....................  T                          Drainage of mouth lesion...          0253         14.79       $769.21       $284.61       $153.84
41008.....................  T                          Drainage of mouth lesion...          0253         14.79       $769.21       $284.61       $153.84
41009.....................  T                          Drainage of mouth lesion...          0251          1.92        $99.86  ............        $19.97
41010.....................  T                          Incision of tongue fold....          0253         14.79       $769.21       $284.61       $153.84
41015.....................  T                          Drainage of mouth lesion...          0251          1.92        $99.86  ............        $19.97
41016.....................  T                          Drainage of mouth lesion...          0252          6.27       $326.10       $114.24        $65.22

[[Page 52207]]

 
41017.....................  T                          Drainage of mouth lesion...          0252          6.27       $326.10       $114.24        $65.22
41018.....................  T                          Drainage of mouth lesion...          0252          6.27       $326.10       $114.24        $65.22
41100.....................  T                          Biopsy of tongue...........          0252          6.27       $326.10       $114.24        $65.22
41105.....................  T                          Biopsy of tongue...........          0253         14.79       $769.21       $284.61       $153.84
41108.....................  T                          Biopsy of floor of mouth...          0252          6.27       $326.10       $114.24        $65.22
41110.....................  T                          Excision of tongue lesion..          0253         14.79       $769.21       $284.61       $153.84
41112.....................  T                          Excision of tongue lesion..          0253         14.79       $769.21       $284.61       $153.84
41113.....................  T                          Excision of tongue lesion..          0253         14.79       $769.21       $284.61       $153.84
41114.....................  T                          Excision of tongue lesion..          0254         21.89     $1,138.48       $352.93       $227.70
41115.....................  T                          Excision of tongue fold....          0252          6.27       $326.10       $114.24        $65.22
41116.....................  T                          Excision of mouth lesion...          0253         14.79       $769.21       $284.61       $153.84
41120.....................  T                          Partial removal of tongue..          0254         21.89     $1,138.48       $352.93       $227.70
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  ............  ............  ............  ............  ............
41250.....................  T                          Repair tongue laceration...          0251          1.92        $99.86  ............        $19.97
41251.....................  T                          Repair tongue laceration...          0252          6.27       $326.10       $114.24        $65.22
41252.....................  T                          Repair tongue laceration...          0252          6.27       $326.10       $114.24        $65.22
41500.....................  T                          Fixation of tongue.........          0254         21.89     $1,138.48       $352.93       $227.70
41510.....................  T                          Tongue to lip surgery......          0253         14.79       $769.21       $284.61       $153.84
41520.....................  T                          Reconstruction, tongue fold          0252          6.27       $326.10       $114.24        $65.22
41599.....................  T                          Tongue and mouth surgery...          0251          1.92        $99.86  ............        $19.97
41800.....................  T                          Drainage of gum lesion.....          0251          1.92        $99.86  ............        $19.97
41805.....................  T                          Removal foreign body, gum..          0254         21.89     $1,138.48       $352.93       $227.70
41806.....................  T                          Removal foreign                      0253         14.79       $769.21       $284.61       $153.84
                                                        body,jawbone.
41820.....................  T                          Excision, gum, each                  0252          6.27       $326.10       $114.24        $65.22
                                                        quadrant.
41821.....................  T                          Excision of gum flap.......          0252          6.27       $326.10       $114.24        $65.22
41822.....................  T                          Excision of gum lesion.....          0253         14.79       $769.21       $284.61       $153.84
41823.....................  T                          Excision of gum lesion.....          0254         21.89     $1,138.48       $352.93       $227.70
41825.....................  T                          Excision of gum lesion.....          0253         14.79       $769.21       $284.61       $153.84
41826.....................  T                          Excision of gum lesion.....          0253         14.79       $769.21       $284.61       $153.84
41827.....................  T                          Excision of gum lesion.....          0254         21.89     $1,138.48       $352.93       $227.70
41828.....................  T                          Excision of gum lesion.....          0253         14.79       $769.21       $284.61       $153.84
41830.....................  T                          Removal of gum tissue......          0253         14.79       $769.21       $284.61       $153.84
41850.....................  T                          Treatment of gum lesion....          0253         14.79       $769.21       $284.61       $153.84
41870.....................  T                          Gum graft..................          0254         21.89     $1,138.48       $352.93       $227.70
41872.....................  T                          Repair gum.................          0253         14.79       $769.21       $284.61       $153.84
41874.....................  T                          Repair tooth socket........          0254         21.89     $1,138.48       $352.93       $227.70
41899.....................  T                          Dental surgery procedure...          0253         14.79       $769.21       $284.61       $153.84
42000.....................  T                          Drainage mouth roof lesion.          0251          1.92        $99.86  ............        $19.97
42100.....................  T                          Biopsy roof of mouth.......          0252          6.27       $326.10       $114.24        $65.22
42104.....................  T                          Excision lesion, mouth roof          0253         14.79       $769.21       $284.61       $153.84
42106.....................  T                          Excision lesion, mouth roof          0253         14.79       $769.21       $284.61       $153.84
42107.....................  T                          Excision lesion, mouth roof          0254         21.89     $1,138.48       $352.93       $227.70
42120.....................  T                          Remove palate/lesion.......          0256         35.51     $1,846.84  ............       $369.37
42140.....................  T                          Excision of uvula..........          0252          6.27       $326.10       $114.24        $65.22
42145.....................  T                          Repair palate, pharynx/              0254         21.89     $1,138.48       $352.93       $227.70
                                                        uvula.
42160.....................  T                          Treatment mouth roof lesion          0253         14.79       $769.21       $284.61       $153.84
42180.....................  T                          Repair palate..............          0251          1.92        $99.86  ............        $19.97
42182.....................  T                          Repair palate..............          0256         35.51     $1,846.84  ............       $369.37
42200.....................  T                          Reconstruct cleft palate...          0256         35.51     $1,846.84  ............       $369.37
42205.....................  T                          Reconstruct cleft palate...          0256         35.51     $1,846.84  ............       $369.37
42210.....................  T                          Reconstruct cleft palate...          0256         35.51     $1,846.84  ............       $369.37
42215.....................  T                          Reconstruct cleft palate...          0256         35.51     $1,846.84  ............       $369.37
42220.....................  T                          Reconstruct cleft palate...          0256         35.51     $1,846.84  ............       $369.37
42225.....................  T                          Reconstruct cleft palate...          0256         35.51     $1,846.84  ............       $369.37
42226.....................  T                          Lengthening of palate......          0256         35.51     $1,846.84  ............       $369.37
42227.....................  T                          Lengthening of palate......          0256         35.51     $1,846.84  ............       $369.37
42235.....................  T                          Repair palate..............          0253         14.79       $769.21       $284.61       $153.84
42260.....................  T                          Repair nose to lip fistula.          0254         21.89     $1,138.48       $352.93       $227.70
42280.....................  T                          Preparation, palate mold...          0251          1.92        $99.86  ............        $19.97
42281.....................  T                          Insertion, palate                    0253         14.79       $769.21       $284.61       $153.84
                                                        prosthesis.

[[Page 52208]]

 
42299.....................  T                          Palate/uvula surgery.......          0251          1.92        $99.86  ............        $19.97
42300.....................  T                          Drainage of salivary gland.          0253         14.79       $769.21       $284.61       $153.84
42305.....................  T                          Drainage of salivary gland.          0253         14.79       $769.21       $284.61       $153.84
42310.....................  T                          Drainage of salivary gland.          0251          1.92        $99.86  ............        $19.97
42320.....................  T                          Drainage of salivary gland.          0251          1.92        $99.86  ............        $19.97
42325.....................  T                          Create salivary cyst drain.          0251          1.92        $99.86  ............        $19.97
42326.....................  T                          Create salivary cyst drain.          0252          6.27       $326.10       $114.24        $65.22
42330.....................  T                          Removal of salivary stone..          0253         14.79       $769.21       $284.61       $153.84
42335.....................  T                          Removal of salivary stone..          0253         14.79       $769.21       $284.61       $153.84
42340.....................  T                          Removal of salivary stone..          0253         14.79       $769.21       $284.61       $153.84
42400.....................  T                          Biopsy of salivary gland...          0004          1.63        $84.77        $22.04        $16.95
42405.....................  T                          Biopsy of salivary gland...          0253         14.79       $769.21       $284.61       $153.84
42408.....................  T                          Excision of salivary cyst..          0253         14.79       $769.21       $284.61       $153.84
42409.....................  T                          Drainage of salivary cyst..          0253         14.79       $769.21       $284.61       $153.84
42410.....................  T                          Excise parotid gland/lesion          0256         35.51     $1,846.84  ............       $369.37
42415.....................  T                          Excise parotid gland/lesion          0256         35.51     $1,846.84  ............       $369.37
42420.....................  T                          Excise parotid gland/lesion          0256         35.51     $1,846.84  ............       $369.37
42425.....................  T                          Excise parotid gland/lesion          0256         35.51     $1,846.84  ............       $369.37
42426.....................  C                          Excise parotid gland/lesion  ............  ............  ............  ............  ............
42440.....................  T                          Excise submaxillary gland..          0256         35.51     $1,846.84  ............       $369.37
42450.....................  T                          Excise sublingual gland....          0254         21.89     $1,138.48       $352.93       $227.70
42500.....................  T                          Repair salivary duct.......          0254         21.89     $1,138.48       $352.93       $227.70
42505.....................  T                          Repair salivary duct.......          0256         35.51     $1,846.84  ............       $369.37
42507.....................  T                          Parotid duct diversion.....          0256         35.51     $1,846.84  ............       $369.37
42508.....................  T                          Parotid duct diversion.....          0256         35.51     $1,846.84  ............       $369.37
42509.....................  T                          Parotid duct diversion.....          0256         35.51     $1,846.84  ............       $369.37
42510.....................  T                          Parotid duct diversion.....          0256         35.51     $1,846.84  ............       $369.37
42550.....................  N                          Injection for salivary x-    ............  ............  ............  ............  ............
                                                        ray.
42600.....................  T                          Closure of salivary fistula          0253         14.79       $769.21       $284.61       $153.84
42650.....................  T                          Dilation of salivary duct..          0252          6.27       $326.10       $114.24        $65.22
42660.....................  T                          Dilation of salivary duct..          0252          6.27       $326.10       $114.24        $65.22
42665.....................  T                          Ligation of salivary duct..          0254         21.89     $1,138.48       $352.93       $227.70
42699.....................  T                          Salivary surgery procedure.          0253         14.79       $769.21       $284.61       $153.84
42700.....................  T                          Drainage of tonsil abscess.          0251          1.92        $99.86  ............        $19.97
42720.....................  T                          Drainage of throat abscess.          0253         14.79       $769.21       $284.61       $153.84
42725.....................  T                          Drainage of throat abscess.          0256         35.51     $1,846.84  ............       $369.37
42800.....................  T                          Biopsy of throat...........          0252          6.27       $326.10       $114.24        $65.22
42802.....................  T                          Biopsy of throat...........          0253         14.79       $769.21       $284.61       $153.84
42804.....................  T                          Biopsy of upper nose/throat          0253         14.79       $769.21       $284.61       $153.84
42806.....................  T                          Biopsy of upper nose/throat          0254         21.89     $1,138.48       $352.93       $227.70
42808.....................  T                          Excise pharynx lesion......          0253         14.79       $769.21       $284.61       $153.84
42809.....................  X                          Remove pharynx foreign body          0340          0.66        $34.33  ............         $6.87
42810.....................  T                          Excision of neck cyst......          0254         21.89     $1,138.48       $352.93       $227.70
42815.....................  T                          Excision of neck cyst......          0256         35.51     $1,846.84  ............       $369.37
42820.....................  T                          Remove tonsils and adenoids          0258         21.15     $1,099.99       $437.25       $220.00
42821.....................  T                          Remove tonsils and adenoids          0258         21.15     $1,099.99       $437.25       $220.00
42825.....................  T                          Removal of tonsils.........          0258         21.15     $1,099.99       $437.25       $220.00
42826.....................  T                          Removal of tonsils.........          0258         21.15     $1,099.99       $437.25       $220.00
42830.....................  T                          Removal of adenoids........          0258         21.15     $1,099.99       $437.25       $220.00
42831.....................  T                          Removal of adenoids........          0258         21.15     $1,099.99       $437.25       $220.00
42835.....................  T                          Removal of adenoids........          0258         21.15     $1,099.99       $437.25       $220.00
42836.....................  T                          Removal of adenoids........          0258         21.15     $1,099.99       $437.25       $220.00
42842.....................  T                          Extensive surgery of throat          0254         21.89     $1,138.48       $352.93       $227.70
42844.....................  T                          Extensive surgery of throat          0256         35.51     $1,846.84  ............       $369.37
42845.....................  C                          Extensive surgery of throat  ............  ............  ............  ............  ............
42860.....................  T                          Excision of tonsil tags....          0258         21.15     $1,099.99       $437.25       $220.00
42870.....................  T                          Excision of lingual tonsil.          0258         21.15     $1,099.99       $437.25       $220.00
42890.....................  T                          Partial removal of pharynx.          0256         35.51     $1,846.84  ............       $369.37
42892.....................  T                          Revision of pharyngeal               0256         35.51     $1,846.84  ............       $369.37
                                                        walls.
42894.....................  C                          Revision of pharyngeal       ............  ............  ............  ............  ............
                                                        walls.
42900.....................  T                          Repair throat wound........          0252          6.27       $326.10       $114.24        $65.22
42950.....................  T                          Reconstruction of throat...          0254         21.89     $1,138.48       $352.93       $227.70
42953.....................  C                          Repair throat, esophagus...  ............  ............  ............  ............  ............
42955.....................  T                          Surgical opening of throat.          0254         21.89     $1,138.48       $352.93       $227.70
42960.....................  T                          Control throat bleeding....          0250          1.68        $87.38        $30.58        $17.48
42961.....................  C                          Control throat bleeding....  ............  ............  ............  ............  ............

[[Page 52209]]

 
42962.....................  T                          Control throat bleeding....          0256         35.51     $1,846.84  ............       $369.37
42970.....................  T                          Control nose/throat                  0250          1.68        $87.38        $30.58        $17.48
                                                        bleeding.
42971.....................  C                          Control nose/throat          ............  ............  ............  ............  ............
                                                        bleeding.
42972.....................  T                          Control nose/throat                  0253         14.79       $769.21       $284.61       $153.84
                                                        bleeding.
42999.....................  T                          Throat surgery procedure...          0252          6.27       $326.10       $114.24        $65.22
43020.....................  T                          Incision of esophagus......          0252          6.27       $326.10       $114.24        $65.22
43030.....................  T                          Throat muscle surgery......          0253         14.79       $769.21       $284.61       $153.84
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.....................  T                          Removal of esophagus pouch.          0254         21.89     $1,138.48       $352.93       $227.70
43135.....................  C                          Removal of esophagus pouch.  ............  ............  ............  ............  ............
43200.....................  T                          Esophagus endoscopy........          0141          7.82       $406.71       $150.48        $81.34
43202.....................  T                          Esophagus endoscopy, biopsy          0141          7.82       $406.71       $150.48        $81.34
43204.....................  T                          Esophagus endoscopy &                0141          7.82       $406.71       $150.48        $81.34
                                                        inject.
43205.....................  T                          Esophagus endoscopy/                 0141          7.82       $406.71       $150.48        $81.34
                                                        ligation.
43215.....................  T                          Esophagus endoscopy........          0141          7.82       $406.71       $150.48        $81.34
43216.....................  T                          Esophagus endoscopy/lesion.          0141          7.82       $406.71       $150.48        $81.34
43217.....................  T                          Esophagus endoscopy........          0141          7.82       $406.71       $150.48        $81.34
43219.....................  T                          Esophagus endoscopy........          0141          7.82       $406.71       $150.48        $81.34
43220.....................  T                          Esoph endoscopy, dilation..          0141          7.82       $406.71       $150.48        $81.34
43226.....................  T                          Esoph endoscopy, dilation..          0141          7.82       $406.71       $150.48        $81.34
43227.....................  T                          Esoph endoscopy, repair....          0141          7.82       $406.71       $150.48        $81.34
43228.....................  T                          Esoph endoscopy, ablation..          0141          7.82       $406.71       $150.48        $81.34
43231.....................  T                          Esoph endoscopy w/us exam..          0141          7.82       $406.71       $150.48        $81.34
43232.....................  T                          Esoph endoscopy w/us fn bx.          0141          7.82       $406.71       $150.48        $81.34
43234.....................  T                          Upper GI endoscopy, exam...          0141          7.82       $406.71       $150.48        $81.34
43235.....................  T                          Uppr gi endoscopy,                   0141          7.82       $406.71       $150.48        $81.34
                                                        diagnosis.
43239.....................  T                          Upper GI endoscopy, biopsy.          0141          7.82       $406.71       $150.48        $81.34
43240.....................  T                          Esoph endoscope w/drain              0141          7.82       $406.71       $150.48        $81.34
                                                        cyst.
43241.....................  T                          Upper GI endoscopy with              0141          7.82       $406.71       $150.48        $81.34
                                                        tube.
43242.....................  T                          Uppr gi endoscopy w/us fn            0141          7.82       $406.71       $150.48        $81.34
                                                        bx.
43243.....................  T                          Upper gi endoscopy & inject          0141          7.82       $406.71       $150.48        $81.34
43244.....................  T                          Upper GI endoscopy/ligation          0141          7.82       $406.71       $150.48        $81.34
43245.....................  T                          Operative upper GI                   0141          7.82       $406.71       $150.48        $81.34
                                                        endoscopy.
43246.....................  T                          Place gastrostomy tube.....          0141          7.82       $406.71       $150.48        $81.34
43247.....................  T                          Operative upper GI                   0141          7.82       $406.71       $150.48        $81.34
                                                        endoscopy.
43248.....................  T                          Uppr gi endoscopy/guide              0141          7.82       $406.71       $150.48        $81.34
                                                        wire.
43249.....................  T                          Esoph endoscopy, dilation..          0141          7.82       $406.71       $150.48        $81.34
43250.....................  T                          Upper GI endoscopy/tumor...          0141          7.82       $406.71       $150.48        $81.34
43251.....................  T                          Operative upper GI                   0141          7.82       $406.71       $150.48        $81.34
                                                        endoscopy.
43255.....................  T                          Operative upper GI                   0141          7.82       $406.71       $150.48        $81.34
                                                        endoscopy.
43256.....................  T                          Uppr gi endoscopy w stent..          0141          7.82       $406.71       $150.48        $81.34
43258.....................  T                          Operative upper GI                   0141          7.82       $406.71       $150.48        $81.34
                                                        endoscopy.
43259.....................  T                          Endoscopic ultrasound exam.          0141          7.82       $406.71       $150.48        $81.34
43260.....................  T                          Endo                                 0151         18.23       $948.12       $245.46       $189.62
                                                        cholangiopancreatograph.
43261.....................  T                          Endo                                 0151         18.23       $948.12       $245.46       $189.62
                                                        cholangiopancreatograph.
43262.....................  T                          Endo                                 0151         18.23       $948.12       $245.46       $189.62
                                                        cholangiopancreatograph.
43263.....................  T                          Endo                                 0151         18.23       $948.12       $245.46       $189.62
                                                        cholangiopancreatograph.
43264.....................  T                          Endo                                 0151         18.23       $948.12       $245.46       $189.62
                                                        cholangiopancreatograph.
43265.....................  T                          Endo                                 0151         18.23       $948.12       $245.46       $189.62
                                                        cholangiopancreatograph.
43267.....................  T                          Endo                                 0151         18.23       $948.12       $245.46       $189.62
                                                        cholangiopancreatograph.
43268.....................  T                          Endo                                 0151         18.23       $948.12       $245.46       $189.62
                                                        cholangiopancreatograph.
43269.....................  T                          Endo                                 0151         18.23       $948.12       $245.46       $189.62
                                                        cholangiopancreatograph.
43271.....................  T                          Endo                                 0151         18.23       $948.12       $245.46       $189.62
                                                        cholangiopancreatograph.

[[Page 52210]]

 
43272.....................  T                          Endo                                 0151         18.23       $948.12       $245.46       $189.62
                                                        cholangiopancreatograph.
43280.....................  T                          Laparoscopy, fundoplasty...          0132         57.95     $3,013.92     $1,239.22       $602.78
43289.....................  T                          Laparoscope proc, esoph....          0130         31.99     $1,663.77       $659.53       $332.75
43300.....................  C                          Repair of esophagus........  ............  ............  ............  ............  ............
43305.....................  C                          Repair esophagus and         ............  ............  ............  ............  ............
                                                        fistula.
43310.....................  C                          Repair of esophagus........  ............  ............  ............  ............  ............
43312.....................  C                          Repair esophagus and         ............  ............  ............  ............  ............
                                                        fistula.
43313.....................  C                          Esophagoplasty congential..  ............  ............  ............  ............  ............
43314.....................  C                          Tracheo-esophagoplasty cong  ............  ............  ............  ............  ............
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          5.84       $303.73       $107.24        $60.75
43453.....................  T                          Dilate esophagus...........          0140          5.84       $303.73       $107.24        $60.75
43456.....................  T                          Dilate esophagus...........          0140          5.84       $303.73       $107.24        $60.75
43458.....................  T                          Dilate esophagus...........          0140          5.84       $303.73       $107.24        $60.75
43460.....................  C                          Pressure treatment           ............  ............  ............  ............  ............
                                                        esophagus.
43496.....................  C                          Free jejunum flap,           ............  ............  ............  ............  ............
                                                        microvasc.
43499.....................  T                          Esophagus surgery procedure          0141          7.82       $406.71       $150.48        $81.34
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          7.82       $406.71       $150.48        $81.34
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         57.95     $3,013.92     $1,239.22       $602.78
43652.....................  T                          Laparoscopy, vagus nerve...          0132         57.95     $3,013.92     $1,239.22       $602.78
43653.....................  T                          Laparoscopy, gastrostomy...          0131         42.44     $2,207.26     $1,001.89       $441.45
43659.....................  T                          Laparoscope proc, stom.....          0130         31.99     $1,663.77       $659.53       $332.75
43750.....................  T                          Place gastrostomy tube.....          0141          7.82       $406.71       $150.48        $81.34
43752.....................  E                          Nasal/orogastric w/stent...  ............  ............  ............  ............  ............
43760.....................  T                          Change gastrostomy tube....          0121          2.17       $112.86        $45.14        $22.57
43761.....................  T                          Reposition gastrostomy tube          0121          2.17       $112.86        $45.14        $22.57
43800.....................  C                          Reconstruction of pylorus..  ............  ............  ............  ............  ............

[[Page 52211]]

 
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          7.82       $406.71       $150.48        $81.34
43831.....................  T                          Place gastrostomy tube.....          0141          7.82       $406.71       $150.48        $81.34
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.....          0141          7.82       $406.71       $150.48        $81.34
43880.....................  C                          Repair stomach-bowel         ............  ............  ............  ............  ............
                                                        fistula.
43999.....................  T                          Stomach surgery procedure..          0141          7.82       $406.71       $150.48        $81.34
44005.....................  C                          Freeing of bowel adhesion..  ............  ............  ............  ............  ............
44010.....................  C                          Incision of small bowel....  ............  ............  ............  ............  ............
44015.....................  C                          Insert needle cath bowel...  ............  ............  ............  ............  ............
44020.....................  C                          Explore small intestine....  ............  ............  ............  ............  ............
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          7.82       $406.71       $150.48        $81.34
44110.....................  C                          Excise intestine 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.  ............  ............  ............  ............  ............
44126.....................  C                          Enterectomy w/taper, cong..  ............  ............  ............  ............  ............
44127.....................  C                          Enterectomy w/o taper, cong  ............  ............  ............  ............  ............
44128.....................  C                          Enterectomy cong, add-on...  ............  ............  ............  ............  ............
44130.....................  C                          Bowel to bowel fusion......  ............  ............  ............  ............  ............
44132.....................  C                          Enterectomy, cadaver donor.  ............  ............  ............  ............  ............
44133.....................  C                          Enterectomy, live donor....  ............  ............  ............  ............  ............
44135.....................  C                          Intestine transplnt,         ............  ............  ............  ............  ............
                                                        cadaver.
44136.....................  C                          Intestine transplant, live.  ............  ............  ............  ............  ............
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         42.44     $2,207.26     $1,001.89       $441.45
44201.....................  T                          Laparoscopy, jejunostomy...          0131         42.44     $2,207.26     $1,001.89       $441.45
44202.....................  C                          Lap resect s/intestine       ............  ............  ............  ............  ............
                                                        singl.
44203.....................  C                          Lap resect s/intestine,      ............  ............  ............  ............  ............
                                                        addl.
44204.....................  C                          Laparo partial colectomy...  ............  ............  ............  ............  ............
44205.....................  C                          Lap colectomy part w/ileum.  ............  ............  ............  ............  ............
44209.....................  T                          Laparoscope proc, intestine          0130         31.99     $1,663.77       $659.53       $332.75
44300.....................  C                          Open bowel to skin.........  ............  ............  ............  ............  ............
44310.....................  C                          Ileostomy/jejunostomy......  ............  ............  ............  ............  ............
44312.....................  T                          Revision of ileostomy......          0027         15.73       $818.10       $343.60       $163.62

[[Page 52212]]

 
44314.....................  C                          Revision of ileostomy......  ............  ............  ............  ............  ............
44316.....................  C                          Devise bowel pouch.........  ............  ............  ............  ............  ............
44320.....................  C                          Colostomy..................  ............  ............  ............  ............  ............
44322.....................  C                          Colostomy with biopsies....  ............  ............  ............  ............  ............
44340.....................  T                          Revision of colostomy......          0027         15.73       $818.10       $343.60       $163.62
44345.....................  C                          Revision of colostomy......  ............  ............  ............  ............  ............
44346.....................  C                          Revision of colostomy......  ............  ............  ............  ............  ............
44360.....................  T                          Small bowel endoscopy......          0142          8.21       $426.99       $152.78        $85.40
44361.....................  T                          Small bowel endoscopy/               0142          8.21       $426.99       $152.78        $85.40
                                                        biopsy.
44363.....................  T                          Small bowel endoscopy......          0142          8.21       $426.99       $152.78        $85.40
44364.....................  T                          Small bowel endoscopy......          0142          8.21       $426.99       $152.78        $85.40
44365.....................  T                          Small bowel endoscopy......          0142          8.21       $426.99       $152.78        $85.40
44366.....................  T                          Small bowel endoscopy......          0142          8.21       $426.99       $152.78        $85.40
44369.....................  T                          Small bowel endoscopy......          0142          8.21       $426.99       $152.78        $85.40
44370.....................  T                          Small bowel endoscopy/stent          0142          8.21       $426.99       $152.78        $85.40
44372.....................  T                          Small bowel endoscopy......          0142          8.21       $426.99       $152.78        $85.40
44373.....................  T                          Small bowel endoscopy......          0142          8.21       $426.99       $152.78        $85.40
44376.....................  T                          Small bowel endoscopy......          0142          8.21       $426.99       $152.78        $85.40
44377.....................  T                          Small bowel endoscopy/               0142          8.21       $426.99       $152.78        $85.40
                                                        biopsy.
44378.....................  T                          Small bowel endoscopy......          0142          8.21       $426.99       $152.78        $85.40
44379.....................  T                          S bowel endoscope w/stent..          0142          8.21       $426.99       $152.78        $85.40
44380.....................  T                          Small bowel endoscopy......          0142          8.21       $426.99       $152.78        $85.40
44382.....................  T                          Small bowel endoscopy......          0142          8.21       $426.99       $152.78        $85.40
44383.....................  T                          Ileoscopy w/stent..........          0142          8.21       $426.99       $152.78        $85.40
44385.....................  T                          Endoscopy of bowel pouch...          0143          8.37       $435.32       $186.06        $87.06
44386.....................  T                          Endoscopy, bowel pouch/biop          0143          8.37       $435.32       $186.06        $87.06
44388.....................  T                          Colon endoscopy............          0143          8.37       $435.32       $186.06        $87.06
44389.....................  T                          Colonoscopy with biopsy....          0143          8.37       $435.32       $186.06        $87.06
44390.....................  T                          Colonoscopy for foreign              0143          8.37       $435.32       $186.06        $87.06
                                                        body.
44391.....................  T                          Colonoscopy for bleeding...          0143          8.37       $435.32       $186.06        $87.06
44392.....................  T                          Colonoscopy & polypectomy..          0143          8.37       $435.32       $186.06        $87.06
44393.....................  T                          Colonoscopy, lesion removal          0143          8.37       $435.32       $186.06        $87.06
44394.....................  T                          Colonoscopy w/snare........          0143          8.37       $435.32       $186.06        $87.06
44397.....................  T                          Colonoscopy w stent........          0143          8.37       $435.32       $186.06        $87.06
44500.....................  T                          Intro, gastrointestinal              0121          2.17       $112.86        $45.14        $22.57
                                                        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          8.21       $426.99       $152.78        $85.40
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         31.99     $1,663.77       $659.53       $332.75
44979.....................  T                          Laparoscope proc, app......          0130         31.99     $1,663.77       $659.53       $332.75
45000.....................  T                          Drainage of pelvic abscess.          0149         16.91       $879.47       $293.06       $175.89
45005.....................  T                          Drainage of rectal abscess.          0148          3.61       $187.75        $67.59        $37.55
45020.....................  T                          Drainage of rectal abscess.          0149         16.91       $879.47       $293.06       $175.89
45100.....................  T                          Biopsy of rectum...........          0149         16.91       $879.47       $293.06       $175.89
45108.....................  T                          Removal of anorectal lesion          0150         22.02     $1,145.24       $437.12       $229.05

[[Page 52213]]

 
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  ............  ............  ............  ............  ............
45136.....................  C                          Excise ileoanal reservoir..  ............  ............  ............  ............  ............
45150.....................  T                          Excision of rectal                   0150         22.02     $1,145.24       $437.12       $229.05
                                                        stricture.
45160.....................  T                          Excision of rectal lesion..          0150         22.02     $1,145.24       $437.12       $229.05
45170.....................  T                          Excision of rectal lesion..          0150         22.02     $1,145.24       $437.12       $229.05
45190.....................  T                          Destruction, rectal tumor..          0150         22.02     $1,145.24       $437.12       $229.05
45300.....................  T                          Proctosigmoidoscopy dx.....          0146          3.47       $180.47        $64.40        $36.09
45303.....................  T                          Proctosigmoidoscopy dilate.          0146          3.47       $180.47        $64.40        $36.09
45305.....................  T                          Protosigmoidoscopy w/bx....          0146          3.47       $180.47        $64.40        $36.09
45307.....................  T                          Protosigmoidoscopy fb......          0146          3.47       $180.47        $64.40        $36.09
45308.....................  T                          Protosigmoidoscopy removal.          0147          7.30       $379.67        $83.53        $75.93
45309.....................  T                          Protosigmoidoscopy removal.          0147          7.30       $379.67        $83.53        $75.93
45315.....................  T                          Protosigmoidoscopy removal.          0147          7.30       $379.67        $83.53        $75.93
45317.....................  T                          Protosigmoidoscopy bleed...          0146          3.47       $180.47        $64.40        $36.09
45320.....................  T                          Protosigmoidoscopy ablate..          0147          7.30       $379.67        $83.53        $75.93
45321.....................  T                          Protosigmoidoscopy volvul..          0147          7.30       $379.67        $83.53        $75.93
45327.....................  T                          Proctosigmoidoscopy w/stent          0147          7.30       $379.67        $83.53        $75.93
45330.....................  T                          Diagnostic sigmoidoscopy...          0146          3.47       $180.47        $64.40        $36.09
45331.....................  T                          Sigmoidoscopy and biopsy...          0146          3.47       $180.47        $64.40        $36.09
45332.....................  T                          Sigmoidoscopy w/fb removal.          0146          3.47       $180.47        $64.40        $36.09
45333.....................  T                          Sigmoidoscopy & polypectomy          0147          7.30       $379.67        $83.53        $75.93
45334.....................  T                          Sigmoidoscopy for bleeding.          0147          7.30       $379.67        $83.53        $75.93
45337.....................  T                          Sigmoidoscopy & decompress.          0147          7.30       $379.67        $83.53        $75.93
45338.....................  T                          Sigmoidoscpy w/tumr remove.          0147          7.30       $379.67        $83.53        $75.93
45339.....................  T                          Sigmoidoscopy w/ablate tumr          0147          7.30       $379.67        $83.53        $75.93
45341.....................  T                          Sigmoidoscopy w/ultrasound.          0147          7.30       $379.67        $83.53        $75.93
45342.....................  T                          Sigmoidoscopy w/us guide bx          0147          7.30       $379.67        $83.53        $75.93
45345.....................  T                          Sigmodoscopy w/stent.......          0147          7.30       $379.67        $83.53        $75.93
45355.....................  T                          Surgical colonoscopy.......          0143          8.37       $435.32       $186.06        $87.06
45378.....................  T                          Diagnostic colonoscopy.....          0143          8.37       $435.32       $186.06        $87.06
45379.....................  T                          Colonoscopy w/fb removal...          0143          8.37       $435.32       $186.06        $87.06
45380.....................  T                          Colonoscopy and biopsy.....          0143          8.37       $435.32       $186.06        $87.06
45382.....................  T                          Colonoscopy/control                  0143          8.37       $435.32       $186.06        $87.06
                                                        bleeding.
45383.....................  T                          Lesion removal colonoscopy.          0143          8.37       $435.32       $186.06        $87.06
45384.....................  T                          Lesion remove colonoscopy..          0143          8.37       $435.32       $186.06        $87.06
45385.....................  T                          Lesion removal colonoscopy.          0143          8.37       $435.32       $186.06        $87.06
45387.....................  T                          Colonoscopy w/stent........          0143          8.37       $435.32       $186.06        $87.06
45500.....................  T                          Repair of rectum...........          0150         22.02     $1,145.24       $437.12       $229.05
45505.....................  T                          Repair of rectum...........          0150         22.02     $1,145.24       $437.12       $229.05
45520.....................  T                          Treatment of rectal                  0098          1.90        $98.82        $20.88        $19.76
                                                        prolapse.
45540.....................  C                          Correct rectal prolapse....  ............  ............  ............  ............  ............
45541.....................  C                          Correct rectal prolapse....  ............  ............  ............  ............  ............
45550.....................  C                          Repair rectum/remove         ............  ............  ............  ............  ............
                                                        sigmoid.
45560.....................  T                          Repair of rectocele........          0150         22.02     $1,145.24       $437.12       $229.05
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                  0148          3.61       $187.75        $67.59        $37.55
                                                        prolapse.
45905.....................  T                          Dilation of anal sphincter.          0149         16.91       $879.47       $293.06       $175.89
45910.....................  T                          Dilation of rectal                   0149         16.91       $879.47       $293.06       $175.89
                                                        narrowing.
45915.....................  T                          Remove rectal obstruction..          0148          3.61       $187.75        $67.59        $37.55

[[Page 52214]]

 
45999.....................  T                          Rectum surgery procedure...          0148          3.61       $187.75        $67.59        $37.55
46020.....................  T                          Placement of seton.........          0148          3.61       $187.75        $67.59        $37.55
46030.....................  T                          Removal of rectal marker...          0148          3.61       $187.75        $67.59        $37.55
46040.....................  T                          Incision of rectal abscess.          0155         10.05       $522.69       $188.17       $104.54
46045.....................  T                          Incision of rectal abscess.          0150         22.02     $1,145.24       $437.12       $229.05
46050.....................  T                          Incision of anal abscess...          0155         10.05       $522.69       $188.17       $104.54
46060.....................  T                          Incision of rectal abscess.          0150         22.02     $1,145.24       $437.12       $229.05
46070.....................  T                          Incision of anal septum....          0155         10.05       $522.69       $188.17       $104.54
46080.....................  T                          Incision of anal sphincter.          0149         16.91       $879.47       $293.06       $175.89
46083.....................  T                          Incise external hemorrhoid.          0148          3.61       $187.75        $67.59        $37.55
46200.....................  T                          Removal of anal fissure....          0150         22.02     $1,145.24       $437.12       $229.05
46210.....................  T                          Removal of anal crypt......          0149         16.91       $879.47       $293.06       $175.89
46211.....................  T                          Removal of anal crypts.....          0150         22.02     $1,145.24       $437.12       $229.05
46220.....................  T                          Removal of anal tab........          0149         16.91       $879.47       $293.06       $175.89
46221.....................  T                          Ligation of hemorrhoid(s)..          0148          3.61       $187.75        $67.59        $37.55
46230.....................  T                          Removal of anal tabs.......          0149         16.91       $879.47       $293.06       $175.89
46250.....................  T                          Hemorrhoidectomy...........          0150         22.02     $1,145.24       $437.12       $229.05
46255.....................  T                          Hemorrhoidectomy...........          0150         22.02     $1,145.24       $437.12       $229.05
46257.....................  T                          Remove hemorrhoids &                 0150         22.02     $1,145.24       $437.12       $229.05
                                                        fissure.
46258.....................  T                          Remove hemorrhoids &                 0150         22.02     $1,145.24       $437.12       $229.05
                                                        fistula.
46260.....................  T                          Hemorrhoidectomy...........          0150         22.02     $1,145.24       $437.12       $229.05
46261.....................  T                          Remove hemorrhoids &                 0150         22.02     $1,145.24       $437.12       $229.05
                                                        fissure.
46262.....................  T                          Remove hemorrhoids &                 0150         22.02     $1,145.24       $437.12       $229.05
                                                        fistula.
46270.....................  T                          Removal of anal fistula....          0150         22.02     $1,145.24       $437.12       $229.05
46275.....................  T                          Removal of anal fistula....          0150         22.02     $1,145.24       $437.12       $229.05
46280.....................  T                          Removal of anal fistula....          0150         22.02     $1,145.24       $437.12       $229.05
46285.....................  T                          Removal of anal fistula....          0150         22.02     $1,145.24       $437.12       $229.05
46288.....................  T                          Repair anal fistula........          0150         22.02     $1,145.24       $437.12       $229.05
46320.....................  T                          Removal of hemorrhoid clot.          0148          3.61       $187.75        $67.59        $37.55
46500.....................  T                          Injection into                       0155         10.05       $522.69       $188.17       $104.54
                                                        hemorrhoid(s).
46600.....................  X                          Diagnostic anoscopy........          0340          0.66        $34.33  ............         $6.87
46604.....................  T                          Anoscopy and dilation......          0147          7.30       $379.67        $83.53        $75.93
46606.....................  T                          Anoscopy and biopsy........          0147          7.30       $379.67        $83.53        $75.93
46608.....................  T                          Anoscopy/ remove for body..          0147          7.30       $379.67        $83.53        $75.93
46610.....................  T                          Anoscopy/remove lesion.....          0147          7.30       $379.67        $83.53        $75.93
46611.....................  T                          Anoscopy...................          0147          7.30       $379.67        $83.53        $75.93
46612.....................  T                          Anoscopy/ remove lesions...          0147          7.30       $379.67        $83.53        $75.93
46614.....................  T                          Anoscopy/control bleeding..          0147          7.30       $379.67        $83.53        $75.93
46615.....................  T                          Anoscopy...................          0147          7.30       $379.67        $83.53        $75.93
46700.....................  T                          Repair of anal stricture...          0150         22.02     $1,145.24       $437.12       $229.05
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         22.02     $1,145.24       $437.12       $229.05
46751.....................  C                          Repair of anal sphincter...  ............  ............  ............  ............  ............
46753.....................  T                          Reconstruction of anus.....          0150         22.02     $1,145.24       $437.12       $229.05
46754.....................  T                          Removal of suture from anus          0149         16.91       $879.47       $293.06       $175.89
46760.....................  T                          Repair of anal sphincter...          0150         22.02     $1,145.24       $437.12       $229.05
46761.....................  T                          Repair of anal sphincter...          0150         22.02     $1,145.24       $437.12       $229.05
46762.....................  T                          Implant artificial                   0150         22.02     $1,145.24       $437.12       $229.05
                                                        sphincter.
46900.....................  T                          Destruction, anal lesion(s)          0016          2.57       $133.66        $56.14        $26.73
46910.....................  T                          Destruction, anal lesion(s)          0017         16.46       $856.07       $227.84       $171.21
46916.....................  T                          Cryosurgery, anal lesion(s)          0013          1.10        $57.21        $14.30        $11.44
46917.....................  T                          Laser surgery, anal lesions          0695         19.65     $1,021.98       $266.59       $204.40
46922.....................  T                          Excision of anal lesion(s).          0695         19.65     $1,021.98       $266.59       $204.40
46924.....................  T                          Destruction, anal lesion(s)          0695         19.65     $1,021.98       $266.59       $204.40
46934.....................  T                          Destruction of hemorrhoids.          0155         10.05       $522.69       $188.17       $104.54
46935.....................  T                          Destruction of hemorrhoids.          0155         10.05       $522.69       $188.17       $104.54
46936.....................  T                          Destruction of hemorrhoids.          0149         16.91       $879.47       $293.06       $175.89

[[Page 52215]]

 
46937.....................  T                          Cryotherapy of rectal                0149         16.91       $879.47       $293.06       $175.89
                                                        lesion.
46938.....................  T                          Cryotherapy of rectal                0150         22.02     $1,145.24       $437.12       $229.05
                                                        lesion.
46940.....................  T                          Treatment of anal fissure..          0149         16.91       $879.47       $293.06       $175.89
46942.....................  T                          Treatment of anal fissure..          0148          3.61       $187.75        $67.59        $37.55
46945.....................  T                          Ligation of hemorrhoids....          0155         10.05       $522.69       $188.17       $104.54
46946.....................  T                          Ligation of hemorrhoids....          0155         10.05       $522.69       $188.17       $104.54
46999.....................  T                          Anus surgery procedure.....          0148          3.61       $187.75        $67.59        $37.55
47000.....................  T                          Needle biopsy of liver.....          0685          4.47       $232.48       $102.29        $46.50
47001.....................  N                          Needle biopsy, liver add-on  ............  ............  ............  ............  ............
47010.....................  C                          Open drainage, liver lesion  ............  ............  ............  ............  ............
47011.....................  T                          Percut drain, liver lesion.          0005          3.02       $157.07        $69.11        $31.41
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.........  ............  ............  ............  ............  ............
47370.....................  T                          Laparo ablate liver tumor            0130         31.99     $1,663.77       $659.53       $332.75
                                                        rf.
47371.....................  T                          Laparo ablate liver cryosug          0130         31.99     $1,663.77       $659.53       $332.75
47379.....................  T                          Laparoscope procedure,               0130         31.99     $1,663.77       $659.53       $332.75
                                                        liver.
47380.....................  C                          Open ablate liver tumor rf.  ............  ............  ............  ............  ............
47381.....................  C                          Open ablate liver tumor      ............  ............  ............  ............  ............
                                                        cryo.
47382.....................  T                          Percut ablate liver rf.....          0980  ............     $1,875.00  ............       $375.00
47399.....................  T                          Liver surgery procedure....          0005          3.02       $157.07        $69.11        $31.41
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.....................  T                          Incision of gallbladder....          0152          6.18       $321.42        $80.36        $64.28
47500.....................  N                          Injection for liver x-rays.  ............  ............  ............  ............  ............
47505.....................  N                          Injection for liver x-rays.  ............  ............  ............  ............  ............
47510.....................  T                          Insert catheter, bile duct.          0152          6.18       $321.42        $80.36        $64.28
47511.....................  T                          Insert bile duct drain.....          0152          6.18       $321.42        $80.36        $64.28
47525.....................  T                          Change bile duct catheter..          0122          3.89       $202.32        $46.53        $40.46
47530.....................  T                          Revise/reinsert bile tube..          0121          2.17       $112.86        $45.14        $22.57
47550.....................  C                          Bile duct endoscopy add-on.  ............  ............  ............  ............  ............
47552.....................  T                          Biliary endoscopy thru skin          0152          6.18       $321.42        $80.36        $64.28
47553.....................  T                          Biliary endoscopy thru skin          0152          6.18       $321.42        $80.36        $64.28
47554.....................  T                          Biliary endoscopy thru skin          0152          6.18       $321.42        $80.36        $64.28
47555.....................  T                          Biliary endoscopy thru skin          0152          6.18       $321.42        $80.36        $64.28
47556.....................  T                          Biliary endoscopy thru skin          0152          6.18       $321.42        $80.36        $64.28
47560.....................  T                          Laparoscopy w/cholangio....          0130         31.99     $1,663.77       $659.53       $332.75
47561.....................  T                          Laparo w/cholangio/biopsy..          0130         31.99     $1,663.77       $659.53       $332.75
47562.....................  T                          Laparoscopic                         0131         42.44     $2,207.26     $1,001.89       $441.45
                                                        cholecystectomy.
47563.....................  T                          Laparo cholecystectomy/              0131         42.44     $2,207.26     $1,001.89       $441.45
                                                        graph.
47564.....................  T                          Laparo cholecystectomy/              0131         42.44     $2,207.26     $1,001.89       $441.45
                                                        explr.
47570.....................  C                          Laparo                       ............  ............  ............  ............  ............
                                                        cholecystoenterostomy.
47579.....................  T                          Laparoscope proc, biliary..          0130         31.99     $1,663.77       $659.53       $332.75
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          6.18       $321.42        $80.36        $64.28
47700.....................  C                          Exploration of bile ducts..  ............  ............  ............  ............  ............
47701.....................  C                          Bile duct revision.........  ............  ............  ............  ............  ............

[[Page 52216]]

 
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                   0152          6.18       $321.42        $80.36        $64.28
                                                        procedure.
48000.....................  C                          Drainage of abdomen........  ............  ............  ............  ............  ............
48001.....................  C                          Placement of drain,          ............  ............  ............  ............  ............
                                                        pancreas.
48005.....................  C                          Resect/debride pancreas....  ............  ............  ............  ............  ............
48020.....................  C                          Removal of pancreatic stone  ............  ............  ............  ............  ............
48100.....................  C                          Biopsy of pancreas, open...  ............  ............  ............  ............  ............
48102.....................  T                          Needle biopsy, pancreas....          0685          4.47       $232.48       $102.29        $46.50
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 pancreatic cyst.  ............  ............  ............  ............  ............
48510.....................  C                          Drain pancreatic pseudocyst  ............  ............  ............  ............  ............
48511.....................  T                          Drain pancreatic pseudocyst          0005          3.02       $157.07        $69.11        $31.41
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          3.02       $157.07        $69.11        $31.41
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          3.30       $171.63  ............        $34.33
49081.....................  T                          Removal of abdominal fluid.          0070          3.30       $171.63  ............        $34.33
49085.....................  T                          Remove abdomen foreign body          0153         25.99     $1,351.71       $540.68       $270.34
49180.....................  T                          Biopsy, abdominal mass.....          0685          4.47       $232.48       $102.29        $46.50
49200.....................  T                          Removal of abdominal lesion          0130         31.99     $1,663.77       $659.53       $332.75
49201.....................  C                          Removal of abdominal lesion  ............  ............  ............  ............  ............
49215.....................  C                          Excise sacral spine tumor..  ............  ............  ............  ............  ............
49220.....................  C                          Multiple surgery, abdomen..  ............  ............  ............  ............  ............
49250.....................  T                          Excision of umbilicus......          0153         25.99     $1,351.71       $540.68       $270.34

[[Page 52217]]

 
49255.....................  C                          Removal of omentum.........  ............  ............  ............  ............  ............
49320.....................  T                          Diag laparo separate proc..          0130         31.99     $1,663.77       $659.53       $332.75
49321.....................  T                          Laparoscopy, biopsy........          0130         31.99     $1,663.77       $659.53       $332.75
49322.....................  T                          Laparoscopy, aspiration....          0130         31.99     $1,663.77       $659.53       $332.75
49323.....................  T                          Laparo drain lymphocele....          0130         31.99     $1,663.77       $659.53       $332.75
49329.....................  T                          Laparo proc, abdm/per/oment          0130         31.99     $1,663.77       $659.53       $332.75
49400.....................  N                          Air injection into abdomen.  ............  ............  ............  ............  ............
49420.....................  T                          Insert abdominal drain.....          0153         25.99     $1,351.71       $540.68       $270.34
49421.....................  T                          Insert abdominal drain.....          0153         25.99     $1,351.71       $540.68       $270.34
49422.....................  T                          Remove perm cannula/                 0105         19.14       $995.45       $370.40       $199.09
                                                        catheter.
49423.....................  T                          Exchange drainage catheter.          0152          6.18       $321.42        $80.36        $64.28
49424.....................  N                          Assess cyst, contrast        ............  ............  ............  ............  ............
                                                        inject.
49425.....................  C                          Insert abdomen-venous drain  ............  ............  ............  ............  ............
49426.....................  T                          Revise abdomen-venous shunt          0153         25.99     $1,351.71       $540.68       $270.34
49427.....................  N                          Injection, abdominal shunt.  ............  ............  ............  ............  ............
49428.....................  C                          Ligation of shunt..........  ............  ............  ............  ............  ............
49429.....................  T                          Removal of shunt...........          0105         19.14       $995.45       $370.40       $199.09
49491.....................  T                          Repairing hern premie reduc          0154         26.98     $1,403.20       $491.12       $280.64
49492.....................  T                          Rpr ing hern premie,                 0154         26.98     $1,403.20       $491.12       $280.64
                                                        blocked.
49495.....................  T                          Rpr ing hernia baby, reduc.          0154         26.98     $1,403.20       $491.12       $280.64
49496.....................  T                          Rpr ing hernia baby,                 0154         26.98     $1,403.20       $491.12       $280.64
                                                        blocked.
49500.....................  T                          Rpr ing hernia, init,                0154         26.98     $1,403.20       $491.12       $280.64
                                                        reduce.
49501.....................  T                          Rpr ing hernia, init                 0154         26.98     $1,403.20       $491.12       $280.64
                                                        blocked.
49505.....................  T                          Rpr i/hern init reduc>5 yr.          0154         26.98     $1,403.20       $491.12       $280.64
49507.....................  T                          Rpr i/hern init block>5 yr.          0154         26.98     $1,403.20       $491.12       $280.64
49520.....................  T                          Rerepair ing hernia, reduce          0154         26.98     $1,403.20       $491.12       $280.64
49521.....................  T                          Rerepair ing hernia,                 0154         26.98     $1,403.20       $491.12       $280.64
                                                        blocked.
49525.....................  T                          Repair ing hernia, sliding.          0154         26.98     $1,403.20       $491.12       $280.64
49540.....................  T                          Repair lumbar hernia.......          0154         26.98     $1,403.20       $491.12       $280.64
49550.....................  T                          Rpr fem hernia, init,                0154         26.98     $1,403.20       $491.12       $280.64
                                                        reduce.
49553.....................  T                          Rpr fem hernia, init                 0154         26.98     $1,403.20       $491.12       $280.64
                                                        blocked.
49555.....................  T                          Rerepair fem hernia, reduce          0154         26.98     $1,403.20       $491.12       $280.64
49557.....................  T                          Rerepair fem hernia,                 0154         26.98     $1,403.20       $491.12       $280.64
                                                        blocked.
49560.....................  T                          Rpr ventral hern init,               0154         26.98     $1,403.20       $491.12       $280.64
                                                        reduc.
49561.....................  T                          Rpr ventral hern init,               0154         26.98     $1,403.20       $491.12       $280.64
                                                        block.
49565.....................  T                          Rerepair ventrl hern,                0154         26.98     $1,403.20       $491.12       $280.64
                                                        reduce.
49566.....................  T                          Rerepair ventrl hern, block          0154         26.98     $1,403.20       $491.12       $280.64
49568.....................  T                          Hernia repair w/mesh.......          0154         26.98     $1,403.20       $491.12       $280.64
49570.....................  T                          Rpr epigastric hern, reduce          0154         26.98     $1,403.20       $491.12       $280.64
49572.....................  T                          Rpr epigastric hern,                 0154         26.98     $1,403.20       $491.12       $280.64
                                                        blocked.
49580.....................  T                          Rpr umbil hern, reduc 5 yr.          0154         26.98     $1,403.20       $491.12       $280.64
49582.....................  T                          Rpr umbil hern, block  5 yr          0154         26.98     $1,403.20       $491.12       $280.64
49585.....................  T                          Rpr umbil hern, reduc > 5            0154         26.98     $1,403.20       $491.12       $280.64
                                                        yr.
49587.....................  T                          Rpr umbil hern, block > 5            0154         26.98     $1,403.20       $491.12       $280.64
                                                        yr.
49590.....................  T                          Repair spigelian hernia....          0154         26.98     $1,403.20       $491.12       $280.64
49600.....................  T                          Repair umbilical lesion....          0154         26.98     $1,403.20       $491.12       $280.64
49605.....................  C                          Repair umbilical lesion....  ............  ............  ............  ............  ............
49606.....................  C                          Repair umbilical lesion....  ............  ............  ............  ............  ............
49610.....................  C                          Repair umbilical lesion....  ............  ............  ............  ............  ............
49611.....................  C                          Repair umbilical lesion....  ............  ............  ............  ............  ............
49650.....................  T                          Laparo hernia repair                 0131         42.44     $2,207.26     $1,001.89       $441.45
                                                        initial.
49651.....................  T                          Laparo hernia repair recur.          0131         42.44     $2,207.26     $1,001.89       $441.45
49659.....................  T                          Laparo proc, hernia repair.          0131         42.44     $2,207.26     $1,001.89       $441.45
49900.....................  C                          Repair of abdominal wall...  ............  ............  ............  ............  ............
49905.....................  C                          Omental flap...............  ............  ............  ............  ............  ............
49906.....................  C                          Free omental flap,           ............  ............  ............  ............  ............
                                                        microvasc.
49999.....................  T                          Abdomen surgery procedure..          0153         25.99     $1,351.71       $540.68       $270.34
50010.....................  C                          Exploration of kidney......  ............  ............  ............  ............  ............
50020.....................  C                          Renal abscess, open drain..  ............  ............  ............  ............  ............
50021.....................  T                          Renal abscess, percut drain          0005          3.02       $157.07        $69.11        $31.41
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....  ............  ............  ............  ............  ............

[[Page 52218]]

 
50080.....................  T                          Removal of kidney stone....          0163         24.77     $1,288.26  ............       $257.65
50081.....................  T                          Removal of kidney stone....          0163         24.77     $1,288.26  ............       $257.65
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...........          0685          4.47       $232.48       $102.29        $46.50
50205.....................  C                          Biopsy of kidney...........  ............  ............  ............  ............  ............
50220.....................  C                          Remove kidney, open........  ............  ............  ............  ............  ............
50225.....................  C                          Removal kidney open,         ............  ............  ............  ............  ............
                                                        complex.
50230.....................  C                          Removal kidney open,         ............  ............  ............  ............  ............
                                                        radical.
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..          0685          4.47       $232.48       $102.29        $46.50
50392.....................  T                          Insert kidney drain........          0161         16.03       $833.70       $249.36       $166.74
50393.....................  T                          Insert ureteral tube.......          0161         16.03       $833.70       $249.36       $166.74
50394.....................  N                          Injection for kidney x-ray.  ............  ............  ............  ............  ............
50395.....................  T                          Create passage to kidney...          0161         16.03       $833.70       $249.36       $166.74
50396.....................  T                          Measure kidney pressure....          0164          1.18        $61.37        $18.41        $12.27
50398.....................  T                          Change kidney tube.........          0122          3.89       $202.32        $46.53        $40.46
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...          0130         31.99     $1,663.77       $659.53       $332.75
50544.....................  T                          Laparoscopy, pyeloplasty...          0130         31.99     $1,663.77       $659.53       $332.75
50545.....................  C                          Laparo radical nephrectomy.  ............  ............  ............  ............  ............
50546.....................  C                          Laparoscopic nephrectomy...  ............  ............  ............  ............  ............
50547.....................  C                          Laparo removal donor kidney  ............  ............  ............  ............  ............
50548.....................  C                          Laparo remove k/ureter.....  ............  ............  ............  ............  ............
50549.....................  T                          Laparoscope proc, renal....          0130         31.99     $1,663.77       $659.53       $332.75
50551.....................  T                          Kidney endoscopy...........          0160          6.44       $334.94       $105.06        $66.99
50553.....................  T                          Kidney endoscopy...........          0161         16.03       $833.70       $249.36       $166.74
50555.....................  T                          Kidney endoscopy & biopsy..          0160          6.44       $334.94       $105.06        $66.99
50557.....................  T                          Kidney endoscopy &                   0162         21.50     $1,118.19  ............       $223.64
                                                        treatment.
50559.....................  T                          Renal endoscopy/radiotracer          0160          6.44       $334.94       $105.06        $66.99
50561.....................  T                          Kidney endoscopy &                   0161         16.03       $833.70       $249.36       $166.74
                                                        treatment.
50570.....................  C                          Kidney endoscopy...........  ............  ............  ............  ............  ............
50572.....................  C                          Kidney endoscopy...........  ............  ............  ............  ............  ............
50574.....................  C                          Kidney endoscopy & biopsy..  ............  ............  ............  ............  ............
50575.....................  C                          Kidney endoscopy...........  ............  ............  ............  ............  ............
50576.....................  C                          Kidney endoscopy &           ............  ............  ............  ............  ............
                                                        treatment.
50578.....................  C                          Renal endoscopy/radiotracer  ............  ............  ............  ............  ............
50580.....................  C                          Kidney endoscopy &           ............  ............  ............  ............  ............
                                                        treatment.
50590.....................  T                          Fragmenting of kidney stone          0169         46.44     $2,415.30     $1,115.69       $483.06
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..........  ............  ............  ............  ............  ............

[[Page 52219]]

 
50684.....................  N                          Injection for ureter x-ray.  ............  ............  ............  ............  ............
50686.....................  T                          Measure ureter pressure....          0164          1.18        $61.37        $18.41        $12.27
50688.....................  T                          Change of ureter tube......          0121          2.17       $112.86        $45.14        $22.57
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 intestine...  ............  ............  ............  ............  ............
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                          0131         42.44     $2,207.26     $1,001.89       $441.45
                                                        ureterolithotomy.
50947.....................  T                          Laparo new ureter/bladder..          0131         42.44     $2,207.26     $1,001.89       $441.45
50948.....................  T                          Laparo new ureter/bladder..          0131         42.44     $2,207.26     $1,001.89       $441.45
50949.....................  T                          Laparoscope proc, ureter...          0130         31.99     $1,663.77       $659.53       $332.75
50951.....................  T                          Endoscopy of ureter........          0160          6.44       $334.94       $105.06        $66.99
50953.....................  T                          Endoscopy of ureter........          0160          6.44       $334.94       $105.06        $66.99
50955.....................  T                          Ureter endoscopy & biopsy..          0161         16.03       $833.70       $249.36       $166.74
50957.....................  T                          Ureter endoscopy &                   0161         16.03       $833.70       $249.36       $166.74
                                                        treatment.
50959.....................  T                          Ureter endoscopy & tracer..          0161         16.03       $833.70       $249.36       $166.74
50961.....................  T                          Ureter endoscopy &                   0161         16.03       $833.70       $249.36       $166.74
                                                        treatment.
50970.....................  T                          Ureter endoscopy...........          0160          6.44       $334.94       $105.06        $66.99
50972.....................  T                          Ureter endoscopy & catheter          0160          6.44       $334.94       $105.06        $66.99
50974.....................  T                          Ureter endoscopy & biopsy..          0161         16.03       $833.70       $249.36       $166.74
50976.....................  T                          Ureter endoscopy &                   0161         16.03       $833.70       $249.36       $166.74
                                                        treatment.
50978.....................  T                          Ureter endoscopy & tracer..          0161         16.03       $833.70       $249.36       $166.74
50980.....................  T                          Ureter endoscopy &                   0161         16.03       $833.70       $249.36       $166.74
                                                        treatment.
51000.....................  T                          Drainage of bladder........          0165         12.62       $656.35  ............       $131.27
51005.....................  T                          Drainage of bladder........          0164          1.18        $61.37        $18.41        $12.27
51010.....................  T                          Drainage of bladder........          0165         12.62       $656.35  ............       $131.27
51020.....................  T                          Incise & treat bladder.....          0162         21.50     $1,118.19  ............       $223.64
51030.....................  T                          Incise & treat bladder.....          0162         21.50     $1,118.19  ............       $223.64
51040.....................  T                          Incise & drain bladder.....          0162         21.50     $1,118.19  ............       $223.64
51045.....................  T                          Incise bladder/drain ureter          0160          6.44       $334.94       $105.06        $66.99
51050.....................  T                          Removal of bladder stone...          0162         21.50     $1,118.19  ............       $223.64
51060.....................  C                          Removal of ureter stone....  ............  ............  ............  ............  ............
51065.....................  T                          Remove ureter calculus.....          0162         21.50     $1,118.19  ............       $223.64
51080.....................  T                          Drainage of bladder abscess          0007          9.44       $490.96       $103.10        $98.19
51500.....................  T                          Removal of bladder cyst....          0154         26.98     $1,403.20       $491.12       $280.64
51520.....................  T                          Removal of bladder lesion..          0162         21.50     $1,118.19  ............       $223.64
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 52220]]

 
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      ............  ............  ............  ............  ............
                                                        xray.
51610.....................  N                          Injection for bladder x-ray  ............  ............  ............  ............  ............
51700.....................  T                          Irrigation of bladder......          0164          1.18        $61.37        $18.41        $12.27
51705.....................  T                          Change of bladder tube.....          0121          2.17       $112.86        $45.14        $22.57
51710.....................  T                          Change of bladder tube.....          0121          2.17       $112.86        $45.14        $22.57
51715.....................  T                          Endoscopic injection/                0167         27.15     $1,412.04       $555.84       $282.41
                                                        implant.
51720.....................  T                          Treatment of bladder lesion          0156          3.10       $161.23        $48.37        $32.25
51725.....................  T                          Simple cystometrogram......          0156          3.10       $161.23        $48.37        $32.25
51726.....................  T                          Complex cystometrogram.....          0156          3.10       $161.23        $48.37        $32.25
51736.....................  T                          Urine flow measurement.....          0164          1.18        $61.37        $18.41        $12.27
51741.....................  T                          Electro-uroflowmetry, first          0164          1.18        $61.37        $18.41        $12.27
51772.....................  T                          Urethra pressure profile...          0164          1.18        $61.37        $18.41        $12.27
51784.....................  T                          Anal/urinary muscle study..          0164          1.18        $61.37        $18.41        $12.27
51785.....................  T                          Anal/urinary muscle study..          0164          1.18        $61.37        $18.41        $12.27
51792.....................  T                          Urinary reflex study.......          0164          1.18        $61.37        $18.41        $12.27
51795.....................  T                          Urine voiding pressure               0164          1.18        $61.37        $18.41        $12.27
                                                        study.
51797.....................  T                          Intraabdominal pressure              0164          1.18        $61.37        $18.41        $12.27
                                                        test.
51800.....................  C                          Revision of bladder/urethra  ............  ............  ............  ............  ............
51820.....................  C                          Revision of urinary tract..  ............  ............  ............  ............  ............
51840.....................  C                          Attach bladder/urethra.....  ............  ............  ............  ............  ............
51841.....................  C                          Attach bladder/urethra.....  ............  ............  ............  ............  ............
51845.....................  C                          Repair bladder neck........  ............  ............  ............  ............  ............
51860.....................  C                          Repair of bladder wound....  ............  ............  ............  ............  ............
51865.....................  C                          Repair of bladder wound....  ............  ............  ............  ............  ............
51880.....................  T                          Repair of bladder opening..          0162         21.50     $1,118.19  ............       $223.64
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         42.44     $2,207.26     $1,001.89       $441.45
51992.....................  T                          Laparo sling operation.....          0132         57.95     $3,013.92     $1,239.22       $602.78
52000.....................  T                          Cystoscopy.................          0160          6.44       $334.94       $105.06        $66.99
52001.....................  T                          Cystoscopy, removal of               0160          6.44       $334.94       $105.06        $66.99
                                                        clots.
52005.....................  T                          Cystoscopy & ureter                  0161         16.03       $833.70       $249.36       $166.74
                                                        catheter.
52007.....................  T                          Cystoscopy and biopsy......          0161         16.03       $833.70       $249.36       $166.74
52010.....................  T                          Cystoscopy & duct catheter.          0160          6.44       $334.94       $105.06        $66.99
52204.....................  T                          Cystoscopy.................          0161         16.03       $833.70       $249.36       $166.74
52214.....................  T                          Cystoscopy and treatment...          0162         21.50     $1,118.19  ............       $223.64
52224.....................  T                          Cystoscopy and treatment...          0162         21.50     $1,118.19  ............       $223.64
52234.....................  T                          Cystoscopy and treatment...          0163         24.77     $1,288.26  ............       $257.65
52235.....................  T                          Cystoscopy and treatment...          0163         24.77     $1,288.26  ............       $257.65
52240.....................  T                          Cystoscopy and treatment...          0162         21.50     $1,118.19  ............       $223.64
52250.....................  T                          Cystoscopy and radiotracer.          0162         21.50     $1,118.19  ............       $223.64
52260.....................  T                          Cystoscopy and treatment...          0161         16.03       $833.70       $249.36       $166.74
52265.....................  T                          Cystoscopy and treatment...          0160          6.44       $334.94       $105.06        $66.99
52270.....................  T                          Cystoscopy & revise urethra          0161         16.03       $833.70       $249.36       $166.74
52275.....................  T                          Cystoscopy & revise urethra          0161         16.03       $833.70       $249.36       $166.74
52276.....................  T                          Cystoscopy and treatment...          0161         16.03       $833.70       $249.36       $166.74
52277.....................  T                          Cystoscopy and treatment...          0162         21.50     $1,118.19  ............       $223.64
52281.....................  T                          Cystoscopy and treatment...          0161         16.03       $833.70       $249.36       $166.74
52282.....................  T                          Cystoscopy, implant stent..          0163         24.77     $1,288.26  ............       $257.65
52283.....................  T                          Cystoscopy and treatment...          0161         16.03       $833.70       $249.36       $166.74
52285.....................  T                          Cystoscopy and treatment...          0161         16.03       $833.70       $249.36       $166.74
52290.....................  T                          Cystoscopy and treatment...          0161         16.03       $833.70       $249.36       $166.74
52300.....................  T                          Cystoscopy and treatment...          0161         16.03       $833.70       $249.36       $166.74

[[Page 52221]]

 
52301.....................  T                          Cystoscopy and treatment...          0161         16.03       $833.70       $249.36       $166.74
52305.....................  T                          Cystoscopy and treatment...          0161         16.03       $833.70       $249.36       $166.74
52310.....................  T                          Cystoscopy and treatment...          0160          6.44       $334.94       $105.06        $66.99
52315.....................  T                          Cystoscopy and treatment...          0161         16.03       $833.70       $249.36       $166.74
52317.....................  T                          Remove bladder stone.......          0162         21.50     $1,118.19  ............       $223.64
52318.....................  T                          Remove bladder stone.......          0162         21.50     $1,118.19  ............       $223.64
52320.....................  T                          Cystoscopy and treatment...          0162         21.50     $1,118.19  ............       $223.64
52325.....................  T                          Cystoscopy, stone removal..          0162         21.50     $1,118.19  ............       $223.64
52327.....................  T                          Cystoscopy, inject material          0162         21.50     $1,118.19  ............       $223.64
52330.....................  T                          Cystoscopy and treatment...          0162         21.50     $1,118.19  ............       $223.64
52332.....................  T                          Cystoscopy and treatment...          0162         21.50     $1,118.19  ............       $223.64
52334.....................  T                          Create passage to kidney...          0162         21.50     $1,118.19  ............       $223.64
52341.....................  T                          Cysto w/ureter stricture tx          0162         21.50     $1,118.19  ............       $223.64
52342.....................  T                          Cysto w/up stricture tx....          0162         21.50     $1,118.19  ............       $223.64
52343.....................  T                          Cysto w/renal stricture tx.          0162         21.50     $1,118.19  ............       $223.64
52344.....................  T                          Cysto/uretero, stone remove          0162         21.50     $1,118.19  ............       $223.64
52345.....................  T                          Cysto/uretero w/up                   0162         21.50     $1,118.19  ............       $223.64
                                                        stricture.
52346.....................  T                          Cystouretero w/renal strict          0162         21.50     $1,118.19  ............       $223.64
52347.....................  T                          Cystoscopy, resect ducts...          0160          6.44       $334.94       $105.06        $66.99
52351.....................  T                          Cystouretro & or pyeloscope          0160          6.44       $334.94       $105.06        $66.99
52352.....................  T                          Cystouretro w/stone remove.          0162         21.50     $1,118.19  ............       $223.64
52353.....................  T                          Cystouretero w/lithotripsy.          0163         24.77     $1,288.26  ............       $257.65
52354.....................  T                          Cystouretero w/biopsy......          0162         21.50     $1,118.19  ............       $223.64
52355.....................  T                          Cystouretero w/excise tumor          0162         21.50     $1,118.19  ............       $223.64
52400.....................  T                          Cystouretero w/congen repr.          0162         21.50     $1,118.19  ............       $223.64
52450.....................  T                          Incision of prostate.......          0162         21.50     $1,118.19  ............       $223.64
52500.....................  T                          Revision of bladder neck...          0162         21.50     $1,118.19  ............       $223.64
52510.....................  T                          Dilation prostatic urethra.          0161         16.03       $833.70       $249.36       $166.74
52601.....................  T                          Prostatectomy (TURP).......          0163         24.77     $1,288.26  ............       $257.65
52606.....................  T                          Control postop bleeding....          0162         21.50     $1,118.19  ............       $223.64
52612.....................  T                          Prostatectomy, first stage.          0163         24.77     $1,288.26  ............       $257.65
52614.....................  T                          Prostatectomy, second stage          0163         24.77     $1,288.26  ............       $257.65
52620.....................  T                          Remove residual prostate...          0163         24.77     $1,288.26  ............       $257.65
52630.....................  T                          Remove prostate regrowth...          0163         24.77     $1,288.26  ............       $257.65
52640.....................  T                          Relieve bladder contracture          0162         21.50     $1,118.19  ............       $223.64
52647.....................  T                          Laser surgery of prostate..          0163         24.77     $1,288.26  ............       $257.65
52648.....................  T                          Laser surgery of prostate..          0163         24.77     $1,288.26  ............       $257.65
52700.....................  T                          Drainage of prostate                 0162         21.50     $1,118.19  ............       $223.64
                                                        abscess.
53000.....................  T                          Incision of urethra........          0166         15.63       $812.90       $218.73       $162.58
53010.....................  T                          Incision of urethra........          0166         15.63       $812.90       $218.73       $162.58
53020.....................  T                          Incision of urethra........          0166         15.63       $812.90       $218.73       $162.58
53025.....................  T                          Incision of urethra........          0166         15.63       $812.90       $218.73       $162.58
53040.....................  T                          Drainage of urethra abscess          0166         15.63       $812.90       $218.73       $162.58
53060.....................  T                          Drainage of urethra abscess          0166         15.63       $812.90       $218.73       $162.58
53080.....................  T                          Drainage of urinary leakage          0166         15.63       $812.90       $218.73       $162.58
53085.....................  C                          Drainage of urinary leakage  ............  ............  ............  ............  ............
53200.....................  T                          Biopsy of urethra..........          0166         15.63       $812.90       $218.73       $162.58
53210.....................  T                          Removal of urethra.........          0168         24.10     $1,253.42       $405.60       $250.68
53215.....................  T                          Removal of urethra.........          0168         24.10     $1,253.42       $405.60       $250.68
53220.....................  T                          Treatment of urethra lesion          0168         24.10     $1,253.42       $405.60       $250.68
53230.....................  T                          Removal of urethra lesion..          0168         24.10     $1,253.42       $405.60       $250.68
53235.....................  T                          Removal of urethra lesion..          0168         24.10     $1,253.42       $405.60       $250.68
53240.....................  T                          Surgery for urethra pouch..          0168         24.10     $1,253.42       $405.60       $250.68
53250.....................  T                          Removal of urethra gland...          0166         15.63       $812.90       $218.73       $162.58
53260.....................  T                          Treatment of urethra lesion          0166         15.63       $812.90       $218.73       $162.58
53265.....................  T                          Treatment of urethra lesion          0166         15.63       $812.90       $218.73       $162.58
53270.....................  T                          Removal of urethra gland...          0167         27.15     $1,412.04       $555.84       $282.41
53275.....................  T                          Repair of urethra defect...          0166         15.63       $812.90       $218.73       $162.58
53400.....................  T                          Revise urethra, stage 1....          0168         24.10     $1,253.42       $405.60       $250.68
53405.....................  T                          Revise urethra, stage 2....          0168         24.10     $1,253.42       $405.60       $250.68
53410.....................  T                          Reconstruction of urethra..          0168         24.10     $1,253.42       $405.60       $250.68
53415.....................  C                          Reconstruction of urethra..  ............  ............  ............  ............  ............
53420.....................  T                          Reconstruct urethra, stage           0168         24.10     $1,253.42       $405.60       $250.68
                                                        1.
53425.....................  T                          Reconstruct urethra, stage           0168         24.10     $1,253.42       $405.60       $250.68
                                                        2.
53430.....................  T                          Reconstruction of urethra..          0168         24.10     $1,253.42       $405.60       $250.68
53431.....................  T                          Reconstruct urethra/bladder          0168         24.10     $1,253.42       $405.60       $250.68

[[Page 52222]]

 
53440.....................  T                          Correct bladder function...          0179         81.28     $4,227.29     $1,817.73       $845.46
53442.....................  T                          Remove perineal prosthesis.          0166         15.63       $812.90       $218.73       $162.58
53444.....................  T                          Insert tandem cuff.........          0179         81.28     $4,227.29     $1,817.73       $845.46
53445.....................  T                          Insert uro/ves nck                   0179         81.28     $4,227.29     $1,817.73       $845.46
                                                        sphincter.
53446.....................  T                          Remove uro sphincter.......          0168         24.10     $1,253.42       $405.60       $250.68
53447.....................  T                          Remove/replace ur sphincter          0179         81.28     $4,227.29     $1,817.73       $845.46
53448.....................  C                          Remov/replc ur sphinctr      ............  ............  ............  ............  ............
                                                        comp.
53449.....................  T                          Repair uro sphincter.......          0168         24.10     $1,253.42       $405.60       $250.68
53450.....................  T                          Revision of urethra........          0168         24.10     $1,253.42       $405.60       $250.68
53460.....................  T                          Revision of urethra........          0168         24.10     $1,253.42       $405.60       $250.68
53502.....................  T                          Repair of urethra injury...          0166         15.63       $812.90       $218.73       $162.58
53505.....................  T                          Repair of urethra injury...          0167         27.15     $1,412.04       $555.84       $282.41
53510.....................  T                          Repair of urethra injury...          0166         15.63       $812.90       $218.73       $162.58
53515.....................  T                          Repair of urethra injury...          0168         24.10     $1,253.42       $405.60       $250.68
53520.....................  T                          Repair of urethra defect...          0168         24.10     $1,253.42       $405.60       $250.68
53600.....................  T                          Dilate urethra stricture...          0156          3.10       $161.23        $48.37        $32.25
53601.....................  T                          Dilate urethra stricture...          0164          1.18        $61.37        $18.41        $12.27
53605.....................  T                          Dilate urethra stricture...          0161         16.03       $833.70       $249.36       $166.74
53620.....................  T                          Dilate urethra stricture...          0165         12.62       $656.35  ............       $131.27
53621.....................  T                          Dilate urethra stricture...          0164          1.18        $61.37        $18.41        $12.27
53660.....................  T                          Dilation of urethra........          0164          1.18        $61.37        $18.41        $12.27
53661.....................  T                          Dilation of urethra........          0164          1.18        $61.37        $18.41        $12.27
53665.....................  T                          Dilation of urethra........          0166         15.63       $812.90       $218.73       $162.58
53670.....................  N                          Insert urinary catheter....  ............  ............  ............  ............  ............
53675.....................  T                          Insert urinary catheter....          0164          1.18        $61.37        $18.41        $12.27
53850.....................  T                          Prostatic microwave                  0675         51.57     $2,682.10  ............       $536.42
                                                        thermotx.
53852.....................  T                          Prostatic rf thermotx......          0675         51.57     $2,682.10  ............       $536.42
53853.....................  T                          Prostatic water thermother.          0977  ............     $1,125.00  ............       $225.00
53899.....................  T                          Urology surgery procedure..          0164          1.18        $61.37        $18.41        $12.27
54000.....................  T                          Slitting of prepuce........          0166         15.63       $812.90       $218.73       $162.58
54001.....................  T                          Slitting of prepuce........          0166         15.63       $812.90       $218.73       $162.58
54015.....................  T                          Drain penis lesion.........          0007          9.44       $490.96       $103.10        $98.19
54050.....................  T                          Destruction, penis                   0013          1.10        $57.21        $14.30        $11.44
                                                        lesion(s).
54055.....................  T                          Destruction, penis                   0017         16.46       $856.07       $227.84       $171.21
                                                        lesion(s).
54056.....................  T                          Cryosurgery, penis                   0012          0.76        $39.53        $10.67         $7.91
                                                        lesion(s).
54057.....................  T                          Laser surg, penis lesion(s)          0017         16.46       $856.07       $227.84       $171.21
54060.....................  T                          Excision of penis lesion(s)          0017         16.46       $856.07       $227.84       $171.21
54065.....................  T                          Destruction, penis                   0695         19.65     $1,021.98       $266.59       $204.40
                                                        lesion(s).
54100.....................  T                          Biopsy of penis............          0021         14.58       $758.29       $227.49       $151.66
54105.....................  T                          Biopsy of penis............          0022         18.10       $941.36       $367.13       $188.27
54110.....................  T                          Treatment of penis lesion..          0181         29.88     $1,554.03       $621.82       $310.81
54111.....................  T                          Treat penis lesion, graft..          0181         29.88     $1,554.03       $621.82       $310.81
54112.....................  T                          Treat penis lesion, graft..          0181         29.88     $1,554.03       $621.82       $310.81
54115.....................  T                          Treatment of penis lesion..          0008         16.32       $848.79  ............       $169.76
54120.....................  T                          Partial removal of penis...          0181         29.88     $1,554.03       $621.82       $310.81
54125.....................  C                          Removal of penis...........  ............  ............  ............  ............  ............
54130.....................  C                          Remove penis & nodes.......  ............  ............  ............  ............  ............
54135.....................  C                          Remove penis & nodes.......  ............  ............  ............  ............  ............
54150.....................  T                          Circumcision...............          0180         18.95       $985.57       $304.87       $197.11
54152.....................  T                          Circumcision...............          0180         18.95       $985.57       $304.87       $197.11
54160.....................  T                          Circumcision...............          0180         18.95       $985.57       $304.87       $197.11
54161.....................  T                          Circumcision...............          0180         18.95       $985.57       $304.87       $197.11
54162.....................  T                          Lysis penil circumcis                0180         18.95       $985.57       $304.87       $197.11
                                                        lesion.
54163.....................  T                          Repair of circumcision.....          0180         18.95       $985.57       $304.87       $197.11
54164.....................  T                          Frenulotomy of penis.......          0180         18.95       $985.57       $304.87       $197.11
54200.....................  T                          Treatment of penis lesion..          0156          3.10       $161.23        $48.37        $32.25
54205.....................  T                          Treatment of penis lesion..          0181         29.88     $1,554.03       $621.82       $310.81
54220.....................  T                          Treatment of penis lesion..          0156          3.10       $161.23        $48.37        $32.25
54230.....................  N                          Prepare penis study........  ............  ............  ............  ............  ............
54231.....................  T                          Dynamic cavernosometry.....          0165         12.62       $656.35  ............       $131.27
54235.....................  T                          Penile injection...........          0164          1.18        $61.37        $18.41        $12.27
54240.....................  T                          Penis study................          0164          1.18        $61.37        $18.41        $12.27
54250.....................  T                          Penis study................          0165         12.62       $656.35  ............       $131.27
54300.....................  T                          Revision of penis..........          0181         29.88     $1,554.03       $621.82       $310.81
54304.....................  T                          Revision of penis..........          0181         29.88     $1,554.03       $621.82       $310.81
54308.....................  T                          Reconstruction of urethra..          0181         29.88     $1,554.03       $621.82       $310.81

