[Federal Register Volume 67, Number 212 (Friday, November 1, 2002)]
[Rules and Regulations]
[Pages 66718-67046]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 02-27548]



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Part II





Department of Health and Human Services





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Centers for Medicare & Medicaid Services



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42 CFR Parts 405 and 419



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; Final Rule

  Federal Register / Vol. 67, No. 212 / Friday, November 1, 2002 / 
Rules and Regulations  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 405 and 419

[CMS-1206-FC and CMS-1179-F]
RIN 0938-AL19 and 0938-AK59


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: Final rule with comment period.

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SUMMARY: This final rule with comment period revises 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 describes 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 are applicable to services furnished on or after January 
1, 2003. This rule also allows the Secretary to suspend Medicare 
payments ``in whole or in part'' if a provider fails to file a timely 
and acceptable cost report.
    In addition, this rule responds to public comments received on the 
November 2, 2001 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 
payment under the Medicare's hospital outpatient prospective payment 
system. Finally, this rule responds to public comments received on the 
August 9, 2002 proposed rule for revisions to the hospital outpatient 
prospective payment system and payment rates (67 FR 52092). CMS finds 
good cause to waive proposed rulemaking for the assignment of new codes 
to Ambulatory Payment Classifications and for the payment of influenza 
and pneuomococcal vaccines under reasonable cost; justification for the 
waiver will follow in a subsequent Federal Register notice.

DATES: Effective date: This final rule is effective January 1, 2003.
    Comment date: We will consider comments on the ambulatory payment 
classification assignments of Healthcare Common Procedure Coding System 
codes identified in Addendum B with condition code NI, and on Sec.  
419.23(d)(3), if we receive them at the appropriate address, as 
provided below, no later than 5 pm on December 31, 2002.

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

SUPPLEMENTARY INFORMATION:

Availability of Copies and Electronic Access

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    This Federal Register document is also available from the Federal 
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Government Printing Offi ce. 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

I. Background
    A. Authority for the Outpatient Prospective Payment System 
(OPPS)
    B. Summary of Rulemaking for the Outpatient Prospective Payment 
System
    C. Authority for Payment Suspensions for Unfiled Cost Reports
    D. Summary of Changes in the August 9, 2002 Proposed Rule
    1. Changes Relating to the OPPS
    a. Changes Required by Statute
    b. Additional Changes to OPPS
    c. Changes to the Regulations Text
    2. Changes Relating to Payment Suspension for Unfiled Cost 
Reports
    E. Summary of the November 2, 2001 Interim Final Rule with 
Comment Period
    F. Public Comments and Responses to the August 9, 2002 Proposed 
Rule
    1. OPPS
    2. Payment Suspension for Unfiled Cost Reports
II. 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 Ambulatory Payment Classification 
(APC) Assignments
    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 Calenday Year 
(CY) 2002 and Selected Codes and APC Assignments for 2003
    4. Other Public Comments on APC Assignments and Payment Rates
    5. Procedures That Will Be Paid Only As Inpatient Procedures
    C. Partial Hospitalization
III. Recalibration of APC 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
IV. 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 for Devices
    D. Expiration of Transitional Pass-Through Payments in Calendar 
Year 2003 for Drugs and Biologicals (Including Radiopharmaceuticals, 
Blood, and Blood Products)
    E. Expiration of Transitional Pass-Through Payments in Calendar 
Year 2003 for Brachytherapy
    F. Payment for Transitional Pass-Through Drugs and Biologicals 
for Calendar Year 2003
V. Criteria for New Device Categories As Implemented in the November 
2, 2001 Interim Final Rule with Comment
    A. Criteria for Eligibility for Pass-Through Payment of a 
Medical Device
    B. Criteria for Establishing Additional Device Categories
    1. Application Process for Creation of a New Device Category
    2. Announcing a New Device Category
VI. Wage Index Changes for Calendar Year 2003
VII. Copayment for Calendar Year 2003
VIII. Conversion Factor Update for Calendar Year 2003
IX. Outlier Policy for Calendar Year 2003
X. Other Policy Decisions and 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
XI. Summary and Responses of Public Comments to CMS's Response to 
MedPAC Recommendations
XII. Provisions of the Final Rule With Comment for 2003
    A. OPPS
    1. Statutory and Discretionary Changes
    2. Changes to the Regulations Text
    B. Payment Suspension for Unfiled Cost Reports
    C. Partial Hospitalization Services
    D. Pneumococcal and Influenza Vaccines
XIII. Response to Public Comments
XIV. Collection of Information Requirements
XV. Regulatory Impact Analysis
    A. OPPS
    1. General
    2. Changes in this Final Rule
    3. Limitations of Our Analysis
    4. Estimated Impacts of this Final Rule on Hospitals
    5. Estimated Impacts of this Final Rule on Beneficiaries
    B. Payment Suspension for Unfiled Cost Reports Regulations Text
    1. Effects on Provider that File Cost Reports
    2. Effects on Other Providers
    3. Effects on the Medicare Program
    4. Effects on Beneficiaries

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 Web site Only
    Addendum D--Payment Status Indicators for the Hospital 
Outpatient Prospective Payment System
    Addendum D1--Code Conditions
    Addendum E--CPT Codes That Would Be Paid Only As Inpatient 
Procedures
    Addendum G--Service Mix Indices by Hospital: Displayed on Web 
site Only
    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 Final 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

I. Background

A. Authority for the Outpatient Prospective Payment System (OPPS)

    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 Payment System

    [sbull] 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.
    [sbull] 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.

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    [sbull] 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.
    [sbull] 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.
    [sbull] 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.
    [sbull] On August 24, 2001, we published a proposed rule (66 FR 
44672) that would revise the OPPS to implement applicable statutory 
requirements, including relevant provisions of the Medicare, Medicaid, 
and SCHIP Benefits Improvement and Protection Act of 2002 (BIPA) and 
changes arising from our continuing experience with this system. It 
also described proposed changes to the amounts and factors used to 
determine the payment rates for Medicare hospital outpatient services 
paid under the PPS. The changes applied to services furnished on or 
after January 1, 2002.
    [sbull] 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.
    [sbull] 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.
    [sbull] 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.
    [sbull] 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.
    [sbull] 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.
    [sbull] On August 9, 2002, we published a proposed rule (67 FR 
52092) that would revise the OPPS to implement applicable statutory 
requirements and changes arising from our continuing experience with 
this system. The changes would be applicable to services furnished on 
or afterJanuary 1, 2003. This rule also proposed 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.

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, 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.

D. Summary of Changes in the August 9, 2002 Proposed Rule

1. Changes Relating to the OPPS
    On August 9, 2002, we published a proposed rule (67 FR 52092) that 
set forth proposed changes to the Medicare hospital OPPS and CY 2003 
payment rates including changes used to determine these payment rates. 
The following is a summary of the major changes that we proposed and 
the issues we addressed in the August 9, 2002 proposed rule.
    a. Changes Required By Statute
    We proposed the following changes to implement statutory 
requirements:
    [sbull] Add APCs, delete APCs, and modify the composition of some 
existing APCs.
    [sbull] Recalibrate the relative payment weights of the APCs.
    [sbull] Update the conversion factor and the wage index.
    [sbull] Revise the APC payment amounts to reflect the APC 
reclassifications, the recalibration of payment weights, and the other 
required updates and adjustments.
    [sbull] 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
    We proposed the following additional changes to the OPPS and 
Payment Suspension Provisions:
    [sbull] Creation of new evaluation and management service codes for 
outpatient clinic and emergency department encounters for 
implementation no earlier than January 1, 2004.
    [sbull] Changes to the list of services that we do not pay in 
outpatient departments because we define them as inpatient only 
procedures.
    [sbull] Changes to our policy of nonpayment for procedures on the 
inpatient only list in special cases involving death or transfer before 
inpatient admission.
    [sbull] Changes to our policy governing observation in cases of 
direct admission to observation.
    [sbull] Changes to status indicators for Healthcare Common 
Procedure Coding System (HCPCS) codes.
    [sbull] Changes to our policies governing dialysis for end-stage 
renal disease (ESRD) patients and regarding partial hospitalization.
    C. Changes to the Regulations Text
    A. We proposed to make the following changes to our regulations:
    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.
    2. Changes Relating to Payment Suspension for Unfiled Cost Reports

[[Page 66721]]

    We proposed 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.

E. Summary of the November 2, 2001 Interim Final Rule with Comment 
Period

    On November 2, 2001, we published an interim final rule with 
comment period in the Federal Register (66 FR 55850) that set forth the 
criteria for establishing new categories of medical devices eligible 
for transitional pass-through payments under Medicare's hospital OPPS 
as required by section 1833(t)(6)(B)(ii) of the Act, as amended by 
BIPA.
    In the April 7, 2000 final rule with comment period (65 FR 18480), 
we defined new or innovative devices using eight criteria, three of 
which were revised in our August 3, 2000 interim final rule with 
comment period (65 FR 47673-74). These criteria remained applicable 
when defining a new category for devices, (that is, devices to be 
included in a category must meet all previously established applicable 
criteria for a device eligible for transitional pass-through payments) 
but we revised the definition of an eligible device to conform the 
requirements of amended section 1833(t)(6)(B)(ii) of the Act.
    We also clarified our criterion that states that a device must be 
approved or cleared by the Food and Drug Administration (FDA).
    In establishing the criteria for establishing additional 
categories, the Act mandates that new categories be established for 
devices that were not being paid for as an outpatient hospital service 
as of December 31, 1996 and for which no categories in effect (or 
previously in effect) are appropriate, in such a way that no device is 
described by more than one category and the average cost of devices to 
be included in the category is not insignificant in relation to the APC 
payment amount for the associated service. Based on these requirements, 
we used the following criteria to establish a category of devices:
    [sbull] Substantial clinical improvement. The category describes 
devices that demonstrate a substantial improvement in medical benefits 
for Medicare beneficiaries compared to the benefits obtained by devices 
in previously established categories or other available treatments, as 
described in regulations at new Sec.  419.66(c)(1).
    [sbull] Cost. We determine that the estimated cost to hospitals of 
the devices in a new category (including any candidate devices and the 
other devices that we believe will be included in the category) is 
``not insignificant'' relative to the payment rate for the applicable 
procedures.
    We received five timely items of correspondence on the November 2, 
2001 interim final rule with comment period. Summaries of the public 
comments and our responses to those comments are set forth below under 
the appropriate section heading of this final rule with comment period.

F. Public Comments and Responses to the August 9, 2002 Proposed Rule

    We received approximately 1,000 timely items of correspondence 
containing multiple comments on the August 9, 2002 proposed rule. Of 
that total, we received eight comments relating to the payment 
suspension provision described in section I.D.2. Summaries of the 
public comments received on other provisions and our responses to those 
comments are provided below in section I.F.2 of this preamble.
1. OPPS
    We received comments from various sources including but not limited 
to health care facilities, physicians, drug and device manufacturers, 
and beneficiaries. Hospital associations and the Medicare Payment 
Advisory Commission (MedPAC) generally supported our proposed approach 
to revising the relative weights and incorporating the drugs and 
devices into payment for APCs. Pharmaceutial and medical device 
manufacturers and some individual hospitals that furnish particular 
devices or drugs were concerned with the proposed reductions in payment 
for medical devices and drugs. We received many thoughtful comments 
from a wide range of commenters with regard to methodological issues in 
OPPS. In addition, several comments provided data to support their 
assertions. The following are the major OPPS related issues addressed 
by the commenters:
    [sbull] Expiration of pass-through payment for most devices and 
drugs/biologicals.
    [sbull] Extent of reduction in payments for devices compared to 
payments in 2002.
    [sbull] Potential impact on access to care of proposed payments.
    [sbull] The proposal to package drugs with a per line cost less 
than $150 and to pay separately for others.
    [sbull] Assignment and reassignment of codes to APCs (including 
assignments to procedural APCs from new tech APCs).
    [sbull] Quality, quantity and content of claims data used to set 
payment weights.
    [sbull] Continuation of a list of procedures that are not paid 
under OPPS because we believe that they should be performed as 
inpatient services.
    [sbull] Policy on payment for outpatient observation care.
    [sbull] Creation of evaluation and management codes for OPPS use.
    Summaries of the public comments received and our responses to 
those comments are set forth below under the appropriate headings of 
this final rule with comment period.
2. Payment Suspension for Unfiled Cost Reports
Comments and Responses
    Comment: All of the commenters stated that the rule provides for 
increased flexibility and a reduction in the financial impact of 
payment suspensions on providers. They indicated the increased 
flexibility would allow providers to receive partial payments from 
Medicare, which would lessen the financial impact of payment 
suspensions.
    Response: We appreciate the hospital associations supporting this 
change.
    Comment: One commenter suggested that payment suspension be limited 
to those payments directly determined by the cost report.
    Response: We believe that immediate suspension of all payments when 
a cost report is not filed timely may not always be the appropriate 
response. However, if we require a provider to file a cost report, it 
is important for the cost report to be filed in a timely manner 
regardless of the amount of payment that is determined based on the 
cost report. We need flexibility in determining the amount of a 
provider's payments to suspend if its cost report is not filed timely. 
This could include the potential suspension of payments that are not 
determined by the cost report. Thus, we will retain Sec.  405.371 of 
the regulation as set forth in the proposed rule.

II. 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

[[Page 66722]]

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 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.''
    For purposes of the proposed rule and for this final rule with 
comment period, we analyzed the APC groups 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 Web 
site. We convened the second meeting of the Panel on January 22 through 
January 24, 2002.
2. General Issues Considered by the Advisory Panel
    In the proposed rule, we summarized 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 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, 
upon the Panel's recommendation, the Research Subcommittee was 
established during the 2001 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:
    [sbull] Name, address, and telephone number of the proposed 
presenter.
    [sbull] Financial relationship(s), if any, with any company whose 
products, services, or procedures are under consideration.
    [sbull] CPT codes involved.
    [sbull] APC(s) affected.
    [sbull] Description of the issue.
    [sbull] Clinical description of the service under discussion, with 
comparison to other services within the APC.
    [sbull] Description of the resource inputs associated with the 
service under discussion, with a comparison to resource inputs for 
other services within the APC.
    [sbull] Recommendations and rationale for change.
    [sbull] 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

[[Page 66723]]

 
32201.....................................  Drain, precut, lung lesion
33967.....................................  Insert a precut 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
------------------------------------------------------------------------

    As the Panel recommended, we solicited comments and additional 
information from hospitals and medical specialty societies that have an 
interest in these procedures. At their 2003 meeting, the Panel also 
recommended that we present to them 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. We agreed with the Panel's 
recommendation and we proposed to remove 47001 from the inpatient list. 
We further proposed to assign it status indicator ``N'' so that costs 
associated withCPT code 47001 would be packaged into the APC payment 
for the primary procedure performed during the same operative session.
    In section II.B.5 of the proposed rule, we discussed additional 
procedures, which were not considered by the Panel, that we proposed to 
remove from the inpatient list. We discussed in detail our reasons for 
proposing these additional changes, and we proposed 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 of the proposed rule lists all the procedures we 
proposed to remove from the inpatient list, including those discussed 
by the Panel. We considered 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 were not able to confirm that this procedure is being 
performed on Medicare beneficiaries in an outpatient setting. We 
solicited comments, including clinical data and specific case reports, 
which would support payment for CPT 33967 under the OPPS.
    Our discussion of the comments we received on this issue, our 
response and the statement of final action regarding what services to 
remove from the inpatient list is contained in section II.B.5.

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.
    The Subcommittee made the following recommendations to the Panel, 
which the Panel approved:
    [sbull] 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.
    [sbull] 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.
    [sbull] 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 agreed with that suggestion. In section II.B.4 of the proposed 
rule, we described how we determined the number of single claims used 
to set the APC relative weights proposed for 2003 using this 
methodology. We requested comments on our methodology.
    Discussion of the comments we received on this issue, our 
responses, and the statement of final action are contained in section 
III.A.
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.
    In the proposed rule, we discussed why we package the costs of 
certain procedures. We specified for example, that ``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)

[[Page 66724]]

would be returned to the provider for correction and resubmission.
    Also, we explained that 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.
    After hearing the requests of several presenters, (details 
discussed at 66 FR 52098 of the proposed rule) 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.
    Our discussion of the comments we received on this issue, our 
responses and a statement of final action is contained in section 
III.B.
Add-On Codes
    As discussed in the proposed rule (66 FR 52098), 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. 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 proposed 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 proposed 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 the proposed rule, we summarized the issues considered by the 
Panel, the Panel's APC recommendations and our subsequent action with 
regard to the Panel's recommendations. 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. In the proposed rule, we provided a detailed 
summary of the Panel discussion and recommendations (67 FR 52098-
52102). See the proposed rule for more details regarding these 
discussions. 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 Addendum 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 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:
    [sbull] Move CPT codes 95858, 95921, and 95922 from APC 215 to APC 
218.
    [sbull] Move CPT code 95930 from APC 216 to APC 218.
    [sbull] Move CPT code 92275 from APC 216 to APC 231.
    [sbull] Move CPT code 95920 from APC 218 to APC 216.
    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
    We discussed the Panel's recommendations related to facility coding 
for clinic and emergency department visits are discussed below, in 
(section X.A of this rule).
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.
    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 proposed further changes for the Panel's 
consideration next year.
    We proposed 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

[[Page 66725]]

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:
    [sbull] Move CPT codes 65260 and 67218 from APC 237 to 236.
    [sbull] Create a new APC (Level IV Posterior Segment Eye 
Procedures) by moving CPT codes 67107, 67112, 67040, and 67108 from APC 
237.
    [sbull] Move CPT codes 67145, 67105, and 67210 from APC 247 to APC 
248.
    [sbull] Move CPT code 66999 from APC 247 to APC 232.
    [sbull] Move CPT code 67299 from APC 248 to APC 235.
    [sbull] Move CPT codes 65855, 66761, and 66821 from APC 248 to APC 
247.
    [sbull] Move CPT code 67820 from APC 698 to APC 230.
    [sbull] Move CPT code 67208 from APC 231 to APC 235.
    [sbull] Move CPT codes 92226, 92284, 65205, 92140 from APC 231 to 
APC 698.
    [sbull] Move CPT code 92235 from APC 231 to APC 699.
    [sbull] Move CPT code 68100 from APC 233 to APC 232.
    [sbull] Move CPT code 65180 from APC 233 to APC 234.
    [sbull] Create a new APC (Level IV Anterior Segment Eye Procedures) 
by moving CPT codes 66172, 66185, 66180, 66225 from APC 234.
    [sbull] 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 
proposed to accept the Panel's recommendations. We noted in the 
proposed rule 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 proposed to accept the Panel's recommendations because they result 
in more clinically coherent APCs. We solicited comments on further 
changes that would address the violations of the 2 times rule.

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 were inaccurate. These 
APCs were on the 2002 agenda in order to obtain further comment on our 
cost data. We suggested no changes in the structure of these APCs.
    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 IV.D of this rule, we discussed 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 proposed not to accept the Panel's recommendation to 
change current OPPS payment policy for transfusions.
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 proposed 
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 
proposed 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 proposed 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 agreed 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 proposed 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 proposed to continue to work with hospitals to develop 
appropriate coding

[[Page 66726]]

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 proposed 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 proposed 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
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 proposed to move the procedures in APCs 144 and 145 to 
APC 147 with the exception of CPT code 46600, Anoscopy; diagnostic, 
which we proposed 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 proposed 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. Based on 2001 claims data, we proposed to make several 
changes in order to resolve 2 times rule violations and to make these 
APCs more clinically coherent. Specifically, we proposed 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 proposed to move CPT codes 78627, 76825, and 93320 from APC 0269 
to new APC 0671 to achieve more clinical coherence. We also proposed 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 proposed 
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 solicited 
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
PC 694: Level III Excision/Biopsy

    Based on 2001 claims data, we proposed to move several codes from 
APC 19 to APC 20 and several codes from ACP 20 to APC 21. Additionally, 
we proposed to move CPT codes 11770, 54105, and 60512 to APC 22. We 
also proposed 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 proposed 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 proposed 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 the final list of codes to be moved from APC 26 to APC 25 or APC 
27.

   Table 1.--HCPCS Codes to be Moved From APC 26 Into APC 25 or APC 27
------------------------------------------------------------------------
                                                           2003    2003
                       2002 APC 26                        APC 25  APC 27
------------------------------------------------------------------------
11960...................................................  ......   11960
11970...................................................  ......   11970
12037...................................................   12037  ......
12047...................................................   12047  ......
12057...................................................   12057  ......
13150...................................................   13150  ......
13160...................................................  ......   13160
14000...................................................  ......   14000
14001...................................................  ......   14001

[[Page 66727]]

 
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
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 proposed 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.
    We are adopting the changes discussed in the proposed rule as final 
except as noted in our discussion of specific APC changes in section 
II.B, below.

B. Other Changes Affecting Ambulatory Payment Classification (APC) 
Assignments

    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 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 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:
    [sbull] Resource homogeneity.
    [sbull] Clinical homogeneity.
    [sbull] Hospital concentration.
    [sbull] Frequency of service (volume).
    [sbull] Opportunity for upcoding and code fragmentation.
For a detailed discussion of these criteria, refer to the April 7, 
2000, final rule (65 FR 18457).
    We received several comments on this proposal. A summary of these 
comments and our responses are provided below.
    Comment: One commenter recommended that we move CPT code 47556 
(Biliary endoscopy with dilation of biliary stricture with stent) from 
APC 0152 to APC 0153 because its placement in APC 0152 violated the 2 
times rule.
    Response: We will not make any changes at this time, but we will 
present this issue to the APC Advisory Panel. We do not use low-volume 
procedures in determining whether an APC violates the 2 times rule 
because there is a high potential for miscoding of such procedures and 
because our cost data is less reliable. The cost data that we do have 
for CPT 47556 indicates that APC 0152 is appropriate.
    Comment: Several commenters thanked us for creating a separate APC 
for Computed Tomographic Angiography (CTA) but requested that we not 
use claims data to develop a payment rate. These commenters asserted 
that our claims data was faulty because hospitals had not developed 
specific charges for CTA and were using charges for other Computed 
Tomography (CT) when billing for CTA. They recommended that we use 
either the relative ratio of charges from hospitals that billed CTA at 
a higher rate than CT and use that ratio to determine a payment rate 
for CTA, or use a proxy model that the commenter had developed.
    Response: Our payment rates for CT and CTA are different and our 
claims data indicates that CTA costs more than CT. Using claims data 
only from hospitals that charge more for CTA than CT is inappropriate, 
and the proxy model has not been validated. Therefore, we will update 
our payment for CTA next year based on 2002 claims data.
    Table 2 contains the final list of APCs that we 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 Web site: http://www.cms.hhs.gov.

           Table 2.--Table of APCs Exempted From 2 Times Rule
------------------------------------------------------------------------
                  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

[[Page 66728]]

 
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
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 will move several procedures from new 
technology APCs to clinical APCs. Those procedures and the clinical 
APCs to which we are assigning the procedures for payment in 2003 are 
identified in Table 3. Based upon our review of the 2001 outpatient 
prospective payment system (OPPS) claims data, we believe that 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. In the proposed rule at 67 
FR 52103, we discuss the procedures that we followed to make this 
determination. In some cases we proposed 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 
proposed 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 
solicited comments on our proposed reassignment of the new technology 
procedures listed in Table 3 of the proposed rule (67 FR 52103-52104).
    We received several comments on this proposal which are summarized 
below.
    Comment: Several commenters brought to our attention that, as a 
result of moving codes for proton beam radiation therapy out of APC 
0710 and APC 0712 (new technology codes) and into APC 0664 (Proton beam 
radiation therapy), simple treatments would receive a higher payment 
while intermediate and complex treatments would receive a lower 
payment. Commenters requested that these codes remain in APCs 0710 and 
0712 or be split into separate APCs.
    Response: We thank the commenters for bringing this to our 
attention, and we agree that codes for simple proton beam radiation 
therapy (CPT 77522 and CPT 77520) should be placed in a different APC 
than codes for intermediate (CPT 77523) and complex (CPT 77525) 
radiation therapy. However, it would be inappropriate to return these 
codes to their previous new technology APCs (0712 and 0712) due to our 
having sufficient claims data to place them in their own APCs. 
Therefore, we will place codes for simple radiation therapy (CPTs 77522 
and 77520) in APC 0664 and codes for intermediate (CPT 77523) and 
complex (CPT 77525) therapy in the newly created APC 0650.
    Comment: Numerous commenters expressed concern over the movement of 
HCPC G0173 (Stereo radiosurgery, complete) from APC 0721 (New 
Technology Level XV $5,000-$6,000) to APC 0663 (Stereotactic 
radiosurgery), resulting in lower payment. Commenters requested that 
HCPCS G0173 be returned to APC 0721 (New Technology Level XV $5,000-
$6,000) because our current data includes both linear accelerator and 
multi source treatments.
    Response: We agree with commenters and have returned HCPC G0173 
(Stereotactic radiosurgery, complete) to APC 0721 (New Technology Level 
XV $5,000-$6,000). We will review our claims data for next year's 
proposed rule to determine appropriate placement for all stereotactic 
radiosurgery procedures.
    Comment: Many commenters brought to our attention that G0251 
(Stereotactic radiotherapy, multisession) was erroneously omitted from 
the proposed rule. Commenters asserted that G0251 differs substantially 
from G0173 and G0243, and they requested that G0251 be reinstated and 
placed in an APC that pays more than APC 0721 (New Technology Level XV 
$5,000-$6,000).
    Response: We thank the commenters for bringing this to our 
attention, and we agree that the elimination of G0251 in the proposed 
rule was in error. However, we do not agree with the

[[Page 66729]]

placement of G0251 in an APC that pays more than APC 0721 (New 
Technology Level XV $5,000-$6,000). Although there are significant 
fixed costs for all stereotactic radiosurgery procedures, our review of 
cost data does not show that our current APC assignment for G0251 (APC 
713) is inappropriate. We will review the APC assignments for all 
stereotactic radiosurgery procedures next year when we have 2002 claims 
data available.
    Comment: A commenter expressed concern over the bundling of 
payments for CPT 77370 (Special medical radiation physics consultation) 
and CPT 77336 (Continuing medical physics consultation) into code G0242 
(Multisource photon stereotactic plan) based on the understanding that 
G0242 is unrelated to CPT 77370 and CPT 77336. The commenter requested 
that CPT 77370 and CPT 77336 be unbundled from G0242.
    Response: We want hospitals to bill all resources associated with 
G0242 in one code. G0242 includes the work of a physicist and other 
staff, therefore it is appropriate that the resources used for CPT 
77370 and CPT 77336 remain bundled with G0242. Separate payment for 
77370 and 77336 would result in duplicate payment.
    Comment: Many commenters expressed concern that FDG PET procedures 
are moving to a new clinical APC 0667 (Nonmyocardial positron emission 
tomography) with a payment of $971--a reduction of $404. The commenters 
asserted that although the proposed rule would continue separate pass-
through payment for FDG (in APC 1775), the proposed new payment would 
not cover the cost of the PET procedure and would undermine access to 
care.
    Response: We agree that our claims data may not accurately reflect 
the cost of FDG PET procedures.
    On June 29, 2001, CMS announced its intention to issue a national 
coverage determination (NCD) limiting the type of technology that can 
be used to perform Medicare-covered PET scans. This NCD became 
effective January 1, 2002. We believe that our claims data includes a 
significant number of PET scans performed on coincidence cameras that 
are no longer covered by Medicare. This could have the effect of 
lowering the median cost as compared to our future claims data that 
will reflect (due to the NCD) only the use of full-ring or partial-ring 
PET scanners. For this reason, until we are confident that our claims 
data reflects the predominant use of dedicated PET scanners, we will 
continue to pay for FDG PET in APC 714 (New Technology--Level IX $1250-
$1500) until further review of claims data for the 2004 final rule.
    Comment: A commenter expressed concern about our proposal to 
reassign digital mammography from New Technology APC 0707 to a clinical 
APC (0699). Commenters recommended that we retain the assignment to New 
Technology APC 0707 for 1 more year until further data analysis can be 
performed.
    Response: We disagree with the commenter. Hospitals billed for 
approximately 7,000 occurrences of digital mammography in 2001, 
providing us with sufficient data upon which to calculate a median 
cost.
New Technology APC Issues
    Comment: A manufacturer was pleased that we designated endometrial 
cryoablation as eligible for new technology service APC payment, but 
was displeased at the delay in reaching our decision as well as the 
specific new technology service APC in which the service was placed. We 
proposed to place endometrial cryoablation into new technology service 
APC 980, which has a payment rate of $1,875. The commenter contended 
that endometrial cryoablation has similar resource costs as 
cryoablation of the prostate and should be assigned to new technology 
service APC 984, at $4,250, which would cover the cost of a 
cryoablation probe also. It provided a brief cost analysis from a 
single major medical center.
    Response: We assigned endometrial cryoablation into new technology 
service APC 980 based on cost data submitted.
New Technology APC for Preview Planning Software
    Comment: A manufacturer commented on our proposal to reassign the 
procedure related to Preview Treatment Planning Software (C9708) from 
its current APC 975, which pays $625, to APC 973, which pays $250. The 
manufacturer of Preview asserted that its sales records, which it 
provided, demonstrate that the cost to hospitals of providing Preview 
support the assignment of APC 975. It contended that we must have based 
the new APC assignment on faulty claims data.
    Response: For the final rule, we had access to a larger number of 
claims for C9708, and we have moved it back to APC 975.
    Comment: A manufacturer was pleased that we designated endometrial 
cryoablation as eligible for new technology service APC payment, but 
was displeased at the delay in reaching our decision as well as the 
specific new technology service APC in which the service was placed. We 
proposed to place endometrial cryoablation into new technology service 
APC 980, which has a payment rate of $1,875. The commenter contended 
that endometrial cryoablation has similar resource costs as 
cryoablation of the prostate and should be assigned to new technology 
service APC 984, at $4,250, which would cover the cost of a 
cryoablation probe also. It provided a brief cost analysis from a 
single major medical center.
    Response: We assigned endometrial cryoablation into new technology 
service APC 980 based on cost data submitted.
    Table 3 below is the final list of Healthcare Common Procedure 
Coding System (HCPCS) reassignments of new technology procedures.

           Table 3.--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 precut w/device  S               T                   0710      0658
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.

[[Page 66730]]

 
77523............................  Proton trmt, intermediate  S               S                   0712      0664
77525............................  Proton treatment, complex  S               S                   0712      0664
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, per   T               T                   0972      0678
                                    tx.
G0168............................  Wound closure by adhesive  T               X                   0970      0340
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 dxlung   S               S                   0714      0667
                                    ca.
G0211............................  PET img whbd ring init     S               S                   0714      0667
                                    lung.
G0212............................  PET img whbd ring restag   S               S                   0714      0667
                                    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 restag   S               S                   0714      0667
                                    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 dx   S               S                   0714      0667
                                    hea.
G0224............................  PET img whbd reg ring ini  S               S                   0714      0667
                                    hea.
G0225............................  PET img whbd ring restag   S               S                   0714      0667
                                    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; gamma   S               S                   0714      0667
                                    cam.
G0233............................  PET WhBD melanoma; gamma   S               S                   0714      0667
                                    cam.
G0234............................  PET WhBD pulm nod, gamma   S               S                   0714      0667
                                    cam.
----------------------------------------------------------------------------------------------------------------

3. APC Assignment for New Codes Created During Calendar Year (CY) 2002 
and Selected Codes and APC Assignments for 2003
    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, we opened the 
assignments to public comment in the proposed rule. In addition, in the 
proposed rule, we proposed to create several new HCPCS codes and APC 
assignments with an effective date of January 1, 2003 and we solicited 
comments on these proposed codes and proposed APC assignments. 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 will implement in 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.

                Table 4.--New G Codes for 2002 and 2003 for Which There Are Final APC Assignments
----------------------------------------------------------------------------------------------------------------
             Code                             Long descriptor                Effective      Final APC       SI
----------------------------------------------------------------------------------------------------------------
G0245.........................  Initial physician evaluation and               7/1/2002  0600                  V
                                 management of a diabetic patient with
                                 diabetic sensory neuropathy resulting in
                                 a loss of protective sensation (LOPS)
                                 which must include: 1. The diagnosis of
                                 LOPS, 2. A patient history, 3. A physical
                                 examination that consists of at least the
                                 following elements: (a) Visual inspection
                                 of the forefoot, hindfoot, and toe web
                                 spaces, (b) Evaluation of a protective
                                 sensation, (c) Evaluation of foot
                                 structure and biomechanics, (d)
                                 Evaluation of vascular status and skin
                                 integrity, and (e) Evaluation and
                                 recommendation of footwear. 4. Patient
                                 education.

[[Page 66731]]

 
G0246.........................  Follow-up physician evaluation and             7/1/2002  0600                  V
                                 management of a diabetic patient with
                                 diabetic sensory neuropathy resulting in
                                 a LOPS to include at least the following:
                                 1. A patient history. 2. A physical
                                 examination that includes: (a) Visual
                                 inspection of the forefoot, hindfoot, and
                                 toe web spaces, (b) Evaluation of
                                 protective sensation, (c) Evaluation of
                                 foot structure and biomechanics, (d)
                                 Evaluation of vascular status and skin
                                 integrity, and (e) Evaluation and
                                 recommendation of footwear. 3. Patient
                                 education.
G0247.........................  Routine foot care by a physician of a          7/1/2002  0009                  T
                                 diabetic patient with diabetic sensory
                                 neuropathy resulting in a loss of
                                 protective sensation (LOPS) to include if
                                 present, at least the following: (1)
                                 local care of superficial wounds, (2)
                                 debridement of corns and calluses, and
                                 (3) trimming and debridement of nails.
G0248.........................  Demonstration, at initial use, of home INR     7/1/2002  0708                  S
                                 monitoring for patient with mechanical
                                 heart valve(s) who meets Medicare
                                 coverage criteria, under the direction of
                                 a physician; includes: demonstrating 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 patient
                                 ability to perform testing.
G0249.........................  Provision of test materials and equipment      7/1/2002  0708                  S
                                 for home INR monitoring to patient with
                                 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, interpretation and           7/1/2002  N/A                   E
                                 patient management of home INR testing
                                 for a patient with mechanical heart
                                 valve(s) who meets other coverage
                                 criteria; per 4 tests (does not require
                                 face-to-face service).
G0252.........................  PET imaging, full and partial-ring PET        10/1/2002  0714                  S
                                 scanners only, for initial diagnosis of
                                 breast cancer and/or surgical planning
                                 for breast cancer (e.g., initial staging
                                 of axillary lymph nodes).
G0253.........................  PET imaging for breast cancer, full and       10/1/2002  0714                  S
                                 partial-ring PET scanners only, staging/
                                 restaging of local regional recurrence or
                                 distant metastases (i.e., staging/
                                 restaging after or prior to course of
                                 treatment).
G0254.........................  PET imaging for breast cancer, full and       10/1/2002  0714                  S
                                 partial-ring PET scanners only,
                                 evaluation of response to treatment,
                                 performed during course of treatment.
G0255.........................  Current perception threshold/sensory nerve    10/1/2002  N/A                   E
                                 conduction test, (sNCT) per limb, any
                                 nerve.
G0258.........................  Intravenous infusion during separately         1/1/2003  0340 Deleted          X
                                 payable observation stay, per observation                with 90-day
                                 stay (must be reported with G0244).                      grace period
G0257.........................  Unscheduled or emergency dialysis              1/1/2003  0170                  S
                                 treatment for an ESRD patient in a
                                 hospital outpatient department that is
                                 not certified as an ESRD facility.
G0259.........................  Injection procedure for sacroiliac joint;      1/1/2003  N/A                   N
                                 arthrography.
G0260.........................  Injection procedure for sacroiliac joint;      1/1/2003  0204                  T
                                 provision of anesthetic, steroid and/or
                                 other therapeutic agent and arthrography.
G0256.........................  Prostate brachytherapy using permanently       1/1/2003  0649                  T
                                 implanted palladium seeds, including
                                 transperitoneal placement of needles or
                                 catheters into the prostate, cystoscopy
                                 and application of permanent interstitial
                                 radiation source.
G0261.........................  Prostate brachytherapy using permanently       1/1/2003  684                   T
                                 implanted iodine seeds, including
                                 transperitoneal placement of needles or
                                 catheters into the prostate, cystoscopy
                                 and application of permanent interstitial
                                 radiation source.
G0263.........................  Direct admission of patient with diagnosis     1/1/2003  N/A                   N
                                 of congestive heart failure, chest pain
                                 or asthma for observation.
G0264.........................  Initial nursing assessment of patient          1/1/2003  0600                  S
                                 directly admitted to observation with
                                 diagnosis other than congestive heart
                                 failure, chest pain, or asthma.
G0290.........................  Transcatheter placement of a drug eluting      1/1/2003  0656                  E
                                 intracoronary stent(s), percutaneous,
                                 with or without other therapeutic
                                 intervention, any method; single vessel.
G0291.........................  Transcatheter placement of a drug eluting      1/1/2003  0656                  E
                                 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 G0252-G0255 were established October 1, 
2002, as a result of national coverage policies that became effective 
October 1, 2002. These codes were created to accurately describe the 
services covered, to ensure that they were reported correctly, to track 
their utilization, and to establish payment. We solicited 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 did not receive any comments on the codes or APC assignments for 
G0245, G0246, G0247, G0248, G0249, G0250, or G0255. Therefore, we are 
finalizing them as shown.
    We are also finalizing APC assignments for G0252, G0253, and G0254. 
The comments and responses for these services are discussed elsewhere 
in this preamble.
    We implemented HCPCS code G0258 (Intravenous Infusion(s) During 
Separately Payable Observation Stay)

[[Page 66732]]

effective October 1, 2002, to describe infusion therapy given during a 
separately payable observation stay. We assigned it to APC 0340 because 
we believed APC 0340 appropriately accounts for the resources used for 
infusion during observation. As discussed in section X.B, we received 
many comments opposing creation of this code. Therefore, we will delete 
it effective January 1, 2003.
New HCPCS Codes for January 1, 2003, for Which We Proposed APC 
Assignments in the August 9, 2002 Proposed Rule
    In the August 9, 2002, proposed rule, we proposed to create several 
new HCPCS codes for 2003 to address issues that have come to our 
attention, to describe new technology procedures, to implement policy 
proposals discussed in the rule, and to allow more appropriate 
reporting of procedures currently described by (physician's) current 
procedural terminology (CPT) (HCPCS Level I) codes. The codes we 
proposed are as follows:
    (1) G0FFF--Bone Marrow Aspiration and Biopsy Services--we proposed 
to create this code to describe bone marrow aspiration and biopsy 
performed through the same incision. We proposed 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 FR 43846). This code would facilitate proper reporting of 
this procedure.
    As discussed under general comments and responses below, we 
received many comments that objected to the proliferation of G codes 
for the services for which the CPT or HCPCS level II process could be 
used to create a code. After review of the comments, we agree that this 
code should go through the CPT process. Therefore, we have not 
implemented the G code we proposed. We will instead, submit a code for 
``Bone Marrow Biopsy and Aspiration Performed in the Same Bone'' to CPT 
in time for the 2004 CPT code cycle.
    (2) G0257--Unscheduled and Emergency Treatment for ESRD Patients--
we proposed this code to facilitate payment for dialysis provided to 
ESRD patients in the outpatient department of a hospital that does not 
have a certified ESRD facility. The comments, responses, and final 
action regarding these services are discussed in section X.F of this 
rule.
    (3) G0259 and G0260--Sacroiliac Joint Injections--we proposed 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 for 
imaging 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 proposed to 
create G0259, Injection procedure for sacroiliac joint, arthrography, 
and G0260, Injection procedure for sacroiliac joint, provision of 
anesthetic and/or steroid. We proposed to give G0259 status indicator 
N, and we proposed to assign G0260 to APC 0204.
    Comment: Many commenters raised concern over nonpayment for 
sacroiliac joint injections. The commenter brings to our attention that 
when a sacroiliac joint injection, CPT code 27096 (Injection procedure 
for sacroiliac joint, arthrography and/or anesthetic steroid), is 
performed for anesthetic/steroid purposes, the procedure is not being 
paid since the costs are only packaged into the arthrography imaging 
component.
    Response: We appreciate this concern and agree with the commenter 
that payment should be made for sacroiliac joint injections when 
administered for anesthetic/steroid purposes. Therefore, in order to 
facilitate appropriate reporting and payment for the procedures 
described by CPT code 27096 (Injection procedure for sacroiliac joint, 
arthrography and/or anesthetic steroid), we have created the following 
new G-codes to replace CPT code 27096: G0259 (Injection procedure for 
sacroiliac joint, arthrography) and G0260 (Injection procedure for 
sacroiliac joint, provision of anesthetic and/or steroid). G0259 has 
been given status indicator N, and G0260 has been assigned to APC 0204.
    (4) G0KKK--Prostate Brachytherapy--we proposed this code to 
implement our policy decision discussed in section III.C.3 of the 
proposed rule (section IV.E of this rule). As a result of comments we 
created two new codes G0256 and G0261. See section IV.E. for the 
discussion of prostate brachytherapy.
    (5) G0263 and G0264--Observation Care--we proposed 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. We discussed these codes in detail in section VIII.B 
of the proposed rule. Our discussion of the final action, comments, and 
responses is contained in section X.B of this rule.
    (6) G0290, G0291; Drug Eluting Stents--We discuss these codes in 
the immediately following section.
Drug-Eluting Stents
    In the August 9, 2002 proposed rule, we discussed the exceptional 
circumstances that led us to propose a departure from our standard OPPS 
payment methodology as we have done under the inpatient PPS for Federal 
fiscal year (FY) 2003 (67 FR 50003-50005). We made this unusual 
proposal 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 proposed 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 an illness or injury as determined by 
Medicare contractors based on the specifics of individual cases.
    The new HCPCS codes that we proposed are as follows:
    G0290--Transcatheter placement of a drug eluting intracoronary 
stent(s), percutaneous, with or without other therapeutic intervention, 
any method; single vessel
    G0291--Transcatheter placement of a drug eluting intracoronary 
stent(s), percutaneous, with or without other therapeutic intervention, 
any method; each additional vessel
    We proposed to assign G0290 and G0291 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 proposed 
to apply the same assumptions that we used in establishing the weights 
for diagnosis-related group (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

[[Page 66733]]

rule implementing the FY 2003 inpatient PPS. That is, we assume a price 
differential of approximately $1,200 when drug-eluting stents are used. 
We assumed an average of 1.5 stents per procedure, and we proposed to 
add $1,200 to the median costs established for APC 0104 based on 2001 
claims data to determine the payment rate for APC 656. We proposed to 
calculate a relative payment weight and payment rate for APC 0656 in 
accordance with the methodology that we discuss in section III.B. of 
this preamble.
    We proposed 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. Such claims may qualify for outlier payments.
    We proposed 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. In the proposed 
rule, we invited comments on this proposed methodology for recognizing 
the additional costs of drug-eluting stents under the OPPS.
    Comment: All of the commenters who addressed our payment proposal 
for drug-eluting stents supported our taking proactive steps to create 
an APC for this new technology in anticipation of FDA approval by April 
2003. However, most of the commenters expressed concern about the level 
of payment proposed for APC 656, stating that $1,200 significantly 
understates the added cost of the drug-eluting stents. One commenter 
suggested that indications from the market are projecting a cost of 
$2,000 per stent. Another commenter cited vendors who indicate that 
drug-eluting stents will cost 3 times the cost of the current stent for 
an approximate cost of $3,360 each. Several commenters stated that the 
incremental cost between a bare metal and a drug-eluting stent is 
expected to be $2,000. Two commenters urged us to set the rate for APC 
656 based on the actual price difference between the current and drug-
eluting stents, and one commenter recommended setting the initial 
payment amount at a level that is 60 percent above the probable 
hospital acquisition cost. One commenter asked why we added $1,200 to 
APC 656 rather than $1,800. The basis for this request was that the 
incremental payment for inpatient care was $1,800 for an average of 1.5 
stents per procedure.
    Response: To establish a payment rate for APC 656, we proposed to 
add $1,200 to the median cost of stent insertion procedures in APC 104, 
based on assumptions that we applied to establish the weights for DRGs 
involving drug-eluting stents under the inpatient PPS. Based on the 
median cost established for APC 104 using the 2001 claims data that 
were reflected in the August 9, 2002 proposed rates, we determined that 
an additional $1,200 would offset the incremental cost of an average of 
1.5 drug-eluting stents per procedure.
    We do not agree that the incremental payment should be $1,800. 
Although it is true that 1.5 stents are typically placed per procedure, 
it is rare for two stents to be placed in one coronary artery in an 
outpatient setting. Furthermore, hospitals can bill under the OPPS a 
separate code for each vessel in which a stent is placed, unlike the 
inpatient PPS. Because hospitals will in most cases be able to report 
each stent placement separately in the outpatient setting, making an 
incremental payment of $1800 would significantly overpay for each 
stent.
    As we explain elsewhere in this preamble, the payment rates that 
this final rule implements are based on more current data than those 
that were available when we set the rates proposed in the August 9, 
2002 rule. The rates in this final rule also reflect adjustments 
intended to level the transition from rates based on pre-OPPS data and 
estimated pass-through device and drug costs to rates based entirely on 
OPPS data that reflect actual device and drug costs reported by 
hospitals.
    Comment: One commenter expressed concern about our expectation that 
a new technology must ``transform'' medical care and be the object of 
substantial demand in order to justify making an exception to our 
standard OPPS payment methodology. The commenter believes that our 
rationale for making an exception for drug-eluting stents establishes 
an almost unattainable threshold for other technologies to reach in 
order to receive similar treatment in the future. Conversely, another 
commenter expressed concern that by establishing codes and payment 
rates for drug-eluting stents, we are setting a precedent that will 
likely increase the pressure to create new temporary codes for non-
breakthrough technologies. This commenter encouraged us to maintain 
highly selective criteria when creating new codes for new technologies 
in the future.
    Response: As we explain at length in the August 9, 2002 proposed 
rule, we believe that drug-eluting stents are potentially a 
revolutionary approach to the treatment of coronary disease. 
Ordinarily, we would expect a new technology like the drug-eluting 
stent to qualify for a pass-through payment or for payment under a new 
technology APC.
    However, because the drug-eluting stent does not meet the criteria 
established for these two methods of payment for new technology under 
the OPPS, we were compelled to seek an alternative approach in order to 
ensure beneficiary access to this extraordinary new treatment, once it 
receives FDA approval, without placing an extraordinary burden on 
hospital resources. We expect that either a pass-through payment or 
assignment to a new technology APC will, in the overwhelming 
preponderance of cases, provide adequate and timely payment under the 
OPPS for new technology. We agree with the commenter who supported 
maintaining highly selective standards when establishing codes for new 
technology. The threshold for such an approach must be exceptionally 
high and applicable only in the most extraordinary and unusual cases.
    Comment: One commenter asked that we clarify how we will adjust the 
2003 OPPS payment rates if FDA approval is not given for drug-eluting 
stents by April 1, 2003. The commenter is concerned about the adverse 
effect on the rates for other services that would result from our 
having recalibrated and scaled the relative payment weights for all 
services, taking into account additional payment for drug-eluting 
stents that turns out not to be an expenditure.
    Response: We have reviewed the impact of the drug-eluting stents on 
the total recalibration exercise and determined that excluding the 
additional allowance for the drug-eluting stents would not result in a 
significant redistribution of funds for other services if FDA approval 
were not issued by April 1, 2003, triggering payment under the OPPS. We 
estimated that slightly fewer than one-third of the cases paid under 
APC 104 (approximately 5,400 procedures) would be performed using drug-
eluting stents during the three quarters of 2003 when payment would be 
made for APC 656, assuming FDA approval is issued by April 1, 2003. 
Payment for the use of drug-eluting stents represents approximately 
0.17 percent of the total APC weights. Restoration of these payments to 
the pool of weights for other services would not measurably

[[Page 66734]]

change the weights of the other APCs. Therefore, we would not revise 
the 2003 APC weights if payment for drug-eluting stents were not 
allowed beginning April 1, 2003.
    Comment: One commenter expressed concern that the general use of 
data from other countries to set the national payment rate for a new 
device in the absence of hospital claims and cost data raises long term 
issues regarding the impact this approach would have on manufacturers' 
investment and pricing strategies, both abroad and in the United 
States. The commenter recommended that we consider these issues in more 
depth.
    Response: We respond to this issue in our discussion of MedPAC 
comments in section XI.
    Comment: One commenter recommended that we carefully monitor the 
use of APCs for which the national payment rate is established based on 
pricing in countries other than the United States and the costs 
reported by hospitals for those APCs. Another commenter stated that the 
new HCPCS codes for the drug-eluting stent procedures should be 
temporary and that we should ask the CPT Editorial Board to develop 
national CPT codes as soon as possible.
    Response: As we indicated in the August 9, 2002 proposed rule, we 
intend to closely track the utilization and costs associated with the 
drug-eluting stents. We established the G-codes for the use of drug-
eluting stents precisely in order to permit us to collect these data. 
However, the cost data taken from hospital claims associated with the 
use of the drug-eluting stents will ultimately be incorporated into the 
current CPT codes for coronary stent placement. We believe that the 
current CPT codes describe the procedure adequately and that separate 
permanent codes specific to the use of drug-eluting stents are not 
necessary based on the expectation that drug-eluting stents will 
eventually become the standard of care.
    Effective for services furnished on or after April 1, 2003, 
contingent upon FDA approval of the drug-eluting stents, we are 
implementing payment under APC 656, Transcatheter Placement of Drug-
Eluting Coronary Stents, for two temporary HCPCS codes:
    G0290 Transcatheter placement of a drug-eluting intracoronary 
stent(s), percutaneous, with or without other therapeutic intervention, 
any method; single vessel.
    G0291 Transcatheter placement of a drug-eluting intracoronary 
stent(s), percutaneous, with or without other therapeutic intervention, 
any method; each additional vessel.
    Note that Table 6 and Addendum B show status indicator E for HCPCS 
codes G0290 and G0291 since payment under these codes will not be 
effective before April 1, 2001. However, we include the APC for drug 
eluting stent procedures (APC 0656) in Addendum A with the payment rate 
and status indicator of T to identify how these new codes will be paid 
once they are implemented.
    If the FDA grants approval before April 1, 2003, hospitals will be 
paid for placement of drug-eluting stents under APC 104. If the FDA 
does not grant approval by April 1, 2003, we will announce a new 
effective date for APC 0656 and for HCPCS codes G0290 and G0291 by 
Program Memorandum.
G codes for Outpatient Services Under National Clinical Trials
    We have created three new G codes for use in reporting services 
furnished in hospital outpatient departments under national clinical 
trials: G0292 Administration(s) of experimental drug(s) only in a 
Medicare qualifying clinical trial (includes administration for 
chemotherapy and other types of therapy via infusion and/or other than 
infusion), per day.
    G0293 Noncovered surgical procedure(s) using conscious sedation, 
regional, general or spinal anesthesia in a Medicare qualifying 
clinical trial, per day.
    G0294 Noncovered surgical procedure(s) using either no anesthesia 
or local anesthesia only, in a Medicare qualifying clinical trial, per 
day.
    On September 19, 2000, Medicare issued a national coverage decision 
stating that Medicare will pay for the routine costs of clinical 
trials. This policy is published as section 30-1 of Medicare's Coverage 
Issues Manual. Because the experimental intervention is not covered but 
items and services required solely because of the intervention are 
covered, we needed to identify ways to properly code for and pay for 
the routine costs when delivered in a hospital outpatient department.
    We believe that to accurately pay for the covered services 
associated with the administration of drugs as part of a clinical 
trial, we need to create a new code to allow for correct billing and 
payment for routine costs, as defined by the national coverage 
determination. Therefore, the code G0292, ``Administration(s) of 
experimental drug(s) only in a Medicare qualifying clinical trial 
(includes administration for chemotherapy and other types of therapy 
via infusion and/or other than infusion), per day,'' should be billed 
when only experimental drugs are administered as part of a Medicare 
qualifying clinical trial. When an experimental drug is being 
administered in conjunction with payable drugs or on the same day as 
payable drugs, G0292 should not be used. Instead, the appropriate drug 
administration code should be billed.
    There are also procedures that may be performed in the hospital 
outpatient department as part of a qualifying clinical trial. Because 
the intervention is not covered under Medicare's clinical trial policy, 
we need a mechanism to pay the hospital for its covered fixed costs 
associated with providing the service under the clinical trial. We have 
created two codes to allow for correct billing of procedures performed 
as the focus of qualifying clinical trials, G0293 and G0294. G0293 is 
defined as ``Noncovered surgical procedure(s) using conscious sedation, 
regional, general or spinal anesthesia in a Medicare qualifying 
clinical trial, per day,'' and G0294 is defined as ``Noncovered 
surgical procedure(s) using either no anesthesia or local anesthesia 
only, in a Medicare qualifying clinical trial, per day.''
    All three of these codes are for OPPS use only. Other provider 
types may not bill these codes.
    The interim APC assignments for G0292, G0293, and G0294 are APC 
0708, 0710, and 0707, respectively. The status indicator for these 
three codes is S. As discussed below, this APC assignment is subject to 
comment during the comment period discussed in section I of this rule.
General comments on creation and use of G codes
    Comment: Several commenters were concerned about the creation of G 
codes with long descriptors that appear complex and specific to OPPS 
rules. In addition, we received comments indicating that the hospital 
coding community was less familiar with G codes and requesting that CMS 
consider other existing code sets.
    Response: Prior to the creation of any G code, we examine 
alternative mechanisms for implementing coverage and payment policy in 
a timely fashion. In the event no other appropriate mechanism exists, 
we create a G code to allow accurate payment given applicable statutory 
and regulatory requirements. After the creation of a G code, we work 
with the American Medical Association's Current Procedural Terminology 
(CPT) Editorial Panel whenever possible to create a replacement CPT 
code. We are deleting 25 G codes this year as a result of this process. 
However, there are instances

[[Page 66735]]

where G codes cannot be converted to CPT codes due to the unique nature 
of the statutory and regulatory requirements. In these situations, we 
work to educate the provider community as to the appropriate use of 
these codes. Part of this educational effort includes the development 
of comprehensive descriptors at the time the G code is created.
    Comment: Two commenters indicated they would like to see a shorter 
timeframe between the FDA approval for a new drug and the development 
of a HCPCS code for that drug.
    Response: The FDA approval process is one source of information we 
use in reviewing new drugs. However, the FDA process does not address 
the statutory and regulatory requirements of the Medicare program. We 
perform our review of new drugs as expeditiously as possible given 
these requirements. We are conscious of the need to streamline this 
process and we will continue to seek ways to do so.
Public Comments on Interim APC Assignments for Codes New for 2003
    As discussed in section I, we are accepting public comment on the 
interim APC assignments for the new codes shown in Addendum A with the 
indicator NI. These codes are new for 2003 and the APC assignment was 
not subjected to public comment in the August 9, 2002 proposed rule. We 
are not accepting comment on APC assignments that were proposed in the 
August 9, 2002 proposed rule and are being shown as NF in Addendum B 
since they have already been subjected to public comment and are made 
final in this rule.
    Comment: Several commenters expressed concern about the increasing 
frequency of G codes issued by CMS. Commenters asserted that, in the 
interest of coding standardization, clarity, and accuracy, G codes 
should be developed only as a last resort. Commenters also stated that 
G codes sometimes overlap or duplicate other code sets. One commenter 
recommended a single, standardized process for establishment of 
temporary HCPCS Level II codes, ensuring that a duplicate or 
overlapping code is not anticipated in another coding set (for example, 
CPT).
    Response: We agree that, where appropriate, G codes should be 
temporary. Unfortunately, it is sometimes necessary to develop G codes 
to accommodate changes in legislation, regulation, coverage, and 
payment policy. Not only is the timetable for such changes inconsistent 
with the timetable for CPT publication, but frequently these changes 
must be made on a quarterly basis.
    In 2002, CMS and CPT staff, working together, reviewed all existing 
G codes and agreed to transition over 20 of them to CPT codes. 
Therefore, for 2003 many G codes will be deleted in favor of newly 
created CPT codes. We believe that an annual review of G codes by CMS 
and CPT staff is the best way to determine which G codes should be 
transitioned to CPT codes and the process to use for such a transition. 
Therefore, we plan to continue working with CPT staff on an annual 
basis to continue transitioning existing G codes to CPT codes. We 
believe such an annual, comprehensive review will address the 
commenters' concerns. However, we do wish to emphasize that CMS, where 
appropriate, does consult with interested providers prior to the 
creation of G codes in order to facilitate coding clarity and minimize 
the coding burden on hospitals.
4. Other Public Comments on APC Assignments and Payment Rates
    Comment: One commenter asked us to create three new tech APCs for 
cardiac resynchronization therapy, or, alternatively, to establish a 
new tech APC payment for placement of the left ventricular lead used in 
cardiac resynchronization therapy.
    Response: We have placed the CPT codes for left ventricular lead 
placement in new tech APCs. We believe the APC placement accounts for 
the cost of the procedure and for the lead. The cost of the guidewires 
and catheters used in the procedure will be captured in the code used 
to report placement of the pacemaker or cardioverter defibrillator and 
other leads.
    Comment: Several commenters were concerned about bundling payment 
of radiopharmaceuticals into procedures and about payment reductions 
for myocardial perfusion scanning.
    Response: Payment for most myocardial perfusion scans will increase 
in 2003 and the payment reduction for scans in APC 666 is commensurate 
with the costs of performing those procedures. The issue of packaging 
radiopharmaceuticals is discussed elsewhere in this preamble.
    Comment: A commenter expressed concern about CMS's decision to 
discontinue the pass-through category C1780 (New Technology Intraocular 
Lens (IOLs)). The commenter stated that the proposal to eliminate this 
code from pass through status and separate payment contradicts existing 
regulations.
    Response: We do not agree that our proposal contradicts existing 
regulations. We believe the commenter is referring to Sec.  141 (b) of 
the Social Security Act Amendments of 1994 (Public Law 103-432) that 
requires us to implement a process under which interested parties may 
request a review of the appropriateness of payment for IOLs furnished 
by ambulatory surgical centers (ASCs). In compliance with this 
statutory change, we published regulations concerning payment for IOLs 
in ASCs (42 CFR 416). Those regulations do not apply to the payment for 
such lenses furnished to patients of hospital outpatient departments. 
As described elsewhere in the final rule, the cost of IOLs, along with 
the costs of other sunsetting pass through devices, is reflected in the 
median cost and thus the payment for the procedures with which IOLs are 
used.
    Comment: A commenter asserted that the current description of HCPCS 
code J2790 is flawed. According to the commenter, the description of 
``1 dose package'' does not accurately describe the two sizes of dosage 
units available in the marketplace for different indications (50 mcg 
and 300 mcg). The commenter expressed hope that an application for new 
HCPCS codes would be approved, and the commenter also requested that we 
establish separate payment rates for this product based upon the 
distinction between the two dosages. The commenter noted that current 
``Redbook'' average wholesale price (AWP) for the 50 mcg dose is 
$53.90; for the 300 mcg dose, it is $126.14.
    Response: We reviewed the hospital charge data upon which the 
payment amount for this code must be based. In the absence of separate 
codes for two different product sizes, we are unable to determine a 
separate median cost per encounter for the two sizes. We can only base 
our determination about this product on existing data that represents 
the current descriptor of this code. We note that, in using the latest 
set of OPPS claims data available for the final rule, the median cost 
per encounter of this code was below the $150 threshold. Therefore, 
this code will be packaged in 2003.
    Comment: A commenter requested that we create new HCPCS codes, one 
for digital-based computer-aided detection (CAD) with screening 
mammography and one for digital-based CAD with diagnostic mammography.
    Response: When the computer-aided detection codes were originally 
assigned, there was minimal use of CAD in conjunction with direct 
digital mammography. The current descriptors of both HCPCS G0236 and 
CPT code 76085 do not explicitly state that these

[[Page 66736]]

services can be billed in conjunction with either direct digital images 
or standard film images converted to digital images for this reason. We 
agree with the commenter that use of CAD with direct digital images 
should be reportable. Therefore, we have revised the descriptor of 
HCPCS code G0236 to include conversion of both direct digital images 
and standard film images converted to digital images. Additionally, we 
will request that the CPT editorial panel review the current definition 
associated with the screening computer-aided detection code (CPT code 
76085) for future revision. Until any such revision is made to CPT code 
76085, hospitals should use CPT code 76085 for reporting application of 
CAD to both direct digital screening images and standard film images.
    The descriptor for G0236 has been revised to read as follows: 
digitalization of film radiographic images with computer analysis for 
lesion detection, or computer analysis of digital mammogram for lesion 
detection, and further physician review for interpretation, diagnostic 
mammography (list separately in addition to code for primary 
procedure). We believe that we have sufficient claims data to use in 
assigning digital mammography to an APC.
    Comment: Several commenters expressed concern over the payment rate 
reduction for CPT 52353 (Cystoureteroscopy with lithotripsy) in APC 
0163 (Level IV Cystourethroscopy and other genitourinary procedures). 
Commenters also requested that we place CPT 52353 in APC 0169 
(Lithotripsy).
    Response: Movement of CPT 52353 to APC 0169 would result in APC 
0169 no longer being clinically homogenous, therefore CPT 52353 
(Cystoureteroscopy with lithotripsy) will remain in APC 0163 
(Lithotripsy) with other similar procedures.
    Comment: Several commenters brought to our attention that placing 
CPT 52234 (removal of small tumors) and CPT 52235 (removal of medium 
tumors) in APC 163 (Level IV Cystourethroscopy) instead of APC 0162 
(Level III Cystourethroscopy) would adversely affect the payment rate 
for APC 0163, which contains several more costly procedures. 
Furthermore, commenters stated that it seemed illogical for CPT 52234 
(removal of small tumors) and CPT 52235 (removal of medium tumors) to 
be placed in APC 0163 while CPT 52224 (removal of minor tumors) and CPT 
52240 (removal of large tumors) were placed in APC 0162 (Level III 
Cystourethroscopy). These commenters requested that these four codes be 
placed together in APC 0162 (Level III Cystourethroscopy).
    Response: We agree with commenters and have placed CPT codes 52234 
and 52235 in APC 0162 (Level III Cystourethroscopy). This result is a 
significant increase in payment for APC 0163 while maintaining an 
appropriate payment rate for CPT codes 52234 and 52235.
    Comment: A commenter stated that APC 0100 (Cardiac stress tests) 
carries a proposed payment rate of $69.69, which the commenter believes 
does not sufficiently cover the cost of CPT 93025 (Microvolt t-wave 
alternans). The commenter requested that CPT 93025 be assigned to an 
APC that pays in the $250 range.
    Response: CPT 93025 (Microvolt t-wave assessment) is frequently 
performed simultaneously with CPT 93017 (Cardiovascular stress test) 
(that is, the patient is placed on a treadmill once and data for the 
stress test and Microvolt t-wave alternans are obtained 
simultaneously), achieving significant economies of scale. Therefore we 
will keep CPT 93025 (Microvolt t-wave assessment) in APC 0100 (Cardiac 
stress tests). However, we will review this request again next year 
when we have more claims data for 93025.
    Comment: We received several comments urging that CPT 52647 (Laser 
surgery of prostate) be placed in a higher paying APC than APC 0163 
(Level IV Cystourethroscopy and other genitourinary procedures) in 
order to cover the cost of a new laser source involved in this 
procedure.
    Response: We have significant claims for this procedure. Any costs 
associated with new technology developed to perform this procedure 
should be reflected in future claims data, insofar as the new 
technology is used, and will be reflected in our updated payment rates. 
Because we have sufficient claims data indicating the appropriate 
placement of this service is in APC 0163, CPT 52647 (Laser surgery of 
prostate) will remain in APC 0163.
    Comment: A commenter urged that we maintain a separate APC for 
items currently billed under C1784 (Ocular device, intraoperative, 
detached retina). The commenter stated that separate coding and payment 
would ensure that the procedure groupings maintain their clinical 
homogeneity and remain similar with respect to resource consumption.
    Response: We do not agree that a separate APC for items currently 
billed under C1784 (Ocular device, intraoperative, detached retina) is 
necessary to maintain clinical homogeneity or to remain similar with 
respect to resource consumption. Therefore, items currently billed 
under C1784 will not remain in a separate APC. However, we will present 
this issue to the Advisory Panel on Ambulatory Payment Classification 
Groups (the APC Advisory Panel) next year for further review.
    Comment: A commenter expressed concern over the movement of CPT 
15000 (surgical debridement) from APC 0026 (Level III Skin repair) to 
APC 0025 (Level II Skin repair) due to the consolidation of these APCs. 
The commenter believed that if CPT 15000 and CPT 15342 (Cultured skin 
graft, 25 cm) were placed in the same APC that separate payment would 
not be made for both procedures.
    Response: The commenter is incorrect. Separate payment will be made 
for both procedures even if they are in the same APC. Because this APC 
has a status indicator of ``T,'' payment of the full APC amount will be 
made for the first procedure and 50 percent of the APC amount will be 
paid for the second procedure. Furthermore, we believe that the codes 
within APC 0025 are clinically homogeneous and do not violate the 2 
times rule. Therefore, we will not move either of these procedures into 
a different APC.
    Comment: Several commenters stated that autonomic nervous system 
(ANS) services (HCPCS 95921 and 95922) are incongruent with the 
services grouped in APC 0218. The commenter asserted that ANS tests are 
more appropriately grouped in APC 0216 when evaluated on the basis of 
complexity and resources used.
    Response: The APC Advisory Panel reviewed this issue and 
recommended that we move HCPCS 95921 and 95922 to APC 0216 only if our 
claims data supported such a move. Since our claims data did not 
support such a move, HCPCS 95921 and 95922 will remain in APC 0218. 
However, we will present this concern to the APC Advisory Panel again 
next year.
    Comment: A commenter expressed concern over the combination of skin 
tests and miscellaneous red blood cell tests in APC 0341. The commenter 
asserted that the services within this group cannot be considered 
comparable with respect to the resources used. The commenter 
recommended the creation of a new APC titled, ``Miscellaneous Red Blood 
Cell Tests'' and suggested that the new APC contain the following HCPCS 
codes: 86880, 86885, 86886, 86900, and 86901.
    Response: We do not agree with the commenter's assertion that the 
skin tests and miscellaneous red blood cell tests in APC 0341 are not 
comparable with respect to the resources used. However,

[[Page 66737]]

we will present this issue to the APC Advisory Panel.
    Comment: A commenter asserts that HCPCS 86915 (Bone marrow/stem 
cell prep) does not fit within APC 346 (Level II Transfusion Laboratory 
Procedures) and should be moved to the highest paying Transfusion 
Laboratory Procedures APC 347(Level III Transfusion Laboratory 
Procedures). Similarly HCPCS 86932 (Frozen blood freeze/thaw) is more 
properly categorized with its sister codes (HCPCS 86930 and 86931) in 
APC 347.
    Response: We thank the commenter and agree that CPT code 86915 
(Bone marrow/stem cell prep) is not appropriately placed in APC 0346 
(Level II Transfusion Laboratory Procedures). Therefore, we have moved 
HCPC 86915 to APC 0110 (Transfusion). This change maintains the 
clinical homogeneity of APC 110 and allows a more appropriate payment 
for CPT code 86915. We also agree with the commenter that CPT code 
86932 is more appropriately assigned to APC 0347 based on resource 
consumption; therefore, we have assigned HCPC 86932 to APC 0347.
    Comment: Several commenters asserted that the placement of all 
prosthetic urological procedures and devices in APC 0182 (Insertion of 
penile prosthesis) does not adequately reflect the difference in cost 
between inflatable and non-inflatable penile prostheses. These 
commenters suggested that CPTs 54401, 54405, and 54410 (codes for 
inflatable penile prosthesis) be separated from CPTs 54400, 54402, and 
54416 (codes for insertion of penile prosthesis) and that the status 
indicator for APCs 0182 (Insertion of penile prosthesis) and 0179 
(Insertion of artificial urinary sphincters) be changed from ``T'' to 
``S.''
    Response: To the extent that no facility specializes in implanting 
inflatable penile prostheses, the APC payment should, on average, be 
appropriate. Therefore, we will not make any changes in APC 182 at this 
time. However, we will present this issue to the APC Advisory Panel 
next year. In addition, the status indicator for APCs 0182 (Insertion 
of penile prosthesis) and 0179 (Insertion of artificial urinary 
sphincters) will remain a ``T.'' These APCs will rarely, if ever, be 
reported with a higher paying APC and thus rarely subject to reduction.
    Comment: Several commenters were concerned about the large 
reduction in payment for APC 0222 (Implantation of Neurological Device) 
and APC 0225 (Implantation of Neurostimulator). They suggested that we 
continue the use of pass through codes or use manufacturer submitted 
device cost data, or hospital invoice data, to determine payment rates 
for these procedures. One commenter also suggested creating a new APC 
specifically to capture the costs of one brand of devices.
    Response: We are also concerned about the payment reduction to 
these APCs (and other APCs) and have taken steps to address these 
reductions. Such steps are discussed elsewhere in this rule. For these 
APCs, we developed relative weights using only claims that contained C 
codes for devices and in addition we limited the absolute payment 
reduction. Furthermore, because APCs 0022 and 0225 may be billed 
together, we have changed the status indicator of APC 0225 to ``S.'' 
This means that APC 0225 will not be subject to a 50 percent reduction 
in payment when billed with APC 0222. We believe that the measures we 
have taken should address the concerns of the commenters.
    Comment: Several commenters agreed with our proposal to make 
separate payment for radiological guidance procedures.
    Response: We thank these commenters and are finalizing our 
proposal.
    Comment: One commenter, who performs digital reconstruction of 
computed tomographic angiography images, stated that the claims data 
upon which we based our proposed payment rate for C9708 was flawed and 
that we should use other data sources in determining a payment rate for 
this code.
    Response: In developing the final rule, we had access to a larger 
number of claims for C9708 and have concluded our proposed payment rate 
was inappropriate. Accordingly, we will not finalize our proposal, and 
C9708 will continue to be paid in APC 0975.
    Comment: One commenter requested that guidance be provided on 
proper use of codes for strapping and casting (APCs 58 and 59).
    Response: We agree with the commenter and will work with 
appropriate experts to provide such guidance. In view of the similar 
costs for all of these procedures in our current data, we will combine 
these two APCs (as we proposed), as this is administratively easier for 
hospitals.
    Comment: One commenter disagreed with our proposal to combine APCs 
0043 and 0044, as more work is involved in treating a fractured leg 
than a fractured toe.
    Response: Our claims data indicates that the hospital resources 
involved in all of these procedures are very similar. Therefore, we are 
finalizing our proposal.
    Comment: One commenter agreed with our moving all procedures in 
APCs 0144 and 0145 into APC 0147 but disagreed with our moving CPT code 
46600 (diagnostic anoscopy) into APC 0340.
    Response: We disagree. We had a substantial number of single 
procedure claims for CPT 46600, and the median cost for CPT 46600 makes 
it appropriate for placement in APC 0340. We are finalizing our 
proposal.
    Comment: One commenter objected to our placement of impedence 
cardiography in APC 0099. The commenter stated that even though APC 
0099 was clinically homogeneous, the resources required for impedence 
cardiography were greater than the resources required to perform other 
procedures in the APC.
    Response: We disagree. The resources used for the procedures in 
this APC are similar, and it is clinically homogeneous. We are not 
making any changes in this APC at this time.
    Comment: One commenter requested that we move CPT code 95955 (EEG 
during non intracranial surgery) to APC 213 and that we move CPT code 
95904 (Sensory nerve conduction) to APC 0218.
    Response: We are not making any changes at this time because our 
claims data indicates that these procedures are appropriately placed. 
However, we will present these concerns to the APC Advisory Panel.
    Comment: One commenter requested that we move CPT code 0009T 
(Endometrial cryoablation) to APC 0984 because it should have a payment 
rate similar to prostate cryoablation (CPT code 55873).
    Response: We have placed CPT code 0009T in APC 0980. Based on the 
information that we have reviewed, we believe that is an appropriate 
assignment. CPT 0009T is a significantly shorter procedure than CPT 
55873 and requires the use of fewer resources. The main cost of CPT 
0009T is a disposable probe, the cost of which is appropriately 
accounted for in APC 0980.
    Comment: One commenter requested that we change the status 
indicator for CPT code 92974 (Coronary brachytherapy) to S.
    Response: We are not making any changes at this time, but we will 
present this to the APC Advisory Panel next year to obtain its input.
    Comment: A commenter requested that we move CPT code 57288 (Sling 
operation for stress incontinence) from APC 202 into its own APC. This 
is because it is the only procedure in the

[[Page 66738]]

APC that requires use of a device. The commenter also believed our 
claims data was flawed and did not reflect the true cost of the sling 
used for the procedure. The commenter also asked us to create a special 
APC payment for the sling.
    Response: We are not making any changes at this time but will 
present this to the APC Advisory Panel. We note that we had many single 
procedure claims for 57288 and that 57288 was by far the most common 
procedure performed in APC 202. This means that 57288 determined the 
payment rate for the APC. Therefore, moving 57288 into its own APC 
would not change its payment rate. Furthermore, we do not create APCs 
for devices.
    Comment: Two commenters were concerned about reduced payment for 
echocardiography.
    Response: Review of payment rates for echocardiography does not 
show a significant decrease in payment from 2002 for the most commonly 
performed echocardiograms. The reduction in payment for echocardiograms 
in APC 671 appropriately reflects the costs of performing those 
procedures.
    Comment: One commenter asked us to clarify the payment rate for 
Zevalin.
    Response: As discussed elsewhere in this rule we have created G 
codes that describe the diagnostic and therapeutic administration of 
Zevalin. These two G codes are placed in APCs with payment rates that 
account for the procedure and the cost of Zevalin. We will use claims 
data to update the payment rates of these services when such data 
becomes available.
    Comment: One manufacturer of medical devices submitted comments on 
a large number of APCs (76, 81, 83, 85, 86, 87, 93, 109, 141, 147, 151, 
163, 229, 656, and 670). In general the commenter was concerned about 
seeming violations of the two times rule, use of improperly coded 
claims, lack of use of multiple procedure claims, and our use of 
medians to determine payment rates. The commenter also asked us to use 
outside cost data in setting payment rates and made some specific 
requests to move codes to differentAPCs.
    Response: Many of this commenter's concerns have been addressed in 
other responses to APC issues. We did use properly coded claims where 
appropriate. Specifically, for procedures that required use of a device 
we only used claims that contained C codes. We also took other measures 
to mitigate steep reductions in payment for device related APCs and we 
increased the number of claims we used to set payment rates (as 
discussed in the proposed rule). We believe that many of the 
commenter's concerns have been addressed by these measures. However, we 
will review these comments and present several of the specific requests 
concerning APC changes to the APC Advisory Panel.
    Comment: We received many comments from physicians, freestanding 
breast imaging centers, and others who believed that the proposed OPPS 
payment amounts for percutaneous breast biopsy (CPT codes 19102 and 
19103) would affect the payments made for physician services and in 
freestanding breast imaging centers and who objected to reduced 
payments to physicians and to freestanding breast imaging centers.
    Response: These commenters are mistaken. The proposed rates affect 
only hospital outpatient department payment. Payment to physicians and 
to freestanding facilities is addressed in the Physician Fee Schedule.
    Comment: We received comments from hospitals and others who 
understood that the proposed payments would be limited to hospital 
outpatient department services. Some of these commenters indicated that 
the proposed payments for percutaneous breast biopsy (CPT codes 19102 
and 19103) would be substantially below payments to hospitals for open 
breast biopsy (CPT code 19101) and that the proposed rule proposed 
reductions in payment for percutaneous breast biopsy while it proposed 
increases in payment for open breast biopsy. They believe that the 
proposed payment changes would create incentives for performing open 
breast biopsies instead of less invasive procedures such as 
percutaneous biopsies. This may result, they asserted, in an increased 
frequency of open breast biopsies and a decreased frequency of 
percutaneous breast biopsies, resulting in poorer quality of care and 
increased costs to Medicare and to beneficiaries. One commenter 
believed that our claims data do not appropriately account for the 
costs of CPT code 19103 because CPT code 19103 was a new CPT code in 
2001 and hospitals were slow to transition from using CPT code 19101 
for these procedures.
    Response: We thank the commenters for their comments. We note that 
CPT codes 19102 and 19103 are never performed alone. They are always 
performed, at minimum, in conjunction with an imaging guidance 
procedure. Therefore, the true payment rate for CPT codes 19102 and 
19103 is the sum of the APC payments for CPT codes 19102 or 19103 and 
of the APC payments for procedures billed with CPT codes 19102 and 
19103. In order to determine the true payments for these procedures, we 
examined our claims data and determined the most common combination of 
CPT codes billed when CPT codes 19102 and 19103 were on the claim. Our 
claims data verified that CPT codes 19102 and 19103 are rarely 
performed alone.
    Furthermore, we looked at the 10 most frequent combinations of 
codes billed with CPT codes 19102 and 19103 and summed the proposed APC 
payments that would be made for these combinations of codes. This 
represents the true Medicare payment for CPT codes 19102 and 19103. For 
CPT code 19102 (for which the proposed rule proposed payment under APC 
0005 of $157.01), total payment by Medicare would range from $181.45 to 
$549.16 when the 10 most common combinations of services are provided. 
Similarly for CPT code 19103 (for which the proposed rule proposed 
payment under APC 0658 of $289.69), total payment by Medicare would 
range from $532.05 to $681.84. These combination totals are less than 
the proposed payment for open breast biopsy (APC 0028, CPT codes 19105, 
19120 and 19125, for which we proposed to pay $908.04); however, as the 
commenters themselves asserted, the resources required for an open 
surgical procedure are greater than those used for a percutaneous 
procedure. We agree with the commenters that the costs to the Medicare 
program of an open breast biopsy are greater than the cost of a 
percutaneous biopsy. We also believe that the relative total payment 
rates, as discussed above, for open and percutaneous procedures are 
appropriate.
    With regard to hospital miscoding, even if hospitals took time to 
transition from using CPT code 19101 to CPT codes 19102 and 19103, the 
cost data for CPT codes 19102 and 19103 should be accurate. While it is 
possible that the cost data for CPT code 19101 could be high as it may 
include some percutaneous procedures, this would not be true for cost 
data from CPT codes 19102 and 19103. Further, we would note that each 
of CPT codes 19102 and 19103 were reported over 20,000 times by 
hospital outpatient departments and that we had several thousand single 
claims for each code upon which to base relative weights.
    We do not believe that the proposed payments will create incentives 
to perform inappropriate open breast biopsies. We believe that 
physicians will select the procedure that best meets the needs of the 
patient and that the hospital will provide the services

[[Page 66739]]

needed to support the procedure that the physician provides.
5. Procedures That Will Be Paid Only as Inpatient Procedures
    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. 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:
    [sbull] Most outpatient departments are equipped to provide the 
services to the Medicare population.
    [sbull] The simplest procedure described by the code may be 
performed in most outpatient departments.
    [sbull] The procedure is related to codes we have already moved off 
the inpatient list.
    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. As the Panel members recommended, we solicited comments and 
further information about all of these procedures except for CPT code 
47001, which they recommended to be removed from the inpatient list.
    In addition to considering the comments of the APC Panel, 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 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, which are set forth in 42 CFR 
416.22. Therefore, we proposed 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:
    [sbull] We have determined that the procedure is being performed in 
numerous hospitals on an outpatient basis; or
    [sbull] 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 in the proposed rule includes 
other procedures that we proposed to remove from the inpatient list for 
payment under the OPPS for 2003. 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 solicited comments on 
whether the procedures listed in Table 6 of the proposed rule should be 
paid under the OPPS. We also solicited comments on the APC assignment 
that we proposed 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 asked 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 appropriate manner.
    Following our review of the comments, we either assigned a CPT code 
for a service formerly on the inpatient list to an APC for payment 
under the OPPS or, if the comments did not provide sufficient 
information and data to enable us to make a decision, we chose to keep 
the service on the inpatient list for 2003 and to present the comments 
to the APC Panel at its 2003 meeting. Table 6 identifies codes that 
were on the inpatient list in 2002 but are not on the inpatient list in 
2003 and which, therefore, will be payable under the OPPS on and after 
January 1, 2003.
    We received numerous comments on this proposal, which we summarize 
below.
    Comment: In addition to the APC Advisory Panel, numerous hospital 
associations, hospitals, and other organizations recommended that we 
eliminate the inpatient list. They asserted that the inpatient list 
interferes with the practice of medicine and is unnecessarily 
intrusive. Most of these commenters argued that it is the physician, 
not the hospital, who determines what procedures should be performed 
and whether a patient's condition warrants an inpatient admission. 
Numerous commenters asserted that if CMS insists on retaining the 
inpatient list, then the same payment rules should apply to physicians 
as well as to hospitals. These commenters argued that if CMS believes 
Medicare beneficiaries are at risk for safety and quality issues, then 
Medicare should not pay for the professional services of the physician 
who performs a procedure on the inpatient list when payment for the 
hospital services is denied. In addition, several commenters noted that 
because the physician receives payment when a procedure on the 
inpatient list is performed on an outpatient basis, there is no 
incentive for the physician to heed whether Medicare will pay the 
hospital for the procedure. A few commenters noted that the inpatient 
list sometimes conflicts with the policy of private payers, creating 
confusion among physicians, patients, and hospitals. One commenter 
recommended that it should be left to medical review to monitor site of 
service. Several commenters viewed the inpatient list as an attempt to 
punish hospitals for a decision over which they have no real control. 
One commenter objected to the inpatient list because it places an 
unfair financial burden on beneficiaries, who are liable for payment if 
a procedure on the inpatient list is performed in the outpatient 
setting, and because the beneficiary normally relies on the physician 
to determine where a procedure is to be performed.
    Response: Since implementation of the OPPS in August 2000, we have 
engaged in an ongoing review of the procedures on the inpatient list. 
In the August 9, 2002 proposed rule (67 FR 52092), we proposed APC 
assignments for 41 procedures that have a current status indicator 
designation of ``C''. We continue to move procedures from the inpatient 
list to an APC for payment under the OPPS in response to comments and 
recommendations from hospitals, surgeons, professional societies, and 
hospital associations which demonstrate that a procedure on the 
inpatient list meets our criteria for determining that a procedure can 
be performed on an outpatient basis in a

[[Page 66740]]

safe and effective manner. In spite of the assertions made by 
commenters, we have received very few requests since publication of the 
November 30, 2001 final rule.
    Hospitals or associations representing hospitals submitted the 
overwhelming majority of comments recommending elimination of the 
inpatient list. Their comments expressed considerable frustration 
resulting from apparent conflicts with physicians over which procedures 
Medicare will pay for under the OPPS. Although we understand the 
frustration that exists in the hospital community about the inpatient 
list, we believe that appropriate education of physicians and other 
hospital staff by CMS, hospitals, and organizations representing 
hospitals is the best way to minimize any existing confusion. We are 
prepared to remove procedures from the inpatient list as part of the 
quarterly OPPS updates. If a physician believes that a procedure should 
be payable under the OPPS, we urge the hospital and physician to 
provide operative reports about specific procedures on the inpatient 
list are being performed on Medicare beneficiaries who are outpatients. 
In the meantime, we are reviewing with CMS provider education staff 
ways that we can support carrier and fiscal intermediary efforts to 
clarify the reasons for the OPPS inpatient list and its billing and 
payment implications. Also, in section X.C. of this preamble, we 
explain how hospitals can receive payment under certain conditions for 
procedures on the inpatient list that are performed on an emergency 
basis when the status of a patient is that of an outpatient.
    Comment: We received a number of comments regarding the criteria 
that we 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, including the two new criteria that we proposed 
in the August 2002 proposed rule to add to the current criteria. One 
commenter asked what we meant by ``numerous'' hospitals. Several 
commenters commended CMS for recognizing that surgical procedures 
payable in the ambulatory surgical center (ASC) setting should also be 
payable in an outpatient hospital setting and for removing a number of 
codes from the inpatient list that are currently payable in an ASC. 
Several commenters urged CMS to closely monitor and coordinate the OPPS 
inpatient list and the ASC list for consistency and to ensure that 
changes in medical practice are reflected within both lists as 
expeditiously as possible. Commenters expressed concern that more than 
60 CPT codes remain on the inpatient list in Addendum E even though 
they are currently on the approved ASC list and urged CMS to reconcile 
the disparity between the two lists.
    Response: The criterion that a procedure is being performed in 
``numerous'' hospitals on outpatients means that the procedure is being 
performed nationally in hospitals other than a few large teaching 
hospitals that specialize in innovative surgery. We intend to continue 
monitoring for consistency the procedures that Medicare pays for in a 
hospital outpatient setting with those that are payable in an ASC as we 
prepare a final rule to update the ASC list based on the additions and 
deletions that we proposed in the June 12, 1998 Federal Register (63 FR 
32290).
    Comment: One commenter recommended that CMS remove from the 
inpatient list those procedures that routinely show a one-day inpatient 
stay.
    Response: We believe this recommendation has merit and we will 
endeavor to conduct a study to explore the issue in preparation for the 
2004 OPPS update.
    Comment: One commenter stated that CMS should have a formal process 
to solicit and act on suggestions to remove procedures where community 
medical standards and practice can demonstrate the safety and efficacy 
of performing the procedure in an outpatient setting. Another commenter 
stated that physician comments, outcome data, post-procedure care data, 
and medical literature would be better criteria for determining which 
procedures are outpatient.
    Response: As we stated above, anyone interested in having a 
particular code or group of codes on the inpatient list reviewed for 
payment under the OPPS need only submit a request to the Director, 
Division of Outpatient Care, Centers for Medicare & Medicaid Services, 
Mailstop C4-05-17, 7500 Security Boulevard, Baltimore, MD 21244-1850. 
The request should include supporting information and data to 
demonstrate that the code meets the five criteria discussed above. We 
ask that evidence be submitted, including operative reports of actual 
cases and peer-reviewed medical literature, to demonstrate that the 
procedure is being performed on an outpatient basis in a safe and 
appropriate manner in a variety of different types of hospitals. We 
agree with the commenters suggestions, and encourage, in addition to 
medical literature, the submission of community medical standards and 
practice as well physician comments, outcome data, and post-procedure 
care data to reinforce the point.
    When this information is received, it is thoroughly reviewed by our 
medical advisors within the context of the criteria we have 
established. Further information or clarification may be requested. If, 
following this review, we determine that there is sufficient evidence 
to confirm that the code can be safely and appropriately performed on 
an outpatient basis, we will assign the procedure to an APC and include 
it as a payable procedure in the next OPPS quarterly update. The change 
in payment status will be subject to public comment as part of the 
subsequent annual OPPS update.
    Interested parties may also submit a request to change the payment 
status of a code on the inpatient list for consideration as an agenda 
item at the next meeting of the APC Advisory Panel.
    Comment: One commenter expressed concern about the inpatient list 
becoming a ``self-fulfilling prophecy'' because hospitals cannot be 
paid for procedures on the list, therefore no data become available to 
show that the procedure is safely done on an outpatient basis.
    Response: Information may be available on non-Medicare patients 
receiving a procedure on the list. Further, this is not the sole 
criterion upon which a change is based, as we note above.
    Comment: One commenter recommended that CMS establish a 
transitional methodology for estimating appropriate hospital costs for 
CPT codes on the inpatient list that are proposed for payment under the 
OPPS. The commenter expressed particular concern about payment for CPT 
codes 92986, 92987, and 92990.
    Response: The APC assignments for the CPT codes in Table 6 of the 
August 2002 proposed rule (67 FR 52115) for which we propose to make 
payment under the OPPS take into account the expectation that the 
simplest procedure described by the codes, and therefore, relatively, 
the least resource intensive, would be performed on an outpatient 
basis. Also, we identify APCs that consist of procedures that are 
similar both in terms of clinical characteristics and in terms of 
resource consumption. Finally, we invited comments on the proposed APC 
assignment. Over time, claims data for the newly assigned codes will 
confirm either that the procedures belong in the designated APC or that 
they should be moved to different APC.
    Comment: Two commenters supported our proposal to remove CPT

[[Page 66741]]

code 47001, Biopsy of liver, needle; when done for indicated purpose at 
time of other major procedure, from the inpatient list. Several 
commenters supported generally our proposal to pay under the OPPS for 
the procedures in Table 6 of the proposed rule, but did not comment on 
our proposed APC assignments. One commenter urged that CPT code 92986, 
Percutaneous balloon valvuloplasty; aortic valve, not be assigned to 
APC 0083, asserting that this procedure cannot be performed safely in 
an outpatient setting. We received no other comments opposing payment 
under the OPPS for the procedures listed in Table 6 of the August 9 
proposed rule.
    Response: We agree with the commenters and with the APC Panel's 
recommendations that CPT code 47001 be payable under the OPPS beginning 
in 2003. Because this is an add-on code, payment will be packaged with 
the payment for the surgical procedure with which it is billed.
    We are making final our proposal to remove this code from the 
inpatient list, but we will consider presenting this concern to the APC 
Panel. In the absence of comments disagreeing with our proposal to pay 
under the OPPS for the 41 CPT codes listed in Table 6 of the August 
2002 proposed rule (67 FR 52115), we are making these proposed changes 
final.
    Comment: One commenter favored removing CPT 33967, insertion of 
intra-aortic balloon assist device, percutaneous, from the inpatient 
list, but did not submit any information to support this position.
    Response: We discussed in the proposed rule our uncertainty, and 
that of the APC Advisory Panel, about whether or not this procedure 
should be removed from the inpatient list. We also indicated that we 
were having difficulty finding data to confirm that the procedure is 
being performed on Medicare beneficiaries in an outpatient setting. We 
asked for comments and clinical data and case reports that would 
support payment for CPT 33967 under the OPPS. No commenters submitted 
data in any form to support removing the procedure from the inpatient 
list. Therefore, we have decided not to remove CPT 33967 from the 
inpatient list in 2003.
    Comment: One commenter recommended payment for CPT codes 22612, 
22614, 33243, 49000, and 49062 under the OPPS.
    Response: Our medical advisors reviewed these codes and have 
determined that CPT 22612, Arthrodesis, posterior or posterolateral 
technique, single level; lumbar (with or without lateral transverse 
technique), and CPT 22614, Arthrodesis, posterior or posterolateral 
technique, single level; each additional vertebral segment (list 
separately in addition to code for primary procedure), are safely and 
appropriately being performed on an outpatient basis. We are assigning 
these codes to APC 0208.
    We did not propose to remove the other codes suggested by the 
commenter from the inpatient list, and the commenter submitted no 
evidence to support payment for these codes under the OPPS. Nor could 
we find any information to indicate that these codes meet the criteria 
for moving them off the inpatient list. Therefore, we will continue to 
designate these CPT codes with status indicator ``C'' in 2003.
    [sbull] We are adopting two additional criteria to guide our 
determination of whether a procedure should be removed from the 
inpatient list:
    [sbull] The procedure is being performed in numerous hospitals on 
an outpatient basis; or
    [sbull] 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.
    [sbull] We are adding CPT codes 22612 and 22614 to APC 0208 
effective for services furnished on or after January 1, 2003.
    [sbull] We are making final our proposal in the August 2002 rule to 
pay under the OPPS for the CPT codes listed in Table 5, below.

           Table 5.--Procedures on the 2002 Inpatient List Which Are Payable Under the OPPS in CY 2003
----------------------------------------------------------------------------------------------------------------
                                     Status
            CPT Code               Indicator     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).
22612...........................           T      0208  ARTHRODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE,
                                                         SINGLE LEVEL; LUMBAR (WITH OR WITHOUT LATERAL)
                                                         TRANSVERSE TECHNIQUE).
22614...........................           T      0208  ARTHODESIS, POSTERIOR OR POSTEROLATERAL TECHNIQUE,
                                                         SINGLE LEVEL; EACH, ADDITIONAL VERTEBRAL 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.

[[Page 66742]]

 
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 EXCISION 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).
----------------------------------------------------------------------------------------------------------------

C. Partial Hospitalization

Payment Methodology
    As we discussed in the proposed rule, 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). In the August 
1, 2000 final rule (65 FR 18452), we established a per diem payment 
methodology for the PHP APC based on hospital data. The current per 
diem payment amount is $212.27. This amount represents the hospital or 
CMHC overhead costs associated with the program.
    In the August 9, 2002 OPPS proposed rule, we proposed to revise the 
PHP APC using 2001 claims data from hospitals and CMHCs and computed a 
median per diem using the same methodology as that used for all other 
APCs. As we explained in the August 9, 2002 proposed rule, we adjusted 
the CMHC costs to account for the difference between settled and as-
filed cost reports. We proposed that the resulting per diem is $256.96, 
of which $51.39 is the beneficiary's coinsurance.
    In addition, to facilitate proper billing and ensure comparable 
reporting of costs by hospitals and CMHCs, we proposed to revise Sec.  
410.43 (Partial hospitalization services: Conditions and exclusions) to 
add CSW 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. Such revision would mean that hospitals and CMHCs could bill 
the carrier for CSW services furnished to PHP patients.
    Comment: One commenter indicated that the proposed methodology for 
ratesetting is appropriate.
    Response: As we indicated in the April 7, 2000 OPPS final rule, 
payment to providers under OPPS represents the facility costs, that is, 
overhead, support staff, equipment, and supplies. The physician and 
nonphysician practitioner services excluded from the definition of PHP 
services are those professional services paid through the physician fee 
schedule. The facility continues to incur the overhead costs associated 
with provision of the professional service, for example, room, heat, 
lights, mental health technicians, and nurses. The OPPS is intended to 
pay providers for the resource costs associated with their outpatient 
programs, including outpatient psychiatric programs and PHPs.
    As part of our analysis of current billing instructions for PHP, we 
discovered that Addendum B of the November 30, 2001, CY 2002 OPPS final 
rule does not clearly identify all the HCPCS codes that may be billed 
for PHP patients. We plan to revise this addendum in the 2004 update so 
that all PHP services are identified. However, in order to avoid 
billing errors, we are providing the following list of the current 
HCPCS codes for PHPs:

[[Page 66743]]



------------------------------------------------------------------------
       Revenue codes             Description            HCPCS codes
------------------------------------------------------------------------
43X.......................  Occupational Therapy.  G0129.
904.......................  Activity Therapy.....  G0176.
910.......................  Psychiatric General    90801, 90802, 90875,
                             Services.              90876, 90899.
914.......................  Individual             90816, 90817, 90818,
                             Psychotherapy.         90819, 90821, 90822,
                                                    90823, 90824, 90826,
                                                    90827, 90828, 90829.
915.......................  Group Therapy........  90849, 90853, 90857.
916.......................  Family Psychotherapy.  90846, 90847, 90849.
918.......................  Psychiatric Testing..  96100, 96115, 96117.
942.......................  Education/Training...  G0177.
------------------------------------------------------------------------

    Comment: Two national behavioral health care organizations 
commented that the proposed PHP rate for CY 2003 more adequately 
represents the resources needed to provide PHP; however, they expressed 
concern that providers continue to have difficulty in receiving 
reimbursement for PHP services as a result of intermediary medical 
review (MR) of claims.
    Response: As noted in the comment, we have issued a program 
memorandum to intermediaries regarding medical review of PHP claims. 
While we recognize that MR can have a financial impact on PHP claims, 
there is no direct relationship between MR and the level of 
reimbursement for individual claims.

III. 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 proposed 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 proposed 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 CY 2003, the most recent available claims data are more 
than 90 million final action claims for hospital outpatient department 
services furnished on or after April 1, 2001, and before March 31, 
2002, and processed through July 2002. In the proposed rule, we 
proposed to base the 2003 OPPS on claims for services furnished January 
1, 2001 through December 31, 2001. However, after issuance of the 
proposed rule we determined that coding and charges for the period of 
April 1, 2001 thru March 31, 2002 would be a better base for 
recalculation of weights.
    We believe that using claims data from this period is consistent 
with section 1833(t)(9)(A) of the Act, which directs us to take into 
account ``new cost data'' in our annual review and adjustment of 
components of the OPPS. This is also consistent with our proposal in 
the August 9, 2002 proposed rule (67 FR 52108) to use the most recent 
available claims data to set the weights. We had several reasons for 
using claims from this period: claims from this period provide the most 
recent charge data available to us. Since we did not implement the 2002 
OPPS until April 1, 2002, we can use the claims for the period from 
January 1, 2002, through and including March 31, 2002, together with 
claims data from the period of April 1, 2001 to December 31, 2001 to 
set weights. Using claims data for services furnished during this 
period of time also provides the most reliable charge data for devices 
and services that use medical devices because the device category codes 
were in effect for the entire period. Hence, we believe that claims 
from this period are the most reliable basis for setting relative 
weights for CY 2003 OPPS.
    Many of the claims from hospitals 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
    In the August 9, 2002 proposed rule, we discussed in detail the 
circumstances in which we had difficulty with using the data from 
claims that had multiple procedures (67 FR 52108). We solicited public 
comment on the methods we considered for apportioning the total charges 
to individual HCPCS codes as described above. These possible methods 
included: dividing the total charges in a revenue center, or for a 
packaged HCPCS code, by the number of payable HCPCS codes for the 
multiple procedures on the claim; apportioning the charges among the 
codes based on physician work relative value units (RVUs); apportioning 
the charges among the codes based on physician nonfacility practice 
expense RVUs; or requiring the hospital 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 relative 
weights. We also invited 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 solicited information on existing studies that would 
provide comparative hospital outpatient resource inputs by HCPCS code. 
In addition, we welcomed 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.
    Finally, we solicited information regarding the extent to which 
efficiencies are realized when multiple services are furnished during 
the same visit or operative session.
    The discussion of recalibration of relative weights in section 
III.B of this final rule summarizes the process that we used to 
determine the claims that could be used to set the weights.
    Comments and our responses are summarized below:

[[Page 66744]]

Low Numbers of Services Used To Set Weights and Failure To Use Multiple 
Procedure Claims
    Comment: Many commenters indicated that we used very few of the 
claims that were submitted for a particular service and that using so 
few claims resulted in lower weights than would have occurred if we had 
used all claims. Some commenters indicated that by using only single 
procedure claims and data from multiple procedure claims that met the 
criteria we set (see section III.A.I. of this final rule), we 
significantly reduced the validity of the cost data. Some commenters 
stated that by using median costs for procedures that can only be done 
as an add-on to other procedures, we had based the payment for the add-
on procedure on data which, by definition, were faulty. Some commenters 
suggested that we needed to develop an allocation strategy that would 
enable us to use all multiple procedure claims, either based on a study 
of relative resource allocation or an arbitrary allocation that could 
be refined over the years. Some commenters asked that we reconsider our 
data trimming strategy to examine each claim that is eliminated by 
trimming for validity and to determine if it should be used. They asked 
that any claim that represents new technology be returned to the data 
set and used, notwithstanding its aberrancy.
    Response: For 2003, we made great strides by increasing the number 
of claims used to set the OPPS weights from 39.9 million (66 FR 59885) 
for the 2002 OPPS to 62.2 million for the 2003 OPPS. We intend to 
review other means of using data from multiple claims for 2004. We 
recognize that it would be preferable to use data from all claims, 
including those with multiple procedures, in development of the 
weights, as long as we can ensure that the data recovered from those 
claims are valid. We were not able to develop and test a strategy for 
allocating undifferentiated charges to multiple HCPCS codes on a claim 
for the 2003 final rule. Therefore, in some cases, we continued to use 
data from small numbers of claims because many claims did not meet the 
tests for inclusion in the data set. As discussed in section II, the 
APC Panel recommended that we continue to rely on data from single 
procedure claims until we were able to validly allocate charges to 
multiple procedures, even in establishing payments for add-on codes. In 
addition, as requested by some commenters, we excluded claims for 
procedures that could not be performed without a device when the claim 
did not contain the device. This gave us a more valid base of claims on 
which to set the weight for that service but reduced the number of 
claims used for these APCs. It became clear from this activity that 
basing the weights on more claims does not necessarily result in more 
valid data because in the cases of these APCs, deleting claims from the 
set was necessary to arrive at a more valid relative weight.
    With regard to the trimming methodology, it is a routine and 
accepted statistical practice that is well established in inpatient PPS 
data examination and has served well in the past to eliminate anomalies 
that could further skew the data. We will consider whether it is useful 
and to what extent it is practical to examine all trimmed claims to 
determine if they represent the first claims for a new technology and 
should remain in the body of claims.
Recommendations for Including More Multiple Procedure Claims
    Comment: We received a number of comments that contained ideas for 
allocating charges to multiple procedures where they exist on the 
claim. Some commenters recommended that we allocate the charges to 
HCPCS codes in proportion to the relative weight of the HCPCS codes or 
the relative charges for the HCPCS codes. Some commenters suggested 
that we survey hospitals with regard to the most common combinations of 
procedures that appear on claims to determine which services and, 
therefore, which charges go with which HCPCS code. Some commenters 
suggested that we research the relative resources for each HCPCS code 
individually and then create an algorithm by which we would allocate 
charges to HCPCS codes on multiple procedure claims. One commenter 
provided a study that addressed the efficiency of resource usage when 
multiple procedures are performed on the same day that the commenter 
recommended could be useful in allocating charges for the second and 
subsequent procedures on a claim. One commenter also suggested that we 
ensure that the claim assesses services on the same date of service, 
since in many cases, the claim can have services that are spread over a 
period of time and, therefore, are not really multiple procedures 
provided at the same time. Several commenters submitted detailed 
descriptions of ways by which we could allocate charges to HCPCS codes. 
Many hospitals objected to any requirement that hospitals do the 
allocation of all charges to HCPCS codes to show the charges that go 
with each HCPCS code; they noted that doing so would require massive 
accounting and cost report changes and thus impose a burden and cost on 
hospitals, which would exist for no purpose other than to improve the 
Medicare OPPS claims data.
    Response: We expect to explore a number of strategies for 
allocating charges to HCPCS codes on multiple procedure claims for the 
development of the 2004 OPPS and beyond.
Impact on Data of a Visit and Drug Administration the Same Day
    Comment: Several commenters applauded our attempt to include some 
multiple procedure claims in the calculation of OPPS payment rates. 
They were, however, concerned whether some properly coded claims, which 
included both an administration code and a J code or claims that 
included an evaluation and management visit in addition to an 
administration code and a J code, were eliminated as multiple procedure 
claims.
    Response: Where an evaluation and management visit and an 
administration code and J code were billed on the same claim, they 
would have been considered to be a multiple procedure claim and would 
not be used because there would be no way of knowing how to allocate 
the charges in revenue centers to the visit versus the administration 
code. As we explained in detail in the August 9, 2002 proposed rule, 
there would be no way to know to what extent charges in revenue 
centers, such as sterile supplies, were associated with the visit 
versus the administration code. We are concerned about this problem and 
are exploring ways to do an allocation of charges that would enable us 
to use all multiple procedure claims. However, we were not able to do 
it for this final rule.
2. Calendar Year 2002 Charge Data for Transitional Pass-Through Device 
Categories
    In the August 9, 2002 proposed rule, we discussed our concerns with 
the claims data for the devices losing eligible for transitional pass-
through status in CY 2003 (67 FR 52110). We had 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 acknowledged in the 2002 proposed rule that 
changes in billing format and systems for implementation of the OPPS 
may have compounded the problems of billing using the device-specific 
codes during the first 9 months of the OPPS. We had been informed that 
these problems were

[[Page 66745]]

further compounded by the creation and requirement to use category 
codes on and after April 1, 2001. In general, we had 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 proposed to package payment for devices into payment for the 
procedure in which they were furnished because doing so is consistent 
with the concept of a prospective payment system and because we 
believed that it would give us the best data on which to pay devices 
once they ceased to be paid at cost via the pass-through methodology. 
We thought that by packaging the cost of the devices into the cost of 
the procedure with which they were used, we would capture the charges 
for the devices whether billed in revenue centers or with the HCPCS 
code for the device.
    Our subsequent review of the data for the period of April 1, 2001, 
through March 31, 2002, indicated that there was a notable absence of 
hospital billing for devices category codes, even when the procedure 
billed could not be done without a pass-through device. We calculated 
the median costs for the APCs containing procedures that we believed 
required use of devices (including both claims with and claims without 
device C codes on the claim) and compared them to the median costs for 
the procedures from only claims that were billed with devices. We found 
that the median costs on claims billed with devices were more 
consistent with the median costs that we would expect to see for these 
APCs. Hence, for these APCs, we used the median costs calculated from 
claims that reported a device C code in place of the median costs 
calculated from all claims (claims billed both with devices and without 
device C codes). We did not eliminate claims that did not contain a 
device C code where HCPCS codes within an APC indicated that the 
procedure did not require a pass-through device. In such cases, HCPCS 
codes were, appropriately, rarely reported with C codes. The APCs for 
which we used the medians from claims with device C codes billed are 
listed in Table 6. This methodology resulted in higher median costs 
and, therefore, higher weights for these APCs than would have occurred 
had we included claims that did not contain coding for a device. The 
medians we used for all APCs are contained in Addendum C, which is on 
our Web site at http://www.cms.hhs.gov.

  Table 6.--APC Rates Which Are Set Based Only on Claims That Contained
                            Codes for Devices
------------------------------------------------------------------------
                    APC                              Description
------------------------------------------------------------------------
0032......................................  Insertion of Central Venous/
                                             Arterial Catheter.
0048......................................  Arthroplasty with
                                             Prosthesis.
0080......................................  Diagnostic Cardiac
                                             Catheterization.
0081......................................  Non-Coronary Angioplasty or
                                             Atherectomy.
0082......................................  Coronary Atherectomy.
0083......................................  Coronary Angioplasty and
                                             Percutaneous Valvuloplasty.
0085......................................  Level II Electrophysiologic
                                             Evaluation.
0086......................................  Ablate Heart Dysrhythm
                                             Focus.
0087......................................  Cardiac Electrophysiologic
                                             Recording/Mapping.
0089......................................  Insertion/Replacement of
                                             Permanent Pacemaker and
                                             Electrodes.
0655......................................  Insertion/Replacement of
                                             Permanent Dual Chamber
                                             Pacemaker.
0090......................................  Insertion/Replacement of
                                             Pacemaker Pulse Generator.
0680......................................  Insertion of Patient
                                             Activated Event Recorders.
0653......................................  Vascular Reconstruction/
                                             Fistula Repair with Device.
0104......................................  Transcatheter Placement of
                                             Intracoronary Stents.
0106......................................  Insertion/Replacement/Repair
                                             of Pacemaker and/or
                                             Electrodes.
0107......................................  Insertion of Cardioverter-
                                             Defibrillator.
0108......................................  Insertion/Replacement/Repair
                                             of Cardioverter-
                                             Defibrillator Leads.
0115......................................  Cannula/Access Device
                                             Procedures.
0119......................................  Implantation of Devices.
0122......................................  Level II Tube changes and
                                             Repositioning.
0652......................................  Insertion of Intraperitoneal
                                             Catheters.
0167......................................  Level III Urethral
                                             Procedures.
0179......................................  Urinary Incontinence
                                             Procedures.
0182......................................  Insertion of Penile
                                             Prosthesis.
0202......................................  Level VIII Female
                                             Reproductive Proc.
0222......................................  Implantation of Neurological
                                             Device.
0225......................................  Implantation of
                                             Neurostimulator Electrodes.
0226......................................  Implantation of Drug
                                             Infusion Reservoir.
0227......................................  Implantation of Drug
                                             Infusion Device.
0229......................................  Transcatherter Placement of
                                             Intravascular Shunts.
0259......................................  Level VI ENT Procedures.
0670......................................  Intravenous and Intracardiac
                                             Ultrasound.
0680......................................  Insertion of Patient
                                             Activated Event Recorders.
0681......................................  Knee Arthroplasty.
0693A.....................................  Breast Reconstruction with
                                             Prosthesis.
------------------------------------------------------------------------

Application of Cost-to-Charge Ratio to Charges Not Resulting in Costs
    Comment: Many commenters stated that the application of a 
departmental cost-to-charge ratio to the high cost of devices would not 
result in the true cost of the device because hospitals would have to 
mark up the cost by 300 percent or more for that to be the result.
    Response: See the discussion of the comments on cost to charge 
ratios and charge compression in section III.B of this final rule.

[[Page 66746]]

Absence of Devices on Claims
    Comment: Many commenters indicated that hospitals did not bill for 
the devices that were paid under the pass-through mechanism in 2001, 
and therefore the median costs for the APCs for which most of the cost 
is a device are grossly understated.
    Response: As discussed previously, we believe the commenters have a 
point. For the APCs for which the service cannot be furnished without a 
pass-through device, we eliminated claims that were not billed with a 
device C code from the claims used to calculate the median cost for 
those APCs. By taking these steps as well as packaging the device cost 
billed with both revenue centers and device category codes, we believe 
our final rates for these procedures are more appropriate. The APCs for 
which we used only claims with devices are identified in Table 6 above.

B. Description of How Weights Were Calculated for CY 2003

    As discussed previously in this section, we first selected claims 
for services provided from April 1, 2001 through March 31, 2002. The 
methodology we followed to calculate the final APC relative payment 
weights for CY 2003 is as follows:
    [sbull] We excluded from the data 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 ESRD).
    [sbull] We eliminated 1.6 million claims from hospitals located in 
Maryland, Guam, and the U. S. Virgin Islands.
    [sbull] 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.
    [sbull] We eliminated from the hospital CCR data 301 hospitals that 
we identified as having reported charges on their cost reports, which 
were not actual charges (for example, a uniform charge applied to all 
services).
    [sbull] 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.
    [sbull] We excluded from our data approximately 3.6 million claims 
submitted by the hospitals that we removed or trimmed from the hospital 
CCR data.
    [sbull] We matched revenue centers from the remaining universe of 
approximately 92.9 million claims to CCRs for remaining hospitals.
    [sbull] We separated the 92.9 million claims that we had matched 
with a cost report into the following three distinct groups:
    (1) Single-procedure claims.
    (2) Multiple-procedure claims.
    (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), which 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 30.7 million 
single-procedure claims and 20.4 million multiple-procedure claims. 
Approximately 41.8 million claims without at least one covered OPPS 
service were set aside.
    We converted 10.8 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 31.5 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.
    [sbull] 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 III.A.1 of this 
final rule, we did not use multiple-procedure claims that included 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 other multiple-procedure bills to recalibrate APC 
weights that minimizes the risk of improperly assigning charges to the 
wrong procedure or visit.
    [sbull] 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 departmental 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 we 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'').
    [sbull] 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 7 lists packaged 
services by revenue center that we proposed to use to calculate per-
service

[[Page 66747]]

costs for outpatient services furnished in CY 2003.

               Table 7.--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.

[[Page 66748]]

 
-------------------------------------------
                            OTHER DIAGNOSTIC
------------------------------------------------------------------------
254.......................................  PHARMACY INCIDENT TO OTHER
                                             DIAGNOSTIC.
280.......................................  ONCOLOGY.
289.......................................  OTHER ONCOLOGY.
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.
------------------------------------------------------------------------

    [sbull] We standardized costs for geographic wage variation by 
dividing the labor-related portion of the operating and capital costs 
for each billed item by the FY 2003 hospital inpatient prospective 
payment system (IPPS) wage index published in the Federal Register on 
August 1, 2002 (67 FR 49982). 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 the April 7, 2000 final rule 
(65 FR 18496) for a complete description of how we derived this 
percentage).
    [sbull] 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.
    [sbull] 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 
three standard deviations from the geometric mean.
    [sbull] After trimming the procedure and visit level costs, we 
mapped each procedure or visit cost to its assigned APC, including the 
proposed APC changes described in section II.A of this final rule.
    [sbull] We calculated the median cost for each APC by using the 
claims for services included in the APC. In the case of APCs for which 
we eliminated the claims that did not contain device

[[Page 66749]]

C codes, we used only the claims that contained device codes to set the 
median cost for the APC. See section III.A.2 of this final rule for a 
complete discussion of why we used the device code medians for these 
codes (which are identified in Table 6).
    [sbull] Using these 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 RVUs 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 the 2001 through 2002 data, the 
median cost for APC 0601 is $57.56.
    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 ensures that aggregate payments under the OPPS for 2003 are 
neither greater 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 final 
weights. Based on this comparison, in this final rule, we are making an 
adjustment of .969 to the weights. The final weights for CY 2003, which 
incorporate the recalibration adjustments explained in this section, 
are listed in Addendum A and Addendum B of this final rule with comment 
period. The final weights are rounded to 4 decimals for greater 
precision.
    We received many comments on the issues related to calculation of 
the OPPS payment weights, which we summarize and address below:
Changes in Payment Rates from 2002 to 2003
    Comment: We received many comments expressing concern with the 
amount of decreases in payments for many services, in particular those 
that will include drugs and devices that will cease to be eligible for 
pass-through payment in 2003. Many commenters said that the costs for 
drugs and devices derived from claims data, on which we based weights 
for these APCs, were considerably below the acquisition price hospitals 
pay for the drugs and devices. Many commenters said that the proposed 
payments would result in hospitals ceasing to provide services that 
require expensive devices and drugs because they could no longer afford 
to furnish them under the proposed rates.
    Response: We are concerned that our payments not compromise access 
of Medicare beneficiaries to high quality services involving new 
technologies. Accordingly, we have adopted a number of changes in our 
estimating procedures, as described in more detail below and elsewhere 
in this final rule, designed to better ensure that the payment rates we 
establish in this rule are as accurate and reasonable as possible.
    Comment: Many commenters, in particular hospital organizations, 
supported the significant increases in payments for primary care and 
preventive services that were proposed. They strongly stated that we 
should rely only on Medicare claims data to ensure that these services 
would not be reduced in payment by increases to payments for device and 
drug related services, as happened in 2002 when external price data 
were used in the absence of Medicare claims data. They noted that the 
services that received increases in payments using 2001 claims data are 
furnished by all hospitals and that rural hospitals and small urban 
hospitals in particular are heavily dependent on adequate payment for 
these services to be able to continue to offer services to Medicare 
patients in their communities.
    Response: We also are concerned that our payments not compromise 
access of Medicare beneficiaries to high quality services that may not 
involve new technologies; these services in fact represent the bulk of 
services in all hospitals. Accordingly, we have been mindful that 
increases in the payment on some services will result in decreases in 
others.
    Comment: Many commenters shared with us data from various sources 
outside our claims data (for example, manufacturers' prices, prices 
reported by group purchasing organizations, and amounts from invoices 
as proof of acquisition price). Many of these commenters suggested we 
use these data as a substitute for or supplement to claims data for 
particular APCs or where particular drugs or devices are used.
    Response: We appreciate the data that these commenters provided to 
us. We carefully reviewed all the data that were furnished to us and 
used the data to guide us in analysis of claims data and in making 
decisions regarding how to generate the final payment weights.
    We note that the OPPS is not designed to pay hospitals their full 
accounting costs for delivery of particular services. The system was 
set up to be budget neutral to the prior system, which, under several 
provisions of the statute, paid approximately 82 percent of reported 
hospital outpatient department costs as shown on the cost reports. 
Payment rates for individual services are set, in essence, to reflect 
relative resource use within a payment system that pays at what was a 
discount of approximately 18 percent. Thus, for us to make changes to 
ensure that a particular service receives what observers believe is its 
``full'' cost is difficult, partly because determination of ``full'' 
cost for a particular service is an uncertain exercise and partly 
because such a service could only be paid ``full'' cost at the expense 
of all other services, which in principle would be paid at an even 
greater discount than that already implied by the operation of the 
system. Accordingly, while we have used data from external sources to 
evaluate the reasonableness of our payment rates and to guide us in 
choice of methods that would achieve results as reasonable as possible, 
we have not directly substituted such data into our estimates.
    Comment: Many commenters suggested that we use only claims on which 
pass-through devices had been coded to set medians for APCs containing 
procedures that required devices to be furnished.
    Response: We agree that this suggestion presents a useful way to 
edit our data, and adopted it in calculating the rates presented in 
this rule. We calculated medians from our most current set of claims 
data using all claims, (that is, using claims with no device C code, 
and using claims with device C code) and compared the medians. We found 
that, in many APCs because the procedures require use of a pass-through 
device, the medians that resulted from using any claims on which device 
C codes were billed were more similar to the device and procedure costs 
provided by external data than were the medians calculated using all 
claims. For these APCs, shown in Table 6, we used the median calculated 
using only claims on which a device had been coded.
    Comment: Many of the commenters asked that we adjust the weights so 
that no service, or at least no service for which a commenter had 
objected to a decrease, would receive a decrease in payment of more 
than 10 percent from 2002 to 2003.
    Response: We agree that the substantial fall in payment rates for 
some APCs suggests the need for some approach to moderate the changes.

[[Page 66750]]

Many of these decreases appear to be linked to one or more of the 
following:
    [sbull] Changes in the payment methodology for those drugs and 
devices that will no longer be eligible for pass-through payments,
    [sbull] Miscoding,
    [sbull] Restructuring of APCs (in which movement of a single code 
from one APC to another may change the median cost of both APCs), or
    [sbull] Use of data from the period following implementation of the 
OPPS.
    In the interest of using a method that could be employed simply and 
that could ensure that all APCs were treated similarly regardless of 
whether interested parties had identified them as sources of concern, 
we adopted a method that we applied to all APCs except new technology 
APCs, and APCs for drugs and devices that will receive pass-through 
payments in 2003.
    We considered a number of different ways of moderating the 
reductions in payment that would have occurred under the August 9, 2002 
proposed rule. We considered options that would have limited both 
significant increases and significant decreases in some fashion. 
However, we rejected these options because they would have reduced 
payments for those services that would otherwise have significant 
increases. Inspection of APCs that would have significant increases 
suggested that many of these increases were reasonable, and we did not 
want to reduce them more than necessary.
    We considered options that would have created a fixed corridor that 
would have limited any reduction to some fixed value, such as 10 or 15 
percent, as suggested by some commenters. However, we rejected this 
option, because it would have reduced the role of the claims data to a 
minimum, even though these data do reflect hospital charging behavior 
and are likely to have some degree of accuracy. In addition, setting an 
absolute floor on reductions would have shifted significant resources 
away from all other APCs.
    We considered targeting those APCs that would experience a 
reduction in median costs beyond a threshold and limiting the reduction 
in median costs to half of the difference between the threshold level 
and the total reduction. Because of budget neutrality constraints, the 
costs of this approach must be met by reductions in other services. We 
concluded that setting a threshold at a 15 percent reduction and 
decreasing the reduction in median costs by half of the difference 
between the total proposed reduction and the threshold provided an 
appropriate balance, reflecting our assessment of the relative quality 
of claims data, other information from commenters, and the effects on 
services overall.
    Thus, we adopt the following procedure. For any APC where the 
median cost would have fallen by 15 percent or more from between 2002 
to 2003 from the values that would be otherwise applicable for 2003, 
after the data and method improvements noted above, we first decreased 
the reduction in median cost by one half of the difference between the 
value derived from the claims data and 15 percent. This methodology was 
applied to all APCs, not just those involving drugs or devices losing 
pass-through eligibility. We then assessed the results of this 
procedure with information from comments and concluded that several 
additional but more targeted steps were appropriate.
    We examined further those APCs containing procedures involving 
devices where the device represented a very large portion of the 
overall costs. Noting that the overall reduction from cost discussed 
elsewhere in this section would mean that services where devices 
represented 80 percent or more of the total costs would leave virtually 
no margin to cover hospital costs in performing the procedure, we 
limited our attention to those APCs with device costs of 80 percent of 
more. We then calculated adjusted APC median costs for these APCs by 
determining the portion of the cost that was attributable to the 
procedure and summing it with a weighted average of the cost of the 
device. We determined the weighted average of the cost of the device by 
giving a weight of 3 to the median acquisition cost of the device as 
provided by external data and a weight of 1 to the median cost from our 
claims data. We then added the adjusted cost of the device to the 
unadjusted cost of the procedure to calculate the total cost of the 
procedure. Our dampening policy was then applied to the adjusted total 
cost of the procedure.
    We believe that this process gave us credible adjusted medians for 
APCs 107, 108, 222 and 259. We gave external acquisition cost data a 
weight 3 times that of the adjusted claims median data because these 
APCs are disproportionately highly weighted with device costs and we 
recognize that our device data have weaknesses that would otherwise 
result in payments that are so low as to limit beneficiary access to 
these services.
    We also examined further those APCs involving blood and blood 
products, and vaccines. Information from comments raised significant 
concerns about the payment reductions that would result, even after 
improvements in data and methods and the adjustments described above 
were applied, on blood and certain blood products (including 
antihemophilia factors). Considering the importance of these products 
to ongoing operation of hospitals, the short shelf life of many of 
them, other peculiarities of their distribution, and possible adverse 
effects on public health, we concluded that these products should be 
further protected from decreases. Accordingly, we limited the reduction 
in the median cost from 2002 to 2003 for these products to 11 percent, 
which resulted in limiting the reduction in payment from 2002 to 2003 
to about 15 percent. We did this for the APCs listed in Table 8.
    We also adopted specific changes relating to vaccines and certain 
orphan drugs, as described elsewhere in this final rule.
    We created unscaled weights for all APCs by dividing the adjusted 
medians by the median cost for APC 601 (mid level visit). We then 
scaled the weights for budget neutrality. The budget neutrality scaler 
that we applied to the weights was .968969.

         Table 8.--Blood and Blood Products With Special Limits
------------------------------------------------------------------------
                    APC                              Description
------------------------------------------------------------------------
0949......................................  Plasma, Pooled Multiple
                                             Donor, Solvent/Detergent T.
0950......................................  Blood (Whole) For
                                             Transfusion.
0952......................................  Cryoprecipitate.
0954......................................  RBC leukocytes reduced.
0955......................................  Plasma, Fresh Frozen.
0956......................................  Plasma Protein Fraction.
0957......................................  Platelet Concentrate.
0958......................................  Platelet Rich Plasma.

[[Page 66751]]

 
0959......................................  Red Blood Cells.
0960......................................  Washed Red Blood Cells.
0966......................................  Plasmaprotein
                                             fract,5%,250ml.
1009......................................  Cryoprecip reduced plasma.
1010......................................  Blood, L/R, CMV-neg.
1011......................................  Platelets, HLA-m, L/R, unit.
1013......................................  Platelet concentrate, L/R,
                                             unit.
1016......................................  Blood, L/R, froz/deglycerol/
                                             washed.
1017......................................  Platelets, aph/pher, L/R,
                                             CMV-neg, unit.
1018......................................  Blood, L/R, irradiated.
1019......................................  Platelets, aph/pher, L/R,
                                             irradiated, unit.
9500......................................  Platelets, irradiated.
9501......................................  Platelets, pheresis.
9502......................................  Platelet pheresis
                                             irradiated.
9503......................................  Fresh frozen plasma, ea
                                             unit.
9504......................................  RBC deglycerolized.
9505......................................  RBC irradiated.
9506......................................  Granulocytes, pheresis.
0925......................................  Factor viii per iu.
0926......................................  Factor VIII (porcine) per
                                             iu.
0927......................................  Factor viii recombinant per
                                             iu.
0928......................................  Factor ix complex per iu.
0929......................................  Anti-inhibitor per iu.
0931......................................  Factor IX non-recombinant,
                                             per iu.
0932......................................  Factor IX recombinant, per
                                             iu.
1409......................................  Factor viia recombinant, per
                                             1.2 mg.
1618......................................  Vonwillebrandfactrcmplx, per
                                             iu
------------------------------------------------------------------------

    Comment: Many commenters, while indicating appreciation for our 
efforts to use data from multiple claims in determining relative 
weights as described in the August 9, 2002 proposed rule, believe that 
we have not done enough. Although we have significantly increased the 
number and proportion of claims that enter the calculation for relative 
weights, commenters asserted that, in particular, clinical areas, our 
mobility to draw on multiple claims distorts the relative weights 
assigned to services, because in normal circumstances certain services 
would always be performed with other particular services. If packaged 
services also appear on such claims, the claims would not be used in 
our current methodology, and relative weight calculations may not be as 
accurate as desired as a result. These commenters urged us to do more 
to include data from multiple claims.
    Response: We appreciate the recognition of the methodological 
improvements that we have been able to accomplish this year. Although 
intend to continue the gains achieved for 2003, the development of 
appropriate methods is difficult. Further methodological development 
may be very detailed and involve clinical review of particular areas of 
services. We have been unable to develop any further methodological 
changes at present, so for 2003, we are adopting the same methods we 
proposed. We wish to develop further methods of allocation that will 
permit use of more multiple claims in the future, particularly in 
problem areas identified by commenters, and we hope to be able to make 
further progress in this area in time for the 2004 update.
    Comment: Several commenters raised questions about our editing 
procedures relating to which claims were used in analysis. On one hand, 
some questioned whether our standard method of trimming claims with 
values over three standard deviations above the median was appropriate, 
or whether it might leave out reasonable claims involving newly 
disseminating, high cost technologies. Other commenters suggested that 
we edit the claims more restrictively, removing from analysis claims 
with values outside a clinically relevant range (of drug dosages, for 
instance).
    Response: While we think the suggestions made by these commenters 
deserve further consideration, we have made no changes in developing 
the estimates for the final rule. Our procedure for trimming claims 
with values above three standard deviations, an exceedingly small 
proportion of claims, is a standard procedure we use in estimates for 
several payment systems. This procedure prevents undue influence on the 
estimates by claims that have a high probability of coding errors, and 
we have no particular indication that this procedure is inappropriately 
applied in this system. Establishing clinically relevant ranges would 
be difficult. The most obvious method would involve establishment of 
norms of particular services based on the judgment of clinicians, but 
these judgments might not be validated by actual experience in the 
field. We would have to develop this idea more thoroughly before 
adopting it. Accordingly, for 2003 we are using the trimming and 
editing procedures rules described in the August 9, 2002 proposed rule.
    Comment: Several commenters noted that hospital coding appeared to 
improve over the course of 2001, based on quarter-by-quarter 
examination of claims data.
    Response: We agree that hospital coding practices appear to have 
improved during the early months of the implementation of the OPPS. 
Because accurate coding now has definite implications for payment that 
it lacked in the past, this change was expected and comports with our 
experience in implementing other payment systems. To improve the 
quality of estimates for this final rule, we changed the reference 
period of the data used for the final rule by one quarter. The August 
9, 2002 proposed rule was based on data from calendar year 2001; for 
the final rule, we dropped data from the first quarter of 2001 and 
added data from the first quarter of 2002. We were thus able to draw on 
data from a more recent period

[[Page 66752]]

while maintaining approximately the same number of claims for analysis. 
This change was possible in this instance because the implementation of 
the 2002 update on April 1, 2002 meant that the coding during the first 
quarter of calendar year 2002 was unchanged from the prior year. We 
believe that this change has improved the quality of our estimates.
    Comment: Commenters asked a number of very detailed questions about 
our data and methods of calculation.
    Response: Within a few weeks of the publication of this rule, we 
expect to invite interested parties to a meeting at our headquarters in 
Baltimore to discuss these and other questions regarding methods and 
estimates with our technical staff.
Use of Cost-to-Charge Ratios and Charge Compression
    Comment: A number of commenters raised concerns about our use of 
cost-to-charge ratios in determining median costs of items and 
services. Of particular concern is the effect of our procedure on the 
costs we calculate for high-cost drugs and devices. These commenters 
asserted that hospitals markup their acquisition costs of drugs and 
devices by different percentages depending on the cost of the item. If 
so, application of cost-to-charge ratios that do not take this effect 
into account would result in a relative weight (and hence payment) for 
a high-cost item that was inappropriately low. Commenters asserted that 
differential mark-up behavior, sometimes referred to as ``charge 
compression,'' is common among hospitals, at least on purchased inputs 
such as implantable devices.
    To illustrate, assume cost-to-charge ratios are about generally 50 
percent. That would imply that an item that cost, for example, $100, 
would be marked up by 100 percent to $200. ($100/$200 = .5) If the 
hospital decided to mark up the cost of a high cost item by only 50 
percent, the charge for an item that cost $1,000 would be $1,500, and 
the cost-to-charge ratio would be 67 percent. ($1,000/$1,500 = .67) On 
the other hand, the hospital might choose to mark up a low cost item by 
150 percent: The charge for an item that cost $10 would be $25, and the 
cost-to-charge ratio would be 40 percent ($10/$25 = .4).
    Commenters did not provide any useful empirical information on 
issues such as those above. One commenter presented results of a 
statistical analysis of the relation of average wholesale price (AWP) 
of some drugs to our proposed payments, but we do not know if average 
wholesale prices vary uniformly in proportion to the acquisition costs 
of hospitals and consequently do not find this analysis particularly 
informative.
    Response: We calculate OPPS payment rates based on the charges made 
by the hospitals on OPD claims, reduced to costs by application of a 
cost-to-charge ratio that is either specific to each of the various 
departments of each hospital or, in cases where data are inadequate, to 
the individual hospital as a whole. Costs are not available on a 
service-specific basis, but are reported on each hospital's cost report 
by revenue center, which can in turn be grouped by department. Thus, 
the service-specific amount claimed is multiplied by the departmental 
cost-to-charge ratio to convert it into a measure of the cost on a 
service-specific basis. We then use these costs to adjust the relative 
weights for the various APCs as part of the annual update process.
    In making this calculation, we are assuming that the ratio of cost 
to charges is constant across all services to which it is applied. This 
assumption has proved workable in the inpatient setting for almost 20 
years. The calculations may not perfectly capture the costs identified 
for particular services, but as long as we use them in a set of 
relative calculations, any deviations should largely cancel out. 
However, if hospitals do not mark-up services in a uniform fashion 
within departments, the payment rates resulting from application of 
this assumption would be too low for some services (and too high for 
others), and the rates would create incentives for hospitals to avoid 
(or favor) particular services.
    This postulated behavior of hospitals is not implausible, as they 
may attempt to avoid adverse reactions to high prices among consumers 
and to reduce coinsurance burden on high cost items used infrequently. 
However, the possibility of differential mark-up behavior is not well 
documented empirically. We do not know if differential mark-ups are 
common across many hospitals or across many services. Further, we do 
not know the size of any differential that may exist. Do hospitals 
apply differential mark-ups to all services or only to certain 
purchased inputs? Do they apply differential mark-ups only above some 
threshold (such as $1,000), or does the mark-up vary in some uniform 
fashion with the cost of the service?
    In the face of the paucity of reliable empirical information on 
this issue, we find that we cannot move quickly to revise our current 
methodology. We are adopting our proposed methodology for calculating 
cost-to-charge ratios for 2003. We believe this issue merits further 
study, and we expect to address it further in the future.
Use of Means Rather Than Medians To Set Weights
    Comment: Some commenters suggested that CMS use means rather than 
medians to set rates because means will result in higher values for 
device-related APCs than using medians. Some commenters noted that 
means are a better measure of central tendency because medians are so 
sensitive to the atypical distribution of new technology services 
within an APC. Some commenters recommended that if we use medians, we 
should revise the data set by deleting claims for services that require 
a device if the device was not billed.
    Response: We will explore the possibility and potential impact of 
using means rather than medians for the 2004 OPPS. We lacked the 
resources and time to explore the impact of this change for the final 
rule with comment. However, since the purpose of these measures is to 
create relative payment weights, it does not necessarily follow that 
basing the relative weights of services on means will cause a change to 
the weights in a manner that would satisfy the commenter. We did, 
however, revise the data set by deleting claims for procedures that 
required a device if the device was not billed.
Collect at Least 3 Years' Data for Pass-Through Devices Before Setting 
Rates Based on Claims Data
    Comment: Commenters recommended that we not use claims data to set 
weights for pass-through devices unless they have at least 3 years of 
claims data for the device. They argued that this was the minimum 
amount of time needed to allow stability in the hospitals' coding and 
charges for the items.
    Response: We cannot ensure that we will wait for 3 years to pass 
before we will set payments based on data for new devices. The statute 
provides for no less than 2 years and no more than 3 years payment 
under pass-through for items that do not fit a previously existing 
device category. Hence, in most cases, items will not have received 3 
years of transitional pass-through payment before they are priced based 
on costs. Moreover, many new devices do not receive pass-through status 
because they fit in a category that previously met the criteria and, 
once pass-through payment is no longer permitted for the category, 
these devices will be paid through payment for the procedure in which 
they are used from their first use.
    In general, the statute requires us to use costs as the basis for 
the weights.

[[Page 66753]]

Claims data are the single national uniform basis of cost data for all 
OPD items and services. Other data sources are fragmented and are not 
national in scope, and may be biased in various ways. We believe that 2 
years provides a sufficient time for hospitals to establish coding 
practices and to determine what charges to impose for items and 
services paid under the OPPS and that this will be even more true in 
the future as hospital coders and billers become more accustomed to 
HCPCS coding and the impact of charges on future payments.
Continue 2002 Weights for 2003 and Train Hospital Staff Coders and 
Billers Because Claims Data Are Flawed
    Comment: Some commenters asserted that Medicare 2001 claims data 
are so badly flawed that the weights should be left untouched for 2003. 
They requested that we should initiate training of hospital staff 
billers and coders to ensure that future data accurately reflect the 
codes of the services furnished and that the charges accurately reflect 
the costs of drugs and devices.
    Response: We have decided to revise the weights for 2003 based on 
the best available information. We believe that the adjustments and 
moderations we have made to the median costs for the services that 
would have been most adversely affected under the methodology used in 
the August 9, 2002 proposed rule have enabled us to establish a valid 
set of relative weights for the 2003 OPPS. This comports with the 
requirement of section 1833(t)(9)(A) of the Act that we review and 
revise the relative weights annually to take into account new cost data 
and other relevant information, and factors. Regarding training of 
hospital staff, we have greatly expanded our efforts to assist 
providers in complying with all Medicare rules, including creation of 
the Medlearn Web site, issuance of specialized articles and provider 
seminars. However, the fundamental responsibility for correct coding 
and billing for services lies with the hospitals who are paid under the 
OPPS system and who have every incentive to bill correctly to ensure 
that they are paid for all the services they furnish to Medicare 
beneficiaries.
Release of Crosswalk for Packaging Costs to Specific APCs
    Comment: Some commenters asked that we release the crosswalk used 
to assign pass-through device costs to specific APCs. They indicated 
that without this crosswalk, they are unable to make specific comments 
and they urged the Congress to fund an additional activity to correct 
APCs they determine to be severely underfunded after they perform this 
analysis.
    Response: There is no CMS-generated crosswalk that was used to 
assign pass-through device costs to APCs. We relied upon the coding of 
hospitals in their packaging of devices, drugs, and other items and 
services into the payment for the procedure in which they were used. We 
will make a public use file available that containing the claims data 
used to set the final payment weights. By examination of these data, 
interested parties can determine what was packaged into the medians for 
the APCs. While we recognize that the claims may contain errors, we 
believe that the probability of making errors in crosswalking services 
to procedures is reduced by accepting what providers bill as the items 
and services furnished with the procedure.
Impact of Medical Education on OPPS Payment Adequacy
    Comment: Several commenters noted that payment under OPPS does not 
take into account the time and cost components associated with 
providing teaching services in teaching hospitals and thereby puts 
teaching hospitals at a disadvantage. Moreover, teaching hospitals are 
typically on the cutting edge of development and implementation of new 
innovations, technological and otherwise and would therefore be 
underpaid by the low payments proposed for APCs that use expensive 
devices. The commenters asked that Medicare provide an indirect medical 
education (IME) payment percentage add-on for all outpatient APCs 
similar to the IME factor used to adjust DRG payments for inpatient 
services.
    Response: We have not developed an IME add-on for payments made 
under the OPPS because the statute does not provide for this 
adjustment, and we are not unconvinced that it would be appropriate in 
a budget-neutral system in which such changes would result in reduced 
payments to all other hospitals. Moreover, in the final rule, we have 
developed payment weights that we believe resolve many of the issues 
with payments for devices for which payment is packaged into the 
payment for the procedure in which the device is used. These and other 
payment changes should help ensure equitable payment for all hospitals 
as provided within the constraints of the statute.
Elimination of Payment for Cochlear Implants and Vagus Nerve 
Stimulators
    Comments: A number of commenters objected to what they believed was 
a proposal to eliminate payment for cochlear implants and vagus nerve 
stimulators. Those who had the implant indicated that these devices had 
greatly improved their lives, or others who were expected to have the 
device implanted objected to what they believed was a proposal to no 
longer pay for them.
    Response: We did not propose to cease payment for these devices 
under Medicare or to cease payment for services needed to implant them. 
We did propose payment amounts for 2003, and, in this final rule, we 
provide the payment rates that will determine payments under the OPPS 
in 2003. The establishment of payment amounts does not constitute a 
Medicare determination that these items and services are or are not 
covered in any particular case.
Underfunding of OPPS in General
    Comment: Some commenters stated that OPPS was severely underfunded 
when it was established and it will never result in adequate payment of 
costs under its current budget neutrality requirements. They asked that 
we support their efforts to seek increased funding for outpatient 
services since hospital care is increasingly furnished in the 
outpatient setting and because continued absence of adequate funding 
will result in reduced access to services. Some commenters indicated 
that since the budget neutrality scaler is determined on the basis of 
estimates, we have considerable latitude to ensure that payments are as 
close to costs as possible, notwithstanding that the base was set at 82 
percent of cost when the system was established.
    Response: We do not believe that the OPPS system is severely 
underfunded, nor do we believe that the statute gives us flexibility in 
the determination of budget neutrality. Congress set the OPPS system to 
be budget neutral to the total payments under prior payment methods; 
those methods, as result of several statutory provisions dating back to 
FY 1990 and FY 1991, paid for hospital outpatient department services 
at approximately 82 percent of costs. We understand that observers at 
the time believed that hospitals had shifted accounting costs that 
might otherwise have been attributed to inpatient cost centers to the 
outpatient setting because the inpatient PPS limited hospital payment 
on the inpatient side while the outpatient side was not similarly 
constrained. Congress had thus reduced payments for outpatient 
department services below nominal costs, and the OPPS was set to be 
budget neutral relative to total payments under the prior system. 
Whether this situation

[[Page 66754]]

implies that hospital outpatient departments are underfunded under the 
OPPS is hard to judge.
    With respect to budget neutrality, section 1833(t)(9)(B) of the Act 
makes clear that any adjustments to the OPPS made by the Secretary may 
not cause estimated expenditures to increase or decrease. We do not 
believe the statute provides us authority to depart from budget 
neutrality simply because it uses the word ``estimated.''
Data Issues Peculiar to Radiopharmaceuticals
    Comment: Commenters stated various reasons why it would be 
inappropriate to use the 2001 claims data to calculate the median cost 
of radiopharmaceuticals. They claimed that additional costs unique to 
radiopharmaceuticals, such as overhead costs for nuclear pharmacies and 
safety/regulatory costs, were not reported in the 2001 claims. Also, 
they believe not all hospitals billed for their costs, particularly 
costs for overhead items, to the appropriate revenue codes. Therefore, 
they argue this misallocation of charges resulted in an underestimate 
of the cost-to-charge ratios that were used to set the payment rates. 
The low volume of claims for radiopharmaceuticals in the 2001 dataset 
may be attributed to the use of HCPCS A4641, which many hospitals used 
for radiopharmaceutical billing, instead of more specific coding. Also, 
they suggested that we did not receive reliable reporting data from the 
hospitals because of significant descriptor and payment rate changes in 
2001. Thus, they recommended that we not implement the proposed changes 
until more accurate data on hospital costs could be collected.
    Response: As discussed elsewhere in this section, we believe that 
we have satisfactorily resolved the data issues in the claims data for 
2001 to enable us to create an appropriate set of relative weights for 
OPPS services for 2003. We find no justification for delaying the 
update of the 2003 OPPS. Moreover, we see nothing unique in the issues 
raised in the context of data for radiopharmaceuticals. As with other 
services, the costs in revenue centers and for A4641 were packaged into 
the procedure with which the items were billed. Similarly, we do not 
believe that the problem with multiple procedure claims is more of a 
problem for radiopharmaceuticals than for other services that are 
commonly provided in combinations. Lastly, there were significant 
descriptor and payment rate changes for all services paid under OPPS in 
2001, and the extent of the changes for radiopharmaceuticals did not 
differ significantly from the extent of changes for other items and 
services.
Methodological Reasons That the Data for Drugs Are Flawed
    Comment: Many commenters asserted that there are significant 
methodological problems in the 2001 claims data for drugs and 
biologicals, especially the high cost items. They said that the 2001 
claims data do not reflect appropriate codes and charges for separately 
paid drugs and biologicals and that the proposed payment rate does not 
take into account additional pharmacy overhead costs. They indicated 
that when we process a claim, we reject the second and subsequent line 
if it is identical to a previously billed line as a duplicate claim and 
that, therefore, the subsequent lines are not included in the claims 
data. They maintained that the methodology of analyzing single line-
items on drug claims is not consistent with how hospitals bill for 
particular drugs and biologicals. They stated that claims reported by 
hospitals for certain drugs and biologicals showed unit amounts that 
fell outside a therapeutic range and therefore should have been 
excluded from the body of claims used to set the rates. They said that 
many drugs and biologicals have a low HCPCS code dose that skews the 
computation of the relative weights, and thus the payment rates for 
these products.
    Response: We recognize that not all hospitals billed properly for 
drugs and biologicals in 2001. However, since most payment for drugs 
and biologicals was made on a pass-through basis at 95 percent of AWP 
in 2001, hospitals had a significant incentive to bill properly and we 
believe that in most cases they billed properly for the services they 
furnished so as to receive payment for them. We recognize that if a 
claim was submitted in a manner that caused it to be rejected by 
duplicate claims edits, it would not appear in the data. However, we 
expect that in those cases, hospitals would submit an adjustment bill 
to secure payment for the full service and that the costs for the drugs 
or biologicals as shown in the adjustment bill would be reflected in 
the data. We also recognize that some claims reflect that the drugs 
were furnished in amounts that were outside of therapeutic ranges. 
However, we have no reason to believe that those claims do not 
represent what actually was furnished to the patient. Should a 
physician deviate from standard therapeutic ranges in particular a 
case, it is reasonable to expect the claim to reflect what was 
administered. With regard to the low dose of the HCPCS code, the 
payment is set based on the definition of the code and so to the extent 
that the drug or biological is correctly coded on the claim, the claims 
data would reflect the cost of the drug or biological.
Elimination of Data for Hospitals Without Actual Charges
    Comment: Several commenters raised concerns regarding the 
elimination of about 3 million claims from 301 hospitals because their 
reported charges were not actual charges. The commenters requested the 
following information from us on the effect of eliminating these 
claims: Did the elimination of this information create more bias 
against higher cost drugs and biologicals? Were the claims from certain 
specialty hospitals?
    Response: There is no way for us to determine what effect would 
have taken place if these hospitals had reported charges as other 
hospitals did. However, because we know that the reported charges for 
these hospitals are not actual charges, we know that the information 
provided by these hospitals is meaningless for the purpose of 
calculating payment rates under OPPS.
Impact of Rounding of Relative Weights for Drugs
    Comment: Commenters stated that the rounding of relative weights 
down to only two decimal places causes a significant reduction in 
payment. For example, rounding a unit down to a relative weight of 0.01 
from a greater amount (for example, 0.01433) can substantially decrease 
the payment amount of a therapeutic dose.
    Response: We rounded relative weights to 4 decimal places in the 
final rule.
    Comment: A commenter indicated that we included data from the 11 
PPS-exempt cancer hospitals that should have been excluded from the 
rate-setting calculations.
    Response: We disagree with the commenter's concern. According to 42 
CFR 412.23(f), cancer hospitals that meet specific criteria are 
excluded from the inpatient PPS; however, these hospitals are not 
excluded from OPPS. Rather, under OPPS, cancer hospitals are held 
harmless. The hold harmless provision is set forth in our existing 
regulations at 42 CFR 419.70(d)(2). Therefore, we do not exclude claims 
for services furnished in these hospitals in our rate setting 
calculations.
Need for a Special Exceptions Process
    Comment: Some commenters said that CMS should have a process by 
which hospitals should be able to submit special documentation to 
indicate that

[[Page 66755]]

unusual conditions exist and be paid an additional amount set by the 
contractor for the unusual conditions or costs that the hospital is 
incurring. They suggested this as a means of being assured of recouping 
costs where the APC payment would not otherwise reimbursement for full 
costs.
    Response: We did not accept the comment because the OPPS already 
has an outlier system that provides for an additional payment when 
costs are incurred that meet the outlier criteria.
Claims Process
    Comment: One commenter said that the implementation of OPPS was 
extremely daunting to providers because it was so different from prior 
billing and coding for these services and because CMS processes and 
rules changed so frequently. They indicated that software vendors often 
lagged behind CMS requirements and that errors in either provider 
billing or intermediary processing often required a hospital to detect 
a problem and resubmit claims. Moreover, the volume of claims can cause 
a small problem to become a large problem in very little time. They ask 
that CMS do whatever it can to simplify the processes they must 
undertake to achieve submission of a ``clean'' claim.
    Response: We recognize that implementation of CMS was difficult for 
providers and we have tried to do all that we can to simplify billing 
and payment rules and to respond to problems as they arise. Most 
recently, the hospital open door forum calls have provided a means for 
hospitals to bring problems to the attention of the CMS staff as 
quickly as possible so that they can be resolved.
Reduced Quality of Care for Gamma Knife Services
    Comment: A commenter said that reducing payment for hospital 
services for G0242 will force hospitals to reduce the hours of work for 
medical physicists in the hospital and will therefore decrease quality 
by increasing the opportunity for errors in the calculations that must 
be done before treatment.
    Response: We believe that hospitals would not jeopardize themselves 
by decreasing the extent to which they ensure that errors are not made.
    We are finalizing our rate methodology for PHP, including data from 
hospital outpatient and CMHC programs. The national unadjusted rate for 
CY 2003 will be $240.03, of which $48.17 is the beneficiary's national 
unadjusted coinsurance. Upon further review we have determined that we 
will not include the issue of separate billing for clinical social 
worker services provided to PHP patients in this final rule but will 
address it in future rulemaking.

IV. 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.
    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), Public Law 106-554, enacted December 21, 2000).
    Transitional pass-through payments are also required for certain 
``new'' medical devices, drugs, and biological agents that could not be 
described as current, 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://cms.hhs.gov.
    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://cms.hhs.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 respond to 
public comments on that interim final rule in this final rule with 
comment 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 processes 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://cms.hhs.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://cms.hhs.gov/Medicare/hopps/default.asp.
    As we indicated in the NPRM (67FR52130), Determining that a drug or 
biological is eligible for a pass-through payment or making a decision 
to pay a drug or biological on a separate APC basis (rather than 
packaging payment into payment for a procedure) does not represent a 
determination that the drug or biological is covered by the Medicare 
program.
    CMS and its contractors make coverage determinations and the FDA 
makes premarket approval decisions under different statutory standards. 
Whereas the FDA must determine that a product is safe and effective as 
a condition of approval, CMS must determine that the product is 
reasonable and necessary as a condition of coverage under section 
1862(a)(1)(A) of the Social Security Act. Under a premarket approval 
review, the FDA determines whether or not the product is safe and 
effective for its intended use that is

[[Page 66756]]

stated in its proposed labeling. Medicare evidence-based NCD reviews 
consider the medical benefit and clinical utility of an item or service 
in determining whether the item or service and its expenses are 
reasonable and necessary under the Medicare program. Unlike the FDA 
safety and effectiveness evaluation, CMS determines whether or not the 
product is clinically effective, that is, does the item or service 
improve net health outcomes in the Medicare population as compared to 
other covered technologies or procedures. CMS and its contractors do 
require that a drug or biological first be approved by the FDA, 
although not necessarily for the indication for which coverage is 
sought. CMS and its contractors also strongly consider the FDA's 
evaluation when making a coverage determination for a product and do 
not substitute their judgment for that of the FDA's regarding safety 
and effectiveness. Instead, we focus our review on the issues that are 
unique to Medicare's reasonable and necessary determination. (We note 
that approval of a product by the FDA as a drug or biological does not 
automatically assure that Medicare payment for the product will be as a 
drug or biological. The product must still be placed into the most 
appropriate Medicare benefit category before Medicare can make 
appropriate payments.)
    In the case of an FDA-approved indication for drugs and 
biologicals, CMS and its contractors have generally considered that use 
to be reasonable and necessary, without performing a separate review, 
although Medicare has always retained the right to perform a separate 
evaluation. (See, for example, 54 FR 4302, 4306, January 30, 1989) 
(Proposed Rule-Coverage Criteria) (``Questions regarding coverage of 
drugs and biologicals are rarely referred to PHS since we have 
determined as a matter of national policy that drugs or biologicals 
approved for marketing by FDA are safe and effective when used for 
indications specified in their labeling.'') (emphasis added); Medicare 
Carriers Manual section 2049.4 (``Use of the drug or biological must be 
safe and effective and otherwise reasonable and necessary. Drugs or 
biologicals approved for marketing by the Food and Drug Administration 
are considered safe and effective for purposes of this requirement when 
used for indications specified on the labeling.'' (emphasis added). 
Under section 2049.4, our contractors ``may pay for the use of an FDA 
approved drug or biological, if: (1) It was injected on or after the 
date of the FDA's approval; (2) It is reasonable and necessary for the 
individual patient; and (3) All other applicable coverage requirements 
are met.'' (emphasis added).
    CMS developed this approach, because, in the past, it was a more 
efficient mechanism for coverage and the impact of drugs and 
biologicals on the Medicare program was relatively small. Now, as a 
result of the increasing number of novel therapies on the market and 
the impact of new drugs and biologicals on the Medicare program, it is 
prudent for Medicare to perform its traditional coverage analysis for 
appropriate drugs and biologicals as it does for all other items and 
services to ensure that it only pays for those products that are 
clinically effective. For drugs and biologicals, Medicare will continue 
to use FDA approval as a default for a reasonable and necessary 
determination of an FDA-approved indication unless CMS decides 
otherwise. CMS may choose to perform a reasonable and necessary 
determination in several circumstances, including, but not limited to 
the following: the drug or biological in question represents a novel, 
complex or controversial treatment, may be costly to the Medicare 
program, may be subject to overutilization or misuse, or received 
marketing approval based on the use of surrogate outcomes.