[[Page 52223]]

 
54312.....................  T                          Reconstruction of urethra..          0181         29.88     $1,554.03       $621.82       $310.81
54316.....................  T                          Reconstruction of urethra..          0181         29.88     $1,554.03       $621.82       $310.81
54318.....................  T                          Reconstruction of urethra..          0181         29.88     $1,554.03       $621.82       $310.81
54322.....................  T                          Reconstruction of urethra..          0181         29.88     $1,554.03       $621.82       $310.81
54324.....................  T                          Reconstruction of urethra..          0181         29.88     $1,554.03       $621.82       $310.81
54326.....................  T                          Reconstruction of urethra..          0181         29.88     $1,554.03       $621.82       $310.81
54328.....................  T                          Revise penis/urethra.......          0181         29.88     $1,554.03       $621.82       $310.81
54332.....................  C                          Revise penis/urethra.......  ............  ............  ............  ............  ............
54336.....................  C                          Revise penis/urethra.......  ............  ............  ............  ............  ............
54340.....................  T                          Secondary urethral surgery.          0181         29.88     $1,554.03       $621.82       $310.81
54344.....................  T                          Secondary urethral surgery.          0181         29.88     $1,554.03       $621.82       $310.81
54348.....................  T                          Secondary urethral surgery.          0181         29.88     $1,554.03       $621.82       $310.81
54352.....................  T                          Reconstruct urethra/penis..          0181         29.88     $1,554.03       $621.82       $310.81
54360.....................  T                          Penis plastic surgery......          0181         29.88     $1,554.03       $621.82       $310.81
54380.....................  T                          Repair penis...............          0181         29.88     $1,554.03       $621.82       $310.81
54385.....................  T                          Repair penis...............          0181         29.88     $1,554.03       $621.82       $310.81
54390.....................  C                          Repair penis and bladder...  ............  ............  ............  ............  ............
54400.....................  T                          Insert semi-rigid                    0182         83.80     $4,358.35     $1,438.26       $871.67
                                                        prosthesis.
54401.....................  T                          Insert self-contd                    0182         83.80     $4,358.35     $1,438.26       $871.67
                                                        prosthesis.
54405.....................  T                          Insert multi-comp penis              0182         83.80     $4,358.35     $1,438.26       $871.67
                                                        pros.
54406.....................  T                          Remove multi-comp penis              0181         29.88     $1,554.03       $621.82       $310.81
                                                        pros.
54408.....................  T                          Repair multi-comp penis              0181         29.88     $1,554.03       $621.82       $310.81
                                                        pros.
54410.....................  T                          Remove/replace penis prosth          0182         83.80     $4,358.35     $1,438.26       $871.67
54411.....................  C                          Remv/replc penis pros, comp  ............  ............  ............  ............  ............
54415.....................  T                          Remove self-contd penis              0181         29.88     $1,554.03       $621.82       $310.81
                                                        pros.
54416.....................  T                          Remv/repl penis contain              0182         83.80     $4,358.35     $1,438.26       $871.67
                                                        pros.
54417.....................  C                          Remv/replc penis pros,       ............  ............  ............  ............  ............
                                                        compl.
54420.....................  T                          Revision of penis..........          0181         29.88     $1,554.03       $621.82       $310.81
54430.....................  C                          Revision of penis..........  ............  ............  ............  ............  ............
54435.....................  T                          Revision of penis..........          0181         29.88     $1,554.03       $621.82       $310.81
54440.....................  T                          Repair of penis............          0181         29.88     $1,554.03       $621.82       $310.81
54450.....................  T                          Preputial stretching.......          0156          3.10       $161.23        $48.37        $32.25
54500.....................  T                          Biopsy of testis...........          0005          3.02       $157.07        $69.11        $31.41
54505.....................  T                          Biopsy of testis...........          0183         22.19     $1,154.08       $448.94       $230.82
54512.....................  T                          Excise lesion testis.......          0183         22.19     $1,154.08       $448.94       $230.82
54520.....................  T                          Removal of testis..........          0183         22.19     $1,154.08       $448.94       $230.82
54522.....................  T                          Orchiectomy, partial.......          0183         22.19     $1,154.08       $448.94       $230.82
54530.....................  T                          Removal of testis..........          0154         26.98     $1,403.20       $491.12       $280.64
54535.....................  C                          Extensive testis surgery...  ............  ............  ............  ............  ............
54550.....................  T                          Exploration for testis.....          0154         26.98     $1,403.20       $491.12       $280.64
54560.....................  C                          Exploration for testis.....  ............  ............  ............  ............  ............
54600.....................  T                          Reduce testis torsion......          0183         22.19     $1,154.08       $448.94       $230.82
54620.....................  T                          Suspension of testis.......          0183         22.19     $1,154.08       $448.94       $230.82
54640.....................  T                          Suspension of testis.......          0154         26.98     $1,403.20       $491.12       $280.64
54650.....................  C                          Orchiopexy (Fowler-          ............  ............  ............  ............  ............
                                                        Stephens).
54660.....................  T                          Revision of testis.........          0183         22.19     $1,154.08       $448.94       $230.82
54670.....................  T                          Repair testis injury.......          0183         22.19     $1,154.08       $448.94       $230.82
54680.....................  T                          Relocation of testis(es)...          0183         22.19     $1,154.08       $448.94       $230.82
54690.....................  T                          Laparoscopy, orchiectomy...          0131         42.44     $2,207.26     $1,001.89       $441.45
54692.....................  T                          Laparoscopy, orchiopexy....          0132         57.95     $3,013.92     $1,239.22       $602.78
54699.....................  T                          Laparoscope proc, testis...          0130         31.99     $1,663.77       $659.53       $332.75
54700.....................  T                          Drainage of scrotum........          0183         22.19     $1,154.08       $448.94       $230.82
54800.....................  T                          Biopsy of epididymis.......          0004          1.63        $84.77        $22.04        $16.95
54820.....................  T                          Exploration of epididymis..          0183         22.19     $1,154.08       $448.94       $230.82
54830.....................  T                          Remove epididymis lesion...          0183         22.19     $1,154.08       $448.94       $230.82
54840.....................  T                          Remove epididymis lesion...          0183         22.19     $1,154.08       $448.94       $230.82
54860.....................  T                          Removal of epididymis......          0183         22.19     $1,154.08       $448.94       $230.82
54861.....................  T                          Removal of epididymis......          0183         22.19     $1,154.08       $448.94       $230.82
54900.....................  T                          Fusion of spermatic ducts..          0183         22.19     $1,154.08       $448.94       $230.82
54901.....................  T                          Fusion of spermatic ducts..          0183         22.19     $1,154.08       $448.94       $230.82
55000.....................  T                          Drainage of hydrocele......          0004          1.63        $84.77        $22.04        $16.95
55040.....................  T                          Removal of hydrocele.......          0154         26.98     $1,403.20       $491.12       $280.64
55041.....................  T                          Removal of hydroceles......          0154         26.98     $1,403.20       $491.12       $280.64
55060.....................  T                          Repair of hydrocele........          0183         22.19     $1,154.08       $448.94       $230.82
55100.....................  T                          Drainage of scrotum abscess          0007          9.44       $490.96       $103.10        $98.19
55110.....................  T                          Explore scrotum............          0183         22.19     $1,154.08       $448.94       $230.82

[[Page 52224]]

 
55120.....................  T                          Removal of scrotum lesion..          0183         22.19     $1,154.08       $448.94       $230.82
55150.....................  T                          Removal of scrotum.........          0183         22.19     $1,154.08       $448.94       $230.82
55175.....................  T                          Revision of scrotum........          0183         22.19     $1,154.08       $448.94       $230.82
55180.....................  T                          Revision of scrotum........          0183         22.19     $1,154.08       $448.94       $230.82
55200.....................  T                          Incision of sperm duct.....          0183         22.19     $1,154.08       $448.94       $230.82
55250.....................  T                          Removal of sperm duct(s)...          0183         22.19     $1,154.08       $448.94       $230.82
55300.....................  N                          Prepare, sperm duct x-ray..  ............  ............  ............  ............  ............
55400.....................  T                          Repair of sperm duct.......          0183         22.19     $1,154.08       $448.94       $230.82
55450.....................  T                          Ligation of sperm duct.....          0183         22.19     $1,154.08       $448.94       $230.82
55500.....................  T                          Removal of hydrocele.......          0183         22.19     $1,154.08       $448.94       $230.82
55520.....................  T                          Removal of sperm cord                0183         22.19     $1,154.08       $448.94       $230.82
                                                        lesion.
55530.....................  T                          Revise spermatic cord veins          0183         22.19     $1,154.08       $448.94       $230.82
55535.....................  T                          Revise spermatic cord veins          0154         26.98     $1,403.20       $491.12       $280.64
55540.....................  T                          Revise hernia & sperm veins          0154         26.98     $1,403.20       $491.12       $280.64
55550.....................  T                          Laparo ligate spermatic              0131         42.44     $2,207.26     $1,001.89       $441.45
                                                        vein.
55559.....................  T                          Laparo proc, spermatic cord          0130         31.99     $1,663.77       $659.53       $332.75
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         22.19     $1,154.08       $448.94       $230.82
55700.....................  T                          Biopsy of prostate.........          0184          3.66       $190.35        $95.18        $38.07
55705.....................  T                          Biopsy of prostate.........          0184          3.66       $190.35        $95.18        $38.07
55720.....................  T                          Drainage of prostate                 0162         21.50     $1,118.19  ............       $223.64
                                                        abscess.
55725.....................  T                          Drainage of prostate                 0162         21.50     $1,118.19  ............       $223.64
                                                        abscess.
55801.....................  C                          Removal of prostate........  ............  ............  ............  ............  ............
55810.....................  C                          Extensive prostate surgery.  ............  ............  ............  ............  ............
55812.....................  C                          Extensive prostate surgery.  ............  ............  ............  ............  ............
55815.....................  C                          Extensive prostate surgery.  ............  ............  ............  ............  ............
55821.....................  C                          Removal of prostate........  ............  ............  ............  ............  ............
55831.....................  C                          Removal of prostate........  ............  ............  ............  ............  ............
55840.....................  C                          Extensive prostate surgery.  ............  ............  ............  ............  ............
55842.....................  C                          Extensive prostate surgery.  ............  ............  ............  ............  ............
55845.....................  C                          Extensive prostate surgery.  ............  ............  ............  ............  ............
55859.....................  T                          Percut/needle insert, pros.          0163         24.77     $1,288.26  ............       $257.65
55860.....................  T                          Surgical exposure, prostate          0165         12.62       $656.35  ............       $131.27
55862.....................  C                          Extensive prostate surgery.  ............  ............  ............  ............  ............
55865.....................  C                          Extensive prostate surgery.  ............  ............  ............  ............  ............
55870.....................  T                          Electroejaculation.........          0197          1.19        $61.89        $24.76        $12.38
55873.....................  T                          Cryoablate prostate........          0674         69.25     $3,601.62  ............       $720.32
55899.....................  T                          Genital surgery procedure..          0164          1.18        $61.37        $18.41        $12.27
55970.....................  E                          Sex transformation, M to F.  ............  ............  ............  ............  ............
55980.....................  E                          Sex transformation, F to M.  ............  ............  ............  ............  ............
56405.....................  T                          I & D of vulva/perineum....          0192          2.94       $152.91        $42.81        $30.58
56420.....................  T                          Drainage of gland abscess..          0192          2.94       $152.91        $42.81        $30.58
56440.....................  T                          Surgery for vulva lesion...          0194         18.88       $981.93       $397.84       $196.39
56441.....................  T                          Lysis of labial lesion(s)..          0193         14.57       $757.77       $171.13       $151.55
56501.....................  T                          Destroy, vulva lesions,              0017         16.46       $856.07       $227.84       $171.21
                                                        simp.
56515.....................  T                          Destroy vulva lesion/s               0695         19.65     $1,021.98       $266.59       $204.40
                                                        compl.
56605.....................  T                          Biopsy of vulva/perineum...          0019          3.94       $204.92        $75.82        $40.98
56606.....................  T                          Biopsy of vulva/perineum...          0019          3.94       $204.92        $75.82        $40.98
56620.....................  T                          Partial removal of vulva...          0195         24.37     $1,267.46       $483.80       $253.49
56625.....................  T                          Complete removal of vulva..          0195         24.37     $1,267.46       $483.80       $253.49
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         18.88       $981.93       $397.84       $196.39
56720.....................  T                          Incision of hymen..........          0193         14.57       $757.77       $171.13       $151.55
56740.....................  T                          Remove vagina gland lesion.          0194         18.88       $981.93       $397.84       $196.39
56800.....................  T                          Repair of vagina...........          0194         18.88       $981.93       $397.84       $196.39
56805.....................  T                          Repair clitoris............          0194         18.88       $981.93       $397.84       $196.39
56810.....................  T                          Repair of perineum.........          0194         18.88       $981.93       $397.84       $196.39
57000.....................  T                          Exploration of vagina......          0194         18.88       $981.93       $397.84       $196.39

[[Page 52225]]

 
57010.....................  T                          Drainage of pelvic abscess.          0194         18.88       $981.93       $397.84       $196.39
57020.....................  T                          Drainage of pelvic fluid...          0192          2.94       $152.91        $42.81        $30.58
57022.....................  T                          I & d vaginal hematoma, pp.          0007          9.44       $490.96       $103.10        $98.19
57023.....................  T                          I & d vag hematoma, non-ob.          0007          9.44       $490.96       $103.10        $98.19
57061.....................  T                          Destroy vag lesions, simple          0194         18.88       $981.93       $397.84       $196.39
57065.....................  T                          Destroy vag lesions,                 0194         18.88       $981.93       $397.84       $196.39
                                                        complex.
57100.....................  T                          Biopsy of vagina...........          0192          2.94       $152.91        $42.81        $30.58
57105.....................  T                          Biopsy of vagina...........          0194         18.88       $981.93       $397.84       $196.39
57106.....................  T                          Remove vagina wall, partial          0194         18.88       $981.93       $397.84       $196.39
57107.....................  T                          Remove vagina tissue, part.          0195         24.37     $1,267.46       $483.80       $253.49
57109.....................  T                          Vaginectomy partial w/nodes          0202         39.09     $2,033.03       $996.18       $406.61
57110.....................  C                          Remove vagina wall,          ............  ............  ............  ............  ............
                                                        complete.
57111.....................  C                          Remove vagina tissue, compl  ............  ............  ............  ............  ............
57112.....................  C                          Vaginectomy w/nodes, compl.  ............  ............  ............  ............  ............
57120.....................  T                          Closure of vagina..........          0194         18.88       $981.93       $397.84       $196.39
57130.....................  T                          Remove vagina lesion.......          0194         18.88       $981.93       $397.84       $196.39
57135.....................  T                          Remove vagina lesion.......          0194         18.88       $981.93       $397.84       $196.39
57150.....................  T                          Treat vagina infection.....          0191          0.22        $11.44         $3.32         $2.29
57155.....................  T                          Insert uteri tandems/ovoids          0192          2.94       $152.91        $42.81        $30.58
57160.....................  T                          Insert pessary/other device          0188          1.12        $58.25        $11.95        $11.65
57170.....................  T                          Fitting of diaphragm/cap...          0191          0.22        $11.44         $3.32         $2.29
57180.....................  T                          Treat vaginal bleeding.....          0192          2.94       $152.91        $42.81        $30.58
57200.....................  T                          Repair of vagina...........          0194         18.88       $981.93       $397.84       $196.39
57210.....................  T                          Repair vagina/perineum.....          0194         18.88       $981.93       $397.84       $196.39
57220.....................  T                          Revision of urethra........          0195         24.37     $1,267.46       $483.80       $253.49
57230.....................  T                          Repair of urethral lesion..          0194         18.88       $981.93       $397.84       $196.39
57240.....................  T                          Repair bladder & vagina....          0195         24.37     $1,267.46       $483.80       $253.49
57250.....................  T                          Repair rectum & vagina.....          0195         24.37     $1,267.46       $483.80       $253.49
57260.....................  T                          Repair of vagina...........          0195         24.37     $1,267.46       $483.80       $253.49
57265.....................  T                          Extensive repair of vagina.          0195         24.37     $1,267.46       $483.80       $253.49
57268.....................  T                          Repair of bowel bulge......          0195         24.37     $1,267.46       $483.80       $253.49
57270.....................  C                          Repair of bowel pouch......  ............  ............  ............  ............  ............
57280.....................  C                          Suspension of vagina.......  ............  ............  ............  ............  ............
57282.....................  C                          Repair of vaginal prolapse.  ............  ............  ............  ............  ............
57284.....................  T                          Repair paravaginal defect..          0195         24.37     $1,267.46       $483.80       $253.49
57287.....................  T                          Revise/remove sling repair.          0202         39.09     $2,033.03       $996.18       $406.61
57288.....................  T                          Repair bladder defect......          0202         39.09     $2,033.03       $996.18       $406.61
57289.....................  T                          Repair bladder & vagina....          0195         24.37     $1,267.46       $483.80       $253.49
57291.....................  T                          Construction of vagina.....          0195         24.37     $1,267.46       $483.80       $253.49
57292.....................  C                          Construct vagina with graft  ............  ............  ............  ............  ............
57300.....................  T                          Repair rectum-vagina                 0195         24.37     $1,267.46       $483.80       $253.49
                                                        fistula.
57305.....................  C                          Repair rectum-vagina         ............  ............  ............  ............  ............
                                                        fistula.
57307.....................  C                          Fistula repair & colostomy.  ............  ............  ............  ............  ............
57308.....................  C                          Fistula repair, transperine  ............  ............  ............  ............  ............
57310.....................  T                          Repair urethrovaginal                0195         24.37     $1,267.46       $483.80       $253.49
                                                        lesion.
57311.....................  C                          Repair urethrovaginal        ............  ............  ............  ............  ............
                                                        lesion.
57320.....................  T                          Repair bladder-vagina                0195         24.37     $1,267.46       $483.80       $253.49
                                                        lesion.
57330.....................  T                          Repair bladder-vagina                0195         24.37     $1,267.46       $483.80       $253.49
                                                        lesion.
57335.....................  C                          Repair vagina..............  ............  ............  ............  ............  ............
57400.....................  T                          Dilation of vagina.........          0194         18.88       $981.93       $397.84       $196.39
57410.....................  T                          Pelvic examination.........          0194         18.88       $981.93       $397.84       $196.39
57415.....................  T                          Remove vaginal foreign body          0194         18.88       $981.93       $397.84       $196.39
57452.....................  T                          Examination of vagina......          0189          1.63        $84.77        $18.60        $16.95
57454.....................  T                          Vagina examination & biopsy          0192          2.94       $152.91        $42.81        $30.58
57460.....................  T                          Cervix excision............          0193         14.57       $757.77       $171.13       $151.55
57500.....................  T                          Biopsy of cervix...........          0192          2.94       $152.91        $42.81        $30.58
57505.....................  T                          Endocervical curettage.....          0192          2.94       $152.91        $42.81        $30.58
57510.....................  T                          Cauterization of cervix....          0193         14.57       $757.77       $171.13       $151.55
57511.....................  T                          Cryocautery of cervix......          0189          1.63        $84.77        $18.60        $16.95
57513.....................  T                          Laser surgery of cervix....          0193         14.57       $757.77       $171.13       $151.55
57520.....................  T                          Conization of cervix.......          0194         18.88       $981.93       $397.84       $196.39
57522.....................  T                          Conization of cervix.......          0195         24.37     $1,267.46       $483.80       $253.49
57530.....................  T                          Removal of cervix..........          0195         24.37     $1,267.46       $483.80       $253.49
57531.....................  C                          Removal of cervix, radical.  ............  ............  ............  ............  ............
57540.....................  C                          Removal of residual cervix.  ............  ............  ............  ............  ............
57545.....................  C                          Remove cervix/repair pelvis  ............  ............  ............  ............  ............

[[Page 52226]]

 
57550.....................  T                          Removal of residual cervix.          0195         24.37     $1,267.46       $483.80       $253.49
57555.....................  T                          Remove cervix/repair vagina          0195         24.37     $1,267.46       $483.80       $253.49
57556.....................  T                          Remove cervix, repair bowel          0195         24.37     $1,267.46       $483.80       $253.49
57700.....................  T                          Revision of cervix.........          0194         18.88       $981.93       $397.84       $196.39
57720.....................  T                          Revision of cervix.........          0194         18.88       $981.93       $397.84       $196.39
57800.....................  T                          Dilation of cervical canal.          0192          2.94       $152.91        $42.81        $30.58
57820.....................  T                          D & c of residual cervix...          0196         16.32       $848.79       $338.23       $169.76
58100.....................  T                          Biopsy of uterus lining....          0188          1.12        $58.25        $11.95        $11.65
58120.....................  T                          Dilation and curettage.....          0196         16.32       $848.79       $338.23       $169.76
58140.....................  C                          Removal of uterus lesion...  ............  ............  ............  ............  ............
58145.....................  T                          Removal of uterus lesion...          0195         24.37     $1,267.46       $483.80       $253.49
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.          0189          1.63        $84.77        $18.60        $16.95
58321.....................  T                          Artificial insemination....          0197          1.19        $61.89        $24.76        $12.38
58322.....................  T                          Artificial insemination....          0197          1.19        $61.89        $24.76        $12.38
58323.....................  T                          Sperm washing..............          0197          1.19        $61.89        $24.76        $12.38
58340.....................  N                          Catheter for hysterography.  ............  ............  ............  ............  ............
58345.....................  T                          Reopen fallopian tube......          0194         18.88       $981.93       $397.84       $196.39
58346.....................  T                          Insert heyman uteri capsule          0192          2.94       $152.91        $42.81        $30.58
58350.....................  T                          Reopen fallopian tube......          0194         18.88       $981.93       $397.84       $196.39
58353.....................  T                          Endometr ablate, thermal...          0193         14.57       $757.77       $171.13       $151.55
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                      0132         57.95     $3,013.92     $1,239.22       $602.78
                                                        hysterectomy.
58551.....................  T                          Laparoscopy, remove myoma..          0131         42.44     $2,207.26     $1,001.89       $441.45
58555.....................  T                          Hysteroscopy, dx, sep proc.          0194         18.88       $981.93       $397.84       $196.39
58558.....................  T                          Hysteroscopy, biopsy.......          0190         20.06     $1,043.30       $424.28       $208.66
58559.....................  T                          Hysteroscopy, lysis........          0190         20.06     $1,043.30       $424.28       $208.66
58560.....................  T                          Hysteroscopy, resect septum          0190         20.06     $1,043.30       $424.28       $208.66
58561.....................  T                          Hysteroscopy, remove myoma.          0190         20.06     $1,043.30       $424.28       $208.66
58562.....................  T                          Hysteroscopy, remove fb....          0190         20.06     $1,043.30       $424.28       $208.66
58563.....................  T                          Hysteroscopy, ablation.....          0190         20.06     $1,043.30       $424.28       $208.66
58578.....................  T                          Laparo proc, uterus........          0190         20.06     $1,043.30       $424.28       $208.66
58579.....................  T                          Hysteroscope procedure.....          0190         20.06     $1,043.30       $424.28       $208.66
58600.....................  T                          Division of fallopian tube.          0194         18.88       $981.93       $397.84       $196.39
58605.....................  C                          Division of fallopian tube.  ............  ............  ............  ............  ............
58611.....................  C                          Ligate oviduct(s) add-on...  ............  ............  ............  ............  ............
58615.....................  T                          Occlude fallopian tube(s)..          0194         18.88       $981.93       $397.84       $196.39
58660.....................  T                          Laparoscopy, lysis.........          0131         42.44     $2,207.26     $1,001.89       $441.45
58661.....................  T                          Laparoscopy, remove adnexa.          0131         42.44     $2,207.26     $1,001.89       $441.45
58662.....................  T                          Laparoscopy, excise lesions          0131         42.44     $2,207.26     $1,001.89       $441.45
58670.....................  T                          Laparoscopy, tubal cautery.          0131         42.44     $2,207.26     $1,001.89       $441.45
58671.....................  T                          Laparoscopy, tubal block...          0131         42.44     $2,207.26     $1,001.89       $441.45
58672.....................  T                          Laparoscopy, fimbrioplasty.          0131         42.44     $2,207.26     $1,001.89       $441.45
58673.....................  T                          Laparoscopy, salpingostomy.          0131         42.44     $2,207.26     $1,001.89       $441.45
58679.....................  T                          Laparo proc, oviduct-ovary.          0130         31.99     $1,663.77       $659.53       $332.75
58700.....................  C                          Removal of fallopian tube..  ............  ............  ............  ............  ............
58720.....................  C                          Removal of ovary/tube(s)...  ............  ............  ............  ............  ............
58740.....................  C                          Revise fallopian tube(s)...  ............  ............  ............  ............  ............
58750.....................  C                          Repair oviduct.............  ............  ............  ............  ............  ............

[[Page 52227]]

 
58752.....................  C                          Revise ovarian tube(s).....  ............  ............  ............  ............  ............
58760.....................  C                          Remove tubal obstruction...  ............  ............  ............  ............  ............
58770.....................  C                          Create new tubal opening...  ............  ............  ............  ............  ............
58800.....................  T                          Drainage of ovarian cyst(s)          0195         24.37     $1,267.46       $483.80       $253.49
58805.....................  C                          Drainage of ovarian cyst(s)  ............  ............  ............  ............  ............
58820.....................  T                          Drain ovary abscess, open..          0195         24.37     $1,267.46       $483.80       $253.49
58822.....................  C                          Drain ovary abscess, percut  ............  ............  ............  ............  ............
58823.....................  T                          Drain pelvic abscess,                0193         14.57       $757.77       $171.13       $151.55
                                                        percut.
58825.....................  C                          Transposition, ovary(s)....  ............  ............  ............  ............  ............
58900.....................  T                          Biopsy of ovary(s).........          0195         24.37     $1,267.46       $483.80       $253.49
58920.....................  T                          Partial removal of ovary(s)          0202         39.09     $2,033.03       $996.18       $406.61
58925.....................  T                          Removal of ovarian cyst(s).          0202         39.09     $2,033.03       $996.18       $406.61
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..  ............  ............  ............  ............  ............
58953.....................  C                          Tah, rad dissect for debulk  ............  ............  ............  ............  ............
58954.....................  C                          Tah rad debulk/lymph remove  ............  ............  ............  ............  ............
58960.....................  C                          Exploration of abdomen.....  ............  ............  ............  ............  ............
58970.....................  T                          Retrieval of oocyte........          0194         18.88       $981.93       $397.84       $196.39
58974.....................  T                          Transfer of embryo.........          0197          1.19        $61.89        $24.76        $12.38
58976.....................  T                          Transfer of embryo.........          0197          1.19        $61.89        $24.76        $12.38
58999.....................  T                          Genital surgery procedure..          0191          0.22        $11.44         $3.32         $2.29
59000.....................  T                          Amniocentesis, diagnostic..          0198          1.33        $69.17        $32.92        $13.83
59001.....................  T                          Amniocentesis, therapeutic.          0198          1.33        $69.17        $32.92        $13.83
59012.....................  T                          Fetal cord                           0198          1.33        $69.17        $32.92        $13.83
                                                        puncture,prenatal.
59015.....................  T                          Chorion biopsy.............          0198          1.33        $69.17        $32.92        $13.83
59020.....................  T                          Fetal contract stress test.          0198          1.33        $69.17        $32.92        $13.83
59025.....................  T                          Fetal non-stress test......          0198          1.33        $69.17        $32.92        $13.83
59030.....................  T                          Fetal scalp blood sample...          0198          1.33        $69.17        $32.92        $13.83
59050.....................  E                          Fetal monitor w/report.....  ............  ............  ............  ............  ............
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         42.44     $2,207.26     $1,001.89       $441.45
59151.....................  T                          Treat ectopic pregnancy....          0131         42.44     $2,207.26     $1,001.89       $441.45
59160.....................  T                          D & c after delivery.......          0196         16.32       $848.79       $338.23       $169.76
59200.....................  T                          Insert cervical dilator....          0189          1.63        $84.77        $18.60        $16.95
59300.....................  T                          Episiotomy or vaginal                0193         14.57       $757.77       $171.13       $151.55
                                                        repair.
59320.....................  T                          Revision of cervix.........          0194         18.88       $981.93       $397.84       $196.39
59325.....................  C                          Revision of cervix.........  ............  ............  ............  ............  ............
59350.....................  C                          Repair of uterus...........  ............  ............  ............  ............  ............
59400.....................  E                          Obstetrical care...........  ............  ............  ............  ............  ............
59409.....................  T                          Obstetrical care...........          0199          5.69       $295.93        $72.98        $59.19
59410.....................  E                          Obstetrical care...........  ............  ............  ............  ............  ............
59412.....................  T                          Antepartum manipulation....          0199          5.69       $295.93        $72.98        $59.19
59414.....................  T                          Deliver placenta...........          0199          5.69       $295.93        $72.98        $59.19
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          5.69       $295.93        $72.98        $59.19
59614.....................  E                          Vbac care after delivery...  ............  ............  ............  ............  ............
59618.....................  E                          Attempted vbac delivery....  ............  ............  ............  ............  ............
59620.....................  C                          Attempted vbac delivery      ............  ............  ............  ............  ............
                                                        only.
59622.....................  E                          Attempted vbac after care..  ............  ............  ............  ............  ............

[[Page 52228]]

 
59812.....................  T                          Treatment of miscarriage...          0201         15.84       $823.82       $329.65       $164.76
59820.....................  T                          Care of miscarriage........          0201         15.84       $823.82       $329.65       $164.76
59821.....................  T                          Treatment of miscarriage...          0201         15.84       $823.82       $329.65       $164.76
59830.....................  C                          Treat uterus infection.....  ............  ............  ............  ............  ............
59840.....................  T                          Abortion...................          0200         14.49       $753.61       $307.83       $150.72
59841.....................  T                          Abortion...................          0200         14.49       $753.61       $307.83       $150.72
59850.....................  C                          Abortion...................  ............  ............  ............  ............  ............
59851.....................  C                          Abortion...................  ............  ............  ............  ............  ............
59852.....................  C                          Abortion...................  ............  ............  ............  ............  ............
59855.....................  C                          Abortion...................  ............  ............  ............  ............  ............
59856.....................  C                          Abortion...................  ............  ............  ............  ............  ............
59857.....................  C                          Abortion...................  ............  ............  ............  ............  ............
59866.....................  T                          Abortion (mpr).............          0198          1.33        $69.17        $32.92        $13.83
59870.....................  T                          Evacuate mole of uterus....          0201         15.84       $823.82       $329.65       $164.76
59871.....................  T                          Remove cerclage suture.....          0194         18.88       $981.93       $397.84       $196.39
59898.....................  T                          Laparo proc, ob care/                0130         31.99     $1,663.77       $659.53       $332.75
                                                        deliver.
59899.....................  T                          Maternity care procedure...          0198          1.33        $69.17        $32.92        $13.83
60000.....................  T                          Drain thyroid/tongue cyst..          0252          6.27       $326.10       $114.24        $65.22
60001.....................  T                          Aspirate/inject thyriod              0004          1.63        $84.77        $22.04        $16.95
                                                        cyst.
60100.....................  T                          Biopsy of thyroid..........          0004          1.63        $84.77        $22.04        $16.95
60200.....................  T                          Remove thyroid lesion......          0114         37.55     $1,952.94       $507.76       $390.59
60210.....................  T                          Partial thyroid excision...          0114         37.55     $1,952.94       $507.76       $390.59
60212.....................  T                          Parital thyroid excision...          0114         37.55     $1,952.94       $507.76       $390.59
60220.....................  T                          Partial removal of thyroid.          0114         37.55     $1,952.94       $507.76       $390.59
60225.....................  T                          Partial removal of thyroid.          0114         37.55     $1,952.94       $507.76       $390.59
60240.....................  T                          Removal of thyroid.........          0114         37.55     $1,952.94       $507.76       $390.59
60252.....................  T                          Removal of thyroid.........          0256         35.51     $1,846.84  ............       $369.37
60254.....................  C                          Extensive thyroid surgery..  ............  ............  ............  ............  ............
60260.....................  T                          Repeat thyroid surgery.....          0256         35.51     $1,846.84  ............       $369.37
60270.....................  C                          Removal of thyroid.........  ............  ............  ............  ............  ............
60271.....................  C                          Removal of thyroid.........  ............  ............  ............  ............  ............
60280.....................  T                          Remove thyroid duct lesion.          0114         37.55     $1,952.94       $507.76       $390.59
60281.....................  T                          Remove thyroid duct lesion.          0114         37.55     $1,952.94       $507.76       $390.59
60500.....................  T                          Explore parathyroid glands.          0256         35.51     $1,846.84  ............       $369.37
60502.....................  C                          Re-explore parathyroids....  ............  ............  ............  ............  ............
60505.....................  C                          Explore parathyroid glands.  ............  ............  ............  ............  ............
60512.....................  T                          Autotransplant parathyroid.          0022         18.10       $941.36       $367.13       $188.27
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         31.99     $1,663.77       $659.53       $332.75
60699.....................  T                          Endocrine surgery procedure          0114         37.55     $1,952.94       $507.76       $390.59
61000.....................  T                          Remove cranial cavity fluid          0212          3.53       $183.59        $84.45        $36.72
61001.....................  T                          Remove cranial cavity fluid          0212          3.53       $183.59        $84.45        $36.72
61020.....................  T                          Remove brain cavity fluid..          0212          3.53       $183.59        $84.45        $36.72
61026.....................  T                          Injection into brain canal.          0212          3.53       $183.59        $84.45        $36.72
61050.....................  T                          Remove brain canal fluid...          0212          3.53       $183.59        $84.45        $36.72
61055.....................  T                          Injection into brain canal.          0212          3.53       $183.59        $84.45        $36.72
61070.....................  T                          Brain canal shunt procedure          0212          3.53       $183.59        $84.45        $36.72
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..          0224         39.14     $2,035.63       $453.41       $407.13
61250.....................  C                          Pierce skull & explore.....  ............  ............  ............  ............  ............

[[Page 52229]]

 
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         35.51     $1,846.84  ............       $369.37
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.

[[Page 52230]]

 
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.....................  T                          Occlusion/embolization cath          0081         22.69     $1,180.08  ............       $236.02
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  ............  ............  ............  ............  ............
61697.....................  C                          Brain aneurysm repr, complx  ............  ............  ............  ............  ............
61698.....................  C                          Brain aneurysm repr, complx  ............  ............  ............  ............  ............
61700.....................  C                          Brain aneurysm repr ,        ............  ............  ............  ............  ............
                                                        simple.
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         16.66       $866.47  ............       $173.29
61791.....................  T                          Treat trigeminal tract.....          0204          2.13       $110.78        $42.10        $22.16
61793.....................  E                          Focus radiation beam.......  ............  ............  ............  ............  ............
61795.....................  S                          Brain surgery using                  0302         10.17       $528.93       $200.99       $105.79
                                                        computer.
61850.....................  C                          Implant neuroelectrodes....  ............  ............  ............  ............  ............
61860.....................  C                          Implant neuroelectrodes....  ............  ............  ............  ............  ............
61862.....................  C                          Implant neurostimul,         ............  ............  ............  ............  ............
                                                        subcort.
61870.....................  C                          Implant neuroelectrodes....  ............  ............  ............  ............  ............
61875.....................  C                          Implant neuroelectrodes....  ............  ............  ............  ............  ............
61880.....................  T                          Revise/remove                        0687         19.50     $1,014.18       $466.52       $202.84
                                                        neuroelectrode.
61885.....................  T                          Implant neurostim one array          0222        140.56     $7,310.39  ............     $1,462.08
61886.....................  T                          Implant neurostim arrays...          0222        140.56     $7,310.39  ............     $1,462.08
61888.....................  T                          Revise/remove neuroreceiver          0688         30.58     $1,590.44       $779.32       $318.09
62000.....................  C                          Treat skull fracture.......  ............  ............  ............  ............  ............
62005.....................  C                          Treat skull fracture.......  ............  ............  ............  ............  ............
62010.....................  C                          Treatment of head injury...  ............  ............  ............  ............  ............
62100.....................  C                          Repair brain fluid leakage.  ............  ............  ............  ............  ............

[[Page 52231]]

 
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          2.17       $112.86        $45.14        $22.57
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          2.17       $112.86        $45.14        $22.57
62230.....................  T                          Replace/revise brain shunt.          0224         39.14     $2,035.63       $453.41       $407.13
62252.....................  S                          Csf shunt reprogram........          0691          3.14       $163.31        $89.02        $32.66
62256.....................  C                          Remove brain cavity shunt..  ............  ............  ............  ............  ............
62258.....................  C                          Replace brain cavity shunt.  ............  ............  ............  ............  ............
62263.....................  T                          Lysis epidural adhesions...          0203         10.96       $570.02       $256.51       $114.00
62268.....................  T                          Drain spinal cord cyst.....          0212          3.53       $183.59        $84.45        $36.72
62269.....................  T                          Needle biopsy, spinal cord.          0005          3.02       $157.07        $69.11        $31.41
62270.....................  T                          Spinal fluid tap,                    0206          4.89       $254.32        $75.55        $50.86
                                                        diagnostic.
62272.....................  T                          Drain cerebro spinal fluid.          0206          4.89       $254.32        $75.55        $50.86
62273.....................  T                          Treat epidural spine lesion          0206          4.89       $254.32        $75.55        $50.86
62280.....................  T                          Treat spinal cord lesion...          0207          5.97       $310.49       $123.69        $62.10
62281.....................  T                          Treat spinal cord lesion...          0207          5.97       $310.49       $123.69        $62.10
62282.....................  T                          Treat spinal canal lesion..          0207          5.97       $310.49       $123.69        $62.10
62284.....................  N                          Injection for myelogram....  ............  ............  ............  ............  ............
62287.....................  T                          Percutaneous diskectomy....          0220         16.66       $866.47  ............       $173.29
62290.....................  N                          Inject for spine disk x-ray  ............  ............  ............  ............  ............
62291.....................  N                          Inject for spine disk x-ray  ............  ............  ............  ............  ............
62292.....................  T                          Injection into disk lesion.          0212          3.53       $183.59        $84.45        $36.72
62294.....................  T                          Injection into spinal                0212          3.53       $183.59        $84.45        $36.72
                                                        artery.
62310.....................  T                          Inject spine c/t...........          0206          4.89       $254.32        $75.55        $50.86
62311.....................  T                          Inject spine l/s (cd)......          0206          4.89       $254.32        $75.55        $50.86
62318.....................  T                          Inject spine w/cath, c/t...          0206          4.89       $254.32        $75.55        $50.86
62319.....................  T                          Inject spine w/cath l/s              0206          4.89       $254.32        $75.55        $50.86
                                                        (cd).
62350.....................  T                          Implant spinal canal cath..          0223         20.30     $1,055.78  ............       $211.16
62351.....................  T                          Implant spinal canal cath..          0208         39.95     $2,077.76  ............       $415.55
62355.....................  T                          Remove spinal canal                  0203         10.96       $570.02       $256.51       $114.00
                                                        catheter.
62360.....................  T                          Insert spine infusion                0226         44.20     $2,298.80  ............       $459.76
                                                        device.
62361.....................  T                          Implant spine infusion pump          0227        128.03     $6,658.71  ............     $1,331.74
62362.....................  T                          Implant spine infusion pump          0227        128.03     $6,658.71  ............     $1,331.74
62365.....................  T                          Remove spine infusion                0203         10.96       $570.02       $256.51       $114.00
                                                        device.
62367.....................  S                          Analyze spine infusion pump          0691          3.14       $163.31        $89.02        $32.66
62368.....................  S                          Analyze spine infusion pump          0691          3.14       $163.31        $89.02        $32.66
63001.....................  T                          Removal of spinal lamina...          0208         39.95     $2,077.76  ............       $415.55
63003.....................  T                          Removal of spinal lamina...          0208         39.95     $2,077.76  ............       $415.55
63005.....................  T                          Removal of spinal lamina...          0208         39.95     $2,077.76  ............       $415.55
63011.....................  T                          Removal of spinal lamina...          0208         39.95     $2,077.76  ............       $415.55
63012.....................  T                          Removal of spinal lamina...          0208         39.95     $2,077.76  ............       $415.55
63015.....................  T                          Removal of spinal lamina...          0208         39.95     $2,077.76  ............       $415.55
63016.....................  T                          Removal of spinal lamina...          0208         39.95     $2,077.76  ............       $415.55
63017.....................  T                          Removal of spinal lamina...          0208         39.95     $2,077.76  ............       $415.55
63020.....................  T                          Neck spine disk surgery....          0208         39.95     $2,077.76  ............       $415.55
63030.....................  T                          Low back disk surgery......          0208         39.95     $2,077.76  ............       $415.55
63035.....................  T                          Spinal disk surgery add-on.          0208         39.95     $2,077.76  ............       $415.55
63040.....................  T                          Laminotomy, single cervical          0208         39.95     $2,077.76  ............       $415.55
63042.....................  T                          Laminotomy, single lumbar..          0208         39.95     $2,077.76  ............       $415.55

[[Page 52232]]

 
63043.....................  C                          Laminotomy, addl cervical..  ............  ............  ............  ............  ............
63044.....................  C                          Laminotomy, addl lumbar....  ............  ............  ............  ............  ............
63045.....................  T                          Removal of spinal lamina...          0208         39.95     $2,077.76  ............       $415.55
63046.....................  T                          Removal of spinal lamina...          0208         39.95     $2,077.76  ............       $415.55
63047.....................  T                          Removal of spinal lamina...          0208         39.95     $2,077.76  ............       $415.55
63048.....................  T                          Remove spinal lamina add-on          0208         39.95     $2,077.76  ............       $415.55
63055.....................  T                          Decompress spinal cord.....          0208         39.95     $2,077.76  ............       $415.55
63056.....................  T                          Decompress spinal cord.....          0208         39.95     $2,077.76  ............       $415.55
63057.....................  T                          Decompress spine cord add-           0208         39.95     $2,077.76  ............       $415.55
                                                        on.
63064.....................  T                          Decompress spinal cord.....          0208         39.95     $2,077.76  ............       $415.55
63066.....................  T                          Decompress spine cord add-           0208         39.95     $2,077.76  ............       $415.55
                                                        on.
63075.....................  C                          Neck spine disk surgery....  ............  ............  ............  ............  ............
63076.....................  C                          Neck spine disk surgery....  ............  ............  ............  ............  ............
63077.....................  C                          Spine disk surgery, thorax.  ............  ............  ............  ............  ............
63078.....................  C                          Spine disk surgery, thorax.  ............  ............  ............  ............  ............
63081.....................  C                          Removal of vertebral body..  ............  ............  ............  ............  ............
63082.....................  C                          Remove vertebral body add-   ............  ............  ............  ............  ............
                                                        on.
63085.....................  C                          Removal of vertebral body..  ............  ............  ............  ............  ............
63086.....................  C                          Remove vertebral body add-   ............  ............  ............  ............  ............
                                                        on.
63087.....................  C                          Removal of vertebral body..  ............  ............  ............  ............  ............
63088.....................  C                          Remove vertebral body add-   ............  ............  ............  ............  ............
                                                        on.
63090.....................  C                          Removal of vertebral body..  ............  ............  ............  ............  ............
63091.....................  C                          Remove vertebral body add-   ............  ............  ............  ............  ............
                                                        on.
63170.....................  C                          Incise spinal cord tract(s)  ............  ............  ............  ............  ............
63172.....................  C                          Drainage of spinal cyst....  ............  ............  ............  ............  ............
63173.....................  C                          Drainage of spinal cyst....  ............  ............  ............  ............  ............
63180.....................  C                          Revise spinal cord           ............  ............  ............  ............  ............
                                                        ligaments.
63182.....................  C                          Revise spinal cord           ............  ............  ............  ............  ............
                                                        ligaments.
63185.....................  C                          Incise spinal column/nerves  ............  ............  ............  ............  ............
63190.....................  C                          Incise spinal column/nerves  ............  ............  ............  ............  ............
63191.....................  C                          Incise spinal column/nerves  ............  ............  ............  ............  ............
63194.....................  C                          Incise spinal column & cord  ............  ............  ............  ............  ............
63195.....................  C                          Incise spinal column & cord  ............  ............  ............  ............  ............
63196.....................  C                          Incise spinal column & cord  ............  ............  ............  ............  ............
63197.....................  C                          Incise spinal column & cord  ............  ............  ............  ............  ............
63198.....................  C                          Incise spinal column & cord  ............  ............  ............  ............  ............
63199.....................  C                          Incise spinal column & cord  ............  ............  ............  ............  ............
63200.....................  C                          Release of spinal cord.....  ............  ............  ............  ............  ............
63250.....................  C                          Revise spinal cord vessels.  ............  ............  ............  ............  ............
63251.....................  C                          Revise spinal cord vessels.  ............  ............  ............  ............  ............
63252.....................  C                          Revise spinal cord vessels.  ............  ............  ............  ............  ............
63265.....................  C                          Excise intraspinal lesion..  ............  ............  ............  ............  ............
63266.....................  C                          Excise intraspinal lesion..  ............  ............  ............  ............  ............
63267.....................  C                          Excise intraspinal lesion..  ............  ............  ............  ............  ............
63268.....................  C                          Excise intraspinal lesion..  ............  ............  ............  ............  ............
63270.....................  C                          Excise intraspinal lesion..  ............  ............  ............  ............  ............
63271.....................  C                          Excise intraspinal lesion..  ............  ............  ............  ............  ............
63272.....................  C                          Excise intraspinal lesion..  ............  ............  ............  ............  ............
63273.....................  C                          Excise intraspinal lesion..  ............  ............  ............  ............  ............
63275.....................  C                          Biopsy/excise spinal tumor.  ............  ............  ............  ............  ............
63276.....................  C                          Biopsy/excise spinal tumor.  ............  ............  ............  ............  ............
63277.....................  C                          Biopsy/excise spinal tumor.  ............  ............  ............  ............  ............
63278.....................  C                          Biopsy/excise spinal tumor.  ............  ............  ............  ............  ............
63280.....................  C                          Biopsy/excise spinal tumor.  ............  ............  ............  ............  ............
63281.....................  C                          Biopsy/excise spinal tumor.  ............  ............  ............  ............  ............
63282.....................  C                          Biopsy/excise spinal tumor.  ............  ............  ............  ............  ............
63283.....................  C                          Biopsy/excise spinal tumor.  ............  ............  ............  ............  ............
63285.....................  C                          Biopsy/excise spinal tumor.  ............  ............  ............  ............  ............
63286.....................  C                          Biopsy/excise spinal tumor.  ............  ............  ............  ............  ............
63287.....................  C                          Biopsy/excise spinal tumor.  ............  ............  ............  ............  ............
63290.....................  C                          Biopsy/excise spinal tumor.  ............  ............  ............  ............  ............
63300.....................  C                          Removal of vertebral body..  ............  ............  ............  ............  ............
63301.....................  C                          Removal of vertebral body..  ............  ............  ............  ............  ............
63302.....................  C                          Removal of vertebral body..  ............  ............  ............  ............  ............
63303.....................  C                          Removal of vertebral body..  ............  ............  ............  ............  ............
63304.....................  C                          Removal of vertebral body..  ............  ............  ............  ............  ............

[[Page 52233]]

 
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         16.66       $866.47  ............       $173.29
63610.....................  T                          Stimulation of spinal cord.          0220         16.66       $866.47  ............       $173.29
63615.....................  T                          Remove lesion of spinal              0220         16.66       $866.47  ............       $173.29
                                                        cord.
63650.....................  T                          Implant neuroelectrodes....          0225         44.47     $2,312.84  ............       $462.57
63655.....................  T                          Implant neuroelectrodes....          0225         44.47     $2,312.84  ............       $462.57
63660.....................  T                          Revise/remove                        0687         19.50     $1,014.18       $466.52       $202.84
                                                        neuroelectrode.
63685.....................  T                          Implant neuroreceiver......          0222        140.56     $7,310.39  ............     $1,462.08
63688.....................  T                          Revise/remove neuroreceiver          0688         30.58     $1,590.44       $779.32       $318.09
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.....................  T                          Install spinal shunt.......          0228         55.05     $2,863.10       $696.46       $572.62
63744.....................  T                          Revision of spinal shunt...          0228         55.05     $2,863.10       $696.46       $572.62
63746.....................  T                          Removal of spinal shunt....          0109          7.68       $399.43       $131.49        $79.89
64400.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64402.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64405.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64408.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64410.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64412.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64413.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64415.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64417.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64418.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64420.....................  T                          Injection for nerve block..          0207          5.97       $310.49       $123.69        $62.10
64421.....................  T                          Injection for nerve block..          0207          5.97       $310.49       $123.69        $62.10
64425.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64430.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64435.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64445.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64450.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64470.....................  T                          Inj paravertebral c/t......          0207          5.97       $310.49       $123.69        $62.10
64472.....................  T                          Inj paravertebral c/t add-           0207          5.97       $310.49       $123.69        $62.10
                                                        on.
64475.....................  T                          Inj paravertebral l/s......          0207          5.97       $310.49       $123.69        $62.10
64476.....................  T                          Inj paravertebral l/s add-           0207          5.97       $310.49       $123.69        $62.10
                                                        on.
64479.....................  T                          Inj foramen epidural c/t...          0207          5.97       $310.49       $123.69        $62.10
64480.....................  T                          Inj foramen epidural add-on          0207          5.97       $310.49       $123.69        $62.10
64483.....................  T                          Inj foramen epidural l/s...          0207          5.97       $310.49       $123.69        $62.10
64484.....................  T                          Inj foramen epidural add-on          0207          5.97       $310.49       $123.69        $62.10
64505.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64508.....................  T                          Injection for nerve block..          0204          2.13       $110.78        $42.10        $22.16
64510.....................  T                          Injection for nerve block..          0207          5.97       $310.49       $123.69        $62.10
64520.....................  T                          Injection for nerve block..          0207          5.97       $310.49       $123.69        $62.10
64530.....................  T                          Injection for nerve block..          0207          5.97       $310.49       $123.69        $62.10
64550.....................  A                          Apply neurostimulator......  ............  ............  ............  ............  ............
64553.....................  T                          Implant neuroelectrodes....          0225         44.47     $2,312.84  ............       $462.57
64555.....................  T                          Implant neuroelectrodes....          0225         44.47     $2,312.84  ............       $462.57
64560.....................  T                          Implant neuroelectrodes....          0225         44.47     $2,312.84  ............       $462.57
64561.....................  T                          Implant neuroelectrodes....          0225         44.47     $2,312.84  ............       $462.57
64565.....................  T                          Implant neuroelectrodes....          0225         44.47     $2,312.84  ............       $462.57
64573.....................  T                          Implant neuroelectrodes....          0225         44.47     $2,312.84  ............       $462.57
64575.....................  T                          Implant neuroelectrodes....          0225         44.47     $2,312.84  ............       $462.57
64577.....................  T                          Implant neuroelectrodes....          0225         44.47     $2,312.84  ............       $462.57
64580.....................  T                          Implant neuroelectrodes....          0225         44.47     $2,312.84  ............       $462.57
64581.....................  T                          Implant neuroelectrodes....          0225         44.47     $2,312.84  ............       $462.57
64585.....................  T                          Revise/remove                        0687         19.50     $1,014.18       $466.52       $202.84
                                                        neuroelectrode.
64590.....................  T                          Implant neuroreceiver......          0222        140.56     $7,310.39  ............     $1,462.08

[[Page 52234]]

 
64595.....................  T                          Revise/remove neuroreceiver          0688         30.58     $1,590.44       $779.32       $318.09
64600.....................  T                          Injection treatment of               0203         10.96       $570.02       $256.51       $114.00
                                                        nerve.
64605.....................  T                          Injection treatment of               0203         10.96       $570.02       $256.51       $114.00
                                                        nerve.
64610.....................  T                          Injection treatment of               0203         10.96       $570.02       $256.51       $114.00
                                                        nerve.
64612.....................  T                          Destroy nerve, face muscle.          0204          2.13       $110.78        $42.10        $22.16
64613.....................  T                          Destroy nerve, spine muscle          0204          2.13       $110.78        $42.10        $22.16
64614.....................  T                          Destroy nerve, extrem musc.          0204          2.13       $110.78        $42.10        $22.16
64620.....................  T                          Injection treatment of               0203         10.96       $570.02       $256.51       $114.00
                                                        nerve.
64622.....................  T                          Destr paravertebrl nerve l/          0203         10.96       $570.02       $256.51       $114.00
                                                        s.
64623.....................  T                          Destr paravertebral n add-           0203         10.96       $570.02       $256.51       $114.00
                                                        on.
64626.....................  T                          Destr paravertebrl nerve c/          0203         10.96       $570.02       $256.51       $114.00
                                                        t.
64627.....................  T                          Destr paravertebral n add-           0203         10.96       $570.02       $256.51       $114.00
                                                        on.
64630.....................  T                          Injection treatment of               0207          5.97       $310.49       $123.69        $62.10
                                                        nerve.
64640.....................  T                          Injection treatment of               0207          5.97       $310.49       $123.69        $62.10
                                                        nerve.
64680.....................  T                          Injection treatment of               0203         10.96       $570.02       $256.51       $114.00
                                                        nerve.
64702.....................  T                          Revise finger/toe nerve....          0220         16.66       $866.47  ............       $173.29
64704.....................  T                          Revise hand/foot nerve.....          0220         16.66       $866.47  ............       $173.29
64708.....................  T                          Revise arm/leg nerve.......          0220         16.66       $866.47  ............       $173.29
64712.....................  T                          Revision of sciatic nerve..          0220         16.66       $866.47  ............       $173.29
64713.....................  T                          Revision of arm nerve(s)...          0220         16.66       $866.47  ............       $173.29
64714.....................  T                          Revise low back nerve(s)...          0220         16.66       $866.47  ............       $173.29
64716.....................  T                          Revision of cranial nerve..          0220         16.66       $866.47  ............       $173.29
64718.....................  T                          Revise ulnar nerve at elbow          0220         16.66       $866.47  ............       $173.29
64719.....................  T                          Revise ulnar nerve at wrist          0220         16.66       $866.47  ............       $173.29
64721.....................  T                          Carpal tunnel surgery......          0220         16.66       $866.47  ............       $173.29
64722.....................  T                          Relieve pressure on                  0220         16.66       $866.47  ............       $173.29
                                                        nerve(s).
64726.....................  T                          Release foot/toe nerve.....          0220         16.66       $866.47  ............       $173.29
64727.....................  T                          Internal nerve revision....          0220         16.66       $866.47  ............       $173.29
64732.....................  T                          Incision of brow nerve.....          0220         16.66       $866.47  ............       $173.29
64734.....................  T                          Incision of cheek nerve....          0220         16.66       $866.47  ............       $173.29
64736.....................  T                          Incision of chin nerve.....          0220         16.66       $866.47  ............       $173.29
64738.....................  T                          Incision of jaw nerve......          0220         16.66       $866.47  ............       $173.29
64740.....................  T                          Incision of tongue nerve...          0220         16.66       $866.47  ............       $173.29
64742.....................  T                          Incision of facial nerve...          0220         16.66       $866.47  ............       $173.29
64744.....................  T                          Incise nerve, back of head.          0220         16.66       $866.47  ............       $173.29
64746.....................  T                          Incise diaphragm nerve.....          0220         16.66       $866.47  ............       $173.29
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         16.66       $866.47  ............       $173.29
64763.....................  C                          Incise hip/thigh nerve.....  ............  ............  ............  ............  ............
64766.....................  C                          Incise hip/thigh nerve.....  ............  ............  ............  ............  ............
64771.....................  T                          Sever cranial nerve........          0220         16.66       $866.47  ............       $173.29
64772.....................  T                          Incision of spinal nerve...          0220         16.66       $866.47  ............       $173.29
64774.....................  T                          Remove skin nerve lesion...          0220         16.66       $866.47  ............       $173.29
64776.....................  T                          Remove digit nerve lesion..          0220         16.66       $866.47  ............       $173.29
64778.....................  T                          Digit nerve surgery add-on.          0220         16.66       $866.47  ............       $173.29
64782.....................  T                          Remove limb nerve lesion...          0220         16.66       $866.47  ............       $173.29
64783.....................  T                          Limb nerve surgery add-on..          0220         16.66       $866.47  ............       $173.29
64784.....................  T                          Remove nerve lesion........          0220         16.66       $866.47  ............       $173.29
64786.....................  T                          Remove sciatic nerve lesion          0221         25.35     $1,318.43       $463.62       $263.69
64787.....................  T                          Implant nerve end..........          0220         16.66       $866.47  ............       $173.29
64788.....................  T                          Remove skin nerve lesion...          0220         16.66       $866.47  ............       $173.29
64790.....................  T                          Removal of nerve lesion....          0220         16.66       $866.47  ............       $173.29
64792.....................  T                          Removal of nerve lesion....          0221         25.35     $1,318.43       $463.62       $263.69
64795.....................  T                          Biopsy of nerve............          0220         16.66       $866.47  ............       $173.29
64802.....................  T                          Remove sympathetic nerves..          0220         16.66       $866.47  ............       $173.29
64804.....................  C                          Remove sympathetic nerves..  ............  ............  ............  ............  ............
64809.....................  C                          Remove sympathetic nerves..  ............  ............  ............  ............  ............
64818.....................  C                          Remove sympathetic nerves..  ............  ............  ............  ............  ............
64820.....................  T                          Remove sympathetic nerves..          0220         16.66       $866.47  ............       $173.29
64821.....................  T                          Remove sympathetic nerves..          0054         23.50     $1,222.21       $472.33       $244.44
64822.....................  T                          Remove sympathetic nerves..          0054         23.50     $1,222.21       $472.33       $244.44
64823.....................  T                          Remove sympathetic nerves..          0054         23.50     $1,222.21       $472.33       $244.44
64831.....................  T                          Repair of digit nerve......          0221         25.35     $1,318.43       $463.62       $263.69
64832.....................  T                          Repair nerve add-on........          0221         25.35     $1,318.43       $463.62       $263.69

[[Page 52235]]

 
64834.....................  T                          Repair of hand or foot               0221         25.35     $1,318.43       $463.62       $263.69
                                                        nerve.
64835.....................  T                          Repair of hand or foot               0221         25.35     $1,318.43       $463.62       $263.69
                                                        nerve.
64836.....................  T                          Repair of hand or foot               0221         25.35     $1,318.43       $463.62       $263.69
                                                        nerve.
64837.....................  T                          Repair nerve add-on........          0221         25.35     $1,318.43       $463.62       $263.69
64840.....................  T                          Repair of leg nerve........          0221         25.35     $1,318.43       $463.62       $263.69
64856.....................  T                          Repair/transpose nerve.....          0221         25.35     $1,318.43       $463.62       $263.69
64857.....................  T                          Repair arm/leg nerve.......          0221         25.35     $1,318.43       $463.62       $263.69
64858.....................  T                          Repair sciatic nerve.......          0221         25.35     $1,318.43       $463.62       $263.69
64859.....................  T                          Nerve surgery..............          0221         25.35     $1,318.43       $463.62       $263.69
64861.....................  T                          Repair of arm nerves.......          0221         25.35     $1,318.43       $463.62       $263.69
64862.....................  T                          Repair of low back nerves..          0221         25.35     $1,318.43       $463.62       $263.69
64864.....................  T                          Repair of facial nerve.....          0221         25.35     $1,318.43       $463.62       $263.69
64865.....................  T                          Repair of facial nerve.....          0221         25.35     $1,318.43       $463.62       $263.69
64866.....................  C                          Fusion of facial/other       ............  ............  ............  ............  ............
                                                        nerve.
64868.....................  C                          Fusion of facial/other       ............  ............  ............  ............  ............
                                                        nerve.
64870.....................  T                          Fusion of facial/other               0221         25.35     $1,318.43       $463.62       $263.69
                                                        nerve.
64872.....................  T                          Subsequent repair of nerve.          0221         25.35     $1,318.43       $463.62       $263.69
64874.....................  T                          Repair & revise nerve add-           0221         25.35     $1,318.43       $463.62       $263.69
                                                        on.
64876.....................  T                          Repair nerve/shorten bone..          0221         25.35     $1,318.43       $463.62       $263.69
64885.....................  T                          Nerve graft, head or neck..          0221         25.35     $1,318.43       $463.62       $263.69
64886.....................  T                          Nerve graft, head or neck..          0221         25.35     $1,318.43       $463.62       $263.69
64890.....................  T                          Nerve graft, hand or foot..          0221         25.35     $1,318.43       $463.62       $263.69
64891.....................  T                          Nerve graft, hand or foot..          0221         25.35     $1,318.43       $463.62       $263.69
64892.....................  T                          Nerve graft, arm or leg....          0221         25.35     $1,318.43       $463.62       $263.69
64893.....................  T                          Nerve graft, arm or leg....          0221         25.35     $1,318.43       $463.62       $263.69
64895.....................  T                          Nerve graft, hand or foot..          0221         25.35     $1,318.43       $463.62       $263.69
64896.....................  T                          Nerve graft, hand or foot..          0221         25.35     $1,318.43       $463.62       $263.69
64897.....................  T                          Nerve graft, arm or leg....          0221         25.35     $1,318.43       $463.62       $263.69
64898.....................  T                          Nerve graft, arm or leg....          0221         25.35     $1,318.43       $463.62       $263.69
64901.....................  T                          Nerve graft add-on.........          0221         25.35     $1,318.43       $463.62       $263.69
64902.....................  T                          Nerve graft add-on.........          0221         25.35     $1,318.43       $463.62       $263.69
64905.....................  T                          Nerve pedicle transfer.....          0221         25.35     $1,318.43       $463.62       $263.69
64907.....................  T                          Nerve pedicle transfer.....          0221         25.35     $1,318.43       $463.62       $263.69
64999.....................  T                          Nervous system surgery.....          0204          2.13       $110.78        $42.10        $22.16
65091.....................  T                          Revise eye.................          0242         28.87     $1,501.50       $597.36       $300.30
65093.....................  T                          Revise eye with implant....          0241         21.89     $1,138.48       $384.47       $227.70
65101.....................  T                          Removal of eye.............          0242         28.87     $1,501.50       $597.36       $300.30
65103.....................  T                          Remove eye/insert implant..          0242         28.87     $1,501.50       $597.36       $300.30
65105.....................  T                          Remove eye/attach implant..          0242         28.87     $1,501.50       $597.36       $300.30
65110.....................  T                          Removal of eye.............          0242         28.87     $1,501.50       $597.36       $300.30
65112.....................  T                          Remove eye/revise socket...          0242         28.87     $1,501.50       $597.36       $300.30
65114.....................  T                          Remove eye/revise socket...          0242         28.87     $1,501.50       $597.36       $300.30
65125.....................  T                          Revise ocular implant......          0240         16.99       $883.63       $315.31       $176.73
65130.....................  T                          Insert ocular implant......          0241         21.89     $1,138.48       $384.47       $227.70
65135.....................  T                          Insert ocular implant......          0241         21.89     $1,138.48       $384.47       $227.70
65140.....................  T                          Attach ocular implant......          0242         28.87     $1,501.50       $597.36       $300.30
65150.....................  T                          Revise ocular implant......          0241         21.89     $1,138.48       $384.47       $227.70
65155.....................  T                          Reinsert ocular implant....          0242         28.87     $1,501.50       $597.36       $300.30
65175.....................  T                          Removal of ocular implant..          0240         16.99       $883.63       $315.31       $176.73
65205.....................  S                          Remove foreign body from             0698          1.01        $52.53        $20.49        $10.51
                                                        eye.
65210.....................  S                          Remove foreign body from             0231          2.24       $116.50        $52.43        $23.30
                                                        eye.
65220.....................  S                          Remove foreign body from             0231          2.24       $116.50        $52.43        $23.30
                                                        eye.
65222.....................  S                          Remove foreign body from             0231          2.24       $116.50        $52.43        $23.30
                                                        eye.
65235.....................  T                          Remove foreign body from             0233         13.43       $698.48       $266.33       $139.70
                                                        eye.
65260.....................  T                          Remove foreign body from             0236         20.62     $1,072.43  ............       $214.49
                                                        eye.
65265.....................  T                          Remove foreign body from             0236         20.62     $1,072.43  ............       $214.49
                                                        eye.
65270.....................  T                          Repair of eye wound........          0240         16.99       $883.63       $315.31       $176.73
65272.....................  T                          Repair of eye wound........          0233         13.43       $698.48       $266.33       $139.70
65273.....................  C                          Repair of eye wound........  ............  ............  ............  ............  ............
65275.....................  T                          Repair of eye wound........          0233         13.43       $698.48       $266.33       $139.70
65280.....................  T                          Repair of eye wound........          0234         21.45     $1,115.59       $535.48       $223.12
65285.....................  T                          Repair of eye wound........          0234         21.45     $1,115.59       $535.48       $223.12
65286.....................  T                          Repair of eye wound........          0233         13.43       $698.48       $266.33       $139.70
65290.....................  T                          Repair of eye socket wound.          0243         20.94     $1,089.07       $431.39       $217.81
65400.....................  T                          Removal of eye lesion......          0233         13.43       $698.48       $266.33       $139.70
65410.....................  T                          Biopsy of cornea...........          0233         13.43       $698.48       $266.33       $139.70

[[Page 52236]]

 
65420.....................  T                          Removal of eye lesion......          0233         13.43       $698.48       $266.33       $139.70
65426.....................  T                          Removal of eye lesion......          0234         21.45     $1,115.59       $535.48       $223.12
65430.....................  S                          Corneal smear..............          0230          0.78        $40.57        $15.82         $8.11
65435.....................  T                          Curette/treat cornea.......          0239          6.91       $359.38       $115.94        $71.88
65436.....................  T                          Curette/treat cornea.......          0233         13.43       $698.48       $266.33       $139.70
65450.....................  S                          Treatment of corneal lesion          0231          2.24       $116.50        $52.43        $23.30
65600.....................  T                          Revision of cornea.........          0240         16.99       $883.63       $315.31       $176.73
65710.....................  T                          Corneal transplant.........          0244         38.14     $1,983.62       $851.42       $396.72
65730.....................  T                          Corneal transplant.........          0244         38.14     $1,983.62       $851.42       $396.72
65750.....................  T                          Corneal transplant.........          0244         38.14     $1,983.62       $851.42       $396.72
65755.....................  T                          Corneal transplant.........          0244         38.14     $1,983.62       $851.42       $396.72
65760.....................  E                          Revision of cornea.........  ............  ............  ............  ............  ............
65765.....................  E                          Revision of cornea.........  ............  ............  ............  ............  ............
65767.....................  E                          Corneal tissue transplant..  ............  ............  ............  ............  ............
65770.....................  T                          Revise cornea with implant.          0244         38.14     $1,983.62       $851.42       $396.72
65771.....................  E                          Radial keratotomy..........  ............  ............  ............  ............  ............
65772.....................  T                          Correction of astigmatism..          0233         13.43       $698.48       $266.33       $139.70
65775.....................  T                          Correction of astigmatism..          0233         13.43       $698.48       $266.33       $139.70
65800.....................  T                          Drainage of eye............          0233         13.43       $698.48       $266.33       $139.70
65805.....................  T                          Drainage of eye............          0233         13.43       $698.48       $266.33       $139.70
65810.....................  T                          Drainage of eye............          0234         21.45     $1,115.59       $535.48       $223.12
65815.....................  T                          Drainage of eye............          0234         21.45     $1,115.59       $535.48       $223.12
65820.....................  T                          Relieve inner eye pressure.          0232          4.91       $255.36       $112.36        $51.07
65850.....................  T                          Incision of eye............          0234         21.45     $1,115.59       $535.48       $223.12
65855.....................  T                          Laser surgery of eye.......          0247          4.97       $258.48       $108.56        $51.70
65860.....................  T                          Incise inner eye adhesions.          0247          4.97       $258.48       $108.56        $51.70
65865.....................  T                          Incise inner eye adhesions.          0233         13.43       $698.48       $266.33       $139.70
65870.....................  T                          Incise inner eye adhesions.          0234         21.45     $1,115.59       $535.48       $223.12
65875.....................  T                          Incise inner eye adhesions.          0234         21.45     $1,115.59       $535.48       $223.12
65880.....................  T                          Incise inner eye adhesions.          0233         13.43       $698.48       $266.33       $139.70
65900.....................  T                          Remove eye lesion..........          0233         13.43       $698.48       $266.33       $139.70
65920.....................  T                          Remove implant of eye......          0233         13.43       $698.48       $266.33       $139.70
65930.....................  T                          Remove blood clot from eye.          0234         21.45     $1,115.59       $535.48       $223.12
66020.....................  T                          Injection treatment of eye.          0233         13.43       $698.48       $266.33       $139.70
66030.....................  T                          Injection treatment of eye.          0233         13.43       $698.48       $266.33       $139.70
66130.....................  T                          Remove eye lesion..........          0234         21.45     $1,115.59       $535.48       $223.12
66150.....................  T                          Glaucoma surgery...........          0233         13.43       $698.48       $266.33       $139.70
66155.....................  T                          Glaucoma surgery...........          0234         21.45     $1,115.59       $535.48       $223.12
66160.....................  T                          Glaucoma surgery...........          0234         21.45     $1,115.59       $535.48       $223.12
66165.....................  T                          Glaucoma surgery...........          0234         21.45     $1,115.59       $535.48       $223.12
66170.....................  T                          Glaucoma surgery...........          0234         21.45     $1,115.59       $535.48       $223.12
66172.....................  T                          Incision of eye............          0673         27.47     $1,428.69       $685.77       $285.74
66180.....................  T                          Implant eye shunt..........          0673         27.47     $1,428.69       $685.77       $285.74
66185.....................  T                          Revise eye shunt...........          0673         27.47     $1,428.69       $685.77       $285.74
66220.....................  T                          Repair eye lesion..........          0236         20.62     $1,072.43  ............       $214.49
66225.....................  T                          Repair/graft eye lesion....          0673         27.47     $1,428.69       $685.77       $285.74
66250.....................  T                          Follow-up surgery of eye...          0233         13.43       $698.48       $266.33       $139.70
66500.....................  T                          Incision of iris...........          0232          4.91       $255.36       $112.36        $51.07
66505.....................  T                          Incision of iris...........          0232          4.91       $255.36       $112.36        $51.07
66600.....................  T                          Remove iris and lesion.....          0233         13.43       $698.48       $266.33       $139.70
66605.....................  T                          Removal of iris............          0234         21.45     $1,115.59       $535.48       $223.12
66625.....................  T                          Removal of iris............          0233         13.43       $698.48       $266.33       $139.70
66630.....................  T                          Removal of iris............          0233         13.43       $698.48       $266.33       $139.70
66635.....................  T                          Removal of iris............          0234         21.45     $1,115.59       $535.48       $223.12
66680.....................  T                          Repair iris & ciliary body.          0234         21.45     $1,115.59       $535.48       $223.12
66682.....................  T                          Repair iris & ciliary body.          0234         21.45     $1,115.59       $535.48       $223.12
66700.....................  T                          Destruction, ciliary body..          0233         13.43       $698.48       $266.33       $139.70
66710.....................  T                          Destruction, ciliary body..          0233         13.43       $698.48       $266.33       $139.70
66720.....................  T                          Destruction, ciliary body..          0233         13.43       $698.48       $266.33       $139.70
66740.....................  T                          Destruction, ciliary body..          0233         13.43       $698.48       $266.33       $139.70
66761.....................  T                          Revision of iris...........          0247          4.97       $258.48       $108.56        $51.70
66762.....................  T                          Revision of iris...........          0247          4.97       $258.48       $108.56        $51.70
66770.....................  T                          Removal of inner eye lesion          0247          4.97       $258.48       $108.56        $51.70
66820.....................  T                          Incision, secondary                  0232          4.91       $255.36       $112.36        $51.07
                                                        cataract.
66821.....................  T                          After cataract laser                 0247          4.97       $258.48       $108.56        $51.70
                                                        surgery.
66825.....................  T                          Reposition intraocular lens          0234         21.45     $1,115.59       $535.48       $223.12

[[Page 52237]]

 
66830.....................  T                          Removal of lens lesion.....          0232          4.91       $255.36       $112.36        $51.07
66840.....................  T                          Removal of lens material...          0245         14.39       $748.41       $251.21       $149.68
66850.....................  T                          Removal of lens material...          0249         27.75     $1,443.25       $524.67       $288.65
66852.....................  T                          Removal of lens material...          0249         27.75     $1,443.25       $524.67       $288.65
66920.....................  T                          Extraction of lens.........          0249         27.75     $1,443.25       $524.67       $288.65
66930.....................  T                          Extraction of lens.........          0249         27.75     $1,443.25       $524.67       $288.65
66940.....................  T                          Extraction of lens.........          0245         14.39       $748.41       $251.21       $149.68
66982.....................  T                          Cataract surgery, complex..          0246         23.59     $1,226.89       $495.96       $245.38
66983.....................  T                          Cataract surg w/iol, 1               0246         23.59     $1,226.89       $495.96       $245.38
                                                        stage.
66984.....................  T                          Cataract surg w/iol, i               0246         23.59     $1,226.89       $495.96       $245.38
                                                        stage.
66985.....................  T                          Insert lens prosthesis.....          0246         23.59     $1,226.89       $495.96       $245.38
66986.....................  T                          Exchange lens prosthesis...          0246         23.59     $1,226.89       $495.96       $245.38
66999.....................  T                          Eye surgery procedure......          0232          4.91       $255.36       $112.36        $51.07
67005.....................  T                          Partial removal of eye               0237         35.09     $1,825.00       $818.54       $365.00
                                                        fluid.
67010.....................  T                          Partial removal of eye               0237         35.09     $1,825.00       $818.54       $365.00
                                                        fluid.
67015.....................  T                          Release of eye fluid.......          0237         35.09     $1,825.00       $818.54       $365.00
67025.....................  T                          Replace eye fluid..........          0236         20.62     $1,072.43  ............       $214.49
67027.....................  T                          Implant eye drug system....          0237         35.09     $1,825.00       $818.54       $365.00
67028.....................  T                          Injection eye drug.........          0235          5.62       $292.29        $81.84        $58.46
67030.....................  T                          Incise inner eye strands...          0236         20.62     $1,072.43  ............       $214.49
67031.....................  T                          Laser surgery, eye strands.          0247          4.97       $258.48       $108.56        $51.70
67036.....................  T                          Removal of inner eye fluid.          0237         35.09     $1,825.00       $818.54       $365.00
67038.....................  T                          Strip retinal membrane.....          0237         35.09     $1,825.00       $818.54       $365.00
67039.....................  T                          Laser treatment of retina..          0237         35.09     $1,825.00       $818.54       $365.00
67040.....................  T                          Laser treatment of retina..          0672         39.95     $2,077.76     $1,038.88       $415.55
67101.....................  T                          Repair detached retina.....          0235          5.62       $292.29        $81.84        $58.46
67105.....................  T                          Repair detached retina.....          0248          4.44       $230.92        $96.99        $46.18
67107.....................  T                          Repair detached retina.....          0672         39.95     $2,077.76     $1,038.88       $415.55
67108.....................  T                          Repair detached retina.....          0672         39.95     $2,077.76     $1,038.88       $415.55
67110.....................  T                          Repair detached retina.....          0235          5.62       $292.29        $81.84        $58.46
67112.....................  T                          Rerepair detached retina...          0672         39.95     $2,077.76     $1,038.88       $415.55
67115.....................  T                          Release encircling material          0236         20.62     $1,072.43  ............       $214.49
67120.....................  T                          Remove eye implant material          0236         20.62     $1,072.43  ............       $214.49
67121.....................  T                          Remove eye implant material          0237         35.09     $1,825.00       $818.54       $365.00
67141.....................  T                          Treatment of retina........          0235          5.62       $292.29        $81.84        $58.46
67145.....................  T                          Treatment of retina........          0248          4.44       $230.92        $96.99        $46.18
67208.....................  T                          Treatment of retinal lesion          0235          5.62       $292.29        $81.84        $58.46
67210.....................  T                          Treatment of retinal lesion          0248          4.44       $230.92        $96.99        $46.18
67218.....................  T                          Treatment of retinal lesion          0236         20.62     $1,072.43  ............       $214.49
67220.....................  T                          Treatment of choroid lesion          0235          5.62       $292.29        $81.84        $58.46
67221.....................  T                          Ocular photodynamic ther...          0235          5.62       $292.29        $81.84        $58.46
67225.....................  T                          Eye photodynamic ther add-           0235          5.62       $292.29        $81.84        $58.46
                                                        on.
67227.....................  T                          Treatment of retinal lesion          0235          5.62       $292.29        $81.84        $58.46
67228.....................  T                          Treatment of retinal lesion          0248          4.44       $230.92        $96.99        $46.18
67250.....................  T                          Reinforce eye wall.........          0240         16.99       $883.63       $315.31       $176.73
67255.....................  T                          Reinforce/graft eye wall...          0237         35.09     $1,825.00       $818.54       $365.00
67299.....................  T                          Eye surgery procedure......          0235          5.62       $292.29        $81.84        $58.46
67311.....................  T                          Revise eye muscle..........          0243         20.94     $1,089.07       $431.39       $217.81
67312.....................  T                          Revise two eye muscles.....          0243         20.94     $1,089.07       $431.39       $217.81
67314.....................  T                          Revise eye muscle..........          0243         20.94     $1,089.07       $431.39       $217.81
67316.....................  T                          Revise two eye muscles.....          0243         20.94     $1,089.07       $431.39       $217.81
67318.....................  T                          Revise eye muscle(s).......          0243         20.94     $1,089.07       $431.39       $217.81
67320.....................  T                          Revise eye muscle(s) add-on          0243         20.94     $1,089.07       $431.39       $217.81
67331.....................  T                          Eye surgery follow-up add-           0243         20.94     $1,089.07       $431.39       $217.81
                                                        on.
67332.....................  T                          Rerevise eye muscles add-on          0243         20.94     $1,089.07       $431.39       $217.81
67334.....................  T                          Revise eye muscle w/suture.          0243         20.94     $1,089.07       $431.39       $217.81
67335.....................  T                          Eye suture during surgery..          0243         20.94     $1,089.07       $431.39       $217.81
67340.....................  T                          Revise eye muscle add-on...          0243         20.94     $1,089.07       $431.39       $217.81
67343.....................  T                          Release eye tissue.........          0243         20.94     $1,089.07       $431.39       $217.81
67345.....................  T                          Destroy nerve of eye muscle          0238          3.04       $158.11        $58.96        $31.62
67350.....................  T                          Biopsy eye muscle..........          0699          2.37       $123.26        $55.47        $24.65
67399.....................  T                          Eye muscle surgery                   0243         20.94     $1,089.07       $431.39       $217.81
                                                        procedure.
67400.....................  T                          Explore/biopsy eye socket..          0241         21.89     $1,138.48       $384.47       $227.70
67405.....................  T                          Explore/drain eye socket...          0241         21.89     $1,138.48       $384.47       $227.70
67412.....................  T                          Explore/treat eye socket...          0241         21.89     $1,138.48       $384.47       $227.70
67413.....................  T                          Explore/treat eye socket...          0241         21.89     $1,138.48       $384.47       $227.70