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 
pass-through payments will exceed the applicable percentage but also to 
determine the appropriate reduction to the conversion factor.
    In the August 9, 2002 proposed rule, we describe in detail the 
methodology we would use to make an estimate of pass-through spending 
in 2003 (67 FR 52117 through 52118). Very generally, after projecting 
2003 pass-through spending for the groups of devices, drugs, 
biologicals, and radiopharmaceuticals as described in the proposed 
rule, 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 the table was 
developed. In the August 9, 2002 proposed rule we indicated that we 
were uncertain whether pass-through spending in 2003 will exceed $467 
million or 2.5 percent of total estimated OPPS spending because we had 
not yet completed the estimate of pass-through spending for a number of 
drugs. We invited comments on the methodology we proposed to use to 
determine if a pro rata reduction would be necessary as well as the 
assumptions shown in Table X of the August 9, 2002 proposed rule that 
included anticipated utilization and utilization not yet determined.
    We received several comments on this proposal, which are summarized 
below.
Estimates of Pass-Through Spending
    Comment: A device manufacturer stated that it would be premature to 
impose pro rata reductions before we accurately account for an APC's 
device offset amount.
    Response: Where applicable we have applied offset amounts to APCs 
with device categories for determining the final estimate of 2003 pass-
through spending.
    Comment: Many commenters said that there should be no pro rata 
reduction because we did not present the cost and utilization data that 
would be used to determine if the criteria for a reduction were met. 
Some commenters said that the pro rata reduction is discretionary and 
that we should not impose one because of the magnitude of the decreases 
for APCs that require expensive devices and the decreases in APCs for 
drugs (as compared to the pass-through payment). Some commenters said 
that our proposed projections overestimated the volumes that could be 
expected to occur in 2003.
    Response: Section 1833(t)(6)(E)(i) of the Act requires that the 
Secretary estimate the total pass-through payments to be made for the 
forthcoming year (which allows us to determine the amount of the 
conversion factor for the forthcoming year) and to the extent the 
estimate exceeds the statutory limit, reduce the amount of each pass-
through payment. For 2003,

[[Page 66757]]

the statutory limit is 2.5 percent of total estimated program payments. 
In the August 9, 2002 proposed rule, we provided our best estimate at 
that time of pass-through payments for the drugs and devices for which 
we expected to make pass-through payments in 2003, and we explained our 
methodology for determining the estimate for the final rule. We 
provided a list of the devices and drugs we either knew would be paid 
under pass-through next year or which we believed may be paid as pass-
through items in 2003.
    We have refined and finalized our estimate of pass-through spending 
in 2003 and, for the reasons discussed below, we have determined that 
no pro rata reduction will be required in 2003. Moreover, as discussed 
below the estimate falls under the statutory limit of 2.5 percent. 
Therefore, the conversion factor has been increased.
    Comment: A commenter disagreed with the 2003 payment estimates in 
Table X of the August 9, 2002 proposed rule for the diagnostic and 
therapeutic radiopharmaceutical agents, IN-111 Zevalin and Y-90 
Zevalin. The commenter estimated the number of patients receiving this 
therapy in the outpatient department setting in 2003 at approximately 
2,500 for both the diagnostic and therapeutic portions, instead of the 
9,000 that we projected in our August 9, 2002 proposed rule. The 
commenter further stated that the payment per patient for the Y-90 
Zevalin therapy should be based on 40 mCi, the amount required in the 
preparation of the dose.
    Response: Since publication of the August 9, 2002 proposed rule, we 
have determined that the appropriate payment mechanism for IN-111 
Zevalin and Y-90 Zevalin is through the new technology APCs, rather 
than through the transitional pass-through payment methodology. Zevalin 
began receiving pass-through payment as a hospital outpatient service 
in 2002 as a radiopharmaceutical drug. After careful reexamination of 
Zevalin, we have determined that Zevalin is not a drug and therefore 
does not qualify for a pass-through payment.
    Section 1861(t)(1) provides that the terms drugs and biologicals 
``include only such drugs (including contrast agents) and biologicals, 
respectively, as are included (or approved for inclusion) in [one of 
several pharmacopoeias] (except for any drugs and biologicals 
unfavorably evaluated therein), or as are approved by the pharmacy and 
drug therapeutics committee (or equivalent committee) of the medical 
staff of the hospital furnishing such drugs and biologicals for use in 
such hospital.'' A careful reading of this statutory language convinces 
us that inclusion of an item in, for example, the USPDI (as Zevalin is 
included, as a biological), does not necessarily mean that the item is 
a drug or biological. Inclusion in such reference (or approval by a 
hospital committee) is a necessary condition for us to call a product a 
drug or biological, but it is not enough. Rather, if we are to call a 
product a drug or a biological for our purposes, CMS must still make 
its own determination that the product is a drug or biological. In the 
case of Zevalin, we have determined that Zevalin is not a drug or a 
biological.
    Zevalin consists of a radioactive isotope that is delivered to its 
target tissue by a monoclonal antibody. Because of the specific 
requirements associated with delivery of radioactive isotope therapy, 
any product containing a therapeutic radioisotope, including Y-90 
Zevalin, will be considered to be in the category of benefits described 
under section 1861(s)(4) of the Act. Similarly, the appropriate benefit 
category for all diagnostic radiopharmaceuticals, including IN-111 
Zevalin, is 1861(s)(3). We will consider neither diagnostic nor 
theraputic radiopharmaceuticals to be drugs as described in section 
1861(t).
    Thus, we have determined that the most appropriate Medicare benefit 
categories for IN-111 Zevalin and Y-90 Zevalin are as provided in 
sections 1861(s)(3) and (4) of the Act because they are a new 
diagnostic test and new radioactive isotope therapy, respectively. We 
will pay for IN-111 Zevalin under the New Technology APC 718 and for Y-
90 Zevalin under the New Technology APC 725 until we have sufficient 
hospital charge data upon which to use in assigning these services to 
clinical APCs. Because we have decided that Zevalin does not qualify 
for transitional pass-through payments, we have not included the 
estimated payments for Zevalin in our revised estimates of total 2003 
transitional pass-through payments.
    We have based the determination of New Technology APCs for IN-111 
Zevalin and Y-90 Zevalin on information received from the manufacturer 
and invoices made available to us, and we believe the resulting payment 
rates to hospitals should be adequate. We note that had we found it 
necessary to pay for these products as drugs, the average wholesale 
price alone could have exceeded $28,000 per treatment. We believe his 
pricing is excessive and that it would have placed an unnecessarily 
large burden on the Medicare Trust Funds. Had we found it necessary to 
treat these products as drugs, however, we could have invoked the 
authority of section 1833(t)(2)(E) to establish a more equitable 
payment rate.
    A hospital may bill for the number of millicuries billed to them by 
a radiopharmacy or, if the hospital prepares Zevalin itself, the number 
of millicuries prepared for administration to the patient but, in 
either case, no more than 40 millicuries.
    CMS has also undertaken a national coverage determination (NCD) for 
Zevalin, which has been approved by the Food and Drug Administration 
(FDA) to treat certain types of non-Hodgkin's lymphoma, to assure that 
the product is appropriately used in the Medicare program. A decision 
memorandum addressing the clinical uses of Zevalin to be covered by 
Medicare will appear on the CMS coverage Web site (http://www.cms.hhs.gov/coverage) soon after publication of this rule.
    Comment: A drug company raised concerns about the relationship of 
epoetin alpha and darbepoetin alpha, two competing biologicals used for 
treatment of anemia. The commenter urged that CMS determine that the 
two products are substitutes with the same clinical effects and argued 
that the two should be paid, subject to an appropriate conversion 
ratio, at the same rate.
    Response: Erythropoietin, a protein produced by the kidney, 
stimulates the bone marrow to produce red blood cells. In severe kidney 
disease, the kidney is not able to produce normal amounts of 
erythropoietin, and this leads to the anemia. Additionally, certain 
chemotherapeutic agents used in the treatment of some cancers suppress 
the bone marrow and cause anemia. Treatment with exogenous 
erythropoietin can increase red blood cell production in these patients 
and treat their anemia.
    In the late 1980's, scientists used recombinant DNA technology to 
produce an erythropoietin-like protein called epoetin alpha. Epoetin 
alpha has exactly the same amino acid structure as the erythropoietin 
humans produce naturally, and, when given to patients with anemia, 
stimulates red blood cell production.
    Two commercial epoetin-alpha products are currently marketed in the 
United States: Epogen\TM\ (marketed by Amgen) and Procrit\TM\ (marketed 
by Ortho Biotech). These products are exactly the same but are marketed 
under two different trade names. Both Epogen\TM\ and Procrit\TM\ are 
approved by FDA for marketing for the following conditions: (1) 
Treatment of anemia of chronic renal failure (including patients

[[Page 66758]]

on and not on dialysis), (2) treatment of Zidovudine-related anemia in 
HIV patients, (3) treatment of anemia in cancer patients on 
chemotherapy, and (4) treatment of anemia related to allogenic blood 
transfusions in surgery patients. Both products are given either 
intravenously or subcutaneously up to three times a week.
    Amgen has recently developed a new erythropoietin-like product, 
darbepoetin alpha, which it markets as Aranesp\TM\. Also produced by 
recombinant DNA technology, darbepoetin alpha differs from epoetin 
alpha by the addition of two carbohydrate chains. The addition of these 
two carbohydrate chains affects the biologic half-life. This change, in 
turn, affects how often the biological can be administered, which 
yields a decreased dosing schedule for darbepoetin alpha by comparison 
to epoetin alpha. Amgen has received FDA approval to market Aranesp\TM\ 
for treatment of anemia related to chronic renal failure (including 
patients on and not on dialysis) and for treatment of chemotherapy-
related anemia in cancer patients.
    Because darbepoetin alpha has two additional carbohydrate side-
chains, it is not structurally identical to epoetin alpha. However, the 
two products are functionally equivalent: In this case, both products 
use the same biological mechanism to produce the same clinical result, 
stimulation of the bone marrow to produce red blood cells. Thus, 
Epogen\TM\, Procrit\TM\, and Aranesp\TM\ are all functionally 
equivalent.
    These biologicals are dosed in different units. Epoetin alpha is 
dosed in Units per kilogram (U/kg) of patient weight and darbepoetin 
alpha in micrograms per kilogram (mcg/kg). The difference in dosing 
metric is due to changes in the accepted convention at the time of each 
product's development. At the time epoetin alpha was developed, 
biologicals (such as those developed through recombinant DNA) were 
typically dosed in International Units (or Units for short), a measure 
of the product's biologic activity. They were not dosed by weight (for 
example, micrograms) because of a concern that weight might not 
accurately reflect their standard biologic activity. The biologic 
activity of such products can now be accurately predicted by weight, 
however, and manufacturers have begun specifying the doses of such 
biologicals by weight. No standard formula exists for converting 
amounts of a biologic dosed in Units to amounts of a drug dosed by 
weight.
    In clinical practice, CMS recognizes that no strict method of 
converting an epoetin alpha dose to a darbepoetin alpha dose exists. 
There are general guidelines for conversion, and clinicians modify the 
dose based on the patient's hematopoietic response. For developing a 
payment policy, however, it is feasible to establish a method of 
converting the dose of each of these drugs to the other.
    As part of the process to define a conversion ratio between these 
biologicals, CMS held a series of meetings with both Amgen and Ortho 
Biotech. Both companies provided substantial written and published 
information. We reviewed the Food and Drug Administration labeling for 
each product (EpogenTM, ProcritTM, and 
AranespTM). We also hired an independent contractor to 
review the available clinical evidence, and we performed an internal 
review of this evidence as well. The body of literature reviewed 
included 40 scientific articles culled from references submitted by the 
companies as well as a Medline literature search. CMS took into 
consideration both published and unpublished studies as well as 
abstracts, conference reports, and materials provided by the two 
companies.
    In selecting articles for review, CMS sought studies that (1) 
provided a ``head-to-head'' comparison of epoetin alpha to darbepoetin 
alpha either in patients with chronic kidney disease (on or not on 
dialysis) or in cancer patients with chemotherapy-induced anemia, and 
(2) in which an appropriate outcome measure was used. In the absence of 
such data, we also considered clinical studies that either compared 
both products to each other or that linked the dose of a particular 
product with an appropriate health outcome measure.
    CMS's identification of a conversion ratio between the dosages of 
these two products, darbepoetin alpha and epoetin alpha, is solely for 
the purpose of developing a Medicare payment policy. It is not meant to 
imply or suggest what should be done for individual patients in 
clinical practice. In addition, by using a conversion ratio CMS is not 
attempting to establish a lower or upper limit on the amount of either 
biological a physician can prescribe to a patient. CMS expects that 
physicians will continue to prescribe these biologicals based on the 
needs of individual patients. In terms of payment, however, CMS 
considers these biologicals to be functionally equivalent (even if 
structurally different), and, therefore, will establish an equitable 
payment policy that relates dosage of the agents to each other.
    In our review, we placed the greatest emphasis on published, high 
quality clinical studies and looked for the best possible estimates 
based on an evaluation of the dosing of each product that, on average, 
produced the same clinical response. Based on our own review of the 
evidence, our consultation with the independent contactor who also 
reviewed the evidence, and our discussions with Amgen and Ortho 
Biotech, CMS concludes that an appropriate conversion ratio for the 
purposes of a payment policy is to 260 International Units of epoetin 
alpha to one microgram of darbepoetin alpha (260:1).
    We think that improved information from clinical trials involving 
``head-to-head'' comparisons of these two products could help us insure 
our policy is correct and if necessary update this policy in the 
future. In this vein, the National Cancer Institute has been directed 
to work with CMS to quickly develop and sponsor a trial or trials to 
evaluate the appropriate conversion ratio between these products for 
the purpose of Medicare pricing. We expect this project to be completed 
during the cycle for development of the 2004 OPPS update regulation. If 
we can estimate a more accurate conversion ratio based on this study or 
from our review of our own payment data, we will make a change to 
reflect this ratio so as soon as practicable.
    We proposed that transitional pass-through payments for epoetin 
alpha end at the end of this calendar year, and that payment be made in 
calendar year 2003 in a separate, unpackaged APC. We are adopting these 
policies for the final rule.
    We had proposed to continue transitional pass-through payments for 
darbepoetin alpha. We accept, however, the comment suggesting that 
these two biologicals should be paid at the same rate. As noted above, 
the products are almost identical; nevertheless there is a great 
disparity in their costs. In this situation, we believe it is 
appropriate for us to rely on our authority in section 1833(t)(2)(E) of 
the Social Security Act to make an adjustment we determine ``necessary 
to ensure equitable payments.'' We do not believe it would be equitable 
or an efficient use of Medicare funds to pay for these two functionally 
equivalent products at greatly different rates. We would package these 
two biologicals into the same APC, but the difference in dosage metrics 
makes this step technically impossible if we are to maintain the 
ability to pay on the basis of the actual dose used. Consequently, they 
will be in separate APCs but paid at equivalent rates. The 2003 payment 
rate for non-ESRD epoetin alpha is established as $9.10 per 1000 Units 
elsewhere in this

[[Page 66759]]

rule. We employ the conversion ratio of 260:1 to establish the 2003 
payment rate for darbepoetin alpha as $2.37 per 1 microgram. Because 
this payment rate equals the payment rate for epoetin alpha (albeit 
expressed in different units), we reduce the transitional pass-through 
payment for darbepoetin alpha to zero.
    An alternative line of reasoning would produce the same result. 
Section 1833(t)(6)(A) of the Social Security Act distinguishes between 
``current'' and ``new'' biologicals. Epoetin alpha is a ``current'' 
biological. Since April 2002, we have treated darbepoetin alpha as a 
``new'' biological. However, section 1833(t)(6)(A)(iv) sets forth the 
criteria that must be met for a biological to be considered ``new.'' 
One criterion is that the biological is not described by any item 
described in clauses (i), (ii) or (iii) of section 1833(t)(6)(A) of the 
Act, which define ``current'' drugs, biologicals, and devices. Given 
the determination stated above that these products are functionally 
equivalent, we believe that darbepoetin alpha is already described by 
epoetin alpha, a ``current'' biological. Because darbepoetin alpha is 
functionally equivalent to epoetin alpha, we believe we could conclude 
that it would be most appropriate to consider darbepoetin alpha a 
``current'' biological. In that event, it would not qualify for a pass-
through payment as a ``new'' biological. Accordingly, under this 
analysis, we would terminate the duration of transitional pass-through 
payment eligibility for darbepoetin alpha on December 31, 2002, and pay 
for it in a fashion comparable to other products that lose eligibility 
for transitional pass-through status on that date. More particularly, 
we would pay it equivalently to epoetin alpha.
    Beneficiary copayments are unchanged as a result of the change in 
payment for darbepoetin alpha, because under this rule the copayment 
amount for both biologicals would have equaled that calculated for 
epoetin alpha in any case.
    This change is budget neutral. As a result of this change, our 
estimate of total transitional pass-through payments is smaller than it 
would otherwise have been. The percentage we have reduced the 
conversion factor to compensate for transitional pass-through spending 
is accordingly smaller, and in a budget neutral fashion payment rates 
for other services are correspondingly higher.
    We do not expect to make nationally-applicable determinations of 
similarity of drugs or biologicals, such as that discussed above, on a 
routine basis. We regard this situation as unusual, distinguished by 
the very strong similarity of the two products and by the size of the 
potential effects on the Medicare program. We thus believe that making 
this determination and insuring comparable payment is justified in this 
particular instance.
    Comment: Commenters from pharmaceutical manufacturers, trade 
associations, and a provider of oncology services raised concern over 
the methods used to estimate 2003 pass-through payments for drugs. The 
primary concern was that we overestimated pass-through spending for 
2003, and as a result would trigger pro rata reductions in pass-through 
payments for drugs appearing on Table X.
    Some commenters suggested that we refine our estimation procedures 
by utilizing alternative modeling techniques and by using data from 
claims experience. Several of the comments included, in depth, data 
analysis along with models used to predict pass-through drug spending 
for calendar year 2003. Spending estimates ranged from $213 million to 
$441 million dollars.
    Other commenters objected to the techniques used to estimate pass-
through spending for future products, those items first eligible for 
pass-though payments in April 2003 or later. A manufacturer's 
association objected to the use of drugs eligible for pass-through 
payment beginning in January 1, 2003 as the basis of a forecast of 
drugs likely to acquire pass-through statusthroughout the remainder of 
the year. This objection stems from what the association views as the 
lack of similarities between drugs first eligible for pass-through 
payments on January 1, 2003 and those eligible later in the year. 
Further, they object to estimating any additional pass-through payments 
when it is not clear whether or not a product will be added to the list 
during 2003.
    Another commenter proposed the use of a more sophisticated model 
based on drugs currently in the FDA pipeline to be used to project 
spending of drugs first eligible for pass-through payment between April 
and December 2003.
    Other commenters objected to our estimates for specific drugs.
    Response: We have made a number of changes in response to these 
comments and in the course of our efforts to complete and refine our 
preliminary estimates. We have removed several items from the list of 
2003 pass-through items that appeared in our August 9, 2002 proposed 
rule and thus from our final estimates of 2003 pass-through payments. 
These include IN-111 Zevalin and Y-90 Zevalin, as noted above. FDG 
(HCPCS C1775; APC 1775) meets the statutory definition of a current 
radiopharmaceutical and has been receiving pass-through payments. 
Because we have decided that the pass-through status of current 
radiopharmaceuticals will not continue past December 31, 2002, pass-
through payment status for FDG will end on January 1, 2003. Because a 
separate code for FDG did not exist until April 2002, we do not have 
discrete hospital charge data upon which to calculate a median cost for 
FDG. For transition purposes in 2003, we will pay separately for this 
supply based on an estimated acquisition cost of 71 percent applied to 
the 2002 payment rate.
    We address below several other issues that arose during our 
refinement of Table X in the proposed rule. We proposed to continue 
pass-through payment status for TC 99M oxidronate under HCPCS C1058. 
However, following publication of the August 9, 2002 proposed rule, we 
determined that this drug was also represented by HCPCS code Q3009. 
Under HCPCS code Q3009, this radiopharmaceutical agent has received 
pass-through payment status for at least 2 years, and will no longer be 
eligible for pass-through payment under either HCPCS code Q3009 or 
C1058 beginning on January 1, 2003. As proposed, we are packaging the 
cost of Q3009 into the procedures with which the code was billed.
    Two other HCPCS codes representing radiopharmaceutical agents were 
inadvertently included in the list of 2003 pass-through drugs in the 
proposed rule. HCPCS codes C1064 and C1065 were add-on codes used to 
bill for an additional mCi of I-131. These codes, along with the 
related HCPCS code C1188 and C1348, which are used to report an initial 
1-5 or 1-6 mCi, respectively, will no longer be eligible for pass-
through payment on January 1, 2003.
    Table 9 contains the final list of items that are eligible for 
pass-through payments in 2002 and will remain eligible in 2003. Table 9 
also contains items that have been approved for pass-through payments 
beginning in 2003.
    It does not contain categories of devices or drugs for which pass-
through applications are still pending at the time of issuance of this 
final rule or for which applications have yet to be received.
    We used the following methodology to estimate the pass-through 
payments for 2003.
    1. Devices eligible in 2002 [Device categories beginning July 1, 
2002 (C1783, C1888, C1900)] that will continue in 2003: We used 
manufacturers' retail prices along with

[[Page 66760]]

claims utilization estimated for 2003 by our clinical staff, based on 
our claims data and coding and projected utilization information 
supplied in the applications. No device offsets were applicable.
    2. Drugs eligible in 2002 that will continue in 2003: We used the 
July 2002 Redbook prices to determine the AWP, which we used in 
combination with our ratios for establishing estimated acquisition 
costs to derive pass-through payments for drugs in 2003. We determined 
the volume for pass-through drugs by soliciting manufacturer estimates 
of volume for the Medicare population where possible and relying upon a 
commenter's estimates for the volumes of other drugs.
    3. Devices eligible in January 2003: We used manufacturers' retail 
prices along with claims utilization estimated for 2003 by our clinical 
staff, based on our claims data and coding and projected utilization 
information supplied in the applications. We applied offsets to 
procedures associated with devices that mapped to APCs with offsets.
    4. Drugs eligible in January 2003: We used the July 2002 Redbook 
prices to determine the AWP which we used in combination with our 
ratios for establishing estimated acquisition costs to derive pass-
through payments for drugs in 2003. We determined the volume for pass-
through drugs by soliciting manufacturer estimates of volume for the 
Medicare population where possible and relying upon a commenter's 
estimates for the volumes of other drugs.
    5. Devices eligible in 2001 and will continue in 2003: We used 
manufacturers' retail prices along with claims utilization for the 12 
months that ended March 31, 2002, increased to 2003 by the growth rate 
provided by our actuary.
    Our final estimate of transitional pass-through spending for 2003 
also includes projected spending for items that have not yet been 
approved for 2003. We had proposed to base our estimate of spending for 
such items on items that have been newly approved for January 1, 2003. 
In response to comments, we have based our projection for items that 
will be approved later in 2003 on items that were newly approved for 
October 1, 2002 and January 1, 2003. We have based our estimate on the 
two most recent quarters of approval because we anticipate a higher 
volume of pass-through approvals compared to early 2002 for two 
reasons. First, we began paying for categories of devices on April 1, 
2001. The vast majority of items in use at that time, as well as newly 
FDA approved items, could receive pass-through payments under a 
category code. We received, and subsequently approved, a relatively 
small number of pass-through applications in the first half of 2002. 
Consequently, we based our projection of spending for items that will 
be determined eligible for pass-through status in 2003 based on items 
determined eligible for October 1, 2002 and items determined eligible 
or expected to be determined eligible for January 1, 2003.
    In summary, we estimate that pass-through spending in 2003 will 
approximate $427.4 million. We believe that pass-through spending in 
2003 will break out into the following categories for 2003:

                               Table 9.--Estimate of Pass-Through Spending in 2003
----------------------------------------------------------------------------------------------------------------
                                                                         2003 Pass-                     2003
                                                                           through        2003       Anticipated
               HCPC                   APC         Drug Biological          payment      Estimated   pass-through
                                                                           portion     utilization     payment
----------------------------------------------------------------------------------------------------------------
                                     Existing Pass-through Drugs/biologicals
================================================================================================================
A9700.............................    9016  Echocardiography Contrast.        $30.00       423,220    12,696,607
J9017.............................    9012  Arsenic Trioxide..........         $7.92         4,047        32,054
J0587.............................    9018  Botulinum toxin type B....         $2.22       350,000       777,000
J0637.............................    9019  Caspofugen acetate, 5 mg..         $8.64        98,950       854,928
J9010.............................    9110  Alemtuzumab, per 10mg/ml..       $129.15   11249.19861     1,452,834
C9111.............................    9111  Injectin Bivalrudin, 250         $100.50        38,549     3,874,219
                                             mg vial.
C9112.............................    9112  Perflutren lipid micro, 2          $1.25    12,676,293    15,845,366
                                             ml.
C9113.............................    9113  Inj Pantoprazole sodium,           $5.76        20,000       115,200
                                             vial.
J2324.............................    9114  Nesiritide, per 1.5 mg            $36.48        48,000     1,751,040
                                             vial.
J3487.............................    9115  Zoledronic acid, 2 mg.....       $102.77       228,000    23,431,560
C9200.............................    9200  Orcel, per 36 cm2.........       $286.80         1,000       286,800
C9201.............................    9201  Dermagraft, per 37.5 sq cm       $145.92         4,770       696,038
C9116.............................    9116  Ertapenum sodium..........        $11.45         8,902       101,928
C9119.............................    9119  Pegfilgrastim.............       $708.00       102,645    72,672,864
J9219.............................    7051  Leuprolide acetate implant     $1,364.16           373       508,493
===================================
                              Pass-through Drugs/Biologicals Effective January 2003
================================================================================================================
C9120.............................    9120  Faslodex..................        $22.13         9,690       214,440
C9121.............................    9121  Argatroban................         $3.60        50,000       180,000
===================================
                                          Existing Pass-through Devices
================================================================================================================
C1765.............................    1765  Adhesior barrier..........  ............           224       110,880
C2618.............................    2618  Probe, cryoablation.......  ............           752       150,400
C1783.............................    1783  Ocular implant, aqueous     ............         2,042     1,327,300
                                             drainage dev.
C1888.............................    1888  Endovascular non-cardiac    ............           208       150,800
                                             ablation catheter.
C1900.............................    1900  Lead, left ventricular      ............         2,042     4,084,000
                                             coronary venous.
===================================
                                   Pass-through Devices Effective January 2003
================================================================================================================
C2614.............................    2614  Brachytherapy solution/     ............           100       840,000
                                             liquid,I-125.
C2632.............................    2632  Percutaneous Lumbar         ............           612     1,190,340
                                             Discectomy Probe.

[[Page 66761]]

 
===================================
                             Other Items Expected to Be Determined Eligible for 2003
================================================================================================================
                                    ......  Spending for future         ............  ............   234,581,267
                                             approved drugs.
                                    ......  Spending for future         ............  ............    49,519,559
                                             approved devices.
                                    ......  Total Spending for Pass-    ............  ............   427,445,917
                                             through Drugs/
                                             biologicals, and devices
                                             2003.
----------------------------------------------------------------------------------------------------------------

    Our total 2003 estimate of $427.4 million is 2.3 percent of total 
estimated program payment. We proposed to reduce the conversion factor 
by 2.5 percent to account for pass-through spending. Since our estimate 
is now below 2.5 percent, we have adopted a reduction of 2.3 percent to 
the conversion factor in accord with our estimate of pass-through 
payments. Our final assumptions used to create the estimate are shown 
in Table 9 above.

C. Expiration of Transitional Pass-Through Payments in Calendar Year 
2003 for 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 proposed 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,) To establish the expiration date for the category 
codes listed in Table 10, 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 proposed 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 10.--List of Pass-Through Device Categories With Expiration Dates
----------------------------------------------------------------------------------------------------------------
                                                                                                    Expiration
              HCPCS codes                  Category long descriptor       Date first populated         date
----------------------------------------------------------------------------------------------------------------
1 C1883...............................  Adaptor/extension, pacing lead  8/1/00..................        12/31/02
                                         or neurostimulator lead
                                         (implantable).
2 C1765...............................  Adhesion barrier..............  10/01/00-3/31/01; 7/1/01        12/31/03
3 C1713...............................  Anchor/screw for opposing bone- 8/1/00..................        12/31/02
                                         to-bone or soft tissue-to-
                                         bone (implantable).
4 C1715...............................  Brachytherapy needle..........  8/1/00..................        12/31/02
5 C1716...............................  Brachytherapy seed, Gold 198..  10/1/00.................        12/31/02
6 C1717...............................  Brachytherapy seed, High Dose   1/1/01..................        12/31/02
                                         Rate Iridium 192.
7 C1718...............................  Brachytherapy seed, Iodine 125  8/1/00..................        12/31/02
8 C1719...............................  Brachytherapy seed, Non-High    10/1/00.................        12/31/02
                                         Dose Rate Iridium 192.
9 C1720...............................  Brachytherapy seed, Palladium   8/1/00..................        12/31/02
                                         103.
10 C2616..............................  Brachytherapy seed, Yttrium-90  1/1/01..................        12/31/02
11 C1721..............................  Cardioverter-defibrillator,     8/1/00..................        12/31/02
                                         dual chamber (implantable).
12 C1882..............................  Cardioverter-defibrillator,     8/1/00..................        12/31/02
                                         other than single or dual
                                         chamber (implantable).
13 C1722..............................  Cardioverter-defibrillator,     8/1/00..................        12/31/02
                                         single chamber (implantable).
14 C1888..............................  Catheter, ablation, non-        7/1/02..................        12/31/04
                                         cardiac, endovascular
                                         (implantable).
15 C1726..............................  Catheter, balloon dilatation,   8/1/00..................        12/31/02
                                         non-vascular.
16 C1727..............................  Catheter, balloon tissue        8/1/00..................        12/31/02
                                         dissector, non-vascular
                                         (insertable).
17 C1728..............................  Catheter, brachytherapy seed    1/1/01..................        12/31/02
                                         administration.
18 C1729..............................  Catheter, drainage............  10/1/00.................        12/31/02
19 C1730..............................  Catheter, electrophysiology,    8/1/00..................        12/31/02
                                         diagnostic, other than 3D
                                         mapping (19 or fewer
                                         electrodes).
20 C1731..............................  Catheter, electrophysiology,    8/1/00..................        12/31/02
                                         diagnostic, other than 3D
                                         mapping (20 or more
                                         electrodes).
21 C1732..............................  Catheter, electrophysiology,    8/1/00..................        12/31/02
                                         diagnostic/ablation, 3D or
                                         vector mapping.
22 C1733..............................  Catheter, electrophysiology,    8/1/00..................        12/31/02
                                         diagnostic/ablation, other
                                         than 3D or vector mapping,
                                         other than cool-tip.

[[Page 66762]]

 
23 C2630..............................  Catheter, electrophysiology,    10/1/00.................        12/31/02
                                         diagnostic/ablation, other
                                         than 3D or vector mapping,
                                         cool-tip.
24 C1887..............................  Catheter, guiding (may include  8/1/00..................        12/31/02
                                         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, inserted    8/1/00..................        12/31/02
                                         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).
44 C1763..............................  Connective tissue, non-human    10/1/00.................        12/31/02
                                         (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, programmable     10/1/00.................        12/31/02
                                         (implantable).
54 C1893..............................  Introducer/sheath, guiding,     10/1/00.................        12/31/02
                                         intracardiac
                                         electrophysiological, fixed-
                                         curve, other than peel-away.
55 C1766..............................  Introducer/sheath, guiding,     1/1/01..................        12/31/02
                                         intracardiac
                                         electrophysiological,
                                         steerable, other than peel-
                                         away.
56 C1892..............................  Introducer/sheath, guiding,     1/1/01..................        12/31/02
                                         intracardiac
                                         electrophysiological, fixed-
                                         curve, peel- away.
57 C1894..............................  Introducer/sheath, other than   8/1/00..................        12/31/02
                                         guiding, other than
                                         intracardiac
                                         electrophysiological, non-
                                         laser.
58 C2629..............................  Introducer/sheath, other than   1/1/01..................        12/31/02
                                         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 kit  8/1/00..................        12/31/02
                                         (implantable).
66 C1898..............................  Lead, pacemaker, other than     8/1/00..................        12/31/02
                                         transvenous VDD single pass.
67 C1779..............................  Lead, pacemaker, transvenous    8/1/00..................        12/31/02
                                         VDD single pass.
68 C1899..............................  Lead, pacemaker/cardioverter-   1/1/01..................        12/31/02
                                         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, intraoperative,  1/1/01..................        12/31/02
                                         detached retina.
74 C1783..............................  Ocular implant, aqueous         7/1/02..................        12/31/04
                                         drainage assist device.
75 C2619..............................  Pacemaker, dual chamber, non    8/1/00..................        12/31/02
                                         rate-responsive (implantable).
76 C1785..............................  Pacemaker, dual chamber, rate-  8/1/00..................        12/31/02
                                         responsive (implantable).
77 C2621..............................  Pacemaker, other than single    1/1/01..................        12/31/02
                                         or dual chamber (implantable).
78 C2620..............................  Pacemaker, single chamber, non  8/1/00..................        12/31/02
                                         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 (implantable)  8/1/00..................        12/31/02

[[Page 66763]]

 
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, inflatable  8/1/00..................        12/31/02
85 C2622..............................  Prosthesis, penile, non-        10/1/01.................        12/31/02
                                         inflatable.
86 C1815..............................  Prosthesis, urinary sphincter   10/1/00.................        12/31/02
                                         (implantable).
87 C1816..............................  Receiver and/or transmitter,    8/1/00..................        12/31/02
                                         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, insertable..  1/1/01..................        12/31/02
91 C2615..............................  Sealant, pulmonary, liquid      1/1/01..................        12/31/02
                                         (Implantable).
92 C1817..............................  Septal defect implant system,   8/1/00..................        12/31/02
                                         intracardiac.
93 C1874..............................  Stent, coated/covered, with     8/1/00..................        12/31/02
                                         delivery system.
94 C1875..............................  Stent, coated/covered, without  8/1/00..................        12/31/02
                                         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-covered,  8/1/00..................        12/31/02
                                         with delivery system.
98 C1877..............................  Stent, non-coated/non-covered,  8/1/00..................        12/31/02
                                         without delivery system.
99 C1879..............................  Tissue marker (implantable)...  8/1/00..................        12/31/02
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.
    After carefully considering all the comments, concerns, and 
recommendations submitted to us regarding payment for devices and drugs 
and biologicals that would no longer be eligible for pass-through 
payments in 2003, we proposed 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 IV.D.)
    The methodology that we proposed to use to package pass-through 
device costs is consistent with the methodology for packaging that we 
describe in section III.B of this preamble. 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.
    To prevent the loss of the device costs billed by hospitals through 
revenue centers in developing our relative weights for APCs, we 
proposed to package the costs of both the device ``C'' codes and the 
billed revenue centers, whichever appeared on the claim. At the time, 
we believed that this method would allow us to capture all device 
related costs billed by hospitals. See our discussion of charges for 
devices in section III.A.2 of the preamble for this issue.
    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 proposed 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 proposed 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 proposed to reject line items containing a ``C'' 
code for a device category scheduled to expire effective January 1, 
2003.
    We received several comments on this proposal, which are summarized 
below.
General
    Comment: A number of hospital organizations indicated they were 
pleased with our handling of the transitional pass-through payment 
provisions. The commenters supported our proposal to package into 
procedural APCs the costs of devices that are no longer eligible for 
pass-through payment. The commenters asserted that packaging of device 
costs into base APC payments minimized the confusion and complication 
of identifying pass-through codes for certain devices and eliminates 
special payment incentives to use pass-through devices. Provider 
organizations emphasized the difficult and complicated task of 
appropriate coding of pass-through items, especially during the 
transition from a brand-specific to device category system. These 
commenters also supported our proposal to include device costs from 
revenue centers in packaging device costs into APCs, to include all 
device costs.
    Response: We appreciate these comments. We are adopting our 
proposed policy in this area as final for 2003.
    Comment: A hospital organization proposed that we release the 
crosswalk we used to assign pass-through device costs to specific APCs, 
so that it can study the assignments made, out of concern that some 
APCs may receive inadequate payment rates.
    Response: Our methodology did not involve a cross-walk, so we do 
not have

[[Page 66764]]

one available. Claims files we have made publicly available may be used 
to analyze where device costs were allocated.
    Comment: A device manufacturer stated it conceptually agreed that 
costs of devices should be packaged into ``base'' APC rates of related 
procedures. However, it viewed as critical that 2003 payment rates 
appropriately and adequately capture device costs.
    Response: We agree. As described elsewhere, we are adopting a 
number of changes in our methodology to help insure appropriate 
payments for procedures whose payment rates would otherwise have fallen 
significantly from 2002.
    Comment: A hospital provider organization urged us to remain 
committed to the averaging process inherent in a prospective payment 
system, rather than seek to pay actual cost for elements of total 
costs, such as new technology. It opposed the imposition of additional 
administrative costs, for example, any required reporting of 
acquisition costs on claims, in order to ``fine tune'' pass-through 
payments or relative weights. It preferred a sample survey to any 
reporting of acquisition costs. It also preferred that hospitals be 
permitted to establish their charge structures separately from our 
payment policies. It recommended that we avoid overriding the hospital-
specific cost-to-charge ratio in order to alter the ratios for new 
technology devices and not distort the PPS to pay for selected items.
    Response: We appreciate this comment. We have no plans to require 
reporting of acquisition costs on claims. Although we intend to 
consider further improvements in our methods for determining OPPS 
payment rates in the future, we recognize that the importance of 
maintaining a well developed and coherent methodology.
    Comment: A hospital provider organization recommended that we 
furnish a regulatory impact analysis that reflects the total change in 
payments that are estimated to occur that include outlier, pass-through 
and corridor payments and each of these items should be separately 
identifiable.
    Response: We regret that we are unable to provide the level of 
detail the commenter requests in the impact analysis. We discuss the 
extent of our knowledge of accuracy of the pro rata reduction and fold 
in impact in 2002 in section VIII.
    Comment: A commenter requested that we disclose how much the 
``fold-in'' of device costs into procedure APC payments for 2002 and 
the pro rata reduction imposed during 2002 over or under compensated 
hospitals for the new technology devices and drugs. This organization 
contended that we overestimated the amount of pass-through payments in 
2002, when compared to actual payments, and thus arbitrarily removed 
some $400 million from an already underfunded OPPS.
    Response: We do not have a revised estimate of transitional pass-
through spending for 2002 available at this time. We note that the lack 
of a pro rata reduction in 2001 may have resulted in higher than 
expected spending in that year. In either case, the statute does not 
provide for any retrospective adjustments, either up or down, if the 
Secretary's estimate of transitional pass-through spending made in 
advance of the start of the relevant calendar year, and which is used 
to determine whether a pro rata reduction is necessary and if so how 
large it must be, later proves too high or too low.
Expiration of Device Categories
    Comment: A large number of commenters questioned the adequacy of 
rates proposed for 2003 for APCs involving devices now paid 
transitional pass-through payments in instances where the device 
categories expire. Many of these commenters provided information about 
manufacturers' prices for these devices.
    Response: We are also concerned about the adequacy of these payment 
rates. We have reviewed the information provided, and it has helped 
guide us in determining our final policies for 2003. As discussed 
elsewhere in this preamble, we have used more recent data, carefully 
selected appropriate claims for use in relative weight calculations, 
and adopted dampening provisions to mitigate the reduction in payment 
rates that might otherwise have occurred.
    Comment: Some commenters recommended that we delay expiration of 
transitional pass-through device categories until we collect more 
accurate data. A device manufacturer suggested that we extend the pass-
through payment period for another year to allow time to study ways of 
capturing hospital costs, to improve accuracy of APC rates.
    Response: For devices that have been paid in 2000, we cannot extend 
the pass-through payment as suggested, because this would violate the 
statutory provision that limits pass-through payments for at least 2 
but not more than 3 years. Section 1833(t)(6)(B)(iii)(II) states that a 
category of devices shall be in effect for a period of at least 2 but 
not more than 3 years, which begins in the case of the categories 
initially implemented on April 1, 2001, ``on the first date on which 
payment was made * * * for any device described by such category 
(including payments made during the period before April 1, 2001.'' We 
cannot extend the transitional pass-through payments in order to 
collect more data.
    Comment: A number of organizations recommended that we continue 
transitional pass-through payment status for an additional year for one 
or more of several categories that were first populated with devices on 
January 1, 2001. One commenter recommended that we continue pass-
through payments for all current device categories until July 31, 2003 
and through December 31, 2003 for items in categories first populated 
as of January 1, 2001, stating that we make mid-year changes to billing 
requirements and HCPCS codes. The commenter acknowledged that this may 
be burdensome, but stated that the benefit of paying appropriately 
outweighs the cost of revising rates in mid-year.
    Response: We have reviewed these categories and do not see a marked 
difference between these categories and the other categories the 
eligibility of which is expiring. As a result, we do not believe it 
would be appropriate to continue transitional pass-through payment 
status for them beyond December 31, 2002.
    Revising rates in mid-year is not generally part of Medicare rate-
making policy and is not appropriate in this instance either. It is not 
only burdensome for this agency, it also burdens the providers and 
fiscal intermediaries, and it would add confusion to an already complex 
system.
    Comment: Organizations recommended that we continue pass-through 
payment status for cardiac resynchronization ICDs devices through 
category C1882. We indicated that this category contains devices that 
first received transitional pass-through payments as of August 1, 2000. 
The commenter is concerned that this category, which is described as 
``cardioverter-defibrillator, other than single or dual chamber,'' also 
includes a cardiac resynchronization ICD that was first eligible for 
transitional pass-through payments on January 1, 2001. The commenter 
suggested that in order to avoid any unfair competitive advantage among 
categories with competing technologies, we should extend pass-through 
payments for both C1882 and C2621, ``pacemaker, other than single or 
dual chamber,'' which includes cardiac pacemakers.

[[Page 66765]]

    Response: We cannot extend the pass-through payment status for 
C1882. We believe the most appropriate step is to end these categories 
in tandem. Therefore, we will terminate transitional pass-through 
payments for these 2 categories simultaneously as of January 1, 2003.
    Comment: A hospital organization requested clarification regarding 
the expiration of transitional pass-through device categories effective 
January 1, 2003. This commenter was confused by our stated proposal to 
delete 95 pass-through category codes as of January 1, 2003, yet 
Addendum B of the proposed rule shows these 95 codes as active codes 
with an OPPS status indicator of ``N'' (packaged). A number of 
commenters recommended that hospitals retain the option to code them 
and have the ``N'' status drive the payment, or in order to continue to 
report and track those devices.
    Response: We intend on deleting these codes, with the line item use 
of the codes rejected. We clarify the status indicator in this final 
rule.
    Comment: A hospital provider organization requested clarification 
on our proposal that hospitals submit charges for all surgically 
inserted devices in the supply, implant, or device revenue center that 
most appropriately describes the implant and that the device costs will 
then be packaged into and reflected in the costs for the procedure with 
which they are associated. It noted that we published clear 
requirements on what revenue codes were appropriate for reporting 
medical devices that had been granted pass-through status in Program 
Memorandum A-01-50. The organization stated that that this would 
constitute the appropriate revenue center list to use for these devices 
even though they are now packaged.
    Response: In the proposed rule we indicated that effective for 
services furnished on or after January 1, 2003, hospitals would not 
bill a ``C'' code for devices that no longer qualify for pass-through 
payment, but would submit charges for surgically inserted devices in 
the supply, implant or device revenue center that most appropriately 
describes the implant. We agree with the commenter that the revenue 
codes listed in Program Memorandum A-01-50 will continue to constitute 
the appropriate revenue codes under which such devices must be billed, 
even when the devices are no longer eligible for pass-through payments.
Use of Codes for Expiring Categories After January 1, 2003
    Comment: A commenter asked us to clarify the use of device HCPCS 
codes after their expiration dates. Commenters expressed concern that 
our proposed deletion of the pass-through codes of drugs and devices as 
of January 1, 2003 without a grace period would place a burden on 
hospitals. One commenter recommends that we change the status indicator 
to ``N'', that is, packaged with other services. One commenter stated 
that we should keep all C-codes in effect permanently, even without 
reimbursement. The commenter argues that this step would provide better 
tracking for providers and payers and eliminates the coding burden 
caused by deletion of codes.
    Response: We proposed to delete the pass-through category codes for 
devices when the eligibility of the category for pass-through payments 
expires. Therefore, any claims that use these codes will be returned to 
providers. We proposed to reject the line item in the proposed rule. 
However, on further consideration and discussion within CMS, we decided 
that we must return the claim to the provider so that the provider may 
correctly place the charges for the device in a revenue center. This is 
important to ensure that the hospital receives any hold harmless, 
corridor or outlier payments that it is due. If we were to line item 
reject the deleted code and process the rest of the claim, then the 
hospital could be underpaid by the absence of payments that would 
result if the charges for the device were correctly reported. Given the 
frequency with which our data shows that providers fail to bill for the 
device (even when they could receive pass-through payment for it as 
discussed in section III.A.2 of the preamble), we believe that it is 
important that the claim be returned to the provider so that it can be 
corrected and resubmitted for payment.
    Comment: A hospital organization agreed with our proposal not to 
have a 90-day grace period for C-codes scheduled for deletion, to 
prevent additions to the pass-through payment pool, which could then 
contribute to a pro rata reduction to other services.
    Response: We agree. We believe it is necessary in this instance to 
forgo a grace period to prevent incorrect payments.
New Device Categories
    Comment: A number of commentersprovided both supportive and 
critical comments to the August 9, 2002 proposed rule on our criteria 
for establishing new device categories for transitional pass-through 
payment. One commenter indicated that we have been reviewing and 
evaluating applications for new device categories even though we have 
not issued a final rule on this subject.
    Response: We have summarized comments that we received timely in 
response to the November 2, 2001 interim final rule on the criteria, 
and these are addressed in section V of this final rule. We will take 
note of all comments as we evaluate the new device category process and 
any modifications to the process we might propose in the future. Our 
review of applications for device categories has been done under 
authority of the November 2, 2001 interim final rule.
Stent Categories C1874 and C1875
    Comment: A number of commenters took issue with our interpretation 
of existing category limitation in evaluating applications for new 
pass-through device categories. They cited our discussion on drug-
eluting stents, that is, that this new technology was described by 
existing categories C1874, stent, coated/covered with delivery system, 
and C1875, stent, coated/covered without delivery system. These 
commenters asserted that neither of the existing categories 
appropriately describes the drug-eluting stent technology. While they 
indicated that creating a new APC for drug-eluting stents is 
appropriate, they expressed concern that many existing categories are 
described in broad terms, thus potentially excluding other new 
technologies from additional categories. Examples of applications for 
ICDs and total joint implants were provided.
    Response: We are making final our proposal for separate, procedure 
APCs for procedures involving drug-eluting stents. These stents will 
not be in a transitional pass-through category nor receive transitional 
pass-through payments. In the case of breakthrough therapies that may 
quickly achieve widespread distribution and that are sufficiently 
expensive to have a significant effect on hospitals, we may propose to 
create appropriate APCs, as we have done in this instance. The existing 
transitional pass-through device categories were deliberately specified 
in fairly broad terms in order to provide an appropriate balance 
between specificity and the reporting burden on hospitals.
DME Payment for Implantable Devices
    Comment: One commenter, concerned about reduced payments for 
implantable devices, suggested that we define certain implantable 
devices as durable

[[Page 66766]]

medical equipment and/or prosthetics, for payment under the durable 
medical equipment fee schedule instead of the OPPS.
    Response: The BBRA of 1999 changed the OPPS and durable medical 
equipment fee schedule (see sections 1833(t)(1)(B)(iii) and 
1834(h)(4)(B) of the Act) so that implantable prosthetic devices 
delivered in the hospital outpatient setting must be paid through the 
OPPS, rather than on the durable medical equipment fee schedule.
Category C1765, Adhesion Barrier
    Comment: A commenter claimed that one of our categories that we 
propose to continue pass-through payment in 2003, Adhesion Barrier 
(C1765), contains a product that was manufactured by a single company. 
The FDA asked the company to recall the product, and it has been off 
the market for more than a year. This commenter suggested that C1765 be 
removed from the APC system for 2003, since neither this nor equivalent 
products are on the market. If and when this or another similar product 
is reintroduced to the market, it should be considered for pass-through 
payment at that time.
    Response: We will not remove category C1765 from active pass-
through payment, which is scheduled to continue through December 31, 
2003. C1765 is open to any product that fits the category description 
of adhesion barrier in accordance with the definition in Program 
Memorandum A-02-050, not only the product of the stated manufacturer.
Cochlear Implants
    Comment: Numerous providers, including hospitals, ENT clinics, 
physicians, clinical audiologists and other commenters, protested our 
proposed payment rates for cochlear implant services. They questioned 
our data for 2001, saying insufficient claims data appear to be 
reported for the procedure or that the charges appear inappropriately 
low. Some providers requested an average payment of $3,000 for the 
surgery, plus the invoice cost of the device, some offering to include 
the manufacturer's invoice with their claims. Comments also included 
recommendations that we continue to pay for cochlear implants as pass-
through payments for another year or more to develop more accurate 
claims data . A group of manufacturers also recommended that we issue 
written guidance to hospitals regarding the correct billing procedures 
for cochlear implants.
    Response: We have attempted to mitigate the proposed reductions in 
payment rates resulting from the expiration of transitional pass-
through device categories, of which cochlear implant is one . 
Transitional pass-through payments were first made for cochlear 
implants on August 1, 2000, before pass-through category L8614 was 
established. Therefore, we cannot provide another year or more of pass-
through payments, because the statute limits pass-through payments to a 
period of at least 2 years but not more than 3 years. We feel the 
recommendation that we issue guidance to hospitals regarding the 
correct billing procedures for device related procedures, such as 
cochlear implants, may have merit, and we will consider providing 
further guidance in this area.
IOLs
    Comment: A number of commenters expressed concern that the 
expiration of the transitional pass-through device category for new 
technology intraocular lenses (IOLs) on January 1, 2003 would result in 
inadequate payment for new technology lenses. These commenters 
recommended that a new APC be created to pay for the provision of these 
lenses, even though the incremental cost is low. These commenters also 
recommended that we create new categories of new technology IOL ``for 
additional payment similar to the provision applicable in ambulatory 
surgical centers. One commenter was concerned that we not allow the 
broad description of the current category C1780, ``lens, intraocular 
(new technology)'' to interfere with future intraocular lenses being 
eligible for pass-through payment.
    Response: Regarding the adequacy of payment after the new 
technology IOL category expires, no specific data were provided by any 
commenters. However, we believe that the incremental cost of such 
lenses is low. We do not believe a change the APC for implanting new 
technology IOLs is warranted at this time.

Implantation of Neurostimulator (APC 222) and Electrode (APC 225)

    Comment: A manufacturer and a number of medical centers commented 
that the proposed payments for implantation of a neurostimulator 
generator (APC 222) and electrode (APC 225) are inadequate. One of 
these commenters recommended that we delay the expiration of these 
pass-through categories for another year or two.
    Response: The implantations of a neurostimulator generator and 
electrode have been paid via pass-through payment for devices since 
August 2000, and we proposed to retire the pass-through categories as 
of January 1, 2003. For devices that have been paid since August 2000, 
we cannot extend the pass-through payment for another year or two, as 
suggested, because this would violate the statutory provision that 
limits pass-through payments for at least 2 but not more than 3 years. 
Therefore, we are moving to prospective payment for these devices from 
the charge-based pass-through payments.
Dialysis Access Systems
    Comment: A manufacturer of a dialysis access system asserted that 
the 2003 proposed reduction in payment rates for dialysis access would 
curtail patient access.
    The commenter provided two suggestions regarding the expiring 
category code for dialysis access systems, C1881. One option suggested 
is for us to assign a unique HCPCS code for placement of the 
manufacturer's brand specific dialysis system and place it in a new or 
existing APC that has appropriate payment. This commenter contended 
that bundling C1881 within APC 115 will result in inadequate payment, 
because the device will be bundled with standard hemodialysis catheters 
and chemotherapy ports. The second option suggested is to extend pass-
through payment status for category C1881. This commenter stated its 
dialysis system was approved for pass-through payment in August 2000, 
and there were limited sales and therefore claims in 2000 and the first 
half of 2001. Thus, this commenter expressed the opinion that there is 
approximately 1 year of data for this category, not the 2 to 3 years 
required.
    Response: Regarding the option proposed by this commenter for 
assignment of a unique product-specific HCPCS code, we do not assign 
unique HCPCS codes for brand-specific devices. Section 1833(t)(6)(B) of 
the Act indicates that transitional pass-through status of devices is 
to be determined based on categories. HCPCS codes are generally 
assigned for procedures that are not adequately described by existing 
HCPCS codes. This device has had a temporary category code for roughly 
two and one-half years, and we believe there are sufficient data to 
measure its utilization and cost. Regarding this commenter's proposal 
to extend pass-through payment status for category C1881, we cannot, by 
law, extend the pass-through payment period beyond the 2 to 3 year 
period. Although the commenter asserted that there were only limited 
claims for pass-through payment for the device in 2000 and the first 
half of 2001, section 1833(t)(6)(B)(iii) of the

[[Page 66767]]

Act explicitly indicates that the 2 to 3 year period for which 
categories of devices may be in effect applies from the first date on 
which payment was made under the OPPS for any device described by the 
category, which was August 2000.

Specific Category Applications

    Comment: Several commenters commented on specific pass-through 
device category applications which we had open as of the time of the 
comment or applications which we had previously denied as eligible for 
pass-through payment.
    Response: We evaluate all pass-through device category applications 
individually and respond to applicants directly.

D. Expiration of Transitional Pass-Through Payments in Calendar Year 
2003 for Drugs and Biologicals (Including Radiopharmaceutical Agents, 
Blood, and Blood Products)

    Under the OPPS, we currently pay for drugs and biologicals, 
including radiopharmaceutical agents, blood, and blood products, in one 
of three ways: packaged payment, separate APCs and transitional pass-
through payment.
Drugs as Packaged Supplies
    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 III.A.2 of the preamble, 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. In the August 9, 2002 
proposed rule, we provided some illustrations of situations in which 
drugs are considered to be supplies. 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 immediately 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 we cited in the proposed rule. 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.
    We received several comments concerning the treatment of drugs as 
supplies, which are summarized below, along with our responses.
    Comment: Several commenters asked for clarification of CMS's policy 
with respect to self-administered drugs, claiming the discussion in the 
preamble which lists examples of drugs, including self-administered 
drugs, that are packaged and paid as integral to an outpatient service 
conflicts with section 1861(s)(2) of the Act and CMS manuals which 
consider self-administered drugs to be non-covered.
    Response: Our policy is based on the premise that certain drugs are 
so integral to a treatment or procedure that the treatment or procedure 
could not be performed without them. Because such drugs are so clearly 
a component part of the procedure or treatment, we believe that they 
are more appropriately considered as supplies and should be packaged as 
supplies into the APC payment for the procedure or treatment. Moreover, 
the payment for packaged supplies is included in the APC payment for 
the procedure or treatment, so beneficiaries should not be separately 
billed for them.
    Comment: A commenter stated that virtually all drugs furnished in 
the outpatient setting are integral to an outpatient service and asked 
that CMS clarify those circumstances when usually self-administered 
drugs would not be considered integral to a service and therefore, non-
covered.
    Response: A drug would be treated as a packaged supply in cases 
where, although the drug is not separately payable, it is directly 
related and integral to a procedure or treatment and is required to be 
provided to a patient in order for a hospital to perform the procedure 
or treatment during a hospital outpatient encounter. A drug would not 
be treated as a packaged supply if it failed to meet these conditions. 
For example, we would not treat as packaged supplies any drugs that are 
given to a patient for their continued use at home after leaving the 
hospital. Another example would be a situation where a patient who is 
receiving an outpatient chemotherapy treatment develops a headache. Any 
medication given the patient for the headache would not meet the 
conditions necessary to be treated as a packaged supply. Similarly, if 
a patient who is undergoing surgery needs his or her daily insulin or 
hypertension medication, the medication would not be treated as a 
packaged supply.
    Comment: A commenter from a teaching hospital indicated that 
revenue code 819, which is required for the acquisition of bone marrow 
or blood-derived peripheral stem cells, is bundled into the charge for 
the transplantation procedure, CPT 38240. The commenter noted that the 
transplant CPT code pays approximately $350-$400; however, charges for 
acquiring stem cells are generally $25,000-$35,000 each. Therefore, the 
commenter recommended that we create

[[Page 66768]]

a new biological pass-through code for the stem cells until we can 
build the cost of the acquisition into the procedure, and the code 
should be retroactive to January 1, 2002.
    Comment: A commenter from a teaching hospital indicated that 
revenue code 819, which is required for the acquisition of bone marrow 
or blood-derived peripheral stem cells, is bundled into the charge for 
the transplantation procedure, CPT 38240. The commenter noted that the 
transplant CPT code pays approximately $350-$400; however, charges for 
acquiring stem cells are generally $25,000-$35,000 each. Therefore, the 
commenter recommended that we create a new biological pass-through code 
for the stem cells until we can build the cost of the acquisition into 
the procedure, and the code should be retroactive to January 1, 2002.
    Response: We understand the commenter's concern. Pass-through 
payments, after December 31, 2002, will only be made for medical 
devices, drugs, or biologicals in accordance with section 
1833(t)(6)(A)(iv) of the Act. Stems cells are not medical devices nor 
do they meet the statutory prerequisite for calling these items ``drugs 
and biologicals,'' as stated in sections 1861(t)(A) and (B) of the Act. 
For example, stems cells do not receive FDA approval and are not listed 
in the United States Pharmacopoeia.
    The commenter indicates that the hospital is not being paid 
adequately for stem cell acquisition costs. However, the commenter 
should note that hospitals should be reporting all charges associated 
with the purchase of stem cells under Revenue Code 819. Therefore, to 
the extent that hospitals are billing a charge for the cost of 
acquiring stem cells under Revenue Code 819, those costs would be 
packaged into the median cost of CPT 38240 and be reflected in the APC 
payment rate. These services may also qualify for outlier payments.
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 APCs for these drugs and biologicals as 
well as devices. We proposed to create temporary individual APC groups 
for the various drugs classified as tissue plasminogen activators and 
other thromobolytic agents that are used to treat patients with 
myocardial infarctions as well as certain vaccines 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 to 
minimize incentives that would be inconsistent with the promotion of 
blood safety and access.
    In the case of the other drugs and vaccines that we proposed 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 using 2001 claims 
data. We set beneficiary copayment amounts for these drug and 
biological APCs at 20 percent of the payment amount. 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.
General
    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 IV.C. of the 
preamble):
    [sbull] Current orphan drugs, as designated under section 526 of 
the Federal Food, Drug, and Cosmetic Act.
    [sbull] Current drugs and biologic agents used for treatment of 
cancer.
    [sbull] Current radiopharmaceutical drugs and biological products.
    [sbull] 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:
    [sbull] For sole-source drugs, the ratio of acquisition cost to AWP 
equals 0.68.
    [sbull] For multisource drugs, the ratio of acquisition cost to AWP 
equals 0.61.
    [sbull] 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 proposed to remove these drugs from 
transitional pass-through status effective January 1, 2003 because the 
statute 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 by August 1, 2003. 
The next update of the 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 proposed 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

[[Page 66769]]

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 
IV.C 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.
    In spite of 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 proposed to package the cost of many drugs 
for which separate payment is made currently. But we also proposed to 
continue making separate payment for certain orphan drugs (as discussed 
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.
    Comments on this proposal and our responses are summarized below:
    Comment: We received many comments regarding the significant 
reduction in the payment rates for numerous drugs and biologicals that 
are sunsetting from their transitional pass-through status. The 
commenters asserted that proposed payment rates are significantly lower 
than the costs hospitals incur in acquiring and dispensing these 
products. As a result, inadequate payment may drive hospitals to 
discontinue stocking these products, and thus threaten beneficiary 
access to important drugs and biologicals. The commenters attributed 
the dramatic reduction in payment rates on the flaws in the 2001 claims 
data and deficiencies in the methodology that was used to derive the 
APC median costs. Commenters suggested numerous ways to correct the 
payment rates until reliable and sufficient claims data became 
available. Commenters proposed the following suggestions: maintain 
separate pass-through payments for APCs whose proposed payment rates 
decreased; pay a flat amount per item on a per patient basis; develop a 
rate setting methodology that does not depend upon the hospital's 
ability to record the proper number of units of a drug utilized; use 
information provided by commenters to set the 2003 payment rates; 
revise payment rates to include payment for the drug and related 
pharmacy overhead costs; pay 90 to 100 percent of AWP for non-pass-
through drugs; use an appropriate ratio of acquisition cost to AWP as 
estimated in the proposed rule; conduct a new external survey of 
hospitals' drug acquisition costs to obtain more current data; or pay 
according to the median hospital cost for the item.
    Response: As discussed elsewhere in this rule, in order to lessen 
the impact of the dramatic reduction in the proposed payment rates for 
many of the drugs and biologicals from 2002 to 2003, we decided that 
the most appropriate mechanism is to apply a dampening option to all of 
the APCs that decreased in median costs by more than 15 percent. For 
these APCs, we limited the reduction in median costs from 2002 median 
costs to half of the difference between the total proposed reduction 
and 15 percent. However, budget neutrality adjustments needed to 
compensate for the effects of this dampening subsequently reduced 
payment rates of all APCs by an additional percentage. Also, we applied 
a special dampening option to all blood and blood products and 
hemophilia clotting factors that limited the decrease in their payment 
rates to about 15 percent. These adjustments yielded significant 
moderation in the reduction of the final 2003 payment rates. These 
adjustments are described in detail in section III.B of the preamble.
    After carefully reviewing all of the comments, a dampening option 
seemed most plausible and practical for us to undertake. Most of the 
recommendations proposed by the commenters were not feasible or not 
suitable for the purposes of OPPS.
    Comment: Many commenters indicated that the median costs derived 
from the claims data was not reflective of the hospitals' true costs 
for acquiring and dispensing these drugs and biologicals.
    Response: We agree with this point; however, the commenters should 
note that we intend to pay only for the cost of acquiring the drug 
under a drug APC and not for costs associated with the administration 
of the drug. Costs associated with administering the drug and with 
other pharmacy overhead are captured in pharmacy revenue cost centers 
and reflected in the median cost of APCs involving drug administration. 
Therefore, we believe that it is not appropriate for us to duplicate 
these costs in both the administration and drug APCs.
    Comment: Several commenters noted that many drugs and biologicals 
were packaged into administration APCs; however, they were surprised to 
see decreases in the proposed payment rates for several of the 
administration APCs. The commenters stated that the addition of the 
costs of the packaged products should have caused the APC median cost 
levels to increase, thus their payment rates should have also increased 
compared to 2002. However, the commenters assert that the proposed 
payment rates for several administration APCs in which the drugs were 
packaged does not adequately cover the acquisition cost of the drugs 
themselves. Thus, they recommended that we reevaluate our data to 
ensure that costs of the packaged drug were included with the data for 
the applicable administration APCs, or otherwise explain how we plan to 
reimburse hospitals for the costs of the packaged drugs; retain the 
2002 payment rates for administration services and pay for the drugs 
separately; or use our authority to limit any payment reductions for 
certain services. One commenter suggested that we conduct a survey of 
cancer centers to determine the true cost of infusion procedures and 
make an adjustment to the APC rates based on our finding.
    Response: After reanalyzing our data, we were able to verify that 
the median costs of the drugs were indeed packaged into the median 
costs of the

[[Page 66770]]

administration APCs. We acknowledge that the median costs of several 
administration APCs before we packaged drug costs declined between 
those median costs used to set the 2002 rates and those median costs 
developed from the 2001 claims for the 2003 rates. This decline 
occurred because, in setting the 2002 rates, we packaged in 75 percent 
of the cost of pass through devices we projected would be billed with 
the administration codes, based on manufacturer prices. The 2001 claims 
data, however, did not reflect the charges that we predicted would be 
billed for such devices. An increase in the median cost of a service 
does not guarantee that the payment rate for the service will increase 
because payment rates under the OPPS are based on relative costs and 
the budget neutrality adjustment. If the relative cost of a service 
increases at a lower rate than other services, the payment rate may 
actually decline. In addition, all rates are affected by the budget 
neutrality adjustment that has lowered rates over the past several 
years. (We note that it is possible for the budget neutrality 
adjustment to increase rates as occurred in the proposed rates.) As 
noted elsewhere, for APCs whose median costs decreased by more than 15 
percent from 2002 to 2003, the dampening option described elsewhere in 
this rule limits the decreases in their payment rates.
    Comment: A commenter requested that we describe the methodology 
used to calculate the payment rates for sunsetting pass-through drugs 
that are being assigned to separate APCs.
    Response: We have provided a detailed description of the 
methodology we used in the calculation of the APC payment rates for 
sunsetting drugs and biologicals in section III.B of the preamble.
    Comment: A major hospital association supported our proposal to 
incorporate pass-through drugs into APC rates. However, the commenter 
was concerned that many of these same drugs would continue to receive 
95 percent of AWP in other settings, and differential payments may 
result in patient care being directed out of the hospital outpatient 
setting and into physician offices for non-clinical reasons.
    Response: We believe that the payment rates for sunsetting pass-
through drugs and biologicals reflect hospital acquisition cost to a 
sufficient extent so that hospitals will not, in general, stop 
furnishing these products to beneficiaries. While Medicare payment in 
other settings will be higher, the extent of response that may be 
expected to these payment differentials is unclear. We note that the 
same differentials prevailed for years prior to the introduction of the 
outpatient prospective payment system. We believe that the appropriate 
policy response is to address the use of AWP as a basis for payment in 
non-hospital sites.
    Comment: A state hospital association indicated that confusion 
exists among hospitals over which drugs can be self-administered and 
that instructions from fiscal intermediaries are inconsistent and/or 
confusing. The commenter requested that we publish a definitive list of 
drugs that are to be considered to be self-administrable, and thus is 
not part of covered services. Another commenter from a hospital urged 
us to clarify whether self-administrable drugs (both those that are 
integral and non-integral to the patient's procedure) in outpatient and 
observation settings are the patient's responsibility or should be 
packaged under procedure APCs. Another commenter from a hospital 
organization suggested that we exempt hospitals from determining which 
drugs should be classified as self-administered or allow hospitals to 
classify drugs based on the dosing form and pursue payment from the 
beneficiary.
    Response: On May 15, 2002, we issued Transmittal AB-02-072 entitled 
``Medicare Payment for Drugs and Biologicals Furnished Incident to a 
Physician's Service.'' The program memorandum gives instructions to the 
fiscal intermediaries for applying the exclusion to drugs that are 
usually self-administered by the patient. Each fiscal intermediary 
makes its determination on each drug based on whether the drug meets 
all of the program requirements for coverage. The payment rates that we 
are finalizing in this rule only indicate the Medicare payment amounts 
under OPPS when a drug is covered by Medicare; therefore, determination 
of a payment amount does not represent a determination that the 
Medicare program covers the drug. We discuss elsewhere in this preamble 
how Medicare makes payments for drugs that are considered to be 
supplies.
    Comment: Several commenters suggested that we publish various sorts 
of additional information about the methodology we used to calculate 
the payment rates, including technical details of the methodology used 
in analysis of the 2001 claims.
    Response: We do not believe the final rule is the appropriate 
vehicle for conveying the extensive background technical detail that 
may be of interest to the analytical community. However, we plan to 
hold a meeting in December 2002 or January 2003 to address the 
questions these commenters or other interested parties may have about 
our methodology.
    Comment: Several commenters were concerned that fiscal 
intermediaries have addressed the issue of drug units of service with 
respect to billing and waste differently, and requested that we provide 
clear and consistent guidance to the fiscal intermediaries as well to 
providers on how to define ``waste.''
    Response: In the fall of 1996, we issued a memorandum to our 
regional offices with guidance regarding our current policy on drug and 
biological product wastage. Although this memorandum focused on 
guidance for carriers, it overall reflects our current policy for drug 
and biological product wastage.
    We recognize that some drugs may be available only in packaged 
amounts that exceed the needs of an individual patient. Once the drug 
is reconstituted in the hospital's pharmacy, it may have a limited 
shelf life. Since an individual patient may receive less than the fully 
reconstituted amount, we encourage hospitals to schedule patients in 
such a way that the hospital can use the drug most efficiently. 
However, if the hospital must discard the remainder of a vial after 
administering part of it to a Medicare patient, the provider may bill 
for the amount of drug discarded along with the amount administered.

    Example 1: Drug X is available only in a 100-unit size. A 
hospital schedules three Medicare patients to receive drug X on the 
same day within the designated shelf life of the product. An 
appropriate hospital staff member administers 30 units to each 
patient. The remaining 10 units are billed to Medicare on the 
account of the last patient. Therefore, 30 units are billed on 
behalf of the first patient seen and 30 units are billed on behalf 
of the second patient seen. Forty units are billed on behalf of the 
last patient seen because the hospital had to discard 10 units at 
that point.
    Example 2: An appropriate hospital staff must administer 30 
units of drug X to a Medicare patient, and it is not practical to 
schedule another patient who requires the same drug. For example, 
the hospital has only one patient who requires drug X, or the 
hospital sees the patient for the first time and did not know the 
patient's condition. The hospital bills for 100 units on behalf of 
the patient, and Medicare pays for 100 units.

    Comment: A few commenters urged us to provide a crosswalk 
identifying which drugs are being associated with which APCs and in 
what amounts, to help ensure that costs are being appropriately 
transferred to and allocated among APCs.
    Response: Our methodology did not rely on a crosswalk, and we do 
not have one available. In our methodology, we

[[Page 66771]]

packaged drugs and biologicals that fell below the $150 median cost per 
line threshold into the procedure APCs they were billed from April 1, 
2001 to March 31, 2002. Interested parties may analyze the claims data 
that is available to the public to determine the extent to which the 
costs of specific drugs and biologicals were included in payment rates 
of the procedure APCs.
    Comment: A commenter expressed concern related to the adenosine 
products J0150 and J0151. The commenter stated that although these two 
codes reflect different uses and doses of the adenosine products, OPPS 
only recognizes billing only under the lowest dose of J0150 and J0151 
is assigned a status indicator of E. Consequently, the hospitals have 
been billing for both products under code J0150. The commenter 
requested that we clear the confusion that exists among hospitals when 
billing for these products by reinstating J0151 under a separately paid 
APC with an adequate payment rate and revising J0150 so that the code 
is specific to its actual use.
    Response: After reviewing the comment, we assigned a status 
indicator of N to J0150 to indicate that J0150 will be packaged in 
2003; and changed the status indicator for J0151 from E to K and 
assigned it to APC 0917.
    Comment: One commenter requested that we update the HCPCS 
description for all drugs to accurately report all medications in the 
way manufacturers currently package them. The commenter claimed that 
our current use of codes causes confusion and has the potential to 
create reimbursement problems for providers and the Medicare program.
    Response: To the extent possible, when creating the ``C'' codes 
used to report drugs and biologicals eligible for transitional pass-
through payment under OPPS, we employ the lowest common measurement of 
dosage for each drug so that hospitals can bill the number of units 
that are required to treat the patient by using multiple units of a 
single code. As drugs and biologicals retire from pass-through status, 
we expect to retire the ``C'' codes for these items. We expect these 
items will receive appropriate ``non-C'' HCPCS codes.
    Comment: Several commenters claimed that our proposal to package 
many of the non-pass-through, lower cost drugs and biologicals with 
HCPCS codes for therapeutic administration is a violation of the ``two-
times'' rule. Therefore, they recommended that we continue to pay for 
all drugs and biologicals separately or by revising the APCs in which 
the drugs are packaged.
    Response: We do not agree with the commenters' assertion that 
packaging of drugs and biologicals results in violations of the two-
times rule, stated in section 1833(t)(2) of the Act. We understand the 
commenters' confusion and attempt to provide a clarification on how we 
apply the ``two-times'' rule to determine APC structures. Most APC's 
consist of one or more services, which reported with CPT or HCPCS G 
codes, that are similar clinically and in terms of resource use. Many 
individual items (for example, sterile supplies or pharmaceuticals such 
as anesthetic agents) are integral to the procedure, and thus we have 
packaged them with the procedure. In some instances, such as APCs for 
transitional pass-through drugs and devices, the APC includes no 
procedure, and the APC is used only to pay for a specific item.
    The ``two times'' rule requires that the highest median cost of a 
service or item within an APC cannot be more than two times greater 
than the lowest median cost of a service or item within that APC. We 
apply the ``two-times'' rule to the total cost of each procedure (which 
includes items that are packaged within that procedure). In the case of 
APCs containing only items, we apply the rule to the cost of each item 
that is grouped in the APC. We do not apply the two times rule to the 
variation in cost of individual items or ancillary services we 
attribute to a single HCPCS code.
    If we were to attempt to apply the rule to all items within the 
various procedures, accounting for the variation in cost of supplies 
such as bandages, reusable instruments, and other medical supplies 
would be a practical impossibility. It would lead to a highly 
fragmented set of payment cells and a greatly more complex payment 
system that would reduce the incentives for effective management by 
hospitals. We do not believe the Congress would have intended such a 
result.
    Consistent with the principles of prospective payment, we package 
the cost of as many items as possible into the median cost of a 
procedure. Therefore, our payment methodology for 2003 includes 
packaging the costs of drugs and biologicals with median costs below 
$150 per line into the costs of the procedures with which they were 
billed. We reviewed the median cost of the procedures used for 
administration of drugs and biologicals, before and after we packaged 
the costs of drugs and biologicals. Our review indicates that the final 
median cost appropriately accounts for the administration procedure and 
the cost of the administered drug and/or biologic.
    Comment: Numerous commenters were concerned about the proposed 
reduction in payment rates for several radiopharmaceutical products. 
They asserted that hospitals would not be reimbursed adequately for 
these products, and thus, beneficiary access could be negatively 
impacted. They recommended that we should not base payments on the 2001 
claims data and use a different methodology instead. They suggested 
that we estimate acquisitions costs using the proposed ratios for 
acquisition cost to AWP based on analysis conducted by the agency; 
maintain the 2002 payment levels; or create new APCs using cost ranges 
and assign radiopharmaceuticals to APCs based on their costs, as 
determined by AWP plus overhead fees, or another proxy for actual 
hospital costs.
    Response: We are concerned about the possible effects of payment 
reductions on beneficiary access, and accordingly, we have included 
radiopharmaceuticals in the dampening policy described section III.B. 
of the Preamble.
    Comment: Several commenters were concerned with our proposal to 
package numerous radiopharmaceutical products. They claimed that given 
the problems with the claims data and the great variation in the cost 
and use of radiopharmaceuticals for the same procedure, all 
radiopharmaceuticals should be paid under their own APCs, in addition 
to their associated nuclear medicine procedures. This would assure 
appropriate reimbursement for both the product and procedure, and would 
be the best way to capture hospital costs for radiopharmaceuticals in 
future claims data.
    Response: While we acknowledge the commenters' concerns, we believe 
that the most appropriate payment structure is one that packages 
services together to the extent it is reasonable to do so, and thus 
presents hospitals with bundled payments that permit them to 
effectively manage resource allocation in the treatment of particular 
patients. Accordingly, we have not adopted this suggestion.
    Comment: A manufacturer and a trade association suggested that we 
could improve the accuracy of the APC payment rates by establishing new 
revenue codes to accurately capture data and calculate costs for 
radiophamaceuticals in future years.
    Response: While we do want to improve the accuracy of APC payment 
rates, we are reluctant to impose new requirements on hospital cost 
reports. In addition, the creation of new revenue centers must be made 
through a process that includes other payers as well as representatives 
of various providers.

[[Page 66772]]

Therefore, we will not adopt this suggestion for 2003. As discussed in 
section III. B of this final rule, we expect to address the issue of 
improving the accuracy of our data further in the future.
    Comment: A hospital organization indicated that there is a 
competitive disadvantage between different types of providers (clinic, 
Independent Diagnostic Testing Facilities (IDTF), and outpatient 
hospital) and their payment policies for Low Osmolar Contrast Media 
(LOCM). The commenter stated that in a clinic or IDTF, LOMC receives 
separate payment when clinical conditions are met. However, when LOCM 
is administered in an outpatient hospital without an intrathecal 
procedure or if one of the Medicare coverage conditions is non-covered, 
hospitals are expected to issue an ABN to the patient. The commenter 
recommended that we allow hospitals to bill for LOCM even when the 
patient does not meet conditions, or instruct the clinics and IDTFs to 
seek ABNs for LOCM in non-covered circumstances. A state hospital 
association suggested that we eliminate the medical necessity 
requirement for LOCM since it is not applicable to hospital outpatient 
services.
    Response: These suggestions involve several different Medicare 
payment systems, and appropriate resolution of this concern will 
require further analysis. We will consider this issue further in the 
future.
    Comment: One commenter requested clarification on whether there 
will be any more changes to the payment calculation for HCPCS C1775 
(FDG, per dose) other than what is proposed in Table X of the proposed 
rule.
    Response: According to our new policy for radiopharmaceuticals, as 
described elsewhere in this final rule, FDG will no longer be granted 
pass-through status in 2003. It will instead be paid separately under 
its own APC and be assigned to a status indicator of K.
    Comment: Another commenter requested that we describe our waste 
policy on whether a hospital may bill for a medication that is ordered 
and mixed, but not administered to the patient due to a change in 
patient status or a no-show by the patient for that day's visit. If the 
drug cannot be used later or on another patient, the hospital would 
still incur the costs.
    Response: If the drug is not administered to a Medicare 
beneficiary, then payment may not be made by the Medicare Program.
Packaging Issue
    Comment: Several commenters indicated that our methodology of 
analyzing single line-items on drug claims is not consistent with how 
hospitals bill for certain particular drugs and biologicals. This 
inconsistency particularly affects whether a drug or biological falls 
below the $150 median cost per line threshold or not. They claimed that 
we incorrectly assumed ``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.'' Commenters 
noted that this was not always true because hospitals often bill for 
certain drugs using multiple lines in a claim that represents one 
patient encounter. They indicated that in our calculation of the median 
cost per line for a drug, we multiplied the median cost per unit of the 
drug by the average number of units billed per line. Thus, our 
methodology does not take into account all of the units of a drug 
administered during one encounter if the units were billed in multiple 
lines on the claim, and consequently, may not reflect the full cost of 
delivering the drug.
    Response: For 2003, we chose to use the $150 median cost per line 
threshold level to determine whether to package a drug, as opposed to 
another packaging criterion, for the reasons of administrative 
simplicity, administrability, and responsiveness. However, in our 
analysis of the data, we observed that instances where a drug was 
billed on multiple lines in a claim were rare (less than 1 percent of 
total billings for drugs). We reiterate that our intent is to review 
and refine the packaging methodology in the future and will take the 
commenters' concern into account.
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 
proposed 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:
    [sbull] The drug must be designated as an orphan drug by FDA and 
approved by FDA for the orphan condition.
    [sbull] 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 proposed to make separate payment: J0205 
Alglucerase injection; J0256 Alpha 1 proteinase inhibitor; and J09300 
Gemtuzumab ozogamicin.
    Comment: Several commenters stated that the proposed payment rates 
for the orphan drugs would grossly underpay hospitals for providing 
these drugs to patients. They recommended that we pay for orphan drugs 
according to current year acquisition and actual total costs of 
providing the products; maintain the 2002 payment levels; or remove 
from them from the OPPS system and set payment according to the 
methodology used in the physician office and other non-inpatient 
settings.
    Response: After reviewing the comments, we have decided to remove 
the three orphan drugs that do not have any other non-orphan 
indications from the OPPS system and will pay for them on a reasonable 
cost basis. Other drugs that have orphan status according to the FDA 
will be partly protected by the dampening options described in section 
III.B of this final rule.
    Comment: Several commenters objected to what they characterized as 
our definition of ``orphan drug.'' These commenters believe we should 
treat comparably all drugs and biologicals that have been designated as 
under section 526 of the Federal Food, Drug, and Cosmetic Act.
    Response: We emphasize that we are not creating a new definition of 
orphan drugs; instead, we continued to rely on the definition stated in 
the Federal Food, Drug, and Cosmetic Act. However, within the set of 
drugs that the FDA has identified as orphan drugs, we have identified a 
subset of three drugs that have only orphan indications and decided to 
remove them from the outpatient prospective payment system. We have 
distinguished these drugs from other orphan drugs because of their low 
volume of patient use and their lack of other indications, which means 
they can rely on no other source of payment. Many orphan drugs are 
approved for multiple indications, including non-orphan indications 
that have significant patient use that provide the drugs with financial 
support. For example, epoetin alfa was originally identified as an

[[Page 66773]]

orphan drug for use in ESRD patients; however, currently it is being 
used extensively in patients with chemotherapy-induced anemia. Once a 
drug is granted orphan status, no further effort is made to update this 
status, even though indications for use may change substantially with 
experience. After consulting with our clinical advisors, we have 
decided to remove from OPPS the three orphan drugs that have no other 
non-orphan indications. We recognize the importance of all orphan 
drugs, however, and accordingly we have applied the dampening policies 
described in section III.B of the preamble to the other orphan drugs.
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 proposed to continue to pay separately for 
blood and blood products.
    Comment: Several major blood collection organizations, specialty 
physician groups, a large trade association, hospital associations, and 
individual hospitals supported our decision to maintain separate APCs 
for blood and blood products; however, the commenters were concerned 
with the reduction in payment rates for these products in the proposed 
rule.
    The commenters provided several suggestions. They recommended that 
we base the payment rates for blood products on current year 
acquisition costs and actual total costs rather than on hospital claims 
from previous years, and use industry data on the current hospital 
costs of blood and blood products that have been submitted to us; 
consider costs related to additional costs that hospitals incur in 
storing and preparing units for transfusion when assigning APC relative 
weights to blood and blood products; continue the 2002 payment rates 
until more accurate information on the actual costs of blood and blood 
products are gathered; or reimburse hospitals on a reasonable cost 
basis for blood and blood products.
    Response: After carefully reviewing the comments and comparing the 
industry data against our data, we were convinced that the proposed 
reduction in payment rates for many of the blood and blood products 
would result in payment that is significantly lower than hospital 
acquisition costs. Thus, inadequate reimbursement may compromise access 
to beneficiaries and the safety of these products. We continue to be 
aware of the variability in the use of blood and blood products in 
various procedures, and by our desire to recognize costs of new tests 
being performed on blood, we have decided to apply a special dampening 
option to blood and blood products that had significant reductions in 
payment rates from 2002 to 2003. For these products, as described in 
section III.B of the preamble, we limited the decrease in their median 
costs by 11 percent, which limited the decrease in payment rates to 
approximately 15 percent. We note that the APCs for these products are 
intended to cover product costs; costs for storage, etc., are packaged 
into the APCs for the procedures with which the products are used.
    Comment: A commenter from an individual hospital disagreed with our 
proposal to not change the current OPPS payment policy for 
transfusions. The commenter stated that their hospital has more than 
the average number of cases that require more than one unit of blood, 
and thus, averaging the payment would adversely affect specialty 
hospitals.
    Response: For transfusion services that are paid under OPPS, 
hospitals can bill for the administration of the transfusion and the 
number of units of blood transfused. With the payment rates for 
transfusion and blood and blood products that are in the final rule, we 
believe that hospitals, including those that specialize in the 
transfusion of multiple units of blood, will receive adequate payment 
for transfusion services. The hospitals will receive separate payment 
for the blood in addition to the APC payment for the transfusion 
service. Even though we will not change our payment policy for 
transfusions for 2003, this is an issue that we will continue to 
monitor in the future.
    Comment: Two commenters requested that we provide special 
comprehensive billing and coding guidelines in the area of blood, blood 
processing, and transfusion medicine, and the proper use or non-use of 
the transfusion medicine codes. They stated that Transmittal A-01-50 
does not clarify all of the confusing issues that hospitals currently 
experience in billing and coding for blood-related services.
    Response: We acknowledge that need for comprehensive billing and 
coding guidelines in the areas mentioned by the commenters and agree 
that the program memorandum that was issued previously may require 
further clarification. Therefore, this is an area that we expect to 
focus on during the upcoming year.
    Comment: Several hospitals, advocacy organizations, manufacturers, 
and beneficiaries were concerned that the proposed decrease in 
reimbursement for certain clotting factors would not enable hospitals 
to recover the acquisition costs of the products. They indicated that 
inadequate reimbursement would create incentives for hospitals to not 
provide these products at all or to provide only those clotting factors 
that limit financial loss. Commenters also indicated that given the 
high cost of the clotting factors, the average cost to charge ratio 
methodology that might apply to other drugs does not apply to clotting 
factors, and the proposal would shift patients to the inpatient setting 
where costs of care are higher. Their recommendations were that we 
adjust the proposed payment with a rate consistent with the average 
acquisition cost of the drugs; maintain the 2002 payment rates; use 
current hospital inpatient payment rates in place of the proposed 
rates; or remove from the OPPS system and set payment according to the 
methodology used in the physician office and other non-inpatient 
settings.
    Response: We recognize the importance of insuring adequate 
reimbursement and access to hemophilia clotting factors for our 
beneficiaries, as did the Congress when it created a separate benefit 
category for clotting factors in section 1861(s)(2)(I) of the Act. 
Accordingly, we have adopted a provision to insure that the payment 
rates for these products does not decrease by more than approximately 
15 percent from 2002 to 2003.
    Comment: Several commenters were very concerned with the proposed 
payment rates for plasma products and their recombinant analogs 
therapies. They argued that reduction in payments would create 
significant patient access problems since the hospitals will be unable 
to recoup costs incurred in acquiring and dispensing such therapies. 
They recommended that we pay for these products on a reasonable cost 
basis; revise the payment rates significantly to allow hospitals to 
recover their acquisition and dispensing costs; base payment on current 
acquisition costs and actual total costs

[[Page 66774]]

of the products in outpatient settings; maintain payment at the 2002 
level; or establish an add-on payment to be based on a national formula 
derived outside of OPPS.
    Response: We recognize the importance of these drugs, and 
consequently included them in the dampening procedure described section 
III.B of the preamble.
    Comment: Several commenters urged us to clarify the category of 
``blood and blood products'' to include drugs and biologicals that are 
derived from plasma fractionation and their biotechnology analogs. They 
stated that the rationale for creating separate APCs for blood and 
blood products also equally apply to plasma-based products and their 
recombinant therapies. These commenters recommended that we continue to 
pay for all plasma-derived and recombinant analog therapies in separate 
APCs and include them in the category of ``blood and blood products'' 
as it is done under the FDA's definition of ``blood and blood 
products.''
    Response: We acknowledge that plasma-based products and their 
recombinant therapies are derived from blood however, these products 
are highly processed and not manufactured by local blood banks. Upon 
consultation with our clinical advisors, we have determined that these 
products do not have the same access and safety concerns as other blood 
and blood products. Thus, it is reasonable for us to distinguish these 
products from other blood and blood products. For the purposes of OPPS, 
we will not consider any plasma-derived products and their recombinant 
analogs, including albumin and immune globulins and except for 
hemophilia clotting factors, to fall under the category of ``blood and 
blood products''. Accordingly, we apply to these products the same 
packaging procedures applicable to other drugs and biologicals.
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 proposed to pay for these vaccines 
under OPPS through the establishment of separate APCs.
    We received no comments on our proposal to pay for these vaccines 
under separate APCs. However, we have had considerable discussion with 
providers in the past about the cost to hospitals of influenza and 
pneumococcal pneumonia vaccines in particular. In particular, we have 
had many discussions in which we were advised by providers that OPPS 
payment was insufficient for them to be able to guarantee that they 
would be able to offer these important vaccines to Medicare patients 
they treat. They cited the timing of updates to OPPS rates as well as 
volatility of costs as a result of irregular supplies of these vaccines 
as their major concern. Public health officials encourage high risk 
individuals, including Medicare beneficiaries, to receive flu 
immunitions beginning each September. Each flu season, a new vaccine is 
produced; the cost of the vaccine is also typically higher than the 
previous year's vaccine cost. Thus, from September through December, 
providers paid under the OPPS for administering flu vaccines do not 
receive the benefit of the update that occurs in January. In recent 
years, the cost of the vaccine has been volatile because of irregular 
supplies.
    Therefore, we have decided to pay hospitals for influenza and 
pneumococcal pneumonia vaccines under reasonable cost methodology. 
Section 1833(t)(2)(A)(i) of the Act gives the Secretary discretion to 
define outpatient hospital services for purposes of payment under the 
OPPS. Until now we have defined it to include influenza and 
pneumococcal pneumonia vaccines. However, in view of the importance of 
these vaccines to the public health and our strong desire to ensure 
that hospitals are paid appropriately for these vaccines, we have 
decided to exclude them from OPPS.
    We are therefore revising regulations at Sec.  419.21(d)(3) to 
remove the words ``influenza'' and ``pneumococcal pneumonia.'' As a 
result of this change, hospitals, HHAs and hospices which were paid for 
these vaccines under OPPS will be paid reasonable cost for these 
vaccines. We will issue further instructions regarding how CORFs will 
be paid for these vaccines in 2003 and will issue implementation 
instructions for hospitals, HHAs and hospices.
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 
proposed to allow payment under separate APCs for high cost drugs for 
an additional year while we further study various payment options. 
Specifically, we proposed 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 we briefly describe below. We 
provide more detail in the proposed rule regarding the methodology we 
used to determine this threshold (67 FR 52124-52125).
    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. 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. Once we calculated an approximate median cost per line for 
the drug, 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 proposed 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. We solicited 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 requested comments on the factors we considered in determining 
which drugs to package in 2003. We were particularly interested in 
comments for the exclusion of high cost drugs from packaging. We added 
that we would continue to analyze the effect

[[Page 66775]]

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 stated that we 
may revise our threshold or criteria for packaging in the final rule 
for 2003. 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 nonetheless, requested 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. 
Another alternative approach would be to create APCs for groups of 
drugs based on their costs. Still another approach would be to create 
separate APCs for each drug. We emphasized in the proposed rule that we 
welcomed 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.
    Drugs that we pay for separately in 2003 are designated in Addendum 
B by status indicator ``K'' or ``G.''
    A summary of the comments we received on this proposal and our 
responses to them are summarized below.
    Comment: Numerous national trade associations, drug manufacturers, 
consultants, and other commenters opposed our proposal to package 
sunsetting drugs and biologicals that fell below a threshold of $150 
median cost per line into procedure APCs. These commenters urged us to 
continue to pay separately for drugs and biologicals that were paid 
separately in 2002, including those for which pass-through status has 
expired. Some recommended that we maintain the 2002 payment levels 
until more accurate data could be obtained.
    In contrast, one national hospital organization recommended that we 
adopt a much higher threshold of $1,000 for a drug to warrant separate 
payment and package all other drugs that fall below the threshold. 
Furthermore, another national hospital association encouraged us to 
expeditiously incorporate into APCs both low and high cost drugs that 
will lose their eligibility for transitional pass-through payments, 
while limiting separate APC payment only to orphan drugs, blood and 
blood products, certain vaccines and extremely costly drugs. The 
commenter also stated that integrating payments for packaged services 
will be less burdensome for hospitals and will eliminate incentives for 
higher costs that might be created by special additional reimbursement. 
As noted in section XI, the Medicare Payment Advisory Committee also 
urged CMS to incorporate more drugs into the base APCs.
    Response: We appreciate all of the comments regarding the various 
aspects we should consider in making our decision to package lower-cost 
drugs and biologicals into procedure APCs. After carefully considering 
all recommendations submitted by the commenters regarding how we should 
treat these drugs and biologicals, we concluded that the packaging 
methodology we proposed is appropriate. We believe that we have 
sufficient data on drugs and biologicals to allow us to make a 
reasonable decision on whether to package individual items. We further 
believe that our decision to package these costs is consistent with the 
concept of a prospective payment system and we expect to continue 
incorporating additional drugs into the base APCs in future years.
    Comment: Several commenters stated that the $150 threshold 
established for separate APC payment is arbitrary and such a packaging 
rule would create confusion among hospitals. One national hospital 
association was concerned that the policy would create incentives for 
pharmaceutical companies to increase their prices so their drugs will 
receive separate payment, and, potentially, for physicians to choose 
one drug over a clinically appropriate substitute.
    Response: We acknowledge the concerns for using a median cost per 
line threshold level when the cost of a particular drug may fluctuate 
over time. However, we must set the rates prospectively. We will 
consider these issues further as we determine our policy for the 
criteria for packaging as we develop our proposed rule for the 2004 
update.
    Comment: Several commenters supported our decision to pay 
separately for higher-cost drugs, clotting factors, and orphan drugs in 
2003, but recommended that we delay packaging higher-cost drugs until 
more accurate data is available. Other commenters suggested that we 
collect at least 2 more years of data on all drugs and biologicals 
before contemplating bundling them with other APCs. They stated that 
once a drug or biological is bundled, hospitals will have no incentive 
to code for it, and there will be no means of collecting data on the 
product in the future. Thus, by not packaging, we would be able to 
determine appropriate payment rates that reflect variations in hospital 
expenses for these products and continue to collect product-specific 
information.
    Response: We agree with the commenters who stated that we should 
not package higher cost drugs until we have more data on those 
products; however, we disagree with the other commenters who suggested 
that we should not consider packaging any drugs and biologicals until 
we have collected data for two more years. We believe that at this time 
we have sufficient data to determine which drugs and biologicals should 
be packaged and which products we will pay separately for in 2003. 
While some hospitals may fail to separately report codes that represent 
packaged items, we have repeatedly instructed hospitals to submit all 
charges related to covered outpatient services, including those for 
packaged items. The total charges submitted by hospitals for each 
service will be used to set future rates. For that reason, and because 
of the possible impact on their ability to receive outlier payments for 
which they might qualify, it is extremely important that hospitals 
report all appropriate charges for their covered outpatient services.
    Comment: Several commenters suggested that, at minimum, we should 
continue to pay separately for drugs and biologicals that typically 
cost more than $150 per administration, regardless of whether the 
median cost per line exceeds $150 using the 2001 claims data. In 
addition, a trade association suggested that we reflect the common 
practice of combining radiopharmaceuticals and others drugs used in 
performing nuclear medicine procedures by qualifying for separate 
payment those drug combinations which exceed the agency's $150 
threshold.
    Response: We appreciate the commenters' suggestions regarding 
methodologies that would refine the $150 threshold level used in making 
packaging determinations for 2003. We believe our proposed policy 
strikes a reasonable balance of simplicity, administrability, and 
responsiveness. We intend to review and refine our methodology in the 
future, and the proposals submitted by commenters will be taken into 
consideration at that time.

[[Page 66776]]

    Comment: Several commenters claimed that our proposal to package 
many of the non-pass-through, lower cost drugs and biologicals with 
HCPCS codes for therapeutic administration is a violation of the ``two-
times'' rule. Therefore, they recommended that we continue to pay for 
all drugs and biologicals separately or by revising the APCs in which 
the drugs are packaged.
    Response: We do not agree with the commenters' assertion that 
packaging of drugs and biologicals results in violations of the two-
times rule, stated in section 1833(t)(2) of the Act. We understand the 
commenters' confusion and attempt to provide a clarification on how we 
apply the ``two-times'' rule to determine APC structures. Most APC's 
consist of one or more services, which we refer to as ``procedures'' 
and code with CPT or HCPCS G codes, that are similar clinically and in 
terms of resource use. Many individual items (for example, sterile 
supplies or pharmaceuticals such as anesthetic agents) or ancillary 
services (for example, nursing or recovery room services) are integral 
to the procedure, and thus we have packaged them with the procedure. In 
some instances, such as APCs for transitional pass-through drugs and 
devices, the APC includes no procedure, and the APC is used only to pay 
for a specific item.
    The ``two times'' rule requires that the highest median cost of a 
within an APC cannot be more than two times greater than the lowest 
median cost of a procedure within that APC. We apply the ``two-times'' 
rule to the total cost of each procedure (which includes items and 
services that are packaged within that procedure). In the case of APCs 
containing only items, we apply the rule to the cost of each item that 
is grouped in the APC. We do not apply the two times rule to the 
variation in cost of individual items or ancillary services we 
attribute to a single HCPCS code.
    If we were to attempt to apply the rule to all items and ancillary 
services within the various procedures, accounting for the variation in 
cost of supplies such as bandages, reusable instruments, and other 
medical supplies would be a practical impossibility. It would lead to a 
highly fragmented set of payment cells and a greatly more complex 
payment system that would reduce the incentives for effective 
management by hospitals. We do not believe Congress would have intended 
such a result.
    Consistent with the principles of prospective payment, we package 
the cost of as many items and ancillary services as possible into the 
median cost of a procedure. Therefore, our payment methodology for 
2003, includes packaging the costs of drugs and biologicals with median 
costs below $150 per line into the costs of the procedures with which 
they were billed. We reviewed the median cost of the procedures used 
for administration of drugs and biologicals, before and after we 
packaged the costs of drugs and biologicals. Our review indicates that 
the final median cost appropriately accounts for the administration 
procedure and the cost of the administered drug and/or biologic.
    Comment: A commenter requested that we include a statement in the 
final rule that was included in the preamble of the September 8, 1998 
proposed rule (63 FR 47563-47564) that stated ``We propose to allow 
hospitals to provide drugs to patients without requiring that the 
hospital bill the patient, and without Medicare paying the hospital. 
Normally, hospitals are not allowed to waive such billing, since not 
charging a patient could be seen as an inducement to the patient to use 
other services at the hospital, for which the hospital would be paid. 
However, if the benefit is not advertised, we believe that provision of 
the self-administered drugs at no charge to the beneficiary need not 
constitute an inducement in violation of the anti-kickback rules. The 
hospital may not advertise this to the public or in any other way 
induce patients to use the hospital's service in return for forgoing 
payment.''
    Response: We are not making final the proposal in the September 8, 
1998 rule (63 FR 47563-64) that the commenter quotes. Medicare policy 
affecting how payment is made under the OPPS has evolved considerably 
since that rule. In the intervening years, CMS, providers, contractors, 
and beneficiaries all have acquired considerable experience under the 
OPPS that has added perspective and substance to a broad range of 
policy issues, including what is and is not payable under the OPPS. The 
following points summarize our current policy related to the issue 
posed by the commenter:
    [sbull] In accordance with the in section 1861(s)(2)(B) of the Act 
and related Medicare regulations and program issuances, drugs and 
biologicals that are not usually self-administered by the patient are 
payable under the OPPS. As we explain elsewhere in this final rule, 
Medicare makes separate payment for certain drugs and biologicals and 
packages payment for others into the procedure with which they are 
billed.
    [sbull] The fact that a drug has a HCPCS code and a payment rate 
under the OPPS does not imply that the drug is covered by the Medicare 
program, but only indicates how the drug may be paid if it is covered 
by the program.
    [sbull] A code and payment amount does not represent a 
determination that the Medicare program covers a drug. Contractors must 
determine whether the drug meets all program requirements for coverage; 
for example, that the drug is reasonable and necessary to treat the 
beneficiary's condition and whether it is excluded from payment because 
it is usually self-administered.
    [sbull] Certain drugs are so integral to a treatment or procedure 
that the treatment or procedure could not be performed without them. 
Because such drugs are so clearly an integral component part of the 
procedure or treatment, they are packaged as supplies under the OPPS 
into the APC for the procedure or treatment. Consequently, payment for 
them is included in the APC payment for the procedure or treatment of 
which they are an integral part.
    [sbull] Under the OPPS, hospitals may not separately bill 
beneficiaries for items whose costs are packaged into the APC payment 
for the procedure with which they are used (except for the copayment 
that applies to the APC).
    In short, neither the OPPS nor other Medicare reimbursement rules 
regulate the provision or billing by hospitals of non-covered drugs to 
Medicare beneficiaries. Accordingly, it would be inappropriate to 
include the statement in the 1998 rule. However, in some circumstances, 
such practices potentially implicate other statutory and regulatory 
provisions, including the prohibition on inducements to beneficiaries, 
section 1128A(a)(5) of the Act, or the anti-kickback statute, section 
1128B(b) of the Act.

E. Expiration of Transitional Pass-Through Payments in Calendar Year 
2003 for 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 proposed that these categories (and the transitional 
pass-through payments) will be discontinued as of January 1, 2003. 
Furthermore, as discussed above, we

[[Page 66777]]

proposed 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. 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 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, weproposed to package the costs 
into payment for the procedures with which they are billed.
    For other uses of brachytherapy, we proposed to defer packaging of 
brachytherapy seeds for at least 1 year. In those cases, when paying 
separately in 2003 for brachytherapy seeds, we proposed 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 solicited 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 proposed 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. 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 its own 
charge for the radiation source in the charge for the procedure. 
Therefore, we proposed 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 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. 
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 
proposed to establish a G code for hospital use only that will 
specifically identify prostate brachytherapy. We proposed 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 
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.

[[Page 66778]]

    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 proposed 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 
proposed 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 solicited comments on this 
proposal.
Packaging of Other Device Costs Associated With Brachytherapy
    We proposed 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.
Brachytherapy
    Comment: One commenter believed that assigning CPT Code 77799 to 
APC 313 was inappropriate because it was the highest paying 
brachytherapy APC and it violated the two times rule.
    Response: We thank the commenter for bringing this to our 
attention. The CPT code 77799 should be assigned to APC 312, the lowest 
paying brachytherapy APC, which is consistent with our policy of 
assigning unspecified codes to the lowest paying similar APC because we 
do not know what procedures are being performed. However, we do not 
apply the two times rule to unspecified codes like 77799 for that same 
reason. We are assigning 77799 to APC 312.
    Comment: Several commenters were concerned that the proposed 
payment rates for APCs 1718, for iodine seeds, and 1720, for palladium 
seeds were significantly lower than the 2002 payment rates for these 
brachytherapy sources. The commenters stated that the new rates do not 
reflect hospital acquisition costs and recommended that we continue 
pass-through status for these seeds in 2003 or refine the claims data 
used to set payment rates.
    Response: Our payment rates for 1718 and 1720 are based on the 
median costs for these seeds in our 2001 claims data. We are confident 
that these data reflect actual hospital acquisition costs. By statutory 
mandate, the OPPS system, in aggregate, does not pay hospitals full 
costs for services. Therefore, it should not be expected that payment 
rates (which involve turning median costs into relative weights and 
applying scaling factors) will always reflect 100 percent of hospital 
acquisition cost.
    Comment: Several commenters urged us to identify all sources 
currently used in brachytherapy and cover those sources on an interim 
basis. They suggested we retain a C code for ``unlisted'' brachytherapy 
sources to allow hospitals to bill for sources not on the current pass 
through list.
    Response: We only create C codes for items based on formal 
applications for a specific device. We do not create C codes for 
unlisted devices. Interested parties may submit an application for a 
pass through device using the process described in the April 7, 2000 
final rule (65 FR 18481-18482).
    Comment: A commenter suggested continuing the pass-through 
categories for brachytherapy seeds, needles, and catheters for one year 
in order to collect more data.
    Response: Statutory provisions preclude us from continuing these 
categories for an additional year.
    Comment: One commenter asked us to refer to brachytherapy 
``sources'' instead of brachytherapy ``seeds.''
    Response: We agree and will do so.
    Comment: One commenter responded to our solicitation of comments 
regarding the advisability of creating tumor specific brachytherapy 
HCPCS codes in the future. The commenter did not favor this idea 
because of the variability in number and type of brachytherapy devices 
used to treat a single disease. Additionally, it would create an overly 
complex coding system.
    Response: We thank the commenter and are continuing to review this 
issue.
    Comment: Several commenters were concerned about the proposed 
payment reduction for APC 313 (High Dose Afterloading Brachytherapy). 
The commenters stated that hospitals were coding incorrectly for these 
services because many claims did not use C codes for the sources or 
catheters. Therefore, our data did not reflect actual hospital costs. 
The commenters recommended that we increase the payment rate, use only 
claims that were correctly coded, or continue to pay separately for the 
sources.
    Response: As described elsewhere in this rule, we have taken steps 
to mitigate the severe payment decreases that were proposed for several 
APCs including APC 313. Therefore the final payment rate for APC 313 
will be higher than the proposed payment rate. We will continue to 
review the issues raised by the commenters. It is unclear how we should 
address the issue of coding for APC 313 because high dose brachytherapy 
sources are reusable whose costs must be amortized per use over a 90 
day period. Furthermore, hospitals have been using these sources for 
many years; therefore, we would expect their charges would reflect this 
amortized cost even in the absence of using a C code. Additionally, it 
is likely we over estimated device costs for this APC because of the 
methodology we used for folding in device costs insetting 2002 payment 
rates. Lastly, we are unable to continue pass-through payments for 
devices used in APC 313 and do not think it is appropriate to pay 
separately for high dose brachytherapy sources for the reasons 
discussed.
    Comment: Several commenters were concerned about the ``N'' status 
indicator assigned to Yttrium-90 brachytherapy sources. They stated 
that it is an implantable seed used in treating liver cancer. They also 
claimed that its median cost was much higher than the cost reflected in 
our claims data.
    Response: We will place Yttrium-90 in an APC. Assigning status 
indicator ``N'' was an error. We will use our claims data to set the 
payment rate. We will continue to review our claims data and external 
data sources as we update the payment rate in 2004.
    Comment: Several commenters suggested that we create HCPCS codes 
and APCs for high dose implantable brachytherapy sources. They 
explained that sources such as iodine-125 and palladium-103 may be 
``high'' intensity or `low'' intensity (that is, emit different amounts 
of radiation) and that our payment for these sources account for the 
cost variation associated with sources of different intensities. 
Another commenter requested that we create three levels of APCs for 
brachytherapy needles and catheters to account for cost variation of 
those devices. Lastly, another commenter suggested we create

[[Page 66779]]

three APCs to reflect levels of seed utilization (for example, simple 
for less than 85 seeds, intermediate for 85-99 seeds and complex for 
more than 100 seeds).
    Response: We disagree. Our median cost data should reflect the cost 
variation among seeds of different intensity. For example if low 
intensity seeds cost $40 and are used 80 percent of the time, and high 
intensity seeds cost $50 and are used 20 percent of the time, then our 
cost data should reflect a cost of $42 per seed. Insofar as no hospital 
specializes in administering high intensity seeds, on average, 
hospitals should be paid appropriately for both types of seeds. 
Furthermore it would be administratively burdensome and make accurate 
coding very difficult, if we created APCs for every variation in seeds. 
We believe devices other than seeds should be packaged into procedure 
APCs, as we have done with all other devices. Because we pay for 
sources on a ``per seed'' basis there is no reason to create APCs for 
simple, intermediate, and complex seed utilization.
    Comment: One commenter requested that we set up a system to account 
for the variability in use of brachytherapy devices. Another commenter 
said that brachytherapy codes were not well understood so all supplies 
and sources should be paid separately.
    Response: We disagree and are finalizing our proposal to package 
all devices except for seeds in cases of non-prostate cancer 
brachytherapy. Doing what the commenters requested would create an 
extremely burdensome system with no discernable benefit.
    Comment: Many commenters disagreed with our proposal to create a G 
code describing prostate brachytherapy with packaged implantable 
sources, needles, and catheters. They cited the following as reasons:
    [sbull] The high variability in the number of sources used per 
treatment.
    [sbull] The difference in cost between iodine and palladium seeds.
    [sbull] Packaging of seeds violates the two times rule.
    [sbull] Some hospitals specialize in complex cases requiring high 
numbers of seeds and would always be underpaid.
    [sbull] A single payment rate would provide incentives to use 
cheaper (iodine) seeds when more expensive seeds (palladium) were 
clinically appropriate.
    [sbull] A single payment rate would provide an incentive to use 
fewer, higher activity seeds even if use of more lower activity seeds 
was clinically appropriate.
    [sbull] Underpayment for prostate brachytherapy will create an 
incentive to use more invasive, riskier, and costly treatments for 
prostate cancer.
    [sbull] The proposed payment rate is too low as a result of using 
improperly coded claims.
    [sbull] Creating a new G code is administratively burdensome.
    Most commenters recommended that we continue to pay separately for 
brachytherapy sources used for prostate cancer, as we proposed to do 
for other forms of cancer. Some commenters requested that we withdraw 
our proposal for the G code describing brachytherapy and continue to 
recognize CPT codes 55859 and 77778 while other commenters agreed with 
our proposal to create the G code with packaged needles and catheters 
but asked that we not package brachytherapy sources into it. Some 
commenters requested that, if we finalize our G code, that it be paid 
as least as much as combined payment rate for the APCs containing CPT 
codes 55859 and 77778.
    A few commenters agreed with our proposed G code approach but asked 
that we create 2 G codes, one for prostate brachytherapy using iodine 
seeds and another for prostate brachytherapy using palladium seeds. 
They also suggested that if CMS finalizes one or more G codes, coding 
edits should be developed to ensure proper coding of these procedures.
    Response: We thank all the commenters. After review of all the 
comments we have decided to create 2 G codes describing prostate 
brachytherapy. G0256, Prostate brachytherapy using permanently 
implanted palladium seeds, including transperitoneal placement of 
needles or catheters into the prostate, cystoscopy and application of 
permanent interstitial radiation source, and G0261, Prostate 
brachytherapy using permanently implanted iodine seeds, including 
transperitoneal placement of needles or catheters into the prostate, 
cystoscopy and application of permanent interstitial radiation source. 
These codes package the costs of needles, catheters, and sources. In 
developing payment rates for these codes we used only correctly coded 
claims. For example, for G0256 we used only claims that included CPT 
codes 55859, 77778, and a C code for palladium sources. We did not use 
any claims where there was no C code for a brachytherapy source or a 
claim where there were C codes for more than one source (for example, 
palladium and iodine sources). Analysis of the claims we used in 
setting payment rates revealed that the median number of seeds packaged 
into both codes is 85. We believe that the median costs of these codes 
reflect the resources required to perform these procedures.
    We believe that implementation of these G codes should address the 
clinical concerns of the commenters. We do not believe these codes will 
create an incentive to use one type of source rather than another. 
Additionally, because of the number of seeds packaged we do not believe 
there will be an incentive to use fewer seeds inappropriately. 
Furthermore, we believe the number of packaged seeds addresses the 
concerns about seed variability as we are not aware of facilities that 
specialize in using more palladium or iodine than are packaged in these 
codes. Finally, we do not have evidence that implementation of these G 
codes and their payment rates will create an incentive to treat 
prostate cancer with more invasive, more costly treatments.
    For non-clinical concerns, we think that implementation of the G 
codes will actually decrease administrative burden as it will now be 
easier for hospitals to properly code for prostate brachytherapy 
procedures, and we believe that the methodology we used to develop 
median costs addresses the concerns about underpayment.
    When performing prostate brachytherapy hospitals should use G0256 
and G0261 and should not report CPT codes 55859 and 77778. Furthermore 
hospitals should not report the APCs for iodine and palladium 
brachytherapy sources. CMS will create edits to prevent billing of 
these items and services with prostate brachytherapy. However, other 
services provided during the provision of prostate brachytherapy such 
as intraoperative ultrasound, dosimetry, etc., are separately payable 
and should be reported on the claim if performed.

F. 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 proposed 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

[[Page 66780]]

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--
    [sbull] For drugs available through only one source drugs, the 
ratio of acquisition cost to AWP equals 0.68;
    [sbull] For multisource drugs, the ratio of acquisition cost to AWP 
equals 0.61;
    [sbull] 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:
    [sbull] For sole-source drugs, the ratio of cost to AWP equals 71.0 
percent.
    [sbull] For multisource drugs, the ratio of cost to AWP equals 68.0 
percent.
    [sbull] For drugs with generic competitors, the ratio of cost to 
AWP equals 46.0 percent.
    We proposed 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 for 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.
    We received several comments on this proposal, which are summarized 
below.
    Comment: A commenter stated that the payments for pass-through 
drugs were too generous compared to those for the devices.
    Response: We calculated payments for pass-through drugs and devices 
in accordance with the statute in sections 1833(t)(6)(D)(i) and (ii) of 
the Act.
    Comment: Numerous commenters were concerned with the time required 
to incorporate new drugs and biologicals into the APC system. Some 
commenters indicated that we frequently depart from our own timeframe 
of 4 to 7 months from the date of submission of an application to the 
potential effective data for pass-through status. Thus, they urged us 
to follow one of the following recommendations: Expedite the processing 
of pass-through applications and the creation of C codes; develop C 
codes for products pending FDA approval, or permit retroactive dates 
for new codes to allow for retroactive reimbursement for hospitals. 
Another commenter suggested that we create a centralized on-line 
listing of all current pass-through drugs, biologicals, and devices 
along with all of the new applications under review.
    Response: We understand the commenters' concerns, and we would like 
to clarify the operation of our quarterly deadlines. We establish 
deadlines for submission of transitional pass-through applications that 
are 4 months in advance of the next quarterly update to the claims-
payment system in order to accommodate time for review and decision and 
for revisions to the claims-payment systems. Thus an applicant 
submitting by the deadline can be assured we will consider the 
application for possible inclusion in the next quarterly update. 
However, we cannot guarantee that we will be able to make a decision 
regarding the application within that period of time. Incomplete 
applications or the need to answer technical questions that arise 
during review may extend the period of review.
    We have instructed hospitals through our fiscal intermediaries that 
hospitals may bill for new drugs following FDA approval using an 
unspecified HCPCS code until a permanent HCPCS is established for the 
drug and/or we have approved pass-through payment for the drug. Payment 
for a new drug, if determined by the fiscal intermediary to be a 
covered drug, would be packaged. However inclusion of the drug charges 
for the procedure will be considered in determining outlier payments 
and will be used in future rate setting for the procedure and/or the 
drug once its pass-through status expires. Hospitals should note that 
we have lowered the threshold for outlier payments for 2003, and this 
new threshold requirement is described in section IX of the preamble.
    We intend to minimize the delays in the review process as much as 
possible so that we can facilitate access to new products and services 
for our beneficiaries, which is why we review new pass-through 
applications on a quarterly basis. We disagree with the commenters who 
suggested that we allow retroactive reimbursement for hospitals to the 
date of FDA approval. Moving to such a policy would greatly increase 
the burden on our and hospitals' computer systems in programming, 
testing, and implementing updates to the payment system. We do not 
provide for retroactive changes in reimbursement because this is a 
prospectively

[[Page 66781]]

determined payment system and because retroactive payment rate changes 
are administratively burdensome and confusing for beneficiaries and 
providers.
    We appreciate the suggestion to create an on-line listing of all 
transitional pass-through items and applications that are under review, 
and will consider it for the future.
    Comment: Several national trade associations and drug companies 
were concerned with our proposal to consider drugs and biologicals that 
were subject to repackaging as multisource drugs. They indicated that 
repackagers do not manufacture the products; instead, they purchase the 
products from the manufacturers, package them differently, and then 
sell the products. The manufacturer of the product continues to be the 
sole source of the product; therefore, we should regard repackaged 
products as sole source drugs. Also, they recommended that we utilize 
the ``Orange Book'' to determine whether a drug should considered 
single source, multisource, or generic for OPPS purposes.
    Response: We acknowledge that we treat certain drugs that have only 
one manufacturer as a multisource drug. Our rationale behind regarding 
a repackaged drug as a multisource product is that, even though there 
may be only one manufacturer of a repackaged drug, there is more than 
one party selling the repackaged drug in the market. Therefore, a 
repackager may charge a different price to hospitals for the same 
product sold by its manufacturer. Our intention in the payment system 
is to account for the economic relationship between market prices for 
repackagers, multisource drugs, and sole source drugs. From our 
analysis, we judged the drugs sold by repackagers to be similar to 
drugs available from more than one manufacturer in terms of price 
differentials and estimated hospital acquisition costs. We also note 
that if we were to recategorize these drugs as single source, we would 
have to recalculate the average values for acquisition costs for the 
three categories of drugs.
    Comment: Several commenters suggested that we use the October 2002 
Red Book information to set the final pass-through payment rates for 
2003. Also, the commenters urged us to update the pass-through payment 
rates quarterly since there will be significantly fewer pass-through 
drugs in 2003.
    Response: Upon considering the commenters' suggestions in using the 
October 2002 Red Book to set the pass-through payment rates for drugs 
and biologicals, we decided to continue using the July 2002 Red Book as 
we proposed since it is most consistent with our publication schedule. 
In the future, for all of our final rules that must be published by 
November, we will continue to use the July edition of the Red Book for 
that year.
    We carefully considered the proposal to update the pass-through 
payments on a quarterly basis and decided to continue with only annual 
updates of the rates. From previous experience, we know that doing a 
quarterly update of the prices for all the pass-through drugs and 
biologicals would be burdensome on our contractors and disruptive to 
both our computer systems and pricing software. Although we make other 
updates on a quarterly basis, we do not include revision of rates in 
these updates unless an error was made in the calculation of the rate. 
We see no compelling reason to update the transitional pass-through 
drug prices under the OPPS more frequently than the other payment rates 
in the outpatient system.
    Comment: Several commenters indicated that in the proposed rule we 
appeared intent on estimating pass-through expenditures that will 
exceed the statutory cap and trigger a pro-rata reduction of pass-
through payments in 2003.
    Response: Frankly, we find it puzzling that commenters would 
believe we would manipulate the estimates of pass-through spending with 
the intention of ensuring that a pro-rata reduction would be imposed. 
Our estimate of transitional pass-through spending indicates that no 
pro-rata reduction will be necessary in 2003.
    Comment: A commenter urged us to develop a process for 
acknowledgement and payment adjustment when it is determined that the 
rates published in the Red Book are incorrect.
    Response: As stated elsewhere in this final rule, we update payment 
rates for pass-through drugs and biologicals only on an annual basis 
using the information published in the July edition of the Red Book. We 
rely on information supplied by manufacturers to the Red Book to be 
accurate.

V. Criteria for New Device Categories As Implemented in the November 2, 
2001 Interim Final Rule With Comment

    The Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act of 
1999 (BBRA), Public Law 106-113, amended section 1833(t) of the Act to 
make major changes that affected the new PPS for hospital outpatient 
services. Section 1833(t)(6) of the Act, which was added by section 
201(b) of the BBRA, provided for temporary additional payments, 
referred to as ``transitional pass-through payments,'' for certain 
drugs, biologicals, and devices. Section 1833(t)(b) of the Act provided 
for payment of new medical devices, as well as new drugs and 
biologicals, in instances in which the item was not being paid as a 
hospital outpatient service as of December 31, 1996, and when the cost 
of the item is ``not insignificant'' in relation to the OPPS payment 
amount. Section 402 of BIPA, which amends section 1833(t)(6) of the 
Act, requires us to use categories in determining the eligibility of 
devices for transitional pass-through payments effective April 1, 2001. 
Section 1833(t)(6)(B)(ii)(IV) of the Act, as added by section 402(a) of 
BIPA, requires us to establish a new category for a medical device 
when--
    [sbull] The cost of the device is not insignificant in relation to 
the OPPS payment amount;
    [sbull] No existing or previously existing device category is 
appropriate for the device; and
    [sbull] Payment was not being made for the device as an outpatient 
hospital service as of December 31, 1996. However, section 
1833(t)(6)(B)(iv) of the Act, also added by section 402(a) of BIPA, 
provides that a medical device shall be treated as meeting the first 
and third requirements if either--
    [sbull] The device is described by one of the initial categories 
established and in effect or
    [sbull] The device is described by one of the additional categories 
we established and in effect, and--

--An application under section 515 of the Federal Food, Drug, and 
Cosmetic Act has been approved; or
--The device has been cleared for market under section 510(k) of the 
Federal Food, Drug, and Cosmetic Act; or
--The device is exempt from the requirements of section 510(k) of the 
Federal Food, Drug, and Cosmetic Act under section 510(l) or section 
510(m) of that Act.

Thus, otherwise covered devices that are described by a currently 
existing category may be eligible for transitional pass-through 
payments even if they were paid as part of an outpatient service as of 
December 31, 1996. At the same time, no categories will be created on 
the basis of devices that were paid on or before December 31, 1996.
    Section 1833(t)(6)(B)(i)(I) of the Act, as amended by BIPA, 
required us to establish, by April 1, 2001, an initial set of 
categories based on device by type in such a way that specific devices 
eligible

[[Page 66782]]

for transitional pass-through payments under sections 1833(t)(A)(ii) 
and (iv) of the Act as of January 1, 2001 would be included in a 
category. We developed this initial set of categories in consultation 
with groups representing hospitals, manufacturers of medical devices, 
and other affected parties, as required by section 1833(t)(6)(B)(i)(II) 
of the Act. We issued the list of initial categories on March 22, 2001, 
in Program Memorandum (PM) No. A-01-41. Subsequently, an additional two 
categories and clarifications of some of the categories' long 
descriptors were made. The latest PM that lists all the existing device 
categories (including three additional categories that became effective 
July 1, 2002) is Transmittal No. A-02-050, issued June 17, 2002, which 
can be accessed on our Web site, http://cms.hhs.gov.
    Section 1833(t)(6)(B)(ii)(III) of the Act, as amended by BIPA, 
requires us to establish criteria by July 1, 2001 that will be used to 
create additional categories. Section 1833(t)(6)(B)(ii)(II) of the Act 
requires that no medical device is 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 set forth in an interim final rule (66 FR 
55850) the criteria for establishing new (that is, additional) 
categories of medical devices eligible for transitional pass-through 
payments under the OPPS as required by section 1833(t)(6)(B)(ii) of the 
Act. We received five comments regarding our criteria published in the 
November 2, 2001 interim final rule with comment period. We summarize 
and respond to these comments below.

A. Criteria for Eligibility for Pass-Through Payment of a Medical 
Device

    As noted above, in our April 7, 2000 final rule with comment period 
(65 FR 18480), we defined new or innovative devices using eight 
criteria, three of which were revised in our August 3, 2000 interim 
final rule with comment period (65 FR 47673 through 47674). These 
criteria were set forth in regulations at Sec.  419.43(e)(4). For the 
most part, these criteria remained applicable when defining a new 
category for devices. That is, devices to be included in a category 
must meet all previously established applicable criteria for a device 
eligible for transitional pass-through payments. The definition of an 
eligible device, however, needed to change to conform to the 
requirements of the amended section 1833(t)(6)(B)(ii) of the Act, that 
is, the requirement to establish additional categories, which we 
accomplished in our November 2, 2001 interim final rule.
    In addition, we clarified our criterion that states that a device 
must be approved or cleared by the FDA. The approval or clearance 
criterion applies only if FDA approval or clearance is required for the 
device as specified at new Sec.  419.66(b)(1). For example, a device 
that has received an FDA investigational device exemption (IDE) and has 
been classified as a Category B device by the FDA in accordance with 
Sec.  405.203 through Sec.  405.207 and Sec.  405.211 through Sec.  
405.215 is exempt from this requirement. A device that has received an 
FDA IDE and is classified by the FDA as a Category B device is eligible 
for a transitional pass-through payment if all other requirements are 
met.

B. Criteria for Establishing Additional Device Categories

    As described above, in determining the criteria for establishing 
additional categories, section 1833(t)(6)(B)(ii) of the Act mandates 
that new categories must be established for devices that were not being 
paid for as an outpatient hospital service as of December 31, 1996, and 
for which no category in effect (or previously in effect) is 
appropriate in such a way that no device is described by more than one 
category and the average cost of devices to be included in a category 
is not insignificant in relation to the APC payment amount for the 
associated service. Based on these requirements, we announced in the 
November 2, 2001 interim final rule that we will use the following 
criteria to establish a category of devices:
    [sbull] Substantial clinical improvement. The category describes 
devices that demonstrate a substantial improvement in medical benefits 
for Medicare beneficiaries compared to the benefits obtained by devices 
in previously established (that is, existing or previously existing) 
categories or other available treatments, as described in regulations 
at new Sec.  419.66(c)(1).
    We stated our belief that this criterion ensures that no existing 
or previously existing category contains devices that are substantially 
similar to the devices to be included in the new category. This 
criterion is consistent with the statutory mandate that no device is 
described by more than one category.
    In addition, we said that this criterion limits the number of new 
categories, and consequently transitional pass-through payments, to 
those categories containing devices that offer the prospect of 
substantial clinical improvement in the care of Medicare beneficiaries. 
Section 1833(t)(6)(E)(iii) of the Act, requires that, if the Secretary 
estimates before the beginning of the year that the total estimated 
amount of pass-through payments would exceed a specified percentage of 
total program payments (2.5 percent before 2004 and no more than 2 
percent thereafter), we must uniformly reduce (prospectively) each 
pass-through payment in that year by an amount adequate to ensure that 
the limit is not exceeded.
    We established this criterion because it is important for hospitals 
to receive pass-through payments for devices that offer substantial 
clinical improvement in the treatment of Medicare beneficiaries to 
facilitate access by beneficiaries to the advantages of the new 
technology. Conversely, the need for additional payments for devices 
that offer little or no clinical improvement over a previously existing 
device is less apparent. These devices can still be used by hospitals, 
and hospitals will be paid for them through the appropriate APC 
payment. To the extent these devices are used, the hospitals' charges 
for the associated procedures will reflect their use. We will use data 
on hospital charges to update the APC payment rates as part of the 
annual update cycle. Thus, the payment process will provide an avenue 
to reflect appropriate payments for devices that are not substantial 
improvements.
    We are currently evaluating requests for a new category of devices 
against the following criteria in order to determine if it meets the 
substantial clinical improvement requirement:
    [sbull] The device offers a treatment option for a patient 
population unresponsive to, or ineligible for, currently available 
treatments.
    [sbull] The device offers the ability to diagnose a medical 
condition in a patient population where that medical condition is 
currently undetectable or offers the ability to diagnose a medical 
condition earlier in a patient population than allowed by currently 
available methods. There must also be evidence that use of the device 
to make a diagnosis affects the management of the patient.
    [sbull] Use of the device significantly improves clinical outcomes 
for a patient population as compared to currently available treatments. 
Some examples of outcomes that are frequently evaluated in studies of 
medical devices are the following:

--Reduced mortality rate with use of the device.
--Reduced rate of device-related complications.

[[Page 66783]]

--Decreased rate of subsequent diagnostic or therapeutic interventions 
(for example, due to reduced rate of recurrence of the disease 
process).
--Decreased number of future hospitalizations or physician visits.
--More rapid beneficial resolution of the disease process treated 
because of the use of the device.
--Decreased pain, bleeding, or other quantifiable symptom.
--Reduced recovery time.

    As part of the application process (described in section V.B.1 of 
this final rule), we require the requesting party to submit evidence 
that the category of devices meets one or more of these criteria. We 
noted that the requirements set forth above will be used only for 
determining whether a device is eligible for a new category under 
section 1833(t)(6)(B) of the Act, which authorizes transitional pass-
through payments for categories of devices. These criteria are not 
intended for use in making coverage decisions under section 
1862(a)(1)(A) of the Act. We noted that adoption of these criteria is 
consistent with the recommendation of the Medicare Payment Advisory 
Commission, in its March 2001 Report to Congress, that pass-through 
payments for specific technologies be made only when a technology is 
new or substantially improved.
    We stated that we determine which devices represent a substantial 
clinical improvement over existing devices by using a panel of Federal 
clinical and other experts, supplemented if appropriate by individual 
consultation with outside experts. These decisions are, in general, 
based on information submitted by the requester about the clinical 
benefit of the devices as described in the above criteria, including, 
where available, evidence from clinical trials or other clinical 
investigations. A panel of clinical experts from CMS has thus far made 
all of our decisions on eligibility for an additional device category.
    As indicated in the November 2, 2001 interim final rule, we believe 
that almost all substantial clinical improvements in technology that 
are appropriately paid for under the transitional pass-through 
provisions result in measurable improvements in care from the 
perspective of the beneficiary. Nevertheless, there may be some 
improvements in the medical technology itself that are so significant 
that we may wish to recognize them for separate payment (as opposed to 
packaged payments) even though they do not directly result in 
substantial clinical improvements. For example, improvements in such 
factors as the strength of materials, increased battery life, 
miniaturization, might so improve convenience, durability, ease of 
operation, etc., that such an improvement in medical technology might 
be considered as a separate factor from ``substantial clinical 
improvement'' in beneficiary care.
    We invited public comment on this issue and particularly asked for 
examples of medical technologies for which pass-through payments might 
be appropriate even though they would not also pass a test based on 
substantial improvement in beneficiary outcomes. Although we received a 
number of comments on this criterion, only one attempted to provide an 
example of new medical technology that might not also pass a test based 
on substantial improvement in beneficiary outcomes. This example is 
described in our summary of comments and responses below.
    As we noted in the November 2, 2001 interim final rule, we will 
continue to evaluate these criteria as we gain experience in applying 
them, and we will consider revisions and refinements to them over time 
as appropriate.
    Comment: Most commenters expressed concerns regarding our criterion 
that new device categories demonstrate substantial clinical improvement 
to be eligible for pass-through payment. Device manufacturers and 
representatives felt that evidence of clinical outcomes should not be 
part of the device category evaluation and eligibility process. Some 
maintained that we already have standards for determining clinical 
benefit as part of the Medicare coverage process and we should not have 
such requirements in payment determination. One commenter claimed that 
we would be unable to determine substantial clinical improvement for 
pass-through categories separately from national coverage decisions, 
since we will be reviewing the same types of evidence for both 
processes. This commenter held that a payment policy decision using 
clinical improvement criteria is a de facto coverage decision that our 
Coverage Analysis Group and carriers would feel compelled to go along 
with.
    One device manufacturer was concerned that any employment of 
inappropriate evidentiary standards in evaluating improvement in 
diagnosis or treatment when applying this criterion could be a barrier 
to pass-through payment for some new technologies.
    Yet, some manufacturers agree that pass-through payment should be 
limited to technologies that represent significant advancements in 
providing beneficial new therapy options. A number of commenters felt 
we should take into account improvements in devices' technology per se, 
for example, material, power source, size, etc., and not limit our 
criterion of improvement to clinical improvement. Some commenters held 
that only technological aspects of new medical devices should be 
analyzed to determine whether there are advancements over existing 
pass-through devices to determine whether a device should be considered 
for an additional category. A manufacturer stated that if we feel that 
a criterion based on clinical benefits is needed, we should employ a 
``substantially different'' criterion to determine eligibility for a 
new category. Under this suggestion, any difference in therapeutic 
effect, indication, surgical approach, safety or side effects, 
mechanics or function that offers a ``new beneficial therapeutic 
alternative'' would be considered ``substantial.''
    One manufacturer also stated that a ``substantial clinical 
improvement'' criterion may be unnecessary, because we already have a 
criterion that addresses costs that are ``not insignificant.''
    Response: Although the information required for pass-through 
category applications is similar for coverage determinations, the 
information is used differently. The purpose of the ``reasonable and 
necessary'' condition in evaluating coverage is different than the OPPS 
purpose of determining appropriate pass-through payment for new 
technology items. We are not attempting to determine coverage under the 
OPPS, only whether a payment under the pass-through mechanism is 
warranted. We adopted the ``substantial clinical improvement'' 
criterion to help us identify those devices that are not adequately 
described by any previously established device categories.
    Those who argue that we should employ a ``substantially different'' 
or a ``clinical benefit'' criterion rather than the ``substantial 
clinical improvement'' do not answer the question as to how different a 
new technology should be to be considered eligible for a new device 
category. It seems to us that many of the differences listed in the 
suggestion to base a criterion on ``substantial differences'' noted 
above may not reflect qualitatively meaningful differences and such 
devices could be adequately described by the existing or previously 
existing categories. If a new device technology were adequately 
described by a category of devices in terms of its clinical application 
and benefits, then an additional category would not seem

[[Page 66784]]

warranted. Still, as we have stated in the November 2, 2001 interim 
final rule and again above, there may be some improvements in the 
medical technology itself that are so significant that we may wish to 
recognize them for separate payment even though they do not directly 
result in substantial clinical improvements. We will continue to allow 
the flexibility in our evaluation process to consider such items for 
new categories.
    We believe it is harder to make a determination of substantial 
difference than it is to make a determination as to substantial 
clinical benefit. Furthermore, we believe that, in general, 
transitional pass through payments should be made only for technologies 
that benefit beneficiaries beyond the technologies currently 
available.''
    We believe it is harder to make a determination of substantial 
difference than it is to make a determination as to substantial 
clinical benefit. Furthermore, we believe that, in general, 
transitional pass-through payments should be made only for technologies 
that benefit beneficiaries beyond the technologies currently available.
    The notion that a ``substantial clinical improvement'' criterion 
may be unnecessary, because we already have a criterion that addresses 
``not insignificant cost,'' is misplaced. The cost of the new 
technology may or may not directly address a nominated device's 
clinical benefits. Payment for a costly device may be related to a 
number of factors, such as Medicare payment policy for a technology or 
the cost of raw materials or manufacturing process, irrespective of 
substantial clinical improvement. We established the clinical 
improvement criterion in addition to the cost significance criterion 
mandated under statute because one cannot accurately infer that a high 
relative cost is indicative that a device cannot be described by an 
existing or previous category of devices. Nor can we automatically 
infer that a substantially clinically improved device necessarily bears 
significantly higher cost than what we are currently paying for pass-
through devices and procedural payments through the APC payment rates. 
Therefore, both criteria are needed.
    Comment: In the November 2, 2001 interim final rule, we invited 
public comment on the issue of substantial improvement, saying we would 
be interested in examples of medical technologies for which pass-
through payments might be appropriate even though they would not pass a 
test based on substantial improvement in clinical outcomes. Several 
commenters pointed to differences in brachytherapy devices as examples. 
These commenters said that differences in devices should be reflected 
by establishing separate device categories by: different chemical 
substances/radioisotope, therapeutic radiation activity levels, 
implantation arrays of brachytherapy devices, and mechanisms of 
injecting brachytherapy devices that improve safety and function.
    Response: We have reviewed many applications for brachytherapy 
devices and believe that there is a congruence between new technologies 
that might be eligible for transitional pass-through payments in the 
absence of producing substantial clinical benefit and new technologies 
that do produce substantial clinical benefit.
    Comment: Commenters requested that we clarify the process that is 
employed by Federal and external experts to evaluate substantial 
clinical improvement on the part of nominated devices. One commenter 
expressed concern that a Federal panel of experts may slow down 
decision-making and suggested a flexible process in reviewing category 
applications. The commenter suggested that we rely on our internal 
clinical staff to make decisions not requiring outside assistance. The 
commenter also suggested that our review process should be open and 
allow the manufacturer the opportunity to present information to the 
panel. The list of panelists, agendas, proceedings and decisions should 
be made public.
    Response: Our panel consists of CMS clinical experts. We consult 
with outside experts as appropriate. We believe that this process 
results in making appropriate, timely decisions while allowing for 
maximum flexibility. Public meetings would inevitably slow the process. 
We give ample opportunity for manufacturers to provide information, and 
we frequently meet with manufacturers to discuss their applications.
    Comment: One commenter felt that the language of the statute does 
not support our criterion that devices show evidence of substantial 
clinical improvement in order to be considered for an additional 
category. The commenter stated that the statutory standard that no 
medical device be described by more than one category does not support 
the substantial clinical improvement criterion.
    Response: The statute explicitly requires us to establish criteria 
that will be used for creation of additional categories. (Section 
1833(t)(6)(B)(ii)(I) of the Act) This statutory requirement permits the 
criteria that we have established, including demonstration of 
substantial clinical improvement.
    We are continuing to review the issue of technological change that 
is not associated with substantial clinical benefit to beneficiaries. 
We will continue to review applications for such devices on a case by 
case basis and work with applicants to understand exactly what 
technological changes were made to a device that would make the device 
eligible for transitional pass through payments. We solicit further 
examples of such devices so that, in the future, we may establish a 
more definite criterion for when such changes make a device eligible 
for transitional pass through payments.
    Comment: Associations representing manufacturers stated that our 
assertion in the preamble of the November 2, 2001 interim final rule 
that says MedPAC's recommendation that pass-through payments for 
specific technologies be made only when a technology is new or 
substantially improved is a misinterpretation. The commenters asserted 
that MedPAC considers the concepts of improvements in devices 
themselves and substantial improvement to be separate, and that either 
of the two should be required for a criterion related to device 
improvement for pass-through eligibility.
    Response: While we continue to believe that, in general, new 
technologies without a demonstrated substantial clinical benefit to 
beneficiaries should not receive transitional pass-through payments, we 
do review nominated devices for technological changes that are not 
associated with substantial clinical benefit to beneficiaries.
    Comment: An association representing device manufacturers stated 
that our substantial clinical improvement criterion would significantly 
increase the time between FDA approval to market the device and 
recognition of the device for pass-through payment. The commenter 
claimed that this is counter to an objective of the pass-through 
payment mechanism as a means to promote rapid payment in the OPPS for 
new technology. This commenter, therefore, recommended replacing the 
criterion to demonstrate substantial clinical improvement with a 
requirement to demonstrate ``potential improvement.''
    Similarly, another manufacturers' association asserted that 
clinical outcomes information should not be required for eligibility 
for a new pass-through category. This commenter suggested that our 
rules should request information that is appropriate and

[[Page 66785]]

relevant for the product and related procedures, which should include 
information other than published clinical trials.
    Response: We are making every effort to minimize the time lag 
between FDA approval and establishment of a device category. We believe 
that we have succeeded in making timely decisions in this regard.
    We will consider other information in addition to clinical outcomes 
that is available when clinical trial data are not yet available.
    We do not know how one can demonstrate ``potential'' clinical 
improvement. ``Potential'' refers to the anticipated or possible 
capability, belief, or expectation for clinical improvement, without 
the evidentiary demonstration yet.
    We do not believe potential improvement is an appropriate 
criterion. First, it would be difficult to prove; second, we would be 
in the position of potentially making extra payments for technologies 
that actually harmed beneficiaries. Thus using ``potential'' clinical 
improvement would assure that all new devices would meet such a 
criteria if the manufacturer asserted that the device in question 
offers a ``potential'' clinical improvement.''
    Comment: Some commenters expressed concern with our rule that 
devices that are described by an existing category are not eligible for 
new categories. Some call for flexibility in applying this criterion, 
claiming that some of our category descriptors are too broad and 
confusing. One manufacturer was particularly concerned that newer 
technology pacemakers, internal cardioverter-defibrillators (ICDs), and 
pacemaker and ICD leads would be precluded from achieving new 
categories because they could be described by widely defined existing 
categories. The commenter stated that we should revise definitions of 
existing categories whenever necessary in order to accommodate the 
creation of new categories. Revising category descriptions to make them 
less broadly worded was one such example provided, including categories 
related to pacemakers, ICDs, and pacemaker and ICD leads.
    Some commenters felt that new categories would need to be created 
in order to track cost of newer devices, even if they are described by 
existing categories. These commenters asserted that device costs 
eventually must be placed into APCs that appropriately reflect costs 
for future payment. Some commenters claimed that investigational 
devices that attained pass-through status have low procedural volumes 
and therefore they are underrepresented in the cost data.
    Response: We believe that broadly defined categories are 
appropriate. Such categories are easier for coders to understand and 
allow devices to immediately receive transitional pass-through payments 
upon being marketed (instead of going through an application process). 
We have applied this criterion appropriately. There are devices that 
have been deemed eligible for a new category because the clinical 
applications are substantially different than devices of existing 
categories.
    Some category descriptions have been modified when it has been 
brought to our attention that the descriptor is unclear. We first 
revised the descriptors of device categories in Program Memorandum A-
01-73, effective July 1, 2001, in order to clarify the devices covered 
by categories. However, we do not intend to revise descriptors solely 
to allow the creation of new categories. If a device or class of 
devices is described by the categories we initially created, we will 
apply the criteria we implemented to determine whether an additional 
category is warranted. If we determine that an additional category is 
needed to adequately describe and pay for new devices, we will create a 
category. If in the course of that determination, we find that 
clarification of an existing or previously existing category is needed 
so that only one category describes the device, as required by statute, 
then we will modify the description of the existing or previously 
existing category or categories, in order to achieve that 
clarification.
    We are maintaining our criteria to establish a new category of 
devices for pass-through payment.
    Cost. We determine that the estimated cost to hospitals of the 
devices in a new category (including any candidate devices and the 
other devices that we believe will be included in the category) is 
``not insignificant'' relative to the payment rate for the applicable 
procedures. The estimated cost of devices in a category is considered 
``not insignificant'' if it meets the following criteria found in 
regulations at new Sec.  419.66(d):
    [sbull] The estimated average reasonable cost of devices in the 
category exceeds 25 percent of the applicable APC payment amount for 
the service associated with the category of devices.
    [sbull] The estimated average reasonable cost of devices in the 
category exceeds the cost of the device-related portion of the APC 
payment amount for the service associated with the category of devices 
by at least 25 percent.
    [sbull] The difference between the estimated average reasonable 
cost of the devices in the category and the portion of the APC payment 
amount determined to be associated with the device in the associated 
APC exceeds 10 percent of the total APC payment.
    Of these three cost criteria, the latter two remain unchanged from 
the existing thresholds for individual devices (however, as discussed 
below, their effective date was revised). The first criterion, however, 
represents a change in the percentage threshold.
    In the April 7, 2000 final rule, we provided that a device's 
expected reasonable cost must exceed 25 percent of the applicable APC 
payment for the associated service as the criterion for determining 
when the cost of a specific device is ``not insignificant'' in relation 
to the APC payment (65 FR 18480). In the August 3, 2000 interim final 
rule, we lowered the threshold to 10 percent because we believed the 25 
percent limit was too restrictive based on the brand specific approach 
at the time (65 FR 47673; Sec.  419.43(e)(1)(iv)(C)). However, given 
our payment experience in 2001 using the 10 percent threshold, 
including our information on the estimated amount of pass-through 
payments in CY 2002, we determined a higher threshold was warranted. We 
believed that setting a higher cost threshold ensures that new 
categories are created only in those instances where they are most 
valuable to beneficiaries and hospitals, given the overall limits on 
pass-through payments. That is, pass-through payments will be targeted 
only to those devices where cost considerations might be most likely to 
interfere with patient access.
    We found that once we lowered the threshold to 10 percent, a very 
small minority (less than 10 percent) of devices that met all other 
criteria for the pass-through payment was rejected on the basis of this 
criterion. Partly as a result, the list of devices qualified for pass-
through payments increased to well over 1,000 devices by the end of 
2000. Although the extensive number of qualified devices allowed 
hospitals to receive additional payment for many devices, we estimated 
that the overall pass-through payment amount for calendar year 2002 
would exceed the 2.5 percent cap. Therefore, for that year, a 
substantial reduction in the amount of each pass-through payment, as 
required by section 1833(t)(6)(E)(iii) of the Act, was established. 
Thus, allowing a large number of marginally costly devices to qualify 
for the pass-through payment

[[Page 66786]]

would reduce the amount of additional payment a hospital would receive 
for any one device. We believe raising the threshold for this criterion 
benefits hospitals by focusing the pass-through payments on those 
devices that represent a substantial loss to the hospital. We believe 
this change also preserves beneficiary access to especially expensive 
devices.
    In addition, once a category is established, devices included in 
the category are eligible for pass-through payments regardless of the 
cost of the devices. Therefore, we determined that it is reasonable to 
set a higher threshold than 10 percent to establish a new category. 
While the cost of most devices described by a category may equal or 
exceed the threshold we use in establishing a category, the cost of 
individual devices could easily fall below the threshold. Therefore, we 
believe that it is reasonable to use a higher threshold in establishing 
a category than in qualifying individual devices.
    Concerning the latter two criteria for determining that the 
estimated cost of a category of devices is not insignificant, we 
intended to apply these criteria to devices for which a pass-through 
payment is first made on or after January 1, 2003, as we provided in 
the August 3, 2000 interim final rule (65 FR 47673). We stated that the 
delay would allow us sufficient time to gather and analyze data needed 
to determine the current portion of the APC payment associated with the 
devices.
    Based on the outpatient claims data we have been using for 
analysis, we have been able, in many cases, to use these criteria as of 
the November 2, 2001 interim final rule. Although the 1996 data did not 
provide a level of information that allowed us to determine the portion 
of the APC payment that was related to the device (except in a very few 
cases such as pacemakers), the later data have generally provided this 
level of detail. Therefore we applied the second and third cost 
criteria for the purpose of determining eligibility of proposed new 
categories, as described in regulations at Sec.  419.66(d)(2) and Sec.  
419.66(d)(3), as soon after the implementation of the November 2, 2001 
interim final rule as we had data to do so rather than on January 1, 
2003. Although in some instances the lack of specific data prevented 
the application of these criteria, we believed that should not delay 
our use of these criteria in those situations in which the data have 
been available.
    In order to implement these second and third criteria for the 
purpose of creating new device categories, it is necessary to obtain 
the cost of the device-related portion of the APC payment amount. For 
evaluations of device category applications in 2002, we used the 
device-offset amounts published in our March 1, 2002 final rule (67 FR 
9557 through 9558), which are used to calculate the subtractions to 
device pass-through payments. For 2003, we will use the device-offset 
amounts found in Table 11 in this rule as the device-related portion of 
the APC payment needed for cost criteria 2 and 3. The device-offset 
amounts represent the device costs that have been folded into the 
respective APC payment rates. In those cases where an application is 
received in which the service-related HCPCS codes for the device is 
mapped to no APC that has a device offset amount, we apply only the 
first cost criterion.
    Comment: Some commenters wrote that while we need to limit pass-
through payments for new categories to those devices that are clearly 
underpaid relative to the APC rates, our ``not insignificant'' cost 
tests set the bar too high. Some held that this is particularly the 
case for APCs with high relative weights and consequent payments, in 
which our 25 percent minimum percentage of the APC as well as the 
device offset represent a significant cost to the hospital in absolute 
terms. Commenters proposed alternate percentage thresholds with 
specific dollar caps (for example, 20 percent of the APC payment or 
$1,000, whichever is less).
    Response: In the cases of APCs with high relative weights and 
payment rates, such payments already encompass much of the costs of 
devices. The thresholds in dollar terms in those cases should be set 
higher to test for cost significance. We have heard from many 
commenters to our August 9, 2002 proposed rule that many device costs 
consist of a large percentage of the APC cost. The ratio method (for 
example, 25 percent) therefore equitably accounts for APC payment 
differences for devices.
    We do not see any compelling reason to adopt the proposed alternate 
percentages of the APC amount as the threshold of using as an 
alternative to our current cost significance threshold of 25 percent 
for device portions related to any respective APC. Moreover, the 
initial pass-through categories were based on devices that achieved 
pass-through status with a lower 10 percent threshold.
    Comment: Another commenter claimed that the statutory language 
demonstrates the congressional intent that only the cost of the devices 
in a category be compared to the applicable APC payment. Therefore, 
only the first of our three prongs to test cost significance of a new 
device should be used. This commenter claimed that section 1833(t)(6) 
of the Act states that we shall provide pass-through payments only for 
categories of devices when ``the average cost of the category of 
devices is not insignificant in relation to the OPD fee schedule amount 
* * * .'' The commenter further advocated that our criteria be amended 
to reflect that a proposed category of devices be required to meet any 
one of the three prongs, to give some weight to the potential benefits 
of the second and third prongs.
    Response: The statute requires that the average cost of a new 
device category is not insignificant in relation to the OPD fee 
schedule amount payable for the service or group of services involved. 
The statute further requires the Secretary to establish criteria for 
creating additional categories, including criteria for cost 
significance. Beyond those requirements, the statute allows the 
Secretary the discretion to determine how to apply the cost significant 
criterion.
    In developing the specific criteria for meeting the statutory cost 
significance requirement, we established thresholds which we believe 
ensure that new categories are created where they are most valuable to 
beneficiaries and hospitals, given the overall limits on pass-through 
payments. Our goal is to target pass-through payments at those devices 
where cost considerations might be most likely to interfere with 
patient access.
    To properly target the pass-through payments at devices that could 
represent a substantial loss to the hospital, it is important to both 
assess the incremental cost of performing the procedure using the new 
device as well as to compare the cost of the new device against the 
costs of existing devices already packaged into the APC payment for the 
procedure.
    The first prong of our three prong criterion tests only the 
relationship of the new device to the cost of the entire procedure 
whereas the second and third prongs test for the relationship to device 
costs already incorporated into the payment rate for the procedure.
    Comment: A hospital organization supported our two major criteria 
for establishing an additional device category for pass-through 
payment, that is, that a category of devices must demonstrate 
substantial clinical improvement and have costs that are ``not 
insignificant'' in relation to the APC payment. In particular, the

[[Page 66787]]

organization supported our decision to raise the threshold that device 
costs for a new category must exceed 25 percent of the related APC 
payment, as well as our re-institution of the two additional prongs of 
the not-insignificant cost test. However, the commenter noted that we 
had previously delayed the implementation of these latter two prongs of 
the ``not insignificant'' cost criterion until January 1, 2003, so that 
we could ensure reliable and accurate data to make the cost estimates. 
The organization would support the reinstitution of these cost prongs 
that establish that costs are not insignificant only when CMS has 
sufficiently accurate and reliable data to make such estimates. The 
commenter also believes that the data and methodology should be made 
available to the public for review.
    This organization also felt that the (then) current number of 
initial categories is appropriate. It urged us to make application 
information regarding any proposed new categories public for comment 
before final creation of a new category.
    Response: Based on the outpatient claims data we have been using 
for analysis, we have been able, in many cases, to use the second and 
third cost criteria since the November 2, 2001 interim final rule 
became effective. Although the 1996 data did not provide a level of 
information that allowed us to determine the portion of the APC payment 
that was related to the device (except in a very few cases such as 
pacemakers), the later data we have used has generally provided this 
level of detail. Therefore, we applied the second and third cost 
criteria. As noted earlier, for 2002, we have used the device offsets 
we calculated for subtracting the cost of existing devices in APCs as 
the portion of the APC payment related to the device. We feel the 
offsets have been appropriate as this portion of the APC payment, and 
we will use them for 2003 as well. We therefore feel this commenter's 
concerns have been addressed.
    We will continue to use the three prongs of the not insignificant 
cost test as published in the November 2, 2001 interim final rule.
1. Application Process for Creation of a New Device Category
    Device manufacturers, hospitals, or other interested parties may 
apply for a new device category for transitional pass-through payments. 
Details regarding the informational requirements, deadlines for 
quarterly review, and other aspects of the application process are 
available on our Web site, http://cms.hhs.gov.
    We will accept applications at any time. However, we will establish 
new categories only at the beginning of a calendar quarter, in 
deference to our computer systems needs and those of our contractors 
and hospitals. We must receive applications in sufficient time before 
the beginning of the calendar quarter in which a category would be 
established to allow for decision-making and programming. For now, we 
will require that applications be received at least 4 months before the 
beginning of the quarter. Moreover, we have found, that, due to the 
complexity of the information and review process for additional 
categories, we cannot always complete our review within that time 
frame. Review of applications involving devices with new technologies 
often involves requesting additional information from the applicants, 
as well as consultation with experts in certain clinical specialties 
(usually here at CMS) or with other clinical personnel at CMS with 
expertise in Medicare coverage issues, as needed (for example, the 
hearing aid issue).
    We may change the details of this application process in the future 
to reflect experience in evaluating applications and programmatic 
needs. If we revise these instructions, we will submit the revisions to 
the Office of Management and Budget under the Paperwork Reduction Act. 
We will also post the revisions on our Web site.
    Comment: One commenter recommended that we post draft new 
categories and any draft changes to existing categories to our Web site 
for public review and comment before final publication, as a 
collaborative, informal process to be accomplished within the 4-month 
quarterly application evaluation and update time frame.
    Response: Such process could not be accomplished within the 4-month 
time frame. We note that the greater part of the four month period is 
consumed in systems changes, not review of the application, so little 
time is available for further information. Thus, further consultation 
would result in longer timeframes for action. We have listened and met 
with many parties concerning recommendations for additional categories 
and heard their concerns related to our existing and new categories and 
will continue to do so. However, we believe that the review, 
evaluation, and decision process and publication process for new 
category applications to meet the closest feasible quarterly updates is 
already compact. However, we will continue to consider informal 
comments or feedback from hospitals, manufacturers, and other parties 
regarding our decisions.
    Comment: An association of manufacturers of brachytherapy sources 
and other brachytherapy devices recommended that we establish several 
specific new categories.
    Response: We have established a uniform method for evaluating 
applications for new categories, based on the application information 
published on our Web site. We evaluate the necessity of new categories 
based on the specific information we receive, such as clinical 
differences between items nominated for the new categories and the 
existing or previously existing categories. We therefore are not able 
to react to the specific categories recommended through public comments 
by this commenter without complete applications on the subject 
brachytherapy sources.
    We are making no change to our application process at this time.
2. Announcing a New Device Category
    When we determine a new category is warranted, we issue a Program 
Memorandum specifying a new Healthcare Common Procedure Coding System 
(HCPCS, formerly known as HCFA Common Procedure Coding System) code and 
short and long descriptors for the category. We may also include 
additional clarifying or definitional information to help distinguish 
the new category from other existing or previously existing categories. 
It may be necessary to redefine, or make other changes to, existing or 
previously existing categories to accommodate a new category and ensure 
that no medical device is described by more than one category, though 
we attempt to keep these changes to a minimum. We will post these 
Program Memoranda on our Web site on a quarterly basis. We may find it 
necessary occasionally to correct or amend the list of (and clarifying 
information associated with) pass-through device categories. We do not 
expect this step will be needed often, but if it is necessary, we will 
issue any changes in a Program Memorandum.

VI. 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, the 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

[[Page 66788]]

wage index to make wage adjustments in determining the proposed payment 
rates set forth in the proposed rule. We also proposed to use the final 
FY 2003 hospital inpatient wage index to calculate the final CY 2003 
payment rates and coinsurance amounts for OPPS. We used the final 
Federal FY 2003 hospital inpatient PPS wage index to make wage 
adjustments in determining the final payment rates set forth in this 
final rule with comment. The final FY 2003 hospital inpatient wage 
index published in the August 1, 2002 Federal Register (67 FR 39858) is 
reprinted in this final rule with comment 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 use the final FY 
2003 hospital inpatient wage index to calculate the payment rates and 
coinsurance amounts published in this final rule with comment to 
implement the OPPS for CY 2003. We note, however, that from time to 
time, there are mid-year corrections to these wage indices and that our 
contractors will adopt and implement the mid-year charges for OPPS in 
the same manner that they made mid-year changes for inpatient hospital 
prospective payment.
    Comment: A commenter asked for an explanation of the rationale 
behind applying the area wage index to the device component of an APC. 
Also, another commenter urged us to clarify that APCs for drugs and 
biologicals would not be subject to geographic wage adjustment since 
the APC payment rates primarily reflect drug acquisition costs, not 
labor costs.
    Response: Our rationale for applying the area wage index to the 
device component of an APC is that once a device cost is packaged into 
a procedure APC, we do not differentiate between which costs in the APC 
should or should not have the area wage index applied. We believe that 
it would be complicated and prone to error to segment out a device 
component of the APC and determine the appropriate portion of the APC 
payment amount that consists of device cost only. To address the second 
issue, we would like to clarify that we do not apply the area wage 
index to payment rates for drugs and biologicals that are assigned to 
the status indicator G or K.

VII. 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 national 
unadjusted copayments for 2003. Our regulations at Sec.  419.41 conform 
to this provision of the Act.

VIII. 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 conversion factor for 2003 to ensure that the revisions we 
made to update the wage index are made on a budget-neutral basis. We 
calculated the proposed budget-neutrality factor of .98778 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 resulted in a proposed 
conversion factor for 2003 of 52.009.
    In determining the proposed conversion factor of 52.009, we 
projected 2.5 percent pass-through payments based on our preliminary 
estimates of pass-through payments for CY 2003. As described in the 
section IV discussion of the pro-rata provisions, our final estimate of 
pass-through payments in CY 2003 is 2.3 percent of the total program 
payments for covered OPD services. Therefore, we have increased the 
final conversion factor to reflect the projected change in pass-through 
spending from 2.5 percent to 2.3 percent. After applying this 
adjustment, the 3.5 percent update factor and the final budget-
neutrality adjustment of .98778 to account for changes due to the final 
FY 2003 hospital inpatient wage-index values, we establish the final 
conversion factor for 2003 at $52.151 (or 52.152).
    We received several comments concerning the conversion factor 
update for 2003, which are summarized below along with our responses.
    Comment: Several commenters contended that CMS imposed excessive 
pro-rata reductions in 2002, which exacerbated the inadequacy of 
Medicare payments and urged CMS to use its statutory authority under 
section 1833(t)(3)(C)(iii) to adjust the 2003 conversion factor for the 
unexpectedly low pass-through payments made in 2002.
    Response: The commenters' estimates are based on 2001 claims. We do 
not know yet whether there will be excessive pro-rata reductions in 
2002 because at the time of this rule, we do not have more than first-
quarter 2002 claims data available. Therefore, it would not be 
appropriate to make such an adjustment. Furthermore, we do not believe 
that the statute permits us to make retroactive adjustments.
    Comment: One commenter stated that the statute requires the 
conversion factor to be updated by the full increase in the hospital 
inpatient market basket of 3.5 percent, but the application of a 
budget-neutrality factor of .987156 results in an update factor of only 
2.17 percent. Another commenter indicated the belief that the amount of 
reduction from the 3.5 percent market basket update is excessive and 
beyond what is required to achieve statutory goals. The commenter 
recommended that the 2003 conversion factor be increased.
    Response: Statute requires us to ensure that a conversion factor 
for covered OPD services in subsequent years is an amount equal to the 
conversion factor applicable to the previous year before any increases 
due to the market-basket increase. In order to ensure that we maintain 
budget neutrality (except for the market-basket increase), we must make 
an adjustment to account for changes in the wage index. To do so, we 
calculate the total payments for 2002, using the 2002 wage index and 
weights, and compare that result to total payments calculated by 
applying the new 2003 wage index to

[[Page 66789]]

the 2002 APC weights. For 2003, that comparison resulted in the .969 
adjustment.

IX. 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 
proposed to set the target for outlier payments at 2.0 percent. The 
target was 2.0 percent for CY 2001 and 1.5 percent for 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 proposed 
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.
    In this final rule we are setting the target amount for outlier 
payments at 2 percent of total payments. Based on revised simulations 
performed for the final rule, in order to pay outlier payments at the 
target amount, we are adopting the proposed outlier threshold of 2.75 
but decreasing the outlier payment percentage to 45 percent. 
Simulations using the final APC rates and projecting outlier payments 
for 2003 using a different set of claims than we used for the proposed 
rule (claims for the period April 1, 2001 through March 31, 2002 
instead of claims for calendar year 2001) resulted in outlier payments 
that were in excess of the 2 percent outlier payment target. In order 
to meet, but not exceed, the target we found it necessary to either 
increase the proposed outlier threshold of 2.75 or reduce the proposed 
outlier payment percentage of 50 percent. Because we wanted to make it 
easier for more for high cost services to qualify for outlier payments, 
we chose to adopt the proposed outlier threshold but reduce the outlier 
payment percentage to 45 percent. For 2003, the outlier threshold will 
be met when costs of furnishing a service or procedure exceed 2.75 
times the APC payment amount, and the outlier payment percent will be 
45 percent of the amount of costs in excess of the threshold.
    We received a number of comments concerning our proposed threshold 
and percentages for outlier payments, which are summarized below along 
with our responses. We also received comments concerning the changes 
that we proposed and finalized in 2002 with respect to the calculation 
of outliers on a service-by-service basis. Because we have not proposed 
any changes to the current policy, we do not summarize those comments 
in this preamble.
    Comment: A number of commenters commended CMS on lowering the 
outlier threshold, but they urged CMS to reduce the threshold even 
further. The commenters also said that the outlier payment percentage 
of 50 percent of costs in excess of the outlier threshold was not 
sufficient to offset the losses hospitals incur in high-cost cases. 
Some of these commenters urged CMS to adopt the same marginal payment 
rate of 80 percent that is used for calculating outliers under the 
inpatient PPS.
    Response: Under the OPPS, CMS must address two needs: the need to 
balance payment for high-cost cases with the need to ensure that 
appropriate payments are made for basic services for the average 
patient population. By setting our outlier target of 2 percent, we 
believe that we have struck the right balance to accomplish these 
goals.
    Comment: According to one commenter, new technologies and drugs are 
expanding too rapidly for CMS to appropriately account for the costs in 
the APCs, which is a particular concern at larger hospitals that 
provide a wide scope of services and access to new technologies and 
drugs. The commenter said that outliers can help defray the costs of 
new technologies until adequately reflected in the APC payments and 
urged CMS to consider expanding the outlier target from 2 percent to 
2.5 percent. Another commenter contended that the transition of 
expiring pass-through items into APCs will result in dramatic payment 
reductions and urged CMS to reduce the outlier threshold to 2.5 times 
the APC payment amount for 2003 and increase the outlier target as 
close as possible to the statutory maximum of 2.5 percent of total 
payments.
    Response: As described elsewhere in this final rule, the 
recalibration of weights based on newer data and the additional steps 
that we have taken to limit the payment reductions should decrease the 
need for outliers. Also, the pass-through provisions for new drugs and 
devices and our payment mechanism for new technology procedures provide 
hospitals with an additional mechanism to defray costs for emerging 
technologies.
    Comment: A number of commenters said that CMS does not provide 
sufficient data to support how outlier payments and thresholds are 
determined and to ensure that outlier payments are being made in the 
range of 2 percent to 2.5 percent. Additional outlier data that the 
commenters requested include information such as the actual outlays as 
compared to forecasted outlays 2001, estimated outlays for 2002, the 
historical outlier percentage of total OPPS payments, and information 
on the types of cases that are qualifying for outlier payments. The 
commenters wanted CMS to provide supporting information in the final 
rule, just as it does for the inpatient PPS.
    Response: We agree with the commenters that we should provide this 
data. However, due to the time constraints in producing this final 
rule, we are unable to add this information to this preamble. 
Nonetheless, we will post this information to our Web site shortly 
after publication of the rule. We will notify the public through the 
CMS listserv when the information is available. To subscribe to this 
listserv, please go to the following Web site: www.cms.hhs.gov/medlearn/listserv. Follow the directions for subscribing to the OPPS 
listserv to get the most up-to-date information on OPPS directly from 
CMS.
    Comment: One commenter expressed concern that CMS has made 
significant changes to the outlier target and eligibility thresholds in 
2002 and 2003, in opposite directions, without sufficiently supporting 
the changes with experiential data. The commenter maintained that, in 
aggregate, outlier payments as a percentage of total payments should 
remain relatively predictable and, therefore, questions whether the 
experience in 2001 and 2002 would support the significant swings in 
funding and thresholds.
    Response: It is too early for us to tell what the 2002 experience 
has been like in order to compare it to the 2001 experience. 
Nevertheless, as indicated in the previous response, we will also 
notify the public and share the 2001 data on our Web site.
    Comment: One commenter urged CMS to provide clarification regarding 
the rationale to decrease the cost threshold that permits more items to 
qualify for outlier payments, rather than

[[Page 66790]]

to increase the payment percentage from its current level of 50 
percent, which would provide more payments for high-cost cases.
    Response: We apply an iterative process in which we try different 
combinations of thresholds and payment percentages until an appropriate 
combination results in outlier payments under our simulation that is 
equal to the target percentage of total OPPS payments. While some 
fluctuation is expected each year due to the use of newer and better 
data and policy changes, we attempt both to strike a balance and to 
prevent (to the extent possible) large changes in the outlier payments 
to hospitals. A significant increase in the threshold would limit the 
number of services and hospitals that qualify for outlier services.
    Comment: One commenter expressed concern that without correcting 
for the significant reductions proposed for a number of high-cost APCs, 
those services may unnecessarily qualify for outlier payments because 
the costs that go into the outlier calculation are calculated using a 
hospital's overall cost-to-charge ratio (CCR), which may be higher than 
the departmental CCRs used to determine costs for payment-rate 
calculations. The commenter contends that, if this occurs, it will 
result in outlier payments that are higher than anticipated, which 
could unduly raise thresholds in the future and affect the integrity of 
the outlier policy.
    Response: As described elsewhere in this rule, we believe that the 
adjustments we have made to many APC rates for this final rule will 
address the commenter's concerns about services unnecessarily 
qualifying for outlier payments.

X. Other Policy Decisions and 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. 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.
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.