[[Page 52238]]

 
67414.....................  T                          Explr/decompress eye socket          0242         28.87     $1,501.50       $597.36       $300.30
67415.....................  T                          Aspiration, orbital                  0239          6.91       $359.38       $115.94        $71.88
                                                        contents.
67420.....................  T                          Explore/treat eye socket...          0242         28.87     $1,501.50       $597.36       $300.30
67430.....................  T                          Explore/treat eye socket...          0242         28.87     $1,501.50       $597.36       $300.30
67440.....................  T                          Explore/drain eye socket...          0242         28.87     $1,501.50       $597.36       $300.30
67445.....................  T                          Explr/decompress eye socket          0242         28.87     $1,501.50       $597.36       $300.30
67450.....................  T                          Explore/biopsy eye socket..          0242         28.87     $1,501.50       $597.36       $300.30
67500.....................  S                          Inject/treat eye socket....          0231          2.24       $116.50        $52.43        $23.30
67505.....................  T                          Inject/treat eye socket....          0238          3.04       $158.11        $58.96        $31.62
67515.....................  T                          Inject/treat eye socket....          0239          6.91       $359.38       $115.94        $71.88
67550.....................  T                          Insert eye socket implant..          0242         28.87     $1,501.50       $597.36       $300.30
67560.....................  T                          Revise eye socket implant..          0241         21.89     $1,138.48       $384.47       $227.70
67570.....................  T                          Decompress optic nerve.....          0242         28.87     $1,501.50       $597.36       $300.30
67599.....................  T                          Orbit surgery procedure....          0239          6.91       $359.38       $115.94        $71.88
67700.....................  T                          Drainage of eyelid abscess.          0238          3.04       $158.11        $58.96        $31.62
67710.....................  T                          Incision of eyelid.........          0239          6.91       $359.38       $115.94        $71.88
67715.....................  T                          Incision of eyelid fold....          0240         16.99       $883.63       $315.31       $176.73
67800.....................  T                          Remove eyelid lesion.......          0238          3.04       $158.11        $58.96        $31.62
67801.....................  T                          Remove eyelid lesions......          0239          6.91       $359.38       $115.94        $71.88
67805.....................  T                          Remove eyelid lesions......          0238          3.04       $158.11        $58.96        $31.62
67808.....................  T                          Remove eyelid lesion(s)....          0240         16.99       $883.63       $315.31       $176.73
67810.....................  T                          Biopsy of eyelid...........          0238          3.04       $158.11        $58.96        $31.62
67820.....................  S                          Revise eyelashes...........          0230          0.78        $40.57        $15.82         $8.11
67825.....................  T                          Revise eyelashes...........          0238          3.04       $158.11        $58.96        $31.62
67830.....................  T                          Revise eyelashes...........          0239          6.91       $359.38       $115.94        $71.88
67835.....................  T                          Revise eyelashes...........          0240         16.99       $883.63       $315.31       $176.73
67840.....................  T                          Remove eyelid lesion.......          0239          6.91       $359.38       $115.94        $71.88
67850.....................  T                          Treat eyelid lesion........          0239          6.91       $359.38       $115.94        $71.88
67875.....................  T                          Closure of eyelid by suture          0239          6.91       $359.38       $115.94        $71.88
67880.....................  T                          Revision of eyelid.........          0233         13.43       $698.48       $266.33       $139.70
67882.....................  T                          Revision of eyelid.........          0240         16.99       $883.63       $315.31       $176.73
67900.....................  T                          Repair brow defect.........          0240         16.99       $883.63       $315.31       $176.73
67901.....................  T                          Repair eyelid defect.......          0240         16.99       $883.63       $315.31       $176.73
67902.....................  T                          Repair eyelid defect.......          0240         16.99       $883.63       $315.31       $176.73
67903.....................  T                          Repair eyelid defect.......          0240         16.99       $883.63       $315.31       $176.73
67904.....................  T                          Repair eyelid defect.......          0240         16.99       $883.63       $315.31       $176.73
67906.....................  T                          Repair eyelid defect.......          0240         16.99       $883.63       $315.31       $176.73
67908.....................  T                          Repair eyelid defect.......          0240         16.99       $883.63       $315.31       $176.73
67909.....................  T                          Revise eyelid defect.......          0240         16.99       $883.63       $315.31       $176.73
67911.....................  T                          Revise eyelid defect.......          0240         16.99       $883.63       $315.31       $176.73
67914.....................  T                          Repair eyelid defect.......          0240         16.99       $883.63       $315.31       $176.73
67915.....................  T                          Repair eyelid defect.......          0239          6.91       $359.38       $115.94        $71.88
67916.....................  T                          Repair eyelid defect.......          0240         16.99       $883.63       $315.31       $176.73
67917.....................  T                          Repair eyelid defect.......          0240         16.99       $883.63       $315.31       $176.73
67921.....................  T                          Repair eyelid defect.......          0240         16.99       $883.63       $315.31       $176.73
67922.....................  T                          Repair eyelid defect.......          0239          6.91       $359.38       $115.94        $71.88
67923.....................  T                          Repair eyelid defect.......          0240         16.99       $883.63       $315.31       $176.73
67924.....................  T                          Repair eyelid defect.......          0240         16.99       $883.63       $315.31       $176.73
67930.....................  T                          Repair eyelid wound........          0240         16.99       $883.63       $315.31       $176.73
67935.....................  T                          Repair eyelid wound........          0240         16.99       $883.63       $315.31       $176.73
67938.....................  S                          Remove eyelid foreign body.          0698          1.01        $52.53        $20.49        $10.51
67950.....................  T                          Revision of eyelid.........          0240         16.99       $883.63       $315.31       $176.73
67961.....................  T                          Revision of eyelid.........          0240         16.99       $883.63       $315.31       $176.73
67966.....................  T                          Revision of eyelid.........          0240         16.99       $883.63       $315.31       $176.73
67971.....................  T                          Reconstruction of eyelid...          0241         21.89     $1,138.48       $384.47       $227.70
67973.....................  T                          Reconstruction of eyelid...          0241         21.89     $1,138.48       $384.47       $227.70
67974.....................  T                          Reconstruction of eyelid...          0241         21.89     $1,138.48       $384.47       $227.70
67975.....................  T                          Reconstruction of eyelid...          0240         16.99       $883.63       $315.31       $176.73
67999.....................  T                          Revision of eyelid.........          0240         16.99       $883.63       $315.31       $176.73
68020.....................  T                          Incise/drain eyelid lining.          0240         16.99       $883.63       $315.31       $176.73
68040.....................  S                          Treatment of eyelid lesions          0698          1.01        $52.53        $20.49        $10.51
68100.....................  T                          Biopsy of eyelid lining....          0232          4.91       $255.36       $112.36        $51.07
68110.....................  T                          Remove eyelid lining lesion          0699          2.37       $123.26        $55.47        $24.65
68115.....................  T                          Remove eyelid lining lesion          0239          6.91       $359.38       $115.94        $71.88
68130.....................  T                          Remove eyelid lining lesion          0233         13.43       $698.48       $266.33       $139.70
68135.....................  T                          Remove eyelid lining lesion          0239          6.91       $359.38       $115.94        $71.88

[[Page 52239]]

 
68200.....................  S                          Treat eyelid by injection..          0698          1.01        $52.53        $20.49        $10.51
68320.....................  T                          Revise/graft eyelid lining.          0240         16.99       $883.63       $315.31       $176.73
68325.....................  T                          Revise/graft eyelid lining.          0242         28.87     $1,501.50       $597.36       $300.30
68326.....................  T                          Revise/graft eyelid lining.          0241         21.89     $1,138.48       $384.47       $227.70
68328.....................  T                          Revise/graft eyelid lining.          0241         21.89     $1,138.48       $384.47       $227.70
68330.....................  T                          Revise eyelid lining.......          0233         13.43       $698.48       $266.33       $139.70
68335.....................  T                          Revise/graft eyelid lining.          0241         21.89     $1,138.48       $384.47       $227.70
68340.....................  T                          Separate eyelid adhesions..          0240         16.99       $883.63       $315.31       $176.73
68360.....................  T                          Revise eyelid lining.......          0234         21.45     $1,115.59       $535.48       $223.12
68362.....................  T                          Revise eyelid lining.......          0234         21.45     $1,115.59       $535.48       $223.12
68399.....................  T                          Eyelid lining surgery......          0239          6.91       $359.38       $115.94        $71.88
68400.....................  T                          Incise/drain tear gland....          0238          3.04       $158.11        $58.96        $31.62
68420.....................  T                          Incise/drain tear sac......          0240         16.99       $883.63       $315.31       $176.73
68440.....................  T                          Incise tear duct opening...          0238          3.04       $158.11        $58.96        $31.62
68500.....................  T                          Removal of tear gland......          0241         21.89     $1,138.48       $384.47       $227.70
68505.....................  T                          Partial removal, tear gland          0241         21.89     $1,138.48       $384.47       $227.70
68510.....................  T                          Biopsy of tear gland.......          0240         16.99       $883.63       $315.31       $176.73
68520.....................  T                          Removal of tear sac........          0241         21.89     $1,138.48       $384.47       $227.70
68525.....................  T                          Biopsy of tear sac.........          0240         16.99       $883.63       $315.31       $176.73
68530.....................  T                          Clearance of tear duct.....          0240         16.99       $883.63       $315.31       $176.73
68540.....................  T                          Remove tear gland lesion...          0241         21.89     $1,138.48       $384.47       $227.70
68550.....................  T                          Remove tear gland lesion...          0242         28.87     $1,501.50       $597.36       $300.30
68700.....................  T                          Repair tear ducts..........          0241         21.89     $1,138.48       $384.47       $227.70
68705.....................  T                          Revise tear duct opening...          0238          3.04       $158.11        $58.96        $31.62
68720.....................  T                          Create tear sac drain......          0242         28.87     $1,501.50       $597.36       $300.30
68745.....................  T                          Create tear duct drain.....          0241         21.89     $1,138.48       $384.47       $227.70
68750.....................  T                          Create tear duct drain.....          0242         28.87     $1,501.50       $597.36       $300.30
68760.....................  S                          Close tear duct opening....          0698          1.01        $52.53        $20.49        $10.51
68761.....................  S                          Close tear duct opening....          0231          2.24       $116.50        $52.43        $23.30
68770.....................  T                          Close tear system fistula..          0240         16.99       $883.63       $315.31       $176.73
68801.....................  S                          Dilate tear duct opening...          0231          2.24       $116.50        $52.43        $23.30
68810.....................  T                          Probe nasolacrimal duct....          0699          2.37       $123.26        $55.47        $24.65
68811.....................  T                          Probe nasolacrimal duct....          0240         16.99       $883.63       $315.31       $176.73
68815.....................  T                          Probe nasolacrimal duct....          0240         16.99       $883.63       $315.31       $176.73
68840.....................  T                          Explore/irrigate tear ducts          0699          2.37       $123.26        $55.47        $24.65
68850.....................  N                          Injection for tear sac x-    ............  ............  ............  ............  ............
                                                        ray.
68899.....................  T                          Tear duct system surgery...          0699          2.37       $123.26        $55.47        $24.65
69000.....................  T                          Drain external ear lesion..          0006          1.89        $98.30        $25.56        $19.66
69005.....................  T                          Drain external ear lesion..          0007          9.44       $490.96       $103.10        $98.19
69020.....................  T                          Drain outer ear canal                0006          1.89        $98.30        $25.56        $19.66
                                                        lesion.
69090.....................  E                          Pierce earlobes............  ............  ............  ............  ............  ............
69100.....................  T                          Biopsy of external ear.....          0019          3.94       $204.92        $75.82        $40.98
69105.....................  T                          Biopsy of external ear               0253         14.79       $769.21       $284.61       $153.84
                                                        canal.
69110.....................  T                          Remove external ear,                 0021         14.58       $758.29       $227.49       $151.66
                                                        partial.
69120.....................  T                          Removal of external ear....          0254         21.89     $1,138.48       $352.93       $227.70
69140.....................  T                          Remove ear canal lesion(s).          0254         21.89     $1,138.48       $352.93       $227.70
69145.....................  T                          Remove ear canal lesion(s).          0021         14.58       $758.29       $227.49       $151.66
69150.....................  T                          Extensive ear canal surgery          0252          6.27       $326.10       $114.24        $65.22
69155.....................  C                          Extensive ear/neck surgery.  ............  ............  ............  ............  ............
69200.....................  X                          Clear outer ear canal......          0340          0.66        $34.33  ............         $6.87
69205.....................  T                          Clear outer ear canal......          0022         18.10       $941.36       $367.13       $188.27
69210.....................  X                          Remove impacted ear wax....          0340          0.66        $34.33  ............         $6.87
69220.....................  T                          Clean out mastoid cavity...          0012          0.76        $39.53        $10.67         $7.91
69222.....................  T                          Clean out mastoid cavity...          0253         14.79       $769.21       $284.61       $153.84
69300.....................  T                          Revise external ear........          0254         21.89     $1,138.48       $352.93       $227.70
69310.....................  T                          Rebuild outer ear canal....          0256         35.51     $1,846.84  ............       $369.37
69320.....................  T                          Rebuild outer ear canal....          0256         35.51     $1,846.84  ............       $369.37
69399.....................  T                          Outer ear surgery procedure          0251          1.92        $99.86  ............        $19.97
69400.....................  T                          Inflate middle ear canal...          0251          1.92        $99.86  ............        $19.97
69401.....................  T                          Inflate middle ear canal...          0251          1.92        $99.86  ............        $19.97
69405.....................  T                          Catheterize middle ear               0252          6.27       $326.10       $114.24        $65.22
                                                        canal.
69410.....................  T                          Inset middle ear (baffle)..          0252          6.27       $326.10       $114.24        $65.22
69420.....................  T                          Incision of eardrum........          0251          1.92        $99.86  ............        $19.97
69421.....................  T                          Incision of eardrum........          0253         14.79       $769.21       $284.61       $153.84
69424.....................  T                          Remove ventilating tube....          0252          6.27       $326.10       $114.24        $65.22
69433.....................  T                          Create eardrum opening.....          0252          6.27       $326.10       $114.24        $65.22

[[Page 52240]]

 
69436.....................  T                          Create eardrum opening.....          0253         14.79       $769.21       $284.61       $153.84
69440.....................  T                          Exploration of middle ear..          0254         21.89     $1,138.48       $352.93       $227.70
69450.....................  T                          Eardrum revision...........          0256         35.51     $1,846.84  ............       $369.37
69501.....................  T                          Mastoidectomy..............          0256         35.51     $1,846.84  ............       $369.37
69502.....................  T                          Mastoidectomy..............          0254         21.89     $1,138.48       $352.93       $227.70
69505.....................  T                          Remove mastoid structures..          0256         35.51     $1,846.84  ............       $369.37
69511.....................  T                          Extensive mastoid surgery..          0256         35.51     $1,846.84  ............       $369.37
69530.....................  T                          Extensive mastoid surgery..          0256         35.51     $1,846.84  ............       $369.37
69535.....................  C                          Remove part of temporal      ............  ............  ............  ............  ............
                                                        bone.
69540.....................  T                          Remove ear lesion..........          0253         14.79       $769.21       $284.61       $153.84
69550.....................  T                          Remove ear lesion..........          0256         35.51     $1,846.84  ............       $369.37
69552.....................  T                          Remove ear lesion..........          0256         35.51     $1,846.84  ............       $369.37
69554.....................  C                          Remove ear lesion..........  ............  ............  ............  ............  ............
69601.....................  T                          Mastoid surgery revision...          0256         35.51     $1,846.84  ............       $369.37
69602.....................  T                          Mastoid surgery revision...          0256         35.51     $1,846.84  ............       $369.37
69603.....................  T                          Mastoid surgery revision...          0256         35.51     $1,846.84  ............       $369.37
69604.....................  T                          Mastoid surgery revision...          0256         35.51     $1,846.84  ............       $369.37
69605.....................  T                          Mastoid surgery revision...          0256         35.51     $1,846.84  ............       $369.37
69610.....................  T                          Repair of eardrum..........          0254         21.89     $1,138.48       $352.93       $227.70
69620.....................  T                          Repair of eardrum..........          0254         21.89     $1,138.48       $352.93       $227.70
69631.....................  T                          Repair eardrum structures..          0256         35.51     $1,846.84  ............       $369.37
69632.....................  T                          Rebuild eardrum structures.          0256         35.51     $1,846.84  ............       $369.37
69633.....................  T                          Rebuild eardrum structures.          0256         35.51     $1,846.84  ............       $369.37
69635.....................  T                          Repair eardrum structures..          0256         35.51     $1,846.84  ............       $369.37
69636.....................  T                          Rebuild eardrum structures.          0256         35.51     $1,846.84  ............       $369.37
69637.....................  T                          Rebuild eardrum structures.          0256         35.51     $1,846.84  ............       $369.37
69641.....................  T                          Revise middle ear & mastoid          0256         35.51     $1,846.84  ............       $369.37
69642.....................  T                          Revise middle ear & mastoid          0256         35.51     $1,846.84  ............       $369.37
69643.....................  T                          Revise middle ear & mastoid          0256         35.51     $1,846.84  ............       $369.37
69644.....................  T                          Revise middle ear & mastoid          0256         35.51     $1,846.84  ............       $369.37
69645.....................  T                          Revise middle ear & mastoid          0256         35.51     $1,846.84  ............       $369.37
69646.....................  T                          Revise middle ear & mastoid          0256         35.51     $1,846.84  ............       $369.37
69650.....................  T                          Release middle ear bone....          0254         21.89     $1,138.48       $352.93       $227.70
69660.....................  T                          Revise middle ear bone.....          0256         35.51     $1,846.84  ............       $369.37
69661.....................  T                          Revise middle ear bone.....          0256         35.51     $1,846.84  ............       $369.37
69662.....................  T                          Revise middle ear bone.....          0256         35.51     $1,846.84  ............       $369.37
69666.....................  T                          Repair middle ear                    0256         35.51     $1,846.84  ............       $369.37
                                                        structures.
69667.....................  T                          Repair middle ear                    0256         35.51     $1,846.84  ............       $369.37
                                                        structures.
69670.....................  T                          Remove mastoid air cells...          0256         35.51     $1,846.84  ............       $369.37
69676.....................  T                          Remove middle ear nerve....          0256         35.51     $1,846.84  ............       $369.37
69700.....................  T                          Close mastoid fistula......          0256         35.51     $1,846.84  ............       $369.37
69710.....................  E                          Implant/replace hearing aid  ............  ............  ............  ............  ............
69711.....................  T                          Remove/repair hearing aid..          0256         35.51     $1,846.84  ............       $369.37
69714.....................  T                          Implant temple bone w/               0256         35.51     $1,846.84  ............       $369.37
                                                        stimul.
69715.....................  T                          Temple bne implnt w/                 0256         35.51     $1,846.84  ............       $369.37
                                                        stimulat.
69717.....................  T                          Temple bone implant                  0256         35.51     $1,846.84  ............       $369.37
                                                        revision.
69718.....................  T                          Revise temple bone implant.          0256         35.51     $1,846.84  ............       $369.37
69720.....................  T                          Release facial nerve.......          0256         35.51     $1,846.84  ............       $369.37
69725.....................  T                          Release facial nerve.......          0256         35.51     $1,846.84  ............       $369.37
69740.....................  T                          Repair facial nerve........          0256         35.51     $1,846.84  ............       $369.37
69745.....................  T                          Repair facial nerve........          0256         35.51     $1,846.84  ............       $369.37
69799.....................  T                          Middle ear surgery                   0253         14.79       $769.21       $284.61       $153.84
                                                        procedure.
69801.....................  T                          Incise inner ear...........          0256         35.51     $1,846.84  ............       $369.37
69802.....................  T                          Incise inner ear...........          0256         35.51     $1,846.84  ............       $369.37
69805.....................  T                          Explore inner ear..........          0256         35.51     $1,846.84  ............       $369.37
69806.....................  T                          Explore inner ear..........          0256         35.51     $1,846.84  ............       $369.37
69820.....................  T                          Establish inner ear window.          0256         35.51     $1,846.84  ............       $369.37
69840.....................  T                          Revise inner ear window....          0256         35.51     $1,846.84  ............       $369.37
69905.....................  T                          Remove inner ear...........          0256         35.51     $1,846.84  ............       $369.37
69910.....................  T                          Remove inner ear & mastoid.          0256         35.51     $1,846.84  ............       $369.37
69915.....................  T                          Incise inner ear nerve.....          0256         35.51     $1,846.84  ............       $369.37
69930.....................  T                          Implant cochlear device....          0259        291.05    $15,137.22     $7,417.24     $3,027.44
69949.....................  T                          Inner ear surgery procedure          0253         14.79       $769.21       $284.61       $153.84
69950.....................  C                          Incise inner ear nerve.....  ............  ............  ............  ............  ............
69955.....................  T                          Release facial nerve.......          0256         35.51     $1,846.84  ............       $369.37
69960.....................  T                          Release inner ear canal....          0256         35.51     $1,846.84  ............       $369.37

[[Page 52241]]

 
69970.....................  C                          Remove inner ear lesion....  ............  ............  ............  ............  ............
69979.....................  T                          Temporal bone surgery......          0251          1.92        $99.86  ............        $19.97
69990.....................  N                          Microsurgery add-on........  ............  ............  ............  ............  ............
70010.....................  S                          Contrast x-ray of brain....          0274          3.21       $166.95        $80.14        $33.39
70015.....................  S                          Contrast x-ray of brain....          0274          3.21       $166.95        $80.14        $33.39
70030.....................  X                          X-ray eye for foreign body.          0260          0.81        $42.13        $23.17         $8.43
70100.....................  X                          X-ray exam of jaw..........          0260          0.81        $42.13        $23.17         $8.43
70110.....................  X                          X-ray exam of jaw..........          0260          0.81        $42.13        $23.17         $8.43
70120.....................  X                          X-ray exam of mastoids.....          0260          0.81        $42.13        $23.17         $8.43
70130.....................  X                          X-ray exam of mastoids.....          0260          0.81        $42.13        $23.17         $8.43
70134.....................  X                          X-ray exam of middle ear...          0261          1.37        $71.25        $34.15        $14.25
70140.....................  X                          X-ray exam of facial bones.          0260          0.81        $42.13        $23.17         $8.43
70150.....................  X                          X-ray exam of facial bones.          0260          0.81        $42.13        $23.17         $8.43
70160.....................  X                          X-ray exam of nasal bones..          0260          0.81        $42.13        $23.17         $8.43
70170.....................  X                          X-ray exam of tear duct....          0263          1.99       $103.50        $45.54        $20.70
70190.....................  X                          X-ray exam of eye sockets..          0260          0.81        $42.13        $23.17         $8.43
70200.....................  X                          X-ray exam of eye sockets..          0260          0.81        $42.13        $23.17         $8.43
70210.....................  X                          X-ray exam of sinuses......          0260          0.81        $42.13        $23.17         $8.43
70220.....................  X                          X-ray exam of sinuses......          0260          0.81        $42.13        $23.17         $8.43
70240.....................  X                          X-ray exam, pituitary                0260          0.81        $42.13        $23.17         $8.43
                                                        saddle.
70250.....................  X                          X-ray exam of skull........          0260          0.81        $42.13        $23.17         $8.43
70260.....................  X                          X-ray exam of skull........          0261          1.37        $71.25        $34.15        $14.25
70300.....................  X                          X-ray exam of teeth........          0262          0.60        $31.21        $10.30         $6.24
70310.....................  X                          X-ray exam of teeth........          0262          0.60        $31.21        $10.30         $6.24
70320.....................  X                          Full mouth x-ray of teeth..          0262          0.60        $31.21        $10.30         $6.24
70328.....................  X                          X-ray exam of jaw joint....          0260          0.81        $42.13        $23.17         $8.43
70330.....................  X                          X-ray exam of jaw joints...          0260          0.81        $42.13        $23.17         $8.43
70332.....................  S                          X-ray exam of jaw joint....          0275          3.09       $160.71        $69.09        $32.14
70336.....................  S                          Magnetic image, jaw joint..          0335          6.46       $335.98       $151.46        $67.20
70350.....................  X                          X-ray head for orthodontia.          0260          0.81        $42.13        $23.17         $8.43
70355.....................  X                          Panoramic x-ray of jaws....          0260          0.81        $42.13        $23.17         $8.43
70360.....................  X                          X-ray exam of neck.........          0260          0.81        $42.13        $23.17         $8.43
70370.....................  X                          Throat x-ray & fluoroscopy.          0272          1.38        $71.77        $38.64        $14.35
70371.....................  X                          Speech evaluation, complex.          0272          1.38        $71.77        $38.64        $14.35
70373.....................  X                          Contrast x-ray of larynx...          0263          1.99       $103.50        $45.54        $20.70
70380.....................  X                          X-ray exam of salivary               0260          0.81        $42.13        $23.17         $8.43
                                                        gland.
70390.....................  X                          X-ray exam of salivary duct          0264          2.75       $143.02        $77.23        $28.60
70450.....................  S                          Ct head/brain w/o dye......          0332          3.62       $188.27        $91.27        $37.65
70460.....................  S                          Ct head/brain w/dye........          0283          4.75       $247.04  ............        $49.41
70470.....................  S                          Ct head/brain w/o&w dye....          0333          5.69       $295.93       $146.98        $59.19
70480.....................  S                          Ct orbit/ear/fossa w/o dye.          0332          3.62       $188.27        $91.27        $37.65
70481.....................  S                          Ct orbit/ear/fossa w/dye...          0283          4.75       $247.04  ............        $49.41
70482.....................  S                          Ct orbit/ear/fossa w/o&w             0333          5.69       $295.93       $146.98        $59.19
                                                        dye.
70486.....................  S                          Ct maxillofacial w/o dye...          0332          3.62       $188.27        $91.27        $37.65
70487.....................  S                          Ct maxillofacial w/dye.....          0283          4.75       $247.04  ............        $49.41
70488.....................  S                          Ct maxillofacial w/o&w dye.          0333          5.69       $295.93       $146.98        $59.19
70490.....................  S                          Ct soft tissue neck w/o dye          0332          3.62       $188.27        $91.27        $37.65
70491.....................  S                          Ct soft tissue neck w/dye..          0283          4.75       $247.04  ............        $49.41
70492.....................  S                          Ct sft tsue nck w/o & w/dye          0333          5.69       $295.93       $146.98        $59.19
70496.....................  S                          Ct angiography, head.......          0662          5.96       $309.97       $170.48        $61.99
70498.....................  S                          Ct angiography, neck.......          0662          5.96       $309.97       $170.48        $61.99
70540.....................  S                          Mri orbit/face/neck w/o dye          0336          7.01       $364.58       $176.94        $72.92
70542.....................  S                          Mri orbit/face/neck w/dye..          0284          7.74       $402.55       $201.02        $80.51
70543.....................  S                          Mri orbt/fac/nck w/o&w dye.          0337          9.86       $512.81       $240.77       $102.56
70544.....................  S                          Mr angiography head w/o dye          0336          7.01       $364.58       $176.94        $72.92
70545.....................  S                          Mr angiography head w/dye..          0284          7.74       $402.55       $201.02        $80.51
70546.....................  S                          Mr angiograph head w/o&w             0337          9.86       $512.81       $240.77       $102.56
                                                        dye.
70547.....................  S                          Mr angiography neck w/o dye          0336          7.01       $364.58       $176.94        $72.92
70548.....................  S                          Mr angiography neck w/dye..          0284          7.74       $402.55       $201.02        $80.51
70549.....................  S                          Mr angiograph neck w/o&w             0337          9.86       $512.81       $240.77       $102.56
                                                        dye.
70551.....................  S                          Mri brain w/o dye..........          0336          7.01       $364.58       $176.94        $72.92
70552.....................  S                          Mri brain w/dye............          0284          7.74       $402.55       $201.02        $80.51
70553.....................  S                          Mri brain w/o&w dye........          0337          9.86       $512.81       $240.77       $102.56
71010.....................  X                          Chest x-ray................          0260          0.81        $42.13        $23.17         $8.43
71015.....................  X                          Chest x-ray................          0260          0.81        $42.13        $23.17         $8.43
71020.....................  X                          Chest x-ray................          0260          0.81        $42.13        $23.17         $8.43

[[Page 52242]]

 
71021.....................  X                          Chest x-ray................          0260          0.81        $42.13        $23.17         $8.43
71022.....................  X                          Chest x-ray................          0260          0.81        $42.13        $23.17         $8.43
71023.....................  X                          Chest x-ray and fluoroscopy          0272          1.38        $71.77        $38.64        $14.35
71030.....................  X                          Chest x-ray................          0260          0.81        $42.13        $23.17         $8.43
71034.....................  X                          Chest x-ray and fluoroscopy          0272          1.38        $71.77        $38.64        $14.35
71035.....................  X                          Chest x-ray................          0260          0.81        $42.13        $23.17         $8.43
71040.....................  X                          Contrast x-ray of bronchi..          0263          1.99       $103.50        $45.54        $20.70
71060.....................  X                          Contrast x-ray of bronchi..          0264          2.75       $143.02        $77.23        $28.60
71090.....................  X                          X-ray & pacemaker insertion          0272          1.38        $71.77        $38.64        $14.35
71100.....................  X                          X-ray exam of ribs.........          0260          0.81        $42.13        $23.17         $8.43
71101.....................  X                          X-ray exam of ribs/chest...          0260          0.81        $42.13        $23.17         $8.43
71110.....................  X                          X-ray exam of ribs.........          0260          0.81        $42.13        $23.17         $8.43
71111.....................  X                          X-ray exam of ribs/ chest..          0261          1.37        $71.25        $34.15        $14.25
71120.....................  X                          X-ray exam of breastbone...          0260          0.81        $42.13        $23.17         $8.43
71130.....................  X                          X-ray exam of breastbone...          0260          0.81        $42.13        $23.17         $8.43
71250.....................  S                          Ct thorax w/o dye..........          0332          3.62       $188.27        $91.27        $37.65
71260.....................  S                          Ct thorax w/dye............          0283          4.75       $247.04  ............        $49.41
71270.....................  S                          Ct thorax w/o&w dye........          0333          5.69       $295.93       $146.98        $59.19
71275.....................  S                          Ct angiography, chest......          0662          5.96       $309.97       $170.48        $61.99
71550.....................  S                          Mri chest w/o dye..........          0336          7.01       $364.58       $176.94        $72.92
71551.....................  S                          Mri chest w/dye............          0284          7.74       $402.55       $201.02        $80.51
71552.....................  S                          Mri chest w/o&w dye........          0337          9.86       $512.81       $240.77       $102.56
71555.....................  E                          Mri angio chest w or w/o     ............  ............  ............  ............  ............
                                                        dye.
72010.....................  X                          X-ray exam of spine........          0261          1.37        $71.25        $34.15        $14.25
72020.....................  X                          X-ray exam of spine........          0260          0.81        $42.13        $23.17         $8.43
72040.....................  X                          X-ray exam of neck spine...          0260          0.81        $42.13        $23.17         $8.43
72050.....................  X                          X-ray exam of neck spine...          0261          1.37        $71.25        $34.15        $14.25
72052.....................  X                          X-ray exam of neck spine...          0261          1.37        $71.25        $34.15        $14.25
72069.....................  X                          X-ray exam of trunk spine..          0260          0.81        $42.13        $23.17         $8.43
72070.....................  X                          X-ray exam of thoracic               0260          0.81        $42.13        $23.17         $8.43
                                                        spine.
72072.....................  X                          X-ray exam of thoracic               0260          0.81        $42.13        $23.17         $8.43
                                                        spine.
72074.....................  X                          X-ray exam of thoracic               0260          0.81        $42.13        $23.17         $8.43
                                                        spine.
72080.....................  X                          X-ray exam of trunk spine..          0260          0.81        $42.13        $23.17         $8.43
72090.....................  X                          X-ray exam of trunk spine..          0261          1.37        $71.25        $34.15        $14.25
72100.....................  X                          X-ray exam of lower spine..          0260          0.81        $42.13        $23.17         $8.43
72110.....................  X                          X-ray exam of lower spine..          0261          1.37        $71.25        $34.15        $14.25
72114.....................  X                          X-ray exam of lower spine..          0261          1.37        $71.25        $34.15        $14.25
72120.....................  X                          X-ray exam of lower spine..          0260          0.81        $42.13        $23.17         $8.43
72125.....................  S                          Ct neck spine w/o dye......          0332          3.62       $188.27        $91.27        $37.65
72126.....................  S                          Ct neck spine w/dye........          0283          4.75       $247.04  ............        $49.41
72127.....................  S                          Ct neck spine w/o&w dye....          0333          5.69       $295.93       $146.98        $59.19
72128.....................  S                          Ct chest spine w/o dye.....          0332          3.62       $188.27        $91.27        $37.65
72129.....................  S                          Ct chest spine w/dye.......          0283          4.75       $247.04  ............        $49.41
72130.....................  S                          Ct chest spine w/o&w dye...          0333          5.69       $295.93       $146.98        $59.19
72131.....................  S                          Ct lumbar spine w/o dye....          0332          3.62       $188.27        $91.27        $37.65
72132.....................  S                          Ct lumbar spine w/dye......          0283          4.75       $247.04  ............        $49.41
72133.....................  S                          Ct lumbar spine w/o&w dye..          0333          5.69       $295.93       $146.98        $59.19
72141.....................  S                          Mri neck spine w/o dye.....          0336          7.01       $364.58       $176.94        $72.92
72142.....................  S                          Mri neck spine w/dye.......          0284          7.74       $402.55       $201.02        $80.51
72146.....................  S                          Mri chest spine w/o dye....          0336          7.01       $364.58       $176.94        $72.92
72147.....................  S                          Mri chest spine w/dye......          0284          7.74       $402.55       $201.02        $80.51
72148.....................  S                          Mri lumbar spine w/o dye...          0336          7.01       $364.58       $176.94        $72.92
72149.....................  S                          Mri lumbar spine w/dye.....          0284          7.74       $402.55       $201.02        $80.51
72156.....................  S                          Mri neck spine w/o&w dye...          0337          9.86       $512.81       $240.77       $102.56
72157.....................  S                          Mri chest spine w/o&w dye..          0337          9.86       $512.81       $240.77       $102.56
72158.....................  S                          Mri lumbar spine w/o&w dye.          0337          9.86       $512.81       $240.77       $102.56
72159.....................  E                          Mr angio spine w/o&w dye...  ............  ............  ............  ............  ............
72170.....................  X                          X-ray exam of pelvis.......          0260          0.81        $42.13        $23.17         $8.43
72190.....................  X                          X-ray exam of pelvis.......          0260          0.81        $42.13        $23.17         $8.43
72191.....................  S                          Ct angiograph pelv w/o&w             0662          5.96       $309.97       $170.48        $61.99
                                                        dye.
72192.....................  S                          Ct pelvis w/o dye..........          0332          3.62       $188.27        $91.27        $37.65
72193.....................  S                          Ct pelvis w/dye............          0283          4.75       $247.04  ............        $49.41
72194.....................  S                          Ct pelvis w/o&w dye........          0333          5.69       $295.93       $146.98        $59.19
72195.....................  S                          Mri pelvis w/o dye.........          0336          7.01       $364.58       $176.94        $72.92
72196.....................  S                          Mri pelvis w/dye...........          0284          7.74       $402.55       $201.02        $80.51
72197.....................  S                          Mri pelvis w/o & w dye.....          0337          9.86       $512.81       $240.77       $102.56

[[Page 52243]]

 
72198.....................  E                          Mr angio pelvis w/o&w dye..  ............  ............  ............  ............  ............
72200.....................  X                          X-ray exam sacroiliac                0260          0.81        $42.13        $23.17         $8.43
                                                        joints.
72202.....................  X                          X-ray exam sacroiliac                0260          0.81        $42.13        $23.17         $8.43
                                                        joints.
72220.....................  X                          X-ray exam of tailbone.....          0260          0.81        $42.13        $23.17         $8.43
72240.....................  S                          Contrast x-ray of neck               0274          3.21       $166.95        $80.14        $33.39
                                                        spine.
72255.....................  S                          Contrast x-ray, thorax               0274          3.21       $166.95        $80.14        $33.39
                                                        spine.
72265.....................  S                          Contrast x-ray, lower spine          0274          3.21       $166.95        $80.14        $33.39
72270.....................  S                          Contrast x-ray of spine....          0274          3.21       $166.95        $80.14        $33.39
72275.....................  S                          Epidurography..............          0274          3.21       $166.95        $80.14        $33.39
72285.....................  S                          X-ray c/t spine disk.......          0274          3.21       $166.95        $80.14        $33.39
72295.....................  S                          X-ray of lower spine disk..          0274          3.21       $166.95        $80.14        $33.39
73000.....................  X                          X-ray exam of collar bone..          0260          0.81        $42.13        $23.17         $8.43
73010.....................  X                          X-ray exam of shoulder               0260          0.81        $42.13        $23.17         $8.43
                                                        blade.
73020.....................  X                          X-ray exam of shoulder.....          0260          0.81        $42.13        $23.17         $8.43
73030.....................  X                          X-ray exam of shoulder.....          0260          0.81        $42.13        $23.17         $8.43
73040.....................  S                          Contrast x-ray of shoulder.          0275          3.09       $160.71        $69.09        $32.14
73050.....................  X                          X-ray exam of shoulders....          0260          0.81        $42.13        $23.17         $8.43
73060.....................  X                          X-ray exam of humerus......          0260          0.81        $42.13        $23.17         $8.43
73070.....................  X                          X-ray exam of elbow........          0260          0.81        $42.13        $23.17         $8.43
73080.....................  X                          X-ray exam of elbow........          0260          0.81        $42.13        $23.17         $8.43
73085.....................  S                          Contrast x-ray of elbow....          0275          3.09       $160.71        $69.09        $32.14
73090.....................  X                          X-ray exam of forearm......          0260          0.81        $42.13        $23.17         $8.43
73092.....................  X                          X-ray exam of arm, infant..          0260          0.81        $42.13        $23.17         $8.43
73100.....................  X                          X-ray exam of wrist........          0260          0.81        $42.13        $23.17         $8.43
73110.....................  X                          X-ray exam of wrist........          0260          0.81        $42.13        $23.17         $8.43
73115.....................  S                          Contrast x-ray of wrist....          0275          3.09       $160.71        $69.09        $32.14
73120.....................  X                          X-ray exam of hand.........          0260          0.81        $42.13        $23.17         $8.43
73130.....................  X                          X-ray exam of hand.........          0260          0.81        $42.13        $23.17         $8.43
73140.....................  X                          X-ray exam of finger(s)....          0260          0.81        $42.13        $23.17         $8.43
73200.....................  S                          Ct upper extremity w/o dye.          0332          3.62       $188.27        $91.27        $37.65
73201.....................  S                          Ct upper extremity w/dye...          0283          4.75       $247.04  ............        $49.41
73202.....................  S                          Ct uppr extremity w/o&w dye          0333          5.69       $295.93       $146.98        $59.19
73206.....................  S                          Ct angio upr extrm w/o&w             0662          5.96       $309.97       $170.48        $61.99
                                                        dye.
73218.....................  S                          Mri upper extremity w/o dye          0336          7.01       $364.58       $176.94        $72.92
73219.....................  S                          Mri upper extremity w/dye..          0284          7.74       $402.55       $201.02        $80.51
73220.....................  S                          Mri uppr extremity w/o&w             0337          9.86       $512.81       $240.77       $102.56
                                                        dye.
73221.....................  S                          Mri joint upr extrem w/o             0336          7.01       $364.58       $176.94        $72.92
                                                        dye.
73222.....................  S                          Mri joint upr extrem w/ dye          0284          7.74       $402.55       $201.02        $80.51
73223.....................  S                          Mri joint upr extr w/o&w             0337          9.86       $512.81       $240.77       $102.56
                                                        dye.
73225.....................  E                          Mr angio upr extr w/o&w dye  ............  ............  ............  ............  ............
73500.....................  X                          X-ray exam of hip..........          0260          0.81        $42.13        $23.17         $8.43
73510.....................  X                          X-ray exam of hip..........          0260          0.81        $42.13        $23.17         $8.43
73520.....................  X                          X-ray exam of hips.........          0260          0.81        $42.13        $23.17         $8.43
73525.....................  S                          Contrast x-ray of hip......          0275          3.09       $160.71        $69.09        $32.14
73530.....................  X                          X-ray exam of hip..........          0261          1.37        $71.25        $34.15        $14.25
73540.....................  X                          X-ray exam of pelvis & hips          0260          0.81        $42.13        $23.17         $8.43
73542.....................  S                          X-ray exam, sacroiliac               0275          3.09       $160.71        $69.09        $32.14
                                                        joint.
73550.....................  X                          X-ray exam of thigh........          0260          0.81        $42.13        $23.17         $8.43
73560.....................  X                          X-ray exam of knee, 1 or 2.          0260          0.81        $42.13        $23.17         $8.43
73562.....................  X                          X-ray exam of knee, 3......          0260          0.81        $42.13        $23.17         $8.43
73564.....................  X                          X-ray exam, knee, 4 or more          0260          0.81        $42.13        $23.17         $8.43
73565.....................  X                          X-ray exam of knees........          0260          0.81        $42.13        $23.17         $8.43
73580.....................  S                          Contrast x-ray of knee               0275          3.09       $160.71        $69.09        $32.14
                                                        joint.
73590.....................  X                          X-ray exam of lower leg....          0260          0.81        $42.13        $23.17         $8.43
73592.....................  X                          X-ray exam of leg, infant..          0260          0.81        $42.13        $23.17         $8.43
73600.....................  X                          X-ray exam of ankle........          0260          0.81        $42.13        $23.17         $8.43
73610.....................  X                          X-ray exam of ankle........          0260          0.81        $42.13        $23.17         $8.43
73615.....................  S                          Contrast x-ray of ankle....          0275          3.09       $160.71        $69.09        $32.14
73620.....................  X                          X-ray exam of foot.........          0260          0.81        $42.13        $23.17         $8.43
73630.....................  X                          X-ray exam of foot.........          0260          0.81        $42.13        $23.17         $8.43
73650.....................  X                          X-ray exam of heel.........          0260          0.81        $42.13        $23.17         $8.43
73660.....................  X                          X-ray exam of toe(s).......          0260          0.81        $42.13        $23.17         $8.43
73700.....................  S                          Ct lower extremity w/o dye.          0332          3.62       $188.27        $91.27        $37.65
73701.....................  S                          Ct lower extremity w/dye...          0283          4.75       $247.04  ............        $49.41
73702.....................  S                          Ct lwr extremity w/o&w dye.          0333          5.69       $295.93       $146.98        $59.19
73706.....................  S                          Ct angio lwr extr w/o&w dye          0662          5.96       $309.97       $170.48        $61.99

[[Page 52244]]

 
73718.....................  S                          Mri lower extremity w/o dye          0336          7.01       $364.58       $176.94        $72.92
73719.....................  S                          Mri lower extremity w/dye..          0284          7.74       $402.55       $201.02        $80.51
73720.....................  S                          Mri lwr extremity w/o&w dye          0337          9.86       $512.81       $240.77       $102.56
73721.....................  S                          Mri joint of lwr extre w/o           0336          7.01       $364.58       $176.94        $72.92
                                                        d.
73722.....................  S                          Mri joint of lwr extr w/dye          0284          7.74       $402.55       $201.02        $80.51
73723.....................  S                          Mri joint lwr extr w/o&w             0337          9.86       $512.81       $240.77       $102.56
                                                        dye.
73725.....................  E                          Mr ang lwr ext w or w/o dye  ............  ............  ............  ............  ............
74000.....................  X                          X-ray exam of abdomen......          0260          0.81        $42.13        $23.17         $8.43
74010.....................  X                          X-ray exam of abdomen......          0260          0.81        $42.13        $23.17         $8.43
74020.....................  X                          X-ray exam of abdomen......          0260          0.81        $42.13        $23.17         $8.43
74022.....................  X                          X-ray exam series, abdomen.          0261          1.37        $71.25        $34.15        $14.25
74150.....................  S                          Ct abdomen w/o dye.........          0332          3.62       $188.27        $91.27        $37.65
74160.....................  S                          Ct abdomen w/dye...........          0283          4.75       $247.04  ............        $49.41
74170.....................  S                          Ct abdomen w/o&w dye.......          0333          5.69       $295.93       $146.98        $59.19
74175.....................  S                          Ct angio abdom w/o&w dye...          0662          5.96       $309.97       $170.48        $61.99
74181.....................  S                          Mri abdomen w/o dye........          0336          7.01       $364.58       $176.94        $72.92
74182.....................  S                          Mri abdomen w/dye..........          0284          7.74       $402.55       $201.02        $80.51
74183.....................  S                          Mri abdomen w/o&w dye......          0337          9.86       $512.81       $240.77       $102.56
74185.....................  E                          Mri angio, abdom w or w/o    ............  ............  ............  ............  ............
                                                        dy.
74190.....................  X                          X-ray exam of peritoneum...          0263          1.99       $103.50        $45.54        $20.70
74210.....................  S                          Contrst x-ray exam of                0276          1.69        $87.90        $41.72        $17.58
                                                        throat.
74220.....................  S                          Contrast x-ray, esophagus..          0276          1.69        $87.90        $41.72        $17.58
74230.....................  S                          Cine/video x-ray, throat/            0276          1.69        $87.90        $41.72        $17.58
                                                        eso.
74235.....................  S                          Remove esophagus                     0296          2.12       $110.26        $52.92        $22.05
                                                        obstruction.
74240.....................  S                          X-ray exam, upper gi tract.          0276          1.69        $87.90        $41.72        $17.58
74241.....................  S                          X-ray exam, upper gi tract.          0276          1.69        $87.90        $41.72        $17.58
74245.....................  S                          X-ray exam, upper gi tract.          0277          2.50       $130.02        $60.47        $26.00
74246.....................  S                          Contrst x-ray uppr gi tract          0276          1.69        $87.90        $41.72        $17.58
74247.....................  S                          Contrst x-ray uppr gi tract          0276          1.69        $87.90        $41.72        $17.58
74249.....................  S                          Contrst x-ray uppr gi tract          0277          2.50       $130.02        $60.47        $26.00
74250.....................  S                          X-ray exam of small bowel..          0276          1.69        $87.90        $41.72        $17.58
74251.....................  S                          X-ray exam of small bowel..          0277          2.50       $130.02        $60.47        $26.00
74260.....................  S                          X-ray exam of small bowel..          0277          2.50       $130.02        $60.47        $26.00
74270.....................  S                          Contrast x-ray exam of               0276          1.69        $87.90        $41.72        $17.58
                                                        colon.
74280.....................  S                          Contrast x-ray exam of               0277          2.50       $130.02        $60.47        $26.00
                                                        colon.
74283.....................  S                          Contrast x-ray exam of               0276          1.69        $87.90        $41.72        $17.58
                                                        colon.
74290.....................  S                          Contrast x-ray, gallbladder          0276          1.69        $87.90        $41.72        $17.58
74291.....................  S                          Contrast x-rays,                     0276          1.69        $87.90        $41.72        $17.58
                                                        gallbladder.
74300.....................  X                          X-ray bile ducts/pancreas..          0263          1.99       $103.50        $45.54        $20.70
74301.....................  X                          X-rays at surgery add-on...          0263          1.99       $103.50        $45.54        $20.70
74305.....................  X                          X-ray bile ducts/pancreas..          0263          1.99       $103.50        $45.54        $20.70
74320.....................  X                          Contrast x-ray of bile               0264          2.75       $143.02        $77.23        $28.60
                                                        ducts.
74327.....................  S                          X-ray bile stone removal...          0296          2.12       $110.26        $52.92        $22.05
74328.....................  N                          Xray bile duct endoscopy...  ............  ............  ............  ............  ............
74329.....................  N                          X-ray for pancreas           ............  ............  ............  ............  ............
                                                        endoscopy.
74330.....................  N                          X-ray bile/panc endoscopy..  ............  ............  ............  ............  ............
74340.....................  X                          X-ray guide for GI tube....          0272          1.38        $71.77        $38.64        $14.35
74350.....................  X                          X-ray guide, stomach tube..          0263          1.99       $103.50        $45.54        $20.70
74355.....................  X                          X-ray guide, intestinal              0263          1.99       $103.50        $45.54        $20.70
                                                        tube.
74360.....................  S                          X-ray guide, GI dilation...          0296          2.12       $110.26        $52.92        $22.05
74363.....................  S                          X-ray, bile duct dilation..          0297          7.80       $405.67       $172.51        $81.13
74400.....................  S                          Contrst x-ray, urinary               0278          2.65       $137.82        $66.07        $27.56
                                                        tract.
74410.....................  S                          Contrst x-ray, urinary               0278          2.65       $137.82        $66.07        $27.56
                                                        tract.
74415.....................  S                          Contrst x-ray, urinary               0278          2.65       $137.82        $66.07        $27.56
                                                        tract.
74420.....................  S                          Contrst x-ray, urinary               0278          2.65       $137.82        $66.07        $27.56
                                                        tract.
74425.....................  S                          Contrst x-ray, urinary               0278          2.65       $137.82        $66.07        $27.56
                                                        tract.
74430.....................  S                          Contrast x-ray, bladder....          0278          2.65       $137.82        $66.07        $27.56
74440.....................  S                          X-ray, male genital tract..          0278          2.65       $137.82        $66.07        $27.56
74445.....................  S                          X-ray exam of penis........          0278          2.65       $137.82        $66.07        $27.56
74450.....................  S                          X-ray, urethra/bladder.....          0278          2.65       $137.82        $66.07        $27.56
74455.....................  S                          X-ray, urethra/bladder.....          0278          2.65       $137.82        $66.07        $27.56
74470.....................  X                          X-ray exam of kidney lesion          0264          2.75       $143.02        $77.23        $28.60
74475.....................  S                          X-ray control, cath insert.          0297          7.80       $405.67       $172.51        $81.13
74480.....................  S                          X-ray control, cath insert.          0296          2.12       $110.26        $52.92        $22.05
74485.....................  S                          X-ray guide, GU dilation...          0296          2.12       $110.26        $52.92        $22.05
74710.....................  X                          X-ray measurement of pelvis          0260          0.81        $42.13        $23.17         $8.43

[[Page 52245]]

 
74740.....................  X                          X-ray, female genital tract          0264          2.75       $143.02        $77.23        $28.60
74742.....................  X                          X-ray, fallopian tube......          0263          1.99       $103.50        $45.54        $20.70
74775.....................  S                          X-ray exam of perineum.....          0278          2.65       $137.82        $66.07        $27.56
75552.....................  S                          Heart mri for morph w/o dye          0336          7.01       $364.58       $176.94        $72.92
75553.....................  S                          Heart mri for morph w/dye..          0284          7.74       $402.55       $201.02        $80.51
75554.....................  S                          Cardiac MRI/function.......          0335          6.46       $335.98       $151.46        $67.20
75555.....................  S                          Cardiac MRI/limited study..          0335          6.46       $335.98       $151.46        $67.20
75556.....................  E                          Cardiac MRI/flow mapping...  ............  ............  ............  ............  ............
75600.....................  S                          Contrast x-ray exam of               0280         15.51       $806.66       $353.85       $161.33
                                                        aorta.
75605.....................  S                          Contrast x-ray exam of               0280         15.51       $806.66       $353.85       $161.33
                                                        aorta.
75625.....................  S                          Contrast x-ray exam of               0280         15.51       $806.66       $353.85       $161.33
                                                        aorta.
75630.....................  S                          X-ray aorta, leg arteries..          0280         15.51       $806.66       $353.85       $161.33
75635.....................  S                          Ct angio abdominal arteries          0662          5.96       $309.97       $170.48        $61.99
75650.....................  S                          Artery x-rays, head & neck.          0280         15.51       $806.66       $353.85       $161.33
75658.....................  S                          Artery x-rays, arm.........          0280         15.51       $806.66       $353.85       $161.33
75660.....................  S                          Artery x-rays, head & neck.          0279          8.41       $437.40       $174.57        $87.48
75662.....................  S                          Artery x-rays, head & neck.          0279          8.41       $437.40       $174.57        $87.48
75665.....................  S                          Artery x-rays, head & neck.          0280         15.51       $806.66       $353.85       $161.33
75671.....................  S                          Artery x-rays, head & neck.          0280         15.51       $806.66       $353.85       $161.33
75676.....................  S                          Artery x-rays, neck........          0280         15.51       $806.66       $353.85       $161.33
75680.....................  S                          Artery x-rays, neck........          0280         15.51       $806.66       $353.85       $161.33
75685.....................  S                          Artery x-rays, spine.......          0279          8.41       $437.40       $174.57        $87.48
75705.....................  S                          Artery x-rays, spine.......          0279          8.41       $437.40       $174.57        $87.48
75710.....................  S                          Artery x-rays, arm/leg.....          0280         15.51       $806.66       $353.85       $161.33
75716.....................  S                          Artery x-rays, arms/legs...          0280         15.51       $806.66       $353.85       $161.33
75722.....................  S                          Artery x-rays, kidney......          0280         15.51       $806.66       $353.85       $161.33
75724.....................  S                          Artery x-rays, kidneys.....          0280         15.51       $806.66       $353.85       $161.33
75726.....................  S                          Artery x-rays, abdomen.....          0280         15.51       $806.66       $353.85       $161.33
75731.....................  S                          Artery x-rays, adrenal               0280         15.51       $806.66       $353.85       $161.33
                                                        gland.
75733.....................  S                          Artery x-rays, adrenals....          0280         15.51       $806.66       $353.85       $161.33
75736.....................  S                          Artery x-rays, pelvis......          0280         15.51       $806.66       $353.85       $161.33
75741.....................  S                          Artery x-rays, lung........          0279          8.41       $437.40       $174.57        $87.48
75743.....................  S                          Artery x-rays, lungs.......          0280         15.51       $806.66       $353.85       $161.33
75746.....................  S                          Artery x-rays, lung........          0279          8.41       $437.40       $174.57        $87.48
75756.....................  S                          Artery x-rays, chest.......          0279          8.41       $437.40       $174.57        $87.48
75774.....................  S                          Artery x-ray, each vessel..          0668          5.36       $278.77       $122.66        $55.75
75790.....................  S                          Visualize A-V shunt........          0281          5.23       $272.01       $115.16        $54.40
75801.....................  X                          Lymph vessel x-ray, arm/leg          0264          2.75       $143.02        $77.23        $28.60
75803.....................  X                          Lymph vessel x-ray,arms/             0264          2.75       $143.02        $77.23        $28.60
                                                        legs.
75805.....................  X                          Lymph vessel x-ray, trunk..          0264          2.75       $143.02        $77.23        $28.60
75807.....................  X                          Lymph vessel x-ray, trunk..          0264          2.75       $143.02        $77.23        $28.60
75809.....................  X                          Nonvascular shunt, x-ray...          0263          1.99       $103.50        $45.54        $20.70
75810.....................  S                          Vein x-ray, spleen/liver...          0279          8.41       $437.40       $174.57        $87.48
75820.....................  S                          Vein x-ray, arm/leg........          0281          5.23       $272.01       $115.16        $54.40
75822.....................  S                          Vein x-ray, arms/legs......          0281          5.23       $272.01       $115.16        $54.40
75825.....................  S                          Vein x-ray, trunk..........          0279          8.41       $437.40       $174.57        $87.48
75827.....................  S                          Vein x-ray, chest..........          0279          8.41       $437.40       $174.57        $87.48
75831.....................  S                          Vein x-ray, kidney.........          0287          7.13       $370.82       $114.51        $74.16
75833.....................  S                          Vein x-ray, kidneys........          0279          8.41       $437.40       $174.57        $87.48
75840.....................  S                          Vein x-ray, adrenal gland..          0287          7.13       $370.82       $114.51        $74.16
75842.....................  S                          Vein x-ray, adrenal glands.          0287          7.13       $370.82       $114.51        $74.16
75860.....................  S                          Vein x-ray, neck...........          0287          7.13       $370.82       $114.51        $74.16
75870.....................  S                          Vein x-ray, skull..........          0287          7.13       $370.82       $114.51        $74.16
75872.....................  S                          Vein x-ray, skull..........          0287          7.13       $370.82       $114.51        $74.16
75880.....................  S                          Vein x-ray, eye socket.....          0287          7.13       $370.82       $114.51        $74.16
75885.....................  S                          Vein x-ray, liver..........          0279          8.41       $437.40       $174.57        $87.48
75887.....................  S                          Vein x-ray, liver..........          0280         15.51       $806.66       $353.85       $161.33
75889.....................  S                          Vein x-ray, liver..........          0279          8.41       $437.40       $174.57        $87.48
75891.....................  S                          Vein x-ray, liver..........          0279          8.41       $437.40       $174.57        $87.48
75893.....................  N                          Venous sampling by catheter  ............  ............  ............  ............  ............
75894.....................  S                          X-rays, transcath therapy..          0297          7.80       $405.67       $172.51        $81.13
75896.....................  S                          X-rays, transcath therapy..          0297          7.80       $405.67       $172.51        $81.13
75898.....................  X                          Follow-up angiography......          0264          2.75       $143.02        $77.23        $28.60
75900.....................  C                          Arterial catheter exchange.  ............  ............  ............  ............  ............
75940.....................  X                          X-ray placement, vein                0187          4.19       $217.92        $94.96        $43.58
                                                        filter.
75945.....................  S                          Intravascular us...........          0267          2.58       $134.18        $65.52        $26.84

[[Page 52246]]

 
75946.....................  S                          Intravascular us add-on....          0267          2.58       $134.18        $65.52        $26.84
75952.....................  C                          Endovasc repair abdom aorta  ............  ............  ............  ............  ............
75953.....................  C                          Abdom aneurysm endovas rpr.  ............  ............  ............  ............  ............
75960.....................  S                          Transcatheter intro, stent.          0280         15.51       $806.66       $353.85       $161.33
75961.....................  S                          Retrieval, broken catheter.          0280         15.51       $806.66       $353.85       $161.33
75962.....................  S                          Repair arterial blockage...          0280         15.51       $806.66       $353.85       $161.33
75964.....................  S                          Repair artery blockage,              0280         15.51       $806.66       $353.85       $161.33
                                                        each.
75966.....................  S                          Repair arterial blockage...          0280         15.51       $806.66       $353.85       $161.33
75968.....................  S                          Repair artery blockage,              0280         15.51       $806.66       $353.85       $161.33
                                                        each.
75970.....................  S                          Vascular biopsy............          0280         15.51       $806.66       $353.85       $161.33
75978.....................  S                          Repair venous blockage.....          0668          5.36       $278.77       $122.66        $55.75
75980.....................  S                          Contrast xray exam bile              0296          2.12       $110.26        $52.92        $22.05
                                                        duct.
75982.....................  S                          Contrast xray exam bile              0297          7.80       $405.67       $172.51        $81.13
                                                        duct.
75984.....................  X                          Xray control catheter                0264          2.75       $143.02        $77.23        $28.60
                                                        change.
75989.....................  N                          Abscess drainage under x-    ............  ............  ............  ............  ............
                                                        ray.
75992.....................  S                          Atherectomy, x-ray exam....          0280         15.51       $806.66       $353.85       $161.33
75993.....................  S                          Atherectomy, x-ray exam....          0280         15.51       $806.66       $353.85       $161.33
75994.....................  S                          Atherectomy, x-ray exam....          0280         15.51       $806.66       $353.85       $161.33
75995.....................  S                          Atherectomy, x-ray exam....          0280         15.51       $806.66       $353.85       $161.33
75996.....................  S                          Atherectomy, x-ray exam....          0280         15.51       $806.66       $353.85       $161.33
76000.....................  X                          Fluoroscope examination....          0272          1.38        $71.77        $38.64        $14.35
76001.....................  N                          Fluoroscope exam, extensive  ............  ............  ............  ............  ............
76003.....................  N                          Needle localization by x-    ............  ............  ............  ............  ............
                                                        ray.
76005.....................  N                          Fluoroguide for spine        ............  ............  ............  ............  ............
                                                        inject.
76006.....................  X                          X-ray stress view..........          0260          0.81        $42.13        $23.17         $8.43
76010.....................  X                          X-ray, nose to rectum......          0260          0.81        $42.13        $23.17         $8.43
76012.....................  S                          Percut vertebroplasty fluor          0274          3.21       $166.95        $80.14        $33.39
76013.....................  S                          Percut vertebroplasty, ct..          0274          3.21       $166.95        $80.14        $33.39
76020.....................  X                          X-rays for bone age........          0260          0.81        $42.13        $23.17         $8.43
76040.....................  X                          X-rays, bone evaluation....          0260          0.81        $42.13        $23.17         $8.43
76061.....................  X                          X-rays, bone survey........          0261          1.37        $71.25        $34.15        $14.25
76062.....................  X                          X-rays, bone survey........          0261          1.37        $71.25        $34.15        $14.25
76065.....................  X                          X-rays, bone evaluation....          0261          1.37        $71.25        $34.15        $14.25
76066.....................  X                          Joint survey, single view..          0260          0.81        $42.13        $23.17         $8.43
76070.....................  E                          CT scan, bone density study  ............  ............  ............  ............  ............
76075.....................  S                          Dual energy x-ray study....          0288          1.38        $71.77  ............        $14.35
76076.....................  S                          Dual energy x-ray study....          0665          0.73        $37.97  ............         $7.59
76078.....................  X                          Radiographic absorptiometry          0261          1.37        $71.25        $34.15        $14.25
76080.....................  X                          X-ray exam of fistula......          0263          1.99       $103.50        $45.54        $20.70
76085.....................  A                          Computer mammogram add-on..  ............  ............  ............  ............  ............
76086.....................  X                          X-ray of mammary duct......          0263          1.99       $103.50        $45.54        $20.70
76088.....................  X                          X-ray of mammary ducts.....          0263          1.99       $103.50        $45.54        $20.70
76090.....................  S                          Mammogram, one breast......          0271          0.69        $35.89        $16.80         $7.18
76091.....................  S                          Mammogram, both breasts....          0271          0.69        $35.89        $16.80         $7.18
76092.....................  A                          Mammogram, screening.......  ............  ............  ............  ............  ............
76093.....................  E                          Magnetic image, breast.....  ............  ............  ............  ............  ............
76094.....................  E                          Magnetic image, both         ............  ............  ............  ............  ............
                                                        breasts.
76095.....................  X                          Stereotactic breast biopsy.          0187          4.19       $217.92        $94.96        $43.58
76096.....................  X                          X-ray of needle wire,                0289          1.84        $95.70        $44.80        $19.14
                                                        breast.
76098.....................  X                          X-ray exam, breast specimen          0260          0.81        $42.13        $23.17         $8.43
76100.....................  X                          X-ray exam of body section.          0261          1.37        $71.25        $34.15        $14.25
76101.....................  X                          Complex body section x-ray.          0264          2.75       $143.02        $77.23        $28.60
76102.....................  X                          Complex body section x-rays          0264          2.75       $143.02        $77.23        $28.60
76120.....................  X                          Cine/video x-rays..........          0260          0.81        $42.13        $23.17         $8.43
76125.....................  X                          Cine/ video x-rays add-on..          0260          0.81        $42.13        $23.17         $8.43
76140.....................  E                          X-ray consultation.........  ............  ............  ............  ............  ............
76150.....................  X                          X-ray exam, dry process....          0260          0.81        $42.13        $23.17         $8.43
76350.....................  N                          Special x-ray contrast       ............  ............  ............  ............  ............
                                                        study.
76355.....................  S                          CAT scan for localization..          0283          4.75       $247.04  ............        $49.41
76360.....................  S                          CAT scan for needle biopsy.          0283          4.75       $247.04  ............        $49.41
76362.....................  N                          Cat scan for tissue          ............  ............  ............  ............  ............
                                                        ablation.
76370.....................  S                          CAT scan for therapy guide.          0282          1.76        $91.54        $44.51        $18.31
76375.....................  S                          3d/holograph reconstr add-           0282          1.76        $91.54        $44.51        $18.31
                                                        on.
76380.....................  S                          CAT scan follow-up study...          0282          1.76        $91.54        $44.51        $18.31
76390.....................  E                          Mr spectroscopy............  ............  ............  ............  ............  ............
76393.....................  N                          Mr guidance for needle       ............  ............  ............  ............  ............
                                                        place.

[[Page 52247]]

 
76394.....................  N                          Mri for tissue ablation....  ............  ............  ............  ............  ............
76400.....................  S                          Magnetic image, bone marrow          0335          6.46       $335.98       $151.46        $67.20
76490.....................  N                          Us for tissue ablation.....  ............  ............  ............  ............  ............
76499.....................  X                          Radiographic procedure.....          0260          0.81        $42.13        $23.17         $8.43
76506.....................  S                          Echo exam of head..........          0266          1.70        $88.42        $48.63        $17.68
76511.....................  S                          Echo exam of eye...........          0266          1.70        $88.42        $48.63        $17.68
76512.....................  S                          Echo exam of eye...........          0266          1.70        $88.42        $48.63        $17.68
76513.....................  S                          Echo exam of eye, water              0265          1.04        $54.09        $29.75        $10.82
                                                        bath.
76516.....................  S                          Echo exam of eye...........          0266          1.70        $88.42        $48.63        $17.68
76519.....................  S                          Echo exam of eye...........          0266          1.70        $88.42        $48.63        $17.68
76529.....................  S                          Echo exam of eye...........          0265          1.04        $54.09        $29.75        $10.82
76536.....................  S                          Us exam of head and neck...          0266          1.70        $88.42        $48.63        $17.68
76604.....................  S                          Us exam, chest, b-scan.....          0266          1.70        $88.42        $48.63        $17.68
76645.....................  S                          Us exam, breast(s).........          0265          1.04        $54.09        $29.75        $10.82
76700.....................  S                          Us exam, abdom, complete...          0266          1.70        $88.42        $48.63        $17.68
76705.....................  S                          Us exam, abdom, limited....          0266          1.70        $88.42        $48.63        $17.68
76770.....................  S                          Us exam abdo back wall,              0266          1.70        $88.42        $48.63        $17.68
                                                        comp.
76775.....................  S                          Us exam abdo back wall, lim          0266          1.70        $88.42        $48.63        $17.68
76778.....................  S                          Us exam kidney transplant..          0266          1.70        $88.42        $48.63        $17.68
76800.....................  S                          Us exam, spinal canal......          0266          1.70        $88.42        $48.63        $17.68
76805.....................  S                          Us exam, pg uterus, compl..          0266          1.70        $88.42        $48.63        $17.68
76810.....................  S                          Us exam, pg uterus, mult...          0265          1.04        $54.09        $29.75        $10.82
76815.....................  S                          Us exam, pg uterus limit...          0265          1.04        $54.09        $29.75        $10.82
76816.....................  S                          Us exam pg uterus repeat...          0265          1.04        $54.09        $29.75        $10.82
76818.....................  S                          Fetal biophy profile w/nst.          0266          1.70        $88.42        $48.63        $17.68
76819.....................  S                          Fetal biophys profil w/o             0266          1.70        $88.42        $48.63        $17.68
                                                        nst.
76825.....................  S                          Echo exam of fetal heart...          0671          1.68        $87.38        $45.44        $17.48
76826.....................  S                          Echo exam of fetal heart...          0697          1.51        $78.53        $40.84        $15.71
76827.....................  S                          Echo exam of fetal heart...          0671          1.68        $87.38        $45.44        $17.48
76828.....................  S                          Echo exam of fetal heart...          0697          1.51        $78.53        $40.84        $15.71
76830.....................  S                          Us exam, transvaginal......          0266          1.70        $88.42        $48.63        $17.68
76831.....................  S                          Echo exam, uterus..........          0266          1.70        $88.42        $48.63        $17.68
76856.....................  S                          Us exam, pelvic, complete..          0266          1.70        $88.42        $48.63        $17.68
76857.....................  S                          Us exam, pelvic, limited...          0265          1.04        $54.09        $29.75        $10.82
76870.....................  S                          Us exam, scrotum...........          0266          1.70        $88.42        $48.63        $17.68
76872.....................  S                          Echo exam, transrectal.....          0266          1.70        $88.42        $48.63        $17.68
76873.....................  S                          Echograp trans r, pros               0266          1.70        $88.42        $48.63        $17.68
                                                        study.
76880.....................  S                          Us exam, extremity.........          0266          1.70        $88.42        $48.63        $17.68
76885.....................  S                          Us exam infant hips,                 0266          1.70        $88.42        $48.63        $17.68
                                                        dynamic.
76886.....................  S                          Us exam infant hips, static          0266          1.70        $88.42        $48.63        $17.68
76930.....................  S                          Echo guide, cardiocentesis.          0268          1.48        $76.97  ............        $15.39
76932.....................  S                          Echo guide for heart biopsy          0268          1.48        $76.97  ............        $15.39
76936.....................  S                          Echo guide for artery                0268          1.48        $76.97  ............        $15.39
                                                        repair.
76941.....................  S                          Echo guide for transfusion.          0268          1.48        $76.97  ............        $15.39
76942.....................  S                          Echo guide for biopsy......          0268          1.48        $76.97  ............        $15.39
76945.....................  S                          Echo guide, villus sampling          0268          1.48        $76.97  ............        $15.39
76946.....................  S                          Echo guide for                       0268          1.48        $76.97  ............        $15.39
                                                        amniocentesis.
76948.....................  S                          Echo guide, ova aspiration.          0268          1.48        $76.97  ............        $15.39
76950.....................  S                          Echo guidance radiotherapy.          0268          1.48        $76.97  ............        $15.39
76965.....................  S                          Echo guidance radiotherapy.          0268          1.48        $76.97  ............        $15.39
76970.....................  S                          Ultrasound exam follow-up..          0265          1.04        $54.09        $29.75        $10.82
76975.....................  S                          GI endoscopic ultrasound...          0266          1.70        $88.42        $48.63        $17.68
76977.....................  S                          Us bone density measure....          0265          1.04        $54.09        $29.75        $10.82
76986.....................  S                          Ultrasound guide intraoper.          0266          1.70        $88.42        $48.63        $17.68
76999.....................  S                          Echo examination procedure.          0265          1.04        $54.09        $29.75        $10.82
77261.....................  E                          Radiation therapy planning.  ............  ............  ............  ............  ............
77262.....................  E                          Radiation therapy planning.  ............  ............  ............  ............  ............
77263.....................  E                          Radiation therapy planning.  ............  ............  ............  ............  ............
77280.....................  X                          Set radiation therapy field          0304          1.69        $87.90        $41.52        $17.58
77285.....................  X                          Set radiation therapy field          0305          3.87       $201.27        $91.38        $40.25
77290.....................  X                          Set radiation therapy field          0305          3.87       $201.27        $91.38        $40.25
77295.....................  X                          Set radiation therapy field          0310         14.38       $747.89       $339.05       $149.58
77299.....................  E                          Radiation therapy planning.  ............  ............  ............  ............  ............
77300.....................  X                          Radiation therapy dose plan          0304          1.69        $87.90        $41.52        $17.58
77301.....................  S                          Radioltherapy dos plan,              0712  ............       $875.00  ............       $175.00
                                                        imrt.
77305.....................  X                          Radiation therapy dose plan          0304          1.69        $87.90        $41.52        $17.58

[[Page 52248]]

 
77310.....................  X                          Radiation therapy dose plan          0304          1.69        $87.90        $41.52        $17.58
77315.....................  X                          Radiation therapy dose plan          0305          3.87       $201.27        $91.38        $40.25
77321.....................  X                          Radiation therapy port plan          0305          3.87       $201.27        $91.38        $40.25
77326.....................  X                          Radiation therapy dose plan          0305          3.87       $201.27        $91.38        $40.25
77327.....................  X                          Radiation therapy dose plan          0305          3.87       $201.27        $91.38        $40.25
77328.....................  X                          Radiation therapy dose plan          0305          3.87       $201.27        $91.38        $40.25
77331.....................  X                          Special radiation dosimetry          0304          1.69        $87.90        $41.52        $17.58
77332.....................  X                          Radiation treatment aid(s).          0303          2.93       $152.39        $68.58        $30.48
77333.....................  X                          Radiation treatment aid(s).          0303          2.93       $152.39        $68.58        $30.48
77334.....................  X                          Radiation treatment aid(s).          0303          2.93       $152.39        $68.58        $30.48
77336.....................  X                          Radiation physics consult..          0304          1.69        $87.90        $41.52        $17.58
77370.....................  X                          Radiation physics consult..          0305          3.87       $201.27        $91.38        $40.25
77399.....................  X                          External radiation                   0304          1.69        $87.90        $41.52        $17.58
                                                        dosimetry.
77401.....................  S                          Radiation treatment                  0300          1.53        $79.57  ............        $15.91
                                                        delivery.
77402.....................  S                          Radiation treatment                  0300          1.53        $79.57  ............        $15.91
                                                        delivery.
77403.....................  S                          Radiation treatment                  0300          1.53        $79.57  ............        $15.91
                                                        delivery.
77404.....................  S                          Radiation treatment                  0300          1.53        $79.57  ............        $15.91
                                                        delivery.
77406.....................  S                          Radiation treatment                  0300          1.53        $79.57  ............        $15.91
                                                        delivery.
77407.....................  S                          Radiation treatment                  0300          1.53        $79.57  ............        $15.91
                                                        delivery.
77408.....................  S                          Radiation treatment                  0300          1.53        $79.57  ............        $15.91
                                                        delivery.
77409.....................  S                          Radiation treatment                  0300          1.53        $79.57  ............        $15.91
                                                        delivery.
77411.....................  S                          Radiation treatment                  0300          1.53        $79.57  ............        $15.91
                                                        delivery.
77412.....................  S                          Radiation treatment                  0301          2.22       $115.46  ............        $23.09
                                                        delivery.
77413.....................  S                          Radiation treatment                  0301          2.22       $115.46  ............        $23.09
                                                        delivery.
77414.....................  S                          Radiation treatment                  0301          2.22       $115.46  ............        $23.09
                                                        delivery.
77416.....................  S                          Radiation treatment                  0301          2.22       $115.46  ............        $23.09
                                                        delivery.
77417.....................  X                          Radiology port film(s).....          0260          0.81        $42.13        $23.17         $8.43
77418.....................  S                          Radiation tx delivery, imrt          0710  ............       $400.00  ............        $80.00
77427.....................  E                          Radiation tx management, x5  ............  ............  ............  ............  ............
77431.....................  E                          Radiation therapy            ............  ............  ............  ............  ............
                                                        management.
77432.....................  E                          Stereotactic radiation trmt  ............  ............  ............  ............  ............
77470.....................  S                          Special radiation treatment          0299          6.20       $322.46  ............        $64.49
77499.....................  E                          Radiation therapy            ............  ............  ............  ............  ............
                                                        management.
77520.....................  S                          Proton trmt, simple w/o              0664         11.03       $573.66  ............       $114.73
                                                        comp.
77522.....................  S                          Proton trmt, simple w/comp.          0664         11.03       $573.66  ............       $114.73
77523.....................  S                          Proton trmt, intermediate..          0664         11.03       $573.66  ............       $114.73
77525.....................  S                          Proton treatment, complex..          0664         11.03       $573.66  ............       $114.73
77600.....................  S                          Hyperthermia treatment.....          0314          4.24       $220.52       $101.77        $44.10
77605.....................  S                          Hyperthermia treatment.....          0314          4.24       $220.52       $101.77        $44.10
77610.....................  S                          Hyperthermia treatment.....          0314          4.24       $220.52       $101.77        $44.10
77615.....................  S                          Hyperthermia treatment.....          0314          4.24       $220.52       $101.77        $44.10
77620.....................  S                          Hyperthermia treatment.....          0314          4.24       $220.52       $101.77        $44.10
77750.....................  S                          Infuse radioactive                   0300          1.53        $79.57  ............        $15.91
                                                        materials.
77761.....................  S                          Apply intrcav radiat simple          0312          4.23       $220.00  ............        $44.00
77762.....................  S                          Apply intrcav radiat interm          0312          4.23       $220.00  ............        $44.00
77763.....................  S                          Apply intrcav radiat compl.          0312          4.23       $220.00  ............        $44.00
77776.....................  S                          Apply interstit radiat               0312          4.23       $220.00  ............        $44.00
                                                        simpl.
77777.....................  S                          Apply interstit radiat               0312          4.23       $220.00  ............        $44.00
                                                        inter.
77778.....................  S                          Apply iterstit radiat compl          0312          4.23       $220.00  ............        $44.00
77781.....................  S                          High intensity                       0313         13.80       $717.72  ............       $143.54
                                                        brachytherapy.
77782.....................  S                          High intensity                       0313         13.80       $717.72  ............       $143.54
                                                        brachytherapy.
77783.....................  S                          High intensity                       0313         13.80       $717.72  ............       $143.54
                                                        brachytherapy.
77784.....................  S                          High intensity                       0313         13.80       $717.72  ............       $143.54
                                                        brachytherapy.
77789.....................  S                          Apply surface radiation....          0300          1.53        $79.57  ............        $15.91
77790.....................  N                          Radiation handling.........  ............  ............  ............  ............  ............
77799.....................  S                          Radium/radioisotope therapy          0313         13.80       $717.72  ............       $143.54
78000.....................  S                          Thyroid, single uptake.....          0290          2.16       $112.34        $56.17        $22.47
78001.....................  S                          Thyroid, multiple uptakes..          0290          2.16       $112.34        $56.17        $22.47
78003.....................  S                          Thyroid suppress/stimul....          0290          2.16       $112.34        $56.17        $22.47
78006.....................  S                          Thyroid imaging with uptake          0291          4.19       $217.92       $108.96        $43.58
78007.....................  S                          Thyroid image, mult uptakes          0292          4.53       $235.60       $117.80        $47.12
78010.....................  S                          Thyroid imaging............          0291          4.19       $217.92       $108.96        $43.58
78011.....................  S                          Thyroid imaging with flow..          0292          4.53       $235.60       $117.80        $47.12
78015.....................  S                          Thyroid met imaging........          0291          4.19       $217.92       $108.96        $43.58
78016.....................  S                          Thyroid met imaging/studies          0292          4.53       $235.60       $117.80        $47.12
78018.....................  S                          Thyroid met imaging, body..          0292          4.53       $235.60       $117.80        $47.12

[[Page 52249]]