[[Page 66791]]

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.
Proposed Rule
    We reviewed the written comments, the oral testimony before the APC 
Panel, and the Panel's recommendations; we agreed that facility-coding 
guidelines should be implemented as soon as possible. We were 
particularly concerned that facilities be able to comply with HIPAA 
requirements. We announced that we have worked, and will continue to 
work, on this issue with hospitals, organizations representing 
hospitals, physicians, and organizations representing physicians. We 
noted 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 wanted 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 proposed 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 
were 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 realized 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 believed that the potential drawbacks of each of 
the recommended sets of guidelines outweighed 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 were also concerned that all the proposed 
guidelines allow counting of separately paid services (for example, 
intravenous infusion, x-ray, EKG, lab tests, and so forth) 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 Panel recommendations, we also 
reviewed, for the proposed rule, the current distribution of paid 
emergency and clinic visit codes in the OPPS. With regard to emergency 
visits, we observed that well over 50 percent of the visits were 
considered ``multiple procedure claims'' because the claim includes 
services such as diagnostic tests (for example, EKGs and x-rays) or 
therapeutic interventions (for example, intravenous infusions). The 
distribution of all emergency services was in a bell-shaped curve with 
a slight left shift because there were 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 noted that the 
median costs for successive levels of emergency visits show an expected 
increase across APCs.
    With regard to clinic visits, we observed that more than 50 percent 
of the services were considered ``single claims'' meaning that they 
were billed without any other significant procedures such as diagnostic 
tests or therapeutic interventions. We also noted that the distribution 
of clinic visits is skewed with the majority being low-level clinic 
visits. This distribution was 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, did 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 believed that an incremental approach to developing and 
implementing documentation guidelines for emergency and clinic visits 
was appropriate. For example, as hospitals became more familiar with 
the OPPS and with the need to differentiate emergency and clinic visits 
based on resource consumption, we would continue to review the 
advantages and disadvantages of detailed, uniform documentation 
guidelines. We planned to begin the development of uniform guidelines 
over the next year. If we were ready, we would propose the guidelines 
for comments in our Federal Register document for the CY 2004 update. 
For CY 2003, we proposed the following new codes:
Emergency Visits
    Because, our data indicated that, in general, hospitals under the 
OPPS were reporting emergency visits appropriately, we believed that 
insofar as hospitals have existing guidelines for determining the level 
of emergency service, those guidelines reflected facility resource 
consumption. Therefore, we proposed that GXXX1--Level 1 Facility 
Emergency Services be reported when facilities deliver, and document, 
basic emergency department services. These services included 
registration, triage, initial nursing assessment, minimal monitoring in 
the emergency department (for example,

[[Page 66792]]

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 expected that these services would be delivered to 
patients who present with minor problems of low acuity.
    With regard to GXXX2 through GXXX5, we proposed to require that 
facilities develop internal documentation guidelines based on hospital 
resource consumption (for example, staff time). These guidelines would 
be appropriate for the type of services provided in the hospital and 
also clearly differentiate the relative resource consumption for each 
level of service so that a medical reviewer could easily infer the 
type, complexity, and medical necessity of the services provided and 
validate the level of service reported. Because of the great 
variability in available facility resources, staff, and clinical 
protocols among facilities, we did not believe that it is advisable to 
require a single set of guidelines for all facilities. Instead, we 
believed it is appropriate for each facility to develop its own 
documentation guidelines that took into account the facility's clinical 
protocols, available facility resources, and staff types. As stated 
above, we did not propose any specific requirements with regard to the 
basis of these guidelines. However, the guidelines were to 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 proposed to require that facilities have 
documentation guidelines available for review upon request. The 
guidelines had to emphasize relative resource consumption and 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 three emergency 
visit).
    We proposed that these requirements, if made final, would be 
interim. We proposed to work with interested parties to revise these 
requirements and to propose any revision to these requirements in a 
future proposed rule.

Clinic Visits

    We believed that the current distribution of codes for clinic 
visits were due to a facility's continued use of pre-OPPS coding 
policies for clinic visits. We believed that over time facilities would 
become as experienced differentiating levels of clinic visits as they 
were at differentiating levels of emergency visits. Therefore, we 
proposed a set of guidelines for clinic visits that paralleled the 
requirements for emergency visits. We proposed that GXXX6--Level 1 
Facility Clinic Services, be reported when facilities deliver, and 
document, basic clinic services. These services included 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 was 
the same as for GXXX2 through GXXX5 except that the facility-specific 
guidelines were 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 had to 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.
    We proposed that, if made final, these requirements would be 
interim. Any changes would be proposed in a future proposed rule.
    We proposed 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 proposed to implement the new codes and 
documentation guidelines no earlier than January 1, 2004. This would 
have given hospitals time to develop documentation guidelines for the 
new codes and prepare their internal billing systems to accommodate the 
changes. We proposed to continue to work with hospitals throughout CY 
2003 as they developed the documentation guidelines. In the proposed 
rule, we solicited comments on this proposal overall as well as the 
specific components of the proposal.
    Comment: Many commenters recommended that CMS should keep the 
current E/M coding system until national coding guidelines with 
standard definitions can be established. Commenters also recommended 
that CMS convene a panel of experts to develop standard code 
definitions and guidelines that are simple to understand and implement 
and that allow for compliance with HIPAA requirements. Commenters 
generally recommended that code definitions and guidelines be 
established and implemented in 2003.
    Response: We agree with many of the commenters concerns. While we 
agree that standard code definitions and guidelines should be 
implemented as soon as possible, we want to ensure that those 
definitions and guidelines are developed using an open process 
involving a variety of experts (for example, clinicians, coders, and 
compliance officers) in the field. Furthermore, the process should 
include adequate time for the education of clinicians and coders and 
for hospitals to make the necessary changes in their systems to 
accommodate the codes and guidelines.
    In view of the comments received we believe that the most 
appropriate forum for development of code definitions and guidelines is 
an independent expert panel that makes recommendations to CMS in time 
for CMS to propose specific code definitions in the next year's 
proposed rule. Organizations such as the American Hospital Association 
(AHA) and the American Health Information Management Association 
(AHIMA) have such expertise and are particularly well equipped to 
provide the ongoing education of providers. We believe it is critically 
important to the development, acceptance, and implementation of code 
definitions and guidelines for the organizations that develop the 
guidelines to also maintain them, update them, and provide ongoing 
education to providers concerning them. We would be happy to work with 
such an expert panel as code definitions and guidelines are developed.
    We encourage any independent expert panel sending recommendations 
to CMS concerning guidelines to carefully review the principles and 
requirements for codes and guidelines that we announced in the proposed 
rule. We still believe that any set of national guidelines must adhere 
to those principles and requirements (for example, guidelines must be 
resource-based). Moreover, we encourage any such panel to address our 
concerns about existing guidelines (for example, potential for 
upcoding) in its recommendations to CMS. For example, our Advisory 
Panel on APC Groups recommended that CMS adopt the facility coding 
guidelines developed by the American College of Emergency Physicians 
(ACEP). While we understand that those guidelines have widespread 
support in the hospital community and that an independent panel may 
review them while developing guidelines, we would encourage such a 
panel to review the

[[Page 66793]]

ACEP guidelines in light of the principles, requirements, and concerns 
we enunciated in the proposed rule.
    CMS hopes to receive recommendations on code definitions in time to 
include them in the notice of proposed rulemaking for 2004. We agree 
with the commenters who were concerned about implementing code 
definitions without national guidelines, and we will not propose or 
finalize code definitions until national guidelines for them have been 
developed.
    Comment: Several commenters believed that use of G codes to 
describe facility visits would cause problems with payment by non-
Medicare payers for these services. They believed this problem would 
worsen if the G codes were not accompanied by guidelines.
    Response: G codes are national codes and must be recognized by 
other payers, though other payers do not need to use these codes for 
payment. We are unsure if the commenters' assertions are true. However, 
as stated in the previous response, we do not plan to finalize new 
codes for these services until guidelines for their use have been 
developed. Moreover, we will work with CPT, as appropriate, to develop 
CPT codes for these services once we have finalized and implemented 
them.
    Comment: One commenter asked that CMS provide protection for 
hospitals against fraud and abuse allegations stemming from the current 
ambiguous guidelines.
    Response: We are unsure if the commenter is referring to the CPT 
guidelines as being ambiguous for facilities or if the concern is over 
allowing facilities to develop and implement facility-specific 
guidelines until national codes and guidelines are implemented. In any 
case, we believe that written facility guidelines-developed in 
accordance with the principles (which we enunciated in the proposed 
rule and reaffirmed in this final rule) and which are widely 
disseminated in the facility, accompanied by appropriate education of 
clinicians and coders, and made available to reviewers-should address 
the concerns of the commenters.
    Comment: Several commenters voiced concerns about what activities 
should be described in possible guidelines (e.g., use of time as a 
criterion for selecting a level of service), the burden on facilities 
of having to adapt to a new set of codes for visits, and any 
requirements for facilities to develop their own guidelines. One 
commenter listed several principles for the development of facility 
codes and descriptors (that is, codes and guidelines should: focus on 
resource use, be supported by medical record documentation, support 
code assignment by the chargemaster, and provide a means for 
benchmarking medical-visit data across the industry).
    Response: We believe that having an independent panel develop 
guidelines and make recommendations to CMS will address the concerns of 
these commenters. With regard to requiring facilities to develop 
internal guidelines for visit services, we believe that development of 
internal guidelines is critical for ensuring appropriate medical review 
and for enabling facilities to prove that billing for services were 
actually rendered.
    Comment: One commenter asked CMS to clarify the terms ``nursing 
assessment'' and ``nursing discharge'' when assigning a level of 
service to a visit.
    Response: Because we expect to receive recommendations from an 
independent panel regarding coding guidelines, we will not finalize the 
proposal describing what constitutes a level one emergency or clinic 
visit. Instead, we will continue to allow hospitals to develop their 
own internal guidelines for such visits until we finalize codes and 
guidelines.
    Comment: One commenter asked that we create five payment rates for 
emergency and clinic visits, one for each level of service--instead of 
the three payment rates that we currently use.
    Response: We review the relative weights of each APC on a yearly 
basis, and we would consider such a change if our claims data indicated 
such a change is appropriate.
    Comment: One commenter asked that we craft a surgical global 
package for facilities to provide guidance for facility billing of 
surgical procedures and visits.
    Response: The current APC structure and coding edits already do 
this. Payment for surgical procedures includes payment for all services 
related to the procedure (for example, postoperative care, preoperative 
valuation). Facilities may bill for visits in addition to surgical 
procedures when the visit is a separately identifiable service 
unrelated to the procedure. In such cases, the facilities attest to 
this by appending the -25 modifier to the line item for the visit.
    Comment: One commenter said that CMS should provide guidance as to 
when it is appropriate to add together levels of service from two 
visits, and bill one visit at a higher level. Another commenter 
requested that CMS stop using the GO condition code in favor of the -27 
modifier.
    Response: We disagree. Each clinic visit should be coded 
separately. It is important to track utilization and for each clinic 
visit to be reported separately. This is critical for determining 
proper payment rates in the OPPS. Clinic visits should never be added 
together and billed as a single service with a higher level of service. 
We plan to continue using the GO modifier as it specifically addresses 
coding issues arising in the OPPS.
    Comment: One commenter asked us to reconsider our G code 
descriptors for clinic and emergency visits.
    Response: We will propose and finalize G code descriptors after we 
receive recommendations from an independent expert panel.
    Comment: Several commenters asked us to develop guidelines based on 
a point or acuity system.
    Response: The divergence of opinion in the hospital community makes 
it imperative that an independent expert panel be convened and that 
such a panel should make recommendations to CMS on these issues.
    Comment: Several commenters were concerned about disparities 
between physician and facility coding for the same service. One 
commenter asked that hospitals be allowed to code a different level of 
service than the physicians.
    Response: We do not believe that facilities and physicians would be 
expected to bill similar levels of service for the same encounter. The 
resources used by a facility for a visit may be quite different from 
the resources used by a physician for the same visit. Facilities should 
code a level of service based on facility resource consumption, not 
physician resource consumption. This includes situations where patients 
may see a physician only briefly, or not at all.
    However, if a visit and another service is also billed (that is, 
chemotherapy, diagnostic test, surgical procedure) the visit must be 
separately identifiable from the other service because the resources 
used to provide non-visit services including staff time, equipment, 
supplies, and so forth, are captured in the line item for that service. 
Billing a visit in addition to another service merely because the 
patient interacted with hospital staff or spent time in a room for that 
service is inappropriate.
    Comment: One commenter asked CMS to clarify proper billing for E/M 
services when a visit and another service, such as chemotherapy, have 
been provided.
    Response: If a visit and another service is also billed (that is, 
chemotherapy, diagnostic test, or surgical procedure) the visit must be 
separately identifiable from the other

[[Page 66794]]

service. This is because the resources used to provide non-visit 
services (including staff time, equipment, supplies and so forth) are 
captured in the line item for that particular service. However, billing 
a visit in addition to another service--merely because the patient 
interacted with hospital staff or spent time in a room for that 
service--is inappropriate.

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 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 that 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:
    [sbull] 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);
    [sbull] For asthma, a peak expiratory flow rate (94010) or pulse 
oximetry (94760, 94761, or 94762);
    [sbull] For congestive heart failure, a chest x-ray (71010, 71020, 
or 71030) and an electrocardiogram (93005) and pulse oximetry (94760, 
94761, or 94762).
    [sbull] Note: Pulse oximetry codes 94760, 94761, and 94762 are 
treated as packaged services under the OPPS. Although no separate 
payment is made for packaged 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.
    Comment: A few commenters requested clarification of the 
requirement that CPT 94010 (peak flow) be billed to establish a 
diagnosis of asthma. The commenter noted that CPT 94010 is the code for 
spirometry with recording and that it would be erroneous to bill peak 
flow, which is all that is relevant for asthma, as a spirometry, which 
requires a record and should include such elements as vital capacity 
and flow-volume loops. The commenter is concerned that we are 
instructing hospitals to bill incorrectly if our intention is solely to 
require peak flow.
    Response: We are reviewing this comment and if we determine that a 
modification of the current requirement for peak flow is appropriate, 
we will revise the requirement in the program memorandum that 
implements the 2003 OPPS update effective January 1, 2003.
    Comment: One commenter asked whether bedside services other than 
infusion, such as CVP placement, arterial punctures, and IV injections, 
can be billed when furnished to observation patients or whether these 
services are considered to be packaged into the observation payment.
    Response: We would not expect that placement of a CVP line would be 
billed for a patient in observation. However, in general, any service 
that is separately payable under the OPPS, that is, procedures with 
status indicators S, X, K, G, V, or H, can be billed with G0244 and 
paid separately, although services with status indicator ``T'' (with 
the exception of Q0081), as we explain below, are not separately 
payable 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

[[Page 66795]]

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, and so forth. 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 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, and so forth, 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 
proposed to modify the criteria and coding for observation services 
furnished on or after January 1, 2003. Specifically, we proposed 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 were 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 proposed 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 proposed not to make separate payment for G0LLL. Rather, we 
proposed 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 proposed to assign G0MMM 
for payment under APC 0706, New Technology--Level I. We proposed 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 
proposed 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. In the proposed rule, we invited 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.
    Comment: Everyone who commented on our proposed refinements of the 
requirements to enable separate payment for observation services 
supported the proposal to allow separate payment for patients admitted 
to observation directly from physicians' offices. However, the majority 
of commenters opposed the coding and payment methodology that we 
proposed to implement this change.
    Commenters stated that having to use G0LLL and G0MMM, combined with 
the other requirements that have to be met in order to receive separate 
payment for observation of patients with asthma, congestive heart 
failure, and chest pain, would be burdensome and confusing, and would 
create operational inconsistencies and problems for hospitals. Several 
commenters urged CMS to simplify, the observation rules in order to 
reduce their complexity and lessen the burden they currently impose on 
hospitals. Some commenters were concerned that other payors might not 
accept the proposed new codes and that the codes would not be HIPAA 
compliant.
    A number of commenters recommended alternatives to the 
establishment of G0LLL and G0MMM that would utilize information already 
being reported by hospitals on the UB-92 within the existing coding 
system for revenue centers, diagnoses, and source and type of 
admission. One commenter suggested a single G code for ``Intake into 
observation after outside evaluation'' supported by appropriate 
diagnosis coding and claims edits. One

[[Page 66796]]

commenter recommended instituting a ``per visit'' payment logic in the 
OCE and PRICER similar to that used for mental health and PHP services. 
Several commenters suggested returning observation to a time-based 
charging and coding methodology based on hours. Several commenters 
supported using existing E/M codes instead of creating new codes.
    Response: We agree with many of the commenters that our proposal 
for direct admissions to observation seems administratively burdensome. 
However, we believe that the importance of creating a payment mechanism 
for direct admissions to observation outweighs the administrative 
burden at this time. We also believe it is vital that we be able to 
track the utilization of these services so we will have data upon which 
to base policy decisions in the future.
    A number of the alternatives suggested by commenters are promising 
and merit further analysis and review. However, our preliminary 
inquiries revealed that most of the suggested alternatives would 
require systems changes that could take six months or longer to develop 
and install, and that such changes could not be implemented effective 
January 1, 2003. Therefore, we have decided to implement the proposed G 
codes as follows:
    G0263, Direct admission of patient with diagnosis of congestive 
heart failure, chest pain or asthma for observation.
    G0264, Initial nursing assessment of patient directly admitted to 
observation with diagnosis other than congestive heart failure, chest 
pain, or asthma.
    These codes would be HIPPA compliant. Other payers would make their 
own decisions about whether to use these codes for their own payment 
purposes.
    Comment: One commenter asked that we instruct Fiscal Intermediaries 
to accept another revenue code in the 76X range for G0263 and G0264 
because RC 762 may only be used to report observation charges.
    Response: We are reviewing with our coding and claims processing 
experts to determine if there is a more appropriate revenue code to use 
when billing G0263 and G0264. We will provide specific instructions in 
the program memorandum issued to implement the January 2003 OPPS 
update.
    Comment: Cancer centers urged CMS to expand the conditions for 
which we would make separate payment for observation to include febrile 
neutropenia, electrolyte disorders, chemotherapy hypersensitivity 
reaction, pulmonary embolisms, acute GI hemorrhage, and seizures 
presented by cancer patients under treatment at Cancer Centers. Other 
commenters suggested psychiatric conditions, acute abdominal pain, 
post-transplant threat of rejection, and pneumonia as appropriate for 
separate payment for observation.
    Response: As we indicate in the November 30, 2001 final rule, we 
will review the indications for separately payable observation after we 
have acquired sufficient experience under the current system to make an 
informed decision as to whether an expansion is appropriate.
    Comment: Most commenters asserted that our proposed payment for 
G0MMM for initial nursing assessment of a patient directly admitted to 
observation with a diagnosis other than chest pain, asthma, or 
congestive heart failure (APC 706) is too low and does not recognize 
the substantial type, level, and quality of the initial nursing 
services being provided. Commenters urged CMS either to set a higher 
payment rate for G0MMM or to allow an E/M code to be billed with G0MMM. 
Another commenter suggested assigning G0MMM to APC 0600 to be 
consistent with what CMS says in the FAQ 97. One commenter noted that 
it is inappropriate to assign G0MMM to a new technology APC because the 
code describes an E/M service, not a new technology service.
    Response: We agree. We have therefore assigned G0264 for payment in 
APC 600, Low Level Clinic Visits.
    Comment: One commenter wanted to know if G0LLL and G0MMM could be 
used for patients admitted from their homes, either (1) based solely 
upon a telephone call from the patient to the community physician and 
that physician's call to the hospital to order a direct admission for 
observation management, or (2) when directly admitted by the physician 
after going home following a visit to the physician's office, the 
patient's condition having deteriorated after seeing the physician.
    Response: As long as the physician notifies the hospital that he/
she is ordering the direct admission of the patient for observation and 
supports that order with the appropriate suspected diagnosis, we 
believe this would constitute a direct admission. Either G0263 or G0264 
would be billed, depending on the final diagnosis supporting the direct 
admission observation services.

C. 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 
Q0081 are denied because of the ``T'' status indicator assigned to 
HCPCS code Q0081. 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 
proposed 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 included 
instructions on the use of G0258 in the program memorandum issued to 
implement OPPS coding changes for the October 1, 2002 OCE. In the 
proposed rule, we solicited comment on the use of this code.
    Comment: While appreciative of our recognizing the need for a 
mechanism that permits hospitals to bill for infusion therapy during 
observation, most commenters did not support our proposal to introduce 
a new code for the service. One commenter recommended terminating G0258 
effective 12/31/02 because it creates operational burdens for the 
hospital and does not accurately reflect the resources used. Several 
commenters urged CMS to change the SI for APC 120 to which Q0081 is 
assigned to S. This would solve the problem and permit payment of Q0081 
with G0244 and would also align the status indicators for the infusion 
of non-chemotherapy drugs with the infusion of chemotherapy drugs.
    Commenters asked if CMS intends hospital to use G0258 instead of 
Q0081 when the infusion therapy is provided to the patient in the 
emergency department or clinic prior to patient's placement in 
observation when the observation stay ultimately qualifies for separate 
payment. The commenters pointed out that the hospital may not know when 
the patient is in the emergency department or clinic and the infusion 
therapy is initiated that the patient will subsequently be placed in an 
observation stay that qualifies for payment under G0244. Commenters

[[Page 66797]]

asked CMS to clarify how G0258 is to be used.
    One commenter recommended, that we install an OCE edit to ignore 
Q0081 when checking for the presence of a procedure with SI=T.
    Many commenters stated that the payment for G0248 should be the 
same as the payment for Q0081 because the resources expended for 
infusion therapy performed during a packaged observation stay are the 
same as those required for Q0081 furnished. These commenters disagreed 
with CMS's assertion that payment for G0258 should be discounted to 
equal 50 percent of the payment for Q0081 because Q0081 is invariably 
billed with a higher-paying procedure and is, therefore, discounted. 
Another commenter advocated adjusting the payment for G0244 to include 
the cost of infusion and eliminating a separate new code. The same 
commenter supported payment at 50 percent of the rate set for Q0081 
because Q0081 would always be discounted because it is always billed 
with another procedure.
    Response: Having reviewed the numerous concerns raised by 
commenters in connection with the use of HCPCS code G0258, Intravenous 
infusion during separately payable observation stay, per observation 
stay (must be reported with G0244), and our proposed payment for G0258, 
we agree with commenters that requiring the use of this code is 
problematic. We have determined that the OCE logic can be modified to 
allow payment for G0244, even though Q0081 is assigned to an APC with 
status indicator T. Therefore, effective for services furnished on or 
after January 1, 2003, we are withdrawing G0258. Instead hospitals may 
submit claims for G0244 with Q0081 when infusion therapy is provided, 
and the claim will be paid if all other requirements and conditions are 
met. The status indicator for G0081 will not change.
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 proposed 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
428.42 Chronic combined systolic and diastolic heart failure
428.43 Acute on chronic combined systolic and diastolic heart failure

    In the August 9, 2002 proposed rule, we invited comment on the 
addition of these diagnosis codes to the criteria for separate payment 
for observation services under APC 0339.
    Comment: One commenter recommended adding the following codes to 
the list of diagnoses for asthma: 493.00, 493.10, 493.20, and 493.90
    Response: We are not including these diagnoses because they would 
not be appropriate for use with patients requiring observation services 
because they are experiencing acute exacerbations of asthma.
    [sbull] Effective for services furnished on or after January 1, 
2003, hospitals may bill for patients directly admitted for observation 
services using the following codes:
    G0263, Direct admission of patient with diagnosis of congestive 
heart failure, chest pain or asthma for observation.
    G0264, Initial nursing assessment of patient directly admitted to 
observation with diagnosis other than congestive heart failure, chest 
pain, or asthma.
    [sbull] Payment for G0264 will be made under APC 600.
    [sbull] Payment for G0263 will be packaged into the payment for APC 
339
    [sbull] Payment for G0244 will be allowed when billed with Q0081, 
Infusion therapy other than chemotherapy, when furnished to patients 
with asthma, congestive heart failure, or chest pain, subject to all 
other conditions for payment having been met.

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 proposed to clarify our policy regarding Medicare payment 
when a procedure with status indicator C is performed under certain 
life-threatening, emergent conditions. In the proposed rule, we 
solicited comments on the extent to which the payment policy described 
below addresses hospitals' concerns. We stated it would be most helpful 
if commenters provided 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.
    [sbull] If the patient dies in the emergency department, make 
payment under the outpatient PPS for services furnished.
    [sbull] 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).
    [sbull] If the patient was not admitted as an inpatient, pay under 
the outpatient PPS (an APC-based payment).
    [sbull] If the patient was not admitted as an inpatient and the 
procedure is

[[Page 66798]]

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 Web site at http://cms.hhs.gov/manuals/pm_trans/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 proposed 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:
    [sbull] 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 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.
    [sbull] Documentation that the reported HCPCS code for the surgical 
procedure with OPPS payment status indicator C (such as CPT code 61345) 
was actually performed.
    [sbull] Documentation that the reported surgical procedure with 
status indicator C was medically necessary.
    [sbull] 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.
    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 proposed to revise Sec.  3610.5 of the 
Medicare Intermediary Manual accordingly.) 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 provisions 
of Sec.  3610.3 of the Medicare Intermediary Manual (``3-day rule'') 
and Sec.  415.6 of the Medicare Hospital Manual.
    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.
    Comment: Commenters agreed that the current policy on billing and 
payment when procedures on the inpatient list are performed on an 
outpatient basis requires clarification and modification. However, 
commenters stated that our proposals, if implemented, would be 
burdensome and create extra work for hospitals. Commenters opposed our 
proposal that an outpatient claim be submitted for rejection and then 
resubmitted as an inpatient claim. Commenters asserted that this would 
be unwieldy and create an unacceptable delay in payment. Many 
commenters were concerned that it would be difficult to expect a 
physician to write an order to admit a patient who expired during 
emergency surgery, and that asking physicians to do so to satisfy a 
billing requirement would not be appropriate. Some commenters were 
concerned that submitting an inpatient claim that is inconsistent with 
medical records documentation could create problems with medical 
review. However, commenters did not provide illustrations of actual 
cases when hospitals have submitted outpatient bills for a procedure 
with status indicator C that was performed in an emergency situation 
and not paid which would have added specificity to the general 
comments.
    Commenters offered several alternatives to our proposal. Several 
commenters suggested that these cases be initially billed as inpatient 
stays,

[[Page 66799]]

supported by documentation that the procedure was performed and was 
medically necessary, and that a presumption of admission be made for 
payment purposes. Several commenters suggested that a reduced DRG-
related amount be established as payment in these special cases. 
Several commenters suggested the use of a condition code that would 
allow submission of an outpatient claim when procedures on the 
inpatient list are performed in emergency situations.
    Response: We appreciate commenters' reactions and suggestions of 
ways to make payment under the OPPS in emergency situations when 
procedures on the inpatient list are performed on a beneficiary who is 
not admitted as an inpatient. After careful review and consideration of 
the comments and recommendations, we have decided to modify certain 
aspects of our proposed policy, while retaining certain others. We are 
also taking steps to ensure that OCE edits are consistent with our 
policy.
    The underlying principle is our policy that procedures on the 
inpatient list performed on patients whose status is that of outpatient 
are not payable as outpatient services.
    However, we recognize that there are occasions when a procedure on 
the inpatient list must be performed to resuscitate or stabilize a 
patient with an emergent, life-threatening condition whose status is 
that of an outpatient. To receive payment in those cases, hospitals 
admit the patient and submit an inpatient claim.
    In cases where a procedure on the inpatient list must be performed 
to resuscitate or stabilize a patient with an emergent, life-
threatening condition whose status is that of an outpatient, the 
patient may be admitted and transferred to another hospital. In these 
cases, the transferring hospital is paid a per diem DRG rate. We shall 
revise section 3610.5 of the Medicare Intermediary Manual to reflect 
this policy.
    On rare occasions, a procedure on the inpatient list must be 
performed to resuscitate or stabilize a patient with an emergent, life-
threatening condition whose status is that of an outpatient and the 
patient dies before being admitted as an inpatient. For those rare and 
unusual cases, we are instructing hospitals to submit an outpatient 
claim for all services furnished, including the procedure code with 
status indicator C to which a new modifier is attached. The exact 
modifier that is to be used in these cases had not been issued by the 
HCPCS alpha-numeric workgroup in time for publication in this final 
rule. The modifier and instructions for its use will be included in the 
program memorandum for the January 2003 update. We believe that such 
patients would typically receive services such as those provided during 
a high-level emergency visit, appropriate diagnostic testing (X-ray, CT 
scan, EKG, and so forth), and administration of intravenous fluids and 
medication prior to the surgical procedure. Because these combined 
services constitute an episode of care, we will pay claims with a 
procedure code on the inpatient list that are billed with the new 
modifier under new technology APC 977. Separate payment will not be 
allowed for other services furnished on the same date. This approach 
allows hospitals to submit an outpatient claim and receive payment 
without additional paperwork, it results in consistency between the 
medical record and patient status, and it allows us to collect data on 
the costs associated with these very unusual and infrequent cases for 
future use in updating the OPPS.
    Procedures with status indicator C but without the new modifier 
that are submitted on an outpatient bill will receive a line item 
denial, and no other services furnished on the same date are payable.
    If an outpatient has a procedure that is on the inpatient list 
performed, and is subsequently admitted to an observation bed, the 
procedure with status indicator C submitted on an outpatient bill will 
receive a line item denial. Further, we have decided not to make final 
our proposal to make payment for APC 610, 611 or 612 under such 
circumstances. Rather, in such cases no other services furnished on the 
same date are payable.
    We did not receive any comments on the documentation that we 
proposed to require in the patient's medical record when a procedure 
with status indicator C is performed and: (1) The patient dies before 
being admitted as an inpatient, or (2) the patient survives the 
procedure and is admitted and transferred. Therefore, we are making 
those requirements final.
4. Orders To Admit
    Some hospitals have raised questions about the timing of a 
physician's order to admit a patient. The requirements for 
authenticating physician orders and the standards for medical record 
keeping fall outside the scope of this rule and OPPS payment policy. 
The payment provisions that we are making final in this rule 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.
    Comment: A few commenters requested clarification on what is meant 
by ``admit'' and the documentation that CMS would expect to see in 
order to substantiate that a patient was admitted as an inpatient. One 
commenter expressed concern about the variability in fiscal 
intermediaries' policies regarding the changing of an admission status 
after the service has been provided.
    Response: As we have indicated, these issues are addressed in the 
Medicare hospital conditions of participation at Sec.  482.24, and are 
governed by applicable State licensing rules and hospital accreditation 
standards. Questions and concerns related to these issues should be 
addressed to the parties who are responsible for these rules, 
regulations, and standards.
    When a procedure on the inpatient list must be performed to 
resuscitate or stabilize a patient with an emergent, life-threatening 
condition whose status is that of an outpatient and the patient dies 
before being admitted as an inpatient, the hospital should submit an 
outpatient claim for all services furnished, including the procedure 
with status indicator C to which a new modifier, which will be 
announced by program memorandum is attached. Claims with a procedure 
code on the inpatient list that are billed with the new modifier will 
be paid under APC 977.
    We are making final the requirement that information specified in 
the proposed rule be included in the medical record to support payment 
when a procedure with status indicator C is performed on an outpatient 
and the patient dies or is admitted and transferred.

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 status indicator 
assignments for APCs in Addendum A, HCPCS codes in

[[Page 66800]]

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 proposed to use the status indicators in 
the following manner:
    [sbull] ``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.
    [sbull] ``C'' to indicate inpatient services that are not payable 
under the OPPS.
    [sbull] ``D'' to indicate a code that was deleted effective with 
the beginning of the calendar year.
    [sbull] ``E'' to indicate services for which payment is not allowed 
under the OPPS or that are not covered by Medicare.
    [sbull] ``F'' to indicate acquisition of corneal tissue, which is 
paid at reasonable cost.
    [sbull] ``G'' to indicate drugs and biologicals that are paid under 
OPPS transitional pass-through rules.
    [sbull] ``H'' to indicate devices that are paid under OPPS 
transitional pass-through rules.
    [sbull] ``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.
    [sbull] ``N'' to indicate services that are paid under the OPPS for 
which payment is packaged into another service or APC group.
    [sbull] ``P'' to indicate services that are paid under the OPPS but 
only in partial hospitalization programs.
    [sbull] ``S'' to indicate significant procedures that are paid 
under OPPS but to which the multiple procedure reduction does not 
apply.
    [sbull] ``T'' to indicate significant services that are paid under 
the OPPS and to which the multiple procedure payment discount under 
OPPS applies.
    [sbull] ``V'' to indicate medical visits (including clinic or 
emergency department visits) that are paid under the OPPS.
    [sbull] ``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.
    Our proposed status indicators identified for each HCPCS code and 
each APC appear in Addenda A and B of the proposed rule. We requested 
comments on the appropriateness of the indicators we have assigned.
    We received several comments on this proposal, which are summarized 
below:
    Comment: Some commenters said that our proposed payment for 
influenza and pneumococceal pneumonia vaccines and orphan drugs were 
inadequate to ensure the provision of these drugs and biologicals.
    Response: As discussed in section III.B, we will pay reasonable 
cost for these drugs and biologicals in 2003. Therefore, we have 
assigned orphan drugs a status indicator of F and have redefined the 
status indicator F to mean that the item or service is paid on a 
reasonable cost basis. Until now, only corneal tissue acquisition has 
been paid as reasonable cost under OPPS and, therefore, the status 
indicator was specific to corneal tissue. However, beginning January 1, 
2003, the ``F'' status indicator will apply to any item or service paid 
at reasonable cost.
    With regard to influenza and pneumococcal pneumonia vaccine, which 
we will also pay on a reasonable cost basis, effective January 1, 2003, 
we have created a new status indicator ``L'' ``Influenza vaccine; 
pneumococcal pneumonia vaccine'' to indicate that these vaccines are 
paid on a reasonable cost basis but deductible and coinsurance do not 
apply to the payment. We show the new status indicator in Addendum D 
and we show it for these services in Addendum B. We are doing the 
following:
    [sbull] Redefining status F to indicate an item or service that is 
paid on a reasonable-cost basis.
    [sbull] Changing the status indicator for influenza and 
pneumococceal pneumonia vaccines to status indicator L and change 
orphan drugs to status indicator F.
    [sbull] Changing the status indicator for APC 225 to S.

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 explained 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 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 proposed 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 proposed 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

[[Page 66801]]

costs of associated C-codes for device categories that were billed with 
the APC packaged into the median. Dividing 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 APC payment amount, we would determine the 
applicable offset amount. Table 11 shows the offsets that we 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.)
    For this final rule, we used the device data for the 12 months 
ended March 31, 2002 to calculate the device and non-device portions of 
APCs median costs. We began with the same APCs that were listed on 
Table 9 of our proposed rule, with two additions. We added APCs 0648 
and 0651, because they showed appreciable device percentages using our 
methodology. We again applied these percentages to the APC payment 
amounts and excluded any APC's percentage of device costs less than one 
percent and calculated offset amounts less than one dollar.
    We received some comments on this proposal, which are summarized 
below:
    Comment. A commenting party contended that our list of device 
offsets in our proposed rule is incorrect since it includes many 
computed offsets to APC payments for devices that will no longer 
receive pass-through payments. The commenter recommended that we 
exclude the offsets of all devices in categories that are bundled, 
since there is no separate pass-through payment to be offset.
    Response. The offset list is a list of potential offsets. We, of 
course, do not know in advance which procedures and APCs will be mapped 
into new categories as the new categories are created and become 
effective. Yet, we are required to subtract the amount of similar 
devices in pass-through payment under section 1833(t)(6)(D)(ii) of the 
Act. Therefore, for the proposed rule, we calculate the device costs in 
each APC and include APCs on the offset list if their device costs were 
at least 1 percent of the APC's cost. We use a similar list for this 
final rule.
    Comment. One commenter expressed concern about the difference in 
offset amounts proposed for APC 0107, Insertion of Cardioverter-
Defibrilator, and APC 0108, Insertion/Replacement/Repair of 
Cardioverter-Defibrilator Leads. The commenter wondered why, when the 
cost of the cardioverter-defibrilator is 2 to 3 times the cost of the 
leads, the offset amount for APC 0107 is less than the offset amount 
for APC 0108.
    Response. The commenter is incorrect that we proposed an offset 
amount for 0107 (83.18 percent) that is less than for 0108 (82.18 
percent). Moreover, the commenter mistakenly believes that APC 0107 is 
for insertion/replacement/repair of cardioverter-defibrilator leads 
when, in fact, the definition of CPT code 33249 (the only CPT code in 
APC 0108) is ``Insertion or repositioning of electroleads for single or 
dual chamber pacing cardioverter-defibrilator and insertion of pulse 
generator.'' Hence, CPT code 33249 is for the insertion of a pulse 
generator and insertion or repositioning of leads. It is not, as the 
commenter indicates, for insertion or repositioning of leads alone. As 
shown in Table 11, the offset percent for APC 0107 is 93.29 and the 
offset percent for APC 0108 is 92.99.
    Comment. A commenting party contended that the offsets appear to be 
computed using departmental cost-to-charge ratios (CCRs), yet pass-
through payments for devices were computed using an overall hospital 
CCR. The party contended that in cases in which the hospital CCR is 
higher than the departmental CCR, there is effectively a zero pass-
through payment for devices. Therefore, the party recommended that the 
offsets should be calculated using the same CCRs used to compute pass-
through payments.
    Response: Although the commenter states that calculating a device 
pass-through payment using a hospital CCR that is higher than the 
departmental CCR used to determine the applicable offset amount results 
in effectively no payment for a device, it appears to us that the 
opposite result would occur. That is, in the situation described, a 
lower offset amount would be applied to a higher calculated device 
cost, resulting in a higher net device payment. Offset amounts 
represent device costs that are included in the median costs of a 
procedure. The median cost of the procedure is determined, as we 
determine median costs for all services, by totaling all the 
procedure's component costs calculated using department-specific CCRs. 
We use department-specific CCRs to calculate the cost of the procedure, 
which includes devices, and because offsets are intended to represent 
the cost of devices that are included in the cost of the procedure, we 
believe the same departmental-CCR method must be applied in calculating 
offsets.

                    Table 11.--Offsets To Be Applied for Each APC That Contains Device Costs
----------------------------------------------------------------------------------------------------------------
                                                                                                 Device related
                                                                                  APC percent      costs to be
             APC                                 Description                     attributed to   subtracted from
                                                                                    devices       pass-through
                                                                                                     payment
----------------------------------------------------------------------------------------------------------------
0032.........................  Insertion of Central Venous/Arterial Catheter..           31.96           $191.22
0048.........................  Arthroplasty with Prosthesis...................           29.92            633.96
0051.........................  Level III Musculoskeletal Procedures Except                1.31             22.48
                                Hand and Foot.
0052.........................  Level IV Musculoskeletal Procedures Except Hand            3.08             65.48
                                and Foot.
0080.........................  Diagnostic Cardiac Catheterization.............           10.63            195.69
0081.........................  Non-Coronary Angioplasty or Atherectomy........           31.45            713.58
0082.........................  Coronary Atherectomy...........................           48.25          2,174.88
0083.........................  Coronary Angioplasty and Percutaneous                     29.59            802.06
                                Valvuloplasty.
0085.........................  Level II Electrophysiologic Evaluation.........           37.00            805.10
0086.........................  Ablate Heart Dysrhythm Focus...................           41.96          1,156.01
0087.........................  Cardiac Electrophysiologic Recording/Mapping...           51.40          1,056.10
0088.........................  Thrombectomy...................................            3.80             64.56
0089.........................  Insertion/Replacement of Permanent Pacemaker              77.40          4,543.29
                                and Electrodes.
0655.........................  Insertion/Replacement/Conversion of a permanent           77.14          4,942.78
                                dual chamber pacemaker.
0090.........................  Insertion/Replacement of Pacemaker Pulse                  79.61          3,782.34
                                Generator.
0654.........................  Insertion/Replacement of a permanent dual                 78.27          3,749.52
                                chamber pacemaker.

[[Page 66802]]

 
0091.........................  Level II Vascular Ligation.....................            1.08             15.04
0653.........................  Vascular Reconstruction/Fistula Repair with               10.83            169.60
                                Device.
0104.........................  Transcatheter Placement of Intracoronary Stents           46.65          1,862.31
0105.........................  Revision/Removal of Pacemakers, AICD, or                   4.60             44.61
                                Vascular.
0106.........................  Insertion/Replacement/Repair of Pacemaker and/            50.46          1,442.72
                                or Electrodes.
0107.........................  Insertion of Cardioverter-Defibrillator........           93.29         15,871.30
0108.........................  Insertion/Replacement/Repair of Cardioverter-             92.99         21,509.86
                                Defibrillator Leads.
0109.........................  Removal of Implanted Devices...................            1.61              6.27
0115.........................  Cannula/Access Device Procedures...............           25.85            327.87
0119.........................  Implantation of Devices........................           74.37          3,463.86
0122.........................  Level II Tube Changes and Repositioning........           40.26            225.62
0124.........................  Revision of Implanted Infusion Pump............           52.73          1,377.33
0151.........................  Endoscopic Retrograde Cholangio-Pancreatography            2.87             26.21
                                (ERCP).
0152.........................  Percutaneous Abdominal and Biliary Procedures..           31.57            165.11
0652.........................  Insertion of Intraperitoneal Catheters.........           10.91            160.05
0154.........................  Hernia/Hydrocele Procedures....................            2.73             36.63
0167.........................  Level III Urethral Procedures..................           43.96            649.32
0168.........................  Level II Urethral Procedures...................            1.15             14.67
0179.........................  Urinary Incontinence Procedures................           56.34          3,066.24
0182.........................  Insertion of Penile Prosthesis.................           58.45          2,908.45
0202.........................  Level VIII Female Reproductive Proc............           38.35            911.22
0222.........................  Implantation of Neurological Device............           88.08         10,461.01
0223.........................  Implantation of Pain Management Device.........           52.96          1,133.11
0225.........................  Implantation of Neurostimulator Electrodes.....           81.03          5,888.13
0226.........................  Implantation of Drug Infusion Reservoir........           82.74          6,228.55
0227.........................  Implantation of Drug Infusion Device...........           81.57          6,147.49
0229.........................  Transcatheter Placement of Intravascular Shunts           63.65          1,907.33
0246.........................  Cataract Procedures with IOL Insert............            1.38             16.00
0259.........................  Level VI ENT Procedures........................           84.07         16,118.86
0279.........................  Level II Angiography and Venography except                 2.18              9.83
                                Extremity.
0280.........................  Level III Angiography and Venography except                4.89             38.80
                                Extremity.
0297.........................  Level II Therapeutic Radiologic Procedures.....            1.35              5.41
0651.........................  Complex Interstitial Radiation Source                     85.13          2,429.25
                                Application.
0670.........................  Intravenous and Intracardiac Ultrasound........           53.75            847.71
0680.........................  Insertion of Patient Activated Event Recorders.           77.72          2,275.14
0681.........................  Knee Arthroplasty..............................           64.16          4,945.63
0686.........................  Level III Skin Repair..........................           37.79            280.72
0687.........................  Revision/Removal of Neurostimulator Electrodes.           35.06            472.51
0688.........................  Revision/Removal of Neurostimulator Pulse                 69.42          2,699.74
                                Generator Receiver.
0648.........................  Breast Reconstruction with Prosthesis..........           31.69            740.32
----------------------------------------------------------------------------------------------------------------

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

[[Page 66803]]

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 then determined which APCs containing devices would be billed 
together. 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.
    We noted 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, 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 proposed to 
continue our current policy of multiple procedure discounting. That is, 
when two or more APCS with status indicator ``T'' are billed together 
we proposed to pay 100 percent for the highest cost APC and 50 percent 
for all other APCs with status indicator ``T.'' We proposed not to 
adjust these payments to account for device costs in the APCs.
    We received a large number of comments on this proposal, which are 
summarized below:
    Comment: Many commenters asked that the status indicator be changed 
from ``T'' to ``S'' for APCs for which a large amount of the cost of 
the APC is cost for a device that is packaged into the APC. They said 
that it is not appropriate to apply the multiple procedure discount 
that is applied to services with status indicator ``T'' to APCs for 
which the cost of a device is the majority of the cost of the APC 
because there is no efficiency in the provision of multiple devices. 
They said that the multiple procedure discount should only apply to the 
nondevice portion of the APC payment.
    Response: We reviewed the data for combinations of APCs billed on 
the same claim and determined that it would not be typical for an APC, 
which is predominantly device cost, to be the second or subsequent APC 
on the same claim. Hence, it would not be typical that the 
predominantly device APC would be reduced (because a predominantly 
device APC would generally be the highest cost APC on the claim).
    In the case of APC 225, however, we did change the status indicator 
to ``S'' because we were convinced that it must be performed when APC 
222 also performed and that, therefore, a status indicator of ``T'' 
would not result in appropriate payment for 225.
    Comment: A number of commenters took issue with our claim 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 asserted that some high cost 
APCs do incur multiple procedure discounting. The example most provided 
is the implantation of a neurostimulator (APC 0222) with 
neurostimulator electrodes or leads (APC 0225). They said that the 
multiple procedure discount along with proposed payment cuts to these 
APCs even more significantly impact the payment of these services and 
warrant extensive review, analysis, and consideration of outside data. 
They also recommended that we change the status indicators for these 
procedures to ``S'' (significant procedure), which are not reduced when 
performed as a multiple procedure in the same session. Other examples 
cited were: bilateral neurostimulator implants for patients with 
Parkinson's disease (APC 0222) and implantation of a spinal infusion 
pump, which involves implantation of a catheter (APC 0223) and infusion 
pump (APC 0227) and dual implantation of an artificial urinary 
sphincter and a penile prosthesis in prostate cancer survivors. One 
commenter recommended that all device-related APCs have a status 
indicator of ``S'' to reflect significant resources.
    Response: We continue to believe that most procedures with 
significant device costs packaged in will, if provided on the same day 
and billed in conjunction with another procedure, be the most expensive 
procedure on the claim and thus not subject to discounting. We are 
concerned that, if we were to discontinue our policy of reducing 
payment for multiple procedures, we would overpay some lower valued 
procedures. We received many thoughtful comments on the multiple 
procedure discounting of certain APCs and we intend to take these 
comments under advisement and study this issue further.
    Comment: One commenter objected to our proposal to stop applying 
the 50 percent discount to offsets to pass-through payments when there 
are multiple procedures involving a claim of a pass-through device 
also.
    Response: As discussed above, the discount to offsets to pass-
through payments will become a much less significant aspect beginning 
January 1, 2003, when we will retire 95 of 97 existing categories and 
add a limited number of new categories.

F. Outpatient Billing for Dialysis

    Currently, Medicare does not pay 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, ESRD patients in need of emergency dialysis 
have been admitted to the hospital. These admissions have been found to 
be inappropriate by the Quality Improvement Organizations, and payment 
has been denied.
    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 ESRD 
patient has to wait until the next scheduled dialysis appointment. We 
are concerned that by maintaining this policy, ESRD patients 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 proposed 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

[[Page 66804]]

would not be included in this payment mechanism.
    In certain instances, it is appropriate to dialyze ESRD patients on 
an outpatient basis. We proposed to allow payment for these nonroutine 
dialysis treatments in medical situations in which the ESRD patient 
cannot obtain her or his regularly scheduled dialysis treatment at a 
certified ESRD facility. The circumstances in which we proposed to 
allow payment are limited to:
    [sbull] Dialysis performed following or in connection with a 
vascular access procedure;
    [sbull] 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
    [sbull] 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 the policy for 
two reasons:
    [sbull] To ensure that hospital outpatient departments are paid for 
providing this much needed service; and
    [sbull] 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 proposed 
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 proposed 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 nonroutine outpatient dialysis to ESRD 
patients.
    We will be monitoring the use of this new code to ensure the 
following:
    [sbull] Certified dialysis facilities are not incorrectly using 
this code.
    [sbull] 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.
    We received eight comments on our proposal to allow payment for 
dialysis treatments for ESRD patients in the outpatient department of a 
hospital. Although all of the comments support our proposed changes, 
some commenters asked for clarification on issues pertaining to this 
provision.
    Comment: One commenter requested that we provide clarification on 
how the payment rate would be determined for this service.
    Response: In the August 9, 2002 proposed rule, we provided the 
payment rate for providing dialysis treatments for ESRD patients in the 
outpatient department of a hospital. The proposed rule stated that this 
service would be assigned Ambulatory Payment Classification (APC) 0170, 
and Addendum A provides the payment rate for this APC. Effective 
January 1, 2003, the payment national unadjusted rate for this service 
will be $252.16.
    Comment: One commenter wanted clarification on how services 
typically associated with outpatient dialysis such as covered 
pharmaceuticals and laboratory testing will be accounted for under the 
proposed policy.
    Response: We would pay separately for laboratory tests based on the 
laboratory fee schedule. Drugs may or may not be paid separately from 
the payment for the dialysis treatment. The drugs that would be paid 
separately would have a separate APC. If there is not a separate APC, 
then the drugs would be packaged into the APC paid for the dialysis 
treatment.
    Comment: One commenter expressed concern that the proposal to 
require the ESRD patient's home facility to obtain and review the 
patient's medical records from the hospital would create an additional 
information collection burden for dialysis facilities. The commenter 
requested that we include language in the final rule that specifically 
outlines the hospital's responsibilities in providing the patient's 
medical records to the home facility.
    Response: There should be a regular exchange of information between 
a patient's home facility and any treating facilities to verify the 
care that has been provided and to ensure that patients are not 
receiving inappropriate or incorrect treatment. The dialysis facility 
is, however, ultimately responsible for effectively coordinating the 
care of its patients, including the inclusion of all information in the 
patient's medical record, and we believe obtaining and reviewing 
information from other treating facilities is part of this 
responsibility. The medical record indicates what care has actually 
been provided, and it also provides the data for evaluation and 
documentation of the quality and appropriateness of the care delivered. 
We believe subsequent dialysis treatment at the patient's home facility 
should not be provided without information from another treatment 
facility because the home facility may need to make adjustments to the 
plan of care when the patient returns to the facility, so the facility 
should obtain this information from the hospital to implement any new 
strategies, etc. Furthermore, since dialysis facilities should already 
be collecting medical records for home dialysis patients and for 
traveling patients, we do not view this as an additional information 
collection burden. We view this as a responsibility within the 
facilities scope of practice.
    Comment: One commenter cautioned us about the potential for abuse 
with this proposal and recommended that we develop clear guidelines 
governing the use of this new code.
    Response: We agree with the commenter, and we plan to issue 
instructions for the use of the code as well as develop code edits to 
monitor the use of this code to prevent potential fraud and abuse. The 
instructions will be issued at a later date.
    Comment: Another commenter requested clarification of the word 
``routine,'' and what criteria that we will apply to establish whether 
a patient is receiving ``routine'' dialysis treatment. The commenter 
also requested documentation requirements (for example, diagnoses, 
other procedures, etc.) for meeting these ``exceptional circumstances'' 
defined in the August 9, 2002 proposed rule.
    Response: We define ``routine'' dialysis as the three times per 
week maintenance treatment the same patient would normally receive at 
his or her home facility. We would consider a patient to be receiving 
routine dialysis if the claims received from the outpatient department 
indicated that the same patient received dialysis treatment more than 
once a week in this setting.
    The August 9, 2002 proposed rule states that we would allow payment 
for this unscheduled dialysis under exceptional circumstances, and 
these circumstances would be (1) dialysis

[[Page 66805]]

 performed following or in connection with a vascular access procedure; 
(2) dialysis performed following treatment for an unrelated medical 
emergency; and (3) emergency dialysis. These are the only situations in 
which payment would be made for dialysis provided in the outpatient 
department of a hospital without a certified dialysis facility. As 
stated above, we plan on issuing instructions governing the specific 
use of this code at a later date.
    Comment: The commenter requested clarification as to whether an 
emergency department that is part of a larger hospital that contains a 
certified dialysis unit is already considered an ESRD certified 
location. Specifically, is this proposed payment change only for those 
providers that do not have a certified dialysis unit on their premises, 
making them a non-ESRD certified outpatient facility? If the answer is 
yes, then would the emergency department that is part of the hospital 
that has an ESRD-certified location bill the new dialysis G code if 
dialysis is given on an emergency basis while the ESRD certified 
location is closed?
    Response: The proposed G code is specifically designated for an 
outpatient department of a hospital that does not have a certified ESRD 
facility. Therefore, a hospital's emergency department cannot use the 
code just because the certified dialysis facility is closed. The basis 
for this decision is to prevent potential fraud and abuse. We do not 
want dialysis facilities to use this as a means of circumventing the 
current requirements to receive a higher reimbursement rate for 
providing dialysis treatment. As stated above, we plan on issuing 
instructions governing the specific use of this code at a later date.

XI. Summary and Responses of Public Comments to CMS's Response to 
MedPAC Recommendations

    In the August 9, 2002 proposed rule, we responded to the Medicare 
Payment Advisory Commission (MedPAC) March 2002 Report to the Congress: 
``Medicare Payment Policy,'' recommendations relating to the OPPS (67 
FR 52141 through 52143). We received no comments on our responses to 
MedPAC's recommendations. Therefore, we will not discuss that response 
further here. We did receive comments from MedPAC on other issues in 
the proposed rule. For convenience we group those comments and our 
responses here:
    Comment: MedPAC endorsed our proposal to create APCs for procedures 
involving drug-eluting stents and noted, ``This step illustrates that 
CMS can respond rapidly to ensure adequate payment for technologies 
that are thought to be of a breakthrough nature.'' The Commission noted 
that our reliance on data from other countries to set the payment rate 
for this new technology appeared adequate in this instance. However, it 
expressed some reservation about the long-term issues that might attend 
more general use of such data. MedPAC has begun to consider these 
issues in more depth and urges us to do so as well.
    Response: We appreciate the Commission's views. We have adopted our 
proposal for drug-eluting stents, including our method of setting the 
payment rate. We will give further consideration to the issues involved 
in use of foreign data.
    Comment: MedPAC discussed the possibility that a pro rata reduction 
to payments for transitional pass-through drugs and devices would be 
needed this year, though we had not reached a conclusion on this 
question in the August 9, 2002 proposed rule. The Commission commented 
that even if a modest pro rata reduction is needed, it does not 
anticipate serious consequences for access to new technology services 
for several reasons. First, the methods for calculating transitional 
pass-through payments may overcompensate for these services. Second, 
hospitals are still likely to use these items to improve care and 
maintain reputations for excellence. Third, little evidence is 
available that indicates access problems resulting from the large pro 
rata reduction in 2002. Fourth, asking hospitals to share in the costs 
of new technologies gives them incentives to assess their value before 
adopting them.
    Response: We have concluded that no pro rata reduction will be 
necessary for 2003. We appreciate and agree with the Commission's 
analysis of the possible effects of a pro rata reduction.
    Comment: Regarding payment for medical devices no longer eligible 
for transitional pass-through payments, MedPAC urged us to work with 
stakeholders in instances where creditable evidence is available that 
coding issues may have led to inaccurate payment rates. The Commission 
does not believe that an extension of transitional pass-through 
eligibility is warranted or that data other than hospital cost data 
should be used where reliable hospital cost data are available. It also 
urged us to monitor beneficiary access to procedures that include such 
devices if payments are cut significantly.
    Response: We agree that extension of transitional pass-through 
eligibility is not warranted, and we do not believe that the statute 
contemplates that it could be continued. We also agree that 
stakeholders may have valuable input, and as we describe elsewhere in 
this final rule, we have received a great deal of helpful information 
that has informed the policies adopted in this rule designed to 
moderate payment reductions that may be associated with use of devices 
(and of drugs) previously in transitional pass-through status. We also 
agree that monitoring access by beneficiaries to these procedures is 
important, and we expect to do so to the extent feasible.
    Comment: MedPAC expressed concern that our proposal to pay 
separately for high-cost drugs but not for other drugs has the 
potential to distort the payment system. Where drugs may substitute for 
one another, hospitals may face incentives to use those paid 
separately. The Commission urged us to limit the amount of time this 
policy is followed and to work to move more drugs into the procedure 
APCs.
    Response: We agree that this policy may have distorting effects on 
incentives, and we do not intend to use it longer than necessary. In 
future years, we hope to propose additional changes to this policy, and 
in particular to package drugs into procedure APCs where this approach 
appears reasonable. We hope further improvements in our data and 
further attention to the structure of APCs involving the use of drugs, 
such as those for infusion and injection, will provide the foundation 
for future policy development in this area.
    Comment: MedPAC commented that hospital cost data are preferable to 
AWPs set by manufacturers. The Commission indicated the need to give 
careful consideration to stakeholder comments on payment for drugs and 
the importance of monitoring beneficiary access.
    Response: We agree.
    Comment: MedPAC commented that the reductions in payments for drugs 
that may no longer be eligible for transitional pass-through payments 
based on 95 percent of average wholesale price (AWP) will result in 
lower payments for these drugs than in other settings, such as 
physicians' offices. These differences may lead to shifts in the site 
of care based on financial considerations. MedPAC commented that this 
effect is not sufficient reason to change payments for these drugs in 
the hospital outpatient setting, but that it indicates the need for a 
new approach to paying for Part B drugs.

[[Page 66806]]

    Response: The possibility of inappropriate shifts in site of 
service is a source of concern. We note, however, that payment rates 
for these drugs only shifted to 95 percent of AWP at the inception of 
the OPPS; before that time, Medicare paid for drugs in outpatient 
departments at reasonable cost, subject to statutory reductions. 
Medicare payment for drugs in physicians' offices has been set at 95 
percent of AWP throughout this period. It is not clear that the 
increase in drug payments in outpatient departments from August 2000 to 
the present has led to substantial shifts in site of service, and the 
response to the forthcoming reductions may be muted as well. 
Nonetheless, we believe that Medicare should attempt to align payments 
across settings to the greatest extent possible in order to avoid 
inappropriate incentives to shift the site of service. In particular, 
we agree that a new approach to paying for Part B drugs would be 
desirable.
    Comment: MedPAC noted that we have the statutory authority to 
modify updates to correct for unnecessary increases in the volume of 
services or for ``upcoding'' by hospitals. The Commission urged us to 
carefully track the volume of services and increases in coding 
intensity.
    Response: We have not proposed any adjustment to the update for 
either of these reasons, and we will not adopt any such adjustment for 
2003. We continue to monitor the progress of the OPPS system to discern 
whether we should make any such adjustment in the future.
    Comment: MedPAC noted that small rural hospitals will continue to 
be held harmless for losses under the OPPS in 2003. The Commission 
urged us to study the performance of small rural hospitals and evaluate 
the impact of the end of their hold-harmless status.
    Response: We agree that small rural hospitals warrant special 
attention. We expect to study the effect of the transitional corridor 
provision, including the protection it affords these hospitals, in the 
period since the implementation of the OPPS so that we can help 
evaluate what provision would be appropriate for 2004 and beyond.

XII. Provisions of the Final Rule With Comment for 2003

A. OPPS

    The provisions of this final rule with comment restate changes to 
the Medicare hospital OPPS and CY 2003 payment rates including changes 
used to determine these payment rates set forth in the August 9, 2002 
proposed rule, except as noted elsewhere in the preamble. The following 
is a highlight of provisions implemented in this final rule, which are 
discussed in detail above.
1. Statutory and Discretionary Changes
    [sbull] We revised the methodology for calculating relative weights 
to dampen the difference in the median costs for all APCs for which the 
median costs fell more than 15 percent from 2002 to 2003; used only 
claims on which devices were reported to set the median for APCs for 
which the device was either essential or frequently used in the 
procedures in the APC; split some APCs for which devices were an issue 
to achieve more accurate pricing; limited the reduction in median costs 
for blood and certain blood products to 11 percent, which limited the 
reduction in payment from 2002 to 2003 to about 15 percent; used 
acquisition costs from external sources as a factor together with 
claims data in setting adjusted medians for four APCs.
    [sbull] We reviewed and revised the composition of APCs to comply 
with the limitation on variation in procedure medians and to achieve 
more accurate reflections of the costs.
    [sbull] We removed from pass-through status those drugs and devices 
that will have been on pass-through status for at least 2 years on 
January 1, 2003. We packaged the costs of the expiring devices into the 
payments for the APCs with which the devices were billed. We packaged 
the costs of the expiring drugs into the APCs with which the drugs were 
billed if the per encounter drug cost was less than $150; we 
established APCs for those drugs for which the per encounter drug cost 
was more than $150 and for blood and certain blood products. We paid 
for influenza and pneumococcal pneumonia vaccines and orphan drugs on a 
reasonable cost basis.
    [sbull] We estimated the amount of payment that would be made under 
the pass through provisions and compared it to 2.5 percent of the 
projected program expenditures; we determined that no pro rata 
reduction would be needed for 2003, and we adjusted the conversion 
factor accordingly.
    [sbull] We established the percentages by which pass-through 
devices would be reduced to remove the part of the payment that is 
packaged into the APC when it is billed with the device.
    [sbull] We finalized the regulations that describe the criteria 
that must be met for a device to get a pass-through code.
    [sbull] We issued the 2003 wage index and conversion factor that 
would be applied to the relative weights to determine the amount of 
payment for a particular hospital.
2. Changes to the Regulations Text
    [sbull] We amended Sec.  419.21(d)(3) to delete influenza and 
pneumococcal pneumonia vaccines from the list of items that are paid to 
CORFs, HHAs, and hospices under OPPS.
    [sbull] We amended 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. We 
received no comments concerning this technical correction to our 
regulations text. We are making this proposal final in this final rule.

B. Payment Suspension for Unfiled Cost Reports

    We are adopting the provisions set forth in the proposed rule 
without change.

C. Partial Hospitalization Services

    In the August 9, 2002 proposed rule, we indicated we would be 
addressing comments received on our proposal to establish a new payment 
amount for partial hospitalization services and remove clinical social 
worker services from the partial hospitalization benefit. Upon further 
review we have determined that we will not include this issue in this 
final rule, but will address it in future rulemaking.

D. Pneumococcal and Influenza Vaccines

    Section 419.21(d)(3) states that ``Pneumococcal vaccine, influenza 
vaccine, and hepatitis B vaccine'' are paid under the OPPS for 
comprehensive outpatient rehabilitation facilities, home health 
agencies, and hospices. There is no specific inclusion of hospitals, 
but we have paid hospitals for them under the OPPS since the OPPS 
began. We are removing the pneumococcal vaccine and influenza vaccine 
from this paragraph and want to pay for it under reasonable cost. We 
are requesting public comment on this change.

XIII. Response to Public Comments

    Because of the large number of items of correspondence we normally 
receive on Federal Register documents published for comment, we are not 
able to acknowledge or respond to them individually. We will consider 
all comments we receive by the date and time specified in the DATES 
section of this preamble, and, if we proceed with a subsequent 
document, we will respond to comments in the preamble to that document.

[[Page 66807]]

XIV. Collection of Information Requirements

    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.

XV. Regulatory Impact Analysis

    The regulatory impact analysis for this final 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 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.
    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibility of duties) 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 in any 1 year).
    We estimate the effects of the provisions that will be implemented 
by this final rule will result in expenditures exceeding $100 million 
in any 1 year. We estimate the total increase (from changes in the 
final 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 final 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 million to $29 million in 
any 1 year (see 65 FR 69432).
    For purposes of the RFA, we have determined that approximately 37 
percent of hospitals will 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 that would be considered to be small 
entities according to the SBA size standards. 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), 
with $5.7 billion in annual sales, 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 604 of the RFA. With 
the exception of hospitals located in certain New England counties, for 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital 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 final rule will 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 final rule has a significant impact on 
a substantial number of small entities. However, the statute provides 
for small rural hospitals (of fewer than 100 beds) to be held harmless 
by the law and to continue to be paid at cost; therefore this final 
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 final rule will not 
mandate any requirements for State, local, or tribal governments. This 
final 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 final 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) will increase by 5 percent under the final rule.
2. Changes in this Final Rule
    We are making 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 
final rule, we are updating the conversion factor and the wage index 
adjustment for hospital outpatient services furnished beginning January 
1, 2003 as we discuss in sections VIII and VI, respectively, of this 
preamble. We are also revising the relative APC payment weights based 
on claims data from January 1, 2001 through December 31, 2001. Finally, 
we are removing 95 devices and more than 200 drugs and biologicals from 
pass-through payment status.
    Under this final rule, the change to the conversion factor as 
provided by statute will increase total OPPS payments by 3.7 percent in 
2003. The changes to the wage index and to the APC weights (which 
incorporate the cessation of pass-through payments for many drugs and 
devices) do not increase OPPS payments because the OPPS is budget 
neutral. However, the

[[Page 66808]]

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 are making and the reasons that we 
are choosing not to make them are discussed throughout this final 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 IV.C regarding the expiration of 
pass-through payment for devices and section IV.D 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 are not choosing 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 IV of this final rule.). We are not choosing 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 will provide a 
basis for some devices to be packaged and for others to be paid 
separately must 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 are not choosing 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 paying 
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 final rule will 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 final rule, 
constitutes a regulatory impact analysis.
    The OPPS rates for CY 2003 will have, overall, a positive effect 
for every category of hospital with the exception of children's 
hospitals, which are held harmless under the OPPS. These changes in the 
OPPS for 2003 will result in an overall 3.7 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 ensure 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 (3.1 percent) than the average increase for all 
hospitals (3.7 percent) while the increase for rural hospitals is 
significantly greater (6.2 percent) than the average increase. Rural 
hospitals gain 2.2 percent from the wage index change, and also gain 
0.1 percent from APC changes. A discussion of the distribution of 
outlier payments that we project under this final rule can be found 
under section XV.A.4 below. Table 11 presents the outlier distribution 
that we expect to see under this final rule.
3. Limitations of Our Analysis
    The distributional impacts represent the projected effects of the 
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 Final 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 final rule, hospitals 
will receive more total payment than in 2002 while in other cases they 
will receive less total payment than they received in 2002. The impact 
of this final rule will 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 will 
change) and the impact of the wage index changes on the hospital.
    Column 4 in Table 12 represents the full impact on each hospital 
group of all the changes for 2003. Columns 2 and 3 in the table reflect 
the independent effects of the 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 
2003 OPPS rates that is summarized in Table 12. 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 will experience a negative impact due to wage index 
changes are those in Puerto Rico, a decrease of 3.2 percent. 
Conversely, the urban hospitals are generally negatively

[[Page 66809]]

affected by wage index changes, with the largest decreases occurring in 
those with 300 to 499 beds (-0.7 percent) and those in the Middle 
Atlantic (-1.0 percent), Pacific (-1.2 percent), and Puerto Rico 
Regions (-1.6 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 300 to 499 beds (-0.6 
percent decrease) and urban hospitals in excess of 500 beds (a -0.8 
percent decrease) all show a decrease attributed to APC recalibration. 
However, this decrease is much less than what would have occurred under 
the proposed rule.
    In urban 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 higher volumes 
are expected to receive higher increases in payments. In rural areas, 
hospitals with volumes greater than 42,999 services are projected to 
experience a significant increase in payments (7.7 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 2.8 percent 
due to these changes.
    Major teaching hospitals are projected to experience a smaller 
increase in payments (2.7 percent) than the aggregate for all hospitals 
(3.7 percent) due to negative impacts of the wage index (-0.3 percent) 
and recalibration (-0.8 percent). Hospitals with less intensive 
teaching programs are projected to experience an overall increase (3.2 
percent) that is smaller than the average for all hospitals.

             Table 12.--Impact of Changes for CY 2003 Hospital Outpatient Prospective Payment System
    [Percent change in total payments to hospitals (program and beneficiary); does not include hold harmless,
                            corridor, outlier or transitional pass-through payments]
----------------------------------------------------------------------------------------------------------------
                                                    Number of                                      All CY 2003
                                                  Hospitals\1\   New Wage Index    APC Changes     Changes \4\
                                                       (1)          \2\  (2)        \3\  (3)           (4)
----------------------------------------------------------------------------------------------------------------
ALL HOSPITALS..................................           4,519               0               0              3.7
NON-TEFRA HOSPITALS............................           3,989               0            -0.1              3.6
URBAN HOSPS....................................           2,420            -0.5            -0.1              3.1
    LARGE URBAN (GT 1 MILL.)...................           1,397            -0.6            -0.1              3.1
    OTHER URBAN (LE 1 MILL.)...................           1,023            -0.5            -0.1              3.1
RURAL HOSPS....................................           1,569             2.2             0.1              6.2
BEDS (URBAN):
    0-99 BEDS..................................             550            -0.4             0.7              4.0
    100-199 BEDS...............................             877            -0.6             0.6              3.7
    200-299 BEDS...............................             488            -0.6             0.1              3.3
    300-499 BEDS...............................             364            -0.7            -0.6              2.4
    500+ BEDS..................................             141            -0.1            -0.8              2.8
BEDS (RURAL):
    0-49 BEDS..................................             752             0.2               0              4.0
    50-99 BEDS.................................             478             1.4            -0.3              4.9
    100-149 BEDS...............................             200             2.4             0.3              6.6
    150-199 BEDS...............................              73             5.4            -0.5              8.9
    200+ BEDS..................................              66             3.1             0.8              8.0
VOLUME (URBAN):
    LT 5,000...................................             182             0.9             3.4              8.0
    5,000-10,999...............................             293            -0.8             2.2              5.2
    11,000-20,999..............................             476            -0.7             1.1              4.2
    21,000-42,999..............................             667            -0.7             0.2              3.2
    GT 42,999..................................             802            -0.5            -0.4              2.8
VOLUME (RURAL):
    LT 5,000...................................             334               0             1.1              4.9
    5,000-10,999...............................             419             0.3             1.2              5.4
    11,000-20,999..............................             387             1.2               0              5.0
    21,000-42,999..............................             295             1.9               0              5.8
    GT 42,999..................................             134             4.1            -0.3              7.7
REGION (URBAN):
    NEW ENGLAND................................             127            -0.6             0.4              3.4
    MIDDLE ATLANTIC............................             372              -1             0.1              2.7
    SOUTH ATLANTIC.............................             367            -0.3             0.5              3.9
    EAST NORTH CENT............................             411            -0.7            -0.9              2.1
    EAST SOUTH CENT............................             153            -0.8            -0.1              2.8
    WEST NORTH CENT............................             170            -0.6            -1.1              2.0
    WEST SOUTH CENT............................             292               1               0              4.8
    MOUNTAIN...................................             122             0.2            -0.8              3.0
    PACIFIC....................................             367            -1.2             0.8              3.3
    PUERTO RICO................................              39            -1.6             2.1              4.1
REGION (RURAL):
    NEW ENGLAND................................              40             1.7            -0.2              5.3
    MIDDLE ATLANTIC............................              63             1.9            -0.5              5.3
    SOUTH ATLANTIC.............................             224             2.4             0.9              7.2
    EAST NORTH CENT............................             212             1.1            -1.7              3.2
    EAST SOUTH CENT............................             232             2.2             1.2              7.3
    WEST NORTH CENT............................             271             1.8            -0.6              5.0

[[Page 66810]]

 
    WEST SOUTH CENT............................             278             1.9             1.4              7.2
    MOUNTAIN...................................             141             4.6            -0.6              7.9
    PACIFIC....................................             103             4.9               1             10.0
    PUERTO RICO................................               5            -3.2             7.2              7.6
TEACHING STATUS:
    NON-TEACHING...............................           2,922             0.3             0.3              4.4
    MINOR......................................             782            -0.3            -0.2              3.2
    MAJOR......................................             284            -0.3            -0.8              2.7
DSH PATIENT PERCENT:
    0..........................................              11             5.3             5.5             15.3
    GT 0-0.10..................................             975            -0.2            -0.6              2.9
    0.10-0.16..................................             872             0.6            -0.6              3.7
    0.16-0.23..................................             766            -0.6               0              3.1
    0.23-0.35..................................             755            -0.1             0.4              4.1
    GE 0.35....................................             610             0.1             1.6              5.5
URBAN IME/DSH:
    IME & DSH..................................             982            -0.6            -0.4              2.7
    IME/NO DSH.................................               0               0               0              0.0
    NO IME/DSH.................................           1,432            -0.5             0.4              3.6
    NO IME/NO DSH..............................               6             6.1             5.1             15.7
RURAL HOSP. TYPES:
    NO SPECIAL STATUS..........................             607             0.5             0.3              4.6
    RRC........................................             167             4.2             0.2              8.4
    SCH/EACH...................................             507             1.4            -0.1              5.1
    MDH........................................             199             0.5            -0.7              3.6
    SCH AND RRC................................              75             3.8             0.1              7.9
TYPE OF OWNERSHIP:
    VOLUNTARY..................................           2,434            -0.1            -0.2              3.5
    PROPRIETARY................................             703            -0.5             0.5              3.7
    GOVERNMENT.................................             852             0.6               0              4.4
SPECIALTY HOSPITALS:
    EYE AND EAR................................              13            -1.3             9.1             11.7
    TRAUMA.....................................             153            -0.3            -0.6              2.9
    CANCER.....................................              10               1            -4.5              0.4
TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES):
    REHAB......................................             163            10.1             0.8             14.7
    PSYCH......................................             191               0             7.4             11.4
    LTC........................................             135             4.3            15.1             23.0
    CHILDREN...................................              41            -1.4              -1             1.3
----------------------------------------------------------------------------------------------------------------
\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 FY 2003
  hospital inpatient wage index after geographic reclassification by the Medicare Geographic Classification
  Review Board. The hospital inpatient final 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.
\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 FY 2003 payment update. The sum of the columns may be different from the percentage changes shown here due
  to rounding.



    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.

    As stated elsewhere in this preamble, we have allocated 2 percent 
of the estimated 2003 expenditures to outlier payments. In Table 13 
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.
    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.

[[Page 66811]]



     Table 13.--Distribution of Outlier Payments for CY 2003 Hospital Outpatient Prospective Payment System
----------------------------------------------------------------------------------------------------------------
                                                                                   Number of        Percent of
                                                 Number of        Percent of     Hospitals with   Total Outlier
                                                 Hospitals     Total Hospitals      Outliers         Payments
----------------------------------------------------------------------------------------------------------------
ALL HOSPITALS...............................            4,519           100.00            4,298           100.00
NON-TEFRA HOSPITALS.........................            3,989            88.20            3,977            99.40
URBAN HOSPS.................................            2,420            53.60            2,413            83.20
    LARGE URBAN (GT 1 MILL.)................            1,397            31.00            1,394            56.00
    OTHER URBAN (LE 1 MILL.)................            1,023            22.60            1,019            27.20
RURAL HOSPS.................................            1,569            34.80            1,564            16.20
BEDS (URBAN):
    0-99 BEDS...............................              550            12.20              545             7.20
    100-199 BEDS............................              877            19.40              875            18.20
    200-299 BEDS............................              488            10.80              488            16.80
    300-499 BEDS............................              364             8.00              364            21.00
    500 + BEDS..............................              141             3.20              141            19.80
BEDS (RURAL):
    0-49 BEDS...............................              752            16.60              749             4.40
    50-99 BEDS..............................              478            10.60              477             5.00
    100-149 BEDS............................              200             4.40              199             2.40
    150-199 BEDS............................               73             1.60               73             2.00
    200 + BEDS..............................               66             1.40               66             2.20
VOLUME (URBAN):
    LT 5,000................................              182             4.00              176             1.00
    5,000-10,999............................              293             6.40              292             2.80
    11,000-20,999...........................              476            10.60              476             6.80
    21,000-42,999...........................              667            14.80              667            17.60
    GT 42,999...............................              802            17.80              802            55.00
VOLUME (RURAL):
    LT 5,000................................              334             7.40              330             1.00
    5,000-10,999............................              419             9.20              418             2.40
    11,000-20,999...........................              387             8.60              387             4.00
    21,000-42,999...........................              295             6.60              295             4.20
    GT 42,999...............................              134             3.00              134             4.40
REGION (URBAN):
    NEW ENGLAND.............................              127             2.80              126             5.60
    MIDDLE ATLANTIC.........................              372             8.20              371            24.20
    SOUTH ATLANTIC..........................              367             8.20              366            11.40
    EAST NORTH CENT.........................              411             9.00              408            14.80
    EAST SOUTH CENT.........................              153             3.40              153             3.20
    WEST NORTH CENT.........................              170             3.80              170             4.20
    WEST SOUTH CENT.........................              292             6.40              292             8.00
    MOUNTAIN................................              122             2.60              122             3.00
    PACIFIC.................................              367             8.20              366             8.80
    PUERTO RICO.............................               39             0.80               39             0.00
REGION (RURAL):
    NEW ENGLAND.............................               40             0.80               40             1.00
    MIDDLE ATLANTIC.........................               63             1.40               63             1.00
    SOUTH ATLANTIC..........................              224             5.00              222             3.00
    EAST NORTH CENT.........................              212             4.60              211             3.00
    EAST SOUTH CENT.........................              232             5.20              232             1.60
    WEST NORTH CENT.........................              271             6.00              270             2.40
    WEST SOUTH CENT.........................              278             6.20              278             1.60
    MOUNTAIN................................              141             3.20              141             1.40
    PACIFIC.................................              103             2.20              102             1.20
    PUERTO RICO.............................                5             0.20                5             0.00
TEACHING STATUS:
    NON-TEACHING............................            2,922            64.60            2,910            40.40
    MINOR...................................              782            17.40              782            27.00
    MAJOR...................................              284             6.20              284            31.80
DSH PATIENT PERCENT:
    0.......................................               11             0.20               11             0.00
    GT 0-0.10...............................              975            21.60              973            24.60
    0.10-0.16...............................              872            19.20              872            19.20
    0.16-0.23...............................              766            17.00              764            17.60
    0.23-0.35...............................              755            16.80              752            19.40
    GE 0.35.................................              610            13.40              605            18.40
URBAN IME/DSH:
    IME & DSH...............................              982            21.80              982            56.60
    IME/NO DSH..............................                0             0.00                0             0.00
    NO IME/DSH..............................            1,432            31.60            1,425            26.40
    NO IME/NO DSH...........................                6             0.20                6             0.00
RURAL HOSP. TYPES:
    NO SPECIAL STATUS.......................              607            13.40              605             5.00

[[Page 66812]]

 
    RRC.....................................              167             3.60              166             4.00
    SCH/EACH................................              507            11.20              507             4.40
    MDH.....................................              199             4.40              198             1.20
    SCH AND RRC.............................               75             1.60               75             1.60
TYPE OF OWNERSHIP:
    VOLUNTARY...............................            2,434            53.80            2,431            73.60
    PROPRIETARY.............................              703            15.60              699            10.60
    GOVERNMENT..............................              852            18.80              847            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             3.60
TEFRA HOSPITALS (NOT INCLUDED ON OTHER
 LINES):
    REHAB...................................              163             3.60              115             0.20
    PSYCH...................................              191             4.20               67             0.00
    LTC.....................................              135             3.00               99             0.20
    CHILDREN................................               41             1.00               40             0.20
----------------------------------------------------------------------------------------------------------------

5. Estimated Impacts of This Final Rule on Beneficiaries
    For services for which the beneficiary pays a coinsurance of 20 
percent of the payment rate, the beneficiary share of payment will 
increase for services for which OPPS payments will rise and will 
decrease for services for which OPPS payments will fall. For example 
for a mid level office visit (APC 0601), the minimum unadjusted 
copayment in 2002 was $9.67; under this final rule, the minimum 
unadjusted copayment for APC 601 is $10.11 because the OPPS payment for 
the service will increase under this final 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 will 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, and is $840 for 2003. 
In general, the impact of this final rule on beneficiaries will 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 final rule as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review), 
the Regulatory Flexibility Act (RFA) (September 16, 1980, Public Law 
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 
XV.A.1.)
    We have determined that the payment suspension provision does not 
have an economic impact on Medicare payments or other payments to 
providers. We are allowing 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 will 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 final 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 regulation. 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 will 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 will 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 provision, the Secretary will have 
the

[[Page 66813]]

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 payment suspension 
provision does not have an economic impact on Medicare payments.