 
78020.....................  S                          Thyroid met uptake.........          0291          4.19       $217.92       $108.96        $43.58
78070.....................  S                          Parathyroid nuclear imaging          0292          4.53       $235.60       $117.80        $47.12
78075.....................  S                          Adrenal nuclear imaging....          0292          4.53       $235.60       $117.80        $47.12
78099.....................  S                          Endocrine nuclear procedure          0291          4.19       $217.92       $108.96        $43.58
78102.....................  S                          Bone marrow imaging, ltd...          0291          4.19       $217.92       $108.96        $43.58
78103.....................  S                          Bone marrow imaging, mult..          0291          4.19       $217.92       $108.96        $43.58
78104.....................  S                          Bone marrow imaging, body..          0291          4.19       $217.92       $108.96        $43.58
78110.....................  S                          Plasma volume, single......          0290          2.16       $112.34        $56.17        $22.47
78111.....................  S                          Plasma volume, multiple....          0290          2.16       $112.34        $56.17        $22.47
78120.....................  S                          Red cell mass, single......          0290          2.16       $112.34        $56.17        $22.47
78121.....................  S                          Red cell mass, multiple....          0290          2.16       $112.34        $56.17        $22.47
78122.....................  S                          Blood volume...............          0290          2.16       $112.34        $56.17        $22.47
78130.....................  S                          Red cell survival study....          0290          2.16       $112.34        $56.17        $22.47
78135.....................  S                          Red cell survival kinetics.          0290          2.16       $112.34        $56.17        $22.47
78140.....................  S                          Red cell sequestration.....          0290          2.16       $112.34        $56.17        $22.47
78160.....................  S                          Plasma iron turnover.......          0290          2.16       $112.34        $56.17        $22.47
78162.....................  S                          Iron absorption exam.......          0290          2.16       $112.34        $56.17        $22.47
78170.....................  S                          Red cell iron utilization..          0290          2.16       $112.34        $56.17        $22.47
78172.....................  S                          Total body iron estimation.          0290          2.16       $112.34        $56.17        $22.47
78185.....................  S                          Spleen imaging.............          0291          4.19       $217.92       $108.96        $43.58
78190.....................  S                          Platelet survival, kinetics          0290          2.16       $112.34        $56.17        $22.47
78191.....................  S                          Platelet survival..........          0292          4.53       $235.60       $117.80        $47.12
78195.....................  S                          Lymph system imaging.......          0292          4.53       $235.60       $117.80        $47.12
78199.....................  S                          Blood/lymph nuclear exam...          0291          4.19       $217.92       $108.96        $43.58
78201.....................  S                          Liver imaging..............          0291          4.19       $217.92       $108.96        $43.58
78202.....................  S                          Liver imaging with flow....          0291          4.19       $217.92       $108.96        $43.58
78205.....................  S                          Liver imaging (3D).........          0291          4.19       $217.92       $108.96        $43.58
78206.....................  S                          Liver image (3d) w/flow....          0292          4.53       $235.60       $117.80        $47.12
78215.....................  S                          Liver and spleen imaging...          0291          4.19       $217.92       $108.96        $43.58
78216.....................  S                          Liver & spleen image/flow..          0291          4.19       $217.92       $108.96        $43.58
78220.....................  S                          Liver function study.......          0291          4.19       $217.92       $108.96        $43.58
78223.....................  S                          Hepatobiliary imaging......          0292          4.53       $235.60       $117.80        $47.12
78230.....................  S                          Salivary gland imaging.....          0292          4.53       $235.60       $117.80        $47.12
78231.....................  S                          Serial salivary imaging....          0292          4.53       $235.60       $117.80        $47.12
78232.....................  S                          Salivary gland function              0292          4.53       $235.60       $117.80        $47.12
                                                        exam.
78258.....................  S                          Esophageal motility study..          0291          4.19       $217.92       $108.96        $43.58
78261.....................  S                          Gastric mucosa imaging.....          0291          4.19       $217.92       $108.96        $43.58
78262.....................  S                          Gastroesophageal reflux              0292          4.53       $235.60       $117.80        $47.12
                                                        exam.
78264.....................  S                          Gastric emptying study.....          0292          4.53       $235.60       $117.80        $47.12
78267.....................  A                          Breath tst attain/anal c-14  ............  ............  ............  ............  ............
78268.....................  A                          Breath test analysis, c-14.  ............  ............  ............  ............  ............
78270.....................  S                          Vit B-12 absorption exam...          0290          2.16       $112.34        $56.17        $22.47
78271.....................  S                          Vit B-12 absorp exam, IF...          0290          2.16       $112.34        $56.17        $22.47
78272.....................  S                          Vit B-12 absorp, combined..          0290          2.16       $112.34        $56.17        $22.47
78278.....................  S                          Acute GI blood loss imaging          0292          4.53       $235.60       $117.80        $47.12
78282.....................  S                          GI protein loss exam.......          0290          2.16       $112.34        $56.17        $22.47
78290.....................  S                          Meckel's divert exam.......          0292          4.53       $235.60       $117.80        $47.12
78291.....................  S                          Leveen/shunt patency exam..          0292          4.53       $235.60       $117.80        $47.12
78299.....................  S                          GI nuclear procedure.......          0291          4.19       $217.92       $108.96        $43.58
78300.....................  S                          Bone imaging, limited area.          0291          4.19       $217.92       $108.96        $43.58
78305.....................  S                          Bone imaging, multiple               0291          4.19       $217.92       $108.96        $43.58
                                                        areas.
78306.....................  S                          Bone imaging, whole body...          0291          4.19       $217.92       $108.96        $43.58
78315.....................  S                          Bone imaging, 3 phase......          0292          4.53       $235.60       $117.80        $47.12
78320.....................  S                          Bone imaging (3D)..........          0291          4.19       $217.92       $108.96        $43.58
78350.....................  X                          Bone mineral, single photon          0261          1.37        $71.25        $34.15        $14.25
78351.....................  E                          Bone mineral, dual photon..  ............  ............  ............  ............  ............
78399.....................  S                          Musculoskeletal nuclear              0291          4.19       $217.92       $108.96        $43.58
                                                        exam.
78414.....................  S                          Non-imaging heart function.          0290          2.16       $112.34        $56.17        $22.47
78428.....................  S                          Cardiac shunt imaging......          0291          4.19       $217.92       $108.96        $43.58
78445.....................  S                          Vascular flow imaging......          0291          4.19       $217.92       $108.96        $43.58
78455.....................  S                          Venous thrombosis study....          0290          2.16       $112.34        $56.17        $22.47
78456.....................  S                          Acute venous thrombus image          0292          4.53       $235.60       $117.80        $47.12
78457.....................  S                          Venous thrombosis imaging..          0291          4.19       $217.92       $108.96        $43.58
78458.....................  S                          Ven thrombosis images,               0292          4.53       $235.60       $117.80        $47.12
                                                        bilat.
78459.....................  E                          Heart muscle imaging (PET).  ............  ............  ............  ............  ............
78460.....................  S                          Heart muscle blood, single.          0286          6.94       $360.94       $198.52        $72.19

[[Page 52250]]

 
78461.....................  S                          Heart muscle blood,                  0286          6.94       $360.94       $198.52        $72.19
                                                        multiple.
78464.....................  S                          Heart image (3d), single...          0286          6.94       $360.94       $198.52        $72.19
78465.....................  S                          Heart image (3d), multiple.          0286          6.94       $360.94       $198.52        $72.19
78466.....................  S                          Heart infarct image........          0291          4.19       $217.92       $108.96        $43.58
78468.....................  S                          Heart infarct image (ef)...          0291          4.19       $217.92       $108.96        $43.58
78469.....................  S                          Heart infarct image (3D)...          0291          4.19       $217.92       $108.96        $43.58
78472.....................  S                          Gated heart, planar, single          0286          6.94       $360.94       $198.52        $72.19
78473.....................  S                          Gated heart, multiple......          0286          6.94       $360.94       $198.52        $72.19
78478.....................  S                          Heart wall motion add-on...          0666          1.59        $82.69        $45.48        $16.54
78480.....................  S                          Heart function add-on......          0666          1.59        $82.69        $45.48        $16.54
78481.....................  S                          Heart first pass, single...          0286          6.94       $360.94       $198.52        $72.19
78483.....................  S                          Heart first pass, multiple.          0286          6.94       $360.94       $198.52        $72.19
78491.....................  E                          Heart image (pet), single..  ............  ............  ............  ............  ............
78492.....................  E                          Heart image (pet), multiple  ............  ............  ............  ............  ............
78494.....................  S                          Heart image, spect.........          0286          6.94       $360.94       $198.52        $72.19
78496.....................  S                          Heart first pass add-on....          0666          1.59        $82.69        $45.48        $16.54
78499.....................  S                          Cardiovascular nuclear exam          0291          4.19       $217.92       $108.96        $43.58
78580.....................  S                          Lung perfusion imaging.....          0291          4.19       $217.92       $108.96        $43.58
78584.....................  S                          Lung V/Q image single                0292          4.53       $235.60       $117.80        $47.12
                                                        breath.
78585.....................  S                          Lung V/Q imaging...........          0292          4.53       $235.60       $117.80        $47.12
78586.....................  S                          Aerosol lung image, single.          0291          4.19       $217.92       $108.96        $43.58
78587.....................  S                          Aerosol lung image,                  0291          4.19       $217.92       $108.96        $43.58
                                                        multiple.
78588.....................  S                          Perfusion lung image.......          0292          4.53       $235.60       $117.80        $47.12
78591.....................  S                          Vent image, 1 breath, 1              0291          4.19       $217.92       $108.96        $43.58
                                                        proj.
78593.....................  S                          Vent image, 1 proj, gas....          0291          4.19       $217.92       $108.96        $43.58
78594.....................  S                          Vent image, mult proj, gas.          0291          4.19       $217.92       $108.96        $43.58
78596.....................  S                          Lung differential function.          0292          4.53       $235.60       $117.80        $47.12
78599.....................  S                          Respiratory nuclear exam...          0291          4.19       $217.92       $108.96        $43.58
78600.....................  S                          Brain imaging, ltd static..          0291          4.19       $217.92       $108.96        $43.58
78601.....................  S                          Brain imaging, ltd w/ flow.          0291          4.19       $217.92       $108.96        $43.58
78605.....................  S                          Brain imaging, complete....          0291          4.19       $217.92       $108.96        $43.58
78606.....................  S                          Brain imaging, compl w/flow          0291          4.19       $217.92       $108.96        $43.58
78607.....................  S                          Brain imaging (3D).........          0291          4.19       $217.92       $108.96        $43.58
78608.....................  E                          Brain imaging (PET)........  ............  ............  ............  ............  ............
78609.....................  E                          Brain imaging (PET)........  ............  ............  ............  ............  ............
78610.....................  S                          Brain flow imaging only....          0291          4.19       $217.92       $108.96        $43.58
78615.....................  S                          Cerebral vascular flow               0291          4.19       $217.92       $108.96        $43.58
                                                        image.
78630.....................  S                          Cerebrospinal fluid scan...          0292          4.53       $235.60       $117.80        $47.12
78635.....................  S                          CSF ventriculography.......          0292          4.53       $235.60       $117.80        $47.12
78645.....................  S                          CSF shunt evaluation.......          0292          4.53       $235.60       $117.80        $47.12
78647.....................  S                          Cerebrospinal fluid scan...          0292          4.53       $235.60       $117.80        $47.12
78650.....................  S                          CSF leakage imaging........          0292          4.53       $235.60       $117.80        $47.12
78660.....................  S                          Nuclear exam of tear flow..          0291          4.19       $217.92       $108.96        $43.58
78699.....................  S                          Nervous system nuclear exam          0291          4.19       $217.92       $108.96        $43.58
78700.....................  S                          Kidney imaging, static.....          0291          4.19       $217.92       $108.96        $43.58
78701.....................  S                          Kidney imaging with flow...          0291          4.19       $217.92       $108.96        $43.58
78704.....................  S                          Imaging renogram...........          0291          4.19       $217.92       $108.96        $43.58
78707.....................  S                          Kidney flow/function image.          0291          4.19       $217.92       $108.96        $43.58
78708.....................  S                          Kidney flow/function image.          0292          4.53       $235.60       $117.80        $47.12
78709.....................  S                          Kidney flow/function image.          0292          4.53       $235.60       $117.80        $47.12
78710.....................  S                          Kidney imaging (3D)........          0291          4.19       $217.92       $108.96        $43.58
78715.....................  S                          Renal vascular flow exam...          0291          4.19       $217.92       $108.96        $43.58
78725.....................  S                          Kidney function study......          0290          2.16       $112.34        $56.17        $22.47
78730.....................  S                          Urinary bladder retention..          0291          4.19       $217.92       $108.96        $43.58
78740.....................  S                          Ureteral reflux study......          0292          4.53       $235.60       $117.80        $47.12
78760.....................  S                          Testicular imaging.........          0291          4.19       $217.92       $108.96        $43.58
78761.....................  S                          Testicular imaging/flow....          0291          4.19       $217.92       $108.96        $43.58
78799.....................  S                          Genitourinary nuclear exam.          0291          4.19       $217.92       $108.96        $43.58
78800.....................  S                          Tumor imaging, limited area          0292          4.53       $235.60       $117.80        $47.12
78801.....................  S                          Tumor imaging, mult areas..          0292          4.53       $235.60       $117.80        $47.12
78802.....................  S                          Tumor imaging, whole body..          0292          4.53       $235.60       $117.80        $47.12
78803.....................  S                          Tumor imaging (3D).........          0292          4.53       $235.60       $117.80        $47.12
78805.....................  S                          Abscess imaging, ltd area..          0292          4.53       $235.60       $117.80        $47.12
78806.....................  S                          Abscess imaging, whole body          0292          4.53       $235.60       $117.80        $47.12
78807.....................  S                          Nuclear localization/                0292          4.53       $235.60       $117.80        $47.12
                                                        abscess.
78810.....................  E                          Tumor imaging (PET)........  ............  ............  ............  ............  ............

[[Page 52251]]

 
78890.....................  N                          Nuclear medicine data proc.  ............  ............  ............  ............  ............
78891.....................  N                          Nuclear med data proc......  ............  ............  ............  ............  ............
78990.....................  N                          Provide diag                 ............  ............  ............  ............  ............
                                                        radionuclide(s).
78999.....................  S                          Nuclear diagnostic exam....          0291          4.19       $217.92       $108.96        $43.58
79000.....................  S                          Init hyperthyroid therapy..          0294          4.45       $231.44       $127.29        $46.29
79001.....................  S                          Repeat hyperthyroid therapy          0294          4.45       $231.44       $127.29        $46.29
79020.....................  S                          Thyroid ablation...........          0294          4.45       $231.44       $127.29        $46.29
79030.....................  S                          Thyroid ablation, carcinoma          0294          4.45       $231.44       $127.29        $46.29
79035.....................  S                          Thyroid metastatic therapy.          0295          3.86       $200.75       $110.41        $40.15
79100.....................  S                          Hematopoetic nuclear                 0294          4.45       $231.44       $127.29        $46.29
                                                        therapy.
79200.....................  S                          Intracavitary nuclear trmt.          0295          3.86       $200.75       $110.41        $40.15
79300.....................  S                          Interstitial nuclear                 0294          4.45       $231.44       $127.29        $46.29
                                                        therapy.
79400.....................  S                          Nonhemato nuclear therapy..          0295          3.86       $200.75       $110.41        $40.15
79420.....................  S                          Intravascular nuclear ther.          0295          3.86       $200.75       $110.41        $40.15
79440.....................  S                          Nuclear joint therapy......          0294          4.45       $231.44       $127.29        $46.29
79900.....................  N                          Provide ther radiopharm(s).  ............  ............  ............  ............  ............
79999.....................  S                          Nuclear medicine therapy...          0294          4.45       $231.44       $127.29        $46.29
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.......  ............  ............  ............  ............  ............
80074.....................  A                          Acute hepatitis panel......  ............  ............  ............  ............  ............
80076.....................  A                          Hepatic function panel.....  ............  ............  ............  ............  ............
80090.....................  A                          Torch antibody panel.......  ............  ............  ............  ............  ............
80100.....................  A                          Drug screen, qualitate/      ............  ............  ............  ............  ............
                                                        multi.
80101.....................  A                          Drug screen, single........  ............  ............  ............  ............  ............
80102.....................  A                          Drug confirmation..........  ............  ............  ............  ............  ............
80103.....................  N                          Drug analysis, tissue prep.  ............  ............  ............  ............  ............
80150.....................  A                          Assay of amikacin..........  ............  ............  ............  ............  ............
80152.....................  A                          Assay of amitriptyline.....  ............  ............  ............  ............  ............
80154.....................  A                          Assay of benzodiazepines...  ............  ............  ............  ............  ............
80156.....................  A                          Assay, carbamazepine, total  ............  ............  ............  ............  ............
80157.....................  A                          Assay, carbamazepine, free.  ............  ............  ............  ............  ............
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..............  ............  ............  ............  ............  ............
80173.....................  A                          Assay of haloperidol.......  ............  ............  ............  ............  ............
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.....  ............  ............  ............  ............  ............

[[Page 52252]]

 
80408.....................  A                          Aldosterone suppression      ............  ............  ............  ............  ............
                                                        eval.
80410.....................  A                          Calcitonin stimul panel....  ............  ............  ............  ............  ............
80412.....................  A                          CRH stimulation panel......  ............  ............  ............  ............  ............
80414.....................  A                          Testosterone response......  ............  ............  ............  ............  ............
80415.....................  A                          Estradiol response panel...  ............  ............  ............  ............  ............
80416.....................  A                          Renin stimulation panel....  ............  ............  ............  ............  ............
80417.....................  A                          Renin stimulation panel....  ............  ............  ............  ............  ............
80418.....................  A                          Pituitary evaluation panel.  ............  ............  ............  ............  ............
80420.....................  A                          Dexamethasone panel........  ............  ............  ............  ............  ............
80422.....................  A                          Glucagon tolerance panel...  ............  ............  ............  ............  ............
80424.....................  A                          Glucagon tolerance panel...  ............  ............  ............  ............  ............
80426.....................  A                          Gonadotropin hormone panel.  ............  ............  ............  ............  ............
80428.....................  A                          Growth hormone panel.......  ............  ............  ............  ............  ............
80430.....................  A                          Growth hormone panel.......  ............  ............  ............  ............  ............
80432.....................  A                          Insulin suppression panel..  ............  ............  ............  ............  ............
80434.....................  A                          Insulin tolerance panel....  ............  ............  ............  ............  ............
80435.....................  A                          Insulin tolerance panel....  ............  ............  ............  ............  ............
80436.....................  A                          Metyrapone panel...........  ............  ............  ............  ............  ............
80438.....................  A                          TRH stimulation panel......  ............  ............  ............  ............  ............
80439.....................  A                          TRH stimulation panel......  ............  ............  ............  ............  ............
80440.....................  A                          TRH stimulation panel......  ............  ............  ............  ............  ............
80500.....................  X                          Lab pathology consultation.          0343          0.47        $24.44        $13.20         $4.89
80502.....................  X                          Lab pathology consultation.          0342          0.23        $11.96         $5.88         $2.39
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........  ............  ............  ............  ............  ............

[[Page 52253]]

 
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..........  ............  ............  ............  ............  ............
82252.....................  A                          Fecal bilirubin test.......  ............  ............  ............  ............  ............
82261.....................  A                          Assay of biotinidase.......  ............  ............  ............  ............  ............
82270.....................  A                          Test for blood, feces......  ............  ............  ............  ............  ............
82273.....................  A                          Test for blood, other        ............  ............  ............  ............  ............
                                                        source.
82274.....................  A                          Assay test for blood, fecal  ............  ............  ............  ............  ............
82286.....................  A                          Assay of bradykinin........  ............  ............  ............  ............  ............
82300.....................  A                          Assay of cadmium...........  ............  ............  ............  ............  ............
82306.....................  A                          Assay of vitamin D.........  ............  ............  ............  ............  ............
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 analysis, qual....  ............  ............  ............  ............  ............
82360.....................  A                          Calculus assay, quant......  ............  ............  ............  ............  ............
82365.....................  A                          Calculus spectroscopy......  ............  ............  ............  ............  ............
82370.....................  A                          X-ray assay, calculus......  ............  ............  ............  ............  ............
82373.....................  A                          Assay, c-d transfer measure  ............  ............  ............  ............  ............
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, bld/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...........  ............  ............  ............  ............  ............

[[Page 52254]]

 
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......  ............  ............  ............  ............  ............
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 or 4, each.....  ............  ............  ............  ............  ............
82800.....................  A                          Blood pH...................  ............  ............  ............  ............  ............

[[Page 52255]]

 
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..........  ............  ............  ............  ............  ............
82945.....................  A                          Glucose other fluid........  ............  ............  ............  ............  ............
82946.....................  A                          Glucagon tolerance test....  ............  ............  ............  ............  ............
82947.....................  A                          Assay, glucose, blood 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 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.  ............  ............  ............  ............  ............
83030.....................  A                          Fetal hemoglobin, chemical.  ............  ............  ............  ............  ............
83033.....................  A                          Fetal hemoglobin assay,      ............  ............  ............  ............  ............
                                                        qual.
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.........  ............  ............  ............  ............  ............
83090.....................  A                          Assay of homocystine.......  ............  ............  ............  ............  ............
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......  ............  ............  ............  ............  ............

[[Page 52256]]

 
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                          L/s ratio, fetal lung......  ............  ............  ............  ............  ............
83662.....................  A                          Foam stability, fetal lung.  ............  ............  ............  ............  ............
83663.....................  A                          Fluoro polarize, fetal lung  ............  ............  ............  ............  ............
83664.....................  A                          Lamellar bdy, fetal lung...  ............  ............  ............  ............  ............
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...  ............  ............  ............  ............  ............
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..........  ............  ............  ............  ............  ............

[[Page 52257]]

 
83918.....................  A                          Organic acids, total, quant  ............  ............  ............  ............  ............
83919.....................  A                          Organic acids, qual, each..  ............  ............  ............  ............  ............
83921.....................  A                          Organic acid, single, quant  ............  ............  ............  ............  ............
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...........  ............  ............  ............  ............  ............
83950.....................  A                          Oncorprotein, her-2/neu....  ............  ............  ............  ............  ............
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.....  ............  ............  ............  ............  ............
84152.....................  A                          Assay of psa, complexed....  ............  ............  ............  ............  ............
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.
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  ............  ............  ............  ............  ............

[[Page 52258]]

 
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                          Reverse assay (t3).........  ............  ............  ............  ............  ............
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.........  ............  ............  ............  ............  ............
84591.....................  A                          Assay of nos vitamin.......  ............  ............  ............  ............  ............
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.........  ............  ............  ............  ............  ............

[[Page 52259]]

 
85007.....................  A                          Differential WBC count.....  ............  ............  ............  ............  ............
85008.....................  A                          Nondifferential WBC count..  ............  ............  ............  ............  ............
85009.....................  A                          Differential WBC count.....  ............  ............  ............  ............  ............
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          0.23        $11.96         $5.88         $2.39
85097.....................  X                          Bone marrow interpretation.          0343          0.47        $24.44        $13.20         $4.89
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..  ............  ............  ............  ............  ............
85307.....................  A                          Assay activated protein c..  ............  ............  ............  ............  ............
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.......  ............  ............  ............  ............  ............

[[Page 52260]]

 
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  ............  ............  ............  ............  ............
85536.....................  A                          Iron stain peripheral blood  ............  ............  ............  ............  ............
85540.....................  A                          Wbc alkaline phosphatase...  ............  ............  ............  ............  ............
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.......  ............  ............  ............  ............  ............
86001.....................  A                          Allergen specific igg......  ............  ............  ............  ............  ............
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                 0343          0.47        $24.44        $13.20         $4.89
                                                        service.
86078.....................  X                          Physician blood bank                 0344          0.66        $34.33        $18.54         $6.87
                                                        service.
86079.....................  X                          Physician blood bank                 0344          0.66        $34.33        $18.54         $6.87
                                                        service.
86140.....................  A                          C-reactive protein.........  ............  ............  ............  ............  ............
86141.....................  A                          C-reactive protein, hs.....  ............  ............  ............  ............  ............
86146.....................  A                          Glycoprotein antibody......  ............  ............  ............  ............  ............
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                          Counterimmunoelectrophoresi  ............  ............  ............  ............  ............
                                                        s.
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.

[[Page 52261]]

 
86256.....................  A                          Fluorescent antibody, titer  ............  ............  ............  ............  ............
86277.....................  A                          Growth hormone antibody....  ............  ............  ............  ............  ............
86280.....................  A                          Hemagglutination inhibition  ............  ............  ............  ............  ............
86294.....................  A                          Immunoassay, tumor qual....  ............  ............  ............  ............  ............
86300.....................  A                          Immunoassay, tumor ca 15-3.  ............  ............  ............  ............  ............
86301.....................  A                          Immunoassay, tumor ca 19-9.  ............  ............  ............  ............  ............
86304.....................  A                          Immunoassay, tumor, ca 125.  ............  ............  ............  ............  ............
86308.....................  A                          Heterophile antibodies.....  ............  ............  ............  ............  ............
86309.....................  A                          Heterophile antibodies.....  ............  ............  ............  ............  ............
86310.....................  A                          Heterophile antibodies.....  ............  ............  ............  ............  ............
86316.....................  A                          Immunoassay, tumor other...  ............  ............  ............  ............  ............
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...  ............  ............  ............  ............  ............
86336.....................  A                          Inhibin A..................  ............  ............  ............  ............  ............
86337.....................  A                          Insulin antibodies.........  ............  ............  ............  ............  ............
86340.....................  A                          Intrinsic factor antibody..  ............  ............  ............  ............  ............
86341.....................  A                          Islet cell antibody........  ............  ............  ............  ............  ............
86343.....................  A                          Leukocyte histamine release  ............  ............  ............  ............  ............
86344.....................  A                          Leukocyte phagocytosis.....  ............  ............  ............  ............  ............
86353.....................  A                          Lymphocyte transformation..  ............  ............  ............  ............  ............
86359.....................  A                          T cells, total count.......  ............  ............  ............  ............  ............
86360.....................  A                          T cell, absolute count/      ............  ............  ............  ............  ............
                                                        ratio.
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          0.16         $8.32         $3.08         $1.66
86490.....................  X                          Coccidioidomycosis skin              0341          0.16         $8.32         $3.08         $1.66
                                                        test.
86510.....................  X                          Histoplasmosis skin test...          0341          0.16         $8.32         $3.08         $1.66
86580.....................  X                          TB intradermal test........          0341          0.16         $8.32         $3.08         $1.66
86585.....................  X                          TB tine test...............          0341          0.16         $8.32         $3.08         $1.66
86586.....................  X                          Skin test, unlisted........          0341          0.16         $8.32         $3.08         $1.66
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.........  ............  ............  ............  ............  ............
86611.....................  A                          Bartonella 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...............  ............  ............  ............  ............  ............

[[Page 52262]]

 
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......  ............  ............  ............  ............  ............
86666.....................  A                          Ehrlichia 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........  ............  ............  ............  ............  ............
86696.....................  A                          Herpes simplex type 2......  ............  ............  ............  ............  ............
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, total.  ............  ............  ............  ............  ............
86705.....................  A                          Hep b core antibody, igm...  ............  ............  ............  ............  ............
86706.....................  A                          Hep b surface antibody.....  ............  ............  ............  ............  ............
86707.....................  A                          Hep be antibody............  ............  ............  ............  ............  ............
86708.....................  A                          Hep a antibody, total......  ............  ............  ............  ............  ............
86709.....................  A                          Hep a antibody, igm........  ............  ............  ............  ............  ............
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.  ............  ............  ............  ............  ............
86757.....................  A                          Rickettsia 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........  ............  ............  ............  ............  ............

[[Page 52263]]

 
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.....................  X                          RBC antibody screen........          0345          0.19         $9.88         $3.06         $1.98
86860.....................  X                          RBC antibody elution.......          0346          0.42        $21.84         $5.46         $4.37
86870.....................  X                          RBC antibody identification          0346          0.42        $21.84         $5.46         $4.37
86880.....................  X                          Coombs test................          0341          0.16         $8.32         $3.08         $1.66
86885.....................  X                          Coombs test................          0341          0.16         $8.32         $3.08         $1.66
86886.....................  X                          Coombs test................          0341          0.16         $8.32         $3.08         $1.66
86890.....................  X                          Autologous blood process...          0347          0.98        $50.97        $12.74        $10.19
86891.....................  X                          Autologous blood, op                 0345          0.19         $9.88         $3.06         $1.98
                                                        salvage.
86900.....................  X                          Blood typing, ABO..........          0341          0.16         $8.32         $3.08         $1.66
86901.....................  X                          Blood typing, Rh (D).......          0345          0.19         $9.88         $3.06         $1.98
86903.....................  X                          Blood typing, antigen                0345          0.19         $9.88         $3.06         $1.98
                                                        screen.
86904.....................  X                          Blood typing, patient serum          0345          0.19         $9.88         $3.06         $1.98
86905.....................  X                          Blood typing, RBC antigens.          0345          0.19         $9.88         $3.06         $1.98
86906.....................  X                          Blood typing, Rh phenotype.          0345          0.19         $9.88         $3.06         $1.98
86910.....................  E                          Blood typing, paternity      ............  ............  ............  ............  ............
                                                        test.
86911.....................  E                          Blood typing, antigen        ............  ............  ............  ............  ............
                                                        system.
86915.....................  X                          Bone marrow/stem cell prep.          0346          0.42        $21.84         $5.46         $4.37
86920.....................  X                          Compatibility test.........          0346          0.42        $21.84         $5.46         $4.37
86921.....................  X                          Compatibility test.........          0345          0.19         $9.88         $3.06         $1.98
86922.....................  X                          Compatibility test.........          0346          0.42        $21.84         $5.46         $4.37
86927.....................  X                          Plasma, fresh frozen.......          0346          0.42        $21.84         $5.46         $4.37
86930.....................  X                          Frozen blood prep..........          0347          0.98        $50.97        $12.74        $10.19
86931.....................  X                          Frozen blood thaw..........          0347          0.98        $50.97        $12.74        $10.19
86932.....................  X                          Frozen blood freeze/thaw...          0346          0.42        $21.84         $5.46         $4.37
86940.....................  A                          Hemolysins/agglutinins,      ............  ............  ............  ............  ............
                                                        auto.
86941.....................  A                          Hemolysins/agglutinins.....  ............  ............  ............  ............  ............
86945.....................  X                          Blood product/irradiation..          0346          0.42        $21.84         $5.46         $4.37
86950.....................  X                          Leukacyte transfusion......          0347          0.98        $50.97        $12.74        $10.19
86965.....................  X                          Pooling blood platelets....          0346          0.42        $21.84         $5.46         $4.37
86970.....................  X                          RBC pretreatment...........          0345          0.19         $9.88         $3.06         $1.98
86971.....................  X                          RBC pretreatment...........          0345          0.19         $9.88         $3.06         $1.98
86972.....................  X                          RBC pretreatment...........          0345          0.19         $9.88         $3.06         $1.98
86975.....................  X                          RBC pretreatment, serum....          0345          0.19         $9.88         $3.06         $1.98
86976.....................  X                          RBC pretreatment, serum....          0345          0.19         $9.88         $3.06         $1.98
86977.....................  X                          RBC pretreatment, serum....          0345          0.19         $9.88         $3.06         $1.98
86978.....................  X                          RBC pretreatment, serum....          0345          0.19         $9.88         $3.06         $1.98
86985.....................  X                          Split blood or products....          0347          0.98        $50.97        $12.74        $10.19
86999.....................  X                          Transfusion procedure......          0345          0.19         $9.88         $3.06         $1.98
87001.....................  A                          Small animal inoculation...  ............  ............  ............  ............  ............
87003.....................  A                          Small animal inoculation...  ............  ............  ............  ............  ............
87015.....................  A                          Specimen concentration.....  ............  ............  ............  ............  ............
87040.....................  A                          Blood culture for bacteria.  ............  ............  ............  ............  ............
87045.....................  A                          Feces culture, bacteria....  ............  ............  ............  ............  ............
87046.....................  A                          Stool cultr, bacteria, each  ............  ............  ............  ............  ............
87070.....................  A                          Culture, bacteria, other...  ............  ............  ............  ............  ............
87071.....................  A                          Culture bacteri aerobic      ............  ............  ............  ............  ............
                                                        othr.
87073.....................  A                          Culture bacteria anaerobic.  ............  ............  ............  ............  ............
87075.....................  A                          Culture bacteria anaerobic.  ............  ............  ............  ............  ............
87076.....................  A                          Culture anaerobe ident,      ............  ............  ............  ............  ............
                                                        each.
87077.....................  A                          Culture aerobic identify...  ............  ............  ............  ............  ............
87081.....................  A                          Culture screen only........  ............  ............  ............  ............  ............
87084.....................  A                          Culture of specimen by kit.  ............  ............  ............  ............  ............
87086.....................  A                          Urine culture/colony count.  ............  ............  ............  ............  ............
87088.....................  A                          Urine bacteria culture.....  ............  ............  ............  ............  ............

[[Page 52264]]

 
87101.....................  A                          Skin fungi culture.........  ............  ............  ............  ............  ............
87102.....................  A                          Fungus isolation culture...  ............  ............  ............  ............  ............
87103.....................  A                          Blood fungus culture.......  ............  ............  ............  ............  ............
87106.....................  A                          Fungi identification, yeast  ............  ............  ............  ............  ............
87107.....................  A                          Fungi identification, mold.  ............  ............  ............  ............  ............
87109.....................  A                          Mycoplasma.................  ............  ............  ............  ............  ............
87110.....................  A                          Chlamydia culture..........  ............  ............  ............  ............  ............
87116.....................  A                          Mycobacteria culture.......  ............  ............  ............  ............  ............
87118.....................  A                          Mycobacteric identification  ............  ............  ............  ............  ............
87140.....................  A                          Cultur type immunofluoresc.  ............  ............  ............  ............  ............
87143.....................  A                          Culture typing, glc/hplc...  ............  ............  ............  ............  ............
87147.....................  A                          Culture type, immunologic..  ............  ............  ............  ............  ............
87149.....................  A                          Culture type, nucleic acid.  ............  ............  ............  ............  ............
87152.....................  A                          Culture type pulse field     ............  ............  ............  ............  ............
                                                        gel.
87158.....................  A                          Culture typing, added        ............  ............  ............  ............  ............
                                                        method.
87164.....................  A                          Dark field examination.....  ............  ............  ............  ............  ............
87166.....................  A                          Dark field examination.....  ............  ............  ............  ............  ............
87168.....................  A                          Macroscopic exam arthropod.  ............  ............  ............  ............  ............
87169.....................  A                          Macacroscopic exam parasite  ............  ............  ............  ............  ............
87172.....................  A                          Pinworm exam...............  ............  ............  ............  ............  ............
87176.....................  A                          Tissue homogenization,       ............  ............  ............  ............  ............
                                                        cultr.
87177.....................  A                          Ova and parasites smears...  ............  ............  ............  ............  ............
87181.....................  A                          Microbe susceptible,         ............  ............  ............  ............  ............
                                                        diffuse.
87184.....................  A                          Microbe susceptible, disk..  ............  ............  ............  ............  ............
87185.....................  A                          Microbe susceptible, enzyme  ............  ............  ............  ............  ............
87186.....................  A                          Microbe susceptible, mic...  ............  ............  ............  ............  ............
87187.....................  A                          Microbe susceptible, mlc...  ............  ............  ............  ............  ............
87188.....................  A                          Microbe suscept, macrobroth  ............  ............  ............  ............  ............
87190.....................  A                          Microbe suscept,             ............  ............  ............  ............  ............
                                                        mycobacteri.
87197.....................  A                          Bactericidal level, serum..  ............  ............  ............  ............  ............
87198.....................  A                          Cytomegalovirus antibody     ............  ............  ............  ............  ............
                                                        dfa.
87199.....................  A                          Enterovirus antibody, dfa..  ............  ............  ............  ............  ............
87205.....................  A                          Smear, gram stain..........  ............  ............  ............  ............  ............
87206.....................  A                          Smear, fluorescent/acid      ............  ............  ............  ............  ............
                                                        stai.
87207.....................  A                          Smear, special stain.......  ............  ............  ............  ............  ............
87210.....................  A                          Smear, wet mount, saline/    ............  ............  ............  ............  ............
                                                        ink.
87220.....................  A                          Tissue exam for fungi......  ............  ............  ............  ............  ............
87230.....................  A                          Assay, toxin or antitoxin..  ............  ............  ............  ............  ............
87250.....................  A                          Virus inoculate, eggs/       ............  ............  ............  ............  ............
                                                        animal.
87252.....................  A                          Virus inoculation, tissue..  ............  ............  ............  ............  ............
87253.....................  A                          Virus inoculate tissue,      ............  ............  ............  ............  ............
                                                        addl.
87254.....................  A                          Virus inoculation, shell     ............  ............  ............  ............  ............
                                                        via.
87260.....................  A                          Adenovirus ag, if..........  ............  ............  ............  ............  ............
87265.....................  A                          Pertussis ag, if...........  ............  ............  ............  ............  ............
87270.....................  A                          Chlamydia trachomatis ag,    ............  ............  ............  ............  ............
                                                        if.
87272.....................  A                          Cryptosporidum/gardia ag,    ............  ............  ............  ............  ............
                                                        if.
87273.....................  A                          Herpes simplex 2, ag, if...  ............  ............  ............  ............  ............
87274.....................  A                          Herpes simplex 1, ag, if...  ............  ............  ............  ............  ............
87275.....................  A                          Influenza b, ag, if........  ............  ............  ............  ............  ............
87276.....................  A                          Influenza a, ag, if........  ............  ............  ............  ............  ............
87277.....................  A                          Legionella micdadei, ag, if  ............  ............  ............  ............  ............
87278.....................  A                          Legion pneumophilia ag, if.  ............  ............  ............  ............  ............
87279.....................  A                          Parainfluenza, ag, if......  ............  ............  ............  ............  ............
87280.....................  A                          Respiratory syncytial ag,    ............  ............  ............  ............  ............
                                                        if.
87281.....................  A                          Pneumocystis carinii, ag,    ............  ............  ............  ............  ............
                                                        if.
87283.....................  A                          Rubeola, ag, if............  ............  ............  ............  ............  ............
87285.....................  A                          Treponema pallidum, ag, if.  ............  ............  ............  ............  ............
87290.....................  A                          Varicella zoster, ag, if...  ............  ............  ............  ............  ............
87299.....................  A                          Antibody detection, nos, if  ............  ............  ............  ............  ............
87300.....................  A                          Ag detection, polyval, if..  ............  ............  ............  ............  ............
87301.....................  A                          Adenovirus ag, eia.........  ............  ............  ............  ............  ............
87320.....................  A                          Chylmd trach ag, eia.......  ............  ............  ............  ............  ............
87324.....................  A                          Clostridium ag, eia........  ............  ............  ............  ............  ............
87327.....................  A                          Cryptococcus neoform ag,     ............  ............  ............  ............  ............
                                                        eia.
87328.....................  A                          Cryptospor ag, eia.........  ............  ............  ............  ............  ............
87332.....................  A                          Cytomegalovirus ag, eia....  ............  ............  ............  ............  ............

[[Page 52265]]

 
87335.....................  A                          E coli 0157 ag, eia........  ............  ............  ............  ............  ............
87336.....................  A                          Entamoeb hist dispr, ag,     ............  ............  ............  ............  ............
                                                        eia.
87337.....................  A                          Entamoeb hist group, ag,     ............  ............  ............  ............  ............
                                                        eia.
87338.....................  A                          Hpylori, stool, eia........  ............  ............  ............  ............  ............
87339.....................  A                          H pylori ag, eia...........  ............  ............  ............  ............  ............
87340.....................  A                          Hepatitis b surface ag, eia  ............  ............  ............  ............  ............
87341.....................  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..............  ............  ............  ............  ............  ............
87400.....................  A                          Influenza a/b, ag, eia.....  ............  ............  ............  ............  ............
87420.....................  A                          Resp syncytial ag, eia.....  ............  ............  ............  ............  ............
87425.....................  A                          Rotavirus ag, eia..........  ............  ............  ............  ............  ............
87427.....................  A                          Shiga-like toxin ag, eia...  ............  ............  ............  ............  ............
87430.....................  A                          Strep a ag, eia............  ............  ............  ............  ............  ............
87449.....................  A                          Ag detect nos, eia, mult...  ............  ............  ............  ............  ............
87450.....................  A                          Ag detect nos, eia, single.  ............  ............  ............  ............  ............
87451.....................  A                          Ag detect polyval, eia,      ............  ............  ............  ............  ............
                                                        mult.
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.

[[Page 52266]]

 
87551.....................  A                          Mycobacteria, dna, amp       ............  ............  ............  ............  ............
                                                        probe.
87552.....................  A                          Mycobacteria, dna, quant...  ............  ............  ............  ............  ............
87555.....................  A                          M.tuberculo, dna, dir probe  ............  ............  ............  ............  ............
87556.....................  A                          M.tuberculo, dna, amp probe  ............  ............  ............  ............  ............
87557.....................  A                          M.tuberculo, dna, quant....  ............  ............  ............  ............  ............
87560.....................  A                          M.avium-intra, dna, dir      ............  ............  ............  ............  ............
                                                        prob.
87561.....................  A                          M.avium-intra, dna, amp      ............  ............  ............  ............  ............
                                                        prob.
87562.....................  A                          M.avium-intra, dna, quant..  ............  ............  ............  ............  ............
87580.....................  A                          M.pneumon, dna, dir probe..  ............  ............  ............  ............  ............
87581.....................  A                          M.pneumon, dna, amp probe..  ............  ............  ............  ............  ............
87582.....................  A                          M.pneumon, dna, quant......  ............  ............  ............  ............  ............
87590.....................  A                          N.gonorrhoeae, dna, dir      ............  ............  ............  ............  ............
                                                        prob.
87591.....................  A                          N.gonorrhoeae, dna, amp      ............  ............  ............  ............  ............
                                                        prob.
87592.....................  A                          N.gonorrhoeae, dna, quant..  ............  ............  ............  ............  ............
87620.....................  A                          Hpv, dna, dir probe........  ............  ............  ............  ............  ............
87621.....................  A                          Hpv, dna, amp probe........  ............  ............  ............  ............  ............
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.
87800.....................  A                          Detect agnt mult, dna,       ............  ............  ............  ............  ............
                                                        direc.
87801.....................  A                          Detect agnt mult, dna,       ............  ............  ............  ............  ............
                                                        ampli.
87802.....................  A                          Strep b assay w/optic......  ............  ............  ............  ............  ............
87803.....................  A                          Clostridium toxin a w/optic  ............  ............  ............  ............  ............
87804.....................  A                          Influenza assay w/optic....  ............  ............  ............  ............  ............
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....  ............  ............  ............  ............  ............
87901.....................  A                          Genotype, dna, hiv reverse   ............  ............  ............  ............  ............
                                                        t.
87902.....................  A                          Genotype, dna, hepatitis C.  ............  ............  ............  ............  ............
87903.....................  A                          Phenotype, dna hiv w/        ............  ............  ............  ............  ............
                                                        culture.
87904.....................  A                          Phenotype, dna hiv w/clt     ............  ............  ............  ............  ............
                                                        add.
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          0.47        $24.44        $13.20         $4.89
88106.....................  X                          Cytopathology, fluids......          0343          0.47        $24.44        $13.20         $4.89
88107.....................  X                          Cytopathology, fluids......          0343          0.47        $24.44        $13.20         $4.89
88108.....................  X                          Cytopath, concentrate tech.          0343          0.47        $24.44        $13.20         $4.89
88125.....................  X                          Forensic cytopathology.....          0342          0.23        $11.96         $5.88         $2.39
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 lyr      ............  ............  ............  ............  ............
                                                        redo.
88144.....................  A                          Cytopath, c/v, thin lyr      ............  ............  ............  ............  ............
                                                        redo.
88145.....................  A                          Cytopath, c/v, thin lyr sel  ............  ............  ............  ............  ............
88147.....................  A                          Cytopath, c/v, automated...  ............  ............  ............  ............  ............

[[Page 52267]]

 
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                0342          0.23        $11.96         $5.88         $2.39
                                                        source.
88161.....................  X                          Cytopath smear, other                0343          0.47        $24.44        $13.20         $4.89
                                                        source.
88162.....................  X                          Cytopath smear, other                0343          0.47        $24.44        $13.20         $4.89
                                                        source.
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..  ............  ............  ............  ............  ............
88172.....................  X                          Cytopathology eval of fna..          0343          0.47        $24.44        $13.20         $4.89
88173.....................  X                          Cytopath eval, fna, report.          0343          0.47        $24.44        $13.20         $4.89
88180.....................  X                          Cell marker study..........          0343          0.47        $24.44        $13.20         $4.89
88182.....................  X                          Cell marker study..........          0344          0.66        $34.33        $18.54         $6.87
88199.....................  A                          Cytopathology procedure....  ............  ............  ............  ............  ............
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.....................  X                          Cytogenetic study..........          0342          0.23        $11.96         $5.88         $2.39
88300.....................  X                          Surgical path, gross.......          0342          0.23        $11.96         $5.88         $2.39
88302.....................  X                          Tissue exam by pathologist.          0342          0.23        $11.96         $5.88         $2.39
88304.....................  X                          Tissue exam by pathologist.          0343          0.47        $24.44        $13.20         $4.89
88305.....................  X                          Tissue exam by pathologist.          0343          0.47        $24.44        $13.20         $4.89
88307.....................  X                          Tissue exam by pathologist.          0344          0.66        $34.33        $18.54         $6.87
88309.....................  X                          Tissue exam by pathologist.          0344          0.66        $34.33        $18.54         $6.87
88311.....................  X                          Decalcify tissue...........          0342          0.23        $11.96         $5.88         $2.39
88312.....................  X                          Special stains.............          0342          0.23        $11.96         $5.88         $2.39
88313.....................  X                          Special stains.............          0342          0.23        $11.96         $5.88         $2.39
88314.....................  X                          Histochemical stain........          0342          0.23        $11.96         $5.88         $2.39
88318.....................  X                          Chemical histochemistry....          0342          0.23        $11.96         $5.88         $2.39
88319.....................  X                          Enzyme histochemistry......          0342          0.23        $11.96         $5.88         $2.39
88321.....................  X                          Microslide consultation....          0342          0.23        $11.96         $5.88         $2.39
88323.....................  X                          Microslide consultation....          0343          0.47        $24.44        $13.20         $4.89
88325.....................  X                          Comprehensive review of              0344          0.66        $34.33        $18.54         $6.87
                                                        data.
88329.....................  X                          Path consult introp........          0342          0.23        $11.96         $5.88         $2.39
88331.....................  X                          Path consult intraop, 1              0343          0.47        $24.44        $13.20         $4.89
                                                        bloc.
88332.....................  X                          Path consult intraop, addl.          0342          0.23        $11.96         $5.88         $2.39
88342.....................  X                          Immunocytochemistry........          0344          0.66        $34.33        $18.54         $6.87
88346.....................  X                          Immunofluorescent study....          0343          0.47        $24.44        $13.20         $4.89
88347.....................  X                          Immunofluorescent study....          0344          0.66        $34.33        $18.54         $6.87

[[Page 52268]]

 
88348.....................  X                          Electron microscopy........          0661          3.46       $179.95        $98.97        $35.99
88349.....................  X                          Scanning electron                    0661          3.46       $179.95        $98.97        $35.99
                                                        microscopy.
88355.....................  X                          Analysis, skeletal muscle..          0344          0.66        $34.33        $18.54         $6.87
88356.....................  X                          Analysis, nerve............          0344          0.66        $34.33        $18.54         $6.87
88358.....................  X                          Analysis, tumor............          0344          0.66        $34.33        $18.54         $6.87
88362.....................  X                          Nerve teasing preparations.          0343          0.47        $24.44        $13.20         $4.89
88365.....................  X                          Tissue hybridization.......          0344          0.66        $34.33        $18.54         $6.87
88371.....................  A                          Protein, western blot        ............  ............  ............  ............  ............
                                                        tissue.
88372.....................  A                          Protein analysis w/probe...  ............  ............  ............  ............  ............
88380.....................  A                          Microdissection............  ............  ............  ............  ............  ............
88399.....................  A                          Surgical pathology           ............  ............  ............  ............  ............
                                                        procedure.
88400.....................  A                          Bilirubin total transcut...  ............  ............  ............  ............  ............
89050.....................  A                          Body fluid cell count......  ............  ............  ............  ............  ............
89051.....................  A                          Body fluid cell count......  ............  ............  ............  ............  ............
89060.....................  A                          Exam synovial fluid          ............  ............  ............  ............  ............
                                                        crystals.
89100.....................  X                          Sample intestinal contents.          0360          1.65        $85.81        $42.91        $17.16
89105.....................  X                          Sample intestinal contents.          0360          1.65        $85.81        $42.91        $17.16
89125.....................  A                          Specimen fat stain.........  ............  ............  ............  ............  ............
89130.....................  X                          Sample stomach contents....          0360          1.65        $85.81        $42.91        $17.16
89132.....................  X                          Sample stomach contents....          0360          1.65        $85.81        $42.91        $17.16
89135.....................  X                          Sample stomach contents....          0360          1.65        $85.81        $42.91        $17.16
89136.....................  X                          Sample stomach contents....          0360          1.65        $85.81        $42.91        $17.16
89140.....................  X                          Sample stomach contents....          0360          1.65        $85.81        $42.91        $17.16
89141.....................  X                          Sample stomach contents....          0360          1.65        $85.81        $42.91        $17.16
89160.....................  A                          Exam feces for meat fibers.  ............  ............  ............  ............  ............
89190.....................  A                          Nasal smear for eosinophils  ............  ............  ............  ............  ............
89250.....................  X                          Fertilization of oocyte....          0348          0.83        $43.17  ............         $8.63
89251.....................  X                          Culture oocyte w/embryos...          0348          0.83        $43.17  ............         $8.63
89252.....................  X                          Assist oocyte fertilization          0348          0.83        $43.17  ............         $8.63
89253.....................  X                          Embryo hatching............          0348          0.83        $43.17  ............         $8.63
89254.....................  X                          Oocyte identification......          0348          0.83        $43.17  ............         $8.63
89255.....................  X                          Prepare embryo for transfer          0348          0.83        $43.17  ............         $8.63
89256.....................  X                          Prepare cryopreserved                0348          0.83        $43.17  ............         $8.63
                                                        embryo.
89257.....................  X                          Sperm identification.......          0348          0.83        $43.17  ............         $8.63
89258.....................  X                          Cryopreservation, embryo...          0348          0.83        $43.17  ............         $8.63
89259.....................  X                          Cryopreservation, sperm....          0348          0.83        $43.17  ............         $8.63
89260.....................  X                          Sperm isolation, simple....          0348          0.83        $43.17  ............         $8.63
89261.....................  X                          Sperm isolation, complex...          0348          0.83        $43.17  ............         $8.63
89264.....................  X                          Identify sperm tissue......          0348          0.83        $43.17  ............         $8.63
89300.....................  A                          Semen analysis.............  ............  ............  ............  ............  ............
89310.....................  A                          Semen analysis.............  ............  ............  ............  ............  ............
89320.....................  A                          Semen analysis.............  ............  ............  ............  ............  ............
89321.....................  A                          Semen analysis.............  ............  ............  ............  ............  ............
89325.....................  A                          Sperm antibody test........  ............  ............  ............  ............  ............
89329.....................  A                          Sperm evaluation test......  ............  ............  ............  ............  ............
89330.....................  A                          Evaluation, cervical mucus.  ............  ............  ............  ............  ............
89350.....................  X                          Sputum specimen collection.          0344          0.66        $34.33        $18.54         $6.87
89355.....................  A                          Exam feces for starch......  ............  ............  ............  ............  ............
89360.....................  X                          Collect sweat for test.....          0344          0.66        $34.33        $18.54         $6.87
89365.....................  A                          Water load test............  ............  ............  ............  ............  ............
89399.....................  A                          Pathology lab procedure....  ............  ............  ............  ............  ............
90281.....................  E                          Human ig, im...............  ............  ............  ............  ............  ............
90283.....................  E                          Human ig, iv...............  ............  ............  ............  ............  ............
90287.....................  E                          Botulinum antitoxin........  ............  ............  ............  ............  ............
90288.....................  E                          Botulism ig, iv............  ............  ............  ............  ............  ............
90291.....................  E                          Cmv ig, iv.................  ............  ............  ............  ............  ............
90296.....................  N                          Diphtheria antitoxin.......  ............  ............  ............  ............  ............
90371.....................  K                          Hep b ig, im...............          0356          0.69        $35.89  ............         $7.18
90375.....................  K                          Rabies ig, im/sc...........          0356          0.69        $35.89  ............         $7.18
90376.....................  K                          Rabies ig, heat treated....          0356          0.69        $35.89  ............         $7.18
90378.....................  N                          Rsv ig, im, 50mg...........  ............  ............  ............  ............  ............
90379.....................  N                          Rsv ig, iv.................  ............  ............  ............  ............  ............
90384.....................  E                          Rh ig, full-dose, im.......  ............  ............  ............  ............  ............
90385.....................  N                          Rh ig, minidose, im........  ............  ............  ............  ............  ............
90386.....................  E                          Rh ig, iv..................  ............  ............  ............  ............  ............
90389.....................  N                          Tetanus ig, im.............  ............  ............  ............  ............  ............

[[Page 52269]]

 
90393.....................  N                          Vaccina ig, im.............  ............  ............  ............  ............  ............
90396.....................  N                          Varicella-zoster ig, im....  ............  ............  ............  ............  ............
90399.....................  E                          Immune globulin............  ............  ............  ............  ............  ............
90471.....................  N                          Immunization admin.........  ............  ............  ............  ............  ............
90472.....................  N                          Immunization admin, each     ............  ............  ............  ............  ............
                                                        add.
90473.....................  E                          Immune admin oral/nasal....  ............  ............  ............  ............  ............
90474.....................  E                          Immune admin oral/nasal      ............  ............  ............  ............  ............
                                                        addl.
90476.....................  N                          Adenovirus vaccine, type 4.  ............  ............  ............  ............  ............
90477.....................  N                          Adenovirus vaccine, type 7.  ............  ............  ............  ............  ............
90581.....................  K                          Anthrax vaccine, sc........          0356          0.69        $35.89  ............         $7.18
90585.....................  N                          Bcg vaccine, percut........  ............  ............  ............  ............  ............
90586.....................  N                          Bcg vaccine, intravesical..  ............  ............  ............  ............  ............
90632.....................  N                          Hep a vaccine, adult im....  ............  ............  ............  ............  ............
90633.....................  N                          Hep a vacc, ped/adol, 2      ............  ............  ............  ............  ............
                                                        dose.
90634.....................  N                          Hep a vacc, ped/adol, 3      ............  ............  ............  ............  ............
                                                        dose.
90636.....................  K                          Hep a/hep b vacc, adult im.          0355          0.24        $12.48  ............         $2.50
90645.....................  N                          Hib vaccine, hboc, im......  ............  ............  ............  ............  ............
90646.....................  N                          Hib vaccine, prp-d, im.....  ............  ............  ............  ............  ............
90647.....................  N                          Hib vaccine, prp-omp, im...  ............  ............  ............  ............  ............
90648.....................  N                          Hib vaccine, prp-t, im.....  ............  ............  ............  ............  ............
90657.....................  K                          Flu vaccine, 6-35 mo, im...          0354          0.09         $4.68  ............  ............
90658.....................  K                          Flu vaccine, 3 yrs, im.....          0354          0.09         $4.68  ............  ............
90659.....................  K                          Flu vaccine, whole, im.....          0354          0.09         $4.68  ............  ............
90660.....................  E                          Flu vaccine, nasal.........  ............  ............  ............  ............  ............
90665.....................  N                          Lyme disease vaccine, im...  ............  ............  ............  ............  ............
90669.....................  E                          Pneumococcal vacc, ped5....  ............  ............  ............  ............  ............
90675.....................  N                          Rabies vaccine, im.........  ............  ............  ............  ............  ............
90676.....................  N                          Rabies vaccine, id.........  ............  ............  ............  ............  ............
90680.....................  N                          Rotovirus vaccine, oral....  ............  ............  ............  ............  ............
90690.....................  N                          Typhoid vaccine, oral......  ............  ............  ............  ............  ............
90691.....................  N                          Typhoid vaccine, im........  ............  ............  ............  ............  ............
90692.....................  N                          Typhoid vaccine, h-p, sc/id  ............  ............  ............  ............  ............
90693.....................  K                          Typhoid vaccine, akd, sc...          0356          0.69        $35.89  ............         $7.18
90700.....................  N                          Dtap vaccine, im...........  ............  ............  ............  ............  ............
90701.....................  N                          Dtp vaccine, im............  ............  ............  ............  ............  ............
90702.....................  N                          Dt vaccine  7, im..........  ............  ............  ............  ............  ............
90703.....................  N                          Tetanus vaccine, im........  ............  ............  ............  ............  ............
90704.....................  N                          Mumps vaccine, sc..........  ............  ............  ............  ............  ............
90705.....................  N                          Measles vaccine, sc........  ............  ............  ............  ............  ............
90706.....................  N                          Rubella vaccine, sc........  ............  ............  ............  ............  ............
90707.....................  N                          Mmr vaccine, sc............  ............  ............  ............  ............  ............
90708.....................  N                          Measles-rubella vaccine, sc  ............  ............  ............  ............  ............
90709.....................  K                          Rubella & mumps vaccine, sc          0356          0.69        $35.89  ............         $7.18
90710.....................  N                          Mmrv vaccine, sc...........  ............  ............  ............  ............  ............
90712.....................  N                          Oral poliovirus vaccine....  ............  ............  ............  ............  ............
90713.....................  N                          Poliovirus, ipv, sc........  ............  ............  ............  ............  ............
90716.....................  N                          Chicken pox vaccine, sc....  ............  ............  ............  ............  ............
90717.....................  N                          Yellow fever vaccine, sc...  ............  ............  ............  ............  ............
90718.....................  N                          Td vaccine > 7, im.........  ............  ............  ............  ............  ............
90719.....................  N                          Diphtheria vaccine, im.....  ............  ............  ............  ............  ............
90720.....................  N                          Dtp/hib vaccine, im........  ............  ............  ............  ............  ............
90721.....................  N                          Dtap/hib vaccine, im.......  ............  ............  ............  ............  ............
90723.....................  K                          Dtap-hep b-ipv vaccine, im.          0356          0.69        $35.89  ............         $7.18
90725.....................  N                          Cholera vaccine, injectable  ............  ............  ............  ............  ............
90727.....................  N                          Plague vaccine, im.........  ............  ............  ............  ............  ............
90732.....................  K                          Pneumococcal vaccine.......          0354          0.09         $4.68  ............  ............
90733.....................  N                          Meningococcal vaccine, sc..  ............  ............  ............  ............  ............
90735.....................  N                          Encephalitis vaccine, sc...  ............  ............  ............  ............  ............
90740.....................  K                          Hepb vacc, ill pat 3 dose            0356          0.69        $35.89  ............         $7.18
                                                        im.
90743.....................  K                          Hep b vacc, adol, 2 dose,            0356          0.69        $35.89  ............         $7.18
                                                        im.
90744.....................  K                          Hepb vacc ped/adol 3 dose            0356          0.69        $35.89  ............         $7.18
                                                        im.
90746.....................  K                          Hep b vaccine, adult, im...          0356          0.69        $35.89  ............         $7.18
90747.....................  K                          Hepb vacc, ill pat 4 dose            0356          0.69        $35.89  ............         $7.18
                                                        im.
90748.....................  K                          Hep b/hib vaccine, im......          0355          0.24        $12.48  ............         $2.50
90749.....................  N                          Vaccine toxoid.............  ............  ............  ............  ............  ............
90780.....................  E                          IV infusion therapy, 1 hour  ............  ............  ............  ............  ............

[[Page 52270]]

 
90781.....................  E                          IV infusion, additional      ............  ............  ............  ............  ............
                                                        hour.
90782.....................  X                          Injection, sc/im...........          0353          0.43        $22.36  ............         $4.47
90783.....................  X                          Injection, ia..............          0359          0.83        $43.17  ............         $8.63
90784.....................  X                          Injection, iv..............          0359          0.83        $43.17  ............         $8.63
90788.....................  X                          Injection of antibiotic....          0359          0.83        $43.17  ............         $8.63
90799.....................  X                          Ther/prophylactic/dx inject          0352          0.14         $7.28  ............         $1.46
90801.....................  S                          Psy dx interview...........          0323          1.95       $101.42        $21.26        $20.28
90802.....................  S                          Intac psy dx interview.....          0323          1.95       $101.42        $21.26        $20.28
90804.....................  S                          Psytx, office, 20-30 min...          0322          1.44        $74.89        $12.40        $14.98
90805.....................  S                          Psytx, off, 20-30 min w/e&m          0322          1.44        $74.89        $12.40        $14.98
90806.....................  S                          Psytx, off, 45-50 min......          0323          1.95       $101.42        $21.26        $20.28
90807.....................  S                          Psytx, off, 45-50 min w/e&m          0323          1.95       $101.42        $21.26        $20.28
90808.....................  S                          Psytx, office, 75-80 min...          0323          1.95       $101.42        $21.26        $20.28
90809.....................  S                          Psytx, off, 75-80, w/e&m...          0323          1.95       $101.42        $21.26        $20.28
90810.....................  S                          Intac psytx, off, 20-30 min          0322          1.44        $74.89        $12.40        $14.98
90811.....................  S                          Intac psytx, 20-30, w/e&m..          0322          1.44        $74.89        $12.40        $14.98
90812.....................  S                          Intac psytx, off, 45-50 min          0323          1.95       $101.42        $21.26        $20.28
90813.....................  S                          Intac psytx, 45-50 min w/            0323          1.95       $101.42        $21.26        $20.28
                                                        e&m.
90814.....................  S                          Intac psytx, off, 75-80 min          0323          1.95       $101.42        $21.26        $20.28
90815.....................  S                          Intac psytx, 75-80 w/e&m...          0323          1.95       $101.42        $21.26        $20.28
90816.....................  S                          Psytx, hosp, 20-30 min.....          0322          1.44        $74.89        $12.40        $14.98
90817.....................  S                          Psytx, hosp, 20-30 min w/            0322          1.44        $74.89        $12.40        $14.98
                                                        e&m.
90818.....................  S                          Psytx, hosp, 45-50 min.....          0323          1.95       $101.42        $21.26        $20.28
90819.....................  S                          Psytx, hosp, 45-50 min w/            0323          1.95       $101.42        $21.26        $20.28
                                                        e&m.
90821.....................  S                          Psytx, hosp, 75-80 min.....          0323          1.95       $101.42        $21.26        $20.28
90822.....................  S                          Psytx, hosp, 75-80 min w/            0323          1.95       $101.42        $21.26        $20.28
                                                        e&m.
90823.....................  S                          Intac psytx, hosp, 20-30             0322          1.44        $74.89        $12.40        $14.98
                                                        min.
90824.....................  S                          Intac psytx, hsp 20-30 w/            0322          1.44        $74.89        $12.40        $14.98
                                                        e&m.
90826.....................  S                          Intac psytx, hosp, 45-50             0323          1.95       $101.42        $21.26        $20.28
                                                        min.
90827.....................  S                          Intac psytx, hsp 45-50 w/            0323          1.95       $101.42        $21.26        $20.28
                                                        e&m.
90828.....................  S                          Intac psytx, hosp, 75-80             0323          1.95       $101.42        $21.26        $20.28
                                                        min.
90829.....................  S                          Intac psytx, hsp 75-80 w/            0323          1.95       $101.42        $21.26        $20.28
                                                        e&m.
90845.....................  S                          Psychoanalysis.............          0323          1.95       $101.42        $21.26        $20.28
90846.....................  S                          Family psytx w/o patient...          0324          2.71       $140.94  ............        $28.19
90847.....................  S                          Family psytx w/patient.....          0324          2.71       $140.94  ............        $28.19
90849.....................  S                          Multiple family group psytx          0325          1.55        $80.61        $18.27        $16.12
90853.....................  S                          Group psychotherapy........          0325          1.55        $80.61        $18.27        $16.12
90857.....................  S                          Intac group psytx..........          0325          1.55        $80.61        $18.27        $16.12
90862.....................  X                          Medication management......          0374          1.20        $62.41  ............        $12.48
90865.....................  S                          Narcosynthesis.............          0323          1.95       $101.42        $21.26        $20.28
90870.....................  S                          Electroconvulsive therapy..          0320          4.46       $231.96        $80.06        $46.39
90871.....................  S                          Electroconvulsive therapy..          0320          4.46       $231.96        $80.06        $46.39
90875.....................  E                          Psychophysiological therapy  ............  ............  ............  ............  ............
90876.....................  E                          Psychophysiological therapy  ............  ............  ............  ............  ............
90880.....................  S                          Hypnotherapy...............          0323          1.95       $101.42        $21.26        $20.28
90882.....................  E                          Environmental manipulation.  ............  ............  ............  ............  ............
90885.....................  N                          Psy evaluation of records..  ............  ............  ............  ............  ............
90887.....................  N                          Consultation with family...  ............  ............  ............  ............  ............
90889.....................  N                          Preparation of report......  ............  ............  ............  ............  ............
90899.....................  S                          Psychiatric service/therapy          0322          1.44        $74.89        $12.40        $14.98
90901.....................  S                          Biofeedback train, any meth          0321          1.27        $66.05        $21.78        $13.21
90911.....................  S                          Biofeedback peri/uro/rectal          0321          1.27        $66.05        $21.78        $13.21
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                    0170          4.79       $249.12  ............        $49.82
                                                        evaluation.
90937.....................  E                          Hemodialysis, repeated eval  ............  ............  ............  ............  ............
90939.....................  N                          Hemodialysis study,          ............  ............  ............  ............  ............
                                                        transcut.
90940.....................  N                          Hemodialysis access study..  ............  ............  ............  ............  ............
90945.....................  S                          Dialysis, one evaluation...          0170          4.79       $249.12  ............        $49.82
90947.....................  E                          Dialysis, repeated eval....  ............  ............  ............  ............  ............

[[Page 52271]]

 
90989.....................  E                          Dialysis training, complete  ............  ............  ............  ............  ............
90993.....................  E                          Dialysis training, incompl.  ............  ............  ............  ............  ............
90997.....................  E                          Hemoperfusion..............  ............  ............  ............  ............  ............
90999.....................  E                          Dialysis procedure.........  ............  ............  ............  ............  ............
91000.....................  X                          Esophageal intubation......          0361          3.55       $184.63        $83.23        $36.93
91010.....................  X                          Esophagus motility study...          0361          3.55       $184.63        $83.23        $36.93
91011.....................  X                          Esophagus motility study...          0361          3.55       $184.63        $83.23        $36.93
91012.....................  X                          Esophagus motility study...          0361          3.55       $184.63        $83.23        $36.93
91020.....................  X                          Gastric motility...........          0361          3.55       $184.63        $83.23        $36.93
91030.....................  X                          Acid perfusion of esophagus          0361          3.55       $184.63        $83.23        $36.93
91032.....................  X                          Esophagus, acid reflux test          0361          3.55       $184.63        $83.23        $36.93
91033.....................  X                          Prolonged acid reflux test.          0361          3.55       $184.63        $83.23        $36.93
91052.....................  X                          Gastric analysis test......          0361          3.55       $184.63        $83.23        $36.93
91055.....................  X                          Gastric intubation for               0360          1.65        $85.81        $42.91        $17.16
                                                        smear.
91060.....................  X                          Gastric saline load test...          0360          1.65        $85.81        $42.91        $17.16
91065.....................  X                          Breath hydrogen test.......          0360          1.65        $85.81        $42.91        $17.16
91100.....................  X                          Pass intestine bleeding              0360          1.65        $85.81        $42.91        $17.16
                                                        tube.
91105.....................  X                          Gastric intubation                   0360          1.65        $85.81        $42.91        $17.16
                                                        treatment.
91122.....................  T                          Anal pressure record.......          0156          3.10       $161.23        $48.37        $32.25
91123.....................  N                          Irrigate fecal impaction...  ............  ............  ............  ............  ............
91132.....................  X                          Electrogastrography........          0360          1.65        $85.81        $42.91        $17.16
91133.....................  X                          Electrogastrography w/test.          0360          1.65        $85.81        $42.91        $17.16
91299.....................  X                          Gastroenterology procedure.          0360          1.65        $85.81        $42.91        $17.16
92002.....................  V                          Eye exam, new patient......          0601          1.04        $54.09  ............        $10.82
92004.....................  V                          Eye exam, new patient......          0602          1.57        $81.65  ............        $16.33
92012.....................  V                          Eye exam established pat...          0600          0.91        $47.33  ............         $9.47
92014.....................  V                          Eye exam & treatment.......          0602          1.57        $81.65  ............        $16.33
92015.....................  E                          Refraction.................  ............  ............  ............  ............  ............
92018.....................  T                          New eye exam & treatment...          0699          2.37       $123.26        $55.47        $24.65
92019.....................  S                          Eye exam & treatment.......          0698          1.01        $52.53        $20.49        $10.51
92020.....................  S                          Special eye evaluation.....          0230          0.78        $40.57        $15.82         $8.11
92060.....................  S                          Special eye evaluation.....          0230          0.78        $40.57        $15.82         $8.11
92065.....................  S                          Orthoptic/pleoptic training          0230          0.78        $40.57        $15.82         $8.11
92070.....................  N                          Fitting of contact lens....  ............  ............  ............  ............  ............
92081.....................  S                          Visual field examination(s)          0230          0.78        $40.57        $15.82         $8.11
92082.....................  S                          Visual field examination(s)          0698          1.01        $52.53        $20.49        $10.51
92083.....................  S                          Visual field examination(s)          0698          1.01        $52.53        $20.49        $10.51
92100.....................  N                          Serial tonometry exam(s)...  ............  ............  ............  ............  ............
92120.....................  S                          Tonography & eye evaluation          0230          0.78        $40.57        $15.82         $8.11
92130.....................  S                          Water provocation                    0698          1.01        $52.53        $20.49        $10.51
                                                        tonography.
92135.....................  S                          Opthalmic dx imaging.......          0230          0.78        $40.57        $15.82         $8.11
92136.....................  S                          Ophthalmic biometry........          0230          0.78        $40.57        $15.82         $8.11
92140.....................  S                          Glaucoma provocative tests.          0698          1.01        $52.53        $20.49        $10.51
92225.....................  S                          Special eye exam, initial..          0698          1.01        $52.53        $20.49        $10.51
92226.....................  S                          Special eye exam,                    0698          1.01        $52.53        $20.49        $10.51
                                                        subsequent.
92230.....................  T                          Eye exam with photos.......          0699          2.37       $123.26        $55.47        $24.65
92235.....................  T                          Eye exam with photos.......          0699          2.37       $123.26        $55.47        $24.65
92240.....................  S                          Icg angiography............          0231          2.24       $116.50        $52.43        $23.30
92250.....................  S                          Eye exam with photos.......          0230          0.78        $40.57        $15.82         $8.11
92260.....................  S                          Ophthalmoscopy/dynamometry.          0230          0.78        $40.57        $15.82         $8.11
92265.....................  S                          Eye muscle evaluation......          0231          2.24       $116.50        $52.43        $23.30
92270.....................  S                          Electro-oculography........          0698          1.01        $52.53        $20.49        $10.51
92275.....................  S                          Electroretinography........          0231          2.24       $116.50        $52.43        $23.30
92283.....................  S                          Color vision examination...          0230          0.78        $40.57        $15.82         $8.11
92284.....................  S                          Dark adaptation eye exam...          0698          1.01        $52.53        $20.49        $10.51
92285.....................  S                          Eye photography............          0230          0.78        $40.57        $15.82         $8.11
92286.....................  S                          Internal eye photography...          0698          1.01        $52.53        $20.49        $10.51
92287.....................  S                          Internal eye photography...          0231          2.24       $116.50        $52.43        $23.30
92310.....................  E                          Contact lens fitting.......  ............  ............  ............  ............  ............
92311.....................  X                          Contact lens fitting.......          0362          2.83       $147.19  ............        $29.44
92312.....................  X                          Contact lens fitting.......          0362          2.83       $147.19  ............        $29.44
92313.....................  X                          Contact lens fitting.......          0362          2.83       $147.19  ............        $29.44
92314.....................  E                          Prescription of contact      ............  ............  ............  ............  ............
                                                        lens.
92315.....................  X                          Prescription of contact              0362          2.83       $147.19  ............        $29.44
                                                        lens.
92316.....................  X                          Prescription of contact              0362          2.83       $147.19  ............        $29.44
                                                        lens.
92317.....................  X                          Prescription of contact              0362          2.83       $147.19  ............        $29.44
                                                        lens.