C. 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 419

    Hospitals, Medicare, Reporting and recordkeeping requirements.

    For the reasons set forth in the preamble, the Centers for Medicare 
& Medicaid Services amends 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 of part 405 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 419--PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL OUTPATIENT 
DEPARTMENT SERVICES

    1. The authority citation for part 419 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).

    2. In Sec.  419.21, paragraph (d)(3) is revised to read as follows:


Sec.  419.21  Hospital outpatient services subject to the outpatient 
prospective payment system.

* * * * *
    (d) * * *
    (3) Hepatitis B vaccine.


Sec.  419.66  [Amended]

    3. 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: October 23, 2002.
Thomas A. Scully,
Administrator, Centers for Medicare and Medicaid Services.
    Approved: October 23, 2002.
Tommy G. Thompson,
Secretary.

[[Page 66814]]



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
----------------------------------------------------------------------------------------------------------------
0001                Level I                 S...................      0.3779      $19.71       $7.09       $3.94
                     Photochemotherapy.
0002                Fine needle Biopsy/     T...................      0.5911      $30.83  ..........       $6.17
                     Aspiration.
0003                Bone Marrow Biopsy/     T...................      1.2306      $64.18  ..........      $12.84
                     Aspiration.
0004                Level I Needle Biopsy/  T...................      1.7441      $90.96      $23.47      $18.19
                     Aspiration Except
                     Bone Marrow.
0005                Level II Needle Biopsy  T...................      3.1201     $162.72      $71.59      $32.54
                     /Aspiration Except
                     Bone Marrow.
0006                Level I Incision &      T...................      1.7926      $93.49      $24.12      $18.70
                     Drainage.
0007                Level II Incision &     T...................     10.0191     $522.51     $108.89     $104.50
                     Drainage.
0008                Level III Incision and  T...................     16.1430     $841.87  ..........     $168.37
                     Drainage.
0009                Nail Procedures.......  T...................      0.6298      $32.84       $8.34       $6.57
0010                Level I Destruction of  T...................      0.6589      $34.36      $10.08       $6.87
                     Lesion.
0011                Level II Destruction    T...................      1.8507      $96.52      $27.88      $19.30
                     of Lesion.
0012                Level I Debridement &   T...................      0.7849      $40.93      $11.18       $8.19
                     Destruction.
0013                Level II Debridement &  T...................      1.0756      $56.09      $14.20      $11.22
                     Destruction.
0015                Level III Debridement   T...................      1.5407      $80.35      $20.35      $16.07
                     & Destruction.
0016                Level IV Debridement &  T...................      2.6162     $136.44      $57.31      $27.29
                     Destruction.
0017                Level VI Debridement &  T...................     15.8233     $825.20     $227.84     $165.04
                     Destruction.
0018                Biopsy of Skin/         T...................      0.9399      $49.02      $16.04       $9.80
                     Puncture of Lesion.
0019                Level I Excision/       T...................      3.7693     $196.57      $71.87      $39.31
                     Biopsy.
0020                Level II Excision/      T...................      7.1898     $374.96     $113.25      $74.99
                     Biopsy.
0021                Level III Excision/     T...................     13.9338     $726.66     $219.48     $145.33
                     Biopsy.
0022                Level IV Excision/      T...................     17.3930     $907.06     $354.45     $181.41
                     Biopsy.
0023                Exploration             T...................      2.5193     $131.38      $40.37      $26.28
                     Penetrating Wound.
0024                Level I Skin Repair...  T...................      1.8507      $96.52      $34.75      $19.30
0025                Level II Skin Repair..  T...................      5.8623     $305.72     $115.49      $61.14
0027                Level IV Skin Repair..  T...................     15.2225     $793.87     $329.72     $158.77
0028                Level I Breast Surgery  T...................     16.8698     $879.78     $303.74     $175.96
0029                Level II Breast         T...................     28.7881   $1,501.33     $632.64     $300.27
                     Surgery.
0030                Level III Breast        T...................     37.5185   $1,956.63     $763.55     $391.33
                     Surgery.
0032                Insertion of Central    T...................     11.4726     $598.31  ..........     $119.66
                     Venous/Arterial
                     Catheter.
0033                Partial                 P...................      4.6026     $240.03      $48.17      $48.01
                     Hospitalization.
0035                Placement of Arterial   T...................      0.2229      $11.62       $3.51       $2.32
                     or Central Venous
                     Catheter.
0041                Level I Arthroscopy...  T...................     26.1234   $1,362.36  ..........     $272.47
0042                Level II Arthroscopy..  T...................     40.9680   $2,136.52     $804.74     $427.30
0043                Closed Treatment        T...................      2.4999     $130.37  ..........      $26.07
                     Fracture Finger/Toe/
                     Trunk.
0045                Bone/Joint              T...................     12.9357     $674.61     $268.47     $134.92
                     Manipulation Under
                     Anesthesia.
0046                Open/Percutaneous       T...................     29.2920   $1,527.61     $535.76     $305.52
                     Treatment Fracture or
                     Dislocation.
0047                Arthroplasty without    T...................     28.2842   $1,475.05     $537.03     $295.01
                     Prosthesis.
0048                Arthroplasty with       T...................     40.6289   $2,118.84     $695.60     $423.77
                     Prosthesis.
0049                Level I                 T...................     18.6042     $970.23     $197.14     $194.05
                     Musculoskeletal
                     Procedures Except
                     Hand and Foot.
0050                Level II                T...................     23.3037   $1,215.31  ..........     $243.06
                     Musculoskeletal
                     Procedures Except
                     Hand and Foot.
0051                Level III               T...................     32.9062   $1,716.09  ..........     $343.22
                     Musculoskeletal
                     Procedures Except
                     Hand and Foot.
0052                Level IV                T...................     40.7646   $2,125.91  ..........     $425.18
                     Musculoskeletal
                     Procedures Except
                     Hand and Foot.
0053                Level I Hand            T...................     14.1760     $739.29     $253.49     $147.86
                     Musculoskeletal
                     Procedures.
0054                Level II Hand           T...................     22.7223   $1,184.99  ..........     $237.00
                     Musculoskeletal
                     Procedures.
0055                Level I Foot            T...................     17.6740     $921.72     $355.34     $184.34
                     Musculoskeletal
                     Procedures.
0056                Level II Foot           T...................     22.1700   $1,156.19     $405.81     $231.24
                     Musculoskeletal
                     Procedures.
0057                Bunion Procedures.....  T...................     22.9064   $1,194.59     $475.91     $238.92
0058                Level I Strapping and   S...................      1.0368      $54.07  ..........      $10.81
                     Cast Application.
0060                Manipulation Therapy..  S...................      0.3294      $17.18  ..........       $3.44
0068                CPAP Initiation.......  S...................      2.0736     $108.14      $59.48      $21.63
0069                Thoracoscopy..........  T...................     27.5575   $1,437.15     $591.64     $287.43
0070                Thoracentesis/Lavage    T...................      3.3623     $175.35  ..........      $35.07
                     Procedures.
0071                Level I Endoscopy       T...................      0.9205      $48.00      $12.89       $9.60
                     Upper Airway.
0072                Level II Endoscopy      T...................      1.1628      $60.64      $26.68      $12.13
                     Upper Airway.
0073                Level III Endoscopy     T...................      3.1976     $166.76      $73.38      $33.35
                     Upper Airway.
0074                Level IV Endoscopy      T...................     12.8582     $670.57     $295.70     $134.11
                     Upper Airway.
0075                Level V Endoscopy       T...................     19.6604   $1,025.31     $445.92     $205.06
                     Upper Airway.
0076                Endoscopy Lower Airway  T...................      8.9533     $466.92     $189.82      $93.38
0077                Level I Pulmonary       S...................      0.2907      $15.16       $8.34       $3.03
                     Treatment.
0078                Level II Pulmonary      S...................      0.6492      $33.86      $14.55       $6.77
                     Treatment.
0079                Ventilation Initiation  S...................      1.6376      $85.40  ..........      $17.08
                     and Management.
0080                Diagnostic Cardiac      T...................     35.2996   $1,840.91     $838.92     $368.18
                     Catheterization.
0081                Non-Coronary            T...................     43.5067   $2,268.92  ..........     $453.78
                     Angioplasty or
                     Atherectomy.
0082                Coronary Atherectomy..  T...................     86.4321   $4,507.52   $1,293.59     $901.50
0083                Coronary Angioplasty    T...................     51.9755   $2,710.57  ..........     $542.11
                     and Percutaneous
                     Valvuloplasty.
0084                Level I                 S...................      9.3312     $486.63  ..........      $97.33
                     Electrophysiologic
                     Evaluation.
0085                Level II                T...................     41.7238   $2,175.94     $480.03     $435.19
                     Electrophysiologic
                     Evaluation.
0086                Ablate Heart Dysrhythm  T...................     52.8282   $2,755.04     $936.35     $551.01
                     Focus.

[[Page 66815]]

 
0087                Cardiac                 T...................     39.3983   $2,054.66  ..........     $410.93
                     Electrophysiologic
                     Recording/Mapping.
0088                Thrombectomy..........  T...................     32.5768   $1,698.91     $655.22     $339.78
0089                Insertion/Replacement   T...................    112.5555   $5,869.88   $1,722.59   $1,173.98
                     of Permanent
                     Pacemaker and
                     Electrodes.
0090                Insertion/Replacement   T...................     87.9631   $4,587.36   $1,651.45     $917.47
                     of Pacemaker Pulse
                     Generator.
0091                Level II Vascular       T...................     26.7048   $1,392.68     $348.23     $278.54
                     Ligation.
0092                Level I Vascular        T...................     23.7882   $1,240.58     $505.37     $248.12
                     Ligation.
0093                Vascular                T...................     20.6294   $1,075.84     $277.34     $215.17
                     Reconstruction/
                     Fistula Repair
                     without Device.
0094                Level I Resuscitation   S...................      3.8371     $200.11      $67.63      $40.02
                     and Cardioversion.
0095                Cardiac Rehabilitation  S...................      0.6105      $31.84      $16.73       $6.37
0096                Non-Invasive Vascular   S...................      1.7054      $88.94      $48.15      $17.79
                     Studies.
0097                Cardiac and Ambulatory  X...................      1.0077      $52.55      $23.80      $10.51
                     Blood Pressure
                     Monitoring.
0098                Injection of            T...................      1.6666      $86.91      $20.88      $17.38
                     Sclerosing Solution.
0099                Electrocardiograms....  S...................      0.3682      $19.20  ..........       $3.84
0100                Cardiac Stress Tests..  X...................      1.6085      $83.88      $41.44      $16.78
0101                Tilt Table Evaluation.  S...................      4.2247     $220.32     $105.27      $44.06
0103                Miscellaneous Vascular  T...................     11.8408     $617.51     $223.63     $123.50
                     Procedures.
0104                Transcatheter           T...................     76.5486   $3,992.09  ..........     $798.42
                     Placement of
                     Intracoronary Stents.
0105                Revision/Removal of     T...................     18.5945     $969.72     $370.40     $193.94
                     Pacemakers, AICD, or
                     Vascular.
0106                Insertion/Replacement/  T...................     54.8243   $2,859.14  ..........     $571.83
                     Repair of Pacemaker
                     and/or Electrodes.
0107                Insertion of            T...................    326.2231  $17,012.86   $3,699.14   $3,402.57
                     Cardioverter-
                     Defibrillator.
0108                Insertion/Replacement/  T...................    443.5460  $23,131.37  ..........   $4,626.27
                     Repair of
                     Cardioverter-
                     Defibrillator Leads.
0109                Removal of Implanted    T...................      7.4708     $389.61     $131.49      $77.92
                     Devices.
0110                Transfusion...........  S...................      4.0309     $210.22  ..........      $42.04
0111                Blood Product Exchange  S...................     14.9803     $781.24     $217.61     $156.25
0112                Apheresis,              S...................     36.4236   $1,899.53     $612.47     $379.91
                     Photopheresis, and
                     Plasmapheresis.
0113                Excision Lymphatic      T...................     18.7496     $977.81  ..........     $195.56
                     System.
0114                Thyroid/                T...................     36.1135   $1,883.36     $485.91     $376.67
                     Lymphadenectomy
                     Procedures.
0115                Cannula/Access Device   T...................     24.3211   $1,268.37     $459.35     $253.67
                     Procedures.
0116                Chemotherapy            S...................      0.7752      $40.43  ..........       $8.09
                     Administration by
                     Other Technique
                     Except Infusion.
0117                Chemotherapy            S...................      3.6046     $187.98      $48.28      $37.60
                     Administration by
                     Infusion Only.
0118                Chemotherapy            S...................      5.4844     $286.02      $72.03      $57.20
                     Administration by
                     Both Infusion and
                     Other Technique.
0119                Implantation of         T...................     89.3100   $4,657.61  ..........     $931.52
                     Devices.
0120                Infusion Therapy        T...................      2.1802     $113.70      $30.75      $22.74
                     Except Chemotherapy.
0121                Level I Tube changes    T...................      2.0833     $108.65      $43.80      $21.73
                     and Repositioning.
0122                Level II Tube changes   T...................     10.7459     $560.41     $114.93     $112.08
                     and Repositioning.
0123                Bone Marrow Harvesting  S...................      6.4049     $334.02  ..........      $66.80
                     and Bone Marrow/Stem
                     Cell Transplant.
0124                Revision of Implanted   T...................     50.0861   $2,612.04  ..........     $522.41
                     Infusion Pump.
0125                Refilling of Infusion   T...................      2.0639     $107.63  ..........      $21.53
                     Pump.
0130                Level I Laparoscopy...  T...................     30.4644   $1,588.75     $659.53     $317.75
0131                Level II Laparoscopy..  T...................     40.2026   $2,096.61   $1,001.89     $419.32
0132                Level III Laparoscopy.  T...................     56.9948   $2,972.34   $1,239.22     $594.47
0140                Esophageal Dilation     T...................      6.0948     $317.85     $107.24      $63.57
                     without Endoscopy.
0141                Upper GI Procedures...  T...................      7.4126     $386.57     $143.38      $77.31
0142                Small Intestine         T...................      8.1393     $424.47     $152.78      $84.89
                     Endoscopy.
0143                Lower GI Endoscopy....  T...................      7.9165     $412.85     $186.06      $82.57
0146                Level I Sigmoidoscopy.  T...................      3.4302     $178.89      $64.40      $35.78
0147                Level II Sigmoidoscopy  T...................      7.0153     $365.85      $79.46      $73.17
0148                Level I Anal/Rectal     T...................      3.4205     $178.38      $63.38      $35.68
                     Procedure.
0149                Level III Anal/Rectal   T...................     16.3756     $854.00     $293.06     $170.80
                     Procedure.
0150                Level IV Anal/Rectal    T...................     21.2398   $1,107.68     $437.12     $221.54
                     Procedure.
0151                Endoscopic Retrograde   T...................     17.5093     $913.13     $245.46     $182.63
                     Cholangio-
                     Pancreatography
                     (ERCP).
0152                Percutaneous Abdominal  T...................     10.0288     $523.01     $131.28     $104.60
                     and Biliary
                     Procedures.
0153                Peritoneal and          T...................     19.5441   $1,019.24     $410.87     $203.85
                     Abdominal Procedures.
0154                Hernia/Hydrocele        T...................     25.7262   $1,341.65     $464.85     $268.33
                     Procedures.
0155                Level II Anal/Rectal    T...................     10.1936     $531.61     $188.89     $106.32
                     Procedure.
0156                Level II Urinary and    T...................      2.9747     $155.13      $46.55      $31.03
                     Anal Procedures.
0157                Colorectal Cancer       S...................      2.5387     $132.40  ..........      $26.48
                     Screening: Barium
                     Enema.
0158                Colorectal Cancer       T...................      7.0638     $368.38  ..........      $92.10
                     Screening:
                     Colonoscopy.
0159                Colorectal Cancer       S...................      2.3255     $121.28  ..........      $30.32
                     Screening: Flexible
                     Sigmoidoscopy.
0160                Level I                 T...................      6.3080     $328.97     $105.06      $65.79
                     Cystourethroscopy and
                     other Genitourinary
                     Procedures.
0161                Level II                T...................     15.7070     $819.14     $249.36     $163.83
                     Cystourethroscopy and
                     other Genitourinary
                     Procedures.
0162                Level III               T...................     20.5906   $1,073.82  ..........     $214.76
                     Cystourethroscopy and
                     other Genitourinary
                     Procedures.
0163                Level IV                T...................     28.3714   $1,479.60  ..........     $295.92
                     Cystourethroscopy and
                     other Genitourinary
                     Procedures.
0164                Level I Urinary and     T...................      1.1240      $58.62      $17.59      $11.72
                     Anal Procedures.
0165                Level III Urinary and   T...................     12.2672     $639.75  ..........     $127.95
                     Anal Procedures.
0166                Level I Urethral        T...................     15.4163     $803.98     $218.73     $160.80
                     Procedures.
0167                Level III Urethral      T...................     28.3230   $1,477.07     $555.84     $295.41
                     Procedures.

[[Page 66816]]

 
0168                Level II Urethral       T...................     24.4665   $1,275.95     $405.60     $255.19
                     Procedures.
0169                Lithotripsy...........  T...................     44.0978   $2,299.74   $1,115.69     $459.95
0170                Dialysis..............  S...................      4.8352     $252.16  ..........      $50.43
0179                Urinary Incontinence    T...................    104.3581   $5,442.38   $2,340.22   $1,088.48
                     Procedures.
0180                Circumcision..........  T...................     18.1004     $943.95     $304.87     $188.79
0181                Penile Procedures.....  T...................     29.2435   $1,525.08     $621.82     $305.02
0182                Insertion of Penile     T...................     95.4145   $4,975.96  ..........     $995.19
                     Prosthesis.
0183                Testes/Epididymis       T...................     21.2592   $1,108.69  ..........     $221.74
                     Procedures.
0184                Prostate Biopsy.......  T...................      3.6918     $192.53      $96.27      $38.51
0187                Miscellaneous           X...................      3.9534     $206.17      $90.71      $41.23
                     Placement/
                     Repositioning.
0188                Level II Female         T...................      1.0465      $54.58      $11.95      $10.92
                     Reproductive Proc.
0189                Level III Female        T...................      1.5310      $79.84      $18.60      $15.97
                     Reproductive Proc.
0190                Surgical Hysteroscopy.  T...................     19.0596     $993.98     $424.28     $198.80
0191                Level I Female          T...................      0.2035      $10.61       $3.08       $2.12
                     Reproductive Proc.
0192                Level IV Female         T...................      2.7228     $142.00      $39.11      $28.40
                     Reproductive Proc.
0193                Level V Female          T...................     14.4764     $754.96     $171.13     $150.99
                     Reproductive Proc.
0194                Level VI Female         T...................     18.0228     $939.91     $397.84     $187.98
                     Reproductive Proc.
0195                Level VII Female        T...................     23.7301   $1,237.55     $483.80     $247.51
                     Reproductive Proc.
0196                Dilation and Curettage  T...................     15.5035     $808.52     $338.23     $161.70
0197                Infertility Procedures  T...................      1.5697      $81.86      $33.06      $16.37
0198                Pregnancy and Neonatal  T...................      1.2597      $65.69      $32.19      $13.14
                     Care Procedures.
0199                Obstetrical Care        T...................      3.9146     $204.15      $57.16      $40.83
                     Service.
0200                Therapeutic Abortion..  T...................     15.1838     $791.85     $307.83     $158.37
0201                Spontaneous Abortion..  T...................     15.3097     $798.42     $329.65     $159.68
0202                Level VIII Female       T...................     45.5610   $2,376.05   $1,164.26     $475.21
                     Reproductive Proc.
0203                Level IV Nerve          T...................     11.7924     $614.99     $276.76     $123.00
                     Injections.
0204                Level I Nerve           T...................      2.0251     $105.61      $40.13      $21.12
                     Injections.
0206                Level II Nerve          T...................      4.7867     $249.63      $75.55      $49.93
                     Injections.
0207                Level III Nerve         T...................      5.7654     $300.67     $123.69      $60.13
                     Injections.
0208                Laminotomies and        T...................     38.4487   $2,005.14  ..........     $401.03
                     Laminectomies.
0209                Extended EEG Studies    S...................     11.3369     $591.23     $280.58     $118.25
                     and Sleep Studies,
                     Level II.
0212                Nervous System          T...................      3.3139     $172.82      $79.53      $34.56
                     Injections.
0213                Extended EEG Studies    S...................      3.2557     $169.79      $70.41      $33.96
                     and Sleep Studies,
                     Level I.
0214                Electroencephalogram..  S...................      2.2286     $116.22      $58.12      $23.24
0215                Level I Nerve and       S...................      0.5814      $30.32      $15.76       $6.06
                     Muscle Tests.
0216                Level III Nerve and     S...................      2.8972     $151.09      $67.98      $30.22
                     Muscle Tests.
0218                Level II Nerve and      S...................      1.0077      $52.55  ..........      $10.51
                     Muscle Tests.
0220                Level I Nerve           T...................     15.8136     $824.70  ..........     $164.94
                     Procedures.
0221                Level II Nerve          T...................     21.5208   $1,122.33     $463.62     $224.47
                     Procedures.
0222                Implantation of         T...................    227.7370  $11,876.71  ..........   $2,375.34
                     Neurological Device.
0223                Implantation of Pain    T...................     41.0262   $2,139.56  ..........     $427.91
                     Management Device.
0224                Implantation of         T...................     34.0302   $1,774.71     $453.41     $354.94
                     Reservoir/Pump/Shunt.
0225                Implantation of         S...................    139.3379   $7,266.61  ..........   $1,453.32
                     Neurostimulator
                     Electrodes.
0226                Implantation of Drug    T...................    144.3474   $7,527.86  ..........   $1,505.57
                     Infusion Reservoir.
0227                Implantation of Drug    T...................    144.5122   $7,536.46  ..........   $1,507.29
                     Infusion Device.
0228                Creation of Lumbar      T...................     59.6207   $3,109.28     $696.46     $621.86
                     Subarachnoid Shunt.
0229                Transcatherter          T...................     57.4599   $2,996.59     $771.23     $599.32
                     Placement of
                     Intravascular Shunts.
0230                Level I Eye Tests &     S...................      0.7364      $38.40      $14.97       $7.68
                     Treatments.
0231                Level III Eye Tests &   S...................      2.1705     $113.19      $50.94      $22.64
                     Treatments.
0232                Level I Anterior        T...................      4.4960     $234.47     $103.17      $46.89
                     Segment Eye
                     Procedures.
0233                Level II Anterior       T...................     13.4202     $699.88     $266.33     $139.98
                     Segment Eye
                     Procedures.
0234                Level III Anterior      T...................     20.4259   $1,065.23     $511.31     $213.05
                     Segment Eye
                     Procedures.
0235                Level I Posterior       T...................      5.0871     $265.30      $73.44      $53.06
                     Segment Eye
                     Procedures.
0236                Level II Posterior      T...................     19.4278   $1,013.18  ..........     $202.64
                     Segment Eye
                     Procedures.
0237                Level III Posterior     T...................     33.2647   $1,734.79     $818.54     $346.96
                     Segment Eye
                     Procedures.
0238                Level I Repair and      T...................      2.9747     $155.13      $58.96      $31.03
                     Plastic Eye
                     Procedures.
0239                Level II Repair and     T...................      6.8119     $355.25     $115.94      $71.05
                     Plastic Eye
                     Procedures.
0240                Level III Repair and    T...................     16.3078     $850.47     $315.31     $170.09
                     Plastic Eye
                     Procedures.
0241                Level IV Repair and     T...................     20.6294   $1,075.84     $384.47     $215.17
                     Plastic Eye
                     Procedures.
0242                Level V Repair and      T...................     28.0517   $1,462.92     $597.36     $292.58
                     Plastic Eye
                     Procedures.
0243                Strabismus/Muscle       T...................     19.9705   $1,041.48     $431.39     $208.30
                     Procedures.
0244                Corneal Transplant....  T...................     35.6290   $1,858.09     $803.26     $371.62
0245                Level I Cataract        T...................     14.5442     $758.49     $251.21     $151.70
                     Procedures without
                     IOL Insert.
0246                Cataract Procedures     T...................     22.2379   $1,159.73     $495.96     $231.95
                     with IOL Insert.
0247                Laser Eye Procedures    T...................      4.7092     $245.59     $104.31      $49.12
                     Except Retinal.
0248                Laser Retinal           T...................      4.2925     $223.86      $95.08      $44.77
                     Procedures.
0249                Level II Cataract       T...................     26.7242   $1,393.69     $524.67     $278.74
                     Procedures without
                     IOL Insert.
0250                Nasal Cauterization/    T...................      1.6376      $85.40      $29.89      $17.08
                     Packing.

[[Page 66817]]

 
0251                Level I ENT Procedures  T...................      1.9089      $99.55  ..........      $19.91
0252                Level II ENT            T...................      5.8041     $302.69     $113.41      $60.54
                     Procedures.
0253                Level III ENT           T...................     14.4473     $753.44     $282.29     $150.69
                     Procedures.
0254                Level IV ENT            T...................     20.1158   $1,049.06     $321.35     $209.81
                     Procedures.
0256                Level V ENT Procedures  T...................     34.0302   $1,774.71  ..........     $354.94
0258                Tonsil and Adenoid      T...................     19.8736   $1,036.43     $437.25     $207.29
                     Procedures.
0259                Level VI ENT            T...................    367.6466  $19,173.14   $9,394.83   $3,834.63
                     Procedures.
0260                Level I Plain Film      X...................      0.7655      $39.92      $21.95       $7.98
                     Except Teeth.
0261                Level II Plain Film     X...................      1.2887      $67.21  ..........      $13.44
                     Except Teeth
                     Including Bone
                     Density Measurement.
0262                Plain Film of Teeth...  X...................      0.5717      $29.81       $9.82       $5.96
0263                Level I Miscellaneous   X...................      1.8992      $99.05      $43.58      $19.81
                     Radiology Procedures.
0264                Level II Miscellaneous  X...................      2.8197     $147.05      $79.41      $29.41
                     Radiology Procedures.
0265                Level I Diagnostic      S...................      0.9787      $51.04      $28.07      $10.21
                     Ultrasound Except
                     Vascular.
0266                Level II Diagnostic     S...................      1.5988      $83.38      $45.86      $16.68
                     Ultrasound Except
                     Vascular.
0267                Level III Diagnostic    S...................      2.4418     $127.34      $65.52      $25.47
                     Ultrasound Except
                     Vascular.
0268                Ultrasound Guidance     S...................      1.3856      $72.26  ..........      $14.45
                     Procedures.
0269                Level III               S...................      3.2170     $167.77      $87.24      $33.55
                     Echocardiogram Except
                     Transesophageal.
0270                Transesophageal         S...................      5.3003     $276.42     $146.79      $55.28
                     Echocardiogram.
0271                Mammography...........  S...................      0.6492      $33.86      $16.80       $6.77
0272                Level I Fluoroscopy...  X...................      1.3372      $69.74      $38.36      $13.95
0274                Myelography...........  S...................      3.8759     $202.13      $96.54      $40.43
0275                Arthrography..........  S...................      2.9747     $155.13      $69.09      $31.03
0276                Level I Digestive       S...................      1.5891      $82.87      $41.72      $16.57
                     Radiology.
0277                Level II Digestive      S...................      2.3546     $122.79      $60.47      $24.56
                     Radiology.
0278                Diagnostic Urography..  S...................      2.5290     $131.89      $66.07      $26.38
0279                Level II Angiography    S...................      8.6432     $450.75     $174.57      $90.15
                     and Venography except
                     Extremity.
0280                Level III Angiography   S...................     15.2128     $793.36     $353.85     $158.67
                     and Venography except
                     Extremity.
0281                Venography of           S...................      5.2227     $272.37     $115.16      $54.47
                     Extremity.
0282                Miscellaneous           S...................      1.6763      $87.42      $44.51      $17.48
                     Computerized Axial
                     Tomography.
0283                Computerized Axial      S...................      4.5057     $234.98     $126.27      $47.00
                     Tomography with
                     Contrast Material.
0284                Magnetic Resonance      S...................      7.2382     $377.48     $201.02      $75.50
                     Imaging and Magnetic
                     Resonance Angiography
                     with Contrast
                     Material.
0285                Myocardial Positron     S...................     18.1294     $945.47     $409.56     $189.09
                     Emission Tomography
                     (PET).
0286                Myocardial Scans......  S...................      6.5309     $340.59     $187.32      $68.12
0287                Complex Venography....  S...................      6.9863     $364.34     $114.51      $72.87
0288                Bone Density:Axial      S...................      1.2984      $67.71  ..........      $13.54
                     Skeleton.
0289                Needle Localization     X...................      1.8992      $99.05      $44.80      $19.81
                     for Breast Biopsy.
0290                Level I Diagnostic      S...................      2.0251     $105.61      $53.17      $21.12
                     Nuclear Medicine
                     Excluding Myocardial
                     Scans.
0291                Level II Diagnostic     S...................      3.9825     $207.69     $104.55      $41.54
                     Nuclear Medicine
                     Excluding Myocardial
                     Scans.
0292                Level III Diagnostic    S...................      4.2925     $223.86     $112.69      $44.77
                     Nuclear Medicine
                     Excluding Myocardial
                     Scans.
0294                Level II Therapeutic    S...................      4.0794     $212.74     $117.01      $42.55
                     Nuclear Medicine.
0296                Level I Therapeutic     S...................      2.4127     $125.82      $69.20      $25.16
                     Radiologic Procedures.
0297                Level II Therapeutic    S...................      7.6839     $400.72     $172.51      $80.14
                     Radiologic Procedures.
0299                Miscellaneous           S...................      5.9785     $311.78  ..........      $62.36
                     Radiation Treatment.
0300                Level I Radiation       S...................      1.5794      $82.37  ..........      $16.47
                     Therapy.
0301                Level II Radiation      S...................      3.1588     $164.73  ..........      $32.95
                     Therapy.
0302                Level III Radiation     S...................      9.2343     $481.58     $182.43      $96.32
                     Therapy.
0303                Treatment Device        X...................      2.8391     $148.06      $66.95      $29.61
                     Construction.
0304                Level I Therapeutic     X...................      1.6182      $84.39      $41.52      $16.88
                     Radiation Treatment
                     Preparation.
0305                Level II Therapeutic    X...................      3.6530     $190.51      $91.38      $38.10
                     Radiation Treatment
                     Preparation.
0310                Level III Therapeutic   X...................     13.6625     $712.51     $325.27     $142.50
                     Radiation Treatment
                     Preparation.
0312                Radioelement            S...................     52.8864   $2,758.08  ..........     $551.62
                     Applications.
0313                Brachytherapy.........  S...................     21.0363   $1,097.06  ..........     $219.41
0314                Hyperthermic Therapies  S...................      4.1763     $217.80     $101.77      $43.56
0320                Electroconvulsive       S...................      4.2635     $222.35      $80.06      $44.47
                     Therapy.
0321                Biofeedback and Other   S...................      1.2112      $63.17      $21.78      $12.63
                     Training.
0322                Brief Individual        S...................      1.3275      $69.23      $12.40      $13.85
                     Psychotherapy.
0323                Extended Individual     S...................      1.8410      $96.01      $21.26      $19.20
                     Psychotherapy.
0324                Family Psychotherapy..  S...................      2.4612     $128.35  ..........      $25.67
0325                Group Psychotherapy...  S...................      1.4244      $74.28      $18.27      $14.86
0330                Dental Procedures.....  S...................      4.7770     $249.13  ..........      $49.83
0332                Computerized Axial      S...................      3.4398     $179.39      $91.27      $35.88
                     Tomography and
                     Computerized
                     Angiography without
                     Contrast Material.
0333                Computerized Axial      S...................      5.3681     $279.95     $146.98      $55.99
                     Tomography and
                     Computerized Angio w/
                     o Contrast Material
                     followed by Contrast.
0335                Magnetic Resonance      S...................      6.2983     $328.46     $151.46      $65.69
                     Imaging,
                     Miscellaneous.

[[Page 66818]]

 
0336                Magnetic Resonance      S...................      6.5987     $344.13     $176.94      $68.83
                     Imaging and Magnetic
                     Resonance Angiography
                     without Contrast.
0337                MRI and Magnetic        S...................      9.2440     $482.08     $240.77      $96.42
                     Resonance Angiography
                     without Contrast
                     Material followed by
                     Contrast Material.
0339                Observation...........  S...................      7.2188     $376.47  ..........      $75.29
0340                Minor Ancillary         X...................      0.6492      $33.86  ..........       $6.77
                     Procedures.
0341                Skin Tests and          X...................      0.1453       $7.58       $3.08       $1.52
                     Miscellaneous Red
                     Blood Cell Tests.
0342                Level I Pathology.....  X...................      0.2132      $11.12       $5.88       $2.22
0343                Level II Pathology....  X...................      0.4457      $23.24      $12.55       $4.65
0344                Level III Pathology...  X...................      0.6201      $32.34      $17.46       $6.47
0345                Level I Transfusion     X...................      0.1938      $10.11       $3.10       $2.02
                     Laboratory Procedures.
0346                Level II Transfusion    X...................      0.5136      $26.78       $6.75       $5.36
                     Laboratory Procedures.
0347                Level III Transfusion   X...................      1.1240      $58.62      $14.76      $11.72
                     Laboratory Procedures.
0348                Fertility Laboratory    X...................      0.5523      $28.80  ..........       $5.76
                     Procedures.
0352                Level I Injections....  X...................      0.2229      $11.62  ..........       $2.32
0353                Level II Allergy        X...................      0.3973      $20.72  ..........       $4.14
                     Injections.
0355                Level III               K...................      0.2132      $11.12  ..........       $2.22
                     Immunizations.
0356                Level IV Immunizations  K...................      0.7655      $39.92  ..........       $7.98
0359                Level II Injections...  X...................      1.1337      $59.12  ..........      $11.82
0360                Level I Alimentary      X...................      1.6279      $84.90      $42.45      $16.98
                     Tests.
0361                Level II Alimentary     X...................      3.3914     $176.86      $83.23      $35.37
                     Tests.
0362                Level III               X...................      2.8391     $148.06  ..........      $29.61
                     Otorhinolaryngologic
                     Function Tests.
0363                Level I                 X...................      1.0852      $56.59      $20.94      $11.32
                     Otorhinolaryngologic
                     Function Tests.
0364                Level I Audiometry....  X...................      0.4457      $23.24       $9.06       $4.65
0365                Level II Audiometry...  X...................      1.2112      $63.17      $18.95      $12.63
0367                Level I Pulmonary Test  X...................      0.5814      $30.32      $15.16       $6.06
0368                Level II Pulmonary      X...................      1.0562      $55.08      $27.55      $11.02
                     Tests.
0369                Level III Pulmonary     X...................      2.5871     $134.92      $44.18      $26.98
                     Tests.
0370                Allergy Tests.........  X...................      0.7752      $40.43      $11.58       $8.09
0371                Level I Allergy         X...................      0.5039      $26.28  ..........       $5.26
                     Injections.
0372                Therapeutic Phlebotomy  X...................      0.5329      $27.79      $10.09       $5.56
0373                Neuropsychological      X...................      2.2577     $117.74  ..........      $23.55
                     Testing.
0374                Monitoring Psychiatric  X...................      1.1434      $59.63       $9.97      $11.93
                     Drugs.
0600                Low Level Clinic        V...................      0.8430      $43.96  ..........       $8.79
                     Visits.
0601                Mid Level Clinic        V...................      0.9690      $50.53  ..........      $10.11
                     Visits.
0602                High Level Clinic       V...................      1.4631      $76.30  ..........      $15.26
                     Visits.
0610                Low Level Emergency     V...................      1.4147      $73.78      $19.57      $14.76
                     Visits.
0611                Mid Level Emergency     V...................      2.5290     $131.89      $36.47      $26.38
                     Visits.
0612                High Level Emergency    V...................      4.3410     $226.39      $54.14      $45.28
                     Visits.
0620                Critical Care.........  S...................      9.9610     $519.48     $150.55     $103.90
0648                Breast Reconstruction   T...................     44.7955   $2,336.13  ..........     $467.23
                     with Prosthesis.
0649                Prostate Brachytherapy  T...................    115.0167   $5,998.24  ..........   $1,199.65
                     Palladium Seeds.
0650                Intermediate/Complex    S...................     12.0152     $626.60  ..........     $125.32
                     Proton Beam Radiation
                     Therapy.
0651                Complex Interstitial    S...................     54.7177   $2,853.58  ..........     $570.72
                     Radiation Source
                     Application.
0652                Insertion of            T...................     28.1292   $1,466.97  ..........     $293.39
                     Intraperitoneal
                     Catheters.
0653                Vascular                T...................     30.0284   $1,566.01  ..........     $313.20
                     Reconstruction/
                     Fistula Repair with
                     Device.
0654                Insertion/Replacement   T...................     91.8583   $4,790.50  ..........     $958.10
                     of a permanent dual
                     chamber pacemaker.
0655                Insertion/Replacement/  T...................    122.8654   $6,407.55  ..........   $1,281.51
                     Conversion of a
                     permanent dual
                     chamber pacemaker.
0656                Transcatheter           T...................     96.7516   $5,045.69  ..........   $1,009.14
                     Placement of
                     Intracoronary of Drug-
                     Eluting Stents.
0657                Placement of Tissue     S...................      1.4438      $75.30  ..........      $15.06
                     Clips.
0658                Percutaneous Breast     T...................      5.2712     $274.90  ..........      $54.98
                     Biopsies.
0659                Hyperbaric Oxygen.....  S...................      3.2364     $168.78  ..........      $33.76
0660                Level II                X...................      1.5891      $82.87      $30.66      $16.57
                     Otorhinolaryngologic
                     Function Tests.
0661                Level IV Pathology....  X...................      3.5077     $182.93     $100.61      $36.59
0662                CT Angiography........  S...................      5.4553     $284.50     $156.47      $56.90
0664                Proton Beam Radiation   S...................     10.0482     $524.02  ..........     $104.80
                     Therapy.
0665                Bone                    S...................      0.8236      $42.95  ..........       $8.59
                     Density:AppendicularS
                     keleton.
0666                Myocardial Add-on       S...................      2.9650     $154.63      $85.05      $30.93
                     Scans.
0668                Level I Angiography     S...................     10.3292     $538.68     $237.76     $107.74
                     and Venography except
                     Extremity.
0669                Digital Mammography...  S...................      0.8915      $46.49  ..........       $9.30
0670                Intravenous and         S...................     30.2416   $1,577.13     $571.17     $315.43
                     Intracardiac
                     Ultrasound.
0671                Level II                S...................      2.3643     $123.30      $64.12      $24.66
                     Echocardiogram Except
                     Transesophageal.
0672                Level IV Posterior      T...................     37.9061   $1,976.84     $988.43     $395.37
                     Segment Procedures.
0673                Level IV Anterior       T...................     25.9490   $1,353.27     $649.56     $270.65
                     Segment Eye
                     Procedures.
0674                Prostate Cryoablation.  T...................     62.9152   $3,281.09  ..........     $656.22
0675                Prostatic               T...................     48.5648   $2,532.70  ..........     $506.54
                     Thermotherapy.
0676                Level II Transcatheter  T...................      4.1278     $215.27      $58.21      $43.05
                     Thrombolysis.

[[Page 66819]]

 
0677                Level I Transcatheter   T...................      2.6453     $137.96  ..........      $27.59
                     Thrombolysis.
0678                External                T...................      2.2189     $115.72  ..........      $23.14
                     Counterpulsation.
0679                Level II Resuscitation  S...................      5.4069     $281.98      $95.30      $56.40
                     and Cardioversion.
0680                Insertion of Patient    S...................     56.1324   $2,927.36  ..........     $585.47
                     Activated Event
                     Recorders.
0681                Knee Arthroplasty.....  T...................    147.8067   $7,708.27   $3,067.55   $1,541.65
0682                Level V Debridement &   T...................      7.2770     $379.50     $174.57      $75.90
                     Destruction.
0683                Level II                S...................      1.8992      $99.05      $35.65      $19.81
                     Photochemotherapy.
0684                Prostate Brachytherapy  T...................     98.8349   $5,154.34  ..........   $1,030.87
                     Iodine Seeds.
0685                Level III Needle        T...................      5.9882     $312.29     $137.40      $62.46
                     Biopsy/Aspiration
                     Except Bone Marrow.
0686                Level III Skin Repair.  T...................     14.2439     $742.83     $341.70     $148.57
0687                Revision/Removal of     T...................     25.8424   $1,347.71     $619.95     $269.54
                     Neurostimulator
                     Electrodes.
0688                Revision/Removal of     T...................     74.5719   $3,889.00   $1,905.61     $777.80
                     Neurostimulator Pulse
                     Generator Receiver.
0689                Electronic Analysis of  S...................      0.5814      $30.32  ..........       $6.06
                     Cardioverter-
                     defibrillators.
0690                Electronic Analysis of  S...................      0.4263      $22.23      $10.63       $4.45
                     Pacemakers and other
                     Cardiac Devices.
0691                Electronic Analysis of  S...................      2.9166     $152.10      $83.65      $30.42
                     Programmable Shunts/
                     Pumps.
0692                Electronic Analysis of  S...................      6.2595     $326.44     $179.54      $65.29
                     Neurostimulator Pulse
                     Generators.
0693                Level II Breast         T...................     37.5863   $1,960.16     $798.17     $392.03
                     Reconstruction.
0694                Mohs Surgery..........  T...................      3.4689     $180.91      $72.36      $36.18
0695                Level VII Debridement   T...................     18.6817     $974.27     $266.59     $194.85
                     & Destruction.
0697                Level I Echocardiogram  S...................      1.5697      $81.86      $42.57      $16.37
                     Except
                     Transesophageal.
0698                Level II Eye Tests &    S...................      0.9205      $48.00      $18.72       $9.60
                     Treatments.
0699                Level IV Eye Tests &    T...................      3.7596     $196.07      $88.23      $39.21
                     Treatments.
0701                SR 89 chloride, per     K...................      8.9920     $468.94  ..........      $93.79
                     mCi.
0702                SM 153 lexidronam, 50   K...................     14.6218     $762.54  ..........     $152.51
                     mCi.
0706                New Technology - Level  S...................  ..........      $25.00  ..........       $5.00
                     I ($0 - $50).
0707                New Technology - Level  S...................  ..........      $75.00  ..........      $15.00
                     II ($50 - $100).
0708                New Technology - Level  S...................  ..........     $150.00  ..........      $30.00
                     III ($100 - $200).
0709                New Technology - Level  S...................  ..........     $250.00  ..........      $50.00
                     IV ($200 - $300).
0710                New Technology - Level  S...................  ..........     $400.00  ..........      $80.00
                     V ($300 - $500).
0711                New Technology - Level  S...................  ..........     $625.00  ..........     $125.00
                     VI ($500 - $750).
0712                New Technology - Level  S...................  ..........     $875.00  ..........     $175.00
                     VII ($750 - $1000).
0713                New Technology - Level  S...................  ..........   $1,125.00  ..........     $225.00
                     VIII ($1000 - $1250).
0714                New Technology - Level  S...................  ..........   $1,375.00  ..........     $275.00
                     IX ($1250 - $1500).
0715                New Technology - Level  S...................  ..........   $1,625.00  ..........     $325.00
                     X ($1500 - $1750).
0716                New Technology - Level  S...................  ..........   $1,875.00  ..........     $375.00
                     XI ($1750 - $2000).
0717                New Technology - Level  S...................  ..........   $2,250.00  ..........     $450.00
                     XII ($2000 - $2500).
0718                New Technology - Level  S...................  ..........   $2,750.00  ..........     $550.00
                     XIII ($2500 - $3000).
0719                New Technology-Level    S...................  ..........   $3,250.00  ..........     $650.00
                     XIV ($3000 - $3500).
0720                New Technology - Level  S...................  ..........   $4,250.00  ..........     $850.00
                     XV ($3500 - $5000).
0721                New Technology - Level  S...................  ..........   $5,500.00  ..........   $1,100.00
                     XVI ($5000 - $6000).
0725                New Technology - Level  S...................  ..........  $20,000.00  ..........   $4,000.00
                     XX ($19500 - $20500).
0726                Dexrazoxane hcl         K...................      2.2577     $117.74  ..........      $23.55
                     injection, 250 mg.
0728                Filgrastim 300 mcg      K...................      2.1027     $109.66  ..........      $21.93
                     injection.
0730                Pamidronate disodium ,  K...................      3.2654     $170.29  ..........      $34.06
                     30 mg.
0732                Mesna injection 200 mg  K...................      0.5039      $26.28  ..........       $5.26
0733                Non esrd epoetin alpha  K...................      0.1744       $9.10  ..........       $1.82
                     inj, 1000 u.
0734                Injection, darbepoetin  K...................      0.0454       $2.37  ..........        $.47
                     alfa (for non-ESRD
                     use), pre 1 mcg.
0800                Leuprolide acetate,     K...................      3.7984     $198.09  ..........      $39.62
                     3.75 mg.
0802                Etoposide oral 50 mg..  K...................      0.5523      $28.80  ..........       $5.76
0807                Aldesleukin/single use  K...................      7.2867     $380.01  ..........      $76.00
                     vial.
0810                Goserelin acetate       K...................      5.5619     $290.06  ..........      $58.01
                     implant 3.6 mg.
0811                Carboplatin injection   K...................      1.4922      $77.82  ..........      $15.56
                     50 mg.
0812                Carmustine, 100 mg....  K...................      1.5310      $79.84  ..........      $15.97
0813                Cisplatin 10 mg         K...................      0.4263      $22.23  ..........       $4.45
                     injection.
0820                Daunorubicin 10 mg....  K...................      1.9379     $101.06  ..........      $20.21
0821                Daunorubicin citrate    K...................      2.9069     $151.60  ..........      $30.32
                     liposom 10 mg.
0822                Diethylstilbestrol      K...................      2.0251     $105.61  ..........      $21.12
                     injection 250 mg.
0823                Docetaxel, 20 mg......  K...................      3.8953     $203.14  ..........      $40.63
0827                Floxuridine injection   K...................      2.2189     $115.72  ..........      $23.14
                     500 mg.
0828                Gemcitabine HCL 200 mg  K...................      1.2984      $67.71  ..........      $13.54
0830                Irinotecan injection    K...................      1.7538      $91.46  ..........      $18.29
                     20 mg.
0831                Ifosfomide injection 1  K...................      1.9186     $100.06  ..........      $20.01
                     gm.
0832                Idarubicin hcl          K...................      4.8642     $253.67  ..........      $50.73
                     injection 5 mg.
0838                Interferon gamma 1-b    K...................      3.0426     $158.67  ..........      $31.73
                     inj, 3 million u.
0840                Melphalan hydrochl 50   K...................      4.5348     $236.49  ..........      $47.30
                     mg.
0842                Fludarabine phosphate   K...................      3.2848     $171.31  ..........      $34.26
                     inj 50 mg.
0843                Pegaspargase, singl     K...................      8.8079     $459.34  ..........      $91.87
                     dose vial.
0844                Pentostatin injection,  K...................     19.8833   $1,036.93  ..........     $207.39
                     10 mg.

[[Page 66820]]

 
0849                Rituximab, 100 mg.....  K...................      5.4941     $286.52  ..........      $57.30
0852                Topotecan, 4 mg.......  K...................      7.7130     $402.24  ..........      $80.45
0855                Vinorelbine tartrate,   K...................      1.0756      $56.09  ..........      $11.22
                     10 mg.
0856                Porfimer sodium, 75 mg  K...................     29.6117   $1,544.28  ..........     $308.86
0857                Bleomycin sulfate       K...................      3.1879     $166.25  ..........      $33.25
                     injection 15 u.
0858                Cladribine, 1mg.......  K...................      0.7946      $41.44  ..........       $8.29
0861                Leuprolide acetate      K...................      0.7752      $40.43  ..........       $8.09
                     injection 1 mg.
0862                Mitomycin 5 mg inj....  K...................      1.1337      $59.12  ..........      $11.82
0863                Paclitaxel injection,   K...................      2.3158     $120.77  ..........      $24.15
                     30 mg.
0864                Mitoxantrone hcl, 5 mg  K...................      2.9263     $152.61  ..........      $30.52
0888                Cyclosporine oral 100   K...................      0.0484       $2.52  ..........        $.50
                     mg.
0890                Lymphocyte immune       K...................      3.3429     $174.34  ..........      $34.87
                     globulin 250 mg.
0891                Tacrolimus oral per 1   K...................      0.0291       $1.52  ..........        $.30
                     mg.
0902                Botulinum toxin a, per  K...................      0.0484       $2.52  ..........        $.50
                     unit.
0903                Cytomegalovirus imm IV/ K...................      4.7383     $247.11  ..........      $49.42
                     vial.
0905                Immune globulin 500 mg  K...................      0.8333      $43.46  ..........       $8.69
0906                RSV-ivig, 50 mg.......  K...................      0.5911      $30.83  ..........       $6.17
0909                Interferon beta-1a, 33  K...................      2.7906     $145.53  ..........      $29.11
                     mcg.
0910                Interferon beta-1b /    K...................      1.9864     $103.59  ..........      $20.72
                     0.25 mg.
0916                Injection imiglucerase  K...................      0.0484       $2.52  ..........        $.50
                     /unit.
0917                Inj, Adenosine, 90 mg.  K...................      3.1986     $166.81  ..........      $33.36
0925                Factor viii per iu....  K...................      0.0097        $.51  ..........        $.10
0926                Factor VIII (porcine)   K...................      0.0291       $1.52  ..........        $.30
                     per iu.
0927                Factor viii             K...................      0.0194       $1.01  ..........        $.20
                     recombinant per iu.
0928                Factor ix complex per   K...................      0.0097        $.51  ..........        $.10
                     iu.
0929                Anti-inhibitor per iu.  K...................      0.0194       $1.01  ..........        $.20
0930                Antithrombin iii        K...................      0.0194       $1.01  ..........        $.20
                     injection per iu.
0931                Factor IX non-          K...................      0.0097        $.51  ..........        $.10
                     recombinant, per iu.
0932                Factor IX recombinant,  K...................      0.0194       $1.01  ..........        $.20
                     per iu.
0949                Plasma, Pooled          K...................      2.3837     $124.31  ..........      $24.86
                     Multiple Donor,
                     Solvent/Detergent T.
0950                Blood (Whole) For       K...................      1.6860      $87.93  ..........      $17.59
                     Transfusion.
0952                Cryoprecipitate.......  K...................      0.5620      $29.31  ..........       $5.86
0954                RBC leukocytes reduced  K...................      2.2868     $119.26  ..........      $23.85
0955                Plasma, Fresh Frozen..  K...................      1.8217      $95.00  ..........      $19.00
0956                Plasma Protein          K...................      1.7829      $92.98  ..........      $18.60
                     Fraction.
0957                Platelet Concentrate..  K...................      0.7946      $41.44  ..........       $8.29
0958                Platelet Rich Plasma..  K...................      1.0271      $53.56  ..........      $10.71
0959                Red Blood Cells.......  K...................      1.6569      $86.41  ..........      $17.28
0960                Washed Red Blood Cells  K...................      3.0813     $160.69  ..........      $32.14
0961                Infusion, Albumin       K...................      0.9980      $52.05  ..........      $10.41
                     (Human) 5%, 50 ml.
0963                Albumin (human), 5%,    K...................      4.9708     $259.23  ..........      $51.85
                     250 ml.
0964                Albumin (human), 25%,   K...................      1.0756      $56.09  ..........      $11.22
                     20 ml.
0965                Albumin (human), 25%,   K...................      2.6840     $139.97  ..........      $27.99
                     50ml.
0966                Plasmaprotein           K...................      8.9145     $464.90  ..........      $92.98
                     fract,5%,250ml.
0970                New Technology - Level  T...................  ..........      $25.00  ..........       $5.00
                     I ($0 - $50).
0971                New Technology - Level  T...................  ..........      $75.00  ..........      $15.00
                     II ($50 - $100).
0972                New Technology - Level  T...................  ..........     $150.00  ..........      $30.00
                     III ($100 - $200).
0973                New Technology - Level  T...................  ..........     $250.00  ..........      $50.00
                     IV ($200 - $300).
0974                New Technology - Level  T...................  ..........     $400.00  ..........      $80.00
                     V ($300 - $500).
0975                New Technology - Level  T...................  ..........     $625.00  ..........     $125.00
                     VI ($500 - $750).
0976                New Technology - Level  T...................  ..........     $875.00  ..........     $175.00
                     VII ($750 - $1000).
0977                New Technology - Level  T...................  ..........   $1,125.00  ..........     $225.00
                     VIII ($1000 - $1250).
0978                New Technology - Level  T...................  ..........   $1,375.00  ..........     $275.00
                     IX ($1250 - $1500).
0979                New Technology - Level  T...................  ..........   $1,625.00  ..........     $325.00
                     X ($1500 - $1750).
0980                New Technology - Level  T...................  ..........   $1,875.00  ..........     $375.00
                     XI ($1750 - $2000).
0981                New Technology - Level  T...................  ..........   $2,250.00  ..........     $450.00
                     XII ($2000 - $2500).
0982                New Technology - Level  T...................  ..........   $2,750.00  ..........     $550.00
                     XIII ($2500 - $3000).
0983                New Technology - Level  T...................  ..........   $3,250.00  ..........     $650.00
                     XIV ($3000 - $3500).
0984                New Technology - Level  T...................  ..........   $4,250.00  ..........     $850.00
                     XV ($3500 - $5000).
0985                New Technology - Level  T...................  ..........   $5,500.00  ..........   $1,100.00
                     XVI ($5000 - $6000).
0989                New Technology - Level  T...................  ..........  $20,000.00  ..........   $4,000.00
                     XX ($19500-$20500).
1009                Cryoprecip reduced      K...................      0.7170      $37.39  ..........       $7.48
                     plasma.
1010                Blood, L/R, CMV-neg...  K...................      2.3352     $121.78  ..........      $24.36
1011                Platelets, HLA-m, L/R,  K...................      9.5831     $499.77  ..........      $99.95
                     unit.
1013                Platelet concentrate,   K...................      0.9496      $49.52  ..........       $9.90
                     L/R, unit.
1016                Blood, L/R, froz/       K...................      5.7848     $301.68  ..........      $60.34
                     deglycerol/washed.
1017                Platelets, aph/pher, L/ K...................      7.5386     $393.15  ..........      $78.63
                     R, CMV-neg, unit.
1018                Blood, L/R, irradiated  K...................      2.5387     $132.40  ..........      $26.48

[[Page 66821]]

 
1019                Platelets, aph/pher, L/ K...................      7.7905     $406.28  ..........      $81.26
                     R, irradiated, unit.
1020                Pit, pher,L/            K...................      9.4959     $495.22  ..........      $99.04
                     R,CMV,irrad.
1021                RBC, frz/deg/wsh, L/R,  K...................      6.4436     $336.04  ..........      $67.21
                     irrad.
1022                RBC, L/R, CMV neg,      K...................      3.8565     $201.12  ..........      $40.22
                     irrad.
1045                Iobenguane sulfate I-   K...................      1.5697      $81.86  ..........      $16.37
                     31per 0.5 mCi.
1059                Cultured chondrocytes   K...................    114.2706   $5,959.33  ..........   $1,191.87
                     implnt.
1084                Denileukin diftitox,    K...................     12.1315     $632.67  ..........     $126.53
                     300 MCG.
1086                Temozolomide,oral 5 mg  K...................      0.0581       $3.03  ..........        $.61
1091                IN 111 Oxyquinoline,    K...................      4.7092     $245.59  ..........      $49.12
                     per .5 mCi.
1092                IN 111 Pentetate, per   K...................      4.4379     $231.44  ..........      $46.29
                     0.5 mCi.
1095                Technetium TC 99M       K...................      5.6006     $292.08  ..........      $58.42
                     Depreotide.
1096                TC 99M Exametazime,     K...................      4.4379     $231.44  ..........      $46.29
                     per dose.
1122                TC 99M arcitumomab,     K...................     11.4726     $598.31  ..........     $119.66
                     per vial.
1167                Epirubicin hcl, 2 mg..  K...................      0.3294      $17.18  ..........       $3.44
1178                Busulfan IV, 6 mg.....  K...................      0.4845      $25.27  ..........       $5.05
1203                Verteporfin for         K...................     16.5209     $861.58  ..........     $172.32
                     injection.
1207                Octreotide acetate      K...................      1.4244      $74.28  ..........      $14.86
                     depot 1mg.
1305                Apligraf..............  K...................     13.0520     $680.67  ..........     $136.13
1348                I-131 sol, per 1-6 mCi  K...................      0.9399      $49.02  ..........       $9.80
1409                Factor viia             K...................     20.7844   $1,083.93  ..........     $216.79
                     recombinant, per 1.2
                     mg.
1604                IN 111 capromab         K...................     16.4434     $857.54  ..........     $171.51
                     pendetide, per dose.
1605                Abciximab injection,    K...................      5.8526     $305.22  ..........      $61.04
                     10 mg.
1609                Rho(D) immune globulin  K...................      0.2229      $11.62  ..........       $2.32
                     h, sd, 100 iu.
1611                Hylan G-F 20            K...................      2.3643     $123.30  ..........      $24.66
                     injection, 16 mg.
1612                Daclizumab,             K...................      4.3991     $229.42  ..........      $45.88
                     parenteral, 25 mg.
1613                Trastuzumab, 10 mg....  K...................      0.6298      $32.84  ..........       $6.57
1614                Valrubicin, 200 mg....  K...................      3.5658     $185.96  ..........      $37.19
1615                Basiliximab, 20 mg....  K...................     13.3621     $696.85  ..........     $139.37
1618                Vonwillebrandfactrcmpl  K...................      0.0194       $1.01  ..........        $.20
                     x, per iu.
1620                Technetium tc99m        K...................      3.8759     $202.13  ..........      $40.43
                     bicisate.
1625                Indium 111-in           K...................      8.2169     $428.52  ..........      $85.70
                     pentetreotide.
1628                Chromic phosphate p32.  K...................      1.5891      $82.87  ..........      $16.57
1716                Brachytx seed, Gold     K...................      0.4360      $22.74  ..........       $4.55
                     198.
1718                Brachytx seed, Iodine   K...................      0.6008      $31.33  ..........       $6.27
                     125.
1719                Brachytxseed, Non-HDR   K...................      0.5232      $27.29  ..........       $5.46
                     Ir-192.
1720                Brachytx seed,          K...................      0.8430      $43.96  ..........       $8.79
                     Palladium 103.
1765                Adhesion barrier......  H...................  ..........  ..........  ..........  ..........
1775                FDG, per dose (4-40     K...................      7.5289     $392.64  ..........      $78.53
                     mCi/ml).
1783                Ocular implant,         H...................  ..........  ..........  ..........  ..........
                     aqueous drain device.
1888                Endovascular non-       H...................  ..........  ..........  ..........  ..........
                     cardiac ablation
                     catheter.
1900                Lead coronary venous..  H...................  ..........  ..........  ..........  ..........
2614                Probe, percutaneous     H...................  ..........  ..........  ..........  ..........
                     lumbar disc.
2616                Brachytx seed, Yttrium- K...................      8.8370     $460.86  ..........      $92.17
                     90.
2618                Probe, cryoablation...  H...................  ..........  ..........  ..........  ..........
2632                Brachytx sol, I-125,    H...................  ..........  ..........  ..........  ..........
                     per mCi.
7000                Amifostine, 500 mg....  K...................      4.5057     $234.98  ..........      $47.00
7001                Amphotericin B lipid    K...................      2.3449     $122.29  ..........      $24.46
                     complex, 50 mg.
7011                Oprelvekin injection,   K...................      2.7325     $142.50  ..........      $28.50
                     5 mg.
7024                Corticorelin ovine      K...................      2.2965     $119.76  ..........      $23.95
                     triflutat.
7025                Digoxin immune FAB      K...................      4.9805     $259.74  ..........      $51.95
                     (ovine).
7030                Hemin, per 1 mg.......  K...................      0.0097        $.51  ..........        $.10
7031                Octreotide acetate      K...................      1.2694      $66.20  ..........      $13.24
                     injection.
7034                Somatropin injection..  K...................      0.7170      $37.39  ..........       $7.48
7035                Teniposide, 50 mg.....  K...................      1.9573     $102.08  ..........      $20.42
7038                Muromonab-CD3, 5 mg...  K...................      6.9572     $362.82  ..........      $72.56
7041                Tirofiban               K...................      4.9417     $257.71  ..........      $51.54
                     hydrochloride 12.5 mg.
7042                Capecitabine, oral,     K...................      0.0291       $1.52  ..........        $.30
                     150 mg.
7043                Infliximab injection    K...................      0.7364      $38.40  ..........       $7.68
                     10 mg.
7045                Trimetrexate            K...................      1.3081      $68.22  ..........      $13.64
                     glucoronate.
7046                Doxorubicin hcl         K...................      4.3894     $228.91  ..........      $45.78
                     liposome inj 10 mg.
7049                Filgrastim 480 mcg      K...................      3.2267     $168.28  ..........      $33.66
                     injection.
7051                Leuprolide acetate      G...................  ..........   $5,399.80  ..........     $807.13
                     implant, 65 mg.
9000                Na chromate Cr51, per   K...................      1.8798      $98.03  ..........      $19.61
                     0.25mCi.
9002                Tenecteplase, 50mg/     K...................     27.5963   $1,439.17  ..........     $287.83
                     vial.
9003                Palivizumab, per 50mg.  K...................      8.5657     $446.71  ..........      $89.34
9005                Reteplase injection...  K...................     12.6547     $659.96  ..........     $131.99
9009                Baclofen refill kit -   K...................      0.7267      $37.90  ..........       $7.58
                     per 2000 mcg.
9010                Baclofen refill kit -   K...................      0.9205      $48.00  ..........       $9.60
                     per 4000 mcg.

[[Page 66822]]

 
9012                Arsenic Trioxide......  G...................  ..........      $31.35  ..........       $4.69
9015                Mycophenolate mofetil   K...................      0.0291       $1.52  ..........        $.30
                     oral 250 mg.
9016                Echocardiography        G...................  ..........     $118.75  ..........      $17.75
                     contrast.
9018                Botulinum toxin B, per  G...................  ..........       $8.79  ..........       $1.31
                     100 u.
9019                Caspofungin acetate, 5  G...................  ..........      $34.20  ..........       $5.11
                     mg.
9020                Sirolimus tablet, 1 mg  K...................      0.0581       $3.03  ..........        $.61
9021                Immune globulin 10 mg.  K...................      0.0097        $.51  ..........        $.10
9022                IM inj interferon beta  K...................      0.9302      $48.51  ..........       $9.70
                     1-a.
9023                Rho d immune globulin   K...................      0.0484       $2.52  ..........        $.50
                     50 mcg.
9024                Amphotericin b lipid    K...................      0.4167      $21.73  ..........       $4.35
                     complex.
9104                Anti-thymocycte         K...................      2.6356     $137.45  ..........      $27.49
                     globulin rabbit.
9105                Hep B imm glob, per 1   K...................      1.5116      $78.83  ..........      $15.77
                     ml.
9108                Thyrotropin alfa, per   K...................      7.5870     $395.67  ..........      $79.13
                     1.1 mg.
9109                Tirofliban hcl, per     K...................      2.1996     $114.71  ..........      $22.94
                     6.25 mg.
9110                Alemtuzumab, per ml...  G...................  ..........     $511.22  ..........      $76.41
9111                Inj, bivalirudin, per   G...................  ..........     $397.81  ..........      $56.46
                     250 mg vial.
9112                Perflutren lipid        G...................  ..........       $4.94  ..........        $.74
                     micro, per 2ml.
9113                Inj, pantoprazole       G...................  ..........      $22.80  ..........       $3.41
                     sodium, vial.
9114                Nesiritide, per 1.5 mg  G...................  ..........     $433.20  ..........      $64.75
                     vial.
9115                Inj, zoledronic acid,   G...................  ..........     $406.78  ..........      $60.80
                     per 2 mg.
9116                Inj, Ertapenem sodium,  G...................  ..........      $45.31  ..........       $6.77
                     per 1 gm vial.
9119                Inj, Pegfilgrastim,     G...................  ..........   $2,802.50  ..........     $418.90
                     per 6 mg single dose
                     vial.
9120                Inj, Fulvestrant, per   G...................  ..........      $87.58  ..........      $13.09
                     50 mg.
9121                Inj, Argatroban, per 5  G...................  ..........      $14.25  ..........       $2.13
                     mg.
9200                Orcel, per 36 cm2.....  G...................  ..........   $1,135.25  ..........     $169.69
9201                Dermagraft, per 37.5    G...................  ..........     $577.60  ..........      $86.34
                     sq cm.
9217                Leuprolide acetate      K...................      6.5696     $342.61  ..........      $68.52
                     suspnsion, 7.5 mg.
9500                Platelets, irradiated.  K...................      1.4341      $74.79  ..........      $14.96
9501                Platelets, pheresis...  K...................      7.8390     $408.81  ..........      $81.76
9502                Platelet pheresis       K...................      8.5076     $443.68  ..........      $88.74
                     irradiated.
9503                Fresh frozen plasma,    K...................      1.3372      $69.74  ..........      $13.95
                     ea unit.
9504                RBC deglycerolized....  K...................      3.5174     $183.44  ..........      $36.69
9505                RBC irradiated........  K...................      2.0833     $108.65  ..........      $21.73
9506                Granulocytes, pheresis  K...................     23.9432   $1,248.66  ..........     $249.73
----------------------------------------------------------------------------------------------------------------

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

Copyright American Dental Association. All rights reserved.

*Code is new in 2002.

[[Page 66822]]



                                            Addendum B.--Payment Status by HCPCS Code and Related Information
                                                                  [Calendar Year 2003]
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                  National     Minimum
    CPT/ HCPCS       Status indicator       Condition               Description              APC        Relative     Payment     unadjusted   unadjusted
                                                                                                         weight        rate      copayment    copayment
--------------------------------------------------------------------------------------------------------------------------------------------------------
0001T               C................  ...................  Endovas repr abdo ao         ...........  ...........  ...........  ...........  ...........
                                                             aneurys.
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.
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      26.1234    $1,362.36  ...........      $272.47
                                                             autograft.
0013T               T................  ...................  Osteochondral knee                  0041      26.1234    $1,362.36  ...........      $272.47
                                                             allograft.
00140               N................  ...................  Anesth, procedures on eye..  ...........  ...........  ...........  ...........  ...........
00142               N................  ...................  Anesth, lens surgery.......  ...........  ...........  ...........  ...........  ...........

[[Page 66823]]

 
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      26.1234    $1,362.36  ...........      $272.47
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       0.5814       $30.32       $15.76        $6.06
                                                             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       0.7364       $38.40       $14.97        $7.68
0026T               A................  ...................  Measure remnant              ...........  ...........  ...........  ...........  ...........
                                                             lipoproteins.
0027T               T................  NI.................  Endoscopic epidural lysis..         0976  ...........      $875.00  ...........      $175.00
0028T               N................  NI.................  Dexa body composition study  ...........  ...........  ...........  ...........  ...........
0029T               N................  NI.................  Magnetic tx for              ...........  ...........  ...........  ...........  ...........
                                                             incontinence.
00300               N................  ...................  Anesth, head/neck/ptrunk...  ...........  ...........  ...........  ...........  ...........
0030T               A................  NI.................  Antiprothrombin antibody...  ...........  ...........  ...........  ...........  ...........
0031T               N................  NI.................  Speculoscopy...............  ...........  ...........  ...........  ...........  ...........
00320               N................  ...................  Anesth, neck organ surgery.  ...........  ...........  ...........  ...........  ...........
00322               N................  ...................  Anesth, biopsy of thyroid..  ...........  ...........  ...........  ...........  ...........
00326               N................  NI.................  Anesth, larynx/trach, < 1    ...........  ...........  ...........  ...........  ...........
                                                             yr.
0032T               N................  NI.................  Speculoscopy w/direct        ...........  ...........  ...........  ...........  ...........
                                                             sample.
0033T               C................  NI.................  Endovasc taa repr incl       ...........  ...........  ...........  ...........  ...........
                                                             subcl.
0034T               C................  NI.................  Endovasc taa repr w/o subcl  ...........  ...........  ...........  ...........  ...........
00350               N................  ...................  Anesth, neck vessel surgery  ...........  ...........  ...........  ...........  ...........
00352               N................  ...................  Anesth, neck vessel surgery  ...........  ...........  ...........  ...........  ...........
0035T               C................  NI.................  Insert endovasc prosth, taa  ...........  ...........  ...........  ...........  ...........
0036T               C................  NI.................  Endovasc prosth, taa, add-   ...........  ...........  ...........  ...........  ...........
                                                             on.
0037T               C................  NI.................  Artery transpose/endovas     ...........  ...........  ...........  ...........  ...........
                                                             taa.
0038T               C................  NI.................  Rad endovasc taa rpr w/      ...........  ...........  ...........  ...........  ...........
                                                             cover.
0039T               C................  NI.................  Rad s/i, endovasc taa        ...........  ...........  ...........  ...........  ...........
                                                             repair.
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..  ...........  ...........  ...........  ...........  ...........
0040T               C................  NI.................  Rad s/i, endovasc taa        ...........  ...........  ...........  ...........  ...........
                                                             prosth.
00410               N................  ...................  Anesth, correct heart        ...........  ...........  ...........  ...........  ...........
                                                             rhythm.
0041T               A................  NI.................  Detect ur infect agnt w/     ...........  ...........  ...........  ...........  ...........
                                                             cpas.
0042T               N................  NI.................  Ct perfusion w/contrast,     ...........  ...........  ...........  ...........  ...........
                                                             cbf.
0043T               A................  NI.................  Co expired gas analysis....  ...........  ...........  ...........  ...........  ...........
0044T               N................  NI.................  Whole body photography.....  ...........  ...........  ...........  ...........  ...........
00450               N................  ...................  Anesth, surgery of shoulder  ...........  ...........  ...........  ...........  ...........
00452               C................  ...................  Anesth, surgery of shoulder  ...........  ...........  ...........  ...........  ...........
00454               N................  ...................  Anesth, collar bone biopsy.  ...........  ...........  ...........  ...........  ...........
00470               N................  ...................  Anesth, removal of rib.....  ...........  ...........  ...........  ...........  ...........

[[Page 66824]]

 
00472               N................  ...................  Anesth, chest wall repair..  ...........  ...........  ...........  ...........  ...........
00474               C................  ...................  Anesth, surgery of rib(s)..  ...........  ...........  ...........  ...........  ...........
00500               N................  ...................  Anesth, esophageal surgery.  ...........  ...........  ...........  ...........  ...........
00520               N................  ...................  Anesth, chest procedure....  ...........  ...........  ...........  ...........  ...........
00522               N................  ...................  Anesth, chest lining biopsy  ...........  ...........  ...........  ...........  ...........
00524               C................  ...................  Anesth, chest drainage.....  ...........  ...........  ...........  ...........  ...........
00528               N................  ...................  Anesth, chest partition      ...........  ...........  ...........  ...........  ...........
                                                             view.
00530               N................  ...................  Anesth, pacemaker insertion  ...........  ...........  ...........  ...........  ...........
00532               N................  ...................  Anesth, vascular access....  ...........  ...........  ...........  ...........  ...........
00534               N................  ...................  Anesth, cardioverter/defib.  ...........  ...........  ...........  ...........  ...........
00537               N................  ...................  Anesth, cardiac electrophys  ...........  ...........  ...........  ...........  ...........
00539               N................  NI.................  Anesth, trach-bronch         ...........  ...........  ...........  ...........  ...........
                                                             reconst.
00540               C................  ...................  Anesth, chest surgery......  ...........  ...........  ...........  ...........  ...........
00541               N................  NI.................  Anesth, one lung             ...........  ...........  ...........  ...........  ...........
                                                             ventilation.
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           ...........  ...........  ...........  ...........  ...........
                                                             transplnt.
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....  ...........  ...........  ...........  ...........  ...........
00640               N................  NI.................  Anesth, spine manipulation.  ...........  ...........  ...........  ...........  ...........
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...  ...........  ...........  ...........  ...........  ...........
00834               N................  NI.................  Anesth, hernia repair< 1 yr  ...........  ...........  ...........  ...........  ...........
00836               N................  NI.................  Anesth hernia repair         ...........  ...........  ...........  ...........  ...........
                                                             preemie.
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.  ...........  ...........  ...........  ...........  ...........

[[Page 66825]]

 
00865               C................  ...................  Anesth, removal of prostate  ...........  ...........  ...........  ...........  ...........
00866               C................  ...................  Anesth, removal of adrenal.  ...........  ...........  ...........  ...........  ...........
00868               C................  ...................  Anesth, kidney transplant..  ...........  ...........  ...........  ...........  ...........
00869               N................  DG.................  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...  ...........  ...........  ...........  ...........  ...........
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..  ...........  ...........  ...........  ...........  ...........
00921               N................  NI.................  Anesth, vasectomy..........  ...........  ...........  ...........  ...........  ...........
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/         ...........  ...........  ...........  ...........  ...........
                                                             urethral.
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  ...........  ...........  ...........  ...........  ...........

[[Page 66826]]

 
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..  ...........  ...........  ...........  ...........  ...........
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  ...........  ...........  ...........  ...........  ...........
01829               N................  NI.................  Anesth, dx wrist             ...........  ...........  ...........  ...........  ...........
                                                             arthroscopy.
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  ...........  ...........  ...........  ...........  ...........