[[Page 52272]]

 
92325.....................  X                          Modification of contact              0362          2.83       $147.19  ............        $29.44
                                                        lens.
92326.....................  X                          Replacement of contact lens          0362          2.83       $147.19  ............        $29.44
92330.....................  S                          Fitting of artificial eye..          0230          0.78        $40.57        $15.82         $8.11
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          2.83       $147.19  ............        $29.44
92353.....................  X                          Special spectacles fitting.          0362          2.83       $147.19  ............        $29.44
92354.....................  X                          Special spectacles fitting.          0362          2.83       $147.19  ............        $29.44
92355.....................  X                          Special spectacles fitting.          0362          2.83       $147.19  ............        $29.44
92358.....................  X                          Eye prosthesis service.....          0362          2.83       $147.19  ............        $29.44
92370.....................  E                          Repair & adjust spectacles.  ............  ............  ............  ............  ............
92371.....................  X                          Repair & adjust spectacles.          0362          2.83       $147.19  ............        $29.44
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          0.78        $40.57        $15.82         $8.11
92502.....................  T                          Ear and throat examination.          0251          1.92        $99.86  ............        $19.97
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          1.01        $52.53        $14.18        $10.51
92512.....................  X                          Nasal function studies.....          0363          0.76        $39.53        $14.63         $7.91
92516.....................  X                          Facial nerve function test.          0660          1.65        $85.81        $31.75        $17.16
92520.....................  X                          Laryngeal function studies.          0660          1.65        $85.81        $31.75        $17.16
92525.....................  A                          Oral function evaluation...  ............  ............  ............  ............  ............
92526.....................  A                          Oral function therapy......  ............  ............  ............  ............  ............
92531.....................  N                          Spontaneous nystagmus study  ............  ............  ............  ............  ............
92532.....................  N                          Positional nystagmus test..  ............  ............  ............  ............  ............
92533.....................  N                          Caloric vestibular test....  ............  ............  ............  ............  ............
92534.....................  N                          Optokinetic nystagmus test.  ............  ............  ............  ............  ............
92541.....................  X                          Spontaneous nystagmus test.          0363          0.76        $39.53        $14.63         $7.91
92542.....................  X                          Positional nystagmus test..          0363          0.76        $39.53        $14.63         $7.91
92543.....................  X                          Caloric vestibular test....          0660          1.65        $85.81        $31.75        $17.16
92544.....................  X                          Optokinetic nystagmus test.          0363          0.76        $39.53        $14.63         $7.91
92545.....................  X                          Oscillating tracking test..          0363          0.76        $39.53        $14.63         $7.91
92546.....................  X                          Sinusoidal rotational test.          0660          1.65        $85.81        $31.75        $17.16
92547.....................  X                          Supplemental electrical              0363          0.76        $39.53        $14.63         $7.91
                                                        test.
92548.....................  X                          Posturography..............          0660          1.65        $85.81        $31.75        $17.16
92551.....................  E                          Pure tone hearing test, air  ............  ............  ............  ............  ............
92552.....................  X                          Pure tone audiometry, air..          0364          0.45        $23.40         $9.13         $4.68
92553.....................  X                          Audiometry, air & bone.....          0365          1.31        $68.13        $20.16        $13.63
92555.....................  X                          Speech threshold audiometry          0364          0.45        $23.40         $9.13         $4.68
92556.....................  X                          Speech audiometry, complete          0364          0.45        $23.40         $9.13         $4.68
92557.....................  X                          Comprehensive hearing test.          0365          1.31        $68.13        $20.16        $13.63
92559.....................  E                          Group audiometric testing..  ............  ............  ............  ............  ............
92560.....................  E                          Bekesy audiometry, screen..  ............  ............  ............  ............  ............
92561.....................  X                          Bekesy audiometry,                   0365          1.31        $68.13        $20.16        $13.63
                                                        diagnosis.
92562.....................  X                          Loudness balance test......          0364          0.45        $23.40         $9.13         $4.68
92563.....................  X                          Tone decay hearing test....          0364          0.45        $23.40         $9.13         $4.68
92564.....................  X                          Sisi hearing test..........          0364          0.45        $23.40         $9.13         $4.68
92565.....................  X                          Stenger test, pure tone....          0364          0.45        $23.40         $9.13         $4.68
92567.....................  X                          Tympanometry...............          0364          0.45        $23.40         $9.13         $4.68
92568.....................  X                          Acoustic reflex testing....          0364          0.45        $23.40         $9.13         $4.68
92569.....................  X                          Acoustic reflex decay test.          0364          0.45        $23.40         $9.13         $4.68
92571.....................  X                          Filtered speech hearing              0364          0.45        $23.40         $9.13         $4.68
                                                        test.
92572.....................  X                          Staggered spondaic word              0364          0.45        $23.40         $9.13         $4.68
                                                        test.
92573.....................  X                          Lombard test...............          0364          0.45        $23.40         $9.13         $4.68
92575.....................  X                          Sensorineural acuity test..          0365          1.31        $68.13        $20.16        $13.63
92576.....................  X                          Synthetic sentence test....          0364          0.45        $23.40         $9.13         $4.68

[[Page 52273]]

 
92577.....................  X                          Stenger test, speech.......          0365          1.31        $68.13        $20.16        $13.63
92579.....................  X                          Visual audiometry (vra)....          0365          1.31        $68.13        $20.16        $13.63
92582.....................  X                          Conditioning play                    0365          1.31        $68.13        $20.16        $13.63
                                                        audiometry.
92583.....................  X                          Select picture audiometry..          0364          0.45        $23.40         $9.13         $4.68
92584.....................  X                          Electrocochleography.......          0660          1.65        $85.81        $31.75        $17.16
92585.....................  S                          Auditor evoke potent,                0216          3.06       $159.15        $71.62        $31.83
                                                        compre.
92586.....................  S                          Auditor evoke potent, limit          0218          1.06        $55.13  ............        $11.03
92587.....................  X                          Evoked auditory test.......          0363          0.76        $39.53        $14.63         $7.91
92588.....................  X                          Evoked auditory test.......          0660          1.65        $85.81        $31.75        $17.16
92589.....................  X                          Auditory function test(s)..          0364          0.45        $23.40         $9.13         $4.68
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          1.31        $68.13        $20.16        $13.63
92597.....................  E                          Voice Prosthetic Evaluation  ............  ............  ............  ............  ............
92598.....................  E                          Voice Prosthetic             ............  ............  ............  ............  ............
                                                        Modification.
92599.....................  X                          ENT procedure/service......          0364          0.45        $23.40         $9.13         $4.68
92950.....................  S                          Heart/lung resuscitation             0094          2.68       $139.38        $47.39        $27.88
                                                        cpr.
92953.....................  S                          Temporary external pacing..          0094          2.68       $139.38        $47.39        $27.88
92960.....................  S                          Cardioversion electric, ext          0679          5.70       $296.45       $100.79        $59.29
92961.....................  S                          Cardioversion, electric,             0679          5.70       $296.45       $100.79        $59.29
                                                        int.
92970.....................  C                          Cardioassist, internal.....  ............  ............  ............  ............  ............
92971.....................  C                          Cardioassist, external.....  ............  ............  ............  ............  ............
92973.....................  T                          Percut coronary                      0973  ............       $250.00  ............        $50.00
                                                        thrombectomy.
92974.....................  T                          Cath place, cardio brachytx          0981  ............     $2,250.00  ............       $450.00
92975.....................  C                          Dissolve clot, heart vessel  ............  ............  ............  ............  ............
92977.....................  T                          Dissolve clot, heart vessel          0676          4.62       $240.28        $64.88        $48.06
92978.....................  S                          Intravasc us, heart add-on.          0670         14.78       $768.69       $276.73       $153.74
92979.....................  S                          Intravasc us, heart add-on.          0670         14.78       $768.69       $276.73       $153.74
92980.....................  T                          Insert intracoronary stent.          0104         72.72     $3,782.09  ............       $756.42
92981.....................  T                          Insert intracoronary stent.          0104         72.72     $3,782.09  ............       $756.42
92982.....................  T                          Coronary artery dilation...          0083         47.83     $2,487.59  ............       $497.52
92984.....................  T                          Coronary artery dilation...          0083         47.83     $2,487.59  ............       $497.52
92986.....................  T                          Revision of aortic valve...          0083         47.83     $2,487.59  ............       $497.52
92987.....................  T                          Revision of mitral valve...          0083         47.83     $2,487.59  ............       $497.52
92990.....................  T                          Revision of pulmonary valve          0083         47.83     $2,487.59  ............       $497.52
92992.....................  C                          Revision of heart chamber..  ............  ............  ............  ............  ............
92993.....................  C                          Revision of heart chamber..  ............  ............  ............  ............  ............
92995.....................  T                          Coronary atherectomy.......          0082         75.42     $3,922.52     $1,137.53       $784.50
92996.....................  T                          Coronary atherectomy add-on          0082         75.42     $3,922.52     $1,137.53       $784.50
92997.....................  T                          Pul art balloon repr,                0081         22.69     $1,180.08  ............       $236.02
                                                        percut.
92998.....................  T                          Pul art balloon repr,                0081         22.69     $1,180.08  ............       $236.02
                                                        percut.
93000.....................  E                          Electrocardiogram, complete  ............  ............  ............  ............  ............
93005.....................  S                          Electrocardiogram, tracing.          0099          0.38        $19.76  ............         $3.95
93010.....................  A                          Electrocardiogram report...  ............  ............  ............  ............  ............
93012.....................  N                          Transmission of ecg........  ............  ............  ............  ............  ............
93014.....................  E                          Report on transmitted ecg..  ............  ............  ............  ............  ............
93015.....................  E                          Cardiovascular stress test.  ............  ............  ............  ............  ............
93016.....................  E                          Cardiovascular stress test.  ............  ............  ............  ............  ............
93017.....................  X                          Cardiovascular stress test.          0100          1.34        $69.69        $38.33        $13.94
93018.....................  E                          Cardiovascular stress test.  ............  ............  ............  ............  ............
93024.....................  X                          Cardiac drug stress test...          0100          1.34        $69.69        $38.33        $13.94
93025.....................  X                          Microvolt t-wave assess....          0100          1.34        $69.69        $38.33        $13.94
93040.....................  E                          Rhythm ECG with report.....  ............  ............  ............  ............  ............
93041.....................  S                          Rhythm ECG, tracing........          0099          0.38        $19.76  ............         $3.95
93042.....................  E                          Rhythm ECG, report.........  ............  ............  ............  ............  ............
93224.....................  E                          ECG monitor/report, 24 hrs.  ............  ............  ............  ............  ............
93225.....................  X                          ECG monitor/record, 24 hrs.          0100          1.34        $69.69        $38.33        $13.94
93226.....................  X                          ECG monitor/report, 24 hrs.          0100          1.34        $69.69        $38.33        $13.94
93227.....................  E                          ECG monitor/review, 24 hrs.  ............  ............  ............  ............  ............
93230.....................  E                          ECG monitor/report, 24 hrs.  ............  ............  ............  ............  ............
93231.....................  X                          Ecg monitor/record, 24 hrs.          0100          1.34        $69.69        $38.33        $13.94
93232.....................  X                          ECG monitor/report, 24 hrs.          0100          1.34        $69.69        $38.33        $13.94

[[Page 52274]]

 
93233.....................  E                          ECG monitor/review, 24 hrs.  ............  ............  ............  ............  ............
93235.....................  E                          ECG monitor/report, 24 hrs.  ............  ............  ............  ............  ............
93236.....................  X                          ECG monitor/report, 24 hrs.          0100          1.34        $69.69        $38.33        $13.94
93237.....................  E                          ECG monitor/review, 24 hrs.  ............  ............  ............  ............  ............
93268.....................  E                          ECG record/review..........  ............  ............  ............  ............  ............
93270.....................  X                          ECG recording..............          0097          0.84        $43.69        $23.80         $8.74
93271.....................  X                          Ecg/monitoring and analysis          0097          0.84        $43.69        $23.80         $8.74
93272.....................  E                          Ecg/review, interpret only.  ............  ............  ............  ............  ............
93278.....................  S                          ECG/signal-averaged........          0099          0.38        $19.76  ............         $3.95
93303.....................  S                          Echo transthoracic.........          0269          3.42       $177.87        $92.49        $35.57
93304.....................  S                          Echo transthoracic.........          0697          1.51        $78.53        $40.84        $15.71
93307.....................  S                          Echo exam of heart.........          0269          3.42       $177.87        $92.49        $35.57
93308.....................  S                          Echo exam of heart.........          0697          1.51        $78.53        $40.84        $15.71
93312.....................  S                          Echo transesophageal.......          0270          5.65       $293.85       $146.79        $58.77
93313.....................  S                          Echo transesophageal.......          0270          5.65       $293.85       $146.79        $58.77
93314.....................  N                          Echo transesophageal.......  ............  ............  ............  ............  ............
93315.....................  S                          Echo transesophageal.......          0270          5.65       $293.85       $146.79        $58.77
93316.....................  S                          Echo transesophageal.......          0270          5.65       $293.85       $146.79        $58.77
93317.....................  N                          Echo transesophageal.......  ............  ............  ............  ............  ............
93318.....................  S                          Echo transesophageal                 0270          5.65       $293.85       $146.79        $58.77
                                                        intraop.
93320.....................  S                          Doppler echo exam, heart...          0671          1.68        $87.38        $45.44        $17.48
93321.....................  S                          Doppler echo exam, heart...          0697          1.51        $78.53        $40.84        $15.71
93325.....................  S                          Doppler color flow add-on..          0697          1.51        $78.53        $40.84        $15.71
93350.....................  S                          Echo transthoracic.........          0269          3.42       $177.87        $92.49        $35.57
93501.....................  T                          Right heart catheterization          0080         35.64     $1,853.60       $838.92       $370.72
93503.....................  T                          Insert/place heart catheter          0103         11.26       $585.62       $210.82       $117.12
93505.....................  T                          Biopsy of heart lining.....          0103         11.26       $585.62       $210.82       $117.12
93508.....................  T                          Cath placement, angiography          0080         35.64     $1,853.60       $838.92       $370.72
93510.....................  T                          Left heart catheterization.          0080         35.64     $1,853.60       $838.92       $370.72
93511.....................  T                          Left heart catheterization.          0080         35.64     $1,853.60       $838.92       $370.72
93514.....................  T                          Left heart catheterization.          0080         35.64     $1,853.60       $838.92       $370.72
93524.....................  T                          Left heart catheterization.          0080         35.64     $1,853.60       $838.92       $370.72
93526.....................  T                          Rt & Lt heart catheters....          0080         35.64     $1,853.60       $838.92       $370.72
93527.....................  T                          Rt & Lt heart catheters....          0080         35.64     $1,853.60       $838.92       $370.72
93528.....................  T                          Rt & Lt heart catheters....          0080         35.64     $1,853.60       $838.92       $370.72
93529.....................  T                          Rt< heart catheterization          0080         35.64     $1,853.60       $838.92       $370.72
93530.....................  T                          Rt heart cath, congenital..          0080         35.64     $1,853.60       $838.92       $370.72
93531.....................  T                          R & l heart cath,                    0080         35.64     $1,853.60       $838.92       $370.72
                                                        congenital.
93532.....................  T                          R & l heart cath,                    0080         35.64     $1,853.60       $838.92       $370.72
                                                        congenital.
93533.....................  T                          R & l heart cath,                    0080         35.64     $1,853.60       $838.92       $370.72
                                                        congenital.
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.....................  T                          Bundle of His recording....          0087          5.81       $302.17  ............        $60.43
93602.....................  T                          Intra-atrial recording.....          0087          5.81       $302.17  ............        $60.43
93603.....................  T                          Right ventricular recording          0087          5.81       $302.17  ............        $60.43
93609.....................  T                          Map tachycardia, add-on....          0087          5.81       $302.17  ............        $60.43
93610.....................  T                          Intra-atrial pacing........          0087          5.81       $302.17  ............        $60.43
93612.....................  T                          Intraventricular pacing....          0087          5.81       $302.17  ............        $60.43
93613.....................  T                          Electrophys map, 3d, add-on          0087          5.81       $302.17  ............        $60.43
93615.....................  T                          Esophageal recording.......          0087          5.81       $302.17  ............        $60.43
93616.....................  T                          Esophageal recording.......          0087          5.81       $302.17  ............        $60.43
93618.....................  T                          Heart rhythm pacing........          0087          5.81       $302.17  ............        $60.43
93619.....................  T                          Electrophysiology                    0085         31.77     $1,652.33       $363.51       $330.47
                                                        evaluation.
93620.....................  T                          Electrophysiology                    0085         31.77     $1,652.33       $363.51       $330.47
                                                        evaluation.
93621.....................  T                          Electrophysiology                    0085         31.77     $1,652.33       $363.51       $330.47
                                                        evaluation.

[[Page 52275]]

 
93622.....................  T                          Electrophysiology                    0085         31.77     $1,652.33       $363.51       $330.47
                                                        evaluation.
93623.....................  T                          Stimulation, pacing heart..          0087          5.81       $302.17  ............        $60.43
93624.....................  S                          Electrophysiologic study...          0084          9.60       $499.29  ............        $99.86
93631.....................  T                          Heart pacing, mapping......          0087          5.81       $302.17  ............        $60.43
93640.....................  S                          Evaluation heart device....          0084          9.60       $499.29  ............        $99.86
93641.....................  S                          Electrophysiology                    0084          9.60       $499.29  ............        $99.86
                                                        evaluation.
93642.....................  S                          Electrophysiology                    0084          9.60       $499.29  ............        $99.86
                                                        evaluation.
93650.....................  T                          Ablate heart dysrhythm               0086         43.70     $2,272.79       $772.75       $454.56
                                                        focus.
93651.....................  T                          Ablate heart dysrhythm               0086         43.70     $2,272.79       $772.75       $454.56
                                                        focus.
93652.....................  T                          Ablate heart dysrhythm               0086         43.70     $2,272.79       $772.75       $454.56
                                                        focus.
93660.....................  S                          Tilt table evaluation......          0101          4.40       $228.84       $105.27        $45.77
93662.....................  S                          Intracardiac ecg (ice).....          0670         14.78       $768.69       $276.73       $153.74
93668.....................  E                          Peripheral vascular rehab..  ............  ............  ............  ............  ............
93701.....................  S                          Bioimpedance, thoracic.....          0099          0.38        $19.76  ............         $3.95
93720.....................  E                          Total body plethysmography.  ............  ............  ............  ............  ............
93721.....................  X                          Plethysmography tracing....          0368          0.96        $49.93        $24.97         $9.99
93722.....................  E                          Plethysmography report.....  ............  ............  ............  ............  ............
93724.....................  S                          Analyze pacemaker system...          0690          0.45        $23.40        $10.63         $4.68
93727.....................  S                          Analyze ilr system.........          0690          0.45        $23.40        $10.63         $4.68
93731.....................  S                          Analyze pacemaker system...          0690          0.45        $23.40        $10.63         $4.68
93732.....................  S                          Analyze pacemaker system...          0690          0.45        $23.40        $10.63         $4.68
93733.....................  S                          Telephone analy, pacemaker.          0690          0.45        $23.40        $10.63         $4.68
93734.....................  S                          Analyze pacemaker system...          0690          0.45        $23.40        $10.63         $4.68
93735.....................  S                          Analyze pacemaker system...          0690          0.45        $23.40        $10.63         $4.68
93736.....................  S                          Telephone analy, pacemaker.          0690          0.45        $23.40        $10.63         $4.68
93740.....................  X                          Temperature gradient                 0367          0.60        $31.21        $15.61         $6.24
                                                        studies.
93741.....................  S                          Analyze ht pace device sngl          0689          0.60        $31.21        $12.03         $6.24
93742.....................  S                          Analyze ht pace device sngl          0689          0.60        $31.21        $12.03         $6.24
93743.....................  S                          Analyze ht pace device dual          0689          0.60        $31.21        $12.03         $6.24
93744.....................  S                          Analyze ht pace device dual          0689          0.60        $31.21        $12.03         $6.24
93760.....................  E                          Cephalic thermogram........  ............  ............  ............  ............  ............
93762.....................  E                          Peripheral thermogram......  ............  ............  ............  ............  ............
93770.....................  N                          Measure venous pressure....  ............  ............  ............  ............  ............
93784.....................  E                          Ambulatory BP monitoring...  ............  ............  ............  ............  ............
93786.....................  X                          Ambulatory BP recording....          0097          0.84        $43.69        $23.80         $8.74
93788.....................  E                          Ambulatory BP analysis.....  ............  ............  ............  ............  ............
93790.....................  E                          Review/report BP recording.  ............  ............  ............  ............  ............
93797.....................  S                          Cardiac rehab..............          0095          0.66        $34.33        $16.73         $6.87
93798.....................  S                          Cardiac rehab/monitor......          0095          0.66        $34.33        $16.73         $6.87
93799.....................  S                          Cardiovascular procedure...          0096          1.82        $94.66        $48.15        $18.93
93875.....................  S                          Extracranial study.........          0096          1.82        $94.66        $48.15        $18.93
93880.....................  S                          Extracranial study.........          0267          2.58       $134.18        $65.52        $26.84
93882.....................  S                          Extracranial study.........          0267          2.58       $134.18        $65.52        $26.84
93886.....................  S                          Intracranial study.........          0267          2.58       $134.18        $65.52        $26.84
93888.....................  S                          Intracranial study.........          0266          1.70        $88.42        $48.63        $17.68
93922.....................  S                          Extremity study............          0096          1.82        $94.66        $48.15        $18.93
93923.....................  S                          Extremity study............          0096          1.82        $94.66        $48.15        $18.93
93924.....................  S                          Extremity study............          0096          1.82        $94.66        $48.15        $18.93
93925.....................  S                          Lower extremity study......          0267          2.58       $134.18        $65.52        $26.84
93926.....................  S                          Lower extremity study......          0267          2.58       $134.18        $65.52        $26.84
93930.....................  S                          Upper extremity study......          0267          2.58       $134.18        $65.52        $26.84
93931.....................  S                          Upper extremity study......          0266          1.70        $88.42        $48.63        $17.68
93965.....................  S                          Extremity study............          0096          1.82        $94.66        $48.15        $18.93
93970.....................  S                          Extremity study............          0267          2.58       $134.18        $65.52        $26.84
93971.....................  S                          Extremity study............          0267          2.58       $134.18        $65.52        $26.84
93975.....................  S                          Vascular study.............          0267          2.58       $134.18        $65.52        $26.84
93976.....................  S                          Vascular study.............          0267          2.58       $134.18        $65.52        $26.84
93978.....................  S                          Vascular study.............          0267          2.58       $134.18        $65.52        $26.84
93979.....................  S                          Vascular study.............          0267          2.58       $134.18        $65.52        $26.84
93980.....................  S                          Penile vascular study......          0267          2.58       $134.18        $65.52        $26.84
93981.....................  S                          Penile vascular study......          0267          2.58       $134.18        $65.52        $26.84
93990.....................  S                          Doppler flow testing.......          0267          2.58       $134.18        $65.52        $26.84
94010.....................  X                          Breathing capacity test....          0368          0.96        $49.93        $24.97         $9.99
94014.....................  X                          Patient recorded spirometry          0367          0.60        $31.21        $15.61         $6.24
94015.....................  X                          Patient recorded spirometry          0367          0.60        $31.21        $15.61         $6.24
94016.....................  A                          Review patient spirometry..  ............  ............  ............  ............  ............

[[Page 52276]]

 
94060.....................  X                          Evaluation of wheezing.....          0368          0.96        $49.93        $24.97         $9.99
94070.....................  X                          Evaluation of wheezing.....          0369          2.39       $124.30        $41.02        $24.86
94150.....................  X                          Vital capacity test........          0367          0.60        $31.21        $15.61         $6.24
94200.....................  X                          Lung function test (MBC/             0367          0.60        $31.21        $15.61         $6.24
                                                        MVV).
94240.....................  X                          Residual lung capacity.....          0368          0.96        $49.93        $24.97         $9.99
94250.....................  X                          Expired gas collection.....          0367          0.60        $31.21        $15.61         $6.24
94260.....................  X                          Thoracic gas volume........          0368          0.96        $49.93        $24.97         $9.99
94350.....................  X                          Lung nitrogen washout curve          0368          0.96        $49.93        $24.97         $9.99
94360.....................  X                          Measure airflow resistance.          0367          0.60        $31.21        $15.61         $6.24
94370.....................  X                          Breath airway closing                0367          0.60        $31.21        $15.61         $6.24
                                                        volume.
94375.....................  X                          Respiratory flow volume              0367          0.60        $31.21        $15.61         $6.24
                                                        loop.
94400.....................  X                          CO2 breathing response               0367          0.60        $31.21        $15.61         $6.24
                                                        curve.
94450.....................  X                          Hypoxia response curve.....          0367          0.60        $31.21        $15.61         $6.24
94620.....................  X                          Pulmonary stress test/               0368          0.96        $49.93        $24.97         $9.99
                                                        simple.
94621.....................  X                          Pulm stress test/complex...          0369          2.39       $124.30        $41.02        $24.86
94640.....................  S                          Airway inhalation treatment          0077          0.26        $13.52         $7.44         $2.70
94642.....................  S                          Aerosol inhalation                   0078          0.68        $35.37        $15.21         $7.07
                                                        treatment.
94650.....................  S                          Pressure breathing (IPPB)..          0077          0.26        $13.52         $7.44         $2.70
94651.....................  S                          Pressure breathing (IPPB)..          0077          0.26        $13.52         $7.44         $2.70
94652.....................  C                          Pressure breathing (IPPB)..  ............  ............  ............  ............  ............
94656.....................  S                          Initial ventilator mgmt....          0079          1.63        $84.77        $16.80        $16.95
94657.....................  S                          Continued ventilator mgmt..          0079          1.63        $84.77        $16.80        $16.95
94660.....................  S                          Pos airway pressure, CPAP..          0068          1.59        $82.69        $45.48        $16.54
94662.....................  S                          Neg press ventilation, cnp.          0079          1.63        $84.77        $16.80        $16.95
94664.....................  S                          Aerosol or vapor                     0077          0.26        $13.52         $7.44         $2.70
                                                        inhalations.
94665.....................  S                          Aerosol or vapor                     0077          0.26        $13.52         $7.44         $2.70
                                                        inhalations.
94667.....................  S                          Chest wall manipulation....          0077          0.26        $13.52         $7.44         $2.70
94668.....................  S                          Chest wall manipulation....          0077          0.26        $13.52         $7.44         $2.70
94680.....................  X                          Exhaled air analysis, o2...          0367          0.60        $31.21        $15.61         $6.24
94681.....................  X                          Exhaled air analysis, o2/            0368          0.96        $49.93        $24.97         $9.99
                                                        co2.
94690.....................  X                          Exhaled air analysis.......          0367          0.60        $31.21        $15.61         $6.24
94720.....................  X                          Monoxide diffusing capacity          0368          0.96        $49.93        $24.97         $9.99
94725.....................  X                          Membrane diffusion capacity          0368          0.96        $49.93        $24.97         $9.99
94750.....................  X                          Pulmonary compliance study.          0367          0.60        $31.21        $15.61         $6.24
94760.....................  N                          Measure blood oxygen level.  ............  ............  ............  ............  ............
94761.....................  N                          Measure blood oxygen level.  ............  ............  ............  ............  ............
94762.....................  N                          Measure blood oxygen level.  ............  ............  ............  ............  ............
94770.....................  X                          Exhaled carbon dioxide test          0367          0.60        $31.21        $15.61         $6.24
94772.....................  X                          Breath recording, infant...          0369          2.39       $124.30        $41.02        $24.86
94799.....................  X                          Pulmonary service/procedure          0367          0.60        $31.21        $15.61         $6.24
95004.....................  X                          Allergy skin tests.........          0370          0.74        $38.49        $11.16         $7.70
95010.....................  X                          Sensitivity skin tests.....          0370          0.74        $38.49        $11.16         $7.70
95015.....................  X                          Sensitivity skin tests.....          0370          0.74        $38.49        $11.16         $7.70
95024.....................  X                          Allergy skin tests.........          0370          0.74        $38.49        $11.16         $7.70
95027.....................  X                          Skin end point titration...          0370          0.74        $38.49        $11.16         $7.70
95028.....................  X                          Allergy skin tests.........          0370          0.74        $38.49        $11.16         $7.70
95044.....................  X                          Allergy patch tests........          0370          0.74        $38.49        $11.16         $7.70
95052.....................  X                          Photo patch test...........          0370          0.74        $38.49        $11.16         $7.70
95056.....................  X                          Photosensitivity tests.....          0370          0.74        $38.49        $11.16         $7.70
95060.....................  X                          Eye allergy tests..........          0370          0.74        $38.49        $11.16         $7.70
95065.....................  X                          Nose allergy test..........          0370          0.74        $38.49        $11.16         $7.70
95070.....................  X                          Bronchial allergy tests....          0369          2.39       $124.30        $41.02        $24.86
95071.....................  X                          Bronchial allergy tests....          0369          2.39       $124.30        $41.02        $24.86
95075.....................  X                          Ingestion challenge test...          0361          3.55       $184.63        $83.23        $36.93
95078.....................  X                          Provocative testing........          0370          0.74        $38.49        $11.16         $7.70
95115.....................  X                          Immunotherapy, one                   0352          0.14         $7.28  ............         $1.46
                                                        injection.
95117.....................  X                          Immunotherapy injections...          0353          0.43        $22.36  ............         $4.47
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          0.50        $26.00  ............         $5.20
95145.....................  X                          Antigen therapy services...          0371          0.50        $26.00  ............         $5.20

[[Page 52277]]

 
95146.....................  X                          Antigen therapy services...          0371          0.50        $26.00  ............         $5.20
95147.....................  X                          Antigen therapy services...          0371          0.50        $26.00  ............         $5.20
95148.....................  X                          Antigen therapy services...          0371          0.50        $26.00  ............         $5.20
95149.....................  X                          Antigen therapy services...          0371          0.50        $26.00  ............         $5.20
95165.....................  X                          Antigen therapy services...          0371          0.50        $26.00  ............         $5.20
95170.....................  X                          Antigen therapy services...          0371          0.50        $26.00  ............         $5.20
95180.....................  X                          Rapid desensitization......          0370          0.74        $38.49        $11.16         $7.70
95199.....................  X                          Allergy immunology services          0370          0.74        $38.49        $11.16         $7.70
95250.....................  T                          Glucose monitoring, cont...          0972  ............       $150.00  ............        $30.00
95805.....................  S                          Multiple sleep latency test          0209         12.09       $628.79       $280.58       $125.76
95806.....................  S                          Sleep study, unattended....          0213          3.38       $175.79        $70.41        $35.16
95807.....................  S                          Sleep study, attended......          0209         12.09       $628.79       $280.58       $125.76
95808.....................  S                          Polysomnography, 1-3.......          0209         12.09       $628.79       $280.58       $125.76
95810.....................  S                          Polysomnography, 4 or more.          0209         12.09       $628.79       $280.58       $125.76
95811.....................  S                          Polysomnography w/cpap.....          0209         12.09       $628.79       $280.58       $125.76
95812.....................  S                          Electroencephalogram (EEG).          0213          3.38       $175.79        $70.41        $35.16
95813.....................  S                          Electroencephalogram (EEG).          0213          3.38       $175.79        $70.41        $35.16
95816.....................  S                          Electroencephalogram (EEG).          0214          2.37       $123.26        $61.63        $24.65
95819.....................  S                          Electroencephalogram (EEG).          0214          2.37       $123.26        $61.63        $24.65
95822.....................  S                          Sleep electroencephalogram.          0214          2.37       $123.26        $61.63        $24.65
95824.....................  S                          Electroencephalography.....          0214          2.37       $123.26        $61.63        $24.65
95827.....................  S                          Night electroencephalogram.          0209         12.09       $628.79       $280.58       $125.76
95829.....................  S                          Surgery electrocorticogram.          0214          2.37       $123.26        $61.63        $24.65
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..............          0218          1.06        $55.13  ............        $11.03
95858.....................  S                          Tensilon test & myogram....          0218          1.06        $55.13  ............        $11.03
95860.....................  S                          Muscle test, one limb......          0218          1.06        $55.13  ............        $11.03
95861.....................  S                          Muscle test, two limbs.....          0218          1.06        $55.13  ............        $11.03
95863.....................  S                          Muscle test, 3 limbs.......          0218          1.06        $55.13  ............        $11.03
95864.....................  S                          Muscle test, 4 limbs.......          0218          1.06        $55.13  ............        $11.03
95867.....................  S                          Muscle test, head or neck..          0218          1.06        $55.13  ............        $11.03
95868.....................  S                          Muscle test, head or neck..          0218          1.06        $55.13  ............        $11.03
95869.....................  S                          Muscle test, thor                    0215          0.60        $31.21  ............         $6.24
                                                        paraspinal.
95870.....................  S                          Muscle test, nonparaspinal.          0218          1.06        $55.13  ............        $11.03
95872.....................  S                          Muscle test, one fiber.....          0218          1.06        $55.13  ............        $11.03
95875.....................  S                          Limb exercise test.........          0215          0.60        $31.21  ............         $6.24
95900.....................  S                          Motor nerve conduction test          0218          1.06        $55.13  ............        $11.03
95903.....................  S                          Motor nerve conduction test          0218          1.06        $55.13  ............        $11.03
95904.....................  S                          Sense nerve conduction test          0215          0.60        $31.21  ............         $6.24
95920.....................  S                          Intraop nerve test add-on..          0216          3.06       $159.15        $71.62        $31.83
95921.....................  S                          Autonomic nerv function              0218          1.06        $55.13  ............        $11.03
                                                        test.
95922.....................  S                          Autonomic nerv function              0218          1.06        $55.13  ............        $11.03
                                                        test.
95923.....................  S                          Autonomic nerv function              0215          0.60        $31.21  ............         $6.24
                                                        test.
95925.....................  S                          Somatosensory testing......          0216          3.06       $159.15        $71.62        $31.83
95926.....................  S                          Somatosensory testing......          0216          3.06       $159.15        $71.62        $31.83
95927.....................  S                          Somatosensory testing......          0216          3.06       $159.15        $71.62        $31.83
95930.....................  S                          Visual evoked potential              0218          1.06        $55.13  ............        $11.03
                                                        test.
95933.....................  S                          Blink reflex test..........          0215          0.60        $31.21  ............         $6.24
95934.....................  S                          H-reflex test..............          0215          0.60        $31.21  ............         $6.24
95936.....................  S                          H-reflex test..............          0215          0.60        $31.21  ............         $6.24
95937.....................  S                          Neuromuscular junction test          0218          1.06        $55.13  ............        $11.03
95950.....................  S                          Ambulatory eeg monitoring..          0213          3.38       $175.79        $70.41        $35.16
95951.....................  S                          EEG monitoring/videorecord.          0209         12.09       $628.79       $280.58       $125.76
95953.....................  S                          EEG monitoring/computer....          0209         12.09       $628.79       $280.58       $125.76
95954.....................  S                          EEG monitoring/giving drugs          0214          2.37       $123.26        $61.63        $24.65
95955.....................  S                          EEG during surgery.........          0214          2.37       $123.26        $61.63        $24.65
95956.....................  S                          Eeg monitoring, cable/radio          0214          2.37       $123.26        $61.63        $24.65
95957.....................  S                          EEG digital analysis.......          0214          2.37       $123.26        $61.63        $24.65
95958.....................  S                          EEG monitoring/function              0213          3.38       $175.79        $70.41        $35.16
                                                        test.
95961.....................  S                          Electrode stimulation,               0216          3.06       $159.15        $71.62        $31.83
                                                        brain.

[[Page 52278]]

 
95962.....................  S                          Electrode stim, brain add-           0216          3.06       $159.15        $71.62        $31.83
                                                        on.
95965.....................  S                          Meg, spontaneous...........          0717  ............     $2,250.00  ............       $450.00
95966.....................  S                          Meg, evoked, single........          0714  ............     $1,375.00  ............       $275.00
95967.....................  S                          Meg, evoked, each addl.....          0712  ............       $875.00  ............       $175.00
95970.....................  S                          Analyze neurostim, no prog.          0692          0.85        $44.21        $24.32         $8.84
95971.....................  S                          Analyze neurostim, simple..          0692          0.85        $44.21        $24.32         $8.84
95972.....................  S                          Analyze neurostim, complex.          0692          0.85        $44.21        $24.32         $8.84
95973.....................  S                          Analyze neurostim, complex.          0692          0.85        $44.21        $24.32         $8.84
95974.....................  S                          Cranial neurostim, complex.          0692          0.85        $44.21        $24.32         $8.84
95975.....................  S                          Cranial neurostim, complex.          0692          0.85        $44.21        $24.32         $8.84
95999.....................  S                          Neurological procedure.....          0215          0.60        $31.21  ............         $6.24
96000.....................  S                          Motion analysis, video/3d..          0708  ............       $150.00  ............        $30.00
96001.....................  S                          Motion test w/ft press meas          0708  ............       $150.00  ............        $30.00
96002.....................  S                          Dynamic surface emg........          0708  ............       $150.00  ............        $30.00
96003.....................  S                          Dynamic fine wire emg......          0708  ............       $150.00  ............        $30.00
96004.....................  E                          Phys review of motion tests  ............  ............  ............  ............  ............
96100.....................  X                          Psychological testing......          0373          2.37       $123.26  ............        $24.65
96105.....................  X                          Assessment of aphasia......          0373          2.37       $123.26  ............        $24.65
96110.....................  X                          Developmental test, lim....          0373          2.37       $123.26  ............        $24.65
96111.....................  X                          Developmental test, extend.          0373          2.37       $123.26  ............        $24.65
96115.....................  X                          Neurobehavior status exam..          0373          2.37       $123.26  ............        $24.65
96117.....................  X                          Neuropsych test battery....          0373          2.37       $123.26  ............        $24.65
96150.....................  S                          Assess hlth/behave, init...          0322          1.44        $74.89        $12.40        $14.98
96151.....................  S                          Assess hlth/behave, subseq.          0322          1.44        $74.89        $12.40        $14.98
96152.....................  S                          Intervene hlth/behave,               0322          1.44        $74.89        $12.40        $14.98
                                                        indiv.
96153.....................  S                          Intervene hlth/behave,               0322          1.44        $74.89        $12.40        $14.98
                                                        group.
96154.....................  S                          Interv hlth/behav, fam w/pt          0322          1.44        $74.89        $12.40        $14.98
96155.....................  S                          Interv hlth/behav fam no pt          0322          1.44        $74.89        $12.40        $14.98
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.....................  T                          Pump refilling, maintenance          0125          1.73        $89.98  ............        $18.00
96530.....................  T                          Pump refilling, maintenance          0125          1.73        $89.98  ............        $18.00
96542.....................  E                          Chemotherapy injection.....  ............  ............  ............  ............  ............
96545.....................  E                          Provide chemotherapy agent.  ............  ............  ............  ............  ............
96549.....................  E                          Chemotherapy, unspecified..  ............  ............  ............  ............  ............
96567.....................  T                          Photodynamic tx, skin......          0972  ............       $150.00  ............        $30.00
96570.....................  T                          Photodynamic tx, 30 min....          0973  ............       $250.00  ............        $50.00
96571.....................  T                          Photodynamic tx, addl 15             0973  ............       $250.00  ............        $50.00
                                                        min.
96900.....................  S                          Ultraviolet light therapy..          0001          0.43        $22.36         $7.88         $4.47
96902.....................  N                          Trichogram.................  ............  ............  ............  ............  ............
96910.....................  S                          Photochemotherapy with UV-B          0001          0.43        $22.36         $7.88         $4.47
96912.....................  S                          Photochemotherapy with UV-A          0001          0.43        $22.36         $7.88         $4.47
96913.....................  S                          Photochemotherapy, UV-A or           0683          2.11       $109.74        $39.51        $21.95
                                                        B.
96999.....................  T                          Dermatological procedure...          0010          0.70        $36.41        $10.56         $7.28
97001.....................  A                          Pt evaluation..............  ............  ............  ............  ............  ............
97002.....................  A                          Pt re-evaluation...........  ............  ............  ............  ............  ............
97003.....................  A                          Ot evaluation..............  ............  ............  ............  ............  ............
97004.....................  A                          Ot re-evaluation...........  ............  ............  ............  ............  ............
97005.....................  E                          Athletic train eval........  ............  ............  ............  ............  ............
97006.....................  E                          Athletic train reeval......  ............  ............  ............  ............  ............
97010.....................  A                          Hot or cold packs therapy..  ............  ............  ............  ............  ............
97012.....................  A                          Mechanical traction therapy  ............  ............  ............  ............  ............
97014.....................  A                          Electric stimulation         ............  ............  ............  ............  ............
                                                        therapy.
97016.....................  A                          Vasopneumatic device         ............  ............  ............  ............  ............
                                                        therapy.

[[Page 52279]]

 
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.....  ............  ............  ............  ............  ............
97532.....................  A                          Cognitive skills             ............  ............  ............  ............  ............
                                                        development.
97533.....................  A                          Sensory integration........  ............  ............  ............  ............  ............
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......  ............  ............  ............  ............  ............
97601.....................  A                          Wound(s) care, selective...  ............  ............  ............  ............  ............
97602.....................  N                          Wound(s) care non-selective  ............  ............  ............  ............  ............
97703.....................  A                          Prosthetic checkout........  ............  ............  ............  ............  ............
97750.....................  A                          Physical performance test..  ............  ............  ............  ............  ............
97780.....................  E                          Acupuncture w/o stimul.....  ............  ............  ............  ............  ............
97781.....................  E                          Acupuncture w/stimul.......  ............  ............  ............  ............  ............
97799.....................  A                          Physical medicine procedure  ............  ............  ............  ............  ............
97802.....................  A                          Medical nutrition, indiv,    ............  ............  ............  ............  ............
                                                        in.
97803.....................  A                          Med nutrition, indiv,        ............  ............  ............  ............  ............
                                                        subseq.
97804.....................  A                          Medical nutrition, group...  ............  ............  ............  ............  ............
98925.....................  S                          Osteopathic manipulation...          0060          0.36        $18.72  ............         $3.74
98926.....................  S                          Osteopathic manipulation...          0060          0.36        $18.72  ............         $3.74
98927.....................  S                          Osteopathic manipulation...          0060          0.36        $18.72  ............         $3.74
98928.....................  S                          Osteopathic manipulation...          0060          0.36        $18.72  ............         $3.74
98929.....................  S                          Osteopathic manipulation...          0060          0.36        $18.72  ............         $3.74
98940.....................  S                          Chiropractic manipulation..          0060          0.36        $18.72  ............         $3.74
98941.....................  S                          Chiropractic manipulation..          0060          0.36        $18.72  ............         $3.74
98942.....................  S                          Chiropractic manipulation..          0060          0.36        $18.72  ............         $3.74
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.....................  N                          Group health education.....  ............  ............  ............  ............  ............
99080.....................  E                          Special reports or forms...  ............  ............  ............  ............  ............
99082.....................  E                          Unusual physician travel...  ............  ............  ............  ............  ............
99090.....................  E                          Computer data analysis.....  ............  ............  ............  ............  ............

[[Page 52280]]

 
99091.....................  E                          Collect/review data from pt  ............  ............  ............  ............  ............
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  ............  ............  ............  ............  ............
99142.....................  N                          Sedation, oral/rectal/nasal  ............  ............  ............  ............  ............
99170.....................  T                          Anogenital exam, child.....          0191          0.22        $11.44         $3.32         $2.29
99172.....................  E                          Ocular function screen.....  ............  ............  ............  ............  ............
99173.....................  E                          Visual acuity screen.......  ............  ............  ............  ............  ............
99175.....................  N                          Induction of vomiting......  ............  ............  ............  ............  ............
99183.....................  E                          Hyperbaric oxygen therapy..  ............  ............  ............  ............  ............
99185.....................  N                          Regional hypothermia.......  ............  ............  ............  ............  ............
99186.....................  N                          Total body hypothermia.....  ............  ............  ............  ............  ............
99190.....................  C                          Special pump services......  ............  ............  ............  ............  ............
99191.....................  C                          Special pump services......  ............  ............  ............  ............  ............
99192.....................  C                          Special pump services......  ............  ............  ............  ............  ............
99195.....................  X                          Phlebotomy.................          0372          0.56        $29.13        $10.09         $5.83
99199.....................  E                          Special service/proc/report  ............  ............  ............  ............  ............
99201.....................  V                          Office/outpatient visit,             0600          0.91        $47.33  ............         $9.47
                                                        new.
99202.....................  V                          Office/outpatient visit,             0600          0.91        $47.33  ............         $9.47
                                                        new.
99203.....................  V                          Office/outpatient visit,             0601          1.04        $54.09  ............        $10.82
                                                        new.
99204.....................  V                          Office/outpatient visit,             0602          1.57        $81.65  ............        $16.33
                                                        new.
99205.....................  V                          Office/outpatient visit,             0602          1.57        $81.65  ............        $16.33
                                                        new.
99211.....................  V                          Office/outpatient visit,             0600          0.91        $47.33  ............         $9.47
                                                        est.
99212.....................  V                          Office/outpatient visit,             0600          0.91        $47.33  ............         $9.47
                                                        est.
99213.....................  V                          Office/outpatient visit,             0601          1.04        $54.09  ............        $10.82
                                                        est.
99214.....................  V                          Office/outpatient visit,             0602          1.57        $81.65  ............        $16.33
                                                        est.
99215.....................  V                          Office/outpatient visit,             0602          1.57        $81.65  ............        $16.33
                                                        est.
99217.....................  N                          Observation care discharge.  ............  ............  ............  ............  ............
99218.....................  N                          Observation care...........  ............  ............  ............  ............  ............
99219.....................  N                          Observation care...........  ............  ............  ............  ............  ............
99220.....................  N                          Observation care...........  ............  ............  ............  ............  ............
99221.....................  E                          Initial hospital care......  ............  ............  ............  ............  ............
99222.....................  E                          Initial hospital care......  ............  ............  ............  ............  ............
99223.....................  E                          Initial hospital care......  ............  ............  ............  ............  ............
99231.....................  E                          Subsequent hospital care...  ............  ............  ............  ............  ............
99232.....................  E                          Subsequent hospital care...  ............  ............  ............  ............  ............
99233.....................  E                          Subsequent hospital care...  ............  ............  ............  ............  ............
99234.....................  N                          Observ/hosp same date......  ............  ............  ............  ............  ............
99235.....................  N                          Observ/hosp same date......  ............  ............  ............  ............  ............
99236.....................  N                          Observ/hosp same date......  ............  ............  ............  ............  ............
99238.....................  E                          Hospital discharge day.....  ............  ............  ............  ............  ............
99239.....................  E                          Hospital discharge day.....  ............  ............  ............  ............  ............
99241.....................  V                          Office consultation........          0600          0.91        $47.33  ............         $9.47
99242.....................  V                          Office consultation........          0600          0.91        $47.33  ............         $9.47
99243.....................  V                          Office consultation........          0601          1.04        $54.09  ............        $10.82
99244.....................  V                          Office consultation........          0602          1.57        $81.65  ............        $16.33
99245.....................  V                          Office consultation........          0602          1.57        $81.65  ............        $16.33
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          0.91        $47.33  ............         $9.47
99272.....................  V                          Confirmatory consultation..          0600          0.91        $47.33  ............         $9.47
99273.....................  V                          Confirmatory consultation..          0601          1.04        $54.09  ............        $10.82
99274.....................  V                          Confirmatory consultation..          0602          1.57        $81.65  ............        $16.33
99275.....................  V                          Confirmatory consultation..          0602          1.57        $81.65  ............        $16.33
99281.....................  V                          Emergency dept visit.......          0610          1.49        $77.49        $19.57        $15.50
99282.....................  V                          Emergency dept visit.......          0610          1.49        $77.49        $19.57        $15.50
99283.....................  V                          Emergency dept visit.......          0611          2.66       $138.34        $36.47        $27.67
99284.....................  V                          Emergency dept visit.......          0612          4.53       $235.60        $54.14        $47.12

[[Page 52281]]

 
99285.....................  V                          Emergency dept visit.......          0612          4.53       $235.60        $54.14        $47.12
99288.....................  E                          Direct advanced life         ............  ............  ............  ............  ............
                                                        support.
99289.....................  N                          Pt transport, 30-74 min....  ............  ............  ............  ............  ............
99290.....................  N                          Pt transport, addl 30 min..  ............  ............  ............  ............  ............
99291.....................  S                          Critical care, first hour..          0620         10.25       $533.09       $150.55       $106.62
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...  ............  ............  ............  ............  ............
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.
99377.....................  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.

[[Page 52282]]

 
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.....................  V                          Initial care, normal                 0600          0.91        $47.33  ............         $9.47
                                                        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          2.68       $139.38        $47.39        $27.88
99450.....................  E                          Life/disability evaluation.  ............  ............  ............  ............  ............
99455.....................  E                          Disability examination.....  ............  ............  ............  ............  ............
99456.....................  E                          Disability examination.....  ............  ............  ............  ............  ............
99499.....................  E                          Unlisted e&m service.......  ............  ............  ............  ............  ............
99500.....................  E                          Home visit, prenatal.......  ............  ............  ............  ............  ............
99501.....................  E                          Home visit, postnatal......  ............  ............  ............  ............  ............
99502.....................  E                          Home visit, nb care........  ............  ............  ............  ............  ............
99503.....................  E                          Home visit, resp therapy...  ............  ............  ............  ............  ............
99504.....................  E                          Home visit mech ventilator.  ............  ............  ............  ............  ............
99505.....................  E                          Home visit, stoma care.....  ............  ............  ............  ............  ............
99506.....................  E                          Home visit, im injection...  ............  ............  ............  ............  ............
99507.....................  E                          Home visit, cath maintain..  ............  ............  ............  ............  ............
99508.....................  E                          Home visit, sleep studies..  ............  ............  ............  ............  ............
99509.....................  E                          Home visit day life          ............  ............  ............  ............  ............
                                                        activity.
99510.....................  E                          Home visit, sing/m/fam       ............  ............  ............  ............  ............
                                                        couns.
99511.....................  E                          Home visit, fecal/enema      ............  ............  ............  ............  ............
                                                        mgmt.
99512.....................  E                          Home visit, hemodialysis...  ............  ............  ............  ............  ............
99539.....................  E                          Home visit, nos............  ............  ............  ............  ............  ............
99551.....................  E                          Home infus, pain mgmt, iv/   ............  ............  ............  ............  ............
                                                        sc.
99552.....................  E                          Hm infus pain mgmt, epid/    ............  ............  ............  ............  ............
                                                        ith.
99553.....................  E                          Home infuse, tocolytic tx..  ............  ............  ............  ............  ............
99554.....................  E                          Home infus, hormone/         ............  ............  ............  ............  ............
                                                        platelet.
99555.....................  E                          Home infuse, chemotheraphy.  ............  ............  ............  ............  ............
99556.....................  E                          Home infus, antibio/fung/    ............  ............  ............  ............  ............
                                                        vir.
99557.....................  E                          Home infuse, anticoagulant.  ............  ............  ............  ............  ............
99558.....................  E                          Home infuse, immunotherapy.  ............  ............  ............  ............  ............
99559.....................  E                          Home infus, periton          ............  ............  ............  ............  ............
                                                        dialysis.
99560.....................  E                          Home infus, entero           ............  ............  ............  ............  ............
                                                        nutrition.
99561.....................  E                          Home infuse, hydration tx..  ............  ............  ............  ............  ............
99562.....................  E                          Home infus, parent           ............  ............  ............  ............  ............
                                                        nutrition.
99563.....................  E                          Home admin, pentamidine....  ............  ............  ............  ............  ............
99564.....................  E                          Hme infus, antihemophil      ............  ............  ............  ............  ............
                                                        agnt.
99565.....................  E                          Home infus, proteinase       ............  ............  ............  ............  ............
                                                        inhib.
99566.....................  E                          Home infuse, iv therapy....  ............  ............  ............  ............  ............
99567.....................  E                          Home infuse, sympath agent.  ............  ............  ............  ............  ............
99568.....................  E                          Home infus, misc drug,       ............  ............  ............  ............  ............
                                                        daily.
99569.....................  E                          Home infuse, each addl tx..  ............  ............  ............  ............  ............
A0021.....................  E                          Outside state ambulance      ............  ............  ............  ............  ............
                                                        serv.
A0080.....................  E                          Noninterest escort in non    ............  ............  ............  ............  ............
                                                        er.
A0090.....................  E                          Interest escort in non er..  ............  ............  ............  ............  ............
A0100.....................  E                          Nonemergency transport taxi  ............  ............  ............  ............  ............
A0110.....................  E                          Nonemergency transport bus.  ............  ............  ............  ............  ............
A0120.....................  E                          Noner transport mini-bus...  ............  ............  ............  ............  ............
A0130.....................  E                          Noner transport wheelch van  ............  ............  ............  ............  ............
A0140.....................  E                          Nonemergency transport air.  ............  ............  ............  ............  ............
A0160.....................  E                          Noner transport case worker  ............  ............  ............  ............  ............
A0170.....................  E                          Noner transport parking      ............  ............  ............  ............  ............
                                                        fees.
A0180.....................  E                          Noner transport lodgng       ............  ............  ............  ............  ............
                                                        recip.
A0190.....................  E                          Noner transport meals recip  ............  ............  ............  ............  ............
A0200.....................  E                          Noner transport lodgng       ............  ............  ............  ............  ............
                                                        escrt.
A0210.....................  E                          Noner transport meals        ............  ............  ............  ............  ............
                                                        escort.
A0225.....................  A                          Neonatal emergency           ............  ............  ............  ............  ............
                                                        transport.
A0380.....................  A                          Basic life support mileage.  ............  ............  ............  ............  ............
A0382.....................  A                          Basic support routine        ............  ............  ............  ............  ............
                                                        suppls.
A0384.....................  A                          Bls defibrillation supplies  ............  ............  ............  ............  ............

[[Page 52283]]

 
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..  ............  ............  ............  ............  ............
A0425.....................  A                          Ground mileage.............  ............  ............  ............  ............  ............
A0426.....................  A                          Als 1......................  ............  ............  ............  ............  ............
A0427.....................  A                          ALS1-emergency.............  ............  ............  ............  ............  ............
A0428.....................  A                          bls........................  ............  ............  ............  ............  ............
A0429.....................  A                          BLS-emergency..............  ............  ............  ............  ............  ............
A0430.....................  A                          Fixed wing air transport...  ............  ............  ............  ............  ............
A0431.....................  A                          Rotary wing air transport..  ............  ............  ............  ............  ............
A0432.....................  A                          PI volunteer ambulance co..  ............  ............  ............  ............  ............
A0433.....................  A                          als 2......................  ............  ............  ............  ............  ............
A0434.....................  A                          Specialty care transport...  ............  ............  ............  ............  ............
A0435.....................  A                          Fixed wing air mileage.....  ............  ............  ............  ............  ............
A0436.....................  A                          Rotary wing air mileage....  ............  ............  ............  ............  ............
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.....................  E                          5+ CC sterile                ............  ............  ............  ............  ............
                                                        syringe&needle.
A4210.....................  E                          Nonneedle injection device.  ............  ............  ............  ............  ............
A4211.....................  E                          Supp for self-adm            ............  ............  ............  ............  ............
                                                        injections.
A4212.....................  E                          Non coring needle or stylet  ............  ............  ............  ............  ............
A4213.....................  E                          20+ CC syringe only........  ............  ............  ............  ............  ............
A4214.....................  A                          30 CC sterile water/saline.  ............  ............  ............  ............  ............
A4215.....................  E                          Sterile needle.............  ............  ............  ............  ............  ............
A4220.....................  A                          Infusion pump refill kit...  ............  ............  ............  ............  ............
A4221.....................  A                          Maint drug infus cath per    ............  ............  ............  ............  ............
                                                        wk.
A4222.....................  A                          Drug infusion pump supplies  ............  ............  ............  ............  ............
A4230.....................  A                          Infus insulin pump non       ............  ............  ............  ............  ............
                                                        needl.
A4231.....................  A                          Infusion insulin pump        ............  ............  ............  ............  ............
                                                        needle.
A4232.....................  A                          Syringe w/needle insulin     ............  ............  ............  ............  ............
                                                        3cc.
A4244.....................  E                          Alcohol or peroxide per      ............  ............  ............  ............  ............
                                                        pint.
A4245.....................  E                          Alcohol wipes per box......  ............  ............  ............  ............  ............
A4246.....................  E                          Betadine/phisohex solution.  ............  ............  ............  ............  ............
A4247.....................  E                          Betadine/iodine swabs/wipes  ............  ............  ............  ............  ............
A4250.....................  E                          Urine reagent strips/        ............  ............  ............  ............  ............
                                                        tablets.
A4253.....................  A                          Blood glucose/reagent        ............  ............  ............  ............  ............
                                                        strips.
A4254.....................  A                          Battery for glucose monitor  ............  ............  ............  ............  ............
A4255.....................  A                          Glucose monitor platforms..  ............  ............  ............  ............  ............
A4256.....................  A                          Calibrator solution/chips..  ............  ............  ............  ............  ............
A4257.....................  A                          Replace Lensshield           ............  ............  ............  ............  ............
                                                        Cartridge.
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.....................  N                          Permanent tear duct plug...  ............  ............  ............  ............  ............
A4265.....................  A                          Paraffin...................  ............  ............  ............  ............  ............
A4270.....................  A                          Disposable endoscope sheath  ............  ............  ............  ............  ............
A4280.....................  A                          Brst prsths adhsv attchmnt.  ............  ............  ............  ............  ............
A4290.....................  E                          Sacral nerve stim test lead  ............  ............  ............  ............  ............
A4300.....................  E                          Cath impl vasc access        ............  ............  ............  ............  ............
                                                        portal.
A4301.....................  E                          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.......  ............  ............  ............  ............  ............

[[Page 52284]]

 
A4314.....................  A                          Cath w/drainage 2-way latex  ............  ............  ............  ............  ............
A4315.....................  A                          Cath w/drainage 2-way        ............  ............  ............  ............  ............
                                                        silcne.
A4316.....................  A                          Cath w/drainage 3-way......  ............  ............  ............  ............  ............
A4319.....................  A                          Sterile H2O irrigation       ............  ............  ............  ............  ............
                                                        solut.
A4320.....................  A                          Irrigation tray............  ............  ............  ............  ............  ............
A4321.....................  A                          Cath therapeutic irrig       ............  ............  ............  ............  ............
                                                        agent.
A4322.....................  A                          Irrigation syringe.........  ............  ............  ............  ............  ............
A4323.....................  A                          Saline irrigation solution.  ............  ............  ............  ............  ............
A4324.....................  A                          Male ext cath w/adh coating  ............  ............  ............  ............  ............
A4325.....................  A                          Male ext cath w/adh strip..  ............  ............  ............  ............  ............
A4326.....................  A                          Male external catheter.....  ............  ............  ............  ............  ............
A4327.....................  A                          Fem urinary collect dev cup  ............  ............  ............  ............  ............
A4328.....................  A                          Fem urinary collect pouch..  ............  ............  ............  ............  ............
A4330.....................  A                          Stool collection pouch.....  ............  ............  ............  ............  ............
A4331.....................  A                          Extension drainage tubing..  ............  ............  ............  ............  ............
A4332.....................  A                          Lubricant for cath           ............  ............  ............  ............  ............
                                                        insertion.
A4333.....................  A                          Urinary cath anchor device.  ............  ............  ............  ............  ............
A4334.....................  A                          Urinary cath leg strap.....  ............  ............  ............  ............  ............
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.....  ............  ............  ............  ............  ............
A4348.....................  A                          Male ext cath extended wear  ............  ............  ............  ............  ............
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 or abdomen bag.  ............  ............  ............  ............  ............
A4359.....................  A                          Urinary suspensory w/o leg   ............  ............  ............  ............  ............
                                                        b.
A4360.....................  A                          Adult incontinence garment.  ............  ............  ............  ............  ............
A4361.....................  A                          Ostomy face plate..........  ............  ............  ............  ............  ............
A4362.....................  A                          Solid skin barrier.........  ............  ............  ............  ............  ............
A4364.....................  A                          Adhesive, liquid or equal..  ............  ............  ............  ............  ............
A4365.....................  A                          Adhesive remover wipes.....  ............  ............  ............  ............  ............
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.
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.

[[Page 52285]]

 
A4394.....................  A                          Ostomy pouch liq deodorant.  ............  ............  ............  ............  ............
A4395.....................  A                          Ostomy pouch solid           ............  ............  ............  ............  ............
                                                        deodorant.
A4396.....................  A                          Peristomal hernia supprt     ............  ............  ............  ............  ............
                                                        blt.
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  ............  ............  ............  ............  ............
A4464.....................  A                          Joint support device/        ............  ............  ............  ............  ............
                                                        garment.
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....  ............  ............  ............  ............  ............
A4561.....................  N                          Pessary rubber, any type...  ............  ............  ............  ............  ............
A4562.....................  N                          Pessary, non rubber,any      ............  ............  ............  ............  ............
                                                        type.
A4565.....................  A                          Slings.....................  ............  ............  ............  ............  ............
A4570.....................  N                          Splint.....................  ............  ............  ............  ............  ............
A4572.....................  A                          Rib belt...................  ............  ............  ............  ............  ............
A4575.....................  E                          Hyperbaric o2 chamber disps  ............  ............  ............  ............  ............
A4580.....................  N                          Cast supplies (plaster)....  ............  ............  ............  ............  ............
A4590.....................  N                          Special casting material...  ............  ............  ............  ............  ............
A4595.....................  A                          TENS suppl 2 lead per month  ............  ............  ............  ............  ............
A4608.....................  A                          Transtracheal oxygen cath..  ............  ............  ............  ............  ............
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...  ............  ............  ............  ............  ............
A4642.....................  N                          Satumomab pendetide per      ............  ............  ............  ............  ............
                                                        dose.

[[Page 52286]]

 
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..........  ............  ............  ............  ............  ............
A4651.....................  A                          Calibrated microcap tube...  ............  ............  ............  ............  ............
A4652.....................  A                          Microcapillary tube sealant  ............  ............  ............  ............  ............
A4656.....................  A                          Dialysis needle............  ............  ............  ............  ............  ............
A4657.....................  A                          Dialysis syringe w/wo        ............  ............  ............  ............  ............
                                                        needle.
A4660.....................  A                          Sphyg/bp app w cuff and      ............  ............  ............  ............  ............
                                                        stet.
A4663.....................  A                          Dialysis blood pressure      ............  ............  ............  ............  ............
                                                        cuff.
A4670.....................  E                          Automatic bp monitor, dial.  ............  ............  ............  ............  ............
A4680.....................  A                          Activated carbon filter, ea  ............  ............  ............  ............  ............
A4690.....................  A                          Dialyzer, each.............  ............  ............  ............  ............  ............
A4706.....................  A                          Bicarbonate conc sol per     ............  ............  ............  ............  ............
                                                        gal.
A4707.....................  A                          Bicarbonate conc pow per     ............  ............  ............  ............  ............
                                                        pac.
A4708.....................  A                          Acetate conc sol per gallon  ............  ............  ............  ............  ............
A4709.....................  A                          Acid conc sol per gallon...  ............  ............  ............  ............  ............
A4712.....................  A                          Sterile water inj per 10 ml  ............  ............  ............  ............  ............
A4714.....................  A                          Treated water per gallon...  ............  ............  ............  ............  ............
A4719.....................  A                          ``Y set'' tubing...........  ............  ............  ............  ............  ............
A4720.....................  A                          Dialysat sol fld vol >       ............  ............  ............  ............  ............
                                                        249cc.
A4721.....................  A                          Dialysat sol fld vol >       ............  ............  ............  ............  ............
                                                        999cc.
A4722.....................  A                          Dialys sol fld vol > 1999cc  ............  ............  ............  ............  ............
A4723.....................  A                          Dialys sol fld vol > 2999cc  ............  ............  ............  ............  ............
A4724.....................  A                          Dialys sol fld vol > 3999cc  ............  ............  ............  ............  ............
A4725.....................  A                          Dialys sol fld vol > 4999cc  ............  ............  ............  ............  ............
A4726.....................  A                          Dialys sol fld vol > 5999cc  ............  ............  ............  ............  ............
A4730.....................  A                          Fistula cannulation set, ea  ............  ............  ............  ............  ............
A4736.....................  A                          Topical anesthetic, per      ............  ............  ............  ............  ............
                                                        gram.
A4737.....................  A                          Inj anesthetic per 10 ml...  ............  ............  ............  ............  ............
A4740.....................  A                          Shunt accessory............  ............  ............  ............  ............  ............
A4750.....................  A                          Art or venous blood tubing.  ............  ............  ............  ............  ............
A4755.....................  A                          Comb art/venous blood        ............  ............  ............  ............  ............
                                                        tubing.
A4760.....................  A                          Dialysate sol test kit,      ............  ............  ............  ............  ............
                                                        each.
A4765.....................  A                          Dialysate conc pow per pack  ............  ............  ............  ............  ............
A4766.....................  A                          Dialysate conc sol add 10    ............  ............  ............  ............  ............
                                                        ml.
A4770.....................  A                          Blood collection tube/       ............  ............  ............  ............  ............
                                                        vacuum.
A4771.....................  A                          Serum clotting time tube...  ............  ............  ............  ............  ............
A4772.....................  A                          Blood glucose test strips..  ............  ............  ............  ............  ............
A4773.....................  A                          Occult blood test strips...  ............  ............  ............  ............  ............
A4774.....................  A                          Ammonia test strips........  ............  ............  ............  ............  ............
A4801.....................  A                          Heparin per 1000 units.....  ............  ............  ............  ............  ............
A4802.....................  A                          Protamine sulfate per 50 mg  ............  ............  ............  ............  ............
A4860.....................  A                          Disposable catheter tips...  ............  ............  ............  ............  ............
A4870.....................  A                          Plumb/elec wk hm hemo equip  ............  ............  ............  ............  ............
A4890.....................  A                          Repair/maint cont hemo       ............  ............  ............  ............  ............
                                                        equip.
A4911.....................  A                          Drain bag/bottle...........  ............  ............  ............  ............  ............
A4913.....................  A                          Misc dialysis supplies noc.  ............  ............  ............  ............  ............
A4918.....................  A                          Venous pressure clamp......  ............  ............  ............  ............  ............
A4927.....................  A                          Non-sterile gloves.........  ............  ............  ............  ............  ............
A4928.....................  A                          Surgical mask..............  ............  ............  ............  ............  ............
A4929.....................  A                          Tourniquet for dialysis, ea  ............  ............  ............  ............  ............
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  ............  ............  ............  ............  ............
A5071.....................  A                          Urinary pouch w/barrier....  ............  ............  ............  ............  ............
A5072.....................  A                          Urinary pouch w/o barrier..  ............  ............  ............  ............  ............
A5073.....................  A                          Urinary pouch on barr w/     ............  ............  ............  ............  ............
                                                        flng.
A5081.....................  A                          Continent stoma plug.......  ............  ............  ............  ............  ............

[[Page 52287]]

 
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..........  ............  ............  ............  ............  ............
A5200.....................  A                          Percutaneous catheter        ............  ............  ............  ............  ............
                                                        anchor.
A5500.....................  A                          Diab shoe for density        ............  ............  ............  ............  ............
                                                        insert.
A5501.....................  A                          Diabetic custom molded shoe  ............  ............  ............  ............  ............
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.......  ............  ............  ............  ............  ............
A5509.....................  A                          Direct heat form shoe        ............  ............  ............  ............  ............
                                                        insert.
A5510.....................  A                          Compression form shoe        ............  ............  ............  ............  ............
                                                        insert.
A5511.....................  A                          Custom fab molded shoe       ............  ............  ............  ............  ............
                                                        inser.
A6000.....................  A                          Wound warming wound cover..  ............  ............  ............  ............  ............
A6010.....................  A                          Collagen based wound filler  ............  ............  ............  ............  ............
A6021.....................  A                          Collagen dressing =16 sq in  ............  ............  ............  ............  ............
A6022.....................  A                          Collagen drsg>6=48 sq in...  ............  ............  ............  ............  ............
A6023.....................  A                          Collagen dressing >48 sq in  ............  ............  ............  ............  ............
A6024.....................  A                          Collagen dsg wound filler..  ............  ............  ............  ............  ............
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.
A6231.....................  A                          Hydrogel dsg=16 sq in......  ............  ............  ............  ............  ............

[[Page 52288]]

 
A6232.....................  A                          Hydrogel dsg>16=48 sq in...  ............  ............  ............  ............  ............
A6233.....................  A                          Hydrogel dressing >48 sq in  ............  ............  ............  ............  ............
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.
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  ............  ............  ............  ............  ............
A7018.....................  A                          Water distilled w/nebulizer  ............  ............  ............  ............  ............
A7019.....................  A                          Saline solution dispenser..  ............  ............  ............  ............  ............
A7020.....................  A                          Sterile H2O or NSS w lgv     ............  ............  ............  ............  ............
                                                        neb.
A7501.....................  A                          Tracheostoma valve w         ............  ............  ............  ............  ............
                                                        diaphra.
A7502.....................  A                          Replacement diaphragm/       ............  ............  ............  ............  ............
                                                        fplate.
A7503.....................  A                          HMES filter holder or cap..  ............  ............  ............  ............  ............
A7504.....................  A                          Tracheostoma HMES filter...  ............  ............  ............  ............  ............
A7505.....................  A                          HMES or trach valve housing  ............  ............  ............  ............  ............
A7506.....................  A                          HMES/trachvalve              ............  ............  ............  ............  ............
                                                        adhesivedisk.

[[Page 52289]]

 
A7507.....................  A                          Integrated filter & holder.  ............  ............  ............  ............  ............
A7508.....................  A                          Housing & Integrated         ............  ............  ............  ............  ............
                                                        Adhesiv.
A7509.....................  A                          Heat & moisture exchange     ............  ............  ............  ............  ............
                                                        sys.
A9150.....................  E                          Misc/exper non-prescript     ............  ............  ............  ............  ............
                                                        dru.
A9270.....................  E                          Non-covered item or service  ............  ............  ............  ............  ............
A9300.....................  E                          Exercise equipment.........  ............  ............  ............  ............  ............
A9500.....................  N                          Technetium TC 99m sestamibi  ............  ............  ............  ............  ............
A9502.....................  N                          Technetium TC99M             ............  ............  ............  ............  ............
                                                        tetrofosmin.
A9503.....................  N                          Technetium TC 99m medronate  ............  ............  ............  ............  ............
A9504.....................  N                          Technetium tc 99m apcitide.  ............  ............  ............  ............  ............
A9505.....................  N                          Thallous chloride TL 201/    ............  ............  ............  ............  ............
                                                        mci.
A9507.....................  K                          Indium/111 capromab                  1604          5.91       $307.37  ............        $61.47
                                                        pendetid.
A9508.....................  N                          Iobenguane sulfate I-131...  ............  ............  ............  ............  ............
A9510.....................  N                          Technetium TC99m Disofenin.  ............  ............  ............  ............  ............
A9511.....................  K                          Technetium TC 99m                    1095          0.25        $13.00  ............         $2.60
                                                        depreotide.
A9600.....................  K                          Strontium-89 chloride......          0701          6.43       $334.42  ............        $66.88
A9605.....................  K                          Samarium sm153 lexidronamm.          0702         15.02       $781.18  ............       $156.24
A9700.....................  G                          Echocardiography Contrast..          9016  ............       $118.75  ............        $17.00
A9900.....................  A                          Supply/accessory/service...  ............  ............  ............  ............  ............
A9901.....................  A                          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  ............  ............  ............  ............  ............
B4086.....................  A                          Gastrostomy/jejunostomy      ............  ............  ............  ............  ............
                                                        tube.
B4150.....................  A                          Enteral formulae category i  ............  ............  ............  ............  ............
B4151.....................  A                          Enteral formulae             ............  ............  ............  ............  ............
                                                        cat1natural.
B4152.....................  A                          Enteral formulae category    ............  ............  ............  ............  ............
                                                        ii.
B4153.....................  A                          Enteral formulae             ............  ............  ............  ............  ............
                                                        categoryIII.
B4154.....................  A                          Enteral formulae category    ............  ............  ............  ............  ............
                                                        IV.
B4155.....................  A                          Enteral formulae category v  ............  ............  ............  ............  ............
B4156.....................  A                          Enteral formulae category    ............  ............  ............  ............  ............
                                                        vi.
B4164.....................  A                          Parenteral 50% dextrose      ............  ............  ............  ............  ............
                                                        solu.
B4168.....................  A                          Parenteral sol amino acid    ............  ............  ............  ............  ............
                                                        3..
B4172.....................  A                          Parenteral sol amino acid    ............  ............  ............  ............  ............
                                                        5..
B4176.....................  A                          Parenteral sol amino acid 7- ............  ............  ............  ............  ............
                                                        .
B4178.....................  A                          Parenteral sol amino acid >  ............  ............  ............  ............  ............
B4180.....................  A                          Parenteral sol carb > 50%..  ............  ............  ............  ............  ............
B4184.....................  A                          Parenteral sol lipids 10%..  ............  ............  ............  ............  ............
B4186.....................  A                          Parenteral sol lipids 20%..  ............  ............  ............  ............  ............
B4189.....................  A                          Parenteral sol amino acid &  ............  ............  ............  ............  ............
B4193.....................  A                          Parenteral sol 52-73 gm      ............  ............  ............  ............  ............
                                                        prot.
B4197.....................  A                          Parenteral sol 74-100 gm     ............  ............  ............  ............  ............
                                                        pro.
B4199.....................  A                          Parenteral sol > 100gm       ............  ............  ............  ............  ............
                                                        prote.
B4216.....................  A                          Parenteral nutrition         ............  ............  ............  ............  ............
                                                        additiv.
B4220.....................  A                          Parenteral supply kit        ............  ............  ............  ............  ............
                                                        premix.
B4222.....................  A                          Parenteral supply kit        ............  ............  ............  ............  ............
                                                        homemi.
B4224.....................  A                          Parenteral administration    ............  ............  ............  ............  ............
                                                        ki.
B5000.....................  A                          Parenteral sol renal-        ............  ............  ............  ............  ............
                                                        amirosy.
B5100.....................  A                          Parenteral sol hepatic-      ............  ............  ............  ............  ............
                                                        fream.
B5200.....................  A                          Parenteral sol stres-brnch   ............  ............  ............  ............  ............
                                                        c.
B9000.....................  A                          Enter infusion pump w/o      ............  ............  ............  ............  ............
                                                        alrm.
B9002.....................  A                          Enteral infusion pump w/     ............  ............  ............  ............  ............
                                                        ala.
B9004.....................  A                          Parenteral infus pump        ............  ............  ............  ............  ............
                                                        portab.
B9006.....................  A                          Parenteral infus pump        ............  ............  ............  ............  ............
                                                        statio.
B9998.....................  A                          Enteral supp not otherwise   ............  ............  ............  ............  ............
                                                        c.
B9999.....................  A                          Parenteral supp not othrws   ............  ............  ............  ............  ............
                                                        c.
C1010.....................  K                          Blood, L/R, CMV-NEG........          1010          1.67        $86.86  ............        $17.37
C1011.....................  K                          Platelets, HLA-m, L/R, unit          1011          6.03       $313.61  ............        $62.72
C1012.....................  K                          PLATELET CONC, L/R, Irrad..          0954          1.59        $82.69  ............        $16.54
C1013.....................  K                          PLATELET CONC, L/R, Unit...          1013          0.91        $47.33  ............         $9.47
C1014.....................  K                          Platelet,Aph/Pher, L/R,              9501          5.10       $265.25  ............        $53.05
                                                        unit.
C1016.....................  K                          BLOOD,L/R,FROZ/DEGLY/Washed          1016          1.09        $56.69  ............        $11.34
C1017.....................  K                          Plt, APH/PHER,L/R,CMV-NEG..          1017          4.78       $248.60  ............        $49.72

[[Page 52290]]

 
C1018.....................  K                          Blood, L/R, IRRADIATED.....          1018          1.90        $98.82  ............        $19.76
C1058.....................  G                          TC 99M oxidronate, per vial          1058  ............        $36.74  ............         $5.26
C1064.....................  G                          I-131 cap, each add mCi....          1064  ............         $5.86  ............          $.75
C1065.....................  G                          I-131 sol, each add mCi....          1065  ............        $15.81  ............         $2.03
C1066.....................  N                          IN 111 satumomab pendetide.  ............  ............  ............  ............  ............
C1079.....................  N                          CO 57/58 per 0.5 uCi.......  ............  ............  ............  ............  ............
C1087.....................  N                          I-123 per 100 uCi..........  ............  ............  ............  ............  ............
C1088.....................  T                          LASER OPTIC TR Sys.........          0980  ............     $1,875.00  ............       $375.00
C1091.....................  K                          IN111                                1091          4.36       $226.76  ............        $45.35
                                                        oxyquinoline,per0.5mCi.
C1092.....................  K                          IN 111 pentetate per 0.5             1092          4.78       $248.60  ............        $49.72
                                                        mCi.
C1094.....................  N                          TC99Malbumin aggr,per        ............  ............  ............  ............  ............
                                                        1.0mCi.
C1096.....................  K                          TC 99M EXAMETAZIME, PER              1096          3.35       $174.23  ............        $34.85
                                                        Dose.
C1097.....................  N                          TC 99M MEBROFENIN, PER Vial  ............  ............  ............  ............  ............
C1098.....................  N                          TC 99M PENTETATE, PER Vial.  ............  ............  ............  ............  ............
C1099.....................  N                          TC 99M PYROPHOSPHATE,PER     ............  ............  ............  ............  ............
                                                        Via.
C1122.....................  K                          Tc 99M ARCITUMOMAB PER VIAL          1122          8.33       $433.23  ............        $86.65
C1166.....................  N                          CYTARABINE LIPOSOMAL, 10 mg  ............  ............  ............  ............  ............
C1167.....................  K                          EPIRUBICIN HCL, 2 mg.......          1167          0.32        $16.64  ............         $3.33
C1178.....................  K                          BUSULFAN IV, 6 Mg..........          1178          0.53        $27.56  ............         $5.51
C1188.....................  N                          I-131 cap, per 1-5 mCi.....  ............  ............  ............  ............  ............
C1200.....................  N                          TC 99M Sodium Glucoheptonat  ............  ............  ............  ............  ............
C1201.....................  N                          TC 99M SUCCIMER, PER Vial..  ............  ............  ............  ............  ............
C1202.....................  N                          TC 99M SULFUR COLLOID, Vial  ............  ............  ............  ............  ............
C1207.....................  K                          OCTREOTIDE ACETATE DEPOT             1207          1.22        $63.45  ............        $12.69
                                                        1mg.
C1300.....................  S                          HYPERBARIC Oxygen..........          0659          3.12       $162.27  ............        $32.45
C1305.....................  K                          Apligraf...................          1305         12.47       $648.55  ............       $129.71
C1348.....................  K                          I-131 sol, per 1-6 mCi.....          1348          0.19         $9.88  ............         $1.98
C1713.....................  N                          Anchor/screw bn/bn,tis/bn..  ............  ............  ............  ............  ............
C1714.....................  N                          Cath, trans atherectomy,     ............  ............  ............  ............  ............
                                                        dir.
C1715.....................  N                          Brachytherapy needle.......  ............  ............  ............  ............  ............
C1716.....................  K                          Brachytx seed, Gold 198....          1716          0.35        $18.20  ............         $3.64
C1717.....................  N                          Brachytx seed, HDR Ir-192..  ............  ............  ............  ............  ............
C1718.....................  K                          Brachytx seed, Iodine 125..          1718          0.64        $33.29  ............         $6.66
C1719.....................  K                          Brachytx seed,Non-HDR Ir-            1719          0.57        $29.65  ............         $5.93
                                                        192.
C1720.....................  K                          Brachytx seed, Palladium             1720          0.89        $46.29  ............         $9.26
                                                        103.
C1721.....................  N                          AICD, dual chamber.........  ............  ............  ............  ............  ............
C1722.....................  N                          AICD, single chamber.......  ............  ............  ............  ............  ............
C1724.....................  N                          Cath, trans                  ............  ............  ............  ............  ............
                                                        atherec,rotation.
C1725.....................  N                          Cath, translumin non-laser.  ............  ............  ............  ............  ............
C1726.....................  N                          Cath, bal dil, non-vascular  ............  ............  ............  ............  ............
C1727.....................  N                          Cath, bal tis dis, non-vas.  ............  ............  ............  ............  ............
C1728.....................  N                          Cath, brachytx seed adm....  ............  ............  ............  ............  ............
C1729.....................  N                          Cath, drainage.............  ............  ............  ............  ............  ............
C1730.....................  N                          Cath, EP, 19 or few elect..  ............  ............  ............  ............  ............
C1731.....................  N                          Cath, EP, 20 or more elec..  ............  ............  ............  ............  ............
C1732.....................  N                          Cath, EP, diag/abl, 3D/vect  ............  ............  ............  ............  ............
C1733.....................  N                          Cath, EP, othr than cool-    ............  ............  ............  ............  ............
                                                        tip.
C1750.....................  N                          Cath, hemodialysis,long-     ............  ............  ............  ............  ............
                                                        term.
C1751.....................  N                          Cath, inf, per/cent/midline  ............  ............  ............  ............  ............
C1752.....................  N                          Cath,hemodialysis,short-     ............  ............  ............  ............  ............
                                                        term.
C1753.....................  N                          Cath, intravas ultrasound..  ............  ............  ............  ............  ............
C1754.....................  N                          Catheter, intradiscal......  ............  ............  ............  ............  ............
C1755.....................  N                          Catheter, intraspinal......  ............  ............  ............  ............  ............
C1756.....................  N                          Cath, pacing, transesoph...  ............  ............  ............  ............  ............
C1757.....................  N                          Cath, thrombectomy/embolect  ............  ............  ............  ............  ............
C1758.....................  N                          Catheter, ureteral.........  ............  ............  ............  ............  ............
C1759.....................  N                          Cath, intra                  ............  ............  ............  ............  ............
                                                        echocardiography.
C1760.....................  N                          Closure dev, vasc..........  ............  ............  ............  ............  ............
C1762.....................  N                          Conn tiss, human(inc         ............  ............  ............  ............  ............
                                                        fascia).
C1763.....................  N                          Conn tiss, non-human.......  ............  ............  ............  ............  ............
C1764.....................  N                          Event recorder, cardiac....  ............  ............  ............  ............  ............
C1765.....................  H                          Adhesion barrier...........          1765  ............  ............  ............  ............
C1766.....................  N                          Intro/sheath,strble,non-     ............  ............  ............  ............  ............
                                                        peel.
C1767.....................  N                          Generator, neurostim, imp..  ............  ............  ............  ............  ............