[[Page 66827]]

 
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.
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....  ...........  ...........  ...........  ...........  ...........
01991               N................  NI.................  Anesth, nerve block/inj....  ...........  ...........  ...........  ...........  ...........
01992               N................  NI.................  Anesth, n block/inj, prone.  ...........  ...........  ...........  ...........  ...........
01995               N................  ...................  Regional anesthesia limb...  ...........  ...........  ...........  ...........  ...........
01996               N................  ...................  Manage daily drug therapy..  ...........  ...........  ...........  ...........  ...........
01999               N................  ...................  Unlisted anesth procedure..  ...........  ...........  ...........  ...........  ...........
10021               T................  ...................  Fna w/o image..............         0002       0.5911       $30.83  ...........        $6.17
10022               T................  ...................  Fna w/image................         0002       0.5911       $30.83  ...........        $6.17
10040               T................  ...................  Acne surgery...............         0010       0.6589       $34.36       $10.08        $6.87
10060               T................  ...................  Drainage of skin abscess...         0006       1.7926       $93.49       $24.12       $18.70
10061               T................  ...................  Drainage of skin abscess...         0006       1.7926       $93.49       $24.12       $18.70
10080               T................  ...................  Drainage of pilonidal cyst.         0006       1.7926       $93.49       $24.12       $18.70
10081               T................  ...................  Drainage of pilonidal cyst.         0007      10.0191      $522.51      $108.89      $104.50
10120               T................  ...................  Remove foreign body........         0006       1.7926       $93.49       $24.12       $18.70
10121               T................  ...................  Remove foreign body........         0021      13.9338      $726.66      $219.48      $145.33
10140               T................  ...................  Drainage of hematoma/fluid.         0007      10.0191      $522.51      $108.89      $104.50
10160               T................  ...................  Puncture drainage of lesion         0018       0.9399       $49.02       $16.04        $9.80
10180               T................  ...................  Complex drainage, wound....         0007      10.0191      $522.51      $108.89      $104.50
11000               T................  ...................  Debride infected skin......         0015       1.5407       $80.35       $20.35       $16.07
11001               T................  ...................  Debride infected skin add-          0013       1.0756       $56.09       $14.20       $11.22
                                                             on.
11010               T................  ...................  Debride skin, fx...........         0022      17.3930      $907.06      $354.45      $181.41
11011               T................  ...................  Debride skin/muscle, fx....         0022      17.3930      $907.06      $354.45      $181.41
11012               T................  ...................  Debride skin/muscle/bone,           0022      17.3930      $907.06      $354.45      $181.41
                                                             fx.
11040               T................  ...................  Debride skin, partial......         0015       1.5407       $80.35       $20.35       $16.07
11041               T................  ...................  Debride skin, full.........         0015       1.5407       $80.35       $20.35       $16.07
11042               T................  ...................  Debride skin/tissue........         0016       2.6162      $136.44       $57.31       $27.29
11043               T................  ...................  Debride tissue/muscle......         0016       2.6162      $136.44       $57.31       $27.29
11044               T................  ...................  Debride tissue/muscle/bone.         0682       7.2770      $379.50      $174.57       $75.90
11055               T................  ...................  Trim skin lesion...........         0012       0.7849       $40.93       $11.18        $8.19
11056               T................  ...................  Trim skin lesions, 2 to 4..         0012       0.7849       $40.93       $11.18        $8.19
11057               T................  ...................  Trim skin lesions, over 4..         0012       0.7849       $40.93       $11.18        $8.19
11100               T................  ...................  Biopsy of skin lesion......         0018       0.9399       $49.02       $16.04        $9.80
11101               T................  ...................  Biopsy, skin add-on........         0018       0.9399       $49.02       $16.04        $9.80
11200               T................  ...................  Removal of skin tags.......         0013       1.0756       $56.09       $14.20       $11.22
11201               T................  ...................  Remove skin tags add-on....         0015       1.5407       $80.35       $20.35       $16.07
11300               T................  ...................  Shave skin lesion..........         0012       0.7849       $40.93       $11.18        $8.19
11301               T................  ...................  Shave skin lesion..........         0012       0.7849       $40.93       $11.18        $8.19
11302               T................  ...................  Shave skin lesion..........         0013       1.0756       $56.09       $14.20       $11.22
11303               T................  ...................  Shave skin lesion..........         0015       1.5407       $80.35       $20.35       $16.07
11305               T................  ...................  Shave skin lesion..........         0013       1.0756       $56.09       $14.20       $11.22
11306               T................  ...................  Shave skin lesion..........         0013       1.0756       $56.09       $14.20       $11.22
11307               T................  ...................  Shave skin lesion..........         0013       1.0756       $56.09       $14.20       $11.22

[[Page 66828]]

 
11308               T................  ...................  Shave skin lesion..........         0013       1.0756       $56.09       $14.20       $11.22
11310               T................  ...................  Shave skin lesion..........         0013       1.0756       $56.09       $14.20       $11.22
11311               T................  ...................  Shave skin lesion..........         0013       1.0756       $56.09       $14.20       $11.22
11312               T................  ...................  Shave skin lesion..........         0013       1.0756       $56.09       $14.20       $11.22
11313               T................  ...................  Shave skin lesion..........         0016       2.6162      $136.44       $57.31       $27.29
11400               T................  ...................  Removal of skin lesion.....         0019       3.7693      $196.57       $71.87       $39.31
11401               T................  ...................  Removal of skin lesion.....         0019       3.7693      $196.57       $71.87       $39.31
11402               T................  ...................  Removal of skin lesion.....         0019       3.7693      $196.57       $71.87       $39.31
11403               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11404               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11406               T................  ...................  Removal of skin lesion.....         0021      13.9338      $726.66      $219.48      $145.33
11420               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11421               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11422               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11423               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11424               T................  ...................  Removal of skin lesion.....         0021      13.9338      $726.66      $219.48      $145.33
11426               T................  ...................  Removal of skin lesion.....         0022      17.3930      $907.06      $354.45      $181.41
11440               T................  ...................  Removal of skin lesion.....         0019       3.7693      $196.57       $71.87       $39.31
11441               T................  ...................  Removal of skin lesion.....         0019       3.7693      $196.57       $71.87       $39.31
11442               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11443               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11444               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11446               T................  ...................  Removal of skin lesion.....         0022      17.3930      $907.06      $354.45      $181.41
11450               T................  ...................  Removal, sweat gland lesion         0022      17.3930      $907.06      $354.45      $181.41
11451               T................  ...................  Removal, sweat gland lesion         0022      17.3930      $907.06      $354.45      $181.41
11462               T................  ...................  Removal, sweat gland lesion         0022      17.3930      $907.06      $354.45      $181.41
11463               T................  ...................  Removal, sweat gland lesion         0022      17.3930      $907.06      $354.45      $181.41
11470               T................  ...................  Removal, sweat gland lesion         0022      17.3930      $907.06      $354.45      $181.41
11471               T................  ...................  Removal, sweat gland lesion         0022      17.3930      $907.06      $354.45      $181.41
11600               T................  ...................  Removal of skin lesion.....         0019       3.7693      $196.57       $71.87       $39.31
11601               T................  ...................  Removal of skin lesion.....         0019       3.7693      $196.57       $71.87       $39.31
11602               T................  ...................  Removal of skin lesion.....         0019       3.7693      $196.57       $71.87       $39.31
11603               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11604               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11606               T................  ...................  Removal of skin lesion.....         0021      13.9338      $726.66      $219.48      $145.33
11620               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11621               T................  ...................  Removal of skin lesion.....         0019       3.7693      $196.57       $71.87       $39.31
11622               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11623               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11624               T................  ...................  Removal of skin lesion.....         0021      13.9338      $726.66      $219.48      $145.33
11626               T................  ...................  Removal of skin lesion.....         0022      17.3930      $907.06      $354.45      $181.41
11640               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11641               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11642               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11643               T................  ...................  Removal of skin lesion.....         0020       7.1898      $374.96      $113.25       $74.99
11644               T................  ...................  Removal of skin lesion.....         0021      13.9338      $726.66      $219.48      $145.33
11646               T................  ...................  Removal of skin lesion.....         0022      17.3930      $907.06      $354.45      $181.41
11719               T................  ...................  Trim nail(s)...............         0009       0.6298       $32.84        $8.34        $6.57
11720               T................  ...................  Debride nail, 1-5..........         0009       0.6298       $32.84        $8.34        $6.57
11721               T................  ...................  Debride nail, 6 or more....         0009       0.6298       $32.84        $8.34        $6.57
11730               T................  ...................  Removal of nail plate......         0013       1.0756       $56.09       $14.20       $11.22
11732               T................  ...................  Remove nail plate, add-on..         0012       0.7849       $40.93       $11.18        $8.19
11740               T................  ...................  Drain blood from under nail         0009       0.6298       $32.84        $8.34        $6.57
11750               T................  ...................  Removal of nail bed........         0019       3.7693      $196.57       $71.87       $39.31
11752               T................  ...................  Remove nail bed/finger tip.         0022      17.3930      $907.06      $354.45      $181.41
11755               T................  ...................  Biopsy, nail unit..........         0019       3.7693      $196.57       $71.87       $39.31
11760               T................  ...................  Repair of nail bed.........         0024       1.8507       $96.52       $34.75       $19.30
11762               T................  ...................  Reconstruction of nail bed.         0024       1.8507       $96.52       $34.75       $19.30
11765               T................  ...................  Excision of nail fold, toe.         0015       1.5407       $80.35       $20.35       $16.07
11770               T................  ...................  Removal of pilonidal lesion         0022      17.3930      $907.06      $354.45      $181.41
11771               T................  ...................  Removal of pilonidal lesion         0022      17.3930      $907.06      $354.45      $181.41
11772               T................  ...................  Removal of pilonidal lesion         0022      17.3930      $907.06      $354.45      $181.41
11900               T................  ...................  Injection into skin lesions         0012       0.7849       $40.93       $11.18        $8.19
11901               T................  ...................  Added skin lesions                  0012       0.7849       $40.93       $11.18        $8.19
                                                             injection.
11920               T................  ...................  Correct skin color defects.         0024       1.8507       $96.52       $34.75       $19.30

[[Page 66829]]

 
11921               T................  ...................  Correct skin color defects.         0024       1.8507       $96.52       $34.75       $19.30
11922               T................  ...................  Correct skin color defects.         0024       1.8507       $96.52       $34.75       $19.30
11950               T................  ...................  Therapy for contour defects         0024       1.8507       $96.52       $34.75       $19.30
11951               T................  ...................  Therapy for contour defects         0024       1.8507       $96.52       $34.75       $19.30
11952               T................  ...................  Therapy for contour defects         0024       1.8507       $96.52       $34.75       $19.30
11954               T................  ...................  Therapy for contour defects         0024       1.8507       $96.52       $34.75       $19.30
11960               T................  ...................  Insert tissue expander(s)..         0027      15.2225      $793.87      $329.72      $158.77
11970               T................  ...................  Replace tissue expander....         0027      15.2225      $793.87      $329.72      $158.77
11971               T................  ...................  Remove tissue expander(s)..         0022      17.3930      $907.06      $354.45      $181.41
11975               E................  ...................  Insert contraceptive cap...  ...........  ...........  ...........  ...........  ...........
11976               T................  ...................  Removal of contraceptive            0019       3.7693      $196.57       $71.87       $39.31
                                                             cap.
11977               E................  ...................  Removal/reinsert contra cap  ...........  ...........  ...........  ...........  ...........
11980               X................  ...................  Implant hormone pellet(s)..         0340       0.6492       $33.86  ...........        $6.77
11981               X................  ...................  Insert drug implant device.         0340       0.6492       $33.86  ...........        $6.77
11982               X................  ...................  Remove drug implant device.         0340       0.6492       $33.86  ...........        $6.77
11983               X................  ...................  Remove/insert drug implant.         0340       0.6492       $33.86  ...........        $6.77
12001               T................  ...................  Repair superficial wound(s)         0024       1.8507       $96.52       $34.75       $19.30
12002               T................  ...................  Repair superficial wound(s)         0024       1.8507       $96.52       $34.75       $19.30
12004               T................  ...................  Repair superficial wound(s)         0024       1.8507       $96.52       $34.75       $19.30
12005               T................  ...................  Repair superficial wound(s)         0024       1.8507       $96.52       $34.75       $19.30
12006               T................  ...................  Repair superficial wound(s)         0024       1.8507       $96.52       $34.75       $19.30
12007               T................  ...................  Repair superficial wound(s)         0024       1.8507       $96.52       $34.75       $19.30
12011               T................  ...................  Repair superficial wound(s)         0024       1.8507       $96.52       $34.75       $19.30
12013               T................  ...................  Repair superficial wound(s)         0024       1.8507       $96.52       $34.75       $19.30
12014               T................  ...................  Repair superficial wound(s)         0024       1.8507       $96.52       $34.75       $19.30
12015               T................  ...................  Repair superficial wound(s)         0024       1.8507       $96.52       $34.75       $19.30
12016               T................  ...................  Repair superficial wound(s)         0024       1.8507       $96.52       $34.75       $19.30
12017               T................  ...................  Repair superficial wound(s)         0024       1.8507       $96.52       $34.75       $19.30
12018               T................  ...................  Repair superficial wound(s)         0024       1.8507       $96.52       $34.75       $19.30
12020               T................  ...................  Closure of split wound.....         0024       1.8507       $96.52       $34.75       $19.30
12021               T................  ...................  Closure of split wound.....         0024       1.8507       $96.52       $34.75       $19.30
12031               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12032               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12034               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12035               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12036               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12037               T................  ...................  Layer closure of wound(s)..         0025       5.8623      $305.72      $115.49       $61.14
12041               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12042               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12044               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12045               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12046               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12047               T................  ...................  Layer closure of wound(s)..         0025       5.8623      $305.72      $115.49       $61.14
12051               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12052               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12053               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12054               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12055               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12056               T................  ...................  Layer closure of wound(s)..         0024       1.8507       $96.52       $34.75       $19.30
12057               T................  ...................  Layer closure of wound(s)..         0025       5.8623      $305.72      $115.49       $61.14
13100               T................  ...................  Repair of wound or lesion..         0025       5.8623      $305.72      $115.49       $61.14
13101               T................  ...................  Repair of wound or lesion..         0025       5.8623      $305.72      $115.49       $61.14
13102               T................  ...................  Repair wound/lesion add-on.         0024       1.8507       $96.52       $34.75       $19.30
13120               T................  ...................  Repair of wound or lesion..         0024       1.8507       $96.52       $34.75       $19.30
13121               T................  ...................  Repair of wound or lesion..         0024       1.8507       $96.52       $34.75       $19.30
13122               T................  ...................  Repair wound/lesion add-on.         0024       1.8507       $96.52       $34.75       $19.30
13131               T................  ...................  Repair of wound or lesion..         0024       1.8507       $96.52       $34.75       $19.30
13132               T................  ...................  Repair of wound or lesion..         0024       1.8507       $96.52       $34.75       $19.30
13133               T................  ...................  Repair wound/lesion add-on.         0024       1.8507       $96.52       $34.75       $19.30
13150               T................  ...................  Repair of wound or lesion..         0025       5.8623      $305.72      $115.49       $61.14
13151               T................  ...................  Repair of wound or lesion..         0024       1.8507       $96.52       $34.75       $19.30
13152               T................  ...................  Repair of wound or lesion..         0025       5.8623      $305.72      $115.49       $61.14
13153               T................  ...................  Repair wound/lesion add-on.         0024       1.8507       $96.52       $34.75       $19.30
13160               T................  ...................  Late closure of wound......         0027      15.2225      $793.87      $329.72      $158.77
14000               T................  ...................  Skin tissue rearrangement..         0027      15.2225      $793.87      $329.72      $158.77

[[Page 66830]]

 
14001               T................  ...................  Skin tissue rearrangement..         0027      15.2225      $793.87      $329.72      $158.77
14020               T................  ...................  Skin tissue rearrangement..         0027      15.2225      $793.87      $329.72      $158.77
14021               T................  ...................  Skin tissue rearrangement..         0027      15.2225      $793.87      $329.72      $158.77
14040               T................  ...................  Skin tissue rearrangement..         0027      15.2225      $793.87      $329.72      $158.77
14041               T................  ...................  Skin tissue rearrangement..         0027      15.2225      $793.87      $329.72      $158.77
14060               T................  ...................  Skin tissue rearrangement..         0027      15.2225      $793.87      $329.72      $158.77
14061               T................  ...................  Skin tissue rearrangement..         0027      15.2225      $793.87      $329.72      $158.77
14300               T................  ...................  Skin tissue rearrangement..         0027      15.2225      $793.87      $329.72      $158.77
14350               T................  ...................  Skin tissue rearrangement..         0027      15.2225      $793.87      $329.72      $158.77
15000               T................  ...................  Skin graft.................         0025       5.8623      $305.72      $115.49       $61.14
15001               T................  ...................  Skin graft add-on..........         0025       5.8623      $305.72      $115.49       $61.14
15050               T................  ...................  Skin pinch graft...........         0025       5.8623      $305.72      $115.49       $61.14
15100               T................  ...................  Skin split graft...........         0027      15.2225      $793.87      $329.72      $158.77
15101               T................  ...................  Skin split graft add-on....         0027      15.2225      $793.87      $329.72      $158.77
15120               T................  ...................  Skin split graft...........         0027      15.2225      $793.87      $329.72      $158.77
15121               T................  ...................  Skin split graft add-on....         0027      15.2225      $793.87      $329.72      $158.77
15200               T................  ...................  Skin full graft............         0027      15.2225      $793.87      $329.72      $158.77
15201               T................  ...................  Skin full graft add-on.....         0025       5.8623      $305.72      $115.49       $61.14
15220               T................  ...................  Skin full graft............         0027      15.2225      $793.87      $329.72      $158.77
15221               T................  ...................  Skin full graft add-on.....         0025       5.8623      $305.72      $115.49       $61.14
15240               T................  ...................  Skin full graft............         0027      15.2225      $793.87      $329.72      $158.77
15241               T................  ...................  Skin full graft add-on.....         0025       5.8623      $305.72      $115.49       $61.14
15260               T................  ...................  Skin full graft............         0027      15.2225      $793.87      $329.72      $158.77
15261               T................  ...................  Skin full graft add-on.....         0025       5.8623      $305.72      $115.49       $61.14
15342               T................  ...................  Cultured skin graft, 25 cm.         0025       5.8623      $305.72      $115.49       $61.14
15343               T................  ...................  Culture skn graft addl 25           0024       1.8507       $96.52       $34.75       $19.30
                                                             cm.
15350               T................  ...................  Skin homograft.............         0686      14.2439      $742.83      $341.70      $148.57
15351               T................  ...................  Skin homograft add-on......         0027      15.2225      $793.87      $329.72      $158.77
15400               T................  ...................  Skin heterograft...........         0025       5.8623      $305.72      $115.49       $61.14
15401               T................  ...................  Skin heterograft add-on....         0025       5.8623      $305.72      $115.49       $61.14
15570               T................  ...................  Form skin pedicle flap.....         0027      15.2225      $793.87      $329.72      $158.77
15572               T................  ...................  Form skin pedicle flap.....         0027      15.2225      $793.87      $329.72      $158.77
15574               T................  ...................  Form skin pedicle flap.....         0027      15.2225      $793.87      $329.72      $158.77
15576               T................  ...................  Form skin pedicle flap.....         0027      15.2225      $793.87      $329.72      $158.77
15600               T................  ...................  Skin graft.................         0027      15.2225      $793.87      $329.72      $158.77
15610               T................  ...................  Skin graft.................         0027      15.2225      $793.87      $329.72      $158.77
15620               T................  ...................  Skin graft.................         0027      15.2225      $793.87      $329.72      $158.77
15630               T................  ...................  Skin graft.................         0027      15.2225      $793.87      $329.72      $158.77
15650               T................  ...................  Transfer skin pedicle flap.         0027      15.2225      $793.87      $329.72      $158.77
15732               T................  ...................  Muscle-skin graft, head/            0027      15.2225      $793.87      $329.72      $158.77
                                                             neck.
15734               T................  ...................  Muscle-skin graft, trunk...         0027      15.2225      $793.87      $329.72      $158.77
15736               T................  ...................  Muscle-skin graft, arm.....         0027      15.2225      $793.87      $329.72      $158.77
15738               T................  ...................  Muscle-skin graft, leg.....         0027      15.2225      $793.87      $329.72      $158.77
15740               T................  ...................  Island pedicle flap graft..         0027      15.2225      $793.87      $329.72      $158.77
15750               T................  ...................  Neurovascular pedicle graft         0027      15.2225      $793.87      $329.72      $158.77
15756               C................  ...................  Free muscle flap, microvasc  ...........  ...........  ...........  ...........  ...........
15757               C................  ...................  Free skin flap, microvasc..  ...........  ...........  ...........  ...........  ...........
15758               C................  ...................  Free fascial flap,           ...........  ...........  ...........  ...........  ...........
                                                             microvasc.
15760               T................  ...................  Composite skin graft.......         0027      15.2225      $793.87      $329.72      $158.77
15770               T................  ...................  Derma-fat-fascia graft.....         0027      15.2225      $793.87      $329.72      $158.77
15775               T................  ...................  Hair transplant punch               0025       5.8623      $305.72      $115.49       $61.14
                                                             grafts.
15776               T................  ...................  Hair transplant punch               0025       5.8623      $305.72      $115.49       $61.14
                                                             grafts.
15780               T................  ...................  Abrasion treatment of skin.         0022      17.3930      $907.06      $354.45      $181.41
15781               T................  ...................  Abrasion treatment of skin.         0022      17.3930      $907.06      $354.45      $181.41
15782               T................  ...................  Abrasion treatment of skin.         0022      17.3930      $907.06      $354.45      $181.41
15783               T................  ...................  Abrasion treatment of skin.         0016       2.6162      $136.44       $57.31       $27.29
15786               T................  ...................  Abrasion, lesion, single...         0013       1.0756       $56.09       $14.20       $11.22
15787               T................  ...................  Abrasion, lesions, add-on..         0013       1.0756       $56.09       $14.20       $11.22
15788               T................  ...................  Chemical peel, face,                0012       0.7849       $40.93       $11.18        $8.19
                                                             epiderm.
15789               T................  ...................  Chemical peel, face, dermal         0015       1.5407       $80.35       $20.35       $16.07
15792               T................  ...................  Chemical peel, nonfacial...         0012       0.7849       $40.93       $11.18        $8.19
15793               T................  ...................  Chemical peel, nonfacial...         0013       1.0756       $56.09       $14.20       $11.22
15810               T................  ...................  Salabrasion................         0016       2.6162      $136.44       $57.31       $27.29
15811               T................  ...................  Salabrasion................         0016       2.6162      $136.44       $57.31       $27.29
15819               T................  ...................  Plastic surgery, neck......         0025       5.8623      $305.72      $115.49       $61.14

[[Page 66831]]

 
15820               T................  ...................  Revision of lower eyelid...         0027      15.2225      $793.87      $329.72      $158.77
15821               T................  ...................  Revision of lower eyelid...         0027      15.2225      $793.87      $329.72      $158.77
15822               T................  ...................  Revision of upper eyelid...         0027      15.2225      $793.87      $329.72      $158.77
15823               T................  ...................  Revision of upper eyelid...         0027      15.2225      $793.87      $329.72      $158.77
15824               T................  ...................  Removal of forehead                 0027      15.2225      $793.87      $329.72      $158.77
                                                             wrinkles.
15825               T................  ...................  Removal of neck wrinkles...         0027      15.2225      $793.87      $329.72      $158.77
15826               T................  ...................  Removal of brow wrinkles...         0027      15.2225      $793.87      $329.72      $158.77
15828               T................  ...................  Removal of face wrinkles...         0027      15.2225      $793.87      $329.72      $158.77
15829               T................  ...................  Removal of skin wrinkles...         0027      15.2225      $793.87      $329.72      $158.77
15831               T................  ...................  Excise excessive skin               0022      17.3930      $907.06      $354.45      $181.41
                                                             tissue.
15832               T................  ...................  Excise excessive skin               0022      17.3930      $907.06      $354.45      $181.41
                                                             tissue.
15833               T................  ...................  Excise excessive skin               0022      17.3930      $907.06      $354.45      $181.41
                                                             tissue.
15834               T................  ...................  Excise excessive skin               0022      17.3930      $907.06      $354.45      $181.41
                                                             tissue.
15835               T................  ...................  Excise excessive skin               0025       5.8623      $305.72      $115.49       $61.14
                                                             tissue.
15836               T................  ...................  Excise excessive skin               0020       7.1898      $374.96      $113.25       $74.99
                                                             tissue.
15837               T................  ...................  Excise excessive skin               0020       7.1898      $374.96      $113.25       $74.99
                                                             tissue.
15838               T................  ...................  Excise excessive skin               0020       7.1898      $374.96      $113.25       $74.99
                                                             tissue.
15839               T................  ...................  Excise excessive skin               0020       7.1898      $374.96      $113.25       $74.99
                                                             tissue.
15840               T................  ...................  Graft for face nerve palsy.         0027      15.2225      $793.87      $329.72      $158.77
15841               T................  ...................  Graft for face nerve palsy.         0027      15.2225      $793.87      $329.72      $158.77
15842               T................  ...................  Flap for face nerve palsy..         0027      15.2225      $793.87      $329.72      $158.77
15845               T................  ...................  Skin and muscle repair,             0027      15.2225      $793.87      $329.72      $158.77
                                                             face.
15850               T................  ...................  Removal of sutures.........         0016       2.6162      $136.44       $57.31       $27.29
15851               T................  ...................  Removal of sutures.........         0013       1.0756       $56.09       $14.20       $11.22
15852               X................  ...................  Dressing change,not for             0340       0.6492       $33.86  ...........        $6.77
                                                             burn.
15860               S................  ...................  Test for blood flow in              0706  ...........       $25.00  ...........        $5.00
                                                             graft.
15876               T................  ...................  Suction assisted lipectomy.         0027      15.2225      $793.87      $329.72      $158.77
15877               T................  ...................  Suction assisted lipectomy.         0027      15.2225      $793.87      $329.72      $158.77
15878               T................  ...................  Suction assisted lipectomy.         0027      15.2225      $793.87      $329.72      $158.77
15879               T................  ...................  Suction assisted lipectomy.         0027      15.2225      $793.87      $329.72      $158.77
15920               T................  ...................  Removal of tail bone ulcer.         0022      17.3930      $907.06      $354.45      $181.41
15922               T................  ...................  Removal of tail bone ulcer.         0027      15.2225      $793.87      $329.72      $158.77
15931               T................  ...................  Remove sacrum pressure sore         0022      17.3930      $907.06      $354.45      $181.41
15933               T................  ...................  Remove sacrum pressure sore         0022      17.3930      $907.06      $354.45      $181.41
15934               T................  ...................  Remove sacrum pressure sore         0027      15.2225      $793.87      $329.72      $158.77
15935               T................  ...................  Remove sacrum pressure sore         0027      15.2225      $793.87      $329.72      $158.77
15936               T................  ...................  Remove sacrum pressure sore         0027      15.2225      $793.87      $329.72      $158.77
15937               T................  ...................  Remove sacrum pressure sore         0027      15.2225      $793.87      $329.72      $158.77
15940               T................  ...................  Remove hip pressure sore...         0022      17.3930      $907.06      $354.45      $181.41
15941               T................  ...................  Remove hip pressure sore...         0022      17.3930      $907.06      $354.45      $181.41
15944               T................  ...................  Remove hip pressure sore...         0027      15.2225      $793.87      $329.72      $158.77
15945               T................  ...................  Remove hip pressure sore...         0027      15.2225      $793.87      $329.72      $158.77
15946               T................  ...................  Remove hip pressure sore...         0027      15.2225      $793.87      $329.72      $158.77
15950               T................  ...................  Remove thigh pressure sore.         0022      17.3930      $907.06      $354.45      $181.41
15951               T................  ...................  Remove thigh pressure sore.         0022      17.3930      $907.06      $354.45      $181.41
15952               T................  ...................  Remove thigh pressure sore.         0027      15.2225      $793.87      $329.72      $158.77
15953               T................  ...................  Remove thigh pressure sore.         0027      15.2225      $793.87      $329.72      $158.77
15956               T................  ...................  Remove thigh pressure sore.         0027      15.2225      $793.87      $329.72      $158.77
15958               T................  ...................  Remove thigh pressure sore.         0027      15.2225      $793.87      $329.72      $158.77
15999               T................  ...................  Removal of pressure sore...         0022      17.3930      $907.06      $354.45      $181.41
16000               T................  ...................  Initial treatment of                0013       1.0756       $56.09       $14.20       $11.22
                                                             burn(s).
16010               T................  ...................  Treatment of burn(s).......         0016       2.6162      $136.44       $57.31       $27.29
16015               T................  ...................  Treatment of burn(s).......         0017      15.8233      $825.20      $227.84      $165.04
16020               T................  ...................  Treatment of burn(s).......         0013       1.0756       $56.09       $14.20       $11.22
16025               T................  ...................  Treatment of burn(s).......         0013       1.0756       $56.09       $14.20       $11.22
16030               T................  ...................  Treatment of burn(s).......         0015       1.5407       $80.35       $20.35       $16.07
16035               C................  ...................  Incision of burn scab,       ...........  ...........  ...........  ...........  ...........
                                                             initi.
16036               C................  ...................  Incise burn scab, addl       ...........  ...........  ...........  ...........  ...........
                                                             incis.
17000               T................  ...................  Destroy benign/premlg               0010       0.6589       $34.36       $10.08        $6.87
                                                             lesion.
17003               T................  ...................  Destroy lesions, 2-14......         0010       0.6589       $34.36       $10.08        $6.87
17004               T................  ...................  Destroy lesions, 15 or more         0011       1.8507       $96.52       $27.88       $19.30
17106               T................  ...................  Destruction of skin lesions         0011       1.8507       $96.52       $27.88       $19.30
17107               T................  ...................  Destruction of skin lesions         0011       1.8507       $96.52       $27.88       $19.30
17108               T................  ...................  Destruction of skin lesions         0011       1.8507       $96.52       $27.88       $19.30
17110               T................  ...................  Destruct lesion, 1-14......         0010       0.6589       $34.36       $10.08        $6.87

[[Page 66832]]

 
17111               T................  ...................  Destruct lesion, 15 or more         0011       1.8507       $96.52       $27.88       $19.30
17250               T................  ...................  Chemical cautery, tissue...         0013       1.0756       $56.09       $14.20       $11.22
17260               T................  ...................  Destruction of skin lesions         0015       1.5407       $80.35       $20.35       $16.07
17261               T................  ...................  Destruction of skin lesions         0015       1.5407       $80.35       $20.35       $16.07
17262               T................  ...................  Destruction of skin lesions         0015       1.5407       $80.35       $20.35       $16.07
17263               T................  ...................  Destruction of skin lesions         0015       1.5407       $80.35       $20.35       $16.07
17264               T................  ...................  Destruction of skin lesions         0015       1.5407       $80.35       $20.35       $16.07
17266               T................  ...................  Destruction of skin lesions         0016       2.6162      $136.44       $57.31       $27.29
17270               T................  ...................  Destruction of skin lesions         0015       1.5407       $80.35       $20.35       $16.07
17271               T................  ...................  Destruction of skin lesions         0013       1.0756       $56.09       $14.20       $11.22
17272               T................  ...................  Destruction of skin lesions         0015       1.5407       $80.35       $20.35       $16.07
17273               T................  ...................  Destruction of skin lesions         0015       1.5407       $80.35       $20.35       $16.07
17274               T................  ...................  Destruction of skin lesions         0016       2.6162      $136.44       $57.31       $27.29
17276               T................  ...................  Destruction of skin lesions         0016       2.6162      $136.44       $57.31       $27.29
17280               T................  ...................  Destruction of skin lesions         0015       1.5407       $80.35       $20.35       $16.07
17281               T................  ...................  Destruction of skin lesions         0015       1.5407       $80.35       $20.35       $16.07
17282               T................  ...................  Destruction of skin lesions         0015       1.5407       $80.35       $20.35       $16.07
17283               T................  ...................  Destruction of skin lesions         0015       1.5407       $80.35       $20.35       $16.07
17284               T................  ...................  Destruction of skin lesions         0016       2.6162      $136.44       $57.31       $27.29
17286               T................  ...................  Destruction of skin lesions         0015       1.5407       $80.35       $20.35       $16.07
17304               T................  ...................  Chemosurgery of skin lesion         0694       3.4689      $180.91       $72.36       $36.18
17305               T................  ...................  2 stage mohs, up to 5 spec.         0694       3.4689      $180.91       $72.36       $36.18
17306               T................  ...................  3 stage mohs, up to 5 spec.         0694       3.4689      $180.91       $72.36       $36.18
17307               T................  ...................  Mohs addl stage up to 5             0694       3.4689      $180.91       $72.36       $36.18
                                                             spec.
17310               T................  ...................  Extensive skin chemosurgery         0694       3.4689      $180.91       $72.36       $36.18
17340               T................  ...................  Cryotherapy of skin........         0012       0.7849       $40.93       $11.18        $8.19
17360               T................  ...................  Skin peel therapy..........         0012       0.7849       $40.93       $11.18        $8.19
17380               T................  ...................  Hair removal by                     0012       0.7849       $40.93       $11.18        $8.19
                                                             electrolysis.
17999               T................  ...................  Skin tissue procedure......         0006       1.7926       $93.49       $24.12       $18.70
19000               T................  ...................  Drainage of breast lesion..         0004       1.7441       $90.96       $23.47       $18.19
19001               T................  ...................  Drain breast lesion add-on.         0004       1.7441       $90.96       $23.47       $18.19
19020               T................  ...................  Incision of breast lesion..         0008      16.1430      $841.87  ...........      $168.37
19030               N................  ...................  Injection for breast x-ray.  ...........  ...........  ...........  ...........  ...........
19100               T................  ...................  Bx breast percut w/o image.         0005       3.1201      $162.72       $71.59       $32.54
19101               T................  ...................  Biopsy of breast, open.....         0028      16.8698      $879.78      $303.74      $175.96
19102               T................  ...................  Bx breast percut w/image...         0005       3.1201      $162.72       $71.59       $32.54
19103               T................  ...................  Bx breast percut w/device..         0658       5.2712      $274.90  ...........       $54.98
19110               T................  ...................  Nipple exploration.........         0028      16.8698      $879.78      $303.74      $175.96
19112               T................  ...................  Excise breast duct fistula.         0028      16.8698      $879.78      $303.74      $175.96
19120               T................  ...................  Removal of breast lesion...         0028      16.8698      $879.78      $303.74      $175.96
19125               T................  ...................  Excision, breast lesion....         0028      16.8698      $879.78      $303.74      $175.96
19126               T................  ...................  Excision, addl breast               0028      16.8698      $879.78      $303.74      $175.96
                                                             lesion.
19140               T................  ...................  Removal of breast tissue...         0028      16.8698      $879.78      $303.74      $175.96
19160               T................  ...................  Removal of breast tissue...         0028      16.8698      $879.78      $303.74      $175.96
19162               T................  ...................  Remove breast tissue, nodes         0693      37.5863    $1,960.16      $798.17      $392.03
19180               T................  ...................  Removal of breast..........         0029      28.7881    $1,501.33      $632.64      $300.27
19182               T................  ...................  Removal of breast..........         0029      28.7881    $1,501.33      $632.64      $300.27
19200               C................  ...................  Removal of breast..........  ...........  ...........  ...........  ...........  ...........
19220               C................  ...................  Removal of breast..........  ...........  ...........  ...........  ...........  ...........
19240               T................  ...................  Removal of breast..........         0030      37.5185    $1,956.63      $763.55      $391.33
19260               T................  ...................  Removal of chest wall               0021      13.9338      $726.66      $219.48      $145.33
                                                             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       1.4438       $75.30  ...........       $15.06
19316               T................  ...................  Suspension of breast.......         0029      28.7881    $1,501.33      $632.64      $300.27
19318               T................  ...................  Reduction of large breast..         0693      37.5863    $1,960.16      $798.17      $392.03
19324               T................  ...................  Enlarge breast.............         0693      37.5863    $1,960.16      $798.17      $392.03
19325               T................  ...................  Enlarge breast with implant         0648      44.7955    $2,336.13  ...........      $467.23
19328               T................  ...................  Removal of breast implant..         0029      28.7881    $1,501.33      $632.64      $300.27
19330               T................  ...................  Removal of implant material         0029      28.7881    $1,501.33      $632.64      $300.27
19340               T................  ...................  Immediate breast prosthesis         0030      37.5185    $1,956.63      $763.55      $391.33
19342               T................  ...................  Delayed breast prosthesis..         0648      44.7955    $2,336.13  ...........      $467.23
19350               T................  ...................  Breast reconstruction......         0029      28.7881    $1,501.33      $632.64      $300.27

[[Page 66833]]

 
19355               T................  ...................  Correct inverted nipple(s).         0029      28.7881    $1,501.33      $632.64      $300.27
19357               T................  ...................  Breast reconstruction......         0648      44.7955    $2,336.13  ...........      $467.23
19361               C................  ...................  Breast reconstruction......  ...........  ...........  ...........  ...........  ...........
19364               C................  ...................  Breast reconstruction......  ...........  ...........  ...........  ...........  ...........
19366               T................  ...................  Breast reconstruction......         0029      28.7881    $1,501.33      $632.64      $300.27
19367               C................  ...................  Breast reconstruction......  ...........  ...........  ...........  ...........  ...........
19368               C................  ...................  Breast reconstruction......  ...........  ...........  ...........  ...........  ...........
19369               C................  ...................  Breast reconstruction......  ...........  ...........  ...........  ...........  ...........
19370               T................  ...................  Surgery of breast capsule..         0029      28.7881    $1,501.33      $632.64      $300.27
19371               T................  ...................  Removal of breast capsule..         0029      28.7881    $1,501.33      $632.64      $300.27
19380               T................  ...................  Revise breast                       0030      37.5185    $1,956.63      $763.55      $391.33
                                                             reconstruction.
19396               T................  ...................  Design custom breast                0029      28.7881    $1,501.33      $632.64      $300.27
                                                             implant.
19499               T................  ...................  Breast surgery procedure...         0028      16.8698      $879.78      $303.74      $175.96
20000               T................  ...................  Incision of abscess........         0006       1.7926       $93.49       $24.12       $18.70
20005               T................  ...................  Incision of deep abscess...         0049      18.6042      $970.23      $197.14      $194.05
20100               T................  ...................  Explore wound, neck........         0023       2.5193      $131.38       $40.37       $26.28
20101               T................  ...................  Explore wound, chest.......         0027      15.2225      $793.87      $329.72      $158.77
20102               T................  ...................  Explore wound, abdomen.....         0027      15.2225      $793.87      $329.72      $158.77
20103               T................  ...................  Explore wound, extremity...         0023       2.5193      $131.38       $40.37       $26.28
20150               T................  ...................  Excise epiphyseal bar......         0051      32.9062    $1,716.09  ...........      $343.22
20200               T................  ...................  Muscle biopsy..............         0021      13.9338      $726.66      $219.48      $145.33
20205               T................  ...................  Deep muscle biopsy.........         0021      13.9338      $726.66      $219.48      $145.33
20206               T................  ...................  Needle biopsy, muscle......         0005       3.1201      $162.72       $71.59       $32.54
20220               T................  ...................  Bone biopsy, trocar/needle.         0019       3.7693      $196.57       $71.87       $39.31
20225               T................  ...................  Bone biopsy, trocar/needle.         0019       3.7693      $196.57       $71.87       $39.31
20240               T................  ...................  Bone biopsy, excisional....         0022      17.3930      $907.06      $354.45      $181.41
20245               T................  ...................  Bone biopsy, excisional....         0022      17.3930      $907.06      $354.45      $181.41
20250               T................  ...................  Open bone biopsy...........         0049      18.6042      $970.23      $197.14      $194.05
20251               T................  ...................  Open bone biopsy...........         0049      18.6042      $970.23      $197.14      $194.05
20500               T................  ...................  Injection of sinus tract...         0251       1.9089       $99.55  ...........       $19.91
20501               N................  ...................  Inject sinus tract for x-    ...........  ...........  ...........  ...........  ...........
                                                             ray.
20520               T................  ...................  Removal of foreign body....         0019       3.7693      $196.57       $71.87       $39.31
20525               T................  ...................  Removal of foreign body....         0022      17.3930      $907.06      $354.45      $181.41
20526               T................  ...................  Ther injection, carp tunnel         0204       2.0251      $105.61       $40.13       $21.12
20550               T................  ...................  Inject tendon/ligament/cyst         0204       2.0251      $105.61       $40.13       $21.12
20551               T................  ...................  Inject tendon origin/insert         0204       2.0251      $105.61       $40.13       $21.12
20552               T................  ...................  Inject trigger point, 1 or          0204       2.0251      $105.61       $40.13       $21.12
                                                             2.
20553               T................  ...................  Inject trigger points,  3.
20600               T................  ...................  Drain/inject, joint/bursa..         0204       2.0251      $105.61       $40.13       $21.12
20605               T................  ...................  Drain/inject, joint/bursa..         0204       2.0251      $105.61       $40.13       $21.12
20610               T................  ...................  Drain/inject, joint/bursa..         0204       2.0251      $105.61       $40.13       $21.12
20612               T................  NI.................  Aspirate/inj ganglion cyst.         0204       2.0251      $105.61       $40.13       $21.12
20615               T................  ...................  Treatment of bone cyst.....         0004       1.7441       $90.96       $23.47       $18.19
20650               T................  ...................  Insert and remove bone pin.         0049      18.6042      $970.23      $197.14      $194.05
20660               C................  ...................  Apply, rem 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       0.6492       $33.86  ...........        $6.77
20670               T................  ...................  Removal of support implant.         0021      13.9338      $726.66      $219.48      $145.33
20680               T................  ...................  Removal of support implant.         0022      17.3930      $907.06      $354.45      $181.41
20690               T................  ...................  Apply bone fixation device.         0050      23.3037    $1,215.31  ...........      $243.06
20692               T................  ...................  Apply bone fixation device.         0050      23.3037    $1,215.31  ...........      $243.06
20693               T................  ...................  Adjust bone fixation device         0049      18.6042      $970.23      $197.14      $194.05
20694               T................  ...................  Remove bone fixation device         0049      18.6042      $970.23      $197.14      $194.05
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      23.3037    $1,215.31  ...........      $243.06

[[Page 66834]]

 
20902               T................  ...................  Removal of bone for graft..         0050      23.3037    $1,215.31  ...........      $243.06
20910               T................  ...................  Remove cartilage for graft.         0027      15.2225      $793.87      $329.72      $158.77
20912               T................  ...................  Remove cartilage for graft.         0027      15.2225      $793.87      $329.72      $158.77
20920               T................  ...................  Removal of fascia for graft         0027      15.2225      $793.87      $329.72      $158.77
20922               T................  ...................  Removal of fascia for graft         0027      15.2225      $793.87      $329.72      $158.77
20924               T................  ...................  Removal of tendon for graft         0050      23.3037    $1,215.31  ...........      $243.06
20926               T................  ...................  Removal of tissue for graft         0027      15.2225      $793.87      $329.72      $158.77
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       1.7926       $93.49       $24.12       $18.70
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      18.6042      $970.23      $197.14      $194.05
20979               A................  ...................  Us bone stimulation........  ...........  ...........  ...........  ...........  ...........
20999               T................  ...................  Musculoskeletal surgery....         0049      18.6042      $970.23      $197.14      $194.05
21010               T................  ...................  Incision of jaw joint......         0254      20.1158    $1,049.06      $321.35      $209.81
21015               T................  ...................  Resection of facial tumor..         0253      14.4473      $753.44      $282.29      $150.69
21025               T................  ...................  Excision of bone, lower jaw         0256      34.0302    $1,774.71  ...........      $354.94
21026               T................  ...................  Excision of facial bone(s).         0256      34.0302    $1,774.71  ...........      $354.94
21029               T................  ...................  Contour of face bone lesion         0256      34.0302    $1,774.71  ...........      $354.94
21030               T................  ...................  Removal of face bone lesion         0254      20.1158    $1,049.06      $321.35      $209.81
21031               T................  ...................  Remove exostosis, mandible.         0254      20.1158    $1,049.06      $321.35      $209.81
21032               T................  ...................  Remove exostosis, maxilla..         0254      20.1158    $1,049.06      $321.35      $209.81
21034               T................  ...................  Removal of face bone lesion         0256      34.0302    $1,774.71  ...........      $354.94
21040               T................  ...................  Removal of jaw bone lesion.         0254      20.1158    $1,049.06      $321.35      $209.81
21041               T................  DG.................  Removal of jaw bone lesion.         0256      34.0302    $1,774.71  ...........      $354.94
21044               T................  ...................  Removal of jaw bone lesion.         0256      34.0302    $1,774.71  ...........      $354.94
21045               C................  ...................  Extensive jaw surgery......  ...........  ...........  ...........  ...........  ...........
21046               T................  NI.................  Remove mandible cyst                0256      34.0302    $1,774.71  ...........      $354.94
                                                             complex.
21047               T................  NI.................  Excise lwr jaw cyst w/              0256      34.0302    $1,774.71  ...........      $354.94
                                                             repair.
21048               T................  NI.................  Remove maxilla cyst complex         0256      34.0302    $1,774.71  ...........      $354.94
21049               T................  NI.................  Excis uppr jaw cyst w/              0256      34.0302    $1,774.71  ...........      $354.94
                                                             repair.
21050               T................  ...................  Removal of jaw joint.......         0256      34.0302    $1,774.71  ...........      $354.94
21060               T................  ...................  Remove jaw joint cartilage.         0256      34.0302    $1,774.71  ...........      $354.94
21070               T................  ...................  Remove coronoid process....         0256      34.0302    $1,774.71  ...........      $354.94
21076               T................  ...................  Prepare face/oral                   0254      20.1158    $1,049.06      $321.35      $209.81
                                                             prosthesis.
21077               T................  ...................  Prepare face/oral                   0256      34.0302    $1,774.71  ...........      $354.94
                                                             prosthesis.
21079               T................  ...................  Prepare face/oral                   0256      34.0302    $1,774.71  ...........      $354.94
                                                             prosthesis.
21080               T................  ...................  Prepare face/oral                   0256      34.0302    $1,774.71  ...........      $354.94
                                                             prosthesis.
21081               T................  ...................  Prepare face/oral                   0256      34.0302    $1,774.71  ...........      $354.94
                                                             prosthesis.
21082               T................  ...................  Prepare face/oral                   0256      34.0302    $1,774.71  ...........      $354.94
                                                             prosthesis.
21083               T................  ...................  Prepare face/oral                   0256      34.0302    $1,774.71  ...........      $354.94
                                                             prosthesis.
21084               T................  ...................  Prepare face/oral                   0256      34.0302    $1,774.71  ...........      $354.94
                                                             prosthesis.
21085               T................  ...................  Prepare face/oral                   0253      14.4473      $753.44      $282.29      $150.69
                                                             prosthesis.
21086               T................  ...................  Prepare face/oral                   0256      34.0302    $1,774.71  ...........      $354.94
                                                             prosthesis.
21087               T................  ...................  Prepare face/oral                   0256      34.0302    $1,774.71  ...........      $354.94
                                                             prosthesis.
21088               T................  ...................  Prepare face/oral                   0256      34.0302    $1,774.71  ...........      $354.94
                                                             prosthesis.
21089               T................  ...................  Prepare face/oral                   0253      14.4473      $753.44      $282.29      $150.69
                                                             prosthesis.
21100               T................  ...................  Maxillofacial fixation.....         0256      34.0302    $1,774.71  ...........      $354.94
21110               T................  ...................  Interdental fixation.......         0252       5.8041      $302.69      $113.41       $60.54
21116               N................  ...................  Injection, jaw joint x-ray.  ...........  ...........  ...........  ...........  ...........
21120               T................  ...................  Reconstruction of chin.....         0254      20.1158    $1,049.06      $321.35      $209.81
21121               T................  ...................  Reconstruction of chin.....         0254      20.1158    $1,049.06      $321.35      $209.81
21122               T................  ...................  Reconstruction of chin.....         0254      20.1158    $1,049.06      $321.35      $209.81
21123               T................  ...................  Reconstruction of chin.....         0254      20.1158    $1,049.06      $321.35      $209.81

[[Page 66835]]

 
21125               T................  ...................  Augmentation, lower jaw             0254      20.1158    $1,049.06      $321.35      $209.81
                                                             bone.
21127               T................  ...................  Augmentation, lower jaw             0256      34.0302    $1,774.71  ...........      $354.94
                                                             bone.
21137               T................  ...................  Reduction of forehead......         0254      20.1158    $1,049.06      $321.35      $209.81
21138               T................  ...................  Reduction of forehead......         0256      34.0302    $1,774.71  ...........      $354.94
21139               T................  ...................  Reduction of forehead......         0256      34.0302    $1,774.71  ...........      $354.94
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      20.1158    $1,049.06      $321.35      $209.81
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.  ...........  ...........  ...........  ...........  ...........
21198               T................  ...................  Reconstr lwr jaw segment...         0256      34.0302    $1,774.71  ...........      $354.94
21199               T................  ...................  Reconstr lwr jaw w/advance.         0256      34.0302    $1,774.71  ...........      $354.94
21206               T................  ...................  Reconstruct upper jaw bone.         0256      34.0302    $1,774.71  ...........      $354.94
21208               T................  ...................  Augmentation of facial              0256      34.0302    $1,774.71  ...........      $354.94
                                                             bones.
21209               T................  ...................  Reduction of facial bones..         0256      34.0302    $1,774.71  ...........      $354.94
21210               T................  ...................  Face bone graft............         0256      34.0302    $1,774.71  ...........      $354.94
21215               T................  ...................  Lower jaw bone graft.......         0256      34.0302    $1,774.71  ...........      $354.94
21230               T................  ...................  Rib cartilage graft........         0256      34.0302    $1,774.71  ...........      $354.94
21235               T................  ...................  Ear cartilage graft........         0254      20.1158    $1,049.06      $321.35      $209.81
21240               T................  ...................  Reconstruction of jaw joint         0256      34.0302    $1,774.71  ...........      $354.94
21242               T................  ...................  Reconstruction of jaw joint         0256      34.0302    $1,774.71  ...........      $354.94
21243               T................  ...................  Reconstruction of jaw joint         0256      34.0302    $1,774.71  ...........      $354.94
21244               T................  ...................  Reconstruction of lower jaw         0256      34.0302    $1,774.71  ...........      $354.94
21245               T................  ...................  Reconstruction of jaw......         0256      34.0302    $1,774.71  ...........      $354.94
21246               T................  ...................  Reconstruction of jaw......         0256      34.0302    $1,774.71  ...........      $354.94
21247               C................  ...................  Reconstruct lower jaw bone.  ...........  ...........  ...........  ...........  ...........
21248               T................  ...................  Reconstruction of jaw......         0256      34.0302    $1,774.71  ...........      $354.94
21249               T................  ...................  Reconstruction of jaw......         0256      34.0302    $1,774.71  ...........      $354.94
21255               C................  ...................  Reconstruct lower jaw bone.  ...........  ...........  ...........  ...........  ...........
21256               C................  ...................  Reconstruction of orbit....  ...........  ...........  ...........  ...........  ...........
21260               T................  ...................  Revise eye sockets.........         0256      34.0302    $1,774.71  ...........      $354.94
21261               T................  ...................  Revise eye sockets.........         0256      34.0302    $1,774.71  ...........      $354.94
21263               T................  ...................  Revise eye sockets.........         0256      34.0302    $1,774.71  ...........      $354.94
21267               T................  ...................  Revise eye sockets.........         0256      34.0302    $1,774.71  ...........      $354.94
21268               C................  ...................  Revise eye sockets.........  ...........  ...........  ...........  ...........  ...........
21270               T................  ...................  Augmentation, cheek bone...         0256      34.0302    $1,774.71  ...........      $354.94
21275               T................  ...................  Revision, orbitofacial              0256      34.0302    $1,774.71  ...........      $354.94
                                                             bones.
21280               T................  ...................  Revision of eyelid.........         0256      34.0302    $1,774.71  ...........      $354.94
21282               T................  ...................  Revision of eyelid.........         0253      14.4473      $753.44      $282.29      $150.69
21295               T................  ...................  Revision of jaw muscle/bone         0252       5.8041      $302.69      $113.41       $60.54
21296               T................  ...................  Revision of jaw muscle/bone         0254      20.1158    $1,049.06      $321.35      $209.81
21299               T................  ...................  Cranio/maxillofacial                0253      14.4473      $753.44      $282.29      $150.69
                                                             surgery.
21300               T................  ...................  Treatment of skull fracture         0253      14.4473      $753.44      $282.29      $150.69
21310               X................  ...................  Treatment of nose fracture.         0340       0.6492       $33.86  ...........        $6.77
21315               X................  ...................  Treatment of nose fracture.         0340       0.6492       $33.86  ...........        $6.77

[[Page 66836]]

 
21320               X................  ...................  Treatment of nose fracture.         0340       0.6492       $33.86  ...........        $6.77
21325               T................  ...................  Treatment of nose fracture.         0254      20.1158    $1,049.06      $321.35      $209.81
21330               T................  ...................  Treatment of nose fracture.         0254      20.1158    $1,049.06      $321.35      $209.81
21335               T................  ...................  Treatment of nose fracture.         0254      20.1158    $1,049.06      $321.35      $209.81
21336               T................  ...................  Treat nasal septal fracture         0046      29.2920    $1,527.61      $535.76      $305.52
21337               T................  ...................  Treat nasal septal fracture         0253      14.4473      $753.44      $282.29      $150.69
21338               T................  ...................  Treat nasoethmoid fracture.         0254      20.1158    $1,049.06      $321.35      $209.81
21339               T................  ...................  Treat nasoethmoid fracture.         0254      20.1158    $1,049.06      $321.35      $209.81
21340               T................  ...................  Treatment of nose fracture.         0256      34.0302    $1,774.71  ...........      $354.94
21343               C................  ...................  Treatment of sinus fracture  ...........  ...........  ...........  ...........  ...........
21344               C................  ...................  Treatment of sinus fracture  ...........  ...........  ...........  ...........  ...........
21345               T................  ...................  Treat nose/jaw fracture....         0254      20.1158    $1,049.06      $321.35      $209.81
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      34.0302    $1,774.71  ...........      $354.94
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      34.0302    $1,774.71  ...........      $354.94
21395               C................  ...................  Treat eye socket fracture..  ...........  ...........  ...........  ...........  ...........
21400               T................  ...................  Treat eye socket fracture..         0252       5.8041      $302.69      $113.41       $60.54
21401               T................  ...................  Treat eye socket fracture..         0253      14.4473      $753.44      $282.29      $150.69
21406               T................  ...................  Treat eye socket fracture..         0256      34.0302    $1,774.71  ...........      $354.94
21407               T................  ...................  Treat eye socket fracture..         0256      34.0302    $1,774.71  ...........      $354.94
21408               C................  ...................  Treat eye socket fracture..  ...........  ...........  ...........  ...........  ...........
21421               T................  ...................  Treat mouth roof fracture..         0254      20.1158    $1,049.06      $321.35      $209.81
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      20.1158    $1,049.06      $321.35      $209.81
21445               T................  ...................  Treat dental ridge fracture         0254      20.1158    $1,049.06      $321.35      $209.81
21450               T................  ...................  Treat lower jaw fracture...         0251       1.9089       $99.55  ...........       $19.91
21451               T................  ...................  Treat lower jaw fracture...         0252       5.8041      $302.69      $113.41       $60.54
21452               T................  ...................  Treat lower jaw fracture...         0253      14.4473      $753.44      $282.29      $150.69
21453               T................  ...................  Treat lower jaw fracture...         0256      34.0302    $1,774.71  ...........      $354.94
21454               T................  ...................  Treat lower jaw fracture...         0254      20.1158    $1,049.06      $321.35      $209.81
21461               T................  ...................  Treat lower jaw fracture...         0256      34.0302    $1,774.71  ...........      $354.94
21462               T................  ...................  Treat lower jaw fracture...         0256      34.0302    $1,774.71  ...........      $354.94
21465               T................  ...................  Treat lower jaw fracture...         0256      34.0302    $1,774.71  ...........      $354.94
21470               T................  ...................  Treat lower jaw fracture...         0256      34.0302    $1,774.71  ...........      $354.94
21480               T................  ...................  Reset dislocated jaw.......         0251       1.9089       $99.55  ...........       $19.91
21485               T................  ...................  Reset dislocated jaw.......         0253      14.4473      $753.44      $282.29      $150.69
21490               T................  ...................  Repair dislocated jaw......         0256      34.0302    $1,774.71  ...........      $354.94
21493               T................  ...................  Treat hyoid bone fracture..         0252       5.8041      $302.69      $113.41       $60.54
21494               T................  ...................  Treat hyoid bone fracture..         0252       5.8041      $302.69      $113.41       $60.54
21495               C................  ...................  Treat hyoid bone fracture..  ...........  ...........  ...........  ...........  ...........
21497               T................  ...................  Interdental wiring.........         0253      14.4473      $753.44      $282.29      $150.69
21499               T................  ...................  Head surgery procedure.....         0253      14.4473      $753.44      $282.29      $150.69
21501               T................  ...................  Drain neck/chest lesion....         0008      16.1430      $841.87  ...........      $168.37
21502               T................  ...................  Drain chest lesion.........         0049      18.6042      $970.23      $197.14      $194.05
21510               C................  ...................  Drainage of bone lesion....  ...........  ...........  ...........  ...........  ...........
21550               T................  ...................  Biopsy of neck/chest.......         0021      13.9338      $726.66      $219.48      $145.33
21555               T................  ...................  Remove lesion, neck/chest..         0022      17.3930      $907.06      $354.45      $181.41
21556               T................  ...................  Remove lesion, neck/chest..         0022      17.3930      $907.06      $354.45      $181.41
21557               C................  ...................  Remove tumor, neck/chest...  ...........  ...........  ...........  ...........  ...........
21600               T................  ...................  Partial removal of rib.....         0050      23.3037    $1,215.31  ...........      $243.06

[[Page 66837]]

 
21610               T................  ...................  Partial removal of rib.....         0050      23.3037    $1,215.31  ...........      $243.06
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      18.6042      $970.23      $197.14      $194.05
21705               C................  ...................  Revision of neck muscle/rib  ...........  ...........  ...........  ...........  ...........
21720               T................  ...................  Revision of neck muscle....         0049      18.6042      $970.23      $197.14      $194.05
21725               T................  ...................  Revision of neck muscle....         0006       1.7926       $93.49       $24.12       $18.70
21740               C................  ...................  Reconstruction of sternum..  ...........  ...........  ...........  ...........  ...........
21742               T................  NI.................  Repair stern/nuss w/o scope         0051      32.9062    $1,716.09  ...........      $343.22
21743               T................  NI.................  Repair sternum/nuss w/scope         0051      32.9062    $1,716.09  ...........      $343.22
21750               C................  ...................  Repair of sternum            ...........  ...........  ...........  ...........  ...........
                                                             separation.
21800               T................  ...................  Treatment of rib fracture..         0043       2.4999      $130.37  ...........       $26.07
21805               T................  ...................  Treatment of rib fracture..         0046      29.2920    $1,527.61      $535.76      $305.52
21810               C................  ...................  Treatment of rib             ...........  ...........  ...........  ...........  ...........
                                                             fracture(s).
21820               T................  ...................  Treat sternum fracture.....         0043       2.4999      $130.37  ...........       $26.07
21825               C................  ...................  Treat sternum fracture.....  ...........  ...........  ...........  ...........  ...........
21899               T................  ...................  Neck/chest surgery                  0252       5.8041      $302.69      $113.41       $60.54
                                                             procedure.
21920               T................  ...................  Biopsy soft tissue of back.         0020       7.1898      $374.96      $113.25       $74.99
21925               T................  ...................  Biopsy soft tissue of back.         0022      17.3930      $907.06      $354.45      $181.41
21930               T................  ...................  Remove lesion, back or              0022      17.3930      $907.06      $354.45      $181.41
                                                             flank.
21935               T................  ...................  Remove tumor, back.........         0022      17.3930      $907.06      $354.45      $181.41
22100               T................  ...................  Remove part of neck                 0208      38.4487    $2,005.14  ...........      $401.03
                                                             vertebra.
22101               T................  ...................  Remove part, thorax                 0208      38.4487    $2,005.14  ...........      $401.03
                                                             vertebra.
22102               T................  ...................  Remove part, lumbar                 0208      38.4487    $2,005.14  ...........      $401.03
                                                             vertebra.
22103               T................  ...................  Remove extra spine segment.         0208      38.4487    $2,005.14  ...........      $401.03
22110               C................  ...................  Remove part of neck          ...........  ...........  ...........  ...........  ...........
                                                             vertebra.
22112               C................  ...................  Remove part, thorax          ...........  ...........  ...........  ...........  ...........
                                                             vertebra.
22114               C................  ...................  Remove part, lumbar          ...........  ...........  ...........  ...........  ...........
                                                             vertebra.
22116               C................  ...................  Remove extra spine segment.  ...........  ...........  ...........  ...........  ...........
22210               C................  ...................  Revision of neck spine.....  ...........  ...........  ...........  ...........  ...........
22212               C................  ...................  Revision of thorax spine...  ...........  ...........  ...........  ...........  ...........
22214               C................  ...................  Revision of lumbar spine...  ...........  ...........  ...........  ...........  ...........
22216               C................  ...................  Revise, extra spine segment  ...........  ...........  ...........  ...........  ...........
22220               C................  ...................  Revision of neck spine.....  ...........  ...........  ...........  ...........  ...........
22222               C................  ...................  Revision of thorax spine...  ...........  ...........  ...........  ...........  ...........
22224               C................  ...................  Revision of lumbar spine...  ...........  ...........  ...........  ...........  ...........
22226               C................  ...................  Revise, extra spine segment  ...........  ...........  ...........  ...........  ...........
22305               T................  ...................  Treat spine process                 0043       2.4999      $130.37  ...........       $26.07
                                                             fracture.
22310               T................  ...................  Treat spine fracture.......         0043       2.4999      $130.37  ...........       $26.07
22315               T................  ...................  Treat spine fracture.......         0043       2.4999      $130.37  ...........       $26.07
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      12.9357      $674.61      $268.47      $134.92
22520               T................  ...................  Percut vertebroplasty thor.         0050      23.3037    $1,215.31  ...........      $243.06
22521               T................  ...................  Percut vertebroplasty lumb.         0050      23.3037    $1,215.31  ...........      $243.06
22522               T................  ...................  Percut vertebroplasty addl.         0050      23.3037    $1,215.31  ...........      $243.06
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               T................  ...................  Lumbar spine fusion........         0208      38.4487    $2,005.14  ...........      $401.03
22614               T................  ...................  Spine fusion, extra segment         0208      38.4487    $2,005.14  ...........      $401.03

[[Page 66838]]

 
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       2.4999      $130.37  ...........       $26.07
22900               T................  ...................  Remove abdominal wall               0022      17.3930      $907.06      $354.45      $181.41
                                                             lesion.
22999               T................  ...................  Abdomen surgery procedure..         0022      17.3930      $907.06      $354.45      $181.41
23000               T................  ...................  Removal of calcium deposits         0021      13.9338      $726.66      $219.48      $145.33
23020               T................  ...................  Release shoulder joint.....         0051      32.9062    $1,716.09  ...........      $343.22
23030               T................  ...................  Drain shoulder lesion......         0008      16.1430      $841.87  ...........      $168.37
23031               T................  ...................  Drain shoulder bursa.......         0008      16.1430      $841.87  ...........      $168.37
23035               T................  ...................  Drain shoulder bone lesion.         0049      18.6042      $970.23      $197.14      $194.05
23040               T................  ...................  Exploratory shoulder                0050      23.3037    $1,215.31  ...........      $243.06
                                                             surgery.
23044               T................  ...................  Exploratory shoulder                0050      23.3037    $1,215.31  ...........      $243.06
                                                             surgery.
23065               T................  ...................  Biopsy shoulder tissues....         0021      13.9338      $726.66      $219.48      $145.33
23066               T................  ...................  Biopsy shoulder tissues....         0022      17.3930      $907.06      $354.45      $181.41
23075               T................  ...................  Removal of shoulder lesion.         0021      13.9338      $726.66      $219.48      $145.33
23076               T................  ...................  Removal of shoulder lesion.         0022      17.3930      $907.06      $354.45      $181.41
23077               T................  ...................  Remove tumor of shoulder...         0022      17.3930      $907.06      $354.45      $181.41
23100               T................  ...................  Biopsy of shoulder joint...         0049      18.6042      $970.23      $197.14      $194.05
23101               T................  ...................  Shoulder joint surgery.....         0050      23.3037    $1,215.31  ...........      $243.06
23105               T................  ...................  Remove shoulder joint               0050      23.3037    $1,215.31  ...........      $243.06
                                                             lining.
23106               T................  ...................  Incision of collarbone              0050      23.3037    $1,215.31  ...........      $243.06
                                                             joint.
23107               T................  ...................  Explore treat shoulder              0050      23.3037    $1,215.31  ...........      $243.06
                                                             joint.
23120               T................  ...................  Partial removal, collar             0051      32.9062    $1,716.09  ...........      $343.22
                                                             bone.
23125               T................  ...................  Removal of collar bone.....         0051      32.9062    $1,716.09  ...........      $343.22
23130               T................  ...................  Remove shoulder bone, part.         0051      32.9062    $1,716.09  ...........      $343.22
23140               T................  ...................  Removal of bone lesion.....         0049      18.6042      $970.23      $197.14      $194.05
23145               T................  ...................  Removal of bone lesion.....         0050      23.3037    $1,215.31  ...........      $243.06
23146               T................  ...................  Removal of bone lesion.....         0050      23.3037    $1,215.31  ...........      $243.06
23150               T................  ...................  Removal of humerus lesion..         0050      23.3037    $1,215.31  ...........      $243.06
23155               T................  ...................  Removal of humerus lesion..         0050      23.3037    $1,215.31  ...........      $243.06
23156               T................  ...................  Removal of humerus lesion..         0050      23.3037    $1,215.31  ...........      $243.06
23170               T................  ...................  Remove collar bone lesion..         0050      23.3037    $1,215.31  ...........      $243.06
23172               T................  ...................  Remove shoulder blade               0050      23.3037    $1,215.31  ...........      $243.06
                                                             lesion.
23174               T................  ...................  Remove humerus lesion......         0050      23.3037    $1,215.31  ...........      $243.06
23180               T................  ...................  Remove collar bone lesion..         0050      23.3037    $1,215.31  ...........      $243.06
23182               T................  ...................  Remove shoulder blade               0050      23.3037    $1,215.31  ...........      $243.06
                                                             lesion.
23184               T................  ...................  Remove humerus lesion......         0050      23.3037    $1,215.31  ...........      $243.06
23190               T................  ...................  Partial removal of scapula.         0050      23.3037    $1,215.31  ...........      $243.06
23195               T................  ...................  Removal of head of humerus.         0050      23.3037    $1,215.31  ...........      $243.06
23200               C................  ...................  Removal of collar bone.....  ...........  ...........  ...........  ...........  ...........
23210               C................  ...................  Removal of shoulder blade..  ...........  ...........  ...........  ...........  ...........
23220               C................  ...................  Partial removal of humerus.  ...........  ...........  ...........  ...........  ...........

[[Page 66839]]

 
23221               C................  ...................  Partial removal of humerus.  ...........  ...........  ...........  ...........  ...........
23222               C................  ...................  Partial removal of humerus.  ...........  ...........  ...........  ...........  ...........
23330               T................  ...................  Remove shoulder foreign             0020       7.1898      $374.96      $113.25       $74.99
                                                             body.
23331               T................  ...................  Remove shoulder foreign             0022      17.3930      $907.06      $354.45      $181.41
                                                             body.
23332               C................  ...................  Remove shoulder foreign      ...........  ...........  ...........  ...........  ...........
                                                             body.
23350               N................  ...................  Injection for shoulder x-    ...........  ...........  ...........  ...........  ...........
                                                             ray.
23395               T................  ...................  Muscle transfer,shoulder/           0051      32.9062    $1,716.09  ...........      $343.22
                                                             arm.
23397               T................  ...................  Muscle transfers...........         0052      40.7646    $2,125.91  ...........      $425.18
23400               T................  ...................  Fixation of shoulder blade.         0050      23.3037    $1,215.31  ...........      $243.06
23405               T................  ...................  Incision of tendon & muscle         0050      23.3037    $1,215.31  ...........      $243.06
23406               T................  ...................  Incise tendon(s) &                  0050      23.3037    $1,215.31  ...........      $243.06
                                                             muscle(s).
23410               T................  ...................  Repair of tendon(s)........         0052      40.7646    $2,125.91  ...........      $425.18
23412               T................  ...................  Repair rotator cuff,                0052      40.7646    $2,125.91  ...........      $425.18
                                                             chronic.
23415               T................  ...................  Release of shoulder                 0051      32.9062    $1,716.09  ...........      $343.22
                                                             ligament.
23420               T................  ...................  Repair of shoulder.........         0052      40.7646    $2,125.91  ...........      $425.18
23430               T................  ...................  Repair biceps tendon.......         0052      40.7646    $2,125.91  ...........      $425.18
23440               T................  ...................  Remove/transplant tendon...         0052      40.7646    $2,125.91  ...........      $425.18
23450               T................  ...................  Repair shoulder capsule....         0052      40.7646    $2,125.91  ...........      $425.18
23455               T................  ...................  Repair shoulder capsule....         0052      40.7646    $2,125.91  ...........      $425.18
23460               T................  ...................  Repair shoulder capsule....         0052      40.7646    $2,125.91  ...........      $425.18
23462               T................  ...................  Repair shoulder capsule....         0052      40.7646    $2,125.91  ...........      $425.18
23465               T................  ...................  Repair shoulder capsule....         0052      40.7646    $2,125.91  ...........      $425.18
23466               T................  ...................  Repair shoulder capsule....         0052      40.7646    $2,125.91  ...........      $425.18
23470               T................  ...................  Reconstruct shoulder joint.         0048      40.6289    $2,118.84      $695.60      $423.77
23472               C................  ...................  Reconstruct shoulder joint.  ...........  ...........  ...........  ...........  ...........
23480               T................  ...................  Revision of collar bone....         0051      32.9062    $1,716.09  ...........      $343.22
23485               T................  ...................  Revision of collar bone....         0051      32.9062    $1,716.09  ...........      $343.22
23490               T................  ...................  Reinforce clavicle.........         0051      32.9062    $1,716.09  ...........      $343.22
23491               T................  ...................  Reinforce shoulder bones...         0051      32.9062    $1,716.09  ...........      $343.22
23500               T................  ...................  Treat clavicle fracture....         0043       2.4999      $130.37  ...........       $26.07
23505               T................  ...................  Treat clavicle fracture....         0043       2.4999      $130.37  ...........       $26.07
23515               T................  ...................  Treat clavicle fracture....         0046      29.2920    $1,527.61      $535.76      $305.52
23520               T................  ...................  Treat clavicle dislocation.         0043       2.4999      $130.37  ...........       $26.07
23525               T................  ...................  Treat clavicle dislocation.         0043       2.4999      $130.37  ...........       $26.07
23530               T................  ...................  Treat clavicle dislocation.         0046      29.2920    $1,527.61      $535.76      $305.52
23532               T................  ...................  Treat clavicle dislocation.         0046      29.2920    $1,527.61      $535.76      $305.52
23540               T................  ...................  Treat clavicle dislocation.         0043       2.4999      $130.37  ...........       $26.07
23545               T................  ...................  Treat clavicle dislocation.         0043       2.4999      $130.37  ...........       $26.07
23550               T................  ...................  Treat clavicle dislocation.         0046      29.2920    $1,527.61      $535.76      $305.52
23552               T................  ...................  Treat clavicle dislocation.         0046      29.2920    $1,527.61      $535.76      $305.52
23570               T................  ...................  Treat shoulder blade fx....         0043       2.4999      $130.37  ...........       $26.07
23575               T................  ...................  Treat shoulder blade fx....         0043       2.4999      $130.37  ...........       $26.07
23585               T................  ...................  Treat scapula fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
23600               T................  ...................  Treat humerus fracture.....         0043       2.4999      $130.37  ...........       $26.07
23605               T................  ...................  Treat humerus fracture.....         0043       2.4999      $130.37  ...........       $26.07
23615               T................  ...................  Treat humerus fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
23616               T................  ...................  Treat humerus fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
23620               T................  ...................  Treat humerus fracture.....         0043       2.4999      $130.37  ...........       $26.07
23625               T................  ...................  Treat humerus fracture.....         0043       2.4999      $130.37  ...........       $26.07
23630               T................  ...................  Treat humerus fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
23650               T................  ...................  Treat shoulder dislocation.         0043       2.4999      $130.37  ...........       $26.07
23655               T................  ...................  Treat shoulder dislocation.         0045      12.9357      $674.61      $268.47      $134.92
23660               T................  ...................  Treat shoulder dislocation.         0046      29.2920    $1,527.61      $535.76      $305.52
23665               T................  ...................  Treat dislocation/fracture.         0043       2.4999      $130.37  ...........       $26.07
23670               T................  ...................  Treat dislocation/fracture.         0046      29.2920    $1,527.61      $535.76      $305.52
23675               T................  ...................  Treat dislocation/fracture.         0043       2.4999      $130.37  ...........       $26.07
23680               T................  ...................  Treat dislocation/fracture.         0046      29.2920    $1,527.61      $535.76      $305.52
23700               T................  ...................  Fixation of shoulder.......         0045      12.9357      $674.61      $268.47      $134.92
23800               T................  ...................  Fusion of shoulder joint...         0051      32.9062    $1,716.09  ...........      $343.22
23802               T................  ...................  Fusion of shoulder joint...         0051      32.9062    $1,716.09  ...........      $343.22
23900               C................  ...................  Amputation of arm & girdle.  ...........  ...........  ...........  ...........  ...........
23920               C................  ...................  Amputation at shoulder       ...........  ...........  ...........  ...........  ...........
                                                             joint.
23921               T................  ...................  Amputation follow-up                0025       5.8623      $305.72      $115.49       $61.14
                                                             surgery.
23929               T................  ...................  Shoulder surgery procedure.         0043       2.4999      $130.37  ...........       $26.07
23930               T................  ...................  Drainage of arm lesion.....         0008      16.1430      $841.87  ...........      $168.37

[[Page 66840]]

 
23931               T................  ...................  Drainage of arm bursa......         0006       1.7926       $93.49       $24.12       $18.70
23935               T................  ...................  Drain arm/elbow bone lesion         0049      18.6042      $970.23      $197.14      $194.05
24000               T................  ...................  Exploratory elbow surgery..         0050      23.3037    $1,215.31  ...........      $243.06
24006               T................  ...................  Release elbow joint........         0050      23.3037    $1,215.31  ...........      $243.06
24065               T................  ...................  Biopsy arm/elbow soft               0021      13.9338      $726.66      $219.48      $145.33
                                                             tissue.
24066               T................  ...................  Biopsy arm/elbow soft               0021      13.9338      $726.66      $219.48      $145.33
                                                             tissue.
24075               T................  ...................  Remove arm/elbow lesion....         0021      13.9338      $726.66      $219.48      $145.33
24076               T................  ...................  Remove arm/elbow lesion....         0022      17.3930      $907.06      $354.45      $181.41
24077               T................  ...................  Remove tumor of arm/elbow..         0022      17.3930      $907.06      $354.45      $181.41
24100               T................  ...................  Biopsy elbow joint lining..         0049      18.6042      $970.23      $197.14      $194.05
24101               T................  ...................  Explore/treat elbow joint..         0050      23.3037    $1,215.31  ...........      $243.06
24102               T................  ...................  Remove elbow joint lining..         0050      23.3037    $1,215.31  ...........      $243.06
24105               T................  ...................  Removal of elbow bursa.....         0049      18.6042      $970.23      $197.14      $194.05
24110               T................  ...................  Remove humerus lesion......         0049      18.6042      $970.23      $197.14      $194.05
24115               T................  ...................  Remove/graft bone lesion...         0050      23.3037    $1,215.31  ...........      $243.06
24116               T................  ...................  Remove/graft bone lesion...         0050      23.3037    $1,215.31  ...........      $243.06
24120               T................  ...................  Remove elbow lesion........         0049      18.6042      $970.23      $197.14      $194.05
24125               T................  ...................  Remove/graft bone lesion...         0050      23.3037    $1,215.31  ...........      $243.06
24126               T................  ...................  Remove/graft bone lesion...         0050      23.3037    $1,215.31  ...........      $243.06
24130               T................  ...................  Removal of head of radius..         0050      23.3037    $1,215.31  ...........      $243.06
24134               T................  ...................  Removal of arm bone lesion.         0050      23.3037    $1,215.31  ...........      $243.06
24136               T................  ...................  Remove radius bone lesion..         0050      23.3037    $1,215.31  ...........      $243.06
24138               T................  ...................  Remove elbow bone lesion...         0050      23.3037    $1,215.31  ...........      $243.06
24140               T................  ...................  Partial removal of arm bone         0050      23.3037    $1,215.31  ...........      $243.06
24145               T................  ...................  Partial removal of radius..         0050      23.3037    $1,215.31  ...........      $243.06
24147               T................  ...................  Partial removal of elbow...         0050      23.3037    $1,215.31  ...........      $243.06
24149               C................  ...................  Radical resection of elbow.  ...........  ...........  ...........  ...........  ...........
24150               T................  ...................  Extensive humerus surgery..         0052      40.7646    $2,125.91  ...........      $425.18
24151               T................  ...................  Extensive humerus surgery..         0052      40.7646    $2,125.91  ...........      $425.18
24152               T................  ...................  Extensive radius surgery...         0052      40.7646    $2,125.91  ...........      $425.18
24153               T................  ...................  Extensive radius surgery...         0052      40.7646    $2,125.91  ...........      $425.18
24155               T................  ...................  Removal of elbow joint.....         0051      32.9062    $1,716.09  ...........      $343.22
24160               T................  ...................  Remove elbow joint implant.         0050      23.3037    $1,215.31  ...........      $243.06
24164               T................  ...................  Remove radius head implant.         0050      23.3037    $1,215.31  ...........      $243.06
24200               T................  ...................  Removal of arm foreign body         0019       3.7693      $196.57       $71.87       $39.31
24201               T................  ...................  Removal of arm foreign body         0021      13.9338      $726.66      $219.48      $145.33
24220               N................  ...................  Injection for elbow x-ray..  ...........  ...........  ...........  ...........  ...........
24300               T................  ...................  Manipulate elbow w/anesth..         0045      12.9357      $674.61      $268.47      $134.92
24301               T................  ...................  Muscle/tendon transfer.....         0050      23.3037    $1,215.31  ...........      $243.06
24305               T................  ...................  Arm tendon lengthening.....         0050      23.3037    $1,215.31  ...........      $243.06
24310               T................  ...................  Revision of arm tendon.....         0049      18.6042      $970.23      $197.14      $194.05
24320               T................  ...................  Repair of arm tendon.......         0051      32.9062    $1,716.09  ...........      $343.22
24330               T................  ...................  Revision of arm muscles....         0051      32.9062    $1,716.09  ...........      $343.22
24331               T................  ...................  Revision of arm muscles....         0051      32.9062    $1,716.09  ...........      $343.22
24332               T................  ...................  Tenolysis, triceps.........         0049      18.6042      $970.23      $197.14      $194.05
24340               T................  ...................  Repair of biceps tendon....         0051      32.9062    $1,716.09  ...........      $343.22
24341               T................  ...................  Repair arm tendon/muscle...         0051      32.9062    $1,716.09  ...........      $343.22
24342               T................  ...................  Repair of ruptured tendon..         0051      32.9062    $1,716.09  ...........      $343.22
24343               T................  ...................  Repr elbow lat ligmnt w/            0050      23.3037    $1,215.31  ...........      $243.06
                                                             tiss.
24344               T................  ...................  Reconstruct elbow lat               0051      32.9062    $1,716.09  ...........      $343.22
                                                             ligmnt.
24345               T................  ...................  Repr elbw med ligmnt w/             0050      23.3037    $1,215.31  ...........      $243.06
                                                             tissu.
24346               T................  ...................  Reconstruct elbow med               0051      32.9062    $1,716.09  ...........      $343.22
                                                             ligmnt.
24350               T................  ...................  Repair of tennis elbow.....         0050      23.3037    $1,215.31  ...........      $243.06
24351               T................  ...................  Repair of tennis elbow.....         0050      23.3037    $1,215.31  ...........      $243.06
24352               T................  ...................  Repair of tennis elbow.....         0050      23.3037    $1,215.31  ...........      $243.06
24354               T................  ...................  Repair of tennis elbow.....         0050      23.3037    $1,215.31  ...........      $243.06
24356               T................  ...................  Revision of tennis elbow...         0050      23.3037    $1,215.31  ...........      $243.06
24360               T................  ...................  Reconstruct elbow joint....         0047      28.2842    $1,475.05      $537.03      $295.01
24361               T................  ...................  Reconstruct elbow joint....         0048      40.6289    $2,118.84      $695.60      $423.77
24362               T................  ...................  Reconstruct elbow joint....         0048      40.6289    $2,118.84      $695.60      $423.77
24363               T................  ...................  Replace elbow joint........         0048      40.6289    $2,118.84      $695.60      $423.77
24365               T................  ...................  Reconstruct head of radius.         0047      28.2842    $1,475.05      $537.03      $295.01
24366               T................  ...................  Reconstruct head of radius.         0048      40.6289    $2,118.84      $695.60      $423.77
24400               T................  ...................  Revision of humerus........         0050      23.3037    $1,215.31  ...........      $243.06
24410               T................  ...................  Revision of humerus........         0050      23.3037    $1,215.31  ...........      $243.06

[[Page 66841]]