[[Page 52291]]

 
C1768.....................  N                          Graft, vascular............  ............  ............  ............  ............  ............
C1769.....................  N                          Guide wire.................  ............  ............  ............  ............  ............
C1770.....................  N                          Imaging coil, MR,            ............  ............  ............  ............  ............
                                                        insertable.
C1771.....................  N                          Rep dev, urinary, w/sling..  ............  ............  ............  ............  ............
C1772.....................  N                          Infusion pump, programmable  ............  ............  ............  ............  ............
C1773.....................  N                          Ret dev, insertable........  ............  ............  ............  ............  ............
C1774.....................  G                          Darbepoetin alfa, 1 mcg....          0734  ............         $4.74  ............          $.68
C1775.....................  G                          FDG, per dose (4-40 mCi/ml)          1775  ............       $475.00  ............        $68.00
C1776.....................  N                          Joint device (implantable).  ............  ............  ............  ............  ............
C1777.....................  N                          Lead, AICD, endo single      ............  ............  ............  ............  ............
                                                        coil.
C1778.....................  N                          Lead, neurostimulator......  ............  ............  ............  ............  ............
C1779.....................  N                          Lead, pmkr, transvenous VDD  ............  ............  ............  ............  ............
C1780.....................  N                          Lens, intraocular (new       ............  ............  ............  ............  ............
                                                        tech).
C1781.....................  N                          Mesh (implantable).........  ............  ............  ............  ............  ............
C1782.....................  N                          Morcellator................  ............  ............  ............  ............  ............
C1783.....................  H                          Ocular imp, aqueous drain            1783  ............  ............  ............  ............
                                                        dev.
C1784.....................  N                          Ocular dev, intraop, det     ............  ............  ............  ............  ............
                                                        ret.
C1785.....................  N                          Pmkr, dual, rate-resp......  ............  ............  ............  ............  ............
C1786.....................  N                          Pmkr, single, rate-resp....  ............  ............  ............  ............  ............
C1787.....................  N                          Patient progr, neurostim...  ............  ............  ............  ............  ............
C1788.....................  N                          Port, indwelling, imp......  ............  ............  ............  ............  ............
C1789.....................  N                          Prosthesis, breast, imp....  ............  ............  ............  ............  ............
C1813.....................  N                          Prosthesis, penile,          ............  ............  ............  ............  ............
                                                        inflatab.
C1815.....................  N                          Pros, urinary sph, imp.....  ............  ............  ............  ............  ............
C1816.....................  N                          Receiver/transmitter, neuro  ............  ............  ............  ............  ............
C1817.....................  N                          Septal defect imp sys......  ............  ............  ............  ............  ............
C1874.....................  N                          Stent, coated/cov w/del sys  ............  ............  ............  ............  ............
C1875.....................  N                          Stent, coated/cov w/o del    ............  ............  ............  ............  ............
                                                        sy.
C1876.....................  N                          Stent, non-coa/non-cov w/    ............  ............  ............  ............  ............
                                                        del.
C1877.....................  N                          Stent, non-coat/cov w/o del  ............  ............  ............  ............  ............
C1878.....................  N                          Matrl for vocal cord.......  ............  ............  ............  ............  ............
C1879.....................  N                          Tissue marker, implantable.  ............  ............  ............  ............  ............
C1880.....................  N                          Vena cava filter...........  ............  ............  ............  ............  ............
C1881.....................  N                          Dialysis access system.....  ............  ............  ............  ............  ............
C1882.....................  N                          AICD, other than sing/dual.  ............  ............  ............  ............  ............
C1883.....................  N                          Adapt/ext, pacing/neuro      ............  ............  ............  ............  ............
                                                        lead.
C1885.....................  N                          Cath, translumin angio       ............  ............  ............  ............  ............
                                                        laser.
C1887.....................  N                          Catheter, guiding..........  ............  ............  ............  ............  ............
C1888.....................  H                          Endovas non-cardiac abl              1888  ............  ............  ............  ............
                                                        cath.
C1891.....................  N                          Infusion pump,non-prog,      ............  ............  ............  ............  ............
                                                        perm.
C1892.....................  N                          Intro/sheath,fixed,peel-     ............  ............  ............  ............  ............
                                                        away.
C1893.....................  N                          Intro/sheath, fixed,non-     ............  ............  ............  ............  ............
                                                        peel.
C1894.....................  N                          Intro/sheath, non-laser....  ............  ............  ............  ............  ............
C1895.....................  N                          Lead, AICD, endo dual coil.  ............  ............  ............  ............  ............
C1896.....................  N                          Lead, AICD, non sing/dual..  ............  ............  ............  ............  ............
C1897.....................  N                          Lead, neurostim test kit...  ............  ............  ............  ............  ............
C1898.....................  N                          Lead, pmkr, other than       ............  ............  ............  ............  ............
                                                        trans.
C1899.....................  N                          Lead, pmkr/AICD combination  ............  ............  ............  ............  ............
C1900.....................  H                          Lead coronary venous.......          1900  ............  ............  ............  ............
C2615.....................  N                          Sealant, pulmonary, liquid.  ............  ............  ............  ............  ............
C2616.....................  N                          Brachytx seed, Yttrium-90..  ............  ............  ............  ............  ............
C2617.....................  N                          Stent, non-cor, tem w/o del  ............  ............  ............  ............  ............
C2618.....................  H                          Probe, cryoablation........          2618  ............  ............  ............  ............
C2619.....................  N                          Pmkr, dual, non rate-resp..  ............  ............  ............  ............  ............
C2620.....................  N                          Pmkr, single, non rate-resp  ............  ............  ............  ............  ............
C2621.....................  N                          Pmkr, other than sing/dual.  ............  ............  ............  ............  ............
C2622.....................  N                          Prosthesis, penile, non-inf  ............  ............  ............  ............  ............
C2625.....................  N                          Stent, non-cor, tem w/del    ............  ............  ............  ............  ............
                                                        sy.
C2626.....................  N                          Infusion pump, non-          ............  ............  ............  ............  ............
                                                        prog,temp.
C2627.....................  N                          Cath, suprapubic/            ............  ............  ............  ............  ............
                                                        cystoscopic.
C2628.....................  N                          Catheter, occlusion........  ............  ............  ............  ............  ............
C2629.....................  N                          Intro/sheath, laser........  ............  ............  ............  ............  ............
C2630.....................  N                          Cath, EP, cool-tip.........  ............  ............  ............  ............  ............
C2631.....................  N                          Rep dev, urinary, w/o sling  ............  ............  ............  ............  ............
C8900.....................  S                          MRA w/cont, abd............          0284          7.74       $402.55       $201.02        $80.51
C8901.....................  S                          MRA w/o cont, abd..........          0336          7.01       $364.58       $176.94        $72.92

[[Page 52292]]

 
C8902.....................  S                          MRA w/o fol w/cont, abd....          0337          9.86       $512.81       $240.77       $102.56
C8903.....................  S                          MRI w/cont, breast, uni....          0284          7.74       $402.55       $201.02        $80.51
C8904.....................  S                          MRI w/o cont, breast, uni..          0336          7.01       $364.58       $176.94        $72.92
C8905.....................  S                          MRI w/o fol w/cont, brst,            0337          9.86       $512.81       $240.77       $102.56
                                                        un.
C8906.....................  S                          MRI w/cont, breast, bi.....          0284          7.74       $402.55       $201.02        $80.51
C8907.....................  S                          MRI w/o cont, breast, bi...          0336          7.01       $364.58       $176.94        $72.92
C8908.....................  S                          MRI w/o fol w/cont, breast,          0337          9.86       $512.81       $240.77       $102.56
C8909.....................  S                          MRA w/cont, chest..........          0284          7.74       $402.55       $201.02        $80.51
C8910.....................  S                          MRA w/o cont, chest........          0336          7.01       $364.58       $176.94        $72.92
C8911.....................  S                          MRA w/o fol w/cont, chest..          0337          9.86       $512.81       $240.77       $102.56
C8912.....................  S                          MRA w/cont, lwr ext........          0284          7.74       $402.55       $201.02        $80.51
C8913.....................  S                          MRA w/o cont, lwr ext......          0336          7.01       $364.58       $176.94        $72.92
C8914.....................  S                          MRA w/o fol w/cont, lwr ext          0337          9.86       $512.81       $240.77       $102.56
C9000.....................  N                          Na chromateCr51, per         ............  ............  ............  ............  ............
                                                        0.25mCi.
C9003.....................  K                          Palivizumab, per 50 mg.....          9003          9.34       $485.76  ............        $97.15
C9007.....................  N                          Baclofen Intrathecal kit-    ............  ............  ............  ............  ............
                                                        1am.
C9008.....................  N                          Baclofen Refill Kit-500mcg.  ............  ............  ............  ............  ............
C9009.....................  K                          Baclofen Refill Kit-2000mcg          9009          0.79        $41.09  ............         $8.22
C9010.....................  K                          Baclofen Refill Kit--                9010          0.95        $49.41  ............         $9.88
                                                        4000mcg.
C9013.....................  N                          Co 57 cobaltous chloride...  ............  ............  ............  ............  ............
C9019.....................  G                          Caspofungin acetate, 5 mg..          9019  ............        $34.20  ............         $4.90
C9020.....................  K                          Sirolimussolution, 1 mg....          9020          0.05         $2.60  ............          $.52
C9100.....................  N                          Iodinated I-131 Albumin....  ............  ............  ............  ............  ............
C9102.....................  N                          51 Na Chromate, 50mCi......  ............  ............  ............  ............  ............
C9103.....................  N                          Na Iothalamate I-125, 10     ............  ............  ............  ............  ............
                                                        uCi.
C9105.....................  K                          Hep B imm glob, per 1 ml...          9105          1.58        $82.17  ............        $16.43
C9108.....................  K                          Thyrotropin alfa, 1.1 mg...          9108          8.79       $457.16  ............        $91.43
C9109.....................  K                          Tirofiban hcl, 6.25 mg.....          9109          2.32       $120.66  ............        $24.13
C9110.....................  G                          Alemtuzumab, per 10mg/ml...          9110  ............       $486.88  ............        $69.70
C9111.....................  G                          Inj, bivalirudin, 250mg              9111  ............       $397.81  ............        $56.95
                                                        vial.
C9112.....................  G                          Perflutren lipid micro, 2ml          9112  ............       $148.20  ............        $21.22
C9113.....................  G                          Inj pantoprazole sodium,             9113  ............        $22.80  ............         $3.26
                                                        via.
C9114.....................  G                          Nesiritide, per 1.5 mg vial          9114  ............       $433.20  ............        $62.02
C9115.....................  G                          Inj, zoledronic acid, 2 mg.          9115  ............       $406.78  ............        $58.23
C9200.....................  G                          Orcel, per 36 cm2..........          9200  ............     $1,135.25  ............       $162.52
C9201.....................  G                          Dermagraft, per 37.5 sq cm.          9201  ............       $577.60  ............        $82.69
C9503.....................  K                          Fresh frozen plasma, ea              9503          0.77        $40.05  ............         $8.01
                                                        unit.
C9701.....................  T                          Stretta System.............          0980  ............     $1,875.00  ............       $375.00
C9703.....................  T                          Bard Endoscopic Suturing             0979  ............     $1,625.00  ............       $325.00
                                                        Sys.
C9708.....................  T                          Preview Tx Planning                  0973  ............       $250.00  ............        $50.00
                                                        Software.
C9711.....................  T                          H.E.L.P. Apheresis System..          0978  ............     $1,375.00  ............       $275.00
D0120.....................  E                          Periodic oral evaluation...  ............  ............  ............  ............  ............
D0140.....................  E                          Limit oral eval problm       ............  ............  ............  ............  ............
                                                        focus.
D0150.....................  S                          Comprehensve oral                    0330          0.64        $33.29  ............         $6.66
                                                        evaluation.
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          0.64        $33.29  ............         $6.66
D0250.....................  S                          Extraoral first film.......          0330          0.64        $33.29  ............         $6.66
D0260.....................  S                          Extraoral ea additional              0330          0.64        $33.29  ............         $6.66
                                                        film.
D0270.....................  S                          Dental bitewing single film          0330          0.64        $33.29  ............         $6.66
D0272.....................  S                          Dental bitewings two films.          0330          0.64        $33.29  ............         $6.66
D0274.....................  S                          Dental bitewings four films          0330          0.64        $33.29  ............         $6.66
D0277.....................  S                          Vert bitewings-sev to eight          0330          0.64        $33.29  ............         $6.66
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.  ............  ............  ............  ............  ............

[[Page 52293]]

 
D0460.....................  S                          Pulp vitality test.........          0330          0.64        $33.29  ............         $6.66
D0470.....................  E                          Diagnostic casts...........  ............  ............  ............  ............  ............
D0472.....................  S                          Gross exam, prep & report..          0330          0.64        $33.29  ............         $6.66
D0473.....................  S                          Micro exam, prep & report..          0330          0.64        $33.29  ............         $6.66
D0474.....................  S                          Micro w exam of surg                 0330          0.64        $33.29  ............         $6.66
                                                        margins.
D0480.....................  S                          Cytopath smear prep &                0330          0.64        $33.29  ............         $6.66
                                                        report.
D0501.....................  S                          Histopathologic                      0330          0.64        $33.29  ............         $6.66
                                                        examinations.
D0502.....................  S                          Other oral pathology                 0330          0.64        $33.29  ............         $6.66
                                                        procedu.
D0999.....................  S                          Unspecified diagnostic               0330          0.64        $33.29  ............         $6.66
                                                        proce.
D1110.....................  E                          Dental prophylaxis adult...  ............  ............  ............  ............  ............
D1120.....................  E                          Dental prophylaxis child...  ............  ............  ............  ............  ............
D1201.....................  E                          Topical fluor w prophy       ............  ............  ............  ............  ............
                                                        child.
D1203.....................  E                          Topical fluor w/o prophy     ............  ............  ............  ............  ............
                                                        chi.
D1204.....................  E                          Topical fluor w/o prophy     ............  ............  ............  ............  ............
                                                        adu.
D1205.....................  E                          Topical fluoride w/ prophy   ............  ............  ............  ............  ............
                                                        a.
D1310.....................  E                          Nutri counsel-control        ............  ............  ............  ............  ............
                                                        caries.
D1320.....................  E                          Tobacco counseling.........  ............  ............  ............  ............  ............
D1330.....................  E                          Oral hygiene instruction...  ............  ............  ............  ............  ............
D1351.....................  E                          Dental sealant per tooth...  ............  ............  ............  ............  ............
D1510.....................  S                          Space maintainer fxd unilat          0330          0.64        $33.29  ............         $6.66
D1515.....................  S                          Fixed bilat space                    0330          0.64        $33.29  ............         $6.66
                                                        maintainer.
D1520.....................  S                          Remove unilat space                  0330          0.64        $33.29  ............         $6.66
                                                        maintain.
D1525.....................  S                          Remove bilat space maintain          0330          0.64        $33.29  ............         $6.66
D1550.....................  S                          Recement space maintainer..          0330          0.64        $33.29  ............         $6.66
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.
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.

[[Page 52294]]

 
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          0.64        $33.29  ............         $6.66
D2980.....................  E                          Crown repair...............  ............  ............  ............  ............  ............
D2999.....................  S                          Dental unspec restorative            0330          0.64        $33.29  ............         $6.66
                                                        pr.
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.  ............  ............  ............  ............  ............
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.
0001T.....................  C                          Endovas repr abdo ao         ............  ............  ............  ............  ............
                                                        aneurys.
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                0330          0.64        $33.29  ............         $6.66
                                                        implan.
D3470.....................  E                          Intentional replantation...  ............  ............  ............  ............  ............
D3910.....................  E                          Isolation- tooth w rubb dam  ............  ............  ............  ............  ............
D3920.....................  E                          Tooth splitting............  ............  ............  ............  ............  ............
D3950.....................  E                          Canal prep/fitting of dowel  ............  ............  ............  ............  ............

[[Page 52295]]

 
D3999.....................  S                          Endodontic procedure.......          0330          0.64        $33.29  ............         $6.66
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                  0330          0.64        $33.29  ............         $6.66
                                                        quadrant.
D4263.....................  S                          Bone replce graft first              0330          0.64        $33.29  ............         $6.66
                                                        site.
D4264.....................  S                          Bone replce graft each add.          0330          0.64        $33.29  ............         $6.66
D4266.....................  E                          Guided tiss regen resorble.  ............  ............  ............  ............  ............
D4267.....................  E                          Guided tiss regen nonresorb  ............  ............  ............  ............  ............
D4268.....................  S                          Surgical revision procedure          0330          0.64        $33.29  ............         $6.66
D4270.....................  S                          Pedicle soft tissue graft            0330          0.64        $33.29  ............         $6.66
                                                        pr.
D4271.....................  S                          Free soft tissue graft proc          0330          0.64        $33.29  ............         $6.66
D4273.....................  S                          Subepithelial tissue graft.          0330          0.64        $33.29  ............         $6.66
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          0.64        $33.29  ............         $6.66
D4381.....................  S                          Localized chemo delivery...          0330          0.64        $33.29  ............         $6.66
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.  ............  ............  ............  ............  ............
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........  ............  ............  ............  ............  ............

[[Page 52296]]

 
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          0.64        $33.29  ............         $6.66
D5912.....................  S                          Facial moulage complete....          0330          0.64        $33.29  ............         $6.66
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          0.64        $33.29  ............         $6.66
D5984.....................  S                          Radiation shield...........          0330          0.64        $33.29  ............         $6.66
D5985.....................  S                          Radiation cone locator.....          0330          0.64        $33.29  ............         $6.66
D5986.....................  E                          Fluoride applicator........  ............  ............  ............  ............  ............
D5987.....................  S                          Commissure splint..........          0330          0.64        $33.29  ............         $6.66
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  ............  ............  ............  ............  ............
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  ............  ............  ............  ............  ............

[[Page 52297]]

 
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          0.64        $33.29  ............         $6.66
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          0.64        $33.29  ............         $6.66
D7120.....................  S                          Each add tooth extraction..          0330          0.64        $33.29  ............         $6.66
D7130.....................  S                          Tooth root removal.........          0330          0.64        $33.29  ............         $6.66
D7210.....................  S                          Rem imp tooth w mucoper flp          0330          0.64        $33.29  ............         $6.66
D7220.....................  S                          Impact tooth remov soft              0330          0.64        $33.29  ............         $6.66
                                                        tiss.
D7230.....................  S                          Impact tooth remov part              0330          0.64        $33.29  ............         $6.66
                                                        bony.
D7240.....................  S                          Impact tooth remov comp              0330          0.64        $33.29  ............         $6.66
                                                        bony.
D7241.....................  S                          Impact tooth rem bony w/             0330          0.64        $33.29  ............         $6.66
                                                        comp.
D7250.....................  S                          Tooth root removal.........          0330          0.64        $33.29  ............         $6.66
D7260.....................  S                          Oral antral fistula closure          0330          0.64        $33.29  ............         $6.66
D7270.....................  E                          Tooth reimplantation.......  ............  ............  ............  ............  ............
D7272.....................  E                          Tooth transplantation......  ............  ............  ............  ............  ............

[[Page 52298]]

 
D7280.....................  E                          Exposure impact tooth        ............  ............  ............  ............  ............
                                                        orthod.
D7281.....................  E                          Exposure tooth aid eruption  ............  ............  ............  ............  ............
D7285.....................  E                          Biopsy of oral tissue hard.  ............  ............  ............  ............  ............
D7286.....................  E                          Biopsy of oral tissue soft.  ............  ............  ............  ............  ............
D7290.....................  E                          Repositioning of teeth.....  ............  ............  ............  ............  ............
D7291.....................  S                          Transseptal fiberotomy.....          0330          0.64        $33.29  ............         $6.66
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  ............  ............  ............  ............  ............

[[Page 52299]]

 
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          0.64        $33.29  ............         $6.66
D7941.....................  E                          Bone cutting ramus closed..  ............  ............  ............  ............  ............
D7943.....................  E                          Cutting ramus open w/graft.  ............  ............  ............  ............  ............
D7944.....................  E                          Bone cutting segmented.....  ............  ............  ............  ............  ............
D7945.....................  E                          Bone cutting body mandible.  ............  ............  ............  ............  ............
D7946.....................  E                          Reconstruction maxilla       ............  ............  ............  ............  ............
                                                        total.
D7947.....................  E                          Reconstruct maxilla segment  ............  ............  ............  ............  ............
D7948.....................  E                          Reconstruct midface no       ............  ............  ............  ............  ............
                                                        graft.
D7949.....................  E                          Reconstruct midface w/graft  ............  ............  ............  ............  ............
D7950.....................  E                          Mandible graft.............  ............  ............  ............  ............  ............
D7955.....................  E                          Repair maxillofacial         ............  ............  ............  ............  ............
                                                        defects.
D7960.....................  E                          Frenulectomy/frenulotomy...  ............  ............  ............  ............  ............
D7970.....................  E                          Excision hyperplastic        ............  ............  ............  ............  ............
                                                        tissue.
D7971.....................  E                          Excision pericoronal         ............  ............  ............  ............  ............
                                                        gingiva.
D7980.....................  E                          Sialolithotomy.............  ............  ............  ............  ............  ............
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.....................  N                          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          0.64        $33.29  ............         $6.66
D9910.....................  E                          Dent appl desensitizing med  ............  ............  ............  ............  ............

[[Page 52300]]

 
D9911.....................  E                          Appl desensitizing resin...  ............  ............  ............  ............  ............
D9920.....................  E                          Behavior management........  ............  ............  ............  ............  ............
D9930.....................  S                          Treatment of complications.          0330          0.64        $33.29  ............         $6.66
D9940.....................  S                          Dental occlusal guard......          0330          0.64        $33.29  ............         $6.66
D9941.....................  E                          Fabrication athletic guard.  ............  ............  ............  ............  ............
D9950.....................  S                          Occlusion analysis.........          0330          0.64        $33.29  ............         $6.66
D9951.....................  S                          Limited occlusal adjustment          0330          0.64        $33.29  ............         $6.66
D9952.....................  S                          Complete occlusal                    0330          0.64        $33.29  ............         $6.66
                                                        adjustment.
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.
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.
E0148.....................  A                          Heavyduty walker no wheels.  ............  ............  ............  ............  ............
E0149.....................  A                          Heavy duty wheeled walker..  ............  ............  ............  ............  ............
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..  ............  ............  ............  ............  ............
E0168.....................  A                          Heavyduty/wide commode       ............  ............  ............  ............  ............
                                                        chair.
E0169.....................  A                          Seatlift incorp              ............  ............  ............  ............  ............
                                                        commodechair.
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.

[[Page 52301]]

 
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.....................  E                          Water circ cold pad w pump.  ............  ............  ............  ............  ............
E0220.....................  A                          Hot water bottle...........  ............  ............  ............  ............  ............
E0221.....................  A                          Infrared heating pad system  ............  ............  ............  ............  ............
E0225.....................  A                          Hydrocollator unit.........  ............  ............  ............  ............  ............
E0230.....................  A                          Ice cap or collar..........  ............  ............  ............  ............  ............
E0231.....................  A                          Wound warming device.......  ............  ............  ............  ............  ............
E0232.....................  A                          Warming card for NWT.......  ............  ............  ............  ............  ............
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.....................  E                          Transfer tub rail            ............  ............  ............  ............  ............
                                                        attachment.
E0249.....................  A                          Pad water circulating heat   ............  ............  ............  ............  ............
                                                        u.
E0250.....................  A                          Hosp bed fixed ht w/         ............  ............  ............  ............  ............
                                                        mattres.
E0251.....................  A                          Hosp bed fixd ht w/o         ............  ............  ............  ............  ............
                                                        mattres.
E0255.....................  A                          Hospital bed var ht w/       ............  ............  ............  ............  ............
                                                        mattr.
E0256.....................  A                          Hospital bed var ht w/o      ............  ............  ............  ............  ............
                                                        matt.
E0260.....................  A                          Hosp bed semi-electr w/      ............  ............  ............  ............  ............
                                                        matt.
E0261.....................  A                          Hosp bed semi-electr w/o     ............  ............  ............  ............  ............
                                                        mat.
E0265.....................  A                          Hosp bed total electr w/     ............  ............  ............  ............  ............
                                                        mat.
E0266.....................  A                          Hosp bed total elec w/o      ............  ............  ............  ............  ............
                                                        matt.
E0270.....................  E                          Hospital bed institutional   ............  ............  ............  ............  ............
                                                        t.
E0271.....................  A                          Mattress innerspring.......  ............  ............  ............  ............  ............
E0272.....................  A                          Mattress foam rubber.......  ............  ............  ............  ............  ............
E0273.....................  E                          Bed board..................  ............  ............  ............  ............  ............
E0274.....................  E                          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.....................  E                          Bed accessory brd/tbl/       ............  ............  ............  ............  ............
                                                        supprt.
E0316.....................  A                          Bed safety enclosure.......  ............  ............  ............  ............  ............
E0325.....................  A                          Urinal male jug-type.......  ............  ............  ............  ............  ............
E0326.....................  A                          Urinal female jug-type.....  ............  ............  ............  ............  ............
E0350.....................  E                          Control unit bowel system..  ............  ............  ............  ............  ............
E0352.....................  E                          Disposable pack w/bowel      ............  ............  ............  ............  ............
                                                        syst.
E0370.....................  E                          Air elevator for heel......  ............  ............  ............  ............  ............
E0371.....................  A                          Nonpower mattress overlay..  ............  ............  ............  ............  ............
E0372.....................  A                          Powered air mattress         ............  ............  ............  ............  ............
                                                        overlay.

[[Page 52302]]

 
E0373.....................  A                          Nonpowered pressure          ............  ............  ............  ............  ............
                                                        mattress.
E0424.....................  A                          Stationary compressed gas    ............  ............  ............  ............  ............
                                                        02.
E0425.....................  E                          Gas system stationary        ............  ............  ............  ............  ............
                                                        compre.
E0430.....................  E                          Oxygen system gas portable.  ............  ............  ............  ............  ............
E0431.....................  A                          Portable gaseous 02........  ............  ............  ............  ............  ............
E0434.....................  A                          Portable liquid 02.........  ............  ............  ............  ............  ............
E0435.....................  E                          Oxygen system liquid         ............  ............  ............  ............  ............
                                                        portabl.
E0439.....................  A                          Stationary liquid 02.......  ............  ............  ............  ............  ............
E0440.....................  E                          Oxygen system liquid         ............  ............  ............  ............  ............
                                                        station.
E0441.....................  A                          Oxygen contents, gaseous...  ............  ............  ............  ............  ............
E0442.....................  A                          Oxygen contents, liquid....  ............  ............  ............  ............  ............
E0443.....................  A                          Portable 02 contents, gas..  ............  ............  ............  ............  ............
E0444.....................  A                          Portable 02 contents,        ............  ............  ............  ............  ............
                                                        liquid.
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.
E0481.....................  A                          Intrpulmnry percuss vent     ............  ............  ............  ............  ............
                                                        sys.
E0482.....................  A                          Cough stimulating device...  ............  ............  ............  ............  ............
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.  ............  ............  ............  ............  ............
E0571.....................  A                          Aerosol compressor for       ............  ............  ............  ............  ............
                                                        svneb.
E0572.....................  A                          Aerosol compressor adjust    ............  ............  ............  ............  ............
                                                        pr.
E0574.....................  A                          Ultrasonic generator w       ............  ............  ............  ............  ............
                                                        svneb.
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.....................  E                          Manual breast pump.........  ............  ............  ............  ............  ............
E0603.....................  A                          Electric breast pump.......  ............  ............  ............  ............  ............
E0604.....................  A                          Hosp grade elec breast pump  ............  ............  ............  ............  ............
E0605.....................  A                          Vaporizer room type........  ............  ............  ............  ............  ............
E0606.....................  A                          Drainage board postural....  ............  ............  ............  ............  ............
E0607.....................  A                          Blood glucose monitor home.  ............  ............  ............  ............  ............
E0608.....................  A                          Apnea monitor..............  ............  ............  ............  ............  ............
E0610.....................  A                          Pacemaker monitr audible/    ............  ............  ............  ............  ............
                                                        vis.
E0615.....................  A                          Pacemaker monitr digital/    ............  ............  ............  ............  ............
                                                        vis.
E0616.....................  N                          Cardiac event recorder.....  ............  ............  ............  ............  ............
E0617.....................  A                          Automatic ext defibrillator  ............  ............  ............  ............  ............
E0620.....................  A                          Cap bld skin piercing laser  ............  ............  ............  ............  ............
E0621.....................  A                          Patient lift sling or seat.  ............  ............  ............  ............  ............
E0625.....................  E                          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.

[[Page 52303]]

 
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.....................  E                          Safety equipment...........  ............  ............  ............  ............  ............
E0710.....................  E                          Restraints any type........  ............  ............  ............  ............  ............
E0720.....................  A                          Tens two lead..............  ............  ............  ............  ............  ............
E0730.....................  A                          Tens four lead.............  ............  ............  ............  ............  ............
E0731.....................  A                          Conductive garment for tens/ ............  ............  ............  ............  ............
                                                        .
E0740.....................  E                          Incontinence treatment       ............  ............  ............  ............  ............
                                                        systm.
E0744.....................  A                          Neuromuscular stim for       ............  ............  ............  ............  ............
                                                        scoli.
E0745.....................  A                          Neuromuscular stim for       ............  ............  ............  ............  ............
                                                        shock.
E0746.....................  E                          Electromyograph biofeedback  ............  ............  ............  ............  ............
E0747.....................  A                          Elec osteogen stim not       ............  ............  ............  ............  ............
                                                        spine.
E0748.....................  A                          Elec osteogen stim spinal..  ............  ............  ............  ............  ............
E0749.....................  N                          Elec osteogen stim           ............  ............  ............  ............  ............
                                                        implanted.
E0752.....................  E                          Neurostimulator electrode..  ............  ............  ............  ............  ............
E0754.....................  A                          Pulsegenerator pt            ............  ............  ............  ............  ............
                                                        programmer.
E0755.....................  E                          Electronic salivary reflex   ............  ............  ............  ............  ............
                                                        s.
E0756.....................  E                          Implantable pulse generator  ............  ............  ............  ............  ............
E0757.....................  E                          Implantable RF receiver....  ............  ............  ............  ............  ............
E0758.....................  A                          External RF transmitter....  ............  ............  ............  ............  ............
E0759.....................  A                          Replace rdfrquncy            ............  ............  ............  ............  ............
                                                        transmittr.
E0760.....................  E                          Osteogen ultrasound          ............  ............  ............  ............  ............
                                                        stimltor.
E0765.....................  E                          Nerve stimulator for tx n&v  ............  ............  ............  ............  ............
E0776.....................  A                          Iv pole....................  ............  ............  ............  ............  ............
E0779.....................  A                          Amb infusion pump            ............  ............  ............  ............  ............
                                                        mechanical.
E0780.....................  A                          Mech amb infusion pump 8hrs  ............  ............  ............  ............  ............
E0781.....................  A                          External ambulatory infus    ............  ............  ............  ............  ............
                                                        pu.
E0782.....................  E                          Non-programble infusion      ............  ............  ............  ............  ............
                                                        pump.
E0783.....................  E                          Programmable infusion pump.  ............  ............  ............  ............  ............
E0784.....................  A                          Ext amb infusn pump insulin  ............  ............  ............  ............  ............
E0785.....................  E                          Replacement impl pump        ............  ............  ............  ............  ............
                                                        cathet.
E0786.....................  E                          Implantable pump             ............  ............  ............  ............  ............
                                                        replacement.
E0791.....................  A                          Parenteral infusion pump     ............  ............  ............  ............  ............
                                                        sta.
E0830.....................  N                          Ambulatory traction device.  ............  ............  ............  ............  ............
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.....................  E                          Tray.......................  ............  ............  ............  ............  ............
E0951.....................  E                          Loop heel..................  ............  ............  ............  ............  ............
E0952.....................  E                          Loop tie...................  ............  ............  ............  ............  ............
E0953.....................  E                          Pneumatic tire.............  ............  ............  ............  ............  ............
E0954.....................  E                          Wheelchair semi-pneumatic    ............  ............  ............  ............  ............
                                                        ca.
E0958.....................  A                          Whlchr att- conv 1 arm       ............  ............  ............  ............  ............
                                                        drive.
E0959.....................  E                          Amputee adapter............  ............  ............  ............  ............  ............
E0961.....................  E                          Wheelchair brake extension.  ............  ............  ............  ............  ............
E0962.....................  A                          Wheelchair 1 inch cushion..  ............  ............  ............  ............  ............

[[Page 52304]]

 
E0963.....................  A                          Wheelchair 2 inch cushion..  ............  ............  ............  ............  ............
E0964.....................  A                          Wheelchair 3 inch cushion..  ............  ............  ............  ............  ............
E0965.....................  A                          Wheelchair 4 inch cushion..  ............  ............  ............  ............  ............
E0966.....................  E                          Wheelchair head rest         ............  ............  ............  ............  ............
                                                        extensi.
E0967.....................  E                          Wheelchair hand rims.......  ............  ............  ............  ............  ............
E0968.....................  A                          Wheelchair commode seat....  ............  ............  ............  ............  ............
E0969.....................  E                          Wheelchair narrowing device  ............  ............  ............  ............  ............
E0970.....................  E                          Wheelchair no. 2 footplates  ............  ............  ............  ............  ............
E0971.....................  E                          Wheelchair anti-tipping      ............  ............  ............  ............  ............
                                                        devi.
E0972.....................  A                          Transfer board or device...  ............  ............  ............  ............  ............
E0973.....................  E                          Wheelchair adjustabl height  ............  ............  ............  ............  ............
E0974.....................  E                          Wheelchair grade-aid.......  ............  ............  ............  ............  ............
E0975.....................  E                          Wheelchair reinforced seat   ............  ............  ............  ............  ............
                                                        u.
E0976.....................  E                          Wheelchair reinforced back   ............  ............  ............  ............  ............
                                                        u.
E0977.....................  E                          Wheelchair wedge cushion...  ............  ............  ............  ............  ............
E0978.....................  E                          Wheelchair belt w/airplane   ............  ............  ............  ............  ............
                                                        b.
E0979.....................  E                          Wheelchair belt with velcro  ............  ............  ............  ............  ............
E0980.....................  E                          Wheelchair safety vest.....  ............  ............  ............  ............  ............
E0990.....................  E                          Whellchair elevating leg     ............  ............  ............  ............  ............
                                                        res.
E0991.....................  E                          Wheelchair upholstry seat..  ............  ............  ............  ............  ............
E0992.....................  E                          Wheelchair solid seat        ............  ............  ............  ............  ............
                                                        insert.
E0993.....................  E                          Wheelchair back upholstery.  ............  ............  ............  ............  ............
E0994.....................  E                          Wheelchair arm rest........  ............  ............  ............  ............  ............
E0995.....................  E                          Wheelchair calf rest.......  ............  ............  ............  ............  ............
E0996.....................  E                          Wheelchair tire solid......  ............  ............  ............  ............  ............
E0997.....................  E                          Wheelchair caster w/ a fork  ............  ............  ............  ............  ............
E0998.....................  E                          Wheelchair caster w/o a      ............  ............  ............  ............  ............
                                                        fork.
E0999.....................  E                          Wheelchr pneumatic tire w/   ............  ............  ............  ............  ............
                                                        wh.
E1000.....................  E                          Wheelchair tire pneumatic    ............  ............  ............  ............  ............
                                                        ca.
E1001.....................  E                          Wheelchair wheel...........  ............  ............  ............  ............  ............
E1031.....................  A                          Rollabout chair with         ............  ............  ............  ............  ............
                                                        casters.
E1035.....................  E                          Patient transfer system....  ............  ............  ............  ............  ............
E1050.....................  A                          Whelchr fxd full length      ............  ............  ............  ............  ............
                                                        arms.
E1060.....................  A                          Wheelchair detachable arms.  ............  ............  ............  ............  ............
E1065.....................  E                          Wheelchair power attachment  ............  ............  ............  ............  ............
E1066.....................  E                          Wheelchair battery charger.  ............  ............  ............  ............  ............
E1069.....................  E                          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  ............  ............  ............  ............  ............

[[Page 52305]]

 
E1220.....................  A                          Whlchr special size/constrc  ............  ............  ............  ............  ............
E1221.....................  A                          Wheelchair spec size w foot  ............  ............  ............  ............  ............
E1222.....................  A                          Wheelchair spec size w/ leg  ............  ............  ............  ............  ............
E1223.....................  A                          Wheelchair spec size w foot  ............  ............  ............  ............  ............
E1224.....................  A                          Wheelchair spec size w/ leg  ............  ............  ............  ............  ............
E1225.....................  A                          Wheelchair spec sz semi-     ............  ............  ............  ............  ............
                                                        recl.
E1226.....................  E                          Wheelchair spec sz full-     ............  ............  ............  ............  ............
                                                        recl.
E1227.....................  E                          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.....................  E                          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.
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.
E1500.....................  A                          Centrifuge.................  ............  ............  ............  ............  ............
E1510.....................  A                          Kidney dialysate delivry     ............  ............  ............  ............  ............
                                                        sys.
E1520.....................  A                          Heparin infusion pump......  ............  ............  ............  ............  ............
E1530.....................  A                          Replacement air bubble       ............  ............  ............  ............  ............
                                                        detec.
E1540.....................  A                          Replacement pressure alarm.  ............  ............  ............  ............  ............
E1550.....................  A                          Bath conductivity meter....  ............  ............  ............  ............  ............
E1560.....................  A                          Replace blood leak detector  ............  ............  ............  ............  ............
E1570.....................  A                          Adjustable chair for esrd    ............  ............  ............  ............  ............
                                                        pt.
E1575.....................  A                          Transducer protect/fld bar.  ............  ............  ............  ............  ............
E1580.....................  A                          Unipuncture control system.  ............  ............  ............  ............  ............
E1590.....................  A                          Hemodialysis machine.......  ............  ............  ............  ............  ............
E1592.....................  A                          Auto interm peritoneal       ............  ............  ............  ............  ............
                                                        dialy.
E1594.....................  A                          Cycler dialysis machine....  ............  ............  ............  ............  ............
E1600.....................  A                          Deli/install chrg hemo       ............  ............  ............  ............  ............
                                                        equip.
E1610.....................  A                          Reverse osmosis h2o puri     ............  ............  ............  ............  ............
                                                        sys.
E1615.....................  A                          Deionizer H2O puri system..  ............  ............  ............  ............  ............
E1620.....................  A                          Replacement blood pump.....  ............  ............  ............  ............  ............
E1625.....................  A                          Water softening system.....  ............  ............  ............  ............  ............
E1630.....................  A                          Reciprocating peritoneal     ............  ............  ............  ............  ............
                                                        dia.
E1632.....................  A                          Wearable artificial kidney.  ............  ............  ............  ............  ............
E1635.....................  A                          Compact travel hemodialyzer  ............  ............  ............  ............  ............
E1636.....................  A                          Sorbent cartridges per 10..  ............  ............  ............  ............  ............
E1637.....................  A                          Hemostats for dialysis,      ............  ............  ............  ............  ............
                                                        each.
E1638.....................  A                          Peri dialysis heating pad..  ............  ............  ............  ............  ............
E1639.....................  A                          Dialysis scale.............  ............  ............  ............  ............  ............
E1699.....................  A                          Dialysis equipment noc.....  ............  ............  ............  ............  ............
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.
E1801.....................  A                          SPS elbow device...........  ............  ............  ............  ............  ............
E1805.....................  A                          Adjust wrist ext/flex        ............  ............  ............  ............  ............
                                                        device.
E1806.....................  A                          SPS wrist device...........  ............  ............  ............  ............  ............
E1810.....................  A                          Adjust knee ext/flex device  ............  ............  ............  ............  ............
E1811.....................  A                          SPS knee device............  ............  ............  ............  ............  ............

[[Page 52306]]

 
E1815.....................  A                          Adjust ankle ext/flex        ............  ............  ............  ............  ............
                                                        device.
E1816.....................  A                          SPS ankle device...........  ............  ............  ............  ............  ............
E1818.....................  A                          SPS forearm device.........  ............  ............  ............  ............  ............
E1820.....................  A                          Soft interface material....  ............  ............  ............  ............  ............
E1821.....................  A                          Replacement interface SPSD.  ............  ............  ............  ............  ............
E1825.....................  A                          Adjust finger ext/flex devc  ............  ............  ............  ............  ............
E1830.....................  A                          Adjust toe ext/flex device.  ............  ............  ............  ............  ............
E1840.....................  A                          Adj shoulder ext/flex        ............  ............  ............  ............  ............
                                                        device.
E1902.....................  A                          AAC non-electronic board...  ............  ............  ............  ............  ............
E2000.....................  A                          Gastric suction pump hme     ............  ............  ............  ............  ............
                                                        mdl.
E2100.....................  A                          Bld glucose monitor w voice  ............  ............  ............  ............  ............
E2101.....................  A                          Bld glucose monitor w lance  ............  ............  ............  ............  ............
G0001.....................  A                          Drawing blood for specimen.  ............  ............  ............  ............  ............
G0002.....................  X                          Temporary urinary catheter.          0340          0.66        $34.33  ............         $6.87
G0004.....................  E                          ECG transm phys review &     ............  ............  ............  ............  ............
                                                        int.
G0005.....................  X                          ECG 24 hour recording......          0097          0.84        $43.69        $23.80         $8.74
G0006.....................  X                          ECG transmission & analysis          0097          0.84        $43.69        $23.80         $8.74
G0007.....................  N                          ECG phy review & interpret.  ............  ............  ............  ............  ............
G0008.....................  K                          Admin influenza virus vac..          0354          0.09         $4.68  ............  ............
G0009.....................  K                          Admin pneumococcal vaccine.          0354          0.09         $4.68  ............  ............
G0010.....................  K                          Admin hepatitis b vaccine..          0355          0.24        $12.48  ............         $2.50
G0015.....................  X                          Post symptom ECG tracing...          0097          0.84        $43.69        $23.80         $8.74
G0025.....................  N                          Collagen skin test kit.....  ............  ............  ............  ............  ............
G0026.....................  A                          Fecal leukocyte examination  ............  ............  ............  ............  ............
G0027.....................  A                          Semen analysis.............  ............  ............  ............  ............  ............
G0030.....................  S                          PET imaging prev PET single          0285         16.73       $870.11       $374.15       $174.02
G0031.....................  S                          PET imaging prev PET                 0285         16.73       $870.11       $374.15       $174.02
                                                        multple.
G0032.....................  S                          PET follow SPECT 78464               0285         16.73       $870.11       $374.15       $174.02
                                                        singl.
G0033.....................  S                          PET follow SPECT 78464 mult          0285         16.73       $870.11       $374.15       $174.02
G0034.....................  S                          PET follow SPECT 76865               0285         16.73       $870.11       $374.15       $174.02
                                                        singl.
G0035.....................  S                          PET follow SPECT 78465 mult          0285         16.73       $870.11       $374.15       $174.02
G0036.....................  S                          PET follow cornry angio              0285         16.73       $870.11       $374.15       $174.02
                                                        sing.
G0037.....................  S                          PET follow cornry angio              0285         16.73       $870.11       $374.15       $174.02
                                                        mult.
G0038.....................  S                          PET follow myocard perf              0285         16.73       $870.11       $374.15       $174.02
                                                        sing.
G0039.....................  S                          PET follow myocard perf              0285         16.73       $870.11       $374.15       $174.02
                                                        mult.
G0040.....................  S                          PET follow stress echo               0285         16.73       $870.11       $374.15       $174.02
                                                        singl.
G0041.....................  S                          PET follow stress echo mult          0285         16.73       $870.11       $374.15       $174.02
G0042.....................  S                          PET follow ventriculogm              0285         16.73       $870.11       $374.15       $174.02
                                                        sing.
G0043.....................  S                          PET follow ventriculogm              0285         16.73       $870.11       $374.15       $174.02
                                                        mult.
G0044.....................  S                          PET following rest ECG               0285         16.73       $870.11       $374.15       $174.02
                                                        singl.
G0045.....................  S                          PET following rest ECG mult          0285         16.73       $870.11       $374.15       $174.02
G0046.....................  S                          PET follow stress ECG singl          0285         16.73       $870.11       $374.15       $174.02
G0047.....................  S                          PET follow stress ECG mult.          0285         16.73       $870.11       $374.15       $174.02
G0050.....................  S                          Residual urine by                    0265          1.04        $54.09        $29.75        $10.82
                                                        ultrasound.
G0101.....................  V                          CA screen;pelvic/breast              0600          0.91        $47.33  ............         $9.47
                                                        exam.
G0102.....................  N                          Prostate ca screening; dre.  ............  ............  ............  ............  ............
G0103.....................  A                          Psa, total screening.......  ............  ............  ............  ............  ............
G0104.....................  S                          CA screen;flexi                      0159          2.48       $128.98  ............        $32.25
                                                        sigmoidscope.
G0105.....................  T                          Colorectal scrn; hi risk             0158          7.56       $393.19  ............        $98.30
                                                        ind.
G0106.....................  S                          Colon CA screen;barium               0157          2.73       $141.98        $22.19        $28.40
                                                        enema.
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.  ............  ............  ............  ............  ............
G0117.....................  S                          Glaucoma scrn hgh risk               0230          0.78        $40.57        $15.82         $8.11
                                                        direc.
G0118.....................  S                          Glaucoma scrn hgh risk               0230          0.78        $40.57        $15.82         $8.11
                                                        direc.
G0120.....................  S                          Colon ca scrn; barium enema          0157          2.73       $141.98        $22.19        $28.40
G0121.....................  T                          Colon ca scrn not hi rsk             0158          7.56       $393.19  ............        $98.30
                                                        ind.
G0122.....................  E                          Colon ca scrn; barium enema  ............  ............  ............  ............  ............
G0123.....................  A                          Screen cerv/vag thin layer.  ............  ............  ............  ............  ............

[[Page 52307]]

 
G0124.....................  A                          Screen c/v thin layer by MD  ............  ............  ............  ............  ............
G0125.....................  S                          PET img WhBD sgl pulm ring.          0667         18.68       $971.53  ............       $194.31
G0127.....................  T                          Trim nail(s)...............          0009          0.68        $35.37         $8.34         $7.07
G0128.....................  E                          CORF skilled nursing         ............  ............  ............  ............  ............
                                                        service.
G0129.....................  P                          Partial hosp prog service..          0033          4.96       $257.96  ............        $51.59
G0130.....................  X                          Single energy x-ray study..          0260          0.81        $42.13        $23.17         $8.43
G0131.....................  S                          CT scan, bone density study          0288          1.38        $71.77  ............        $14.35
G0132.....................  S                          CT scan, bone density study          0665          0.73        $37.97  ............         $7.59
G0141.....................  E                          Scr c/v cyto,autosys and md  ............  ............  ............  ............  ............
G0143.....................  A                          Scr c/v                      ............  ............  ............  ............  ............
                                                        cyto,thinlayer,rescr.
G0144.....................  A                          Scr c/v                      ............  ............  ............  ............  ............
                                                        cyto,thinlayer,rescr.
G0145.....................  A                          Scr c/v                      ............  ............  ............  ............  ............
                                                        cyto,thinlayer,rescr.
G0147.....................  A                          Scr c/v cyto, automated sys  ............  ............  ............  ............  ............
G0148.....................  A                          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..  ............  ............  ............  ............  ............
G0156.....................  E                          HHCP-svs of aide,ea 15 min.  ............  ............  ............  ............  ............
G0166.....................  T                          Extrnl counterpulse, per tx          0678          2.55       $132.62  ............        $26.52
G0167.....................  E                          Hyperbaric oz tx;no md       ............  ............  ............  ............  ............
                                                        reqrd.
G0168.....................  X                          Wound closure by adhesive..          0340          0.66        $34.33  ............         $6.87
G0173.....................  S                          Stereo                               0663         63.69     $3,312.45  ............       $662.49
                                                        radoisurgery,complete.
G0175.....................  V                          OPPS Service,sched team              0602          1.57        $81.65  ............        $16.33
                                                        conf.
G0176.....................  P                          OPPS/PHP;activity therapy..          0033          4.96       $257.96  ............        $51.59
G0177.....................  P                          OPPS/PHP; train & educ serv          0033          4.96       $257.96  ............        $51.59
G0179.....................  E                          MD recertification HHA PT..  ............  ............  ............  ............  ............
G0180.....................  E                          MD certification HHA         ............  ............  ............  ............  ............
                                                        patient.
G0181.....................  E                          Home health care             ............  ............  ............  ............  ............
                                                        supervision.
G0182.....................  E                          Hospice care supervision...  ............  ............  ............  ............  ............
G0185.....................  T                          Transpuppillary thermotx...          0235          5.62       $292.29        $81.84        $58.46
G0186.....................  T                          Dstry eye lesn,fdr vssl              0235          5.62       $292.29        $81.84        $58.46
                                                        tech.
G0187.....................  T                          Dstry mclr drusen,photocoag          0235          5.62       $292.29        $81.84        $58.46
G0192.....................  N                          Immunization oral/           ............  ............  ............  ............  ............
                                                        intranasal.
G0193.....................  A                          Endoscopicstudyswallowfunct  ............  ............  ............  ............  ............
                                                        n.
G0194.....................  A                          Sensorytestingendoscopicstu  ............  ............  ............  ............  ............
                                                        d.
G0195.....................  A                          Clinicalevalswallowingfunct  ............  ............  ............  ............  ............
G0196.....................  A                          Evalofswallowingwithradioop  ............  ............  ............  ............  ............
                                                        a.
G0197.....................  A                          Evalofptforprescipspeechdev  ............  ............  ............  ............  ............
                                                        i.
G0198.....................  A                          Patientadapation&trainforsp  ............  ............  ............  ............  ............
                                                        e.
G0199.....................  A                          Reevaluationofpatientusespe  ............  ............  ............  ............  ............
                                                        c.
G0200.....................  A                          Evalofpatientprescipofvoice  ............  ............  ............  ............  ............
                                                        p.
G0201.....................  A                          Modifortraininginusevoicepr  ............  ............  ............  ............  ............
                                                        o.
G0202.....................  A                          Screeningmammographydigital  ............  ............  ............  ............  ............
G0204.....................  S                          Diagnosticmammographydigita          0669          0.95        $49.41  ............         $9.88
                                                        l.
G0206.....................  S                          Diagnosticmammographydigita          0669          0.95        $49.41  ............         $9.88
                                                        l.
G0210.....................  S                          PET img whbd ring dxlung ca          0667         18.68       $971.53  ............       $194.31
G0211.....................  S                          PET img whbd ring init lung          0667         18.68       $971.53  ............       $194.31
G0212.....................  S                          PET img whbd ring restag             0667         18.68       $971.53  ............       $194.31
                                                        lun.
G0213.....................  S                          PET img whbd ring dx                 0667         18.68       $971.53  ............       $194.31
                                                        colorec.
G0214.....................  S                          PET img whbd ring init               0667         18.68       $971.53  ............       $194.31
                                                        colre.
G0215.....................  S                          PET img whbd restag col....          0667         18.68       $971.53  ............       $194.31
G0216.....................  S                          PET img whbd ring dx                 0667         18.68       $971.53  ............       $194.31
                                                        melanom.
G0217.....................  S                          PET img whbd ring init               0667         18.68       $971.53  ............       $194.31
                                                        melan.
G0218.....................  S                          PET img whbd ring restag             0667         18.68       $971.53  ............       $194.31
                                                        mel.
G0219.....................  E                          PET img whbd ring noncov     ............  ............  ............  ............  ............
                                                        ind.
G0220.....................  S                          PET img whbd ring dx                 0667         18.68       $971.53  ............       $194.31
                                                        lymphom.
G0221.....................  S                          PET img whbd ring init               0667         18.68       $971.53  ............       $194.31
                                                        lymph.
G0222.....................  S                          PET img whbd ring resta              0667         18.68       $971.53  ............       $194.31
                                                        lymp.
G0223.....................  S                          PET img whbd reg ring dx             0667         18.68       $971.53  ............       $194.31
                                                        hea.
G0224.....................  S                          PETimg whbd reg ring ini             0667         18.68       $971.53  ............       $194.31
                                                        hea.
G0225.....................  S                          PET img whbd ring restag             0667         18.68       $971.53  ............       $194.31
                                                        hea.
G0226.....................  S                          PET img whbd dx esophag....          0667         18.68       $971.53  ............       $194.31
G0227.....................  S                          PET img whbd ring ini                0667         18.68       $971.53  ............       $194.31
                                                        esopha.
G0228.....................  S                          PET img whbd ring restg              0667         18.68       $971.53  ............       $194.31
                                                        esop.

[[Page 52308]]

 
G0229.....................  S                          PET img metabolic brain              0667         18.68       $971.53  ............       $194.31
                                                        ring.
G0230.....................  S                          PET myocard viability ring.          0667         18.68       $971.53  ............       $194.31
G0231.....................  S                          PET WhBD colorec; gamma cam          0667         18.68       $971.53  ............       $194.31
G0232.....................  S                          PET whbd lymphoma; gamma             0667         18.68       $971.53  ............       $194.31
                                                        cam.
G0233.....................  S                          PET whbd melanoma; gamma             0667         18.68       $971.53  ............       $194.31
                                                        cam.
G0234.....................  S                          PET WhBD pulm nod; gamma             0667         18.68       $971.53  ............       $194.31
                                                        cam.
G0236.....................  S                          Digital film convert diag            0706  ............        $25.00  ............         $5.00
                                                        ma.
G0237.....................  T                          Therapeutic procd strg               0970  ............        $25.00  ............         $5.00
                                                        endur.
G0238.....................  T                          Oth resp proc, indiv.......          0970  ............        $25.00  ............         $5.00
G0239.....................  T                          Oth resp proc, group.......          0970  ............        $25.00  ............         $5.00
G0240.....................  A                          Critic care by MD transport  ............  ............  ............  ............  ............
G0241.....................  A                          Each additional 30 minutes.  ............  ............  ............  ............  ............
G0242.....................  S                          Multisource photon ster              0714  ............     $1,375.00  ............       $275.00
                                                        plan.
G0243.....................  S                          Multisour photon stero               0721  ............     $5,500.00  ............     $1,100.00
                                                        treat.
G0244.....................  S                          Observ care by facility              0339          7.60       $395.27  ............        $79.05
                                                        topt.
G0245.....................  V                          Initial Foot Exam PTLOPS...          0600          0.91        $47.33  ............         $9.47
G0246.....................  V                          Follow-up Eval of Foot               0600          0.91        $47.33  ............         $9.47
                                                        PTLOPS.
G0247.....................  T                          Routine footcare w LOPS....          0009          0.68        $35.37         $8.34         $7.07
G0248.....................  S                          Demonstrate use home INR             0708  ............       $150.00  ............        $30.00
                                                        mon.
G0249.....................  S                          Provide test                         0708  ............       $150.00  ............        $30.00
                                                        material,equipm.
G0250.....................  E                          MD review interpret of test  ............  ............  ............  ............  ............
G9001.....................  E                          MCCD, initial rate.........  ............  ............  ............  ............  ............
G9002.....................  E                          MCCD,maintenance rate......  ............  ............  ............  ............  ............
G9003.....................  E                          MCCD, risk adj hi, initial.  ............  ............  ............  ............  ............
G9004.....................  E                          MCCD, risk adj lo, initial.  ............  ............  ............  ............  ............
G9005.....................  E                          MCCD, risk adj, maintenance  ............  ............  ............  ............  ............
G9006.....................  E                          MCCD, Home monitoring......  ............  ............  ............  ............  ............
G9007.....................  E                          MCCD, sch team conf........  ............  ............  ............  ............  ............
G9008.....................  E                          Mccd,phys coor-care ovrsght  ............  ............  ............  ............  ............
G9009.....................  E                          MCCD, risk adj, level 3....  ............  ............  ............  ............  ............
G9010.....................  E                          MCCD, risk adj, level 4....  ............  ............  ............  ............  ............
G9011.....................  E                          MCCD, risk adj, level 5....  ............  ............  ............  ............  ............
G9012.....................  E                          Other Specified Case Mgmt..  ............  ............  ............  ............  ............
G9016.....................  A                          Demo-smoking cessation coun  ............  ............  ............  ............  ............
H0001.....................  E                          Alcohol and/or drug assess.  ............  ............  ............  ............  ............
H0002.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        screenin.
H0003.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        screenin.
H0004.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0005.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0006.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0007.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0008.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0009.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0010.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0011.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0012.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0013.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0014.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0015.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0016.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0017.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0018.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0019.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0020.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        services.
H0021.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        training.
H0022.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        interven.
H0023.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        outreach.
H0024.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        preventi.
H0025.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        preventi.
H0026.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        preventi.
H0027.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        preventi.
H0028.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        preventi.
H0029.....................  E                          Alcohol and/or drug          ............  ............  ............  ............  ............
                                                        preventi.
H0030.....................  E                          Alcohol and/or drug hotline  ............  ............  ............  ............  ............
H1000.....................  A                          Prenatal care atrisk         ............  ............  ............  ............  ............
                                                        assessm.
H1001.....................  A                          Antepartum management......  ............  ............  ............  ............  ............

[[Page 52309]]

 
H1002.....................  A                          Carecoordination prenatal..  ............  ............  ............  ............  ............
H1003.....................  A                          Prenatal at risk education.  ............  ............  ............  ............  ............
H1004.....................  A                          Follow up home visit/        ............  ............  ............  ............  ............
                                                        prental.
H1005.....................  A                          Prenatalcare enhanced srv    ............  ............  ............  ............  ............
                                                        pk.
J0120.....................  N                          Tetracyclin injection......  ............  ............  ............  ............  ............
J0130.....................  K                          Abciximab injection........          1605          5.82       $302.69  ............        $60.54
J0150.....................  N                          Injection adenosine 6 MG...  ............  ............  ............  ............  ............
J0151.....................  E                          Adenosine injection........  ............  ............  ............  ............  ............
J0170.....................  N                          Adrenalin epinephrin inject  ............  ............  ............  ............  ............
J0190.....................  N                          Inj biperiden lactate/5 mg.  ............  ............  ............  ............  ............
J0200.....................  N                          Alatrofloxacin mesylate....  ............  ............  ............  ............  ............
J0205.....................  K                          Alglucerase injection......          0900          0.53        $27.56  ............         $5.51
J0207.....................  K                          Amifostine.................          7000          4.46       $231.96  ............        $46.39
J0210.....................  N                          Methyldopate hcl injection.  ............  ............  ............  ............  ............
J0256.....................  K                          Alpha 1 proteinase                   0901          0.02         $1.04  ............          $.21
                                                        inhibitor.
J0270.....................  E                          Alprostadil for injection..  ............  ............  ............  ............  ............
J0275.....................  E                          Alprostadil urethral suppos  ............  ............  ............  ............  ............
J0280.....................  N                          Aminophyllin 250 MG inj....  ............  ............  ............  ............  ............
J0282.....................  N                          Amiodarone HCl.............  ............  ............  ............  ............  ............
J0285.....................  N                          Amphotericin B.............  ............  ............  ............  ............  ............
J0286.....................  K                          Amphotericin B lipid                 7001          2.05       $106.62  ............        $21.32
                                                        complex.
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  ............  ............  ............  ............  ............
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...  ............  ............  ............  ............  ............
J0456.....................  N                          Azithromycin...............  ............  ............  ............  ............  ............
J0460.....................  N                          Atropine sulfate injection.  ............  ............  ............  ............  ............
J0470.....................  N                          Dimecaprol injection.......  ............  ............  ............  ............  ............
J0475.....................  N                          Baclofen 10 MG injection...  ............  ............  ............  ............  ............
J0476.....................  E                          Baclofen intrathecal trial.  ............  ............  ............  ............  ............
J0500.....................  N                          Dicyclomine injection......  ............  ............  ............  ............  ............
J0515.....................  N                          Inj benztropine mesylate...  ............  ............  ............  ............  ............
J0520.....................  N                          Bethanechol chloride inject  ............  ............  ............  ............  ............
J0530.....................  N                          Penicillin g benzathine inj  ............  ............  ............  ............  ............
J0540.....................  N                          Penicillin g benzathine inj  ............  ............  ............  ............  ............
J0550.....................  N                          Penicillin g benzathine inj  ............  ............  ............  ............  ............
J0560.....................  N                          Penicillin g benzathine inj  ............  ............  ............  ............  ............
J0570.....................  N                          Penicillin g benzathine inj  ............  ............  ............  ............  ............
J0580.....................  N                          Penicillin g benzathine inj  ............  ............  ............  ............  ............
J0585.....................  K                          Botulinum toxin a per unit.          0902          0.05         $2.60  ............          $.52
J0587.....................  G                          Botulinum toxin type B.....          9018  ............         $8.79  ............         $1.26
J0600.....................  N                          Edetate calcium disodium     ............  ............  ............  ............  ............
                                                        inj.
J0610.....................  N                          Calcium gluconate injection  ............  ............  ............  ............  ............
J0620.....................  N                          Calcium glycer & lact/10 ML  ............  ............  ............  ............  ............
J0630.....................  N                          Calcitonin salmon injection  ............  ............  ............  ............  ............
J0635.....................  N                          Calcitriol injection.......  ............  ............  ............  ............  ............
J0640.....................  N                          Leucovorin calcium           ............  ............  ............  ............  ............
                                                        injection.
J0670.....................  N                          Inj mepivacaine HCL/10 ml..  ............  ............  ............  ............  ............
J0690.....................  N                          Cefazolin sodium injection.  ............  ............  ............  ............  ............
J0692.....................  N                          Cefepime HCl for injection.  ............  ............  ............  ............  ............
J0694.....................  N                          Cefoxitin sodium injection.  ............  ............  ............  ............  ............
J0696.....................  N                          Ceftriaxone sodium           ............  ............  ............  ............  ............
                                                        injection.
J0697.....................  N                          Sterile cefuroxime           ............  ............  ............  ............  ............
                                                        injection.
J0698.....................  N                          Cefotaxime sodium injection  ............  ............  ............  ............  ............
J0702.....................  N                          Betamethasone acet&sod       ............  ............  ............  ............  ............
                                                        phosp.
J0704.....................  N                          Betamethasone sod phosp/4    ............  ............  ............  ............  ............
                                                        MG.
J0706.....................  N                          Caffeine citrate injection.  ............  ............  ............  ............  ............
J0710.....................  N                          Cephapirin sodium injection  ............  ............  ............  ............  ............
J0713.....................  N                          Inj ceftazidime per 500 mg.  ............  ............  ............  ............  ............
J0715.....................  N                          Ceftizoxime sodium / 500 MG  ............  ............  ............  ............  ............
J0720.....................  N                          Chloramphenicol sodium       ............  ............  ............  ............  ............
                                                        injec.

[[Page 52310]]

 
J0725.....................  N                          Chorionic gonadotropin/      ............  ............  ............  ............  ............
                                                        1000u.
J0735.....................  N                          Clonidine hydrochloride....  ............  ............  ............  ............  ............
J0740.....................  N                          Cidofovir injection........  ............  ............  ............  ............  ............
J0743.....................  N                          Cilastatin sodium injection  ............  ............  ............  ............  ............
J0744.....................  N                          Ciprofloxacin iv...........  ............  ............  ............  ............  ............
J0745.....................  N                          Inj codeine phosphate /30    ............  ............  ............  ............  ............
                                                        MG.
J0760.....................  N                          Colchicine injection.......  ............  ............  ............  ............  ............
J0770.....................  N                          Colistimethate sodium inj..  ............  ............  ............  ............  ............
J0780.....................  N                          Prochlorperazine injection.  ............  ............  ............  ............  ............
J0800.....................  N                          Corticotropin injection....  ............  ............  ............  ............  ............
J0835.....................  N                          Inj cosyntropin per 0.25 MG  ............  ............  ............  ............  ............
J0850.....................  K                          Cytomegalovirus imm IV /             0903          0.34        $17.68  ............         $3.54
                                                        vial.
J0895.....................  N                          Deferoxamine mesylate inj..  ............  ............  ............  ............  ............
J0900.....................  N                          Testosterone enanthate inj.  ............  ............  ............  ............  ............
J0945.....................  N                          Brompheniramine maleate inj  ............  ............  ............  ............  ............
J0970.....................  N                          Estradiol valerate           ............  ............  ............  ............  ............
                                                        injection.
J1000.....................  N                          Depo-estradiol cypionate     ............  ............  ............  ............  ............
                                                        inj.
J1020.....................  N                          Methylprednisolone 20 MG     ............  ............  ............  ............  ............
                                                        inj.
J1030.....................  N                          Methylprednisolone 40 MG     ............  ............  ............  ............  ............
                                                        inj.
J1040.....................  N                          Methylprednisolone 80 MG     ............  ............  ............  ............  ............
                                                        inj.
J1050.....................  N                          Medroxyprogesterone inj....  ............  ............  ............  ............  ............
J1055.....................  E                          Medrxyprogester acetate inj  ............  ............  ............  ............  ............
J1056.....................  E                          MA/EC                        ............  ............  ............  ............  ............
                                                        contraceptiveinjection.
J1060.....................  N                          Testosterone cypionate 1 ML  ............  ............  ............  ............  ............
J1070.....................  N                          Testosterone cypionat 100    ............  ............  ............  ............  ............
                                                        MG.
J1080.....................  N                          Testosterone cypionat 200    ............  ............  ............  ............  ............
                                                        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.......  ............  ............  ............  ............  ............
J1190.....................  K                          Dexrazoxane HCl injection..          0726          2.40       $124.82  ............        $24.96
J1200.....................  N                          Diphenhydramine hcl          ............  ............  ............  ............  ............
                                                        injectio.
J1205.....................  N                          Chlorothiazide sodium inj..  ............  ............  ............  ............  ............
J1212.....................  N                          Dimethyl sulfoxide 50% 50    ............  ............  ............  ............  ............
                                                        ML.
J1230.....................  N                          Methadone injection........  ............  ............  ............  ............  ............
J1240.....................  N                          Dimenhydrinate injection...  ............  ............  ............  ............  ............
J1245.....................  N                          Dipyridamole injection.....  ............  ............  ............  ............  ............
J1250.....................  N                          Inj dobutamine HCL/250 mg..  ............  ............  ............  ............  ............
J1260.....................  N                          Dolasetron mesylate........  ............  ............  ............  ............  ............
J1270.....................  N                          Injection, doxercalciferol.  ............  ............  ............  ............  ............
J1320.....................  N                          Amitriptyline injection....  ............  ............  ............  ............  ............
J1325.....................  N                          Epoprostenol injection.....  ............  ............  ............  ............  ............
J1327.....................  N                          Eptifibatide injection.....  ............  ............  ............  ............  ............
J1330.....................  N                          Ergonovine maleate           ............  ............  ............  ............  ............
                                                        injection.
J1364.....................  N                          Erythro lactobionate /500    ............  ............  ............  ............  ............
                                                        MG.
J1380.....................  N                          Estradiol valerate 10 MG     ............  ............  ............  ............  ............
                                                        inj.
J1390.....................  N                          Estradiol valerate 20 MG     ............  ............  ............  ............  ............
                                                        inj.
J1410.....................  N                          Inj estrogen conjugate 25    ............  ............  ............  ............  ............
                                                        MG.
J1435.....................  N                          Injection estrone per 1 MG.  ............  ............  ............  ............  ............
J1436.....................  N                          Etidronate disodium inj....  ............  ............  ............  ............  ............
J1438.....................  N                          Etanercept injection.......  ............  ............  ............  ............  ............
J1440.....................  K                          Filgrastim 300 mcg                   0728          2.24       $116.50  ............        $23.30
                                                        injection.
J1441.....................  K                          Filgrastim 480 mcg                   7049          3.37       $175.27  ............        $35.05
                                                        injection.
J1450.....................  N                          Fluconazole................  ............  ............  ............  ............  ............
J1452.....................  N                          Intraocular Fomivirsen na..  ............  ............  ............  ............  ............
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 52311]]

 
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.  ............  ............  ............  ............  ............
J1561.....................  K                          Immune globulin 500 mg.....          0905          0.45        $23.40  ............         $4.68
J1563.....................  E                          IV immune globulin.........  ............  ............  ............  ............  ............
J1565.....................  N                          RSV-ivig...................  ............  ............  ............  ............  ............
J1570.....................  N                          Ganciclovir sodium           ............  ............  ............  ............  ............
                                                        injection.
J1580.....................  N                          Garamycin gentamicin inj...  ............  ............  ............  ............  ............
J1590.....................  N                          Gatifloxacin injection.....  ............  ............  ............  ............  ............
J1600.....................  N                          Gold sodium thiomaleate inj  ............  ............  ............  ............  ............
J1610.....................  N                          Glucagon hydrochloride/1 MG  ............  ............  ............  ............  ............
J1620.....................  N                          Gonadorelin hydroch/ 100     ............  ............  ............  ............  ............
                                                        mcg.
J1626.....................  N                          Granisetron HCl injection..  ............  ............  ............  ............  ............
J1630.....................  N                          Haloperidol injection......  ............  ............  ............  ............  ............
J1631.....................  N                          Haloperidol decanoate inj..  ............  ............  ............  ............  ............
J1642.....................  N                          Inj heparin sodium per 10 u  ............  ............  ............  ............  ............
J1644.....................  N                          Inj heparin sodium per       ............  ............  ............  ............  ............
                                                        1000u.
J1645.....................  N                          Dalteparin sodium..........  ............  ............  ............  ............  ............
J1650.....................  E                          Inj enoxaparin sodium......  ............  ............  ............  ............  ............
J1655.....................  N                          Tinzaparin sodium injection  ............  ............  ............  ............  ............
J1670.....................  N                          Tetanus immune globulin inj  ............  ............  ............  ............  ............
J1700.....................  N                          Hydrocortisone acetate inj.  ............  ............  ............  ............  ............
J1710.....................  N                          Hydrocortisone sodium ph     ............  ............  ............  ............  ............
                                                        inj.
J1720.....................  N                          Hydrocortisone sodium succ   ............  ............  ............  ............  ............
                                                        i.
J1730.....................  N                          Diazoxide injection........  ............  ............  ............  ............  ............
J1742.....................  N                          Ibutilide fumarate           ............  ............  ............  ............  ............
                                                        injection.
J1745.....................  K                          Infliximab injection.......          7043          0.74        $38.49  ............         $7.70
J1750.....................  N                          Iron dextran...............  ............  ............  ............  ............  ............
J1755.....................  N                          Iron sucrose injection.....  ............  ............  ............  ............  ............
J1785.....................  K                          Injection imiglucerase /             0916          0.05         $2.60  ............          $.52
                                                        unit.
J1790.....................  N                          Droperidol injection.......  ............  ............  ............  ............  ............
J1800.....................  N                          Propranolol injection......  ............  ............  ............  ............  ............
J1810.....................  E                          Droperidol/fentanyl inj....  ............  ............  ............  ............  ............
J1820.....................  N                          Insulin injection..........  ............  ............  ............  ............  ............
J1825.....................  K                          Interferon beta-1a.........          0909          2.77       $144.06  ............        $28.81
J1830.....................  N                          Interferon beta-1b / .25 MG  ............  ............  ............  ............  ............
J1835.....................  N                          Itraconazole injection.....  ............  ............  ............  ............  ............
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......  ............  ............  ............  ............  ............
J1940.....................  N                          Furosemide injection.......  ............  ............  ............  ............  ............
J1950.....................  K                          Leuprolide acetate /3.75 MG          0800          4.15       $215.84  ............        $43.17
J1955.....................  E                          Inj levocarnitine per 1 gm.  ............  ............  ............  ............  ............
J1956.....................  N                          Levofloxacin injection.....  ............  ............  ............  ............  ............
J1960.....................  N                          Levorphanol tartrate inj...  ............  ............  ............  ............  ............
J1980.....................  N                          Hyoscyamine sulfate inj....  ............  ............  ............  ............  ............
J1990.....................  N                          Chlordiazepoxide injection.  ............  ............  ............  ............  ............
J2000.....................  N                          Lidocaine injection........  ............  ............  ............  ............  ............
J2010.....................  N                          Lincomycin injection.......  ............  ............  ............  ............  ............
J2020.....................  N                          Linezolid 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  ............  ............  ............  ............  ............
J2250.....................  N                          Inj midazolam hydrochloride  ............  ............  ............  ............  ............
J2260.....................  N                          Inj milrinone lactate / 5    ............  ............  ............  ............  ............
                                                        ML.
J2270.....................  N                          Morphine sulfate injection.  ............  ............  ............  ............  ............
J2271.....................  N                          Morphine so4 injection       ............  ............  ............  ............  ............
                                                        100mg.
J2275.....................  N                          Morphine sulfate injection.  ............  ............  ............  ............  ............
J2300.....................  N                          Inj nalbuphine               ............  ............  ............  ............  ............
                                                        hydrochloride.
J2310.....................  N                          Inj naloxone hydrochloride.  ............  ............  ............  ............  ............

[[Page 52312]]

 
J2320.....................  N                          Nandrolone decanoate 50 MG.  ............  ............  ............  ............  ............
J2321.....................  N                          Nandrolone decanoate 100 MG  ............  ............  ............  ............  ............
J2322.....................  N                          Nandrolone decanoate 200 MG  ............  ............  ............  ............  ............
J2352.....................  K                          Octreotide acetate                   7031          0.90        $46.81  ............         $9.36
                                                        injection.
J2355.....................  K                          Oprelvekin injection.......          7011          2.52       $131.06  ............        $26.21
J2360.....................  N                          Orphenadrine injection.....  ............  ............  ............  ............  ............
J2370.....................  N                          Phenylephrine hcl injection  ............  ............  ............  ............  ............
J2400.....................  N                          Chloroprocaine hcl           ............  ............  ............  ............  ............
                                                        injection.
J2405.....................  N                          Ondansetron hcl injection..  ............  ............  ............  ............  ............
J2410.....................  N                          Oxymorphone hcl injection..  ............  ............  ............  ............  ............
J2430.....................  K                          Pamidronate disodium /30 MG          0730          3.46       $179.95  ............        $35.99
J2440.....................  N                          Papaverin hcl injection....  ............  ............  ............  ............  ............
J2460.....................  N                          Oxytetracycline injection..  ............  ............  ............  ............  ............
J2500.....................  N                          Paricalcitol...............  ............  ............  ............  ............  ............
J2510.....................  N                          Penicillin g procaine inj..  ............  ............  ............  ............  ............
J2515.....................  N                          Pentobarbital sodium inj...  ............  ............  ............  ............  ............
J2540.....................  N                          Penicillin g potassium inj.  ............  ............  ............  ............  ............
J2543.....................  N                          Piperacillin/tazobactam....  ............  ............  ............  ............  ............
J2545.....................  A                          Pentamidine isethionte/      ............  ............  ............  ............  ............
                                                        300mg.
J2550.....................  N                          Promethazine hcl injection.  ............  ............  ............  ............  ............
J2560.....................  N                          Phenobarbital sodium inj...  ............  ............  ............  ............  ............
J2590.....................  N                          Oxytocin injection.........  ............  ............  ............  ............  ............
J2597.....................  N                          Inj desmopressin acetate...  ............  ............  ............  ............  ............
J2650.....................  N                          Prednisolone acetate inj...  ............  ............  ............  ............  ............
J2670.....................  N                          Totazoline hcl injection...  ............  ............  ............  ............  ............
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...  ............  ............  ............  ............  ............
J2765.....................  N                          Metoclopramide hcl           ............  ............  ............  ............  ............
                                                        injection.
J2770.....................  N                          Quinupristin/dalfopristin..  ............  ............  ............  ............  ............
J2780.....................  N                          Ranitidine hydrochloride     ............  ............  ............  ............  ............
                                                        inj.
J2790.....................  K                          Rho d immune globulin inj..          0884          0.70        $36.41  ............         $7.28
J2792.....................  K                          Rho(D) immune globulin h,            1609          0.22        $11.44  ............         $2.29
                                                        sd.
J2795.....................  N                          Ropivacaine HCl injection..  ............  ............  ............  ............  ............
J2800.....................  N                          Methocarbamol injection....  ............  ............  ............  ............  ............
J2810.....................  N                          Inj theophylline per 40 MG.  ............  ............  ............  ............  ............
J2820.....................  N                          Sargramostim injection.....  ............  ............  ............  ............  ............
J2910.....................  N                          Aurothioglucose injeciton..  ............  ............  ............  ............  ............
J2912.....................  N                          Sodium chloride injection..  ............  ............  ............  ............  ............
J2915.....................  N                          NA Ferric Gluconate Complex  ............  ............  ............  ............  ............
J2920.....................  N                          Methylprednisolone           ............  ............  ............  ............  ............
                                                        injection.
J2930.....................  N                          Methylprednisolone           ............  ............  ............  ............  ............
                                                        injection.
J2940.....................  N                          Somatrem injection.........  ............  ............  ............  ............  ............
J2941.....................  K                          Somatropin injection.......          7034          0.78        $40.57  ............         $8.11
J2950.....................  N                          Promazine hcl injection....  ............  ............  ............  ............  ............
J2993.....................  K                          Reteplase injection........          9005         10.84       $563.78  ............       $112.76
J2995.....................  N                          Inj streptokinase /250000    ............  ............  ............  ............  ............
                                                        IU.
J2997.....................  N                          Alteplase recombinant......  ............  ............  ............  ............  ............
J3000.....................  N                          Streptomycin injection.....  ............  ............  ............  ............  ............
J3010.....................  N                          Fentanyl citrate injeciton.  ............  ............  ............  ............  ............
J3030.....................  N                          Sumatriptan succinate / 6    ............  ............  ............  ............  ............
                                                        MG.
J3070.....................  N                          Pentazocine hcl injection..  ............  ............  ............  ............  ............
J3100.....................  K                          Tenecteplase injection.....          9002         25.46     $1,324.15  ............       $264.83
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.....................  E                          Thyrotropin injection......  ............  ............  ............  ............  ............
J3245.....................  K                          Tirofiban hydrochloride....          7041          4.82       $250.68  ............        $50.14

[[Page 52313]]

 
J3250.....................  N                          Trimethobenzamide hcl inj..  ............  ............  ............  ............  ............
J3260.....................  N                          Tobramycin sulfate           ............  ............  ............  ............  ............
                                                        injection.
J3265.....................  N                          Injection torsemide 10 mg/   ............  ............  ............  ............  ............
                                                        ml.
J3280.....................  N                          Thiethylperazine maleate     ............  ............  ............  ............  ............
                                                        inj.
J3301.....................  N                          Triamcinolone acetonide inj  ............  ............  ............  ............  ............
J3302.....................  N                          Triamcinolone diacetate inj  ............  ............  ............  ............  ............
J3303.....................  N                          Triamcinolone hexacetonl     ............  ............  ............  ............  ............
                                                        inj.
J3305.....................  K                          Inj trimetrexate                     7045          1.23        $63.97  ............        $12.79
                                                        glucoronate.
J3310.....................  N                          Perphenazine injeciton.....  ............  ............  ............  ............  ............
J3320.....................  N                          Spectinomycn di-hcl inj....  ............  ............  ............  ............  ............
J3350.....................  N                          Urea injection.............  ............  ............  ............  ............  ............
J3360.....................  N                          Diazepam injection.........  ............  ............  ............  ............  ............
J3364.....................  N                          Urokinase 5000 IU injection  ............  ............  ............  ............  ............
J3365.....................  N                          Urokinase 250,000 IU inj...  ............  ............  ............  ............  ............
J3370.....................  N                          Vancomycin hcl injection...  ............  ............  ............  ............  ............
J3395.....................  K                          Verteporfin injection......          1203         16.26       $845.67  ............       $169.13
J3400.....................  N                          Triflupromazine hcl inj....  ............  ............  ............  ............  ............
J3410.....................  N                          Hydroxyzine hcl injection..  ............  ............  ............  ............  ............
J3420.....................  N                          Vitamin b12 injection......  ............  ............  ............  ............  ............
J3430.....................  N                          Vitamin k phytonadione inj.  ............  ............  ............  ............  ............
J3470.....................  N                          Hyaluronidase injection....  ............  ............  ............  ............  ............
J3475.....................  N                          Inj magnesium sulfate......  ............  ............  ............  ............  ............
J3480.....................  N                          Inj potassium chloride.....  ............  ............  ............  ............  ............
J3485.....................  N                          Zidovudine.................  ............  ............  ............  ............  ............
J3490.....................  N                          Drugs unclassified           ............  ............  ............  ............  ............
                                                        injection.
J3520.....................  E                          Edetate disodium per 150 mg  ............  ............  ............  ............  ............
J3530.....................  N                          Nasal vaccine inhalation...  ............  ............  ............  ............  ............
J3535.....................  E                          Metered dose inhaler drug..  ............  ............  ............  ............  ............
J3570.....................  E                          Laetrile amygdalin vit B17.  ............  ............  ............  ............  ............
J7030.....................  N                          Normal saline solution       ............  ............  ............  ............  ............
                                                        infus.
J7040.....................  N                          Normal saline solution       ............  ............  ............  ............  ............
                                                        infus.
J7042.....................  N                          5% dextrose/normal saline..  ............  ............  ............  ............  ............
J7050.....................  N                          Normal saline solution       ............  ............  ............  ............  ............
                                                        infus.
J7051.....................  N                          Sterile saline/water.......  ............  ............  ............  ............  ............
J7060.....................  N                          5% dextrose/water..........  ............  ............  ............  ............  ............
J7070.....................  N                          D5w infusion...............  ............  ............  ............  ............  ............
J7100.....................  N                          Dextran 40 infusion........  ............  ............  ............  ............  ............
J7110.....................  N                          Dextran 75 infusion........  ............  ............  ............  ............  ............
J7120.....................  N                          Ringers lactate infusion...  ............  ............  ............  ............  ............
J7130.....................  N                          Hypertonic saline solution.  ............  ............  ............  ............  ............
J7190.....................  K                          Factor viii................          0925          0.01          $.52  ............          $.10
J7191.....................  K                          Factor VIII (porcine)......          0926          0.02         $1.04  ............          $.21
J7192.....................  K                          Factor viii recombinant....          0927          0.01          $.52  ............          $.10
J7193.....................  K                          Factor IX non-recombinant..          0931          0.01          $.52  ............          $.10
J7194.....................  K                          Factor ix complex..........          0928          0.01          $.52  ............          $.10
J7195.....................  K                          Factor IX recombinant......          0932          0.03         $1.56  ............          $.31
J7197.....................  K                          Antithrombin iii injection.          0930          0.01          $.52  ............          $.10
J7198.....................  K                          Anti-inhibitor.............          0929          0.01          $.52  ............          $.10
J7199.....................  E                          Hemophilia clot factor noc.  ............  ............  ............  ............  ............
J7300.....................  E                          Intraut copper               ............  ............  ............  ............  ............
                                                        contraceptive.
J7302.....................  E                          Levonorgestrel iu            ............  ............  ............  ............  ............
                                                        contracept.
J7308.....................  N                          Aminolevulinic acid hcl top  ............  ............  ............  ............  ............
J7310.....................  N                          Ganciclovir long act         ............  ............  ............  ............  ............
                                                        implant.
J7316.....................  N                          Sodium hyaluronate           ............  ............  ............  ............  ............
                                                        injection.
J7320.....................  K                          Hylan G-F 20 injection.....          1611          2.43       $126.38  ............        $25.28
J7330.....................  K                          Cultured chondrocytes                1059         43.64     $2,269.67  ............       $453.93
                                                        implnt.
J7340.....................  E                          Metabolic active D/E tissue  ............  ............  ............  ............  ............
J7500.....................  N                          Azathioprine oral 50mg.....  ............  ............  ............  ............  ............
J7501.....................  N                          Azathioprine parenteral....  ............  ............  ............  ............  ............
J7502.....................  K                          Cyclosporine oral 100 mg...          0888          0.04         $2.08  ............          $.42
J7504.....................  K                          Lymphocyte immune globulin.          0890          3.64       $189.31  ............        $37.86
J7505.....................  K                          Monoclonal antibodies......          7038          4.43       $230.40  ............        $46.08
J7506.....................  N                          Prednisone oral............  ............  ............  ............  ............  ............
J7507.....................  K                          Tacrolimus oral per 1 MG...          0891          0.02         $1.04  ............          $.21
J7508.....................  E                          Tacrolimus oral per 5 MG...  ............  ............  ............  ............  ............
J7509.....................  N                          Methylprednisolone oral....  ............  ............  ............  ............  ............

[[Page 52314]]

 
J7510.....................  N                          Prednisolone oral per 5 mg.  ............  ............  ............  ............  ............
J7511.....................  K                          Antithymocyte globuln                9104          1.97       $102.46  ............        $20.49
                                                        rabbit.
J7513.....................  K                          Daclizumab, parenteral.....          1612          3.77       $196.07  ............        $39.21
J7515.....................  N                          Cyclosporine oral 25 mg....  ............  ............  ............  ............  ............
J7516.....................  N                          Cyclosporin parenteral       ............  ............  ............  ............  ............
                                                        250mg.
J7517.....................  G                          Mycophenolate mofetil oral.          9015  ............         $2.40  ............          $.34
J7520.....................  K                          Sirolimus, oral............          9106          0.05         $2.60  ............          $.52
J7525.....................  N                          Tacrolimus injection.......  ............  ............  ............  ............  ............
J7599.....................  E                          Immunosuppressive drug noc.  ............  ............  ............  ............  ............
J7608.....................  A                          Acetylcysteine inh sol u d.  ............  ............  ............  ............  ............
J7618.....................  A                          Albuterol inh sol con......  ............  ............  ............  ............  ............
J7619.....................  A                          Albuterol inh sol u d......  ............  ............  ............  ............  ............
J7622.....................  A                          Beclomethasone inhalatn sol  ............  ............  ............  ............  ............
J7624.....................  A                          Betamethasone inhalation     ............  ............  ............  ............  ............
                                                        sol.
J7626.....................  A                          Budesonide inhalation sol..  ............  ............  ............  ............  ............
J7628.....................  A                          Bitolterol mes inhal sol     ............  ............  ............  ............  ............
                                                        con.
J7629.....................  A                          Bitolterol mes inh sol u d.  ............  ............  ............  ............  ............
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  ............  ............  ............  ............  ............
J7639.....................  A                          Dornase alpha inhal sol u d  ............  ............  ............  ............  ............
J7641.....................  A                          Flunisolide, inhalation sol  ............  ............  ............  ............  ............
J7642.....................  A                          Glycopyrrolate inhal sol     ............  ............  ............  ............  ............
                                                        con.
J7643.....................  A                          Glycopyrrolate inhal sol u   ............  ............  ............  ............  ............
                                                        d.
J7644.....................  A                          Ipratropium brom inh sol u   ............  ............  ............  ............  ............
                                                        d.
J7648.....................  A                          Isoetharine hcl inh sol con  ............  ............  ............  ............  ............
J7649.....................  A                          Isoetharine hcl inh sol u d  ............  ............  ............  ............  ............
J7658.....................  A                          Isoproterenolhcl inh sol     ............  ............  ............  ............  ............
                                                        con.
J7659.....................  A                          Isoproterenol hcl inh sol    ............  ............  ............  ............  ............
                                                        ud.
J7668.....................  A                          Metaproterenol inh sol con.  ............  ............  ............  ............  ............
J7669.....................  A                          Metaproterenol inh sol u d.  ............  ............  ............  ............  ............
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  ............  ............  ............  ............  ............
J8499.....................  E                          Oral prescrip drug non       ............  ............  ............  ............  ............
                                                        chemo.
J8510.....................  N                          Oral busulfan..............  ............  ............  ............  ............  ............
J8520.....................  K                          Capecitabine, oral, 150 mg.          7042          0.03         $1.56  ............          $.31
J8521.....................  E                          Capecitabine, oral, 500 mg.  ............  ............  ............  ............  ............
J8530.....................  N                          Cyclophosphamide oral 25 MG  ............  ............  ............  ............  ............
J8560.....................  K                          Etoposide oral 50 MG.......          0802          0.54        $28.08  ............         $5.62
J8600.....................  N                          Melphalan oral 2 MG........  ............  ............  ............  ............  ............
J8610.....................  N                          Methotrexate oral 2.5 MG...  ............  ............  ............  ............  ............
J8700.....................  K                          Temozolmide................          1086          0.05         $2.60  ............          $.52
J8999.....................  E                          Oral prescription drug       ............  ............  ............  ............  ............
                                                        chemo.
J9000.....................  N                          Doxorubic hcl 10 MG vl       ............  ............  ............  ............  ............
                                                        chemo.
J9001.....................  K                          Doxorubicin hcl liposome             7046          4.54       $236.12  ............        $47.22
                                                        inj.
J9015.....................  K                          Aldesleukin/single use vial          0807          6.09       $316.73  ............        $63.35
J9017.....................  G                          Arsenic trioxide...........          9012  ............        $23.75  ............         $3.40
J9020.....................  N                          Asparaginase injection.....  ............  ............  ............  ............  ............
J9031.....................  N                          Bcg live intravesical vac..  ............  ............  ............  ............  ............
J9040.....................  K                          Bleomycin sulfate injection          0857          3.10       $161.23  ............        $32.25
J9045.....................  K                          Carboplatin injection......          0811          1.58        $82.17  ............        $16.43
J9050.....................  N                          Carmus bischl nitro inj....  ............  ............  ............  ............  ............
J9060.....................  K                          Cisplatin 10 MG injection..          0813          0.47        $24.44  ............         $4.89
J9062.....................  E                          Cisplatin 50 MG injection..  ............  ............  ............  ............  ............
J9065.....................  K                          Inj cladribine per 1 MG....          0858          0.84        $43.69  ............         $8.74
J9070.....................  N                          Cyclophosphamide 100 MG inj  ............  ............  ............  ............  ............
J9080.....................  E                          Cyclophosphamide 200 MG inj  ............  ............  ............  ............  ............
J9090.....................  E                          Cyclophosphamide 500 MG inj  ............  ............  ............  ............  ............
J9091.....................  E                          Cyclophosphamide 1.0 grm     ............  ............  ............  ............  ............
                                                        inj.

[[Page 52315]]

 
J9092.....................  E                          Cyclophosphamide 2.0 grm     ............  ............  ............  ............  ............
                                                        inj.
J9093.....................  N                          Cyclophosphamide             ............  ............  ............  ............  ............
                                                        lyophilized.
J9094.....................  E                          Cyclophosphamide             ............  ............  ............  ............  ............
                                                        lyophilized.
J9095.....................  E                          Cyclophosphamide             ............  ............  ............  ............  ............
                                                        lyophilized.
J9096.....................  E                          Cyclophosphamide             ............  ............  ............  ............  ............
                                                        lyophilized.
J9097.....................  E                          Cyclophosphamide             ............  ............  ............  ............  ............
                                                        lyophilized.
J9100.....................  N                          Cytarabine hcl 100 MG inj..  ............  ............  ............  ............  ............
J9110.....................  E                          Cytarabine hcl 500 MG inj..  ............  ............  ............  ............  ............
J9120.....................  N                          Dactinomycin actinomycin d.  ............  ............  ............  ............  ............
J9130.....................  N                          Dacarbazine 10 MG inj......  ............  ............  ............  ............  ............
J9140.....................  E                          Dacarbazine 200 MG inj.....  ............  ............  ............  ............  ............
J9150.....................  K                          Daunorubicin...............          0820          2.27       $118.06  ............        $23.61
J9151.....................  K                          Daunorubicin citrate                 0821          3.17       $164.87  ............        $32.97
                                                        liposom.
J9160.....................  K                          Denileukin diftitox, 300             1084         13.94       $725.01  ............       $145.00
                                                        mcg.
J9165.....................  K                          Diethylstilbestrol                   0822          2.21       $114.94  ............        $22.99
                                                        injection.
J9170.....................  K                          Docetaxel..................          0823          4.01       $208.56  ............        $41.71
J9180.....................  E                          Epirubicin HCl injection...  ............  ............  ............  ............  ............
J9181.....................  N                          Etoposide 10 MG inj........  ............  ............  ............  ............  ............
J9182.....................  E                          Etoposide 100 MG inj.......  ............  ............  ............  ............  ............
J9185.....................  K                          Fludarabine phosphate inj..          0842          3.30       $171.63  ............        $34.33
J9190.....................  N                          Fluorouracil injection.....  ............  ............  ............  ............  ............
J9200.....................  K                          Floxuridine injection......          0827          2.42       $125.86  ............        $25.17
J9201.....................  K                          Gemcitabine HCl............          0828          1.49        $77.49  ............        $15.50
J9202.....................  K                          Goserelin acetate implant..          0810          5.94       $308.93  ............        $61.79
J9206.....................  K                          Irinotecan injection.......          0830          1.86        $96.74  ............        $19.35
J9208.....................  K                          Ifosfomide injection.......          0831          2.06       $107.14  ............        $21.43
J9209.....................  K                          Mesna injection............          0732          0.55        $28.60  ............         $5.72
J9211.....................  K                          Idarubicin hcl injection...          0832          4.57       $237.68  ............        $47.54
J9212.....................  N                          Interferon alfacon-1.......  ............  ............  ............  ............  ............
J9213.....................  N                          Interferon alfa-2a inj.....  ............  ............  ............  ............  ............
J9214.....................  N                          Interferon alfa-2b inj.....  ............  ............  ............  ............  ............
J9215.....................  N                          Interferon alfa-n3 inj.....  ............  ............  ............  ............  ............
J9216.....................  K                          Interferon gamma 1-b inj...          0838          2.49       $129.50  ............        $25.90
J9217.....................  K                          Leuprolide acetate                   9217          6.30       $327.66  ............        $65.53
                                                        suspnsion.
J9218.....................  K                          Leuprolide acetate                   0861          0.84        $43.69  ............         $8.74
                                                        injeciton.
J9219.....................  G                          Leuprolide acetate implant.          7051  ............     $5,399.80  ............       $773.02
J9230.....................  N                          Mechlorethamine hcl inj....  ............  ............  ............  ............  ............
J9245.....................  K                          Inj melphalan hydrochl 50            0840          4.09       $212.72  ............        $42.54
                                                        MG.
J9250.....................  N                          Methotrexate sodium inj....  ............  ............  ............  ............  ............
J9260.....................  E                          Methotrexate sodium inj....  ............  ............  ............  ............  ............
J9265.....................  K                          Paclitaxel injection.......          0863          2.50       $130.02  ............        $26.00
J9266.....................  K                          Pegaspargase/singl dose              0843          2.38       $123.78  ............        $24.76
                                                        vial.
J9268.....................  K                          Pentostatin injection......          0844         21.32     $1,108.83  ............       $221.77
J9270.....................  N                          Plicamycin (mithramycin)     ............  ............  ............  ............  ............
                                                        inj.
J9280.....................  K                          Mitomycin 5 MG inj.........          0862          1.18        $61.37  ............        $12.27
J9290.....................  E                          Mitomycin 20 MG inj........  ............  ............  ............  ............  ............
J9291.....................  E                          Mitomycin 40 MG inj........  ............  ............  ............  ............  ............
J9293.....................  K                          Mitoxantrone hydrochl / 5            0864          3.02       $157.07  ............        $31.41
                                                        MG.
J9300.....................  K                          Gemtuzumab ozogamicin......          9004          1.05        $54.61  ............        $10.92
J9310.....................  K                          Rituximab cancer treatment.          0849          5.71       $296.97  ............        $59.39
J9320.....................  N                          Streptozocin injection.....  ............  ............  ............  ............  ............
J9340.....................  N                          Thiotepa injection.........  ............  ............  ............  ............  ............
J9350.....................  K                          Topotecan..................          0852          7.61       $395.79  ............        $79.16
J9355.....................  K                          Trastuzumab................          1613          0.66        $34.33  ............         $6.87
J9357.....................  K                          Valrubicin, 200 mg.........          1614          2.04       $106.10  ............        $21.22
J9360.....................  N                          Vinblastine sulfate inj....  ............  ............  ............  ............  ............
J9370.....................  N                          Vincristine sulfate 1 MG     ............  ............  ............  ............  ............
                                                        inj.
J9375.....................  E                          Vincristine sulfate 2 MG     ............  ............  ............  ............  ............
                                                        inj.
J9380.....................  E                          Vincristine sulfate 5 MG     ............  ............  ............  ............  ............
                                                        inj.
J9390.....................  K                          Vinorelbine tartrate/10 mg.          0855          1.10        $57.21  ............        $11.44
J9600.....................  K                          Porfimer sodium............          0856         26.35     $1,370.44  ............       $274.09
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..  ............  ............  ............  ............  ............

[[Page 52316]]

 
K0005.....................  A                          Ultralightweight wheelchair  ............  ............  ............  ............  ............
K0006.....................  A                          Heavy duty wheelchair......  ............  ............  ............  ............  ............
K0007.....................  A                          Extra heavy duty wheelchair  ............  ............  ............  ............  ............
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...  ............  ............  ............  ............  ............
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.
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.

[[Page 52317]]

 
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............  ............  ............  ............  ............  ............
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.
K0183.....................  A                          Nasal application device...  ............  ............  ............  ............  ............
K0184.....................  A                          Nasal pillow or face seal..  ............  ............  ............  ............  ............
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.  ............  ............  ............  ............  ............
K0415.....................  E                          RX antiemetic drg, oral NOS  ............  ............  ............  ............  ............
K0416.....................  E                          Rx antiemetic drg,rectal     ............  ............  ............  ............  ............
                                                        NOS.
K0452.....................  A                          Wheelchair bearings........  ............  ............  ............  ............  ............
K0455.....................  A                          Pump uninterrupted infusion  ............  ............  ............  ............  ............
K0460.....................  A                          WC power add-on joystick...  ............  ............  ............  ............  ............
K0461.....................  A                          WC power add-on tiller       ............  ............  ............  ............  ............
                                                        cntrl.
K0462.....................  A                          Temporary replacement        ............  ............  ............  ............  ............
                                                        eqpmnt.
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...  ............  ............  ............  ............  ............
K0538.....................  A                          Neg pressure wnd thrpy pump  ............  ............  ............  ............  ............
K0539.....................  A                          Neg pres wnd thrpy dsg set.  ............  ............  ............  ............  ............
K0540.....................  A                          Neg pres wnd thrp canister.  ............  ............  ............  ............  ............
K0541.....................  A                          SGD prerecorded msg = 8 min  ............  ............  ............  ............  ............
K0542.....................  A                          SGD prerecorded msg > 8 min  ............  ............  ............  ............  ............

[[Page 52318]]

 
K0543.....................  A                          SGD msg formed by spelling.  ............  ............  ............  ............  ............
K0544.....................  A                          SGD w multi methods msg/     ............  ............  ............  ............  ............
                                                        accs.
K0545.....................  A                          SGD sftwre prgrm for PC/PDA  ............  ............  ............  ............  ............
K0546.....................  A                          SGD accessory,mounting       ............  ............  ............  ............  ............
                                                        systm.
K0547.....................  A                          SGD accessory NOC..........  ............  ............  ............  ............  ............
K0548.....................  A                          Insulin lispro.............  ............  ............  ............  ............  ............
K0549.....................  A                          Hosp bed hvy dty xtra wide.  ............  ............  ............  ............  ............
K0550.....................  A                          Hosp bed xtra hvy dty x      ............  ............  ............  ............  ............
                                                        wide.
K0551.....................  A                          Residual limb support        ............  ............  ............  ............  ............
                                                        system.
L0100.....................  A                          Cranial orthosis/helmet      ............  ............  ............  ............  ............
                                                        mold.
L0110.....................  A                          Cranial orthosis/helmet      ............  ............  ............  ............  ............
                                                        nonm.
L0120.....................  A                          Cerv flexible non-           ............  ............  ............  ............  ............
                                                        adjustable.
L0130.....................  A                          Flex thermoplastic collar    ............  ............  ............  ............  ............
                                                        mo.
L0140.....................  A                          Cervical semi-rigid          ............  ............  ............  ............  ............
                                                        adjustab.
L0150.....................  A                          Cerv semi-rig adj molded     ............  ............  ............  ............  ............
                                                        chn.
L0160.....................  A                          Cerv semi-rig wire occ/mand  ............  ............  ............  ............  ............
L0170.....................  A                          Cervical collar molded to    ............  ............  ............  ............  ............
                                                        pt.
L0172.....................  A                          Cerv col thermplas foam 2    ............  ............  ............  ............  ............
                                                        pi.
L0174.....................  A                          Cerv col foam 2 piece w      ............  ............  ............  ............  ............
                                                        thor.
L0180.....................  A                          Cer post col occ/man sup     ............  ............  ............  ............  ............
                                                        adj.
L0190.....................  A                          Cerv collar supp adj cerv    ............  ............  ............  ............  ............
                                                        ba.
L0200.....................  A                          Cerv col supp adj bar &      ............  ............  ............  ............  ............
                                                        thor.
L0210.....................  A                          Thoracic rib belt..........  ............  ............  ............  ............  ............
L0220.....................  A                          Thor rib belt custom         ............  ............  ............  ............  ............
                                                        fabrica.
L0300.....................  A                          TLSO flex surgical support.  ............  ............  ............  ............  ............
L0310.....................  A                          Tlso flexible custom         ............  ............  ............  ............  ............
                                                        fabrica.
L0315.....................  A                          Tlso flex elas rigid post    ............  ............  ............  ............  ............
                                                        pa.
L0317.....................  A                          Tlso flex hypext elas post   ............  ............  ............  ............  ............
                                                        p.
L0320.....................  A                          Tlso a-p contrl w apron      ............  ............  ............  ............  ............
                                                        frnt.
L0321.....................  A                          Tlso anti-post-cntrl prefab  ............  ............  ............  ............  ............
L0330.....................  A                          Tlso ant-pos-lateral         ............  ............  ............  ............  ............
                                                        control.
L0331.....................  A                          Tlso ant-post-lat cntrl      ............  ............  ............  ............  ............
                                                        prfb.
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..  ............  ............  ............  ............  ............
L0391.....................  A                          Tlso ant-post-lat-rot cntrl  ............  ............  ............  ............  ............
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......  ............  ............  ............  ............  ............
L0561.....................  A                          Prefab lso.................  ............  ............  ............  ............  ............
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  ............  ............  ............  ............  ............

[[Page 52319]]

 
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..  ............  ............  ............  ............  ............
L0986.....................  A                          Spinal orth abdm pnl prefab  ............  ............  ............  ............  ............
L0999.....................  A                          Add to spinal orthosis NOS.  ............  ............  ............  ............  ............
L1000.....................  A                          Ctlso milwauke initial       ............  ............  ............  ............  ............
                                                        model.
L1005.....................  A                          Tension based scoliosis      ............  ............  ............  ............  ............
                                                        orth.
L1010.....................  A                          Ctlso axilla sling.........  ............  ............  ............  ............  ............
L1020.....................  A                          Kyphosis pad...............  ............  ............  ............  ............  ............
L1025.....................  A                          Kyphosis pad floating......  ............  ............  ............  ............  ............
L1030.....................  A                          Lumbar bolster pad.........  ............  ............  ............  ............  ............
L1040.....................  A                          Lumbar or lumbar rib pad...  ............  ............  ............  ............  ............
L1050.....................  A                          Sternal pad................  ............  ............  ............  ............  ............
L1060.....................  A                          Thoracic pad...............  ............  ............  ............  ............  ............
L1070.....................  A                          Trapezius sling............  ............  ............  ............  ............  ............
L1080.....................  A                          Outrigger..................  ............  ............  ............  ............  ............
L1085.....................  A                          Outrigger bil w/ vert        ............  ............  ............  ............  ............
                                                        extens.
L1090.....................  A                          Lumbar sling...............  ............  ............  ............  ............  ............
L1100.....................  A                          Ring flange plastic/leather  ............  ............  ............  ............  ............
L1110.....................  A                          Ring flange plas/leather     ............  ............  ............  ............  ............
                                                        mol.
L1120.....................  A                          Covers for upright each....  ............  ............  ............  ............  ............
L1200.....................  A                          Furnsh initial orthosis      ............  ............  ............  ............  ............
                                                        only.
L1210.....................  A                          Lateral thoracic extension.  ............  ............  ............  ............  ............
L1220.....................  A                          Anterior thoracic extension  ............  ............  ............  ............  ............
L1230.....................  A                          Milwaukee type               ............  ............  ............  ............  ............
                                                        superstructur.
L1240.....................  A                          Lumbar derotation pad......  ............  ............  ............  ............  ............
L1250.....................  A                          Anterior asis pad..........  ............  ............  ............  ............  ............
L1260.....................  A                          Anterior thoracic            ............  ............  ............  ............  ............
                                                        derotation.
L1270.....................  A                          Abdominal pad..............  ............  ............  ............  ............  ............
L1280.....................  A                          Rib gusset (elastic) each..  ............  ............  ............  ............  ............
L1290.....................  A                          Lateral trochanteric pad...  ............  ............  ............  ............  ............
L1300.....................  A                          Body jacket mold to patient  ............  ............  ............  ............  ............
L1310.....................  A                          Post-operative body jacket.  ............  ............  ............  ............  ............
L1499.....................  A                          Spinal orthosis NOS........  ............  ............  ............  ............  ............
L1500.....................  A                          Thkao mobility frame.......  ............  ............  ............  ............  ............
L1510.....................  A                          Thkao standing frame.......  ............  ............  ............  ............  ............
L1520.....................  A                          Thkao swivel walker........  ............  ............  ............  ............  ............
L1600.....................  A                          Abduct hip flex frejka w     ............  ............  ............  ............  ............
                                                        cvr.
L1610.....................  A                          Abduct hip flex frejka covr  ............  ............  ............  ............  ............
L1620.....................  A                          Abduct hip flex pavlik       ............  ............  ............  ............  ............
                                                        harne.
L1630.....................  A                          Abduct control hip semi-     ............  ............  ............  ............  ............
                                                        flex.
L1640.....................  A                          Pelv band/spread bar thigh   ............  ............  ............  ............  ............
                                                        c.
L1650.....................  A                          HO abduction hip adjustable  ............  ............  ............  ............  ............
L1660.....................  A                          HO abduction static plastic  ............  ............  ............  ............  ............
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.  ............  ............  ............  ............  ............

[[Page 52320]]

 
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.  ............  ............  ............  ............  ............
L2090.....................  A                          Hkafo unilat torsion ball    ............  ............  ............  ............  ............
                                                        br.
L2102.....................  E                          Afo tibial fx cast plstr     ............  ............  ............  ............  ............
                                                        mol.
L2104.....................  E                          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.....................  E                          Kafo fem fx cast plaster     ............  ............  ............  ............  ............
                                                        mol.
L2124.....................  E                          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.........  ............  ............  ............  ............  ............

[[Page 52321]]

 
L2190.....................  A                          Waist belt.................  ............  ............  ............  ............  ............
L2192.....................  A                          Pelvic band & belt thigh     ............  ............  ............  ............  ............
                                                        fla.
L2200.....................  A                          Limited ankle motion ea jnt  ............  ............  ............  ............  ............
L2210.....................  A                          Dorsiflexion assist each     ............  ............  ............  ............  ............
                                                        joi.
L2220.....................  A                          Dorsi & plantar flex ass/    ............  ............  ............  ............  ............
                                                        res.
L2230.....................  A                          Split flat caliper stirr &   ............  ............  ............  ............  ............
                                                        p.
L2240.....................  A                          Round caliper and plate      ............  ............  ............  ............  ............
                                                        atta.
L2250.....................  A                          Foot plate molded stirrup    ............  ............  ............  ............  ............
                                                        at.
L2260.....................  A                          Reinforced solid stirrup...  ............  ............  ............  ............  ............
L2265.....................  A                          Long tongue stirrup........  ............  ............  ............  ............  ............
L2270.....................  A                          Varus/valgus strap padded/   ............  ............  ............  ............  ............
                                                        li.
L2275.....................  A                          Plastic mod low ext pad/     ............  ............  ............  ............  ............
                                                        line.
L2280.....................  A                          Molded inner boot..........  ............  ............  ............  ............  ............
L2300.....................  A                          Abduction bar jointed        ............  ............  ............  ............  ............
                                                        adjust.
L2310.....................  A                          Abduction bar-straight.....  ............  ............  ............  ............  ............
L2320.....................  A                          Non-molded lacer...........  ............  ............  ............  ............  ............
L2330.....................  A                          Lacer molded to patient      ............  ............  ............  ............  ............
                                                        mode.
L2335.....................  A                          Anterior swing band........  ............  ............  ............  ............  ............
L2340.....................  A                          Pre-tibial shell molded to   ............  ............  ............  ............  ............
                                                        p.
L2350.....................  A                          Prosthetic type socket       ............  ............  ............  ............  ............
                                                        molde.
L2360.....................  A                          Extended steel shank.......  ............  ............  ............  ............  ............
L2370.....................  A                          Patten bottom..............  ............  ............  ............  ............  ............
L2375.....................  A                          Torsion ank & half solid     ............  ............  ............  ............  ............
                                                        sti.
L2380.....................  A                          Torsion straight knee joint  ............  ............  ............  ............  ............
L2385.....................  A                          Straight knee joint heavy    ............  ............  ............  ............  ............
                                                        du.
L2390.....................  A                          Offset knee joint each.....  ............  ............  ............  ............  ............
L2395.....................  A                          Offset knee joint heavy      ............  ............  ............  ............  ............
                                                        duty.
L2397.....................  A                          Suspension sleeve lower ext  ............  ............  ............  ............  ............
L2405.....................  A                          Knee joint drop lock ea jnt  ............  ............  ............  ............  ............
L2415.....................  A                          Knee joint cam lock each     ............  ............  ............  ............  ............
                                                        joi.
L2425.....................  A                          Knee disc/dial lock/adj      ............  ............  ............  ............  ............
                                                        flex.
L2430.....................  A                          Knee jnt ratchet lock ea     ............  ............  ............  ............  ............
                                                        jnt.
L2435.....................  A                          Knee joint polycentric       ............  ............  ............  ............  ............
                                                        joint.
L2492.....................  A                          Knee lift loop drop lock     ............  ............  ............  ............  ............
                                                        rin.
L2500.....................  A                          Thi/glut/ischia wgt bearing  ............  ............  ............  ............  ............
L2510.....................  A                          Th/wght bear quad-lat brim   ............  ............  ............  ............  ............
                                                        m.
L2520.....................  A                          Th/wght bear quad-lat brim   ............  ............  ............  ............  ............
                                                        c.
L2525.....................  A                          Th/wght bear nar m-l brim    ............  ............  ............  ............  ............
                                                        mo.
L2526.....................  A                          Th/wght bear nar m-l brim    ............  ............  ............  ............  ............
                                                        cu.
L2530.....................  A                          Thigh/wght bear lacer non-   ............  ............  ............  ............  ............
                                                        mo.
L2540.....................  A                          Thigh/wght bear lacer        ............  ............  ............  ............  ............
                                                        molded.
L2550.....................  A                          Thigh/wght bear high roll    ............  ............  ............  ............  ............
                                                        cu.
L2570.....................  A                          Hip clevis type 2 posit jnt  ............  ............  ............  ............  ............
L2580.....................  A                          Pelvic control pelvic sling  ............  ............  ............  ............  ............
L2600.....................  A                          Hip clevis/thrust bearing    ............  ............  ............  ............  ............
                                                        fr.
L2610.....................  A                          Hip clevis/thrust bearing    ............  ............  ............  ............  ............
                                                        lo.
L2620.....................  A                          Pelvic control hip heavy     ............  ............  ............  ............  ............
                                                        dut.
L2622.....................  A                          Hip joint adjustable         ............  ............  ............  ............  ............
                                                        flexion.
L2624.....................  A                          Hip adj flex ext abduct      ............  ............  ............  ............  ............
                                                        cont.
L2627.....................  A                          Plastic mold recipro hip &   ............  ............  ............  ............  ............
                                                        c.
L2628.....................  A                          Metal frame recipro hip &    ............  ............  ............  ............  ............
                                                        ca.
L2630.....................  A                          Pelvic control band & belt   ............  ............  ............  ............  ............
                                                        u.
L2640.....................  A                          Pelvic control band & belt   ............  ............  ............  ............  ............
                                                        b.
L2650.....................  A                          Pelv & thor control gluteal  ............  ............  ............  ............  ............
L2660.....................  A                          Thoracic control thoracic    ............  ............  ............  ............  ............
                                                        ba.
L2670.....................  A                          Thorac cont paraspinal       ............  ............  ............  ............  ............
                                                        uprig.
L2680.....................  A                          Thorac cont lat support      ............  ............  ............  ............  ............
                                                        upri.
L2750.....................  A                          Plating chrome/nickel pr     ............  ............  ............  ............  ............
                                                        bar.
L2755.....................  A                          Carbon graphite lamination.  ............  ............  ............  ............  ............
L2760.....................  A                          Extension per extension per  ............  ............  ............  ............  ............
L2768.....................  A                          Ortho sidebar disconnect...  ............  ............  ............  ............  ............
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.

[[Page 52322]]

 
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.....................  E                          Ft insert ucb berkeley       ............  ............  ............  ............  ............
                                                        shell.
L3001.....................  E                          Foot insert remov molded     ............  ............  ............  ............  ............
                                                        spe.
L3002.....................  E                          Foot insert plastazote or    ............  ............  ............  ............  ............
                                                        eq.
L3003.....................  E                          Foot insert silicone gel     ............  ............  ............  ............  ............
                                                        eac.
L3010.....................  E                          Foot longitudinal arch       ............  ............  ............  ............  ............
                                                        suppo.
L3020.....................  E                          Foot longitud/metatarsal     ............  ............  ............  ............  ............
                                                        sup.
L3030.....................  E                          Foot arch support remov      ............  ............  ............  ............  ............
                                                        prem.
L3040.....................  E                          Ft arch suprt premold        ............  ............  ............  ............  ............
                                                        longit.
L3050.....................  E                          Foot arch supp premold       ............  ............  ............  ............  ............
                                                        metat.
L3060.....................  E                          Foot arch supp longitud/     ............  ............  ............  ............  ............
                                                        meta.
L3070.....................  E                          Arch suprt att to sho        ............  ............  ............  ............  ............
                                                        longit.
L3080.....................  E                          Arch supp att to shoe        ............  ............  ............  ............  ............
                                                        metata.
L3090.....................  E                          Arch supp att to shoe long/  ............  ............  ............  ............  ............
                                                        m.
L3100.....................  E                          Hallus-valgus nght dynamic   ............  ............  ............  ............  ............
                                                        s.
L3140.....................  E                          Abduction rotation bar shoe  ............  ............  ............  ............  ............
L3150.....................  E                          Abduct rotation bar w/o      ............  ............  ............  ............  ............
                                                        shoe.
L3160.....................  E                          Shoe styled positioning dev  ............  ............  ............  ............  ............
L3170.....................  E                          Foot plastic heel            ............  ............  ............  ............  ............
                                                        stabilizer.
L3201.....................  E                          Oxford w supinat/pronat inf  ............  ............  ............  ............  ............
L3202.....................  E                          Oxford w/ supinat/pronator   ............  ............  ............  ............  ............
                                                        c.
L3203.....................  E                          Oxford w/ supinator/         ............  ............  ............  ............  ............
                                                        pronator.
L3204.....................  E                          Hightop w/ supp/pronator     ............  ............  ............  ............  ............
                                                        inf.
L3206.....................  E                          Hightop w/ supp/pronator     ............  ............  ............  ............  ............
                                                        chi.
L3207.....................  E                          Hightop w/ supp/pronator     ............  ............  ............  ............  ............
                                                        jun.
L3208.....................  E                          Surgical boot each infant..  ............  ............  ............  ............  ............
L3209.....................  E                          Surgical boot each child...  ............  ............  ............  ............  ............
L3211.....................  E                          Surgical boot each junior..  ............  ............  ............  ............  ............
L3212.....................  E                          Benesch boot pair infant...  ............  ............  ............  ............  ............
L3213.....................  E                          Benesch boot pair child....  ............  ............  ............  ............  ............
L3214.....................  E                          Benesch boot pair junior...  ............  ............  ............  ............  ............
L3215.....................  E                          Orthopedic ftwear ladies     ............  ............  ............  ............  ............
                                                        oxf.
L3216.....................  E                          Orthoped ladies shoes dpth   ............  ............  ............  ............  ............
                                                        i.
L3217.....................  E                          Ladies shoes hightop depth   ............  ............  ............  ............  ............
                                                        i.
L3218.....................  E                          Ladies surgical boot each..  ............  ............  ............  ............  ............
L3219.....................  E                          Orthopedic mens shoes        ............  ............  ............  ............  ............
                                                        oxford.
L3221.....................  E                          Orthopedic mens shoes dpth   ............  ............  ............  ............  ............
                                                        i.
L3222.....................  E                          Mens shoes hightop depth     ............  ............  ............  ............  ............
                                                        inl.
L3223.....................  E                          Mens surgical boot each....  ............  ............  ............  ............  ............
L3224.....................  A                          Woman's shoe oxford brace..  ............  ............  ............  ............  ............
L3225.....................  A                          Man's shoe oxford brace....  ............  ............  ............  ............  ............
L3230.....................  E                          Custom shoes depth inlay...  ............  ............  ............  ............  ............
L3250.....................  E                          Custom mold shoe remov       ............  ............  ............  ............  ............
                                                        prost.
L3251.....................  E                          Shoe molded to pt silicone   ............  ............  ............  ............  ............
                                                        s.
L3252.....................  E                          Shoe molded plastazote cust  ............  ............  ............  ............  ............
L3253.....................  E                          Shoe molded plastazote cust  ............  ............  ............  ............  ............
L3254.....................  E                          Orth foot non-stndard size/  ............  ............  ............  ............  ............
                                                        w.
L3255.....................  E                          Orth foot non-standard size/ ............  ............  ............  ............  ............
                                                        .
L3257.....................  E                          Orth foot add charge split   ............  ............  ............  ............  ............
                                                        s.
L3260.....................  E                          Ambulatory surgical boot     ............  ............  ............  ............  ............
                                                        eac.
L3265.....................  E                          Plastazote sandal each.....  ............  ............  ............  ............  ............
L3300.....................  E                          Sho lift taper to            ............  ............  ............  ............  ............
                                                        metatarsal.
L3310.....................  E                          Shoe lift elev heel/sole     ............  ............  ............  ............  ............
                                                        neo.
L3320.....................  E                          Shoe lift elev heel/sole     ............  ............  ............  ............  ............
                                                        cor.
L3330.....................  E                          Lifts elevation metal        ............  ............  ............  ............  ............
                                                        extens.
L3332.....................  E                          Shoe lifts tapered to one-   ............  ............  ............  ............  ............
                                                        ha.
L3334.....................  E                          Shoe lifts elevation heel /  ............  ............  ............  ............  ............
                                                        i.
L3340.....................  E                          Shoe wedge sach............  ............  ............  ............  ............  ............
L3350.....................  E                          Shoe heel wedge............  ............  ............  ............  ............  ............
L3360.....................  E                          Shoe sole wedge outside      ............  ............  ............  ............  ............
                                                        sole.

[[Page 52323]]

 
L3370.....................  E                          Shoe sole wedge between      ............  ............  ............  ............  ............
                                                        sole.
L3380.....................  E                          Shoe clubfoot wedge........  ............  ............  ............  ............  ............
L3390.....................  E                          Shoe outflare wedge........  ............  ............  ............  ............  ............
L3400.....................  E                          Shoe metatarsal bar wedge    ............  ............  ............  ............  ............
                                                        ro.
L3410.....................  E                          Shoe metatarsal bar between  ............  ............  ............  ............  ............
L3420.....................  E                          Full sole/heel wedge btween  ............  ............  ............  ............  ............
L3430.....................  E                          Sho heel count plast         ............  ............  ............  ............  ............
                                                        reinfor.
L3440.....................  E                          Heel leather reinforced....  ............  ............  ............  ............  ............
L3450.....................  E                          Shoe heel sach cushion type  ............  ............  ............  ............  ............
L3455.....................  E                          Shoe heel new leather        ............  ............  ............  ............  ............
                                                        standa.
L3460.....................  E                          Shoe heel new rubber         ............  ............  ............  ............  ............
                                                        standar.
L3465.....................  E                          Shoe heel thomas with wedge  ............  ............  ............  ............  ............
L3470.....................  E                          Shoe heel thomas extend to   ............  ............  ............  ............  ............
                                                        b.
L3480.....................  E                          Shoe heel pad & depress for  ............  ............  ............  ............  ............
L3485.....................  E                          Shoe heel pad removable for  ............  ............  ............  ............  ............
L3500.....................  E                          Ortho shoe add leather       ............  ............  ............  ............  ............
                                                        insol.
L3510.....................  E                          Orthopedic shoe add rub      ............  ............  ............  ............  ............
                                                        insl.
L3520.....................  E                          O shoe add felt w leath      ............  ............  ............  ............  ............
                                                        insl.
L3530.....................  E                          Ortho shoe add half sole...  ............  ............  ............  ............  ............
L3540.....................  E                          Ortho shoe add full sole...  ............  ............  ............  ............  ............
L3550.....................  E                          O shoe add standard toe tap  ............  ............  ............  ............  ............
L3560.....................  E                          O shoe add horseshoe toe     ............  ............  ............  ............  ............
                                                        tap.
L3570.....................  E                          O shoe add instep extension  ............  ............  ............  ............  ............
L3580.....................  E                          O shoe add instep velcro     ............  ............  ............  ............  ............
                                                        clo.
L3590.....................  E                          O shoe convert to sof        ............  ............  ............  ............  ............
                                                        counte.
L3595.....................  E                          Ortho shoe add march bar...  ............  ............  ............  ............  ............
L3600.....................  E                          Trans shoe calip plate       ............  ............  ............  ............  ............
                                                        exist.
L3610.....................  E                          Trans shoe caliper plate     ............  ............  ............  ............  ............
                                                        new.
L3620.....................  E                          Trans shoe solid stirrup     ............  ............  ............  ............  ............
                                                        exi.
L3630.....................  E                          Trans shoe solid stirrup     ............  ............  ............  ............  ............
                                                        new.
L3640.....................  E                          Shoe dennis browne splint    ............  ............  ............  ............  ............
                                                        bo.
L3649.....................  E                          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.............  ............  ............  ............  ............  ............
L3677.....................  A                          SO hard plastic stabilizer.  ............  ............  ............  ............  ............
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.
L3760.....................  A                          EO withjoint, Prefabricated  ............  ............  ............  ............  ............
L3800.....................  A                          Whfo short opponen no        ............  ............  ............  ............  ............
                                                        attach.
L3805.....................  A                          Whfo long opponens no        ............  ............  ............  ............  ............
                                                        attach.
L3807.....................  A                          WHFO,no joint,               ............  ............  ............  ............  ............
                                                        prefabricated.
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.....................  E                          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........  ............  ............  ............  ............  ............

[[Page 52324]]

 
L3912.....................  A                          Flex glove w/elastic finger  ............  ............  ............  ............  ............
L3914.....................  A                          WHO wrist extension cock-up  ............  ............  ............  ............  ............
L3916.....................  A                          Whfo wrist extens w/         ............  ............  ............  ............  ............
                                                        outrigg.
L3918.....................  A                          HFO knuckle bender.........  ............  ............  ............  ............  ............
L3920.....................  A                          Knuckle bender with          ............  ............  ............  ............  ............
                                                        outrigge.
L3922.....................  A                          Knuckle bend 2 seg to flex   ............  ............  ............  ............  ............
                                                        j.
L3923.....................  A                          HFO, no joint,               ............  ............  ............  ............  ............
                                                        prefabricated.
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.................  ............  ............  ............  ............  ............

[[Page 52325]]

 
L4398.....................  A                          Foot drop splint recumbent.  ............  ............  ............  ............  ............
L5000.....................  A                          Sho insert w arch toe        ............  ............  ............  ............  ............
                                                        filler.
L5010.....................  A                          Mold socket ank hgt w/ toe   ............  ............  ............  ............  ............
                                                        f.
L5020.....................  A                          Tibial tubercle hgt w/ toe   ............  ............  ............  ............  ............
                                                        f.
L5050.....................  A                          Ank symes mold sckt sach ft  ............  ............  ............  ............  ............
L5060.....................  A                          Symes met fr leath socket    ............  ............  ............  ............  ............
                                                        ar.
L5100.....................  A                          Molded socket shin sach      ............  ............  ............  ............  ............
                                                        foot.
L5105.....................  A                          Plast socket jts/thgh lacer  ............  ............  ............  ............  ............
L5150.....................  A                          Mold sckt ext knee shin      ............  ............  ............  ............  ............
                                                        sach.
L5160.....................  A                          Mold socket bent knee shin   ............  ............  ............  ............  ............
                                                        s.
L5200.....................  A                          Kne sing axis fric shin      ............  ............  ............  ............  ............
                                                        sach.
L5210.....................  A                          No knee/ankle joints w/ ft   ............  ............  ............  ............  ............
                                                        b.
L5220.....................  A                          No knee joint with artic     ............  ............  ............  ............  ............
                                                        ali.
L5230.....................  A                          Fem focal defic constant     ............  ............  ............  ............  ............
                                                        fri.
L5250.....................  A                          Hip canad sing axi cons      ............  ............  ............  ............  ............
                                                        fric.
L5270.....................  A                          Tilt table locking hip sing  ............  ............  ............  ............  ............
L5280.....................  A                          Hemipelvect canad sing axis  ............  ............  ............  ............  ............
L5301.....................  A                          BK mold socket SACH ft endo  ............  ............  ............  ............  ............
L5311.....................  A                          Knee disart, SACH ft, endo.  ............  ............  ............  ............  ............
L5321.....................  A                          AK open end SACH...........  ............  ............  ............  ............  ............
L5331.....................  A                          Hip disart canadian SACH ft  ............  ............  ............  ............  ............
L5341.....................  A                          Hemipelvectomy canadian      ............  ............  ............  ............  ............
                                                        SACH.
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.

[[Page 52326]]

 
L5644.....................  A                          Above knee wood socket.....  ............  ............  ............  ............  ............
L5645.....................  A                          Bk flex inner socket ext     ............  ............  ............  ............  ............
                                                        fra.
L5646.....................  A                          Below knee air cushion       ............  ............  ............  ............  ............
                                                        socke.
L5647.....................  A                          Below knee suction socket..  ............  ............  ............  ............  ............
L5648.....................  A                          Above knee air cushion       ............  ............  ............  ............  ............
                                                        socke.
L5649.....................  A                          Isch containmt/narrow m-l    ............  ............  ............  ............  ............
                                                        so.
L5650.....................  A                          Tot contact ak/knee disart   ............  ............  ............  ............  ............
                                                        s.
L5651.....................  A                          Ak flex inner socket ext     ............  ............  ............  ............  ............
                                                        fra.
L5652.....................  A                          Suction susp ak/knee disart  ............  ............  ............  ............  ............
L5653.....................  A                          Knee disart expand wall      ............  ............  ............  ............  ............
                                                        sock.
L5654.....................  A                          Socket insert symes........  ............  ............  ............  ............  ............
L5655.....................  A                          Socket insert below knee...  ............  ............  ............  ............  ............
L5656.....................  A                          Socket insert knee           ............  ............  ............  ............  ............
                                                        articulat.
L5658.....................  A                          Socket insert above knee...  ............  ............  ............  ............  ............
L5660.....................  A                          Sock insrt syme silicone     ............  ............  ............  ............  ............
                                                        gel.
L5661.....................  A                          Multi-durometer symes......  ............  ............  ............  ............  ............
L5662.....................  A                          Socket insert bk silicone    ............  ............  ............  ............  ............
                                                        ge.
L5663.....................  A                          Sock knee disartic silicone  ............  ............  ............  ............  ............
L5664.....................  A                          Socket insert ak silicone    ............  ............  ............  ............  ............
                                                        ge.
L5665.....................  A                          Multi-durometer below knee.  ............  ............  ............  ............  ............
L5666.....................  A                          Below knee cuff suspension.  ............  ............  ............  ............  ............
L5668.....................  A                          Socket insert w/o lock       ............  ............  ............  ............  ............
                                                        lower.
L5670.....................  A                          Bk molded supracondylar      ............  ............  ............  ............  ............
                                                        susp.
L5671.....................  A                          BK/AK locking mechanism....  ............  ............  ............  ............  ............
L5672.....................  A                          Bk removable medial brim     ............  ............  ............  ............  ............
                                                        sus.
L5674.....................  A                          Bk suspension sleeve.......  ............  ............  ............  ............  ............
L5675.....................  A                          Bk heavy duty susp sleeve..  ............  ............  ............  ............  ............
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 cover BK......  ............  ............  ............  ............  ............
L5705.....................  A                          Custom shape cover AK......  ............  ............  ............  ............  ............
L5706.....................  A                          Custom shape cvr knee        ............  ............  ............  ............  ............
                                                        disart.
L5707.....................  A                          Custom shape cvr 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.

[[Page 52327]]

 
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.
L5847.....................  A                          Microprocessor cntrl         ............  ............  ............  ............  ............
                                                        feature.
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.
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.
L5989.....................  A                          Pylon w elctrnc force        ............  ............  ............  ............  ............
                                                        sensor.
L5990.....................  A                          User adjustable heel height  ............  ............  ............  ............  ............
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.

[[Page 52328]]

 
L6388.....................  A                          Postop applicat rigid dsg    ............  ............  ............  ............  ............
                                                        on.
L6400.....................  A                          Below elbow prosth tiss      ............  ............  ............  ............  ............
                                                        shap.
L6450.....................  A                          Elb disart prosth tiss shap  ............  ............  ............  ............  ............
L6500.....................  A                          Above elbow prosth tiss      ............  ............  ............  ............  ............
                                                        shap.
L6550.....................  A                          Shldr disar prosth tiss      ............  ............  ............  ............  ............
                                                        shap.
L6570.....................  A                          Scap thorac prosth tiss      ............  ............  ............  ............  ............
                                                        shap.
L6580.....................  A                          Wrist/elbow bowden cable     ............  ............  ............  ............  ............
                                                        mol.
L6582.....................  A                          Wrist/elbow bowden cbl dir   ............  ............  ............  ............  ............
                                                        f.
L6584.....................  A                          Elbow fair lead cable        ............  ............  ............  ............  ............
                                                        molded.
L6586.....................  A                          Elbow fair lead cable dir    ............  ............  ............  ............  ............
                                                        fo.
L6588.....................  A                          Shdr fair lead cable molded  ............  ............  ............  ............  ............
L6590.....................  A                          Shdr fair lead cable direct  ............  ............  ............  ............  ............
L6600.....................  A                          Polycentric hinge pair.....  ............  ............  ............  ............  ............
L6605.....................  A                          Single pivot hinge pair....  ............  ............  ............  ............  ............
L6610.....................  A                          Flexible metal hinge pair..  ............  ............  ............  ............  ............
L6615.....................  A                          Disconnect locking wrist     ............  ............  ............  ............  ............
                                                        uni.
L6616.....................  A                          Disconnect insert locking    ............  ............  ............  ............  ............
                                                        wr.
L6620.....................  A                          Flexion-friction wrist unit  ............  ............  ............  ............  ............
L6623.....................  A                          Spring-ass rot wrst w/       ............  ............  ............  ............  ............
                                                        latch.
L6625.....................  A                          Rotation wrst w/ cable lock  ............  ............  ............  ............  ............
L6628.....................  A                          Quick disconn hook adapter   ............  ............  ............  ............  ............
                                                        o.
L6629.....................  A                          Lamination collar w/         ............  ............  ............  ............  ............
                                                        couplin.
L6630.....................  A                          Stainless steel any wrist..  ............  ............  ............  ............  ............
L6632.....................  A                          Latex suspension sleeve      ............  ............  ............  ............  ............
                                                        each.
L6635.....................  A                          Lift assist for elbow......  ............  ............  ............  ............  ............
L6637.....................  A                          Nudge control elbow lock...  ............  ............  ............  ............  ............
L6640.....................  A                          Shoulder abduction joint     ............  ............  ............  ............  ............
                                                        pai.
L6641.....................  A                          Excursion amplifier pulley   ............  ............  ............  ............  ............
                                                        t.
L6642.....................  A                          Excursion amplifier lever    ............  ............  ............  ............  ............
                                                        ty.
L6645.....................  A                          Shoulder flexion-abduction   ............  ............  ............  ............  ............
                                                        j.
L6650.....................  A                          Shoulder universal joint...  ............  ............  ............  ............  ............
L6655.....................  A                          Standard control cable       ............  ............  ............  ............  ............
                                                        extra.
L6660.....................  A                          Heavy duty control cable...  ............  ............  ............  ............  ............
L6665.....................  A                          Teflon or equal cable        ............  ............  ............  ............  ............
                                                        lining.
L6670.....................  A                          Hook to hand cable adapter.  ............  ............  ............  ............  ............
L6672.....................  A                          Harness chest/shlder saddle  ............  ............  ............  ............  ............
L6675.....................  A                          Harness figure of 8 sing     ............  ............  ............  ............  ............
                                                        con.
L6676.....................  A                          Harness figure of 8 dual     ............  ............  ............  ............  ............
                                                        con.
L6680.....................  A                          Test sock wrist disart/bel   ............  ............  ............  ............  ............
                                                        e.
L6682.....................  A                          Test sock elbw disart/above  ............  ............  ............  ............  ............
L6684.....................  A                          Test socket shldr disart/    ............  ............  ............  ............  ............
                                                        tho.
L6686.....................  A                          Suction socket.............  ............  ............  ............  ............  ............
L6687.....................  A                          Frame typ socket bel elbow/  ............  ............  ............  ............  ............
                                                        w.
L6688.....................  A                          Frame typ sock above elb/    ............  ............  ............  ............  ............
                                                        dis.
L6689.....................  A                          Frame typ socket shoulder    ............  ............  ............  ............  ............
                                                        di.
L6690.....................  A                          Frame typ sock interscap-    ............  ............  ............  ............  ............
                                                        tho.
L6691.....................  A                          Removable insert each......  ............  ............  ............  ............  ............
L6692.....................  A                          Silicone gel insert or       ............  ............  ............  ............  ............
                                                        equal.
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...  ............  ............  ............  ............  ............

[[Page 52329]]

 
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 grip1/2 or       ............  ............  ............  ............  ............
                                                        equal.
L6808.....................  A                          Term device infant or child  ............  ............  ............  ............  ............
L6809.....................  A                          Trs super sport passive....  ............  ............  ............  ............  ............
L6810.....................  A                          Pincher tool otto bock or    ............  ............  ............  ............  ............
                                                        eq.
L6825.....................  A                          Hands dorrance vo..........  ............  ............  ............  ............  ............
L6830.....................  A                          Hand aprl vc...............  ............  ............  ............  ............  ............
L6835.....................  A                          Hand sierra vo.............  ............  ............  ............  ............  ............
L6840.....................  A                          Hand becker imperial.......  ............  ............  ............  ............  ............
L6845.....................  A                          Hand becker lock grip......  ............  ............  ............  ............  ............
L6850.....................  A                          Term dvc-hand becker         ............  ............  ............  ............  ............
                                                        plylite.
L6855.....................  A                          Hand robin-aids vo.........  ............  ............  ............  ............  ............
L6860.....................  A                          Hand robin-aids vo soft....  ............  ............  ............  ............  ............
L6865.....................  A                          Hand passive hand..........  ............  ............  ............  ............  ............
L6867.....................  A                          Hand detroit infant hand...  ............  ............  ............  ............  ............
L6868.....................  A                          Passive inf hand steeper/    ............  ............  ............  ............  ............
                                                        hos.
L6870.....................  A                          Hand child mitt............  ............  ............  ............  ............  ............
L6872.....................  A                          Hand nyu child hand........  ............  ............  ............  ............  ............
L6873.....................  A                          Hand mech inf steeper or     ............  ............  ............  ............  ............
                                                        equ.
L6875.....................  A                          Hand bock vc...............  ............  ............  ............  ............  ............
L6880.....................  A                          Hand bock vo...............  ............  ............  ............  ............  ............
L6881.....................  A                          Autograsp feature ul term    ............  ............  ............  ............  ............
                                                        dv.
L6882.....................  A                          Microprocessor control       ............  ............  ............  ............  ............
                                                        uplmb.
L6890.....................  A                          Production glove...........  ............  ............  ............  ............  ............
L6895.....................  A                          Custom glove...............  ............  ............  ............  ............  ............
L6900.....................  A                          Hand restorat thumb/1        ............  ............  ............  ............  ............
                                                        finger.
L6905.....................  A                          Hand restoration multiple    ............  ............  ............  ............  ............
                                                        fi.
L6910.....................  A                          Hand restoration no fingers  ............  ............  ............  ............  ............
L6915.....................  A                          Hand restoration replacmnt   ............  ............  ............  ............  ............
                                                        g.
L6920.....................  A                          Wrist disarticul switch      ............  ............  ............  ............  ............
                                                        ctrl.
L6925.....................  A                          Wrist disart myoelectronic   ............  ............  ............  ............  ............
                                                        c.
L6930.....................  A                          Below elbow switch control.  ............  ............  ............  ............  ............
L6935.....................  A                          Below elbow myoelectronic    ............  ............  ............  ............  ............
                                                        ct.
L6940.....................  A                          Elbow disarticulation        ............  ............  ............  ............  ............
                                                        switch.
L6945.....................  A                          Elbow disart myoelectronic   ............  ............  ............  ............  ............
                                                        c.
L6950.....................  A                          Above elbow switch control.  ............  ............  ............  ............  ............
L6955.....................  A                          Above elbow myoelectronic    ............  ............  ............  ............  ............
                                                        ct.
L6960.....................  A                          Shldr disartic switch        ............  ............  ............  ............  ............
                                                        contro.
L6965.....................  A                          Shldr disartic               ............  ............  ............  ............  ............
                                                        myoelectronic.
L6970.....................  A                          Interscapular-thor switch    ............  ............  ............  ............  ............
                                                        ct.
L6975.....................  A                          Interscap-thor               ............  ............  ............  ............  ............
                                                        myoelectronic.
L7010.....................  A                          Hand otto back steeper/eq    ............  ............  ............  ............  ............
                                                        sw.
L7015.....................  A                          Hand sys teknik village      ............  ............  ............  ............  ............
                                                        swit.
L7020.....................  A                          Electronic greifer switch    ............  ............  ............  ............  ............
                                                        ct.
L7025.....................  A                          Electron hand myoelectronic  ............  ............  ............  ............  ............
L7030.....................  A                          Hand sys teknik vill         ............  ............  ............  ............  ............
                                                        myoelec.
L7035.....................  A                          Electron greifer myoelectro  ............  ............  ............  ............  ............
L7040.....................  A                          Prehensile actuator hosmer   ............  ............  ............  ............  ............
                                                        s.
L7045.....................  A                          Electron hook child          ............  ............  ............  ............  ............
                                                        michigan.
L7170.....................  A                          Electronic elbow hosmer      ............  ............  ............  ............  ............
                                                        swit.
L7180.....................  A                          Electronic elbow utah        ............  ............  ............  ............  ............
                                                        myoele.
L7185.....................  A                          Electron elbow adolescent    ............  ............  ............  ............  ............
                                                        sw.
L7186.....................  A                          Electron elbow child switch  ............  ............  ............  ............  ............
L7190.....................  A                          Elbow adolescent             ............  ............  ............  ............  ............
                                                        myoelectron.
L7191.....................  A                          Elbow child myoelectronic    ............  ............  ............  ............  ............
                                                        ct.
L7260.....................  A                          Electron wrist rotator otto  ............  ............  ............  ............  ............
L7261.....................  A                          Electron wrist rotator utah  ............  ............  ............  ............  ............
L7266.....................  A                          Servo control steeper or     ............  ............  ............  ............  ............
                                                        equ.
L7272.....................  A                          Analogue control unb or      ............  ............  ............  ............  ............
                                                        equa.
L7274.....................  A                          Proportional ctl 12 volt     ............  ............  ............  ............  ............
                                                        uta.
L7360.....................  A                          Six volt bat otto bock/eq    ............  ............  ............  ............  ............
                                                        ea.
L7362.....................  A                          Battery chrgr six volt otto  ............  ............  ............  ............  ............
L7364.....................  A                          Twelve volt battery utah/    ............  ............  ............  ............  ............
                                                        equ.

[[Page 52330]]

 
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.............  ............  ............  ............  ............  ............
L8001.....................  A                          Breast prosthesis bra &      ............  ............  ............  ............  ............
                                                        form.
L8002.....................  A                          Brst prsth bra & bilat form  ............  ............  ............  ............  ............
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......  ............  ............  ............  ............  ............
L8040.....................  A                          Nasal prosthesis...........  ............  ............  ............  ............  ............
L8041.....................  A                          Midfacial prosthesis.......  ............  ............  ............  ............  ............
L8042.....................  A                          Orbital prosthesis.........  ............  ............  ............  ............  ............
L8043.....................  A                          Upper facial prosthesis....  ............  ............  ............  ............  ............
L8044.....................  A                          Hemi-facial prosthesis.....  ............  ............  ............  ............  ............
L8045.....................  A                          Auricular prosthesis.......  ............  ............  ............  ............  ............
L8046.....................  A                          Partial facial prosthesis..  ............  ............  ............  ............  ............
L8047.....................  A                          Nasal septal prosthesis....  ............  ............  ............  ............  ............
L8048.....................  A                          Unspec maxillofacial prosth  ............  ............  ............  ............  ............
L8049.....................  A                          Repair maxillofacial prosth  ............  ............  ............  ............  ............
L8100.....................  E                          Compression stocking BK18-   ............  ............  ............  ............  ............
                                                        30.
L8110.....................  E                          Compression stocking BK30-   ............  ............  ............  ............  ............
                                                        40.
L8120.....................  E                          Compression stocking BK40-   ............  ............  ............  ............  ............
                                                        50.
L8130.....................  E                          Gc stocking thighlngth 18-   ............  ............  ............  ............  ............
                                                        30.
L8140.....................  E                          Gc stocking thighlngth 30-   ............  ............  ............  ............  ............
                                                        40.
L8150.....................  E                          Gc stocking thighlngth 40-   ............  ............  ............  ............  ............
                                                        50.
L8160.....................  E                          Gc stocking full lngth 18-   ............  ............  ............  ............  ............
                                                        30.
L8170.....................  E                          Gc stocking full lngth 30-   ............  ............  ............  ............  ............
                                                        40.
L8180.....................  E                          Gc stocking full lngth 40-   ............  ............  ............  ............  ............
                                                        50.
L8190.....................  E                          Gc stocking waistlngth 18-   ............  ............  ............  ............  ............
                                                        30.
L8195.....................  E                          Gc stocking waistlngth 30-   ............  ............  ............  ............  ............
                                                        40.
L8200.....................  E                          Gc stocking waistlngth 40-   ............  ............  ............  ............  ............
                                                        50.
L8210.....................  E                          Gc stocking custom made....  ............  ............  ............  ............  ............
L8220.....................  E                          Gc stocking lymphedema.....  ............  ............  ............  ............  ............
L8230.....................  E                          Gc stocking garter belt....  ............  ............  ............  ............  ............
L8239.....................  E                          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  ............  ............  ............  ............  ............
L8505.....................  A                          Artificial larynx,           ............  ............  ............  ............  ............
                                                        accessory.
L8507.....................  A                          Trach-esoph voice pros pt    ............  ............  ............  ............  ............
                                                        in.
L8509.....................  A                          Trach-esoph voice pros md    ............  ............  ............  ............  ............
                                                        in.
L8510.....................  A                          Voice amplifier............  ............  ............  ............  ............  ............

[[Page 52331]]

 
L8600.....................  N                          Implant breast silicone/eq.  ............  ............  ............  ............  ............
L8603.....................  N                          Collagen imp urinary 2.5 ml  ............  ............  ............  ............  ............
L8606.....................  A                          Synthetic implnt urinary     ............  ............  ............  ............  ............
                                                        1ml.
L8610.....................  N                          Ocular implant.............  ............  ............  ............  ............  ............
L8612.....................  N                          Aqueous shunt prosthesis...  ............  ............  ............  ............  ............
L8613.....................  N                          Ossicular implant..........  ............  ............  ............  ............  ............
L8614.....................  N                          Cochlear device/system.....  ............  ............  ............  ............  ............
L8619.....................  A                          Replace cochlear processor.  ............  ............  ............  ............  ............
L8630.....................  N                          Metacarpophalangeal implant  ............  ............  ............  ............  ............
L8641.....................  N                          Metatarsal joint implant...  ............  ............  ............  ............  ............
L8642.....................  N                          Hallux implant.............  ............  ............  ............  ............  ............
L8658.....................  N                          Interphalangeal joint        ............  ............  ............  ............  ............
                                                        implnt.
L8670.....................  N                          Vascular graft, synthetic..  ............  ............  ............  ............  ............
L8699.....................  N                          Prosthetic implant NOS.....  ............  ............  ............  ............  ............
L9900.....................  A                          O&P supply/accessory/        ............  ............  ............  ............  ............
                                                        service.
M0064.....................  X                          Visit for drug monitoring..          0374          1.20        $62.41  ............        $12.48
M0075.....................  E                          Cellular therapy...........  ............  ............  ............  ............  ............
M0076.....................  E                          Prolotherapy...............  ............  ............  ............  ............  ............
M0100.....................  E                          Intragastric hypothermia...  ............  ............  ............  ............  ............
M0300.....................  E                          IV chelationtherapy........  ............  ............  ............  ............  ............
M0301.....................  E                          Fabric wrapping of aneurysm  ............  ............  ............  ............  ............
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....  ............  ............  ............  ............  ............
P9010.....................  K                          Whole blood for transfusion          0950          1.25        $65.01  ............        $13.00
P9011.....................  E                          Blood split unit...........  ............  ............  ............  ............  ............
P9012.....................  K                          Cryoprecipitate each unit..          0952          0.53        $27.56  ............         $5.51
P9016.....................  K                          RBC leukocytes reduced.....          0954          1.59        $82.69  ............        $16.54
P9017.....................  K                          One donor fresh frozn                0955          0.71        $36.93  ............         $7.39
                                                        plasma.
P9019.....................  K                          Platelets, each unit.......          0957          0.67        $34.85  ............         $6.97
P9020.....................  K                          Plaelet rich plasma unit...          0958          1.12        $58.25  ............        $11.65
P9021.....................  K                          Red blood cells unit.......          0959          1.12        $58.25  ............        $11.65
P9022.....................  K                          Washed red blood cells unit          0960          1.42        $73.85  ............        $14.77
P9023.....................  K                          Frozen plasma, pooled, sd..          0949          1.26        $65.53  ............        $13.11
P9031.....................  K                          Platelets leukocytes                 1013          0.91        $47.33  ............         $9.47
                                                        reduced.
P9032.....................  K                          Platelets, irradiated......          9500          0.92        $47.85  ............         $9.57
P9033.....................  K                          Platelets leukoreduced               0954          1.59        $82.69  ............        $16.54
                                                        irrad.
P9034.....................  K                          Platelets, pheresis........          9501          5.10       $265.25  ............        $53.05
P9035.....................  K                          Platelet pheres                      9501          5.10       $265.25  ............        $53.05
                                                        leukoreduced.
P9036.....................  K                          Platelet pheresis                    9502          1.99       $103.50  ............        $20.70
                                                        irradiated.
P9037.....................  K                          Plate pheres leukoredu               1019          6.93       $360.42  ............        $72.08
                                                        irrad.
P9038.....................  K                          RBC irradiated.............          9505          1.82        $94.66  ............        $18.93
P9039.....................  K                          RBC deglycerolized.........          9504          1.91        $99.34  ............        $19.87
P9040.....................  K                          RBC leukoreduced irradiated          9504          1.91        $99.34  ............        $19.87
P9041.....................  K                          Albumin (human),5%, 50ml...          0961          0.47        $24.44  ............         $4.89
P9043.....................  K                          Plasma protein                       0956          1.94       $100.90  ............        $20.18
                                                        fract,5%,50ml.
P9044.....................  K                          Cryoprecipitatereducedplasm          1009          0.66        $34.33  ............         $6.87
                                                        a.
P9045.....................  K                          Albumin (human), 5%, 250 ml          0963          2.37       $123.26  ............        $24.65
P9046.....................  K                          Albumin (human), 25%, 20 ml          0964          0.50        $26.00  ............         $5.20
P9047.....................  K                          Albumin (human), 25%, 50ml.          0965          1.25        $65.01  ............        $13.00
P9048.....................  K                          Plasmaprotein                        0966          9.71       $505.01  ............       $101.00
                                                        fract,5%,250ml.
P9050.....................  K                          Granulocytes, pheresis unit          9506          0.45        $23.40  ............         $4.68
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  ............  ............  ............  ............  ............
Q0035.....................  X                          Cardiokymography...........          0100          1.34        $69.69        $38.33        $13.94
Q0081.....................  T                          Infusion ther other than             0120          1.81        $94.14        $25.42        $18.83
                                                        che.
Q0083.....................  S                          Chemo by other than                  0116          0.85        $44.21  ............         $8.84
                                                        infusion.
Q0084.....................  S                          Chemotherapy by infusion...          0117          3.87       $201.27        $52.33        $40.25
Q0085.....................  S                          Chemo by both infusion and           0118          5.68       $295.41        $72.03        $59.08
                                                        o.

[[Page 52332]]

 
Q0086.....................  A                          Physical therapy evaluation/ ............  ............  ............  ............  ............
                                                        .
Q0091.....................  T                          Obtaining screen pap smear.          0191          0.22        $11.44         $3.32         $2.29
Q0092.....................  N                          Set up port xray equipment.  ............  ............  ............  ............  ............
Q0111.....................  A                          Wet mounts/ w preparations.  ............  ............  ............  ............  ............
Q0112.....................  A                          Potassium hydroxide preps..  ............  ............  ............  ............  ............
Q0113.....................  A                          Pinworm examinations.......  ............  ............  ............  ............  ............
Q0114.....................  A                          Fern test..................  ............  ............  ............  ............  ............
Q0115.....................  A                          Post-coital mucous exam....  ............  ............  ............  ............  ............
Q0136.....................  K                          Non esrd epoetin alpha inj.          0733          0.19         $9.88  ............         $1.98
Q0163.....................  N                          Diphenhydramine HCl 50mg...  ............  ............  ............  ............  ............
Q0164.....................  N                          Prochlorperazine maleate     ............  ............  ............  ............  ............
                                                        5mg.
Q0165.....................  E                          Prochlorperazine             ............  ............  ............  ............  ............
                                                        maleate10mg.
Q0166.....................  N                          Granisetron HCl 1 mg oral..  ............  ............  ............  ............  ............
Q0167.....................  N                          Dronabinol 2.5mg oral......  ............  ............  ............  ............  ............
Q0168.....................  E                          Dronabinol 5mg oral........  ............  ............  ............  ............  ............
Q0169.....................  N                          Promethazine HCl 12.5mg      ............  ............  ............  ............  ............
                                                        oral.
Q0170.....................  E                          Promethazine HCl 25 mg oral  ............  ............  ............  ............  ............
Q0171.....................  N                          Chlorpromazine HCl 10mg      ............  ............  ............  ............  ............
                                                        oral.
Q0172.....................  E                          Chlorpromazine HCl 25mg      ............  ............  ............  ............  ............
                                                        oral.
Q0173.....................  N                          Trimethobenzamide HCl 250mg  ............  ............  ............  ............  ............
Q0174.....................  N                          Thiethylperazine             ............  ............  ............  ............  ............
                                                        maleate10mg.
Q0175.....................  N                          Perphenazine 4mg oral......  ............  ............  ............  ............  ............
Q0176.....................  E                          Perphenazine 8mg oral......  ............  ............  ............  ............  ............
Q0177.....................  N                          Hydroxyzine pamoate 25mg...  ............  ............  ............  ............  ............
Q0178.....................  E                          Hydroxyzine pamoate 50mg...  ............  ............  ............  ............  ............
Q0179.....................  N                          Ondansetron HCl 8mg oral...  ............  ............  ............  ............  ............
Q0180.....................  N                          Dolasetron mesylate oral...  ............  ............  ............  ............  ............
Q0181.....................  E                          Unspecified oral anti-       ............  ............  ............  ............  ............
                                                        emetic.
Q0183.....................  N                          Nonmetabolic active tissue.  ............  ............  ............  ............  ............
Q0184.....................  N                          Metabolically active tissue  ............  ............  ............  ............  ............
Q0187.....................  K                          Factor viia recombinant....          1409         13.53       $703.68  ............       $140.74
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.....................  N                          Oral cabergoline 0.5 mg....  ............  ............  ............  ............  ............
Q2002.....................  N                          Elliotts b solution per ml.  ............  ............  ............  ............  ............
Q2003.....................  N                          Aprotinin, 10,000 kiu......  ............  ............  ............  ............  ............
Q2004.....................  N                          Bladder calculi irrig sol..  ............  ............  ............  ............  ............
Q2005.....................  K                          Corticorelin ovine                   7024          4.62       $240.28  ............        $48.06
                                                        triflutat.
Q2006.....................  K                          Digoxin immune fab (ovine).          7025          2.77       $144.06  ............        $28.81
Q2007.....................  N                          Ethanolamine oleate 100 mg.  ............  ............  ............  ............  ............
Q2008.....................  N                          Fomepizole, 15 mg..........  ............  ............  ............  ............  ............
Q2009.....................  N                          Fosphenytoin, 50 mg........  ............  ............  ............  ............  ............
Q2010.....................  N                          Glatiramer acetate, per      ............  ............  ............  ............  ............
                                                        dose.
Q2011.....................  K                          Hemin, per 1 mg............          7030          0.01          $.52  ............          $.10
Q2012.....................  N                          Pegademase bovine, 25 iu...  ............  ............  ............  ............  ............
Q2013.....................  N                          Pentastarch 10% solution...  ............  ............  ............  ............  ............
Q2014.....................  N                          Sermorelin acetate, 0.5 mg.  ............  ............  ............  ............  ............
Q2017.....................  K                          Teniposide, 50 mg..........          7035          1.24        $64.49  ............        $12.90
Q2018.....................  N                          Urofollitropin, 75 iu......  ............  ............  ............  ............  ............
Q2019.....................  K                          Basiliximab................          1615          9.64       $501.37  ............       $100.27
Q2020.....................  E                          Histrelin acetate..........  ............  ............  ............  ............  ............
Q2021.....................  N                          Lepirudin..................  ............  ............  ............  ............  ............
Q2022.....................  K                          VonWillebrandFactrCmplxperI          1618          0.01          $.52  ............          $.10
                                                        U.
Q3001.....................  N                          Brachytherapy Radioelements  ............  ............  ............  ............  ............
Q3002.....................  N                          Gallium ga 67..............  ............  ............  ............  ............  ............
Q3003.....................  K                          Technetium tc99m bicisate..          1620          2.80       $145.63  ............        $29.13
Q3004.....................  N                          Xenon xe 133...............  ............  ............  ............  ............  ............
Q3005.....................  N                          Technetium tc99m mertiatide  ............  ............  ............  ............  ............
Q3006.....................  N                          Technetium tc99m             ............  ............  ............  ............  ............
                                                        glucepatate.
Q3007.....................  N                          Sodium phosphate p32.......  ............  ............  ............  ............  ............
Q3008.....................  K                          Indium 111-in pentetreotide          1625          4.57       $237.68  ............        $47.54
Q3009.....................  N                          Technetium tc99m oxidronate  ............  ............  ............  ............  ............
Q3010.....................  N                          Technetium tc99mlabeledrbcs  ............  ............  ............  ............  ............

[[Page 52333]]

 
Q3011.....................  K                          Chromic phosphate p32......          1628          1.35        $70.21  ............        $14.04
Q3012.....................  N                          Cyanocobalamin cobalt co57.  ............  ............  ............  ............  ............
Q3014.....................  A                          Telehealth facility fee....  ............  ............  ............  ............  ............
Q3017.....................  E                          ALS assessment.............  ............  ............  ............  ............  ............
Q3019.....................  A                          ALS emer trans no ALS serv.  ............  ............  ............  ............  ............
Q3020.....................  A                          ALS nonemer trans no ALS se  ............  ............  ............  ............  ............
Q4001.....................  A                          Cast sup body cast plaster.  ............  ............  ............  ............  ............
Q4002.....................  A                          Cast sup body cast           ............  ............  ............  ............  ............
                                                        fiberglas.
Q4003.....................  A                          Cast sup shoulder cast       ............  ............  ............  ............  ............
                                                        plstr.
Q4004.....................  A                          Cast sup shoulder cast       ............  ............  ............  ............  ............
                                                        fbrgl.
Q4005.....................  A                          Cast sup long arm adult      ............  ............  ............  ............  ............
                                                        plst.
Q4006.....................  A                          Cast sup long arm adult      ............  ............  ............  ............  ............
                                                        fbrg.
Q4007.....................  A                          Cast sup long arm ped        ............  ............  ............  ............  ............
                                                        plster.
Q4008.....................  A                          Cast sup long arm ped        ............  ............  ............  ............  ............
                                                        fbrgls.
Q4009.....................  A                          Cast sup sht arm adult       ............  ............  ............  ............  ............
                                                        plstr.
Q4010.....................  A                          Cast sup sht arm adult       ............  ............  ............  ............  ............
                                                        fbrgl.
Q4011.....................  A                          Cast sup sht arm ped         ............  ............  ............  ............  ............
                                                        plaster.
Q4012.....................  A                          Cast sup sht arm ped         ............  ............  ............  ............  ............
                                                        fbrglas.
Q4013.....................  A                          Cast sup gauntlet plaster..  ............  ............  ............  ............  ............
Q4014.....................  A                          Cast sup gauntlet            ............  ............  ............  ............  ............
                                                        fiberglass.
Q4015.....................  A                          Cast sup gauntlet ped        ............  ............  ............  ............  ............
                                                        plster.
Q4016.....................  A                          Cast sup gauntlet ped        ............  ............  ............  ............  ............
                                                        fbrgls.
Q4017.....................  A                          Cast sup lng arm splint      ............  ............  ............  ............  ............
                                                        plst.
Q4018.....................  A                          Cast sup lng arm splint      ............  ............  ............  ............  ............
                                                        fbrg.
Q4019.....................  A                          Cast sup lng arm splnt ped   ............  ............  ............  ............  ............
                                                        p.
Q4020.....................  A                          Cast sup lng arm splnt ped   ............  ............  ............  ............  ............
                                                        f.
Q4021.....................  A                          Cast sup sht arm splint      ............  ............  ............  ............  ............
                                                        plst.
Q4022.....................  A                          Cast sup sht arm splint      ............  ............  ............  ............  ............
                                                        fbrg.
Q4023.....................  A                          Cast sup sht arm splnt ped   ............  ............  ............  ............  ............
                                                        p.
Q4024.....................  A                          Cast sup sht arm splnt ped   ............  ............  ............  ............  ............
                                                        f.
Q4025.....................  A                          Cast sup hip spica plaster.  ............  ............  ............  ............  ............
Q4026.....................  A                          Cast sup hip spica           ............  ............  ............  ............  ............
                                                        fiberglas.
Q4027.....................  A                          Cast sup hip spica ped       ............  ............  ............  ............  ............
                                                        plstr.
Q4028.....................  A                          Cast sup hip spica ped       ............  ............  ............  ............  ............
                                                        fbrgl.
Q4029.....................  A                          Cast sup long leg plaster..  ............  ............  ............  ............  ............
Q4030.....................  A                          Cast sup long leg            ............  ............  ............  ............  ............
                                                        fiberglass.
Q4031.....................  A                          Cast sup lng leg ped         ............  ............  ............  ............  ............
                                                        plaster.
Q4032.....................  A                          Cast sup lng leg ped fbrgls  ............  ............  ............  ............  ............
Q4033.....................  A                          Cast sup lng leg cylinder    ............  ............  ............  ............  ............
                                                        pl.
Q4034.....................  A                          Cast sup lng leg cylinder    ............  ............  ............  ............  ............
                                                        fb.
Q4035.....................  A                          Cast sup lngleg cylndr ped   ............  ............  ............  ............  ............
                                                        p.
Q4036.....................  A                          Cast sup lngleg cylndr ped   ............  ............  ............  ............  ............
                                                        f.
Q4037.....................  A                          Cast sup shrt leg plaster..  ............  ............  ............  ............  ............
Q4038.....................  A                          Cast sup shrt leg            ............  ............  ............  ............  ............
                                                        fiberglass.
Q4039.....................  A                          Cast sup shrt leg ped        ............  ............  ............  ............  ............
                                                        plster.
Q4040.....................  A                          Cast sup shrt leg ped        ............  ............  ............  ............  ............
                                                        fbrgls.
Q4041.....................  A                          Cast sup lng leg splnt       ............  ............  ............  ............  ............
                                                        plstr.
Q4042.....................  A                          Cast sup lng leg splnt       ............  ............  ............  ............  ............
                                                        fbrgl.
Q4043.....................  A                          Cast sup lng leg splnt ped   ............  ............  ............  ............  ............
                                                        p.
Q4044.....................  A                          Cast sup lng leg splnt ped   ............  ............  ............  ............  ............
                                                        f.
Q4045.....................  A                          Cast sup sht leg splnt       ............  ............  ............  ............  ............
                                                        plstr.
Q4046.....................  A                          Cast sup sht leg splnt       ............  ............  ............  ............  ............
                                                        fbrgl.
Q4047.....................  A                          Cast sup sht leg splnt ped   ............  ............  ............  ............  ............
                                                        p.
Q4048.....................  A                          Cast sup sht leg splnt ped   ............  ............  ............  ............  ............
                                                        f.
Q4049.....................  A                          Finger splint, static......  ............  ............  ............  ............  ............
Q4050.....................  A                          Cast supplies unlisted.....  ............  ............  ............  ............  ............
Q4051.....................  A                          Splint supplies misc.......  ............  ............  ............  ............  ............
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......  ............  ............  ............  ............  ............

[[Page 52334]]

 
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.....  ............  ............  ............  ............  ............
T1015.....................  E                          Clinic service.............  ............  ............  ............  ............  ............
V2020.....................  A                          Vision svcs frames           ............  ............  ............  ............  ............
                                                        purchases.
V2025.....................  E                          Eyeglasses delux frames....  ............  ............  ............  ............  ............
V2100.....................  A                          Lens spher single plano      ............  ............  ............  ............  ............
                                                        4.00.
V2101.....................  A                          Single visn sphere 4.12-     ............  ............  ............  ............  ............
                                                        7.00.
V2102.....................  A                          Singl visn sphere 7.12-      ............  ............  ............  ............  ............
                                                        20.00.
V2103.....................  A                          Spherocylindr 4.00d/12-      ............  ............  ............  ............  ............
                                                        2.00d.
V2104.....................  A                          Spherocylindr 4.00d/2.12-4d  ............  ............  ............  ............  ............
V2105.....................  A                          Spherocylinder 4.00d/4.25-   ............  ............  ............  ............  ............
                                                        6d.
V2106.....................  A                          Spherocylinder 4.00d/>6.00d  ............  ............  ............  ............  ............
V2107.....................  A                          Spherocylinder 4.25d/12-2d.  ............  ............  ............  ............  ............
V2108.....................  A                          Spherocylinder 4.25d/2.12-   ............  ............  ............  ............  ............
                                                        4d.
V2109.....................  A                          Spherocylinder 4.25d/4.25-   ............  ............  ............  ............  ............
                                                        6d.
V2110.....................  A                          Spherocylinder 4.25d/over    ............  ............  ............  ............  ............
                                                        6d.
V2111.....................  A                          Spherocylindr 7.25d/.25-     ............  ............  ............  ............  ............
                                                        2.25.
V2112.....................  A                          Spherocylindr 7.25d/2.25-4d  ............  ............  ............  ............  ............
V2113.....................  A                          Spherocylindr 7.25d/4.25-6d  ............  ............  ............  ............  ............
V2114.....................  A                          Spherocylinder over 12.00d.  ............  ............  ............  ............  ............
V2115.....................  A                          Lens lenticular bifocal....  ............  ............  ............  ............  ............
V2116.....................  A                          Nonaspheric lens bifocal...  ............  ............  ............  ............  ............
V2117.....................  A                          Aspheric lens bifocal......  ............  ............  ............  ............  ............
V2118.....................  A                          Lens aniseikonic single....  ............  ............  ............  ............  ............
V2199.....................  A                          Lens single vision not oth   ............  ............  ............  ............  ............
                                                        c.
V2200.....................  A                          Lens spher bifoc plano       ............  ............  ............  ............  ............
                                                        4.00d.
V2201.....................  A                          Lens sphere bifocal 4.12-    ............  ............  ............  ............  ............
                                                        7.0.
V2202.....................  A                          Lens sphere bifocal 7.12-    ............  ............  ............  ............  ............
                                                        20..
V2203.....................  A                          Lens sphcyl bifocal 4.00d/   ............  ............  ............  ............  ............
                                                        .1.
V2204.....................  A                          Lens sphcy bifocal 4.00d/    ............  ............  ............  ............  ............
                                                        2.1.
V2205.....................  A                          Lens sphcy bifocal 4.00d/    ............  ............  ............  ............  ............
                                                        4.2.
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.

[[Page 52335]]

 
V2306.....................  A                          Lens sphcyl trifocal 4.00/   ............  ............  ............  ............  ............
                                                        >6.
V2307.....................  A                          Lens sphcy trifocal 4.25-7/  ............  ............  ............  ............  ............
                                                        ..
V2308.....................  A                          Lens sphc trifocal 4.25-7/   ............  ............  ............  ............  ............
                                                        2..
V2309.....................  A                          Lens sphc trifocal 4.25-7/   ............  ............  ............  ............  ............
                                                        4..
V2310.....................  A                          Lens sphc trifocal 4.25-7/   ............  ............  ............  ............  ............
                                                        >6.
V2311.....................  A                          Lens sphc trifo 7.25-12/.25- ............  ............  ............  ............  ............
                                                        .
V2312.....................  A                          Lens sphc trifo 7.25-12/     ............  ............  ............  ............  ............
                                                        2.25.
V2313.....................  A                          Lens sphc trifo 7.25-12/     ............  ............  ............  ............  ............
                                                        4.25.
V2314.....................  A                          Lens sphcyl trifocal over    ............  ............  ............  ............  ............
                                                        12.
V2315.....................  A                          Lens lenticular trifocal...  ............  ............  ............  ............  ............
V2316.....................  A                          Lens lenticular nonaspheric  ............  ............  ............  ............  ............
V2317.....................  A                          Lens lenticular aspheric     ............  ............  ............  ............  ............
                                                        tri.
V2318.....................  A                          Lens aniseikonic trifocal..  ............  ............  ............  ............  ............
V2319.....................  A                          Lens trifocal seg width >    ............  ............  ............  ............  ............
                                                        28.
V2320.....................  A                          Lens trifocal add over       ............  ............  ............  ............  ............
                                                        3.25d.
V2399.....................  A                          Lens trifocal speciality...  ............  ............  ............  ............  ............
V2410.....................  A                          Lens variab asphericity      ............  ............  ............  ............  ............
                                                        sing.
V2430.....................  A                          Lens variable asphericity    ............  ............  ............  ............  ............
                                                        bi.
V2499.....................  A                          Variable asphericity lens..  ............  ............  ............  ............  ............
V2500.....................  A                          Contact lens pmma spherical  ............  ............  ............  ............  ............
V2501.....................  A                          Cntct lens pmma-toric/prism  ............  ............  ............  ............  ............
V2502.....................  A                          Contact lens pmma bifocal..  ............  ............  ............  ............  ............
V2503.....................  A                          Cntct lens pmma color        ............  ............  ............  ............  ............
                                                        vision.
V2510.....................  A                          Cntct gas permeable          ............  ............  ............  ............  ............
                                                        sphericl.
V2511.....................  A                          Cntct toric prism ballast..  ............  ............  ............  ............  ............
V2512.....................  A                          Cntct lens gas permbl        ............  ............  ............  ............  ............
                                                        bifocl.
V2513.....................  A                          Contact lens extended wear.  ............  ............  ............  ............  ............
V2520.....................  A                          Contact lens hydrophilic...  ............  ............  ............  ............  ............
V2521.....................  A                          Cntct lens hydrophilic       ............  ............  ............  ............  ............
                                                        toric.
V2522.....................  A                          Cntct lens hydrophil bifocl  ............  ............  ............  ............  ............
V2523.....................  A                          Cntct lens hydrophil extend  ............  ............  ............  ............  ............
V2530.....................  A                          Contact lens gas             ............  ............  ............  ............  ............
                                                        impermeable.
V2531.....................  A                          Contact lens gas permeable.  ............  ............  ............  ............  ............
V2599.....................  A                          Contact lens/es other type.  ............  ............  ............  ............  ............
V2600.....................  A                          Hand held low vision aids..  ............  ............  ............  ............  ............
V2610.....................  A                          Single lens spectacle mount  ............  ............  ............  ............  ............
V2615.....................  A                          Telescop/othr compound lens  ............  ............  ............  ............  ............
V2623.....................  A                          Plastic eye prosth custom..  ............  ............  ............  ............  ............
V2624.....................  A                          Polishing artifical eye....  ............  ............  ............  ............  ............
V2625.....................  A                          Enlargemnt of eye            ............  ............  ............  ............  ............
                                                        prosthesis.
V2626.....................  A                          Reduction of eye prosthesis  ............  ............  ............  ............  ............
V2627.....................  A                          Scleral cover shell........  ............  ............  ............  ............  ............
V2628.....................  A                          Fabrication & fitting......  ............  ............  ............  ............  ............
V2629.....................  A                          Prosthetic eye other type..  ............  ............  ............  ............  ............
V2630.....................  N                          Anter chamber intraocul      ............  ............  ............  ............  ............
                                                        lens.
V2631.....................  N                          Iris support intraoclr lens  ............  ............  ............  ............  ............
V2632.....................  N                          Post chmbr intraocular lens  ............  ............  ............  ............  ............
V2700.....................  A                          Balance lens...............  ............  ............  ............  ............  ............
V2710.....................  A                          Glass/plastic slab off       ............  ............  ............  ............  ............
                                                        prism.
V2715.....................  A                          Prism lens/es..............  ............  ............  ............  ............  ............
V2718.....................  A                          Fresnell prism press-on      ............  ............  ............  ............  ............
                                                        lens.
V2730.....................  A                          Special base curve.........  ............  ............  ............  ............  ............
V2740.....................  A                          Rose tint plastic..........  ............  ............  ............  ............  ............
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.....................  E                          Progressive lens per lens..  ............  ............  ............  ............  ............
V2785.....................  F                          Corneal tissue processing..  ............  ............  ............  ............  ............
V2790.....................  N                          Amniotic membrane..........  ............  ............  ............  ............  ............
V2799.....................  A                          Miscellaneous vision         ............  ............  ............  ............  ............
                                                        service.

[[Page 52336]]

 
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                          Hearing aid monaural 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......  ............  ............  ............  ............  ............
V5241.....................  E                          Dispensing fee, monaural...  ............  ............  ............  ............  ............
V5242.....................  E                          Hearing aid, monaural, cic.  ............  ............  ............  ............  ............
V5243.....................  E                          Hearing aid, monaural, itc.  ............  ............  ............  ............  ............
V5244.....................  E                          Hearing aid, prog, mon, cic  ............  ............  ............  ............  ............
V5245.....................  E                          Hearing aid, prog, mon, itc  ............  ............  ............  ............  ............
V5246.....................  E                          Hearing aid, prog, mon, ite  ............  ............  ............  ............  ............
V5247.....................  E                          Hearing aid, prog, mon, bte  ............  ............  ............  ............  ............
V5248.....................  E                          Hearing aid, binaural, cic.  ............  ............  ............  ............  ............
V5249.....................  E                          Hearing aid, binaural, itc.  ............  ............  ............  ............  ............
V5250.....................  E                          Hearing aid, prog, bin, cic  ............  ............  ............  ............  ............
V5251.....................  E                          Hearing aid, prog, bin, itc  ............  ............  ............  ............  ............
V5252.....................  E                          Hearing aid, prog, bin, ite  ............  ............  ............  ............  ............
V5253.....................  E                          Hearing aid, prog, bin, bte  ............  ............  ............  ............  ............
V5254.....................  E                          Hearing id, digit, mon, cic  ............  ............  ............  ............  ............
V5255.....................  E                          Hearing aid, digit, mon,     ............  ............  ............  ............  ............
                                                        itc.
V5256.....................  E                          Hearing aid, digit, mon,     ............  ............  ............  ............  ............
                                                        ite.
V5257.....................  E                          Hearing aid, digit, mon,     ............  ............  ............  ............  ............
                                                        bte.
V5258.....................  E                          Hearing aid, digit, bin,     ............  ............  ............  ............  ............
                                                        cic.
V5259.....................  E                          Hearing aid, digit, bin,     ............  ............  ............  ............  ............
                                                        itc.
V5260.....................  E                          Hearing aid, digit, bin,     ............  ............  ............  ............  ............
                                                        ite.
V5261.....................  E                          Hearing aid, digit, bin,     ............  ............  ............  ............  ............
                                                        bte.
V5262.....................  E                          Hearing aid, disp, monaural  ............  ............  ............  ............  ............
V5263.....................  E                          Hearing aid, disp, binaural  ............  ............  ............  ............  ............
V5264.....................  E                          Ear mold/insert............  ............  ............  ............  ............  ............
V5265.....................  E                          Ear mold/insert, disp......  ............  ............  ............  ............  ............
V5266.....................  E                          Battery for hearing device.  ............  ............  ............  ............  ............
V5267.....................  E                          Hearing aid supply/          ............  ............  ............  ............  ............
                                                        accessory.
V5268.....................  E                          ALD Telephone Amplifier....  ............  ............  ............  ............  ............
V5269.....................  E                          Alerting device, any type..  ............  ............  ............  ............  ............
V5270.....................  E                          ALD, TV amplifier, any type  ............  ............  ............  ............  ............
V5271.....................  E                          ALD, TV caption decoder....  ............  ............  ............  ............  ............
V5272.....................  E                          Tdd........................  ............  ............  ............  ............  ............
V5273.....................  E                          ALD for cochlear implant...  ............  ............  ............  ............  ............
V5274.....................  E                          ALD unspecified............  ............  ............  ............  ............  ............
V5275.....................  E                          Ear impression.............  ............  ............  ............  ............  ............
V5299.....................  E                          Hearing service............  ............  ............  ............  ............  ............
V5336.....................  E                          Repair communication device  ............  ............  ............  ............  ............
V5362.....................  A                          Speech screening...........  ............  ............  ............  ............  ............
V5363.....................  A                          Language screening.........  ............  ............  ............  ............  ............

[[Page 52337]]

 
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.

      
  

  

  Federal Register / Vol. 67, No. 154 / Friday, August 9, 2002 / 
Proposed Rules  

[[Page 52337]]


      

   Addendum D.--Payment Status Indicators for the Hospital Outpatient
                       Prospective Payment System
------------------------------------------------------------------------
       Indicator                Service                   Status
------------------------------------------------------------------------
A.....................  Ambulance..............  Ambulance Fee Schedule.
A.....................  Clinical Diagnostic      Laboratory Fee
                         Laboratory Services.     Schedule.
A.....................  Durable Medical          DMEPOS Fee Schedule.
                         Equipment, Prosthetics
                         and Orthotics
                         (excluding implanted
                         DME and prosthetics).
A.....................  EPO for ESRD Patients..  National Rate.
A.....................  Physical, Occupational   Physician Fee Schedule.
                         and Speech Therapy.
A.....................  Physician Services for   Physician Fee Schedule.
                         ESRD Patients.
A.....................  Screening Mammography..  Physician Fee Schedule.
C.....................  Inpatient Procedures...  Not Payable under OPPS;
                                                  Admit Patient; Bill as
                                                  Inpatient.
D.....................  Deleted Code...........  Deleted Effective
                                                  Beginning of Calendar
                                                  Year.
E.....................  Non-Covered Items and    Not Paid Under Medicare
                         Services, Codes not      or When Performed in a
                         Reportable in Hospital   Hospital Outpatient
                         Outpatient Settings.     Setting.
F.....................  Acquisition of Corneal   Paid at Reasonable
                         Tissue.                  Cost.
G.....................  Drug/Biological Pass-    Paid Under OPPS;
                         Through.                 Separate APC Payment
                                                  Includes Pass Through
                                                  Amount.
H.....................  Device Category Pass-    Paid Under OPPS;
                         Through.                 Separate Cost Based
                                                  Pass Through Payment.
K.....................  Non Pass-Through Drug/   Paid Under OPPS;
                         Biological, Certain      Separate APC.
                         Brachytherapy seeds.
N.....................  Items and Services       Paid under OPPS;
                         Packaged into APC Rate.  Payment Is Packaged
                                                  Into Payment for Other
                                                  Services.
P.....................  Partial Hospitalization  Paid under OPPS; Per
                                                  Diem APC.
S.....................  Significant Procedure,   Paid Under OPPS;
                         Not Discounted When      Separate APC.
                         Multiple.
T.....................  Significant Procedure,   Paid Under OPPS;
                         Multiple Procedure       Separate APC.
                         Reduction Applies.
V.....................  Visit to Clinic or       Paid Under OPPS;
                         Emergency Department.    Separate PC.
X.....................  Ancillary Service......  Paid Under OPPS;
                                                  Separate APC
------------------------------------------------------------------------

    --------------------
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 52337]]



 Addendum E.--CPT Codes Which Would Be Paid Only As Inpatient Procedures
                          [Calender Year 2003]
------------------------------------------------------------------------
    CPT/HCPCS      Status  indicator              Description
------------------------------------------------------------------------
0001T............  C                  Endovas repr abdo ao aneurys
0002T............  C                  Endovas repr abdo ao aneurys
0005T............  C                  Perc cath stent/brain cv art
0006T............  C                  Perc cath stent/brain cv art
0007T............  C                  Perc cath stent/brain cv art
00174............  C                  Anesth, pharyngeal surgery
00176............  C                  Anesth, pharyngeal surgery
00192............  C                  Anesth, facial bone surgery
00214............  C                  Anesth, skull drainage

[[Page 52338]]

 
00215............  C                  Anesth, skull repair/fract
0021T............  C                  Fetal oximetry, trnsvag/cerv
0024T............  C                  Transcath cardiac reduction
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
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, sitting procedure
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, hemorr/excise liver
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
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
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
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, hip arthroplasty
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, knee arthroplasty
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
01990............  C                  Support for organ donor
15756............  C                  Free muscle flap, microvasc
15757............  C                  Free skin flap, microvasc

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15758............  C                  Free fascial flap, microvasc
16035............  C                  Incision of burn scab, initi
16036............  C                  Incise burn scab, addl incis
19200............  C                  Removal of breast
19220............  C                  Removal of breast
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
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                  Reconst lwr jaw w/o graft
21194............  C                  Reconst lwr jaw w/graft
21195............  C                  Reconst lwr jaw w/o fixation
21196............  C                  Reconst lwr jaw w/fixation
21247............  C                  Reconstruct lower jaw bone
21255............  C                  Reconstruct lower jaw bone

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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
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
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

[[Page 52341]]

 
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
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
23472............  C                  Reconstruct shoulder joint
23900............  C                  Amputation of arm & girdle
23920............  C                  Amputation at shoulder joint
24149............  C                  Radical resection of elbow
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
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
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

[[Page 52342]]

 
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 arthroplasty
27132............  C                  Total hip arthroplasty
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
27215............  C                  Treat pelvic fracture(s)
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
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
27447............  C                  Total knee arthroplasty
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

[[Page 52343]]

 
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
27535............  C                  Treat knee fracture
27536............  C                  Treat knee fracture
27540............  C                  Treat knee fracture
27556............  C                  Treat knee dislocation
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
31375............  C                  Partial removal of larynx
31380............  C                  Partial removal of larynx
31382............  C                  Partial removal of larynx
31390............  C                  Removal of larynx & pharynx
31395............  C                  Reconstruct larynx & pharynx
31584............  C                  Treat larynx fracture
31587............  C                  Revision of larynx
31725............  C                  Clearance of airways

[[Page 52344]]

 
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
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
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

[[Page 52345]]

 
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)
33141............  C                  Heart tmr w/other procedure
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
33261............  C                  Ablate heart dysrhythm focus
33300............  C                  Repair of heart wound
33305............  C                  Repair of heart wound
33310............  C                  Exploratory heart surgery
33315............  C                  Exploratory heart surgery
33320............  C                  Repair major blood vessel(s)
33321............  C                  Repair major vessel
33322............  C                  Repair major blood vessel(s)
33330............  C                  Insert major vessel graft
33332............  C                  Insert major vessel graft
33335............  C                  Insert major vessel graft
33400............  C                  Repair of aortic valve
33401............  C                  Valvuloplasty, open
33403............  C                  Valvuloplasty, w/cp bypass
33404............  C                  Prepare heart-aorta conduit
33405............  C                  Replacement of aortic valve
33406............  C                  Replacement 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

[[Page 52346]]

 
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, modified fontan
33617............  C                  Repair single ventricle
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

[[Page 52347]]

 
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
33967............  C                  Insert ia percut device
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
33979............  C                  Insert intracorporeal device

[[Page 52348]]

 
33980............  C                  Remove intracorporeal 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
34451............  C                  Removal of vein clot
34502............  C                  Reconstruct vena cava
34800............  C                  Endovasc abdo repair w/tube
34802............  C                  Endovasc abdo repr w/device
34804............  C                  Endovasc abdo repr w/device
34808............  C                  Endovasc abdo occlud device
34812............  C                  Xpose for endoprosth, aortic
34813............  C                  Xpose for endoprosth, femorl
34820............  C                  Xpose for endoprosth, iliac
34825............  C                  Endovasc extend prosth, init
34826............  C                  Endovasc exten prosth, addl
34830............  C                  Open aortic tube prosth repr
34831............  C                  Open aortoiliac prosth repr
34832............  C                  Open aortofemor prosth repr
35001............  C                  Repair defect of artery
35002............  C                  Repair artery rupture, neck
35005............  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
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

[[Page 52349]]

 
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
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
35600............  C                  Harvest artery for cabg
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
35647............  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

[[Page 52350]]

 
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
35800............  C                  Explore neck vessels
35820............  C                  Explore chest vessels
35840............  C                  Explore abdominal vessels
35870............  C                  Repair vessel graft defect
35901............  C                  Excision, graft, neck
35905............  C                  Excision, graft, thorax
35907............  C                  Excision, graft, abdomen
36510............  C                  Insertion of catheter, vein
36660............  C                  Insertion catheter, artery
36822............  C                  Insertion of cannula(s)
36823............  C                  Insertion of cannula(s)
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
37616............  C                  Ligation of chest artery
37617............  C                  Ligation of abdomen artery
37618............  C                  Ligation of extremity artery
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
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

[[Page 52351]]

 
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
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
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
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
43313............  C                  Esophagoplasty congential
43314............  C                  Tracheo-esophagoplasty cong
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

[[Page 52352]]

 
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
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                  Explore small intestine
44021............  C                  Decompress small bowel
44025............  C                  Incision of large bowel
44050............  C                  Reduce bowel obstruction
44055............  C                  Correct malrotation of bowel
44110............  C                  Excise intestine 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
44126............  C                  Enterectomy w/taper, cong
44127............  C                  Enterectomy w/o taper, cong
44128............  C                  Enterectomy cong, add-on
44130............  C                  Bowel to bowel fusion
44132............  C                  Enterectomy, cadaver donor
44133............  C                  Enterectomy, live donor
44135............  C                  Intestine transplnt, cadaver
44136............  C                  Intestine transplant, live
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                  Lap resect s/intestine singl
44203............  C                  Lap resect s/intestine, addl

[[Page 52353]]

 
44204............  C                  Laparo partial colectomy
44205............  C                  Lap colectomy part w/ileum
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
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
45136............  C                  Excise ileoanal reservoir
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

[[Page 52354]]

 
46748............  C                  Repair of cloacal anomaly
46751............  C                  Repair of anal sphincter
47010............  C                  Open drainage, 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
47380............  C                  Open ablate liver tumor rf
47381............  C                  Open ablate liver tumor cryo
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
47550............  C                  Bile duct endoscopy add-on
47570............  C                  Laparo cholecystoenterostomy
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, open
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

[[Page 52355]]

 
48180............  C                  Fuse pancreas and bowel
48400............  C                  Injection, intraop add-on
48500............  C                  Surgery of pancreatic cyst
48510............  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
49201............  C                  Removal of abdominal lesion
49215............  C                  Excise sacral spine tumor
49220............  C                  Multiple surgery, abdomen
49255............  C                  Removal of omentum
49425............  C                  Insert abdomen-venous drain
49428............  C                  Ligation of shunt
49605............  C                  Repair umbilical lesion
49606............  C                  Repair umbilical lesion
49610............  C                  Repair umbilical lesion
49611............  C                  Repair umbilical lesion
49900............  C                  Repair of abdominal wall
49905............  C                  Omental flap
49906............  C                  Free omental flap, microvasc
50010............  C                  Exploration of kidney
50020............  C                  Renal abscess, open 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                  Remove kidney, open
50225............  C                  Removal kidney open, complex
50230............  C                  Removal kidney open, radical
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

[[Page 52356]]

 
50525............  C                  Repair renal-abdomen fistula
50526............  C                  Repair renal-abdomen fistula
50540............  C                  Revision of horseshoe kidney
50545............  C                  Laparo radical nephrectomy
50546............  C                  Laparoscopic nephrectomy
50547............  C                  Laparo removal donor kidney
50548............  C                  Laparo remove k/ureter
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 intestine
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
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

[[Page 52357]]

 
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
53448............  C                  Remov/replc ur sphinctr comp
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
54411............  C                  Remv/replc penis pros, comp
54417............  C                  Remv/replc penis pros, compl
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
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
57110............  C                  Remove vagina wall, complete
57111............  C                  Remove vagina tissue, compl
57112............  C                  Vaginectomy w/nodes, compl
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
57311............  C                  Repair urethrovaginal 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

[[Page 52358]]

 
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
58605............  C                  Division of fallopian tube
58611............  C                  Ligate oviduct(s) add-on
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
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
58953............  C                  Tah, rad dissect for debulk
58954............  C                  Tah rad debulk/lymph remove
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
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
60254............  C                  Extensive thyroid surgery
60270............  C                  Removal of thyroid
60271............  C                  Removal of thyroid
60502............  C                  Re-explore parathyroids
60505............  C                  Explore parathyroid glands
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

[[Page 52359]]

 
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

[[Page 52360]]

 
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
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
61697............  C                  Brain aneurysm repr, complx
61698............  C                  Brain aneurysm repr, complx
61700............  C                  Brain aneurysm repr , simple
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
61850............  C                  Implant neuroelectrodes
61860............  C                  Implant neuroelectrodes
61862............  C                  Implant neurostimul, subcort

[[Page 52361]]

 
61870............  C                  Implant neuroelectrodes
61875............  C                  Implant neuroelectrodes
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
63043............  C                  Laminotomy, addl cervical
63044............  C                  Laminotomy, addl lumbar
63075............  C                  Neck spine disk surgery
63076............  C                  Neck spine disk surgery
63077............  C                  Spine disk surgery, thorax
63078............  C                  Spine disk surgery, thorax
63081............  C                  Removal of vertebral body
63082............  C                  Remove vertebral body add-on
63085............  C                  Removal of vertebral body
63086............  C                  Remove vertebral body add-on
63087............  C                  Removal of vertebral body
63088............  C                  Remove vertebral body add-on
63090............  C                  Removal of vertebral body
63091............  C                  Remove vertebral body add-on
63170............  C                  Incise spinal cord tract(s)
63172............  C                  Drainage of spinal cyst
63173............  C                  Drainage of spinal cyst
63180............  C                  Revise spinal cord ligaments
63182............  C                  Revise spinal cord ligaments
63185............  C                  Incise spinal column/nerves
63190............  C                  Incise spinal column/nerves
63191............  C                  Incise spinal column/nerves
63194............  C                  Incise spinal column & cord
63195............  C                  Incise spinal column & cord
63196............  C                  Incise spinal column & cord
63197............  C                  Incise spinal column & cord
63198............  C                  Incise spinal column & cord
63199............  C                  Incise spinal column & cord
63200............  C                  Release of spinal cord
63250............  C                  Revise spinal cord vessels
63251............  C                  Revise spinal cord vessels
63252............  C                  Revise spinal cord vessels
63265............  C                  Excise intraspinal lesion
63266............  C                  Excise intraspinal lesion
63267............  C                  Excise intraspinal lesion
63268............  C                  Excise intraspinal lesion
63270............  C                  Excise intraspinal lesion
63271............  C                  Excise intraspinal lesion

[[Page 52362]]

 
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
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
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
64804............  C                  Remove sympathetic nerves
64809............  C                  Remove sympathetic nerves
64818............  C                  Remove sympathetic nerves
64866............  C                  Fusion of facial/other nerve
64868............  C                  Fusion of facial/other nerve
65273............  C                  Repair of eye wound
69155............  C                  Extensive ear/neck surgery
69535............  C                  Remove part of temporal bone
69554............  C                  Remove ear lesion
69950............  C                  Incise inner ear nerve
69970............  C                  Remove inner ear lesion
75900............  C                  Arterial catheter exchange
75952............  C                  Endovasc repair abdom aorta
75953............  C                  Abdom aneurysm endovas rpr
92970............  C                  Cardioassist, internal
92971............  C                  Cardioassist, external
92975............  C                  Dissolve clot, heart vessel
92992............  C                  Revision of heart chamber
92993............  C                  Revision of heart chamber
94652............  C                  Pressure breathing (IPPB)
99190............  C                  Special pump services
99191............  C                  Special pump services
99192............  C                  Special pump services
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

[[Page 52363]]

 
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
------------------------------------------------------------------------
CPT codes and descriptions only are copyright American Medical
  Association. All Rights Reserved. Applicable FARS/DFARS Apply.
Copyright American Dental Association. All rights reserved.

      
  

  

  Federal Register / Vol. 67, No. 154 / Friday, August 9, 2002 / 
Proposed Rules  

[[Page 52363]]


      

                 Addendum H.--Wage Index for Urban Areas
------------------------------------------------------------------------
                                                                  Wage
               Urban area (constituent counties)                  index
------------------------------------------------------------------------
0040  Abilene, TX.............................................    0.9268
  Taylor, TX
0060  Aguadilla, PR...........................................    0.4634
  Aguada, PR
  Aguadilla, PR
  Moca, PR
0080  Akron, OH...............................................    0.9685
  Portage, OH
  Summit, OH
0120  Albany, GA..............................................    1.0835
  Dougherty, GA
  Lee, GA
0160  \2\ Albany-Schenectady-Troy, NY.........................    0.8633
  Albany, NY
  Montgomery, NY
  Rensselaer, NY
  Saratoga, NY
  Schenectady, NY
  Schoharie, NY
0200  Albuquerque, NM.........................................    0.9372
  Bernalillo, NM
  Sandoval, NM
  Valencia, NM
0220  Alexandria, LA..........................................    0.7929
  Rapides, LA
0240  Allentown-Bethlehem-Easton, PA..........................    0.9833
  Carbon, PA
  Lehigh, PA
  Northampton, PA
0280  Altoona, PA.............................................    0.9300
  Blair, PA
0320  Amarillo, TX Potter, TX.................................    0.9051
  Randall, TX
0380  Anchorage, AK...........................................    1.2610
  Anchorage, AK
0440  Ann Arbor, MI...........................................    1.1217
  Lenawee, MI
  Livingston, MI
  Washtenaw, MI
0450  Anniston, AL............................................    0.8126
  Calhoun, AL
0460  \2\ Appleton-Oshkosh-Neenah, WI.........................    0.9229
  Calumet, WI
  Outagamie, WI
  Winnebago, WI
0470  \2\ Arecibo, PR.........................................    0.4400
  Arecibo, PR
  Camuy, PR
  Hatillo, PR
0480  Asheville, NC...........................................    0.9682
  Buncombe, NC
  Madison, NC
0500  Athens, GA..............................................    1.0308
  Clarke, GA
  Madison, GA
  Oconee, GA
0520  \1\ Atlanta, GA.........................................    1.0091
  Barrow, GA
  Bartow, GA
  Carroll, GA
  Cherokee, GA
  Clayton, GA
  Cobb, GA
  Coweta, GA
  DeKalb, GA
  Douglas, GA
  Fayette, GA
  Forsyth, GA
  Fulton, GA
  Gwinnett, GA
  Henry, GA
  Newton, GA
  Paulding, GA
  Pickens, GA
  Rockdale, GA
  Spalding, GA
  Walton, GA
0560  Atlantic-Cape May, NJ...................................    1.1058
  Atlantic, NJ
  Cape May, NJ
0580  Auburn-Opelika, AL......................................    0.8306
  Lee, AL
0600  Augusta-Aiken, GA-SC....................................    1.0364
  Columbia, GA
  McDuffie, GA
  Richmond, GA
  Aiken, SC
  Edgefield, SC
0640  \1\ Austin-San Marcos, TX...............................    0.9529
  Bastrop, TX
  Caldwell, TX
  Hays, TX
  Travis, TX
  Williamson, TX
0680  Bakersfield, CA.........................................    1.0186
  Kern, CA
0720  \1\ Baltimore, MD.......................................    0.9757
  Anne Arundel, MD
  Baltimore, MD
  Baltimore City, MD
  Carroll, MD
  Harford, MD
  Howard, MD
  Queen Anne's, MD
0733  Bangor, ME..............................................    0.9791
  Penobscot, ME
0743  Barnstable-Yarmouth, MA.................................    1.3127
  Barnstable, MA
0760  Baton Rouge, LA.........................................    0.8388
  Ascension, LA
  East Baton Rouge, LA
  Livingston, LA
  West Baton Rouge, LA
0840  Beaumont-Port Arthur, TX................................    0.8389
  Hardin, TX
  Jefferson, TX
  Orange, TX
0860  Bellingham, WA..........................................    1.2407
  Whatcom, WA
0870  Benton Harbor, MI.......................................    0.9072
  Berrien, MI
0875  \1\ Bergen-Passaic, NJ..................................    1.2100
  Bergen, NJ
  Passaic, NJ
0880  Billings, MT............................................    0.9114
  Yellowstone, MT
0920  Biloxi-Gulfport-Pascagoula, MS..........................    0.8830
  Hancock, MS
  Harrison, MS
  Jackson, MS
0960  \2\ Binghamton, NY......................................    0.8633
  Broome, NY
  Tioga, NY
1000  Birmingham, AL..........................................    0.9301
  Blount, AL
  Jefferson, AL
  St. Clair, AL
  Shelby, AL
1010  Bismarck, ND............................................    0.7881
  Burleigh, ND
  Morton, ND
1020  Bloomington, IN.........................................    0.8997
  Monroe, IN
1040  Bloomington-Normal, IL..................................    0.9202
  McLean, IL
1080  Boise City, ID..........................................    0.9403
  Ada, ID

[[Page 52364]]

 
  Canyon, ID
1123  \1\ Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH....    1.1304
  Bristol, MA
  Essex, MA
  Middlesex, MA
  Norfolk, MA
  Plymouth, MA
  Suffolk, MA
  Worcester, MA
  Hillsborough, NH
  Merrimack, NH
  Rockingham, NH
  Strafford, NH
1125  Boulder-Longmont, CO....................................    0.9688
  Boulder, CO
1145  Brazoria, TX............................................    0.8617
  Brazoria, TX
1150  Bremerton, WA...........................................    1.1056
  Kitsap, WA
1240  Brownsville-Harlingen-San Benito, TX....................    0.8992
  Cameron, TX
1260  Bryan-College Station, TX...............................    0.8410
  Brazos, TX
1280  \1\ Buffalo-Niagara Falls, NY...........................    0.9464
  Erie, NY
  Niagara, NY
1303  Burlington, VT..........................................    1.0176
  Chittenden, VT
  Franklin, VT
  Grand Isle, VT
1310  Caguas, PR..............................................    0.4453
  Caguas, PR
  Cayey, PR
  Cidra, PR
  Gurabo, PR
  San Lorenzo, PR
1320  Canton-Massillon, OH....................................    0.9026
  Carroll, OH
  Stark, OH
1350  Casper, WY..............................................    0.9788
  Natrona, WY
1360  Cedar Rapids, IA........................................    0.9149
  Linn, IA
1400  Champaign-Urbana, IL....................................    0.9983
  Champaign, IL
1440  \2\ Charleston-North Charleston, SC.....................    0.8607
  Berkeley, SC
  Charleston, SC
  Dorchester, SC
1480  Charleston, WV..........................................    0.8765
  Kanawha, WV
  Putnam, WV
1520  \1\ Charlotte-Gastonia-Rock Hill, NC-SC.................    0.9839
  Cabarrus, NC
  Gaston, NC
  Lincoln, NC
  Mecklenburg, NC
  Rowan, NC
  Stanly, NC
  Union, NC
  York, SC
1540  Charlottesville, VA.....................................    1.0583
  Albemarle, VA
  Charlottesville City, VA
  Fluvanna, VA
  Greene, VA
1560  Chattanooga, TN-GA......................................    0.9069
  Catoosa, GA
  Dade, GA
  Walker, GA
  Hamilton, TN
  Marion, TN
1580  \2\ Cheyenne, WY........................................    0.8890
  Laramie, WY
1600  \1\ Chicago, IL.........................................    1.1088
  Cook, IL
  DeKalb, IL
  DuPage, IL
  Grundy, IL
  Kane, IL
  Kendall, IL
  Lake, IL
  McHenry, IL
  Will, IL
1620  \2\ Chico-Paradise, CA..................................    0.9934
  Butte, CA
1640  \1\ Cincinnati, OH-KY-IN................................    0.9354
  Dearborn, IN
  Ohio, IN
  Boone, KY
  Campbell, KY
  Gallatin, KY
  Grant, KY
  Kenton, KY
  Pendleton, KY
  Brown, OH
  Clermont, OH
  Hamilton, OH
  Warren, OH
1660  Clarksville-Hopkinsville, TN-KY.........................    0.8386
  Christian, KY
  Montgomery, TN
1680  \1\ Cleveland-Lorain-Elyria, OH.........................    0.9295
  Ashtabula, OH
  Cuyahoga, OH
  Geauga, OH
  Lake, OH
  Lorain, OH
  Medina, OH
1720  Colorado Springs, CO....................................    0.9968
  El Paso, CO
1740  Columbia, MO............................................    0.8737
  Boone, MO
1760  Columbia, SC............................................    0.8990
  Lexington, SC
  Richland, SC
1800  Columbus, GA-ALRussell, AL..............................    0.8450
  Chattahoochee, GA
  Harris, GA
  Muscogee, GA
1840  \1\ Columbus, OH........................................    0.9705
  Delaware, OH
  Fairfield, OH
  Franklin, OH
  Licking, OH
  Madison, OH
  Pickaway, OH
1880  Corpus Christi, TX......................................    0.8154
  Nueces, TX
  San Patricio, TX
1890  Corvallis, OR...........................................    1.1569
  Benton, OR
1900  \2\ Cumberland, MD-WV (MD Hospitals)....................    0.8855
  Allegany, MD
  Mineral, WV
1900  \2\ Cumberland, MD-WV (WV Hospitals)....................    0.8053
  Allegany, MD
  Mineral, WV
1920  \1\ Dallas, TX..........................................    0.9831
  Collin, TX
  Dallas, TX
  Denton, TX
  Ellis, TX
  Henderson, TX
  Hunt, TX
  Kaufman, TX
  Rockwall, TX
1950  Danville, VA............................................    0.8785
  Danville City, VA
  Pittsylvania, VA
1960  Davenport-Moline-Rock Island, IA-IL.....................    0.8872
  Scott, IA
  Henry, IL
  Rock Island, IL
2000  Dayton-Springfield, OH..................................    0.9378
  Clark, OH
  Greene, OH
  Miami, OH
  Montgomery, OH
2020  Daytona Beach, FL.......................................    0.9133
  Flagler, FL
  Volusia, FL
2030  Decatur, AL.............................................    0.9066
  Lawrence, AL
  Morgan, AL
2040  \2\ Decatur, IL.........................................    0.8301
  Macon, IL
2080  \1\ Denver, CO..........................................    1.0401
  Adams, CO
  Arapahoe, CO
  Denver, CO
  Douglas, CO
  Jefferson, CO
2120  Des Moines, IA..........................................    0.8908
  Dallas, IA
  Polk, IA
  Warren, IA
2160  \1\ Detroit, MI.........................................    1.0506
  Lapeer, MI
  Macomb, MI
  Monroe, MI
  Oakland, MI
  St. Clair, MI
  Wayne, MI
2180  Dothan, AL..............................................    0.8028
  Dale, AL
  Houston, AL
2190  Dover, DE...............................................    0.9452
  Kent, DE
2200  Dubuque, IA.............................................    0.8801
  Dubuque, IA
2240  Duluth-Superior, MN-WI..................................    1.0462
  St. Louis, MN
  Douglas, WI
2281  Dutchess County, NY.....................................    1.0793
  Dutchess, NY
2290  \2\ Eau Claire, WI......................................    0.9229
  Chippewa, WI
  Eau Claire, WI

[[Page 52365]]

 
2320  El Paso, TX.............................................    0.9137
  El Paso, TX
2330  Elkhart-Goshen, IN......................................    0.9851
  Elkhart, IN
2335  \2\ Elmira, NY..........................................    0.8633
  Chemung, NY
2340  Enid, OK................................................    0.8387
  Garfield, OK
2360  Erie, PA................................................    0.9016
  Erie, PA
2400  Eugene-Springfield, OR..................................    1.1077
  Lane, OR
2440  \2\ Evansville-Henderson, IN-KY (IN Hospitals)..........    0.8796
  Posey, IN
  Vanderburgh, IN
  Warrick, IN
  Henderson, KY
2440  Evansville-Henderson, IN-KY (KY Hospitals)..............    0.8254
  Posey, IN
  Vanderburgh, IN
  Warrick, IN
  Henderson, KY
2520  Fargo-Moorhead, ND-MN...................................    0.9783
  Clay, MN
  Cass, ND
2560  Fayetteville, NC........................................    0.9055
  Cumberland, NC
2580  Fayetteville-Springdale-Rogers, AR......................    0.8182
  Benton, AR
  Washington, AR
2620  Flagstaff, AZ-UT........................................    1.0791
  Coconino, AZ
  Kane, UT
2640  Flint, MI...............................................    1.1233
  Genesee, MI
2650  Florence, AL............................................    0.7960
  Colbert, AL
  Lauderdale, AL
2655  Florence, SC............................................    0.8869
  Florence, SC
2670  Fort Collins-Loveland, CO...............................    0.9923
  Larimer, CO
2680  \1\ Ft. Lauderdale, FL..................................    1.0792
  Broward, FL
2700  Fort Myers-Cape Coral, FL...............................    0.9456
  Lee, FL
2710  Fort Pierce-Port St. Lucie, FL..........................    0.9959
  Martin, FL
  St. Lucie, FL
2720  Fort Smith, AR-OK.......................................    0.7811
  Crawford, AR
  Sebastian, AR
  Sequoyah, OK
2750  Fort Walton Beach, FL...................................    0.9651
  Okaloosa, FL
2760  Fort Wayne, IN..........................................    0.9499
  Adams, IN
  Allen, IN
  De Kalb, IN
  Huntington, IN
  Wells, IN
  Whitley, IN
2800  \1\ Forth Worth-Arlington, TX...........................    0.9620
  Hood, TX
  Johnson, TX
  Parker, TX
  Tarrant, TX
2840  Fresno, CA..............................................    1.0340
  Fresno, CA
  Madera, CA
2880  Gadsden, AL.............................................    0.8684
  Etowah, AL
2900  Gainesville, FL.........................................    0.9730
  Alachua, FL
2920  Galveston-Texas City, TX................................    0.9603
  Galveston, TX
2960  Gary, IN................................................    0.9676
  Lake, IN
  Porter, IN
2975  \2\ Glens Falls, NY.....................................    0.8633
  Warren, NY
  Washington, NY
2980  Goldsboro, NC...........................................    0.8982
   Wayne, NC
2985  Grand Forks, ND-MN......................................    0.9338
  Polk, MN
  Grand Forks, ND
2995  Grand Junction, CO......................................    0.9824
  Mesa, CO
3000  \1\ Grand Rapids-Muskegon-Holland, MI...................    0.9664
  Allegan, MI
  Kent, MI
  Muskegon, MI
  Ottawa, MI
3040  Great Falls, MT.........................................    0.9057
  Cascade, MT
3060  Greeley, CO.............................................    0.9219
  Weld, CO
3080  Green Bay, WI...........................................    0.9599
  Brown, WI
3120  \1\ Greensboro-Winston-Salem-High Point, NC.............    0.9270
  Alamance, NC
  Davidson, NC
  Davie, NC
  Forsyth, NCGuilford, NC
  Randolph, NC
  Stokes, NC
  Yadkin, NC
3150  Greenville, NC..........................................    0.9257
  Pitt, NC
3160  Greenville-Spartanburg-Anderson, SC.....................    0.9177
  Anderson, SC
  Cherokee, SC
  Greenville, SC
  Pickens, SC
  Spartanburg, SC
3180  Hagerstown, MD..........................................    0.9362
  Washington, MD
3200  Hamilton-Middletown, OH.................................    0.9484
  Butler, OH
3240  Harrisburg-Lebanon-Carlisle, PA.........................    0.9315
  Cumberland, PA
  Dauphin, PA
  Lebanon, PA
  Perry, PA
3283  \1, 2\ Hartford, CT.....................................    1.2520
  Hartford, CT
  Litchfield, CT
  Middlesex, CT
  Tolland, CT
3285  \2\ Hattiesburg, MS.....................................    0.7759
  Forrest, MS
  Lamar, MS
3290  Hickory-Morganton-Lenoir, NC............................    0.8958
  Alexander, NC
  Burke, NC
  Caldwell, NC
  Catawba, NC
3320  Honolulu, HI............................................    1.1121
  Honolulu, HI
3350  Houma, LA...............................................    0.8470
  Lafourche, LA
  Terrebonne, LA
3360  \1\ Houston, TX.........................................    0.9746
  Chambers, TX
  Fort Bend, TX
  Harris, TX
  Liberty, TX
  Montgomery, TX
  Waller, TX
3400  Huntington-Ashland, WV-KY-OH............................    0.9744
  Boyd, KY
  Carter, KY
  Greenup, KY
  Lawrence, OH
  Cabell, WV
  Wayne, WV
3440  Huntsville, AL..........................................    0.8901
  Limestone, AL
  Madison, AL
3480  \1\ Indianapolis, IN....................................    0.9828
  Boone, IN
  Hamilton, IN
  Hancock, IN
  Hendricks, IN
  Johnson, IN
  Madison, IN
  Marion, IN
  Morgan, IN
  Shelby, IN
3500  Iowa City, IA...........................................    1.0025
  Johnson, IA
3520  Jackson, MI.............................................    0.9591
  Jackson, MI
3560  Jackson, MS.............................................    0.8713
  Hinds, MS
  Madison, MS
  Rankin, MS
3580  Jackson, TN.............................................    0.9370
  Madison, TN
  Chester, TN
3600  \1\ Jacksonville, FL....................................    0.9341
  Clay, FL
  Duval, FL
  Nassau, FL
  St. Johns, FL
3605  \2\ Jacksonville, NC....................................    0.8714
  Onslow, NC
3610  \2\ Jamestown, NY.......................................    0.8633
  Chautauqua, NY
3620  Janesville-Beloit, WI...................................    0.9696
  Rock, WI
3640  Jersey City, NJ.........................................    1.1200
  Hudson, NJ
3660  Johnson City-Kingsport-Bristol, TN-VA (TN Hospitals)....    0.8384
  Carter, TN
  Hawkins, TN
  Sullivan, TN
  Unicoi, TN

[[Page 52366]]

 
  Washington, TN
  Bristol City, VA
  Scott, VA
  Washington, VA
3660  \2\ Johnson City-Kingsport-Bristol, TN-VA (VA Hospitals)    0.8494
  Carter, TN
  Hawkins, TN
  Sullivan, TN
  Unicoi, TN
  Washington, TN
  Bristol City, VA
  Scott, VA
  Washington, VA
3680  \2\ Johnstown, PA.......................................    0.8525
  Cambria, PA
  Somerset, PA
3700  Jonesboro, AR...........................................    0.7906
  Craighead, AR
3710  Joplin, MO..............................................    0.8700
  Jasper, MO
  Newton, MO
3720  Kalamazoo-Battlecreek, MI...............................    1.0689
  Calhoun, MI
  Kalamazoo, MI
  Van Buren, MI
3740  Kankakee, IL............................................    0.9591
  Kankakee, IL
3760  \1\ Kansas City, KS-MO..................................    0.9809
  Johnson, KS
  Leavenworth, KS
  Miami, KS
  Wyandotte, KS
  Cass, MO
  Clay, MO
  Clinton, MO
  Jackson, MO
  Lafayette, MO
  Platte, MO
  Ray, MO
3800  Kenosha, WI.............................................    0.9741
  Kenosha, WI
3810  Killeen-Temple, TX......................................    0.8447
  Bell, TX
  Coryell, TX
3840  Knoxville, TN...........................................    0.9090
  Anderson, TN
  Blount, TN
  Knox, TN
  Loudon, TN
  Sevier, TN
  Union, TN
3850  Kokomo, IN..............................................    0.9031
  Howard, IN
  Tipton, IN
3870  \2\ La Crosse, WI-MN (WI Hospitals).....................    0.9229
  Houston, MN
  La Crosse, WI
3870  \2\ La Crosse, WI-MN (MN Hospitals).....................    0.9249
  Houston, MN
  La Crosse, WI
3880  Lafayette, LA...........................................    0.8550
  Acadia, LA
  Lafayette, LA
  St. Landry, LA
  St. Martin, LA
3920  Lafayette, IN...........................................    0.9515
  Clinton, IN
  Tippecanoe, IN
3960  Lake Charles, LA........................................    0.8030
  Calcasieu, LA
3980  Lakeland-Winter Haven, FL...............................    0.9170
  Polk, FL
4000  Lancaster, PA...........................................    0.9171
  Lancaster, PA
4040  Lansing-East Lansing, MI................................    0.9827
  Clinton, MI
  Eaton, MI
  Ingham, MI
4080  Laredo, TX..............................................    0.8504
  Webb, TX
4100  Las Cruces, NM..........................................    0.8888
  Dona Ana, NM
4120  \1\ Las Vegas, NV-AZ....................................    1.1018
  Mohave, AZ
  Clark, NV
  Nye, NV
4150  Lawrence, KS............................................    0.7964
  Douglas, KS
4200  Lawton, OK..............................................    0.8251
  Comanche, OK
4243  Lewiston-Auburn, ME.....................................    0.9249
  Androscoggin, ME
4280  Lexington, KY...........................................    0.8629
  Bourbon, KY
  Clark, KY
  Fayette, KY
  Jessamine, KY
  Madison, KY
  Scott, KY
  Woodford, KY
4320  Lima, OH................................................    0.9515
  Allen, OH
  Auglaize, OH
4360  Lincoln, NE.............................................    0.9133
  Lancaster, NE
4400  Little Rock-North Little Rock, AR.......................    0.9045
  Faulkner, AR
  Lonoke, AR
  Pulaski, AR
  Saline, AR
4420  Longview-Marshall, TX...................................    0.8588
  Gregg, TX
  Harrison, TX
  Upshur, TX
4480  \1\ Los Angeles-Long Beach, CA..........................    1.2044
  Los Angeles, CA
4520  \1\ Louisville, KY-IN...................................    0.9517
  Clark, IN
  Floyd, IN
  Harrison, IN
  Scott, IN
  Bullitt, KY
  Jefferson, KY
  Oldham, KY
4600  Lubbock, TX.............................................    0.7809
  Lubbock, TX
4640  Lynchburg, VA...........................................    0.9311
  Amherst, VA
  Bedford, VA
  Bedford City, VA
  Campbell, VA
  Lynchburg City, VA
4680  Macon, GA...............................................    0.9296
  Bibb, GA
  Houston, GA
  Jones, GA
  Peach, GA
  Twiggs, GA
4720  Madison, WI.............................................    1.0188
  Dane, WI
4800  Mansfield, OH...........................................    0.8989
  Crawford, OH
  Richland, OH
4840  Mayaguez, PR............................................    0.4921
  Anasco, PR
  Cabo Rojo, PR
  Hormigueros, PR
  Mayaguez, PR
  Sabana Grande, PR
  San German, PR
4880  McAllen-Edinburg-Mission, TX............................    0.8419
  Hidalgo, TX
4890  Medford-Ashland, OR.....................................    1.0605
  Jackson, OR
4900  Melbourne-Titusville-Palm Bay, FL.......................    1.0782
  Brevard, Fl
4920  \1\ Memphis, TN-AR-MS...................................    0.8839
  Crittenden, AR
  DeSoto, MS
  Fayette, TN
  Shelby, TN
  Tipton, TN
4940  Merced, CA..............................................    0.9937
  Merced, CA
5000  \1\ Miami, FL...........................................    0.9878
  Dade, FL
5015  \1\ Middlesex-Somerset-Hunterdon, NJ....................    1.1454
  Hunterdon, NJ
  Middlesex, NJ
  Somerset, NJ
5080  \1\ Milwaukee-Waukesha, WI..............................    0.9901
  Milwaukee, WI
  Ozaukee, WI
  Washington, WI
  Waukesha, WI
5120  \1\ Minneapolis-St. Paul, MN-WI.........................    1.0969
  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............................................    0.9250
  Missoula, MT
5160  Mobile, AL..............................................    0.8181
  Baldwin, AL
  Mobile, AL
5170  Modesto, CA.............................................    1.0606
  Stanislaus, CA
5190  \1\ Monmouth-Ocean, NJ..................................    1.1290
  Monmouth, NJ
  Ocean, NJ
5200  Monroe, LA..............................................    0.8191
  Ouachita, LA

[[Page 52367]]

 
5240  \2\ Montgomery, AL......................................    0.7853
  Autauga, AL
  Elmore, AL
  Montgomery, AL
5280  Muncie, IN..............................................    0.9150
  Delaware, IN
5330  Myrtle Beach, SC........................................    0.9141
  Horry, SC
5345  Naples, FL..............................................    0.9803
  Collier, FL
5360  \1\ Nashville, TN.......................................    0.9456
  Cheatham, TN
  Davidson, TN
  Dickson, TN
  Robertson, TN
  Rutherford TN
  Sumner, TN
  Williamson, TN
  Wilson, TN
5380  \1\ Nassau-Suffolk, NY..................................    1.3441
  Nassau, NY
  Suffolk, NY
5483  \1, 2\ New Haven-Bridgeport-Stamford-Waterbury-.........    1.2520
  Danbury, CT
  Fairfield, CT
  New Haven, CT
5523  \2\ New London-Norwich, CT..............................    1.2520
  New London, CT
5560  \1\ New Orleans, LA.....................................    0.9050
  Jefferson, LA
  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........................................    1.4069
  Bronx, NY
  Kings, NY
  New York, NY
  Putnam, NY
  Queens, NY
  Richmond, NY
  Rockland, NY
  Westchester, NY
5640  \1\ Newark, NJ..........................................    1.1546
  Essex, NJ
  Morris, NJ
  Sussex, NJ
  Union, NJ
  Warren, NJ
5660  Newburgh, NY-PA.........................................    1.1434
  Orange, NY
  Pike, PA
5720  \1\ Norfolk-Virginia Beach-Newport News, VA-NC..........    0.8553
  Currituck, NC
  Chesapeake City, VA
  Gloucester, VA
  Hampton City, VA
  Isle of Wight, VA
  James City, VA
  Mathews, VA
  Newport News City, VA
  Norfolk City, VA
  Poquoson City, VA
  Portsmouth City, VA
  Suffolk City, VA
  Virginia Beach City VA
  Williamsburg City, VA
  York, VA
5775  \1\ Oakland, CA.........................................    1.5324
  Alameda, CA
  Contra Costa, CA
5790  Ocala, FL...............................................    0.9526
  Marion, FL
5800  Odessa-Midland, TX......................................    0.9233
  Ector, TX
  Midland, TX
5880  \1\ Oklahoma City, OK...................................    0.8997
  Canadian, OK
  Cleveland, OK
  Logan, OK
  McClain, OK
  Oklahoma, OK
  Pottawatomie, OK
5910  Olympia, WA.............................................    1.1071
  Thurston, WA
5920  Omaha, NE-IA............................................    1.0089
  Pottawattamie, IA
  Cass, NE
  Douglas, NE
  Sarpy, NE
  Washington, NE
5945  \1\ Orange County, CA...................................    1.1726
  Orange, CA
5960  \1\ Orlando, FL.........................................    0.9537
  Lake, FL
  Orange, FL
  Osceola, FL
  Seminole, FL
5990  Owensboro, KY...........................................    0.8283
  Daviess, KY
6015  Panama City, FL.........................................    0.8926
  Bay, FL
6020  Parkersburg-Marietta, WV-OH (WV Hospitals)..............    0.8210
  Washington, OH
  Wood, WV
6020  \2\ Parkersburg-Marietta, WV-OH (OH Hospitals)..........    0.8675
  Washington, OH
  Wood, WV
6080  \2\ Pensacola, FL.......................................    0.8907
  Escambia, FL
  Santa Rosa, FL
6120  Peoria-Pekin, IL........................................    0.8854
  Peoria, IL
  Tazewell, IL
  Woodford, IL
6160  \1\ Philadelphia, PA-NJ.................................    1.0675
  Burlington, NJ
  Camden, NJ
  Gloucester, NJ
  Salem, NJ
  Bucks, PA
  Chester, PA
  Delaware, PA
  Montgomery, PA
  Philadelphia, PA
6200  \1\ Phoenix-Mesa, AZ....................................    0.9562
  Maricopa, AZ
  Pinal, AZ
6240  Pine Bluff, AR..........................................    0.7866
  Jefferson, AR
6280  \1\ Pittsburgh, PA......................................    0.9403
  Allegheny, PA
  Beaver, PA
  Butler, PA
  Fayette, PA
  Washington, PA
  Westmoreland, PA
6323  \2\ Pittsfield, MA......................................    1.1257
  Berkshire, MA
6340  Pocatello, ID...........................................    0.9013
  Bannock, ID
6360  Ponce, PR...............................................    0.5221
  Guayanilla, PR
  Juana Diaz, PR
  Penuelas, PR
  Ponce, PR
  Villalba, PR
  Yauco, PR
6403  Portland, ME............................................    0.9932
  Cumberland, ME
  Sagadahoc, ME
  York, ME
6440  \1\ Portland-Vancouver, OR-WA...........................    1.0792
  Clackamas, OR
  Columbia, OR
  Multnomah, OR
  Washington, OR
  Yamhill, OR
  Clark, WA
6483  \1\ Providence-Warwick-Pawtucket, RI....................    1.0558
  Bristol, RI
  Kent, RI
  Newport, RI
  Providence, RI
  Washington, RI
6520  Provo-Orem, UT..........................................    1.0190
  Utah, UT
6560  \2\ Pueblo, CO..........................................    0.9104
  Pueblo, CO
6580  \2\ Punta Gorda, FL.....................................    0.8907
  Charlotte, FL
6600  Racine, WI..............................................    0.9413
  Racine, WI
6640  \1\ Raleigh-Durham-Chapel Hill, NC......................    1.0083
  Chatham, NC
  Durham, NC
  Franklin, NC
  Johnston, NC
  Orange, NC
  Wake, NC
6660  Rapid City, SD..........................................    0.8936
  Pennington, SD
6680  Reading, PA.............................................    0.9308
  Berks, PA
6690  Redding, CA.............................................    1.1249
  Shasta, CA
6720  Reno, NV................................................    1.0664
  Washoe, NV
6740  Richland-Kennewick-Pasco, WA............................    1.1608
  Benton, WA
  Franklin, WA
6760  Richmond-Petersburg, VA.................................    0.9735
  Charles City County, VA
  Chesterfield, VA
  Colonial Heights City, VA
  Dinwiddie, VA
  Goochland, VA
  Hanover, VA
  Henrico, VA

[[Page 52368]]

 
  Hopewell City, VA
  New Kent, VA
  Petersburg City, VA
  Powhatan, VA
  Prince George, VA
  Richmond City, VA
6780  \1\ Riverside-San Bernardino, CA........................    1.1251
  Riverside, CA
  San Bernardino, CA
6800  Roanoke, VA.............................................    0.8703
  Botetourt, VA
  Roanoke, VA
  Roanoke City, VA
  Salem City, VA
6820  Rochester, MN...........................................    1.2263
  Olmsted, MN
6840  \1\ Rochester, NY.......................................    0.9133
  Genesee, NY
  Livingston, NY
  Monroe, NY
  Ontario, NY
  Orleans, NY
  Wayne, NY
6880  Rockford, IL............................................    0.9456
  Boone, IL
  Ogle, IL
  Winnebago, IL
6895  Rocky Mount, NC.........................................    0.9322
  Edgecombe, NC
  Nash, NC
6920  \1\ Sacramento, CA......................................    1.1636
  El Dorado, CA
  Placer, CA
  Sacramento, CA
6960  Saginaw-Bay City-Midland, MI............................    0.9709
  Bay, MI
  Midland, MI
  Saginaw, MI
6980  St. Cloud, MN...........................................    0.9858
  Benton, MN
  Stearns, MN
7000  \2\ St. Joseph, MO......................................    0.8099
  Andrew, MO
  Buchanan, MO
7040  \1\ St. Louis, MO-IL....................................    0.8907
  Clinton, IL
  Jersey, IL
  Madison, IL
  Monroe, IL
  St. Clair, IL
  Franklin, MO
  Jefferson, MO
  Lincoln, MO
  St. Charles, MO
  St. Louis, MO
  St. Louis City, MO
  Warren, MO
7080  Salem, OR...............................................    1.0473
  Marion, OR
  Polk, OR
7120  Salinas, CA.............................................    1.4772
  Monterey, CA
7160  \1\ Salt Lake City-Ogden, UT............................    1.0035
  Davis, UT
  Salt Lake, UT
  Weber, UT
7200  San Angelo, TX..........................................    0.7956
  Tom Green, TX
7240  \1\ San Antonio, TX.....................................    0.8649
  Bexar, TX
  Comal, TX
  Guadalupe, TX
  Wilson, TX
7320  \1\ San Diego, CA.......................................    1.1247
  San Diego, CA
7360  \1\ San Francisco, CA...................................    1.4288
  Marin, CA
  San Francisco, CA
  San Mateo, CA
7400  \1\ San Jose, CA........................................    1.4162
  Santa Clara, CA
7440  \1\ San Juan-Bayamon, PR................................    0.4706
  Aguas Buenas, PR
  Barceloneta, PR
  Bayamon, PR
  Canovanas, PR
  Carolina, PR
  Catano, PR
  Ceiba, PR
  Comerio, PR
  Corozal, PR
  Dorado, PR
  Fajardo, PR
  Florida, PR
  Guaynabo, PR
  Humacao, PR
  Juncos, PR
  Los Piedras, PR
  Loiza, PR
  Luguillo, PR
  Manati, PR
  Morovis, PR
  Naguabo, PR
  Naranjito, PR
  Rio Grande, PR
  San Juan, PR
  Toa Alta, PR
  Toa Baja, PR
  Trujillo Alto, PR
  Vega Alta, PR
  Vega Baja, PR
  Yabucoa, PR
7460  San Luis Obispo-Atascadero-Paso Robles, CA..............    1.1386
  San Luis Obispo, CA
7480  Santa Barbara-Santa Maria-Lompoc, CA....................    1.0588
  Santa Barbara, CA
7485  Santa Cruz-Watsonville, CA..............................    1.3630
  Santa Cruz, CA
7490  Santa Fe, NM............................................    1.0822
  Los Alamos, NM
  Santa Fe, NM
7500  Santa Rosa, CA..........................................    1.3179
  Sonoma, CA
7510  Sarasota-Bradenton, FL..................................    0.9367
  Manatee, FL
  Sarasota, FL
7520  Savannah, GA............................................    0.9961
  Bryan, GA
  Chatham, GA
  Effingham, GA
7560  \2\ Scranton--Wilkes-Barre--Hazleton, PA................    0.8525
  Columbia, PA
  Lackawanna, PA
  Luzerne, PA
  Wyoming, PA
7600  \1\ Seattle-Bellevue-Everett, WA........................    1.1571
  Island, WA
  King, WA
  Snohomish, WA
7610  \2\ Sharon, PA..........................................    0.8525
  Mercer, PA
7620  \2\ Sheboygan, WI.......................................    0.9229
  Sheboygan, WI
7640  Sherman-Denison, TX.....................................    0.9334
  Grayson, TX
7680  Shreveport-Bossier City, LA.............................    0.8813
  Bossier, LA
  Caddo, LA
  Webster, LA
7720  Sioux City, IA-NE.......................................    0.9138
  Woodbury, IA
  Dakota, NE
7760  Sioux Falls, SD.........................................    0.9098
  Lincoln, SD
  Minnehaha, SD
7800  South Bend, IN..........................................    0.9902
  St. Joseph, IN
7840  Spokane, WA.............................................    1.0961
  Spokane, WA
7880  Springfield, IL.........................................    0.8654
  Menard, IL
  Sangamon, IL
7920  Springfield, MO.........................................    0.8510
  Christian, MO
  Greene, MO
  Webster, MO
8003  \2\ Springfield, MA.....................................    1.1257
  Hampden, MA
  Hampshire, MA
8050  State College, PA.......................................    0.9032
  Centre, PA
8080  Steubenville-Weirton, OH-WV.............................    0.8893
  Jefferson, OH
  Brooke, WV
  Hancock, WV
8120  Stockton-Lodi, CA.......................................    1.0630
  San Joaquin, CA
8140  \2\ Sumter, SC..........................................    0.8607
  Sumter, SC
8160  Syracuse, NY............................................    0.9519
  Cayuga, NY
  Madison, NY
  Onondaga, NY
  Oswego, NY
8200  Tacoma, WA..............................................    1.1052
  Pierce, WA
8240  \2\ Tallahassee, FL.....................................    0.8907
  Gadsden, FL
  Leon, FL
8280  \1\ Tampa-St. Petersburg-Clearwater, FL.................    0.9238
  Hernando, FL
  Hillsborough, FL
  Pasco, FL
  Pinellas, FL
8320  \2\ Terre Haute, IN.....................................    0.8796
  Clay, IN
  Vermillion, IN
  Vigo, IN
8360  Texarkana,AR-Texarkana, TX..............................    0.8193
  Miller, AR
  Bowie, TX

[[Page 52369]]

 
8400  Toledo, OH..............................................    0.9863
  Fulton, OH
  Lucas, OH
  Wood, OH
8440  Topeka, KS..............................................    0.8952
  Shawnee, KS
8480  Trenton, NJ.............................................    1.0710
  Mercer, NJ
8520  Tucson, AZ..............................................    0.8993
  Pima, AZ
8560  Tulsa, OK...............................................    0.8398
  Creek, OK
  Osage, OK
  Rogers, OK
  Tulsa, OK
  Wagoner, OK
8600  Tuscaloosa, AL..........................................    0.8303
  Tuscaloosa, AL
8640  Tyler, TX...............................................    0.9650
  Smith, TX
8680  \2\ Utica-Rome, NY......................................    0.8633
  Herkimer, NY
  Oneida, NY
8720  Vallejo-Fairfield-Napa, CA..............................    1.3544
  Napa, CA
  Solano, CA
8735  Ventura, CA.............................................    1.1209
  Ventura, CA
8750  Victoria, TX............................................    0.8814
  Victoria, TX
8760  Vineland-Millville-Bridgeton, NJ........................    1.0296
  Cumberland, NJ
8780  2Visalia-Tulare-Porterville, CA.........................    0.9934
  Tulare, CA
8800  Waco, TX................................................    0.8802
  McLennan, TX
8840  \1\ Washington, DC-MD-VA-WV.............................    1.0852
  District of Columbia, DC
  Calvert, MD
  Charles, MD
  Frederick, MD
  Montgomery, MD
  Prince Georges, MD
  Alexandria City, VA
  Arlington, VA
  Clarke, VA
  Culpeper, VA
  Fairfax, VA
  Fairfax City, VA
  Falls Church City, VA
  Fauquier, VA
  Fredericksburg City, VA
  King George, VA
  Loudoun, VA
  Manassas City, VA
  Manassas Park City, VA
  Prince William, VA
  Spotsylvania, VA
  Stafford, VA
  Warren, VA
  Berkeley, WV
  Jefferson, WV
8920  Waterloo-Cedar Falls, IA................................    0.8970
  Black Hawk, IA
8940  Wausau, WI..............................................    0.9882
  Marathon, WI
8960  \1\West Palm Beach-Boca Raton, FL.......................    0.9929
  Palm Beach, FL
9000  \2\Wheeling, WV-OH (WV Hospitals).......................    0.8053
  Belmont, OH
  Marshall, WV
  Ohio, WV
9000  \2\ Wheeling, WV-OH (OH Hospitals)......................    0.8675
  Belmont, OH
  Marshall, WV
  Ohio, WV
9040  Wichita, KS.............................................    0.9571
  Butler, KS
  Harvey, KS
  Sedgwick, KS
9080  Wichita Falls, TX.......................................    0.8023
  Archer, TX
  Wichita, TX
9140  Williamsport, PA........................................    0.8624
  Lycoming, PA
9160  Wilmington-Newark, DE-MD................................    1.1287
  New Castle, DE
  Cecil, MD
9200  Wilmington, NC..........................................    0.9471
  New Hanover, NC
  Brunswick, NC
9260  Yakima, WA..............................................    1.0676
  Yakima, WA
9270  \2\ Yolo, CA............................................    0.9934
  Yolo, CA
9280  York, PA................................................    0.9140
  York, PA
9320  Youngstown-Warren, OH...................................    0.9485
  Columbiana, OH
  Mahoning, OH
  Trumbull, OH
9340  Yuba City, CA...........................................    1.0310
  Sutter, CA
  Yuba, CA
9360  Yuma, AZ................................................    0.8677
  Yuma, AZ
------------------------------------------------------------------------
\1\ Large Urban Area
\2\ Hospitals geographically located in the area are assigned the
  statewide rural wage index.


                 Addendum I.--Wage Index for Rural Areas
------------------------------------------------------------------------
                                                                  Wage
                         Nonurban area                            index
------------------------------------------------------------------------
Alabama.......................................................    0.7853
Alaska........................................................    1.2323
Arizona.......................................................    0.8483
Arkansas......................................................    0.7670
California....................................................    0.9934
Colorado......................................................    0.9104
Connecticut...................................................    1.2520
Delaware......................................................    0.9126
Florida.......................................................    0.8907
Georgia.......................................................    0.8254
Hawaii........................................................    1.0342
Idaho.........................................................    0.8799
Illinois......................................................    0.8301
Indiana.......................................................    0.8796
Iowa..........................................................    0.8395
Kansas........................................................    0.7964
Kentucky......................................................    0.8079
Louisiana.....................................................    0.7719
Maine.........................................................    0.8754
Maryland......................................................    0.8855
Massachusetts.................................................    1.1257
Michigan......................................................    0.8961
Minnesota.....................................................    0.9249
Mississippi...................................................    0.7759
Missouri......................................................    0.8099
Montana.......................................................    0.8567
Nebraska......................................................    0.8283
Nevada........................................................    0.9519
New Hampshire.................................................    0.9882
New Jersey \1\................................................  ........
New Mexico....................................................    0.8645
New York......................................................    0.8633
North Carolina................................................    0.8714
North Dakota..................................................    0.7830
Ohio..........................................................    0.8675
Oklahoma......................................................    0.7664
Oregon........................................................    1.0408
Pennsylvania..................................................    0.8525
Puerto Rico...................................................    0.4400
Rhode Island \1\..............................................  ........
South Carolina................................................    0.8607
South Dakota..................................................    0.7895
Tennessee.....................................................    0.7873
Texas.........................................................    0.7759
Utah..........................................................    0.9426
Vermont.......................................................    0.9402
Virginia......................................................    0.8494
Washington....................................................    1.0274
West Virginia.................................................    0.8053
Wisconsin.....................................................    0.9229
Wyoming.......................................................   0.8890
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban.


       Addendum J.--Wage Index for Hospitals That Are Reclassified
------------------------------------------------------------------------
                                                                  Wage
                             Area                                 index
------------------------------------------------------------------------
Abilene, TX...................................................    0.8534
Akron, OH.....................................................    0.9685
Albany, GA....................................................    1.0658
Albuquerque, NM...............................................    0.9372
Alexandria, LA................................................    0.7929
Allentown-Bethlehem-Easton, PA................................    0.9833
Altoona, PA...................................................    0.9300
Amarillo, TX..................................................    0.8900
Anchorage, AK.................................................    1.2610
Ann Arbor, MI.................................................    1.1217
Anniston, AL..................................................    0.7983
Asheville, NC.................................................    0.9448
Athens, GA....................................................    1.0161
Atlanta, GA...................................................    0.9985
Augusta-Aiken, GA-SC..........................................    0.9981
Austin-San Marcos, TX.........................................    0.9529
Barnstable-Yarmouth, MA.......................................    1.2894
Baton Rouge, LA...............................................    0.8281
Bellingham, WA................................................    1.2139
Benton Harbor, MI.............................................    0.9072
Bergen-Passaic, NJ............................................    1.2100
Billings, MT..................................................    0.9114
Biloxi-Gulfport-Pascagoula, MS................................    0.8417
Binghamton, NY................................................    0.8525

[[Page 52370]]

 
Birmingham, AL................................................    0.9301
Bismarck, ND..................................................    0.7881
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH..............    1.1304
Burlington, VT................................................    0.9667
Caguas, PR....................................................    0.4453
Casper, WY....................................................    0.9655
Champaign-Urbana, IL..........................................    0.9334
Charleston-North Charleston, SC...............................    0.8607
Charleston, WV................................................    0.8602
Charlotte-Gastonia-Rock Hill, NC-SC...........................    0.9839
Charlottesville, VA...........................................    1.0252
Chattanooga, TN-GA............................................    0.8878
Chicago, IL...................................................    1.0953
Cincinnati, OH-KY-IN..........................................    0.9354
Clarksville-Hopkinsville, TN-KY...............................    0.8239
Cleveland-Lorain-Elyria, OH...................................    0.9295
Columbia, MO..................................................    0.8737
Columbia, SC..................................................    0.8990
Columbus, GA-AL (GA Hospitals)................................    0.8254
Columbus, GA-AL (AL Hospitals)................................    0.8041
Columbus, OH..................................................    0.9521
Corpus Christi, TX............................................    0.8154
Dallas, TX....................................................    0.9831
Danville, VA..................................................    0.8530
Davenport-Moline-Rock Island, IA-IL...........................    0.8872
Dayton-Springfield, OH........................................    0.9378
Denver, CO....................................................    1.0401
Des Moines, IA................................................    0.8908
Detroit, MI...................................................    1.0506
Dothan, AL....................................................    0.8028
Dover, DE.....................................................    0.9274
Duluth-Superior, MN-WI........................................    1.0462
Eau Claire, WI................................................    0.9229
Elkhart-Goshen, IN............................................    0.9484
Erie, PA......................................................    0.8850
Eugene-Springfield, OR........................................    1.1077
Fargo-Moorhead, ND-MN.........................................    0.9564
Fayetteville, NC..............................................    0.9055
Flagstaff, AZ-UT..............................................    1.0234
Flint, MI.....................................................    1.1041
Florence, AL..................................................    0.7960
Florence, SC..................................................    0.8869
Fort Collins-Loveland, CO.....................................    0.9923
Ft. Lauderdale, FL............................................    1.0792
Fort Pierce-Port St. Lucie, FL................................    0.9959
Fort Smith, AR-OK.............................................    0.7681
Fort Walton Beach, FL.........................................    0.9365
Forth Worth-Arlington, TX.....................................    0.9620
Gadsden, AL...................................................    0.8684
Grand Forks, ND-MN............................................    0.9338
Grand Junction, CO............................................    0.9824
Grand Rapids-Muskegon-Holland, MI.............................    0.9664
Great Falls, MT...............................................    0.9057
Greeley, CO...................................................    0.9219
Green Bay, WI.................................................    0.9347
Greensboro-Winston-Salem-High Point, NC.......................    0.9131
Greenville, NC................................................    0.9257
Harrisburg-Lebanon-Carlisle, PA...............................    0.9315
Hartford, CT..................................................    1.1550
Hattiesburg, MS...............................................    0.7759
Hickory-Morganton-Lenoir, NC..................................    0.8958
Houston, TX...................................................    0.9746
Huntington-Ashland, WV-KY-OH..................................    0.9251
Huntsville, AL................................................    0.8901
Indianapolis, IN..............................................    0.9828
Iowa City, IA.................................................    0.9828
Jackson, MS...................................................    0.8587
Jackson, TN...................................................    0.9032
Jacksonville, FL..............................................    0.9225
Johnson City-Kingsport-Bristol, TN-VA (VA Hospitals)..........    0.8494
Johnson City-Kingsport-Bristol, TN-VA (KY Hospitals)..........    0.8384
Johnstown, PA.................................................    0.0000
Jonesboro, AR (AR Hospitals)..................................    0.7906
Jonesboro, AR (MO Hospitals)..................................    0.8099
Joplin, MO....................................................    0.8700
Kalamazoo-Battlecreek, MI.....................................    1.0490
Kansas City, KS-MO............................................    0.9809
Knoxville, TN.................................................    0.9090
Kokomo, IN....................................................    0.9031
Lafayette, LA.................................................    0.8392
Lakeland-Winter Haven, FL.....................................    0.9170
Las Vegas, NV-AZ..............................................    1.1018
Lawton, OK....................................................    0.8073
Lexington, KY.................................................    0.8629
Lima, OH......................................................    0.9515
Lincoln, NE...................................................    0.9133
Little Rock-North Little Rock, AR.............................    0.8926
Longview-Marshall, TX.........................................    0.8588
Los Angeles-Long Beach, CA....................................    1.2044
Louisville, KY-IN.............................................    0.9382
Lubbock, TX...................................................    0.7809
Lynchburg, VA.................................................    0.9114
Macon, GA.....................................................    0.9296
Madison, WI...................................................    1.0188
Mansfield, OH.................................................    0.8989
Medford-Ashland, OR...........................................    1.0408
Memphis, TN-AR-MS.............................................    0.8667
Miami, FL.....................................................    0.9878
Milwaukee-Waukesha, WI........................................    0.9901
Minneapolis-St. Paul, MN-WI...................................    1.0969
Missoula, MT..................................................    0.9139
Mobile, AL....................................................    0.8181
Modesto, CA...................................................    1.0606
Monmouth-Ocean, NJ............................................    1.1290
Monroe, LA....................................................    0.8191
Montgomery, AL................................................    0.7853
Nashville, TN.................................................    0.9283
New Haven-Bridgeport-Stamford-Waterbury-......................
 Danbury, CT..................................................    1.2520
New London-Norwich, CT........................................    1.1683
New Orleans, LA...............................................    0.9050
New York, NY..................................................    1.3936
Newark, NJ....................................................    1.1546
Newburgh, NY-PA...............................................    1.0820
Norfolk-Virginia Beach-Newport News, VA-NC....................    0.8714
Oakland, CA...................................................    1.5324
Ocala, FL.....................................................    0.9343
Odessa-Midland, TX............................................    0.8910
Oklahoma City, OK.............................................    0.8997
Omaha, NE-IA..................................................    1.0089
Orange County, CA.............................................    1.1726
Orlando, FL...................................................    0.9537
Peoria-Pekin, IL..............................................    0.8854
Philadelphia, PA-NJ...........................................    1.0675
Phoenix-Mesa, AZ..............................................    0.9562
Pine Bluff, AR................................................    0.7760
Pittsburgh, PA................................................    0.9268
Pittsfield, MA................................................    0.9869
Pocatello, ID.................................................    0.9013
Portland, ME..................................................    0.9698
Portland-Vancouver, OR-WA.....................................    1.0792
Provo-Orem, UT................................................    1.0088
Raleigh-Durham-Chapel Hill, NC................................    0.9978
Rapid City, SD................................................    0.8936
Reading, PA...................................................    0.9126
Redding, CA...................................................    1.1249
Reno, NV......................................................    1.0445
Richland-Kennewick-Pasco, WA..................................    1.1209
Richmond-Petersburg, VA.......................................    0.9735
Roanoke, VA...................................................    0.8703
Rochester, MN.................................................    1.2263
Rockford, IL..................................................    0.9456
Sacramento, CA................................................    1.1636
Saginaw-Bay City-Midland, MI..................................    0.9709
St. Cloud, MN.................................................    0.9858
St. Joseph, MO................................................    0.8300
St. Louis, MO-IL..............................................    0.8907
Salinas, CA...................................................    1.4772
Salt Lake City-Ogden, UT......................................    1.0035
San Antonio, TX...............................................    0.8649
San Diego, CA.................................................    1.1247
Santa Fe, NM..................................................    0.9927
Santa Rosa, CA................................................    1.2891
Sarasota-Bradenton, FL........................................    0.9367
Savannah, GA..................................................    0.9841
Seattle-Bellevue-Everett, WA..................................    1.1571
Sherman-Denison, TX...........................................    0.9090
Shreveport-Bossier City, LA...................................    0.8813
Sioux City, IA-NE.............................................    0.8736
Sioux Falls, SD...............................................    0.8950
South Bend, IN................................................    0.9902
Spokane, WA...................................................    1.0770
Springfield, IL...............................................    0.8654
Springfield, MO...............................................    0.8236
Stockton-Lodi, CA.............................................    1.0630
Syracuse, NY..................................................    0.9519
Tampa-St. Petersburg-Clearwater, FL...........................    0.9238
Texarkana,AR-Texarkana, TX....................................    0.8193
Toledo, OH....................................................    0.9863
Topeka, KS....................................................    0.8840
Tucson, AZ....................................................    0.8993
Tulsa, OK.....................................................    0.8398
Tuscaloosa, AL................................................    0.8303
Tyler, TX.....................................................    0.9249
Vallejo-Fairfield-Napa, CA....................................    1.3544
Victoria, TX..................................................    0.8668
Waco, TX......................................................    0.8671
Washington, DC-MD-VA-WV.......................................    1.0852
Waterloo-Cedar Falls, IA......................................    0.8970
Wausau, WI....................................................    0.9710
West Palm Beach-Boca Raton, FL................................    0.9929
Wichita, KS...................................................    0.9235
Wichita Falls, TX.............................................    0.7918
Wilmington-Newark, DE-MD......................................    1.0973
Wilmington, NC................................................    0.9336
York, PA......................................................    0.9140
Youngstown-Warren, OH.........................................    0.9485
Rural Alabama.................................................    0.7853
Rural Florida.................................................    0.8907
Rural Illinois (IA Hospitals).................................    0.8395
Rural Illinois (MO Hospitals).................................    0.8301
Rural Kentucky................................................    0.8079
Rural Louisiana...............................................    0.7719
Rural Massachusetts...........................................    1.0417
Rural Michigan................................................    0.8961
Rural Minnesota...............................................    0.9249
Rural Mississippi.............................................    0.7759

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Rural Missouri................................................    0.8099
Rural Montana.................................................    0.8567
Rural Nebraska................................................    0.8283
Rural Nevada..................................................    0.9097
Rural Texas...................................................    0.7759
Rural Washington..............................................    1.0274
Rural Wyoming.................................................    0.8890
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[FR Doc. 02-20146 Filed 8-6-02; 12:38 pm]
BILLING CODE 4120-01-P