 
24420               T................  ...................  Revision of humerus........         0051      32.9062    $1,716.09  ...........      $343.22
24430               T................  ...................  Repair of humerus..........         0051      32.9062    $1,716.09  ...........      $343.22
24435               T................  ...................  Repair humerus with graft..         0051      32.9062    $1,716.09  ...........      $343.22
24470               T................  ...................  Revision of elbow joint....         0051      32.9062    $1,716.09  ...........      $343.22
24495               T................  ...................  Decompression of forearm...         0050      23.3037    $1,215.31  ...........      $243.06
24498               T................  ...................  Reinforce humerus..........         0051      32.9062    $1,716.09  ...........      $343.22
24500               T................  ...................  Treat humerus fracture.....         0043       2.4999      $130.37  ...........       $26.07
24505               T................  ...................  Treat humerus fracture.....         0043       2.4999      $130.37  ...........       $26.07
24515               T................  ...................  Treat humerus fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
24516               T................  ...................  Treat humerus fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
24530               T................  ...................  Treat humerus fracture.....         0043       2.4999      $130.37  ...........       $26.07
24535               T................  ...................  Treat humerus fracture.....         0043       2.4999      $130.37  ...........       $26.07
24538               T................  ...................  Treat humerus fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
24545               T................  ...................  Treat humerus fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
24546               T................  ...................  Treat humerus fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
24560               T................  ...................  Treat humerus fracture.....         0043       2.4999      $130.37  ...........       $26.07
24565               T................  ...................  Treat humerus fracture.....         0043       2.4999      $130.37  ...........       $26.07
24566               T................  ...................  Treat humerus fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
24575               T................  ...................  Treat humerus fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
24576               T................  ...................  Treat humerus fracture.....         0043       2.4999      $130.37  ...........       $26.07
24577               T................  ...................  Treat humerus fracture.....         0043       2.4999      $130.37  ...........       $26.07
24579               T................  ...................  Treat humerus fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
24582               T................  ...................  Treat humerus fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
24586               T................  ...................  Treat elbow fracture.......         0046      29.2920    $1,527.61      $535.76      $305.52
24587               T................  ...................  Treat elbow fracture.......         0046      29.2920    $1,527.61      $535.76      $305.52
24600               T................  ...................  Treat elbow dislocation....         0043       2.4999      $130.37  ...........       $26.07
24605               T................  ...................  Treat elbow dislocation....         0045      12.9357      $674.61      $268.47      $134.92
24615               T................  ...................  Treat elbow dislocation....         0046      29.2920    $1,527.61      $535.76      $305.52
24620               T................  ...................  Treat elbow fracture.......         0043       2.4999      $130.37  ...........       $26.07
24635               T................  ...................  Treat elbow fracture.......         0046      29.2920    $1,527.61      $535.76      $305.52
24640               T................  ...................  Treat elbow dislocation....         0043       2.4999      $130.37  ...........       $26.07
24650               T................  ...................  Treat radius fracture......         0043       2.4999      $130.37  ...........       $26.07
24655               T................  ...................  Treat radius fracture......         0043       2.4999      $130.37  ...........       $26.07
24665               T................  ...................  Treat radius fracture......         0046      29.2920    $1,527.61      $535.76      $305.52
24666               T................  ...................  Treat radius fracture......         0046      29.2920    $1,527.61      $535.76      $305.52
24670               T................  ...................  Treat ulnar fracture.......         0043       2.4999      $130.37  ...........       $26.07
24675               T................  ...................  Treat ulnar fracture.......         0043       2.4999      $130.37  ...........       $26.07
24685               T................  ...................  Treat ulnar fracture.......         0046      29.2920    $1,527.61      $535.76      $305.52
24800               T................  ...................  Fusion of elbow joint......         0051      32.9062    $1,716.09  ...........      $343.22
24802               T................  ...................  Fusion/graft of elbow joint         0051      32.9062    $1,716.09  ...........      $343.22
24900               C................  ...................  Amputation of upper arm....  ...........  ...........  ...........  ...........  ...........
24920               C................  ...................  Amputation of upper arm....  ...........  ...........  ...........  ...........  ...........
24925               T................  ...................  Amputation follow-up                0049      18.6042      $970.23      $197.14      $194.05
                                                             surgery.
24930               C................  ...................  Amputation follow-up         ...........  ...........  ...........  ...........  ...........
                                                             surgery.
24931               C................  ...................  Amputate upper arm &         ...........  ...........  ...........  ...........  ...........
                                                             implant.
24935               T................  ...................  Revision of amputation.....         0052      40.7646    $2,125.91  ...........      $425.18
24940               C................  ...................  Revision of upper arm......  ...........  ...........  ...........  ...........  ...........
24999               T................  ...................  Upper arm/elbow surgery....         0043       2.4999      $130.37  ...........       $26.07
25000               T................  ...................  Incision of tendon sheath..         0049      18.6042      $970.23      $197.14      $194.05
25001               T................  ...................  Incise flexor carpi                 0049      18.6042      $970.23      $197.14      $194.05
                                                             radialis.
25020               T................  ...................  Decompress forearm 1 space.         0049      18.6042      $970.23      $197.14      $194.05
25023               T................  ...................  Decompress forearm 1 space.         0050      23.3037    $1,215.31  ...........      $243.06
25024               T................  ...................  Decompress forearm 2 spaces         0050      23.3037    $1,215.31  ...........      $243.06
25025               T................  ...................  Decompress forarm 2 spaces.         0050      23.3037    $1,215.31  ...........      $243.06
25028               T................  ...................  Drainage of forearm lesion.         0049      18.6042      $970.23      $197.14      $194.05
25031               T................  ...................  Drainage of forearm bursa..         0049      18.6042      $970.23      $197.14      $194.05
25035               T................  ...................  Treat forearm bone lesion..         0049      18.6042      $970.23      $197.14      $194.05
25040               T................  ...................  Explore/treat wrist joint..         0050      23.3037    $1,215.31  ...........      $243.06
25065               T................  ...................  Biopsy forearm soft tissues         0021      13.9338      $726.66      $219.48      $145.33
25066               T................  ...................  Biopsy forearm soft tissues         0022      17.3930      $907.06      $354.45      $181.41
25075               T................  ...................  Removel forearm lesion              0021      13.9338      $726.66      $219.48      $145.33
                                                             subcu.
25076               T................  ...................  Removel forearm lesion deep         0022      17.3930      $907.06      $354.45      $181.41
25077               T................  ...................  Remove tumor, forearm/wrist         0022      17.3930      $907.06      $354.45      $181.41
25085               T................  ...................  Incision of wrist capsule..         0049      18.6042      $970.23      $197.14      $194.05
25100               T................  ...................  Biopsy of wrist joint......         0049      18.6042      $970.23      $197.14      $194.05

[[Page 66842]]

 
25101               T................  ...................  Explore/treat wrist joint..         0050      23.3037    $1,215.31  ...........      $243.06
25105               T................  ...................  Remove wrist joint lining..         0050      23.3037    $1,215.31  ...........      $243.06
25107               T................  ...................  Remove wrist joint                  0050      23.3037    $1,215.31  ...........      $243.06
                                                             cartilage.
25110               T................  ...................  Remove wrist tendon lesion.         0049      18.6042      $970.23      $197.14      $194.05
25111               T................  ...................  Remove wrist tendon lesion.         0053      14.1760      $739.29      $253.49      $147.86
25112               T................  ...................  Reremove wrist tendon               0053      14.1760      $739.29      $253.49      $147.86
                                                             lesion.
25115               T................  ...................  Remove wrist/forearm lesion         0049      18.6042      $970.23      $197.14      $194.05
25116               T................  ...................  Remove wrist/forearm lesion         0049      18.6042      $970.23      $197.14      $194.05
25118               T................  ...................  Excise wrist tendon sheath.         0050      23.3037    $1,215.31  ...........      $243.06
25119               T................  ...................  Partial removal of ulna....         0050      23.3037    $1,215.31  ...........      $243.06
25120               T................  ...................  Removal of forearm lesion..         0050      23.3037    $1,215.31  ...........      $243.06
25125               T................  ...................  Remove/graft forearm lesion         0050      23.3037    $1,215.31  ...........      $243.06
25126               T................  ...................  Remove/graft forearm lesion         0050      23.3037    $1,215.31  ...........      $243.06
25130               T................  ...................  Removal of wrist lesion....         0050      23.3037    $1,215.31  ...........      $243.06
25135               T................  ...................  Remove & graft wrist lesion         0050      23.3037    $1,215.31  ...........      $243.06
25136               T................  ...................  Remove & graft wrist lesion         0050      23.3037    $1,215.31  ...........      $243.06
25145               T................  ...................  Remove forearm bone lesion.         0050      23.3037    $1,215.31  ...........      $243.06
25150               T................  ...................  Partial removal of ulna....         0050      23.3037    $1,215.31  ...........      $243.06
25151               T................  ...................  Partial removal of radius..         0050      23.3037    $1,215.31  ...........      $243.06
25170               T................  ...................  Extensive forearm surgery..         0052      40.7646    $2,125.91  ...........      $425.18
25210               T................  ...................  Removal of wrist bone......         0054      22.7223    $1,184.99  ...........      $237.00
25215               T................  ...................  Removal of wrist bones.....         0054      22.7223    $1,184.99  ...........      $237.00
25230               T................  ...................  Partial removal of radius..         0050      23.3037    $1,215.31  ...........      $243.06
25240               T................  ...................  Partial removal of ulna....         0050      23.3037    $1,215.31  ...........      $243.06
25246               N................  ...................  Injection for wrist x-ray..  ...........  ...........  ...........  ...........  ...........
25248               T................  ...................  Remove forearm foreign body         0049      18.6042      $970.23      $197.14      $194.05
25250               T................  ...................  Removal of wrist prosthesis         0050      23.3037    $1,215.31  ...........      $243.06
25251               T................  ...................  Removal of wrist prosthesis         0050      23.3037    $1,215.31  ...........      $243.06
25259               T................  ...................  Manipulate wrist w/anesthes         0043       2.4999      $130.37  ...........       $26.07
25260               T................  ...................  Repair forearm tendon/              0050      23.3037    $1,215.31  ...........      $243.06
                                                             muscle.
25263               T................  ...................  Repair forearm tendon/              0050      23.3037    $1,215.31  ...........      $243.06
                                                             muscle.
25265               T................  ...................  Repair forearm tendon/              0050      23.3037    $1,215.31  ...........      $243.06
                                                             muscle.
25270               T................  ...................  Repair forearm tendon/              0050      23.3037    $1,215.31  ...........      $243.06
                                                             muscle.
25272               T................  ...................  Repair forearm tendon/              0050      23.3037    $1,215.31  ...........      $243.06
                                                             muscle.
25274               T................  ...................  Repair forearm tendon/              0050      23.3037    $1,215.31  ...........      $243.06
                                                             muscle.
25275               T................  ...................  Repair forearm tendon               0050      23.3037    $1,215.31  ...........      $243.06
                                                             sheath.
25280               T................  ...................  Revise wrist/forearm tendon         0050      23.3037    $1,215.31  ...........      $243.06
25290               T................  ...................  Incise wrist/forearm tendon         0050      23.3037    $1,215.31  ...........      $243.06
25295               T................  ...................  Release wrist/forearm               0049      18.6042      $970.23      $197.14      $194.05
                                                             tendon.
25300               T................  ...................  Fusion of tendons at wrist.         0050      23.3037    $1,215.31  ...........      $243.06
25301               T................  ...................  Fusion of tendons at wrist.         0050      23.3037    $1,215.31  ...........      $243.06
25310               T................  ...................  Transplant forearm tendon..         0051      32.9062    $1,716.09  ...........      $343.22
25312               T................  ...................  Transplant forearm tendon..         0051      32.9062    $1,716.09  ...........      $343.22
25315               T................  ...................  Revise palsy hand tendon(s)         0051      32.9062    $1,716.09  ...........      $343.22
25316               T................  ...................  Revise palsy hand tendon(s)         0051      32.9062    $1,716.09  ...........      $343.22
25320               T................  ...................  Repair/revise wrist joint..         0051      32.9062    $1,716.09  ...........      $343.22
25332               T................  ...................  Revise wrist joint.........         0047      28.2842    $1,475.05      $537.03      $295.01
25335               T................  ...................  Realignment of hand........         0051      32.9062    $1,716.09  ...........      $343.22
25337               T................  ...................  Reconstruct ulna/radioulnar         0051      32.9062    $1,716.09  ...........      $343.22
25350               T................  ...................  Revision of radius.........         0051      32.9062    $1,716.09  ...........      $343.22
25355               T................  ...................  Revision of radius.........         0051      32.9062    $1,716.09  ...........      $343.22
25360               T................  ...................  Revision of ulna...........         0050      23.3037    $1,215.31  ...........      $243.06
25365               T................  ...................  Revise radius & ulna.......         0050      23.3037    $1,215.31  ...........      $243.06
25370               T................  ...................  Revise radius or ulna......         0051      32.9062    $1,716.09  ...........      $343.22
25375               T................  ...................  Revise radius & ulna.......         0051      32.9062    $1,716.09  ...........      $343.22
25390               T................  ...................  Shorten radius or ulna.....         0050      23.3037    $1,215.31  ...........      $243.06
25391               T................  ...................  Lengthen radius or ulna....         0051      32.9062    $1,716.09  ...........      $343.22
25392               T................  ...................  Shorten radius & ulna......         0050      23.3037    $1,215.31  ...........      $243.06
25393               T................  ...................  Lengthen radius & ulna.....         0051      32.9062    $1,716.09  ...........      $343.22
25394               T................  ...................  Repair carpal bone, shorten         0053      14.1760      $739.29      $253.49      $147.86
25400               T................  ...................  Repair radius or ulna......         0050      23.3037    $1,215.31  ...........      $243.06
25405               T................  ...................  Repair/graft radius or ulna         0050      23.3037    $1,215.31  ...........      $243.06
25415               T................  ...................  Repair radius & ulna.......         0050      23.3037    $1,215.31  ...........      $243.06
25420               T................  ...................  Repair/graft radius & ulna.         0051      32.9062    $1,716.09  ...........      $343.22
25425               T................  ...................  Repair/graft radius or ulna         0051      32.9062    $1,716.09  ...........      $343.22

[[Page 66843]]

 
25426               T................  ...................  Repair/graft radius & ulna.         0051      32.9062    $1,716.09  ...........      $343.22
25430               T................  ...................  Vasc graft into carpal bone         0054      22.7223    $1,184.99  ...........      $237.00
25431               T................  ...................  Repair nonunion carpal bone         0054      22.7223    $1,184.99  ...........      $237.00
25440               T................  ...................  Repair/graft wrist bone....         0051      32.9062    $1,716.09  ...........      $343.22
25441               T................  ...................  Reconstruct wrist joint....         0048      40.6289    $2,118.84      $695.60      $423.77
25442               T................  ...................  Reconstruct wrist joint....         0048      40.6289    $2,118.84      $695.60      $423.77
25443               T................  ...................  Reconstruct wrist joint....         0048      40.6289    $2,118.84      $695.60      $423.77
25444               T................  ...................  Reconstruct wrist joint....         0048      40.6289    $2,118.84      $695.60      $423.77
25445               T................  ...................  Reconstruct wrist joint....         0048      40.6289    $2,118.84      $695.60      $423.77
25446               T................  ...................  Wrist replacement..........         0048      40.6289    $2,118.84      $695.60      $423.77
25447               T................  ...................  Repair wrist joint(s)......         0047      28.2842    $1,475.05      $537.03      $295.01
25449               T................  ...................  Remove wrist joint implant.         0047      28.2842    $1,475.05      $537.03      $295.01
25450               T................  ...................  Revision of wrist joint....         0051      32.9062    $1,716.09  ...........      $343.22
25455               T................  ...................  Revision of wrist joint....         0051      32.9062    $1,716.09  ...........      $343.22
25490               T................  ...................  Reinforce radius...........         0051      32.9062    $1,716.09  ...........      $343.22
25491               T................  ...................  Reinforce ulna.............         0051      32.9062    $1,716.09  ...........      $343.22
25492               T................  ...................  Reinforce radius and ulna..         0051      32.9062    $1,716.09  ...........      $343.22
25500               T................  ...................  Treat fracture of radius...         0043       2.4999      $130.37  ...........       $26.07
25505               T................  ...................  Treat fracture of radius...         0043       2.4999      $130.37  ...........       $26.07
25515               T................  ...................  Treat fracture of radius...         0046      29.2920    $1,527.61      $535.76      $305.52
25520               T................  ...................  Treat fracture of radius...         0043       2.4999      $130.37  ...........       $26.07
25525               T................  ...................  Treat fracture of radius...         0046      29.2920    $1,527.61      $535.76      $305.52
25526               T................  ...................  Treat fracture of radius...         0046      29.2920    $1,527.61      $535.76      $305.52
25530               T................  ...................  Treat fracture of ulna.....         0043       2.4999      $130.37  ...........       $26.07
25535               T................  ...................  Treat fracture of ulna.....         0043       2.4999      $130.37  ...........       $26.07
25545               T................  ...................  Treat fracture of ulna.....         0046      29.2920    $1,527.61      $535.76      $305.52
25560               T................  ...................  Treat fracture radius &             0043       2.4999      $130.37  ...........       $26.07
                                                             ulna.
25565               T................  ...................  Treat fracture radius &             0043       2.4999      $130.37  ...........       $26.07
                                                             ulna.
25574               T................  ...................  Treat fracture radius &             0046      29.2920    $1,527.61      $535.76      $305.52
                                                             ulna.
25575               T................  ...................  Treat fracture radius/ulna.         0046      29.2920    $1,527.61      $535.76      $305.52
25600               T................  ...................  Treat fracture radius/ulna.         0043       2.4999      $130.37  ...........       $26.07
25605               T................  ...................  Treat fracture radius/ulna.         0043       2.4999      $130.37  ...........       $26.07
25611               T................  ...................  Treat fracture radius/ulna.         0046      29.2920    $1,527.61      $535.76      $305.52
25620               T................  ...................  Treat fracture radius/ulna.         0046      29.2920    $1,527.61      $535.76      $305.52
25622               T................  ...................  Treat wrist bone fracture..         0043       2.4999      $130.37  ...........       $26.07
25624               T................  ...................  Treat wrist bone fracture..         0043       2.4999      $130.37  ...........       $26.07
25628               T................  ...................  Treat wrist bone fracture..         0046      29.2920    $1,527.61      $535.76      $305.52
25630               T................  ...................  Treat wrist bone fracture..         0043       2.4999      $130.37  ...........       $26.07
25635               T................  ...................  Treat wrist bone fracture..         0043       2.4999      $130.37  ...........       $26.07
25645               T................  ...................  Treat wrist bone fracture..         0046      29.2920    $1,527.61      $535.76      $305.52
25650               T................  ...................  Treat wrist bone fracture..         0043       2.4999      $130.37  ...........       $26.07
25651               T................  ...................  Pin ulnar styloid fracture.         0046      29.2920    $1,527.61      $535.76      $305.52
25652               T................  ...................  Treat fracture ulnar                0046      29.2920    $1,527.61      $535.76      $305.52
                                                             styloid.
25660               T................  ...................  Treat wrist dislocation....         0043       2.4999      $130.37  ...........       $26.07
25670               T................  ...................  Treat wrist dislocation....         0046      29.2920    $1,527.61      $535.76      $305.52
25671               T................  ...................  Pin radioulnar dislocation.         0046      29.2920    $1,527.61      $535.76      $305.52
25675               T................  ...................  Treat wrist dislocation....         0043       2.4999      $130.37  ...........       $26.07
25676               T................  ...................  Treat wrist dislocation....         0046      29.2920    $1,527.61      $535.76      $305.52
25680               T................  ...................  Treat wrist fracture.......         0043       2.4999      $130.37  ...........       $26.07
25685               T................  ...................  Treat wrist fracture.......         0046      29.2920    $1,527.61      $535.76      $305.52
25690               T................  ...................  Treat wrist dislocation....         0043       2.4999      $130.37  ...........       $26.07
25695               T................  ...................  Treat wrist dislocation....         0046      29.2920    $1,527.61      $535.76      $305.52
25800               T................  ...................  Fusion of wrist joint......         0051      32.9062    $1,716.09  ...........      $343.22
25805               T................  ...................  Fusion/graft of wrist joint         0051      32.9062    $1,716.09  ...........      $343.22
25810               T................  ...................  Fusion/graft of wrist joint         0051      32.9062    $1,716.09  ...........      $343.22
25820               T................  ...................  Fusion of hand bones.......         0053      14.1760      $739.29      $253.49      $147.86
25825               T................  ...................  Fuse hand bones with graft.         0054      22.7223    $1,184.99  ...........      $237.00
25830               T................  ...................  Fusion, radioulnar jnt/ulna         0051      32.9062    $1,716.09  ...........      $343.22
25900               C................  ...................  Amputation of forearm......  ...........  ...........  ...........  ...........  ...........
25905               C................  ...................  Amputation of forearm......  ...........  ...........  ...........  ...........  ...........
25907               T................  ...................  Amputation follow-up                0049      18.6042      $970.23      $197.14      $194.05
                                                             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      18.6042      $970.23      $197.14      $194.05

[[Page 66844]]

 
25924               C................  ...................  Amputation follow-up         ...........  ...........  ...........  ...........  ...........
                                                             surgery.
25927               C................  ...................  Amputation of hand.........  ...........  ...........  ...........  ...........  ...........
25929               T................  ...................  Amputation follow-up                0027      15.2225      $793.87      $329.72      $158.77
                                                             surgery.
25931               C................  ...................  Amputation follow-up         ...........  ...........  ...........  ...........  ...........
                                                             surgery.
25999               T................  ...................  Forearm or wrist surgery...         0043       2.4999      $130.37  ...........       $26.07
26010               T................  ...................  Drainage of finger abscess.         0006       1.7926       $93.49       $24.12       $18.70
26011               T................  ...................  Drainage of finger abscess.         0007      10.0191      $522.51      $108.89      $104.50
26020               T................  ...................  Drain hand tendon sheath...         0053      14.1760      $739.29      $253.49      $147.86
26025               T................  ...................  Drainage of palm bursa.....         0053      14.1760      $739.29      $253.49      $147.86
26030               T................  ...................  Drainage of palm bursa(s)..         0053      14.1760      $739.29      $253.49      $147.86
26034               T................  ...................  Treat hand bone lesion.....         0053      14.1760      $739.29      $253.49      $147.86
26035               T................  ...................  Decompress fingers/hand....         0053      14.1760      $739.29      $253.49      $147.86
26037               T................  ...................  Decompress fingers/hand....         0053      14.1760      $739.29      $253.49      $147.86
26040               T................  ...................  Release palm contracture...         0054      22.7223    $1,184.99  ...........      $237.00
26045               T................  ...................  Release palm contracture...         0054      22.7223    $1,184.99  ...........      $237.00
26055               T................  ...................  Incise finger tendon sheath         0053      14.1760      $739.29      $253.49      $147.86
26060               T................  ...................  Incision of finger tendon..         0053      14.1760      $739.29      $253.49      $147.86
26070               T................  ...................  Explore/treat hand joint...         0053      14.1760      $739.29      $253.49      $147.86
26075               T................  ...................  Explore/treat finger joint.         0053      14.1760      $739.29      $253.49      $147.86
26080               T................  ...................  Explore/treat finger joint.         0053      14.1760      $739.29      $253.49      $147.86
26100               T................  ...................  Biopsy hand joint lining...         0053      14.1760      $739.29      $253.49      $147.86
26105               T................  ...................  Biopsy finger joint lining.         0053      14.1760      $739.29      $253.49      $147.86
26110               T................  ...................  Biopsy finger joint lining.         0053      14.1760      $739.29      $253.49      $147.86
26115               T................  ...................  Removel hand lesion subcut.         0022      17.3930      $907.06      $354.45      $181.41
26116               T................  ...................  Removel hand lesion, deep..         0022      17.3930      $907.06      $354.45      $181.41
26117               T................  ...................  Remove tumor, hand/finger..         0022      17.3930      $907.06      $354.45      $181.41
26121               T................  ...................  Release palm contracture...         0054      22.7223    $1,184.99  ...........      $237.00
26123               T................  ...................  Release palm contracture...         0054      22.7223    $1,184.99  ...........      $237.00
26125               T................  ...................  Release palm contracture...         0054      22.7223    $1,184.99  ...........      $237.00
26130               T................  ...................  Remove wrist joint lining..         0053      14.1760      $739.29      $253.49      $147.86
26135               T................  ...................  Revise finger joint, each..         0054      22.7223    $1,184.99  ...........      $237.00
26140               T................  ...................  Revise finger joint, each..         0053      14.1760      $739.29      $253.49      $147.86
26145               T................  ...................  Tendon excision, palm/              0053      14.1760      $739.29      $253.49      $147.86
                                                             finger.
26160               T................  ...................  Remove tendon sheath lesion         0053      14.1760      $739.29      $253.49      $147.86
26170               T................  ...................  Removal of palm tendon,             0053      14.1760      $739.29      $253.49      $147.86
                                                             each.
26180               T................  ...................  Removal of finger tendon...         0053      14.1760      $739.29      $253.49      $147.86
26185               T................  ...................  Remove finger bone.........         0053      14.1760      $739.29      $253.49      $147.86
26200               T................  ...................  Remove hand bone lesion....         0053      14.1760      $739.29      $253.49      $147.86
26205               T................  ...................  Remove/graft bone lesion...         0054      22.7223    $1,184.99  ...........      $237.00
26210               T................  ...................  Removal of finger lesion...         0053      14.1760      $739.29      $253.49      $147.86
26215               T................  ...................  Remove/graft finger lesion.         0053      14.1760      $739.29      $253.49      $147.86
26230               T................  ...................  Partial removal of hand             0053      14.1760      $739.29      $253.49      $147.86
                                                             bone.
26235               T................  ...................  Partial removal, finger             0053      14.1760      $739.29      $253.49      $147.86
                                                             bone.
26236               T................  ...................  Partial removal, finger             0053      14.1760      $739.29      $253.49      $147.86
                                                             bone.
26250               T................  ...................  Extensive hand surgery.....         0053      14.1760      $739.29      $253.49      $147.86
26255               T................  ...................  Extensive hand surgery.....         0054      22.7223    $1,184.99  ...........      $237.00
26260               T................  ...................  Extensive finger surgery...         0053      14.1760      $739.29      $253.49      $147.86
26261               T................  ...................  Extensive finger surgery...         0053      14.1760      $739.29      $253.49      $147.86
26262               T................  ...................  Partial removal of finger..         0053      14.1760      $739.29      $253.49      $147.86
26320               T................  ...................  Removal of implant from             0021      13.9338      $726.66      $219.48      $145.33
                                                             hand.
26340               T................  ...................  Manipulate finger w/anesth.         0043       2.4999      $130.37  ...........       $26.07
26350               T................  ...................  Repair finger/hand tendon..         0054      22.7223    $1,184.99  ...........      $237.00
26352               T................  ...................  Repair/graft hand tendon...         0054      22.7223    $1,184.99  ...........      $237.00
26356               T................  ...................  Repair finger/hand tendon..         0054      22.7223    $1,184.99  ...........      $237.00
26357               T................  ...................  Repair finger/hand tendon..         0054      22.7223    $1,184.99  ...........      $237.00
26358               T................  ...................  Repair/graft hand tendon...         0054      22.7223    $1,184.99  ...........      $237.00
26370               T................  ...................  Repair finger/hand tendon..         0054      22.7223    $1,184.99  ...........      $237.00
26372               T................  ...................  Repair/graft hand tendon...         0054      22.7223    $1,184.99  ...........      $237.00
26373               T................  ...................  Repair finger/hand tendon..         0054      22.7223    $1,184.99  ...........      $237.00
26390               T................  ...................  Revise hand/finger tendon..         0054      22.7223    $1,184.99  ...........      $237.00
26392               T................  ...................  Repair/graft hand tendon...         0054      22.7223    $1,184.99  ...........      $237.00
26410               T................  ...................  Repair hand tendon.........         0053      14.1760      $739.29      $253.49      $147.86
26412               T................  ...................  Repair/graft hand tendon...         0054      22.7223    $1,184.99  ...........      $237.00
26415               T................  ...................  Excision, hand/finger               0054      22.7223    $1,184.99  ...........      $237.00
                                                             tendon.
26416               T................  ...................  Graft hand or finger tendon         0054      22.7223    $1,184.99  ...........      $237.00

[[Page 66845]]

 
26418               T................  ...................  Repair finger tendon.......         0053      14.1760      $739.29      $253.49      $147.86
26420               T................  ...................  Repair/graft finger tendon.         0054      22.7223    $1,184.99  ...........      $237.00
26426               T................  ...................  Repair finger/hand tendon..         0054      22.7223    $1,184.99  ...........      $237.00
26428               T................  ...................  Repair/graft finger tendon.         0054      22.7223    $1,184.99  ...........      $237.00
26432               T................  ...................  Repair finger tendon.......         0053      14.1760      $739.29      $253.49      $147.86
26433               T................  ...................  Repair finger tendon.......         0053      14.1760      $739.29      $253.49      $147.86
26434               T................  ...................  Repair/graft finger tendon.         0054      22.7223    $1,184.99  ...........      $237.00
26437               T................  ...................  Realignment of tendons.....         0053      14.1760      $739.29      $253.49      $147.86
26440               T................  ...................  Release palm/finger tendon.         0053      14.1760      $739.29      $253.49      $147.86
26442               T................  ...................  Release palm & finger               0054      22.7223    $1,184.99  ...........      $237.00
                                                             tendon.
26445               T................  ...................  Release hand/finger tendon.         0053      14.1760      $739.29      $253.49      $147.86
26449               T................  ...................  Release forearm/hand tendon         0054      22.7223    $1,184.99  ...........      $237.00
26450               T................  ...................  Incision of palm tendon....         0053      14.1760      $739.29      $253.49      $147.86
26455               T................  ...................  Incision of finger tendon..         0053      14.1760      $739.29      $253.49      $147.86
26460               T................  ...................  Incise hand/finger tendon..         0053      14.1760      $739.29      $253.49      $147.86
26471               T................  ...................  Fusion of finger tendons...         0053      14.1760      $739.29      $253.49      $147.86
26474               T................  ...................  Fusion of finger tendons...         0053      14.1760      $739.29      $253.49      $147.86
26476               T................  ...................  Tendon lengthening.........         0053      14.1760      $739.29      $253.49      $147.86
26477               T................  ...................  Tendon shortening..........         0053      14.1760      $739.29      $253.49      $147.86
26478               T................  ...................  Lengthening of hand tendon.         0053      14.1760      $739.29      $253.49      $147.86
26479               T................  ...................  Shortening of hand tendon..         0053      14.1760      $739.29      $253.49      $147.86
26480               T................  ...................  Transplant hand tendon.....         0054      22.7223    $1,184.99  ...........      $237.00
26483               T................  ...................  Transplant/graft hand               0054      22.7223    $1,184.99  ...........      $237.00
                                                             tendon.
26485               T................  ...................  Transplant palm tendon.....         0054      22.7223    $1,184.99  ...........      $237.00
26489               T................  ...................  Transplant/graft palm               0054      22.7223    $1,184.99  ...........      $237.00
                                                             tendon.
26490               T................  ...................  Revise thumb tendon........         0054      22.7223    $1,184.99  ...........      $237.00
26492               T................  ...................  Tendon transfer with graft.         0054      22.7223    $1,184.99  ...........      $237.00
26494               T................  ...................  Hand tendon/muscle transfer         0054      22.7223    $1,184.99  ...........      $237.00
26496               T................  ...................  Revise thumb tendon........         0054      22.7223    $1,184.99  ...........      $237.00
26497               T................  ...................  Finger tendon transfer.....         0054      22.7223    $1,184.99  ...........      $237.00
26498               T................  ...................  Finger tendon transfer.....         0054      22.7223    $1,184.99  ...........      $237.00
26499               T................  ...................  Revision of finger.........         0054      22.7223    $1,184.99  ...........      $237.00
26500               T................  ...................  Hand tendon reconstruction.         0053      14.1760      $739.29      $253.49      $147.86
26502               T................  ...................  Hand tendon reconstruction.         0054      22.7223    $1,184.99  ...........      $237.00
26504               T................  ...................  Hand tendon reconstruction.         0054      22.7223    $1,184.99  ...........      $237.00
26508               T................  ...................  Release thumb contracture..         0053      14.1760      $739.29      $253.49      $147.86
26510               T................  ...................  Thumb tendon transfer......         0054      22.7223    $1,184.99  ...........      $237.00
26516               T................  ...................  Fusion of knuckle joint....         0054      22.7223    $1,184.99  ...........      $237.00
26517               T................  ...................  Fusion of knuckle joints...         0054      22.7223    $1,184.99  ...........      $237.00
26518               T................  ...................  Fusion of knuckle joints...         0054      22.7223    $1,184.99  ...........      $237.00
26520               T................  ...................  Release knuckle contracture         0053      14.1760      $739.29      $253.49      $147.86
26525               T................  ...................  Release finger contracture.         0053      14.1760      $739.29      $253.49      $147.86
26530               T................  ...................  Revise knuckle joint.......         0047      28.2842    $1,475.05      $537.03      $295.01
26531               T................  ...................  Revise knuckle with implant         0048      40.6289    $2,118.84      $695.60      $423.77
26535               T................  ...................  Revise finger joint........         0047      28.2842    $1,475.05      $537.03      $295.01
26536               T................  ...................  Revise/implant finger joint         0048      40.6289    $2,118.84      $695.60      $423.77
26540               T................  ...................  Repair hand joint..........         0053      14.1760      $739.29      $253.49      $147.86
26541               T................  ...................  Repair hand joint with              0054      22.7223    $1,184.99  ...........      $237.00
                                                             graft.
26542               T................  ...................  Repair hand joint with              0053      14.1760      $739.29      $253.49      $147.86
                                                             graft.
26545               T................  ...................  Reconstruct finger joint...         0054      22.7223    $1,184.99  ...........      $237.00
26546               T................  ...................  Repair nonunion hand.......         0054      22.7223    $1,184.99  ...........      $237.00
26548               T................  ...................  Reconstruct finger joint...         0054      22.7223    $1,184.99  ...........      $237.00
26550               T................  ...................  Construct thumb replacement         0054      22.7223    $1,184.99  ...........      $237.00
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      22.7223    $1,184.99  ...........      $237.00
26556               C................  ...................  Toe joint transfer.........  ...........  ...........  ...........  ...........  ...........
26560               T................  ...................  Repair of web finger.......         0053      14.1760      $739.29      $253.49      $147.86
26561               T................  ...................  Repair of web finger.......         0054      22.7223    $1,184.99  ...........      $237.00
26562               T................  ...................  Repair of web finger.......         0054      22.7223    $1,184.99  ...........      $237.00
26565               T................  ...................  Correct metacarpal flaw....         0054      22.7223    $1,184.99  ...........      $237.00
26567               T................  ...................  Correct finger deformity...         0054      22.7223    $1,184.99  ...........      $237.00
26568               T................  ...................  Lengthen metacarpal/finger.         0054      22.7223    $1,184.99  ...........      $237.00
26580               T................  ...................  Repair hand deformity......         0054      22.7223    $1,184.99  ...........      $237.00

[[Page 66846]]

 
26587               T................  ...................  Reconstruct extra finger...         0053      14.1760      $739.29      $253.49      $147.86
26590               T................  ...................  Repair finger deformity....         0054      22.7223    $1,184.99  ...........      $237.00
26591               T................  ...................  Repair muscles of hand.....         0054      22.7223    $1,184.99  ...........      $237.00
26593               T................  ...................  Release muscles of hand....         0053      14.1760      $739.29      $253.49      $147.86
26596               T................  ...................  Excision constricting               0054      22.7223    $1,184.99  ...........      $237.00
                                                             tissue.
26600               T................  ...................  Treat metacarpal fracture..         0043       2.4999      $130.37  ...........       $26.07
26605               T................  ...................  Treat metacarpal fracture..         0043       2.4999      $130.37  ...........       $26.07
26607               T................  ...................  Treat metacarpal fracture..         0043       2.4999      $130.37  ...........       $26.07
26608               T................  ...................  Treat metacarpal fracture..         0046      29.2920    $1,527.61      $535.76      $305.52
26615               T................  ...................  Treat metacarpal fracture..         0046      29.2920    $1,527.61      $535.76      $305.52
26641               T................  ...................  Treat thumb dislocation....         0043       2.4999      $130.37  ...........       $26.07
26645               T................  ...................  Treat thumb fracture.......         0043       2.4999      $130.37  ...........       $26.07
26650               T................  ...................  Treat thumb fracture.......         0046      29.2920    $1,527.61      $535.76      $305.52
26665               T................  ...................  Treat thumb fracture.......         0046      29.2920    $1,527.61      $535.76      $305.52
26670               T................  ...................  Treat hand dislocation.....         0043       2.4999      $130.37  ...........       $26.07
26675               T................  ...................  Treat hand dislocation.....         0043       2.4999      $130.37  ...........       $26.07
26676               T................  ...................  Pin hand dislocation.......         0046      29.2920    $1,527.61      $535.76      $305.52
26685               T................  ...................  Treat hand dislocation.....         0046      29.2920    $1,527.61      $535.76      $305.52
26686               T................  ...................  Treat hand dislocation.....         0046      29.2920    $1,527.61      $535.76      $305.52
26700               T................  ...................  Treat knuckle dislocation..         0043       2.4999      $130.37  ...........       $26.07
26705               T................  ...................  Treat knuckle dislocation..         0043       2.4999      $130.37  ...........       $26.07
26706               T................  ...................  Pin knuckle dislocation....         0043       2.4999      $130.37  ...........       $26.07
26715               T................  ...................  Treat knuckle dislocation..         0046      29.2920    $1,527.61      $535.76      $305.52
26720               T................  ...................  Treat finger fracture, each         0043       2.4999      $130.37  ...........       $26.07
26725               T................  ...................  Treat finger fracture, each         0043       2.4999      $130.37  ...........       $26.07
26727               T................  ...................  Treat finger fracture, each         0046      29.2920    $1,527.61      $535.76      $305.52
26735               T................  ...................  Treat finger fracture, each         0046      29.2920    $1,527.61      $535.76      $305.52
26740               T................  ...................  Treat finger fracture, each         0043       2.4999      $130.37  ...........       $26.07
26742               T................  ...................  Treat finger fracture, each         0043       2.4999      $130.37  ...........       $26.07
26746               T................  ...................  Treat finger fracture, each         0046      29.2920    $1,527.61      $535.76      $305.52
26750               T................  ...................  Treat finger fracture, each         0043       2.4999      $130.37  ...........       $26.07
26755               T................  ...................  Treat finger fracture, each         0043       2.4999      $130.37  ...........       $26.07
26756               T................  ...................  Pin finger fracture, each..         0046      29.2920    $1,527.61      $535.76      $305.52
26765               T................  ...................  Treat finger fracture, each         0046      29.2920    $1,527.61      $535.76      $305.52
26770               T................  ...................  Treat finger dislocation...         0043       2.4999      $130.37  ...........       $26.07
26775               T................  ...................  Treat finger dislocation...         0045      12.9357      $674.61      $268.47      $134.92
26776               T................  ...................  Pin finger dislocation.....         0046      29.2920    $1,527.61      $535.76      $305.52
26785               T................  ...................  Treat finger dislocation...         0046      29.2920    $1,527.61      $535.76      $305.52
26820               T................  ...................  Thumb fusion with graft....         0054      22.7223    $1,184.99  ...........      $237.00
26841               T................  ...................  Fusion of thumb............         0054      22.7223    $1,184.99  ...........      $237.00
26842               T................  ...................  Thumb fusion with graft....         0054      22.7223    $1,184.99  ...........      $237.00
26843               T................  ...................  Fusion of hand joint.......         0054      22.7223    $1,184.99  ...........      $237.00
26844               T................  ...................  Fusion/graft of hand joint.         0054      22.7223    $1,184.99  ...........      $237.00
26850               T................  ...................  Fusion of knuckle..........         0054      22.7223    $1,184.99  ...........      $237.00
26852               T................  ...................  Fusion of knuckle with              0054      22.7223    $1,184.99  ...........      $237.00
                                                             graft.
26860               T................  ...................  Fusion of finger joint.....         0054      22.7223    $1,184.99  ...........      $237.00
26861               T................  ...................  Fusion of finger jnt, add-          0054      22.7223    $1,184.99  ...........      $237.00
                                                             on.
26862               T................  ...................  Fusion/graft of finger              0054      22.7223    $1,184.99  ...........      $237.00
                                                             joint.
26863               T................  ...................  Fuse/graft added joint.....         0054      22.7223    $1,184.99  ...........      $237.00
26910               T................  ...................  Amputate metacarpal bone...         0054      22.7223    $1,184.99  ...........      $237.00
26951               T................  ...................  Amputation of finger/thumb.         0053      14.1760      $739.29      $253.49      $147.86
26952               T................  ...................  Amputation of finger/thumb.         0053      14.1760      $739.29      $253.49      $147.86
26989               T................  ...................  Hand/finger surgery........         0043       2.4999      $130.37  ...........       $26.07
26990               T................  ...................  Drainage of pelvis lesion..         0049      18.6042      $970.23      $197.14      $194.05
26991               T................  ...................  Drainage of pelvis bursa...         0049      18.6042      $970.23      $197.14      $194.05
26992               C................  ...................  Drainage of bone lesion....  ...........  ...........  ...........  ...........  ...........
27000               T................  ...................  Incision of hip tendon.....         0049      18.6042      $970.23      $197.14      $194.05
27001               T................  ...................  Incision of hip tendon.....         0050      23.3037    $1,215.31  ...........      $243.06
27003               T................  ...................  Incision of hip tendon.....         0050      23.3037    $1,215.31  ...........      $243.06
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      32.9062    $1,716.09  ...........      $343.22
27035               T................  ...................  Denervation of hip joint...         0052      40.7646    $2,125.91  ...........      $425.18

[[Page 66847]]

 
27036               C................  ...................  Excision of hip joint/       ...........  ...........  ...........  ...........  ...........
                                                             muscle.
27040               T................  ...................  Biopsy of soft tissues.....         0021      13.9338      $726.66      $219.48      $145.33
27041               T................  ...................  Biopsy of soft tissues.....         0022      17.3930      $907.06      $354.45      $181.41
27047               T................  ...................  Remove hip/pelvis lesion...         0022      17.3930      $907.06      $354.45      $181.41
27048               T................  ...................  Remove hip/pelvis lesion...         0022      17.3930      $907.06      $354.45      $181.41
27049               T................  ...................  Remove tumor, hip/pelvis...         0022      17.3930      $907.06      $354.45      $181.41
27050               T................  ...................  Biopsy of sacroiliac joint.         0049      18.6042      $970.23      $197.14      $194.05
27052               T................  ...................  Biopsy of hip joint........         0049      18.6042      $970.23      $197.14      $194.05
27054               C................  ...................  Removal of hip joint lining  ...........  ...........  ...........  ...........  ...........
27060               T................  ...................  Removal of ischial bursa...         0049      18.6042      $970.23      $197.14      $194.05
27062               T................  ...................  Remove femur lesion/bursa..         0049      18.6042      $970.23      $197.14      $194.05
27065               T................  ...................  Removal of hip bone lesion.         0049      18.6042      $970.23      $197.14      $194.05
27066               T................  ...................  Removal of hip bone lesion.         0050      23.3037    $1,215.31  ...........      $243.06
27067               T................  ...................  Remove/graft hip bone               0050      23.3037    $1,215.31  ...........      $243.06
                                                             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      23.3037    $1,215.31  ...........      $243.06
27086               T................  ...................  Remove hip foreign body....         0020       7.1898      $374.96      $113.25       $74.99
27087               T................  ...................  Remove hip foreign body....         0049      18.6042      $970.23      $197.14      $194.05
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      23.3037    $1,215.31  ...........      $243.06
27098               T................  ...................  Transfer tendon to pelvis..         0050      23.3037    $1,215.31  ...........      $243.06
27100               T................  ...................  Transfer of abdominal               0051      32.9062    $1,716.09  ...........      $343.22
                                                             muscle.
27105               T................  ...................  Transfer of spinal muscle..         0051      32.9062    $1,716.09  ...........      $343.22
27110               T................  ...................  Transfer of iliopsoas               0051      32.9062    $1,716.09  ...........      $343.22
                                                             muscle.
27111               T................  ...................  Transfer of iliopsoas               0051      32.9062    $1,716.09  ...........      $343.22
                                                             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.....  ...........  ...........  ...........  ...........  ...........
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       2.4999      $130.37  ...........       $26.07
27194               T................  ...................  Treat pelvic ring fracture.         0045      12.9357      $674.61      $268.47      $134.92
27200               T................  ...................  Treat tail bone fracture...         0043       2.4999      $130.37  ...........       $26.07
27202               T................  ...................  Treat tail bone fracture...         0046      29.2920    $1,527.61      $535.76      $305.52
27215               C................  ...................  Treat pelvic fracture(s)...  ...........  ...........  ...........  ...........  ...........

[[Page 66848]]

 
27216               T................  ...................  Treat pelvic ring fracture.         0050      23.3037    $1,215.31  ...........      $243.06
27217               C................  ...................  Treat pelvic ring fracture.  ...........  ...........  ...........  ...........  ...........
27218               C................  ...................  Treat pelvic ring fracture.  ...........  ...........  ...........  ...........  ...........
27220               T................  ...................  Treat hip socket fracture..         0043       2.4999      $130.37  ...........       $26.07
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       2.4999      $130.37  ...........       $26.07
27232               C................  ...................  Treat thigh fracture.......  ...........  ...........  ...........  ...........  ...........
27235               T................  ...................  Treat thigh fracture.......         0050      23.3037    $1,215.31  ...........      $243.06
27236               C................  ...................  Treat thigh fracture.......  ...........  ...........  ...........  ...........  ...........
27238               T................  ...................  Treat thigh fracture.......         0043       2.4999      $130.37  ...........       $26.07
27240               C................  ...................  Treat thigh fracture.......  ...........  ...........  ...........  ...........  ...........
27244               C................  ...................  Treat thigh fracture.......  ...........  ...........  ...........  ...........  ...........
27245               C................  ...................  Treat thigh fracture.......  ...........  ...........  ...........  ...........  ...........
27246               T................  ...................  Treat thigh fracture.......         0043       2.4999      $130.37  ...........       $26.07
27248               C................  ...................  Treat thigh fracture.......  ...........  ...........  ...........  ...........  ...........
27250               T................  ...................  Treat hip dislocation......         0043       2.4999      $130.37  ...........       $26.07
27252               T................  ...................  Treat hip dislocation......         0045      12.9357      $674.61      $268.47      $134.92
27253               C................  ...................  Treat hip dislocation......  ...........  ...........  ...........  ...........  ...........
27254               C................  ...................  Treat hip dislocation......  ...........  ...........  ...........  ...........  ...........
27256               T................  ...................  Treat hip dislocation......         0043       2.4999      $130.37  ...........       $26.07
27257               T................  ...................  Treat hip dislocation......         0045      12.9357      $674.61      $268.47      $134.92
27258               C................  ...................  Treat hip dislocation......  ...........  ...........  ...........  ...........  ...........
27259               C................  ...................  Treat hip dislocation......  ...........  ...........  ...........  ...........  ...........
27265               T................  ...................  Treat hip dislocation......         0043       2.4999      $130.37  ...........       $26.07
27266               T................  ...................  Treat hip dislocation......         0045      12.9357      $674.61      $268.47      $134.92
27275               T................  ...................  Manipulation of hip joint..         0045      12.9357      $674.61      $268.47      $134.92
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       2.4999      $130.37  ...........       $26.07
27301               T................  ...................  Drain thigh/knee lesion....         0008      16.1430      $841.87  ...........      $168.37
27303               C................  ...................  Drainage of bone lesion....  ...........  ...........  ...........  ...........  ...........
27305               T................  ...................  Incise thigh tendon &               0049      18.6042      $970.23      $197.14      $194.05
                                                             fascia.
27306               T................  ...................  Incision of thigh tendon...         0049      18.6042      $970.23      $197.14      $194.05
27307               T................  ...................  Incision of thigh tendons..         0049      18.6042      $970.23      $197.14      $194.05
27310               T................  ...................  Exploration of knee joint..         0050      23.3037    $1,215.31  ...........      $243.06
27315               T................  ...................  Partial removal, thigh              0220      15.8136      $824.70  ...........      $164.94
                                                             nerve.
27320               T................  ...................  Partial removal, thigh              0220      15.8136      $824.70  ...........      $164.94
                                                             nerve.
27323               T................  ...................  Biopsy, thigh soft tissues.         0021      13.9338      $726.66      $219.48      $145.33
27324               T................  ...................  Biopsy, thigh soft tissues.         0022      17.3930      $907.06      $354.45      $181.41
27327               T................  ...................  Removal of thigh lesion....         0022      17.3930      $907.06      $354.45      $181.41
27328               T................  ...................  Removal of thigh lesion....         0022      17.3930      $907.06      $354.45      $181.41
27329               T................  ...................  Remove tumor, thigh/knee...         0022      17.3930      $907.06      $354.45      $181.41
27330               T................  ...................  Biopsy, knee joint lining..         0050      23.3037    $1,215.31  ...........      $243.06
27331               T................  ...................  Explore/treat knee joint...         0050      23.3037    $1,215.31  ...........      $243.06
27332               T................  ...................  Removal of knee cartilage..         0050      23.3037    $1,215.31  ...........      $243.06
27333               T................  ...................  Removal of knee cartilage..         0050      23.3037    $1,215.31  ...........      $243.06
27334               T................  ...................  Remove knee joint lining...         0050      23.3037    $1,215.31  ...........      $243.06
27335               T................  ...................  Remove knee joint lining...         0050      23.3037    $1,215.31  ...........      $243.06
27340               T................  ...................  Removal of kneecap bursa...         0049      18.6042      $970.23      $197.14      $194.05
27345               T................  ...................  Removal of knee cyst.......         0049      18.6042      $970.23      $197.14      $194.05
27347               T................  ...................  Remove knee cyst...........         0049      18.6042      $970.23      $197.14      $194.05
27350               T................  ...................  Removal of kneecap.........         0050      23.3037    $1,215.31  ...........      $243.06
27355               T................  ...................  Remove femur lesion........         0050      23.3037    $1,215.31  ...........      $243.06
27356               T................  ...................  Remove femur lesion/graft..         0050      23.3037    $1,215.31  ...........      $243.06
27357               T................  ...................  Remove femur lesion/graft..         0050      23.3037    $1,215.31  ...........      $243.06
27358               T................  ...................  Remove femur lesion/                0050      23.3037    $1,215.31  ...........      $243.06
                                                             fixation.
27360               T................  ...................  Partial removal, leg                0050      23.3037    $1,215.31  ...........      $243.06
                                                             bone(s).
27365               C................  ...................  Extensive leg surgery......  ...........  ...........  ...........  ...........  ...........

[[Page 66849]]

 
27370               N................  ...................  Injection for knee x-ray...  ...........  ...........  ...........  ...........  ...........
27372               T................  ...................  Removal of foreign body....         0022      17.3930      $907.06      $354.45      $181.41
27380               T................  ...................  Repair of kneecap tendon...         0049      18.6042      $970.23      $197.14      $194.05
27381               T................  ...................  Repair/graft kneecap tendon         0049      18.6042      $970.23      $197.14      $194.05
27385               T................  ...................  Repair of thigh muscle.....         0049      18.6042      $970.23      $197.14      $194.05
27386               T................  ...................  Repair/graft of thigh               0049      18.6042      $970.23      $197.14      $194.05
                                                             muscle.
27390               T................  ...................  Incision of thigh tendon...         0049      18.6042      $970.23      $197.14      $194.05
27391               T................  ...................  Incision of thigh tendons..         0049      18.6042      $970.23      $197.14      $194.05
27392               T................  ...................  Incision of thigh tendons..         0049      18.6042      $970.23      $197.14      $194.05
27393               T................  ...................  Lengthening of thigh tendon         0050      23.3037    $1,215.31  ...........      $243.06
27394               T................  ...................  Lengthening of thigh                0050      23.3037    $1,215.31  ...........      $243.06
                                                             tendons.
27395               T................  ...................  Lengthening of thigh                0051      32.9062    $1,716.09  ...........      $343.22
                                                             tendons.
27396               T................  ...................  Transplant of thigh tendon.         0050      23.3037    $1,215.31  ...........      $243.06
27397               T................  ...................  Transplants of thigh                0051      32.9062    $1,716.09  ...........      $343.22
                                                             tendons.
27400               T................  ...................  Revise thigh muscles/               0051      32.9062    $1,716.09  ...........      $343.22
                                                             tendons.
27403               T................  ...................  Repair of knee cartilage...         0050      23.3037    $1,215.31  ...........      $243.06
27405               T................  ...................  Repair of knee ligament....         0051      32.9062    $1,716.09  ...........      $343.22
27407               T................  ...................  Repair of knee ligament....         0051      32.9062    $1,716.09  ...........      $343.22
27409               T................  ...................  Repair of knee ligaments...         0051      32.9062    $1,716.09  ...........      $343.22
27418               T................  ...................  Repair degenerated kneecap.         0051      32.9062    $1,716.09  ...........      $343.22
27420               T................  ...................  Revision of unstable                0051      32.9062    $1,716.09  ...........      $343.22
                                                             kneecap.
27422               T................  ...................  Revision of unstable                0051      32.9062    $1,716.09  ...........      $343.22
                                                             kneecap.
27424               T................  ...................  Revision/removal of kneecap         0051      32.9062    $1,716.09  ...........      $343.22
27425               T................  ...................  Lateral retinacular release         0050      23.3037    $1,215.31  ...........      $243.06
27427               T................  ...................  Reconstruction, knee.......         0052      40.7646    $2,125.91  ...........      $425.18
27428               T................  ...................  Reconstruction, knee.......         0052      40.7646    $2,125.91  ...........      $425.18
27429               T................  ...................  Reconstruction, knee.......         0052      40.7646    $2,125.91  ...........      $425.18
27430               T................  ...................  Revision of thigh muscles..         0051      32.9062    $1,716.09  ...........      $343.22
27435               T................  ...................  Incision of knee joint.....         0051      32.9062    $1,716.09  ...........      $343.22
27437               T................  ...................  Revise kneecap.............         0047      28.2842    $1,475.05      $537.03      $295.01
27438               T................  ...................  Revise kneecap with implant         0048      40.6289    $2,118.84      $695.60      $423.77
27440               T................  ...................  Revision of knee joint.....         0047      28.2842    $1,475.05      $537.03      $295.01
27441               T................  ...................  Revision of knee joint.....         0047      28.2842    $1,475.05      $537.03      $295.01
27442               T................  ...................  Revision of knee joint.....         0047      28.2842    $1,475.05      $537.03      $295.01
27443               T................  ...................  Revision of knee joint.....         0047      28.2842    $1,475.05      $537.03      $295.01
27445               C................  ...................  Revision of knee joint.....  ...........  ...........  ...........  ...........  ...........
27446               T................  ...................  Revision of knee joint.....         0681     147.8067    $7,708.27    $3,067.55    $1,541.65
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............  ...........  ...........  ...........  ...........  ...........
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      18.6042      $970.23      $197.14      $194.05
27497               T................  ...................  Decompression of thigh/knee         0049      18.6042      $970.23      $197.14      $194.05
27498               T................  ...................  Decompression of thigh/knee         0049      18.6042      $970.23      $197.14      $194.05
27499               T................  ...................  Decompression of thigh/knee         0049      18.6042      $970.23      $197.14      $194.05
27500               T................  ...................  Treatment of thigh fracture         0043       2.4999      $130.37  ...........       $26.07
27501               T................  ...................  Treatment of thigh fracture         0043       2.4999      $130.37  ...........       $26.07
27502               T................  ...................  Treatment of thigh fracture         0043       2.4999      $130.37  ...........       $26.07
27503               T................  ...................  Treatment of thigh fracture         0043       2.4999      $130.37  ...........       $26.07
27506               C................  ...................  Treatment of thigh fracture  ...........  ...........  ...........  ...........  ...........

[[Page 66850]]

 
27507               C................  ...................  Treatment of thigh fracture  ...........  ...........  ...........  ...........  ...........
27508               T................  ...................  Treatment of thigh fracture         0043       2.4999      $130.37  ...........       $26.07
27509               T................  ...................  Treatment of thigh fracture         0046      29.2920    $1,527.61      $535.76      $305.52
27510               T................  ...................  Treatment of thigh fracture         0043       2.4999      $130.37  ...........       $26.07
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       2.4999      $130.37  ...........       $26.07
27517               T................  ...................  Treat thigh fx growth plate         0043       2.4999      $130.37  ...........       $26.07
27519               C................  ...................  Treat thigh fx growth plate  ...........  ...........  ...........  ...........  ...........
27520               T................  ...................  Treat kneecap fracture.....         0043       2.4999      $130.37  ...........       $26.07
27524               T................  ...................  Treat kneecap fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
27530               T................  ...................  Treat knee fracture........         0043       2.4999      $130.37  ...........       $26.07
27532               T................  ...................  Treat knee fracture........         0043       2.4999      $130.37  ...........       $26.07
27535               C................  ...................  Treat knee fracture........  ...........  ...........  ...........  ...........  ...........
27536               C................  ...................  Treat knee fracture........  ...........  ...........  ...........  ...........  ...........
27538               T................  ...................  Treat knee fracture(s).....         0043       2.4999      $130.37  ...........       $26.07
27540               C................  ...................  Treat knee fracture........  ...........  ...........  ...........  ...........  ...........
27550               T................  ...................  Treat knee dislocation.....         0043       2.4999      $130.37  ...........       $26.07
27552               T................  ...................  Treat knee dislocation.....         0045      12.9357      $674.61      $268.47      $134.92
27556               C................  ...................  Treat knee dislocation.....  ...........  ...........  ...........  ...........  ...........
27557               C................  ...................  Treat knee dislocation.....  ...........  ...........  ...........  ...........  ...........
27558               C................  ...................  Treat knee dislocation.....  ...........  ...........  ...........  ...........  ...........
27560               T................  ...................  Treat kneecap dislocation..         0043       2.4999      $130.37  ...........       $26.07
27562               T................  ...................  Treat kneecap dislocation..         0045      12.9357      $674.61      $268.47      $134.92
27566               T................  ...................  Treat kneecap dislocation..         0046      29.2920    $1,527.61      $535.76      $305.52
27570               T................  ...................  Fixation of knee joint.....         0045      12.9357      $674.61      $268.47      $134.92
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      18.6042      $970.23      $197.14      $194.05
                                                             surgery.
27596               C................  ...................  Amputation follow-up         ...........  ...........  ...........  ...........  ...........
                                                             surgery.
27598               C................  ...................  Amputate lower leg at knee.  ...........  ...........  ...........  ...........  ...........
27599               T................  ...................  Leg surgery procedure......         0043       2.4999      $130.37  ...........       $26.07
27600               T................  ...................  Decompression of lower leg.         0049      18.6042      $970.23      $197.14      $194.05
27601               T................  ...................  Decompression of lower leg.         0049      18.6042      $970.23      $197.14      $194.05
27602               T................  ...................  Decompression of lower leg.         0049      18.6042      $970.23      $197.14      $194.05
27603               T................  ...................  Drain lower leg lesion.....         0008      16.1430      $841.87  ...........      $168.37
27604               T................  ...................  Drain lower leg bursa......         0049      18.6042      $970.23      $197.14      $194.05
27605               T................  ...................  Incision of achilles tendon         0055      17.6740      $921.72      $355.34      $184.34
27606               T................  ...................  Incision of achilles tendon         0049      18.6042      $970.23      $197.14      $194.05
27607               T................  ...................  Treat lower leg bone lesion         0049      18.6042      $970.23      $197.14      $194.05
27610               T................  ...................  Explore/treat ankle joint..         0050      23.3037    $1,215.31  ...........      $243.06
27612               T................  ...................  Exploration of ankle joint.         0050      23.3037    $1,215.31  ...........      $243.06
27613               T................  ...................  Biopsy lower leg soft               0020       7.1898      $374.96      $113.25       $74.99
                                                             tissue.
27614               T................  ...................  Biopsy lower leg soft               0022      17.3930      $907.06      $354.45      $181.41
                                                             tissue.
27615               T................  ...................  Remove tumor, lower leg....         0046      29.2920    $1,527.61      $535.76      $305.52
27618               T................  ...................  Remove lower leg lesion....         0021      13.9338      $726.66      $219.48      $145.33
27619               T................  ...................  Remove lower leg lesion....         0022      17.3930      $907.06      $354.45      $181.41
27620               T................  ...................  Explore/treat ankle joint..         0050      23.3037    $1,215.31  ...........      $243.06
27625               T................  ...................  Remove ankle joint lining..         0050      23.3037    $1,215.31  ...........      $243.06
27626               T................  ...................  Remove ankle joint lining..         0050      23.3037    $1,215.31  ...........      $243.06
27630               T................  ...................  Removal of tendon lesion...         0049      18.6042      $970.23      $197.14      $194.05
27635               T................  ...................  Remove lower leg bone               0050      23.3037    $1,215.31  ...........      $243.06
                                                             lesion.
27637               T................  ...................  Remove/graft leg bone               0050      23.3037    $1,215.31  ...........      $243.06
                                                             lesion.
27638               T................  ...................  Remove/graft leg bone               0050      23.3037    $1,215.31  ...........      $243.06
                                                             lesion.
27640               T................  ...................  Partial removal of tibia...         0051      32.9062    $1,716.09  ...........      $343.22
27641               T................  ...................  Partial removal of fibula..         0050      23.3037    $1,215.31  ...........      $243.06
27645               C................  ...................  Extensive lower leg surgery  ...........  ...........  ...........  ...........  ...........
27646               C................  ...................  Extensive lower leg surgery  ...........  ...........  ...........  ...........  ...........
27647               T................  ...................  Extensive ankle/heel                0051      32.9062    $1,716.09  ...........      $343.22
                                                             surgery.
27648               N................  ...................  Injection for ankle x-ray..  ...........  ...........  ...........  ...........  ...........
27650               T................  ...................  Repair achilles tendon.....         0051      32.9062    $1,716.09  ...........      $343.22
27652               T................  ...................  Repair/graft achilles               0051      32.9062    $1,716.09  ...........      $343.22
                                                             tendon.

[[Page 66851]]

 
27654               T................  ...................  Repair of achilles tendon..         0051      32.9062    $1,716.09  ...........      $343.22
27656               T................  ...................  Repair leg fascia defect...         0049      18.6042      $970.23      $197.14      $194.05
27658               T................  ...................  Repair of leg tendon, each.         0049      18.6042      $970.23      $197.14      $194.05
27659               T................  ...................  Repair of leg tendon, each.         0049      18.6042      $970.23      $197.14      $194.05
27664               T................  ...................  Repair of leg tendon, each.         0049      18.6042      $970.23      $197.14      $194.05
27665               T................  ...................  Repair of leg tendon, each.         0050      23.3037    $1,215.31  ...........      $243.06
27675               T................  ...................  Repair lower leg tendons...         0049      18.6042      $970.23      $197.14      $194.05
27676               T................  ...................  Repair lower leg tendons...         0050      23.3037    $1,215.31  ...........      $243.06
27680               T................  ...................  Release of lower leg tendon         0050      23.3037    $1,215.31  ...........      $243.06
27681               T................  ...................  Release of lower leg                0050      23.3037    $1,215.31  ...........      $243.06
                                                             tendons.
27685               T................  ...................  Revision of lower leg               0050      23.3037    $1,215.31  ...........      $243.06
                                                             tendon.
27686               T................  ...................  Revise lower leg tendons...         0050      23.3037    $1,215.31  ...........      $243.06
27687               T................  ...................  Revision of calf tendon....         0050      23.3037    $1,215.31  ...........      $243.06
27690               T................  ...................  Revise lower leg tendon....         0051      32.9062    $1,716.09  ...........      $343.22
27691               T................  ...................  Revise lower leg tendon....         0051      32.9062    $1,716.09  ...........      $343.22
27692               T................  ...................  Revise additional leg               0051      32.9062    $1,716.09  ...........      $343.22
                                                             tendon.
27695               T................  ...................  Repair of ankle ligament...         0050      23.3037    $1,215.31  ...........      $243.06
27696               T................  ...................  Repair of ankle ligaments..         0050      23.3037    $1,215.31  ...........      $243.06
27698               T................  ...................  Repair of ankle ligament...         0050      23.3037    $1,215.31  ...........      $243.06
27700               T................  ...................  Revision of ankle joint....         0047      28.2842    $1,475.05      $537.03      $295.01
27702               C................  ...................  Reconstruct ankle joint....  ...........  ...........  ...........  ...........  ...........
27703               C................  ...................  Reconstruction, ankle joint  ...........  ...........  ...........  ...........  ...........
27704               T................  ...................  Removal of ankle implant...         0049      18.6042      $970.23      $197.14      $194.05
27705               T................  ...................  Incision of tibia..........         0051      32.9062    $1,716.09  ...........      $343.22
27707               T................  ...................  Incision of fibula.........         0049      18.6042      $970.23      $197.14      $194.05
27709               T................  ...................  Incision of tibia & fibula.         0050      23.3037    $1,215.31  ...........      $243.06
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      23.3037    $1,215.31  ...........      $243.06
27732               T................  ...................  Repair of fibula epiphysis.         0050      23.3037    $1,215.31  ...........      $243.06
27734               T................  ...................  Repair lower leg epiphyses.         0050      23.3037    $1,215.31  ...........      $243.06
27740               T................  ...................  Repair of leg epiphyses....         0050      23.3037    $1,215.31  ...........      $243.06
27742               T................  ...................  Repair of leg epiphyses....         0051      32.9062    $1,716.09  ...........      $343.22
27745               T................  ...................  Reinforce tibia............         0051      32.9062    $1,716.09  ...........      $343.22
27750               T................  ...................  Treatment of tibia fracture         0043       2.4999      $130.37  ...........       $26.07
27752               T................  ...................  Treatment of tibia fracture         0043       2.4999      $130.37  ...........       $26.07
27756               T................  ...................  Treatment of tibia fracture         0046      29.2920    $1,527.61      $535.76      $305.52
27758               T................  ...................  Treatment of tibia fracture         0046      29.2920    $1,527.61      $535.76      $305.52
27759               T................  ...................  Treatment of tibia fracture         0046      29.2920    $1,527.61      $535.76      $305.52
27760               T................  ...................  Treatment of ankle fracture         0043       2.4999      $130.37  ...........       $26.07
27762               T................  ...................  Treatment of ankle fracture         0043       2.4999      $130.37  ...........       $26.07
27766               T................  ...................  Treatment of ankle fracture         0046      29.2920    $1,527.61      $535.76      $305.52
27780               T................  ...................  Treatment of fibula                 0043       2.4999      $130.37  ...........       $26.07
                                                             fracture.
27781               T................  ...................  Treatment of fibula                 0043       2.4999      $130.37  ...........       $26.07
                                                             fracture.
27784               T................  ...................  Treatment of fibula                 0046      29.2920    $1,527.61      $535.76      $305.52
                                                             fracture.
27786               T................  ...................  Treatment of ankle fracture         0043       2.4999      $130.37  ...........       $26.07
27788               T................  ...................  Treatment of ankle fracture         0043       2.4999      $130.37  ...........       $26.07
27792               T................  ...................  Treatment of ankle fracture         0046      29.2920    $1,527.61      $535.76      $305.52
27808               T................  ...................  Treatment of ankle fracture         0043       2.4999      $130.37  ...........       $26.07
27810               T................  ...................  Treatment of ankle fracture         0043       2.4999      $130.37  ...........       $26.07
27814               T................  ...................  Treatment of ankle fracture         0046      29.2920    $1,527.61      $535.76      $305.52
27816               T................  ...................  Treatment of ankle fracture         0043       2.4999      $130.37  ...........       $26.07
27818               T................  ...................  Treatment of ankle fracture         0043       2.4999      $130.37  ...........       $26.07
27822               T................  ...................  Treatment of ankle fracture         0046      29.2920    $1,527.61      $535.76      $305.52
27823               T................  ...................  Treatment of ankle fracture         0046      29.2920    $1,527.61      $535.76      $305.52
27824               T................  ...................  Treat lower leg fracture...         0043       2.4999      $130.37  ...........       $26.07
27825               T................  ...................  Treat lower leg fracture...         0043       2.4999      $130.37  ...........       $26.07
27826               T................  ...................  Treat lower leg fracture...         0046      29.2920    $1,527.61      $535.76      $305.52
27827               T................  ...................  Treat lower leg fracture...         0046      29.2920    $1,527.61      $535.76      $305.52
27828               T................  ...................  Treat lower leg fracture...         0046      29.2920    $1,527.61      $535.76      $305.52

[[Page 66852]]

 
27829               T................  ...................  Treat lower leg joint......         0046      29.2920    $1,527.61      $535.76      $305.52
27830               T................  ...................  Treat lower leg dislocation         0043       2.4999      $130.37  ...........       $26.07
27831               T................  ...................  Treat lower leg dislocation         0043       2.4999      $130.37  ...........       $26.07
27832               T................  ...................  Treat lower leg dislocation         0046      29.2920    $1,527.61      $535.76      $305.52
27840               T................  ...................  Treat ankle dislocation....         0043       2.4999      $130.37  ...........       $26.07
27842               T................  ...................  Treat ankle dislocation....         0045      12.9357      $674.61      $268.47      $134.92
27846               T................  ...................  Treat ankle dislocation....         0046      29.2920    $1,527.61      $535.76      $305.52
27848               T................  ...................  Treat ankle dislocation....         0046      29.2920    $1,527.61      $535.76      $305.52
27860               T................  ...................  Fixation of ankle joint....         0045      12.9357      $674.61      $268.47      $134.92
27870               T................  ...................  Fusion of ankle joint......         0051      32.9062    $1,716.09  ...........      $343.22
27871               T................  ...................  Fusion of tibiofibular              0051      32.9062    $1,716.09  ...........      $343.22
                                                             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      18.6042      $970.23      $197.14      $194.05
                                                             surgery.
27886               C................  ...................  Amputation follow-up         ...........  ...........  ...........  ...........  ...........
                                                             surgery.
27888               C................  ...................  Amputation of foot at ankle  ...........  ...........  ...........  ...........  ...........
27889               T................  ...................  Amputation of foot at ankle         0050      23.3037    $1,215.31  ...........      $243.06
27892               T................  ...................  Decompression of leg.......         0049      18.6042      $970.23      $197.14      $194.05
27893               T................  ...................  Decompression of leg.......         0049      18.6042      $970.23      $197.14      $194.05
27894               T................  ...................  Decompression of leg.......         0049      18.6042      $970.23      $197.14      $194.05
27899               T................  ...................  Leg/ankle surgery procedure         0043       2.4999      $130.37  ...........       $26.07
28001               T................  ...................  Drainage of bursa of foot..         0008      16.1430      $841.87  ...........      $168.37
28002               T................  ...................  Treatment of foot infection         0049      18.6042      $970.23      $197.14      $194.05
28003               T................  ...................  Treatment of foot infection         0049      18.6042      $970.23      $197.14      $194.05
28005               T................  ...................  Treat foot bone lesion.....         0055      17.6740      $921.72      $355.34      $184.34
28008               T................  ...................  Incision of foot fascia....         0055      17.6740      $921.72      $355.34      $184.34
28010               T................  ...................  Incision of toe tendon.....         0055      17.6740      $921.72      $355.34      $184.34
28011               T................  ...................  Incision of toe tendons....         0055      17.6740      $921.72      $355.34      $184.34
28020               T................  ...................  Exploration of foot joint..         0055      17.6740      $921.72      $355.34      $184.34
28022               T................  ...................  Exploration of foot joint..         0055      17.6740      $921.72      $355.34      $184.34
28024               T................  ...................  Exploration of toe joint...         0055      17.6740      $921.72      $355.34      $184.34
28030               T................  ...................  Removal of foot nerve......         0220      15.8136      $824.70  ...........      $164.94
28035               T................  ...................  Decompression of tibia              0220      15.8136      $824.70  ...........      $164.94
                                                             nerve.
28043               T................  ...................  Excision of foot lesion....         0021      13.9338      $726.66      $219.48      $145.33
28045               T................  ...................  Excision of foot lesion....         0055      17.6740      $921.72      $355.34      $184.34
28046               T................  ...................  Resection of tumor, foot...         0055      17.6740      $921.72      $355.34      $184.34
28050               T................  ...................  Biopsy of foot joint lining         0055      17.6740      $921.72      $355.34      $184.34
28052               T................  ...................  Biopsy of foot joint lining         0055      17.6740      $921.72      $355.34      $184.34
28054               T................  ...................  Biopsy of toe joint lining.         0055      17.6740      $921.72      $355.34      $184.34
28060               T................  ...................  Partial removal, foot               0056      22.1700    $1,156.19      $405.81      $231.24
                                                             fascia.
28062               T................  ...................  Removal of foot fascia.....         0056      22.1700    $1,156.19      $405.81      $231.24
28070               T................  ...................  Removal of foot joint               0056      22.1700    $1,156.19      $405.81      $231.24
                                                             lining.
28072               T................  ...................  Removal of foot joint               0056      22.1700    $1,156.19      $405.81      $231.24
                                                             lining.
28080               T................  ...................  Removal of foot lesion.....         0055      17.6740      $921.72      $355.34      $184.34
28086               T................  ...................  Excise foot tendon sheath..         0055      17.6740      $921.72      $355.34      $184.34
28088               T................  ...................  Excise foot tendon sheath..         0055      17.6740      $921.72      $355.34      $184.34
28090               T................  ...................  Removal of foot lesion.....         0055      17.6740      $921.72      $355.34      $184.34
28092               T................  ...................  Removal of toe lesions.....         0055      17.6740      $921.72      $355.34      $184.34
28100               T................  ...................  Removal of ankle/heel               0055      17.6740      $921.72      $355.34      $184.34
                                                             lesion.
28102               T................  ...................  Remove/graft foot lesion...         0056      22.1700    $1,156.19      $405.81      $231.24
28103               T................  ...................  Remove/graft foot lesion...         0056      22.1700    $1,156.19      $405.81      $231.24
28104               T................  ...................  Removal of foot lesion.....         0055      17.6740      $921.72      $355.34      $184.34
28106               T................  ...................  Remove/graft foot lesion...         0056      22.1700    $1,156.19      $405.81      $231.24
28107               T................  ...................  Remove/graft foot lesion...         0056      22.1700    $1,156.19      $405.81      $231.24
28108               T................  ...................  Removal of toe lesions.....         0055      17.6740      $921.72      $355.34      $184.34
28110               T................  ...................  Part removal of metatarsal.         0056      22.1700    $1,156.19      $405.81      $231.24
28111               T................  ...................  Part removal of metatarsal.         0055      17.6740      $921.72      $355.34      $184.34
28112               T................  ...................  Part removal of metatarsal.         0055      17.6740      $921.72      $355.34      $184.34
28113               T................  ...................  Part removal of metatarsal.         0055      17.6740      $921.72      $355.34      $184.34
28114               T................  ...................  Removal of metatarsal heads         0055      17.6740      $921.72      $355.34      $184.34
28116               T................  ...................  Revision of foot...........         0055      17.6740      $921.72      $355.34      $184.34
28118               T................  ...................  Removal of heel bone.......         0055      17.6740      $921.72      $355.34      $184.34
28119               T................  ...................  Removal of heel spur.......         0055      17.6740      $921.72      $355.34      $184.34
28120               T................  ...................  Part removal of ankle/heel.         0055      17.6740      $921.72      $355.34      $184.34

[[Page 66853]]

 
28122               T................  ...................  Partial removal of foot             0055      17.6740      $921.72      $355.34      $184.34
                                                             bone.
28124               T................  ...................  Partial removal of toe.....         0055      17.6740      $921.72      $355.34      $184.34
28126               T................  ...................  Partial removal of toe.....         0055      17.6740      $921.72      $355.34      $184.34
28130               T................  ...................  Removal of ankle bone......         0055      17.6740      $921.72      $355.34      $184.34
28140               T................  ...................  Removal of metatarsal......         0055      17.6740      $921.72      $355.34      $184.34
28150               T................  ...................  Removal of toe.............         0055      17.6740      $921.72      $355.34      $184.34
28153               T................  ...................  Partial removal of toe.....         0055      17.6740      $921.72      $355.34      $184.34
28160               T................  ...................  Partial removal of toe.....         0055      17.6740      $921.72      $355.34      $184.34
28171               T................  ...................  Extensive foot surgery.....         0055      17.6740      $921.72      $355.34      $184.34
28173               T................  ...................  Extensive foot surgery.....         0055      17.6740      $921.72      $355.34      $184.34
28175               T................  ...................  Extensive foot surgery.....         0055      17.6740      $921.72      $355.34      $184.34
28190               T................  ...................  Removal of foot foreign             0019       3.7693      $196.57       $71.87       $39.31
                                                             body.
28192               T................  ...................  Removal of foot foreign             0021      13.9338      $726.66      $219.48      $145.33
                                                             body.
28193               T................  ...................  Removal of foot foreign             0021      13.9338      $726.66      $219.48      $145.33
                                                             body.
28200               T................  ...................  Repair of foot tendon......         0055      17.6740      $921.72      $355.34      $184.34
28202               T................  ...................  Repair/graft of foot tendon         0056      22.1700    $1,156.19      $405.81      $231.24
28208               T................  ...................  Repair of foot tendon......         0055      17.6740      $921.72      $355.34      $184.34
28210               T................  ...................  Repair/graft of foot tendon         0055      17.6740      $921.72      $355.34      $184.34
28220               T................  ...................  Release of foot tendon.....         0055      17.6740      $921.72      $355.34      $184.34
28222               T................  ...................  Release of foot tendons....         0055      17.6740      $921.72      $355.34      $184.34
28225               T................  ...................  Release of foot tendon.....         0055      17.6740      $921.72      $355.34      $184.34
28226               T................  ...................  Release of foot tendons....         0055      17.6740      $921.72      $355.34      $184.34
28230               T................  ...................  Incision of foot tendon(s).         0055      17.6740      $921.72      $355.34      $184.34
28232               T................  ...................  Incision of toe tendon.....         0055      17.6740      $921.72      $355.34      $184.34
28234               T................  ...................  Incision of foot tendon....         0055      17.6740      $921.72      $355.34      $184.34
28238               T................  ...................  Revision of foot tendon....         0056      22.1700    $1,156.19      $405.81      $231.24
28240               T................  ...................  Release of big toe.........         0055      17.6740      $921.72      $355.34      $184.34
28250               T................  ...................  Revision of foot fascia....         0056      22.1700    $1,156.19      $405.81      $231.24
28260               T................  ...................  Release of midfoot joint...         0056      22.1700    $1,156.19      $405.81      $231.24
28261               T................  ...................  Revision of foot tendon....         0056      22.1700    $1,156.19      $405.81      $231.24
28262               T................  ...................  Revision of foot and ankle.         0056      22.1700    $1,156.19      $405.81      $231.24
28264               T................  ...................  Release of midfoot joint...         0056      22.1700    $1,156.19      $405.81      $231.24
28270               T................  ...................  Release of foot contracture         0055      17.6740      $921.72      $355.34      $184.34
28272               T................  ...................  Release of toe joint, each.         0055      17.6740      $921.72      $355.34      $184.34
28280               T................  ...................  Fusion of toes.............         0055      17.6740      $921.72      $355.34      $184.34
28285               T................  ...................  Repair of hammertoe........         0055      17.6740      $921.72      $355.34      $184.34
28286               T................  ...................  Repair of hammertoe........         0055      17.6740      $921.72      $355.34      $184.34
28288               T................  ...................  Partial removal of foot             0056      22.1700    $1,156.19      $405.81      $231.24
                                                             bone.
28289               T................  ...................  Repair hallux rigidus......         0056      22.1700    $1,156.19      $405.81      $231.24
28290               T................  ...................  Correction of bunion.......         0056      22.1700    $1,156.19      $405.81      $231.24
28292               T................  ...................  Correction of bunion.......         0057      22.9064    $1,194.59      $475.91      $238.92
28293               T................  ...................  Correction of bunion.......         0057      22.9064    $1,194.59      $475.91      $238.92
28294               T................  ...................  Correction of bunion.......         0056      22.1700    $1,156.19      $405.81      $231.24
28296               T................  ...................  Correction of bunion.......         0056      22.1700    $1,156.19      $405.81      $231.24
28297               T................  ...................  Correction of bunion.......         0057      22.9064    $1,194.59      $475.91      $238.92
28298               T................  ...................  Correction of bunion.......         0056      22.1700    $1,156.19      $405.81      $231.24
28299               T................  ...................  Correction of bunion.......         0057      22.9064    $1,194.59      $475.91      $238.92
28300               T................  ...................  Incision of heel bone......         0056      22.1700    $1,156.19      $405.81      $231.24
28302               T................  ...................  Incision of ankle bone.....         0056      22.1700    $1,156.19      $405.81      $231.24
28304               T................  ...................  Incision of midfoot bones..         0056      22.1700    $1,156.19      $405.81      $231.24
28305               T................  ...................  Incise/graft midfoot bones.         0056      22.1700    $1,156.19      $405.81      $231.24
28306               T................  ...................  Incision of metatarsal.....         0056      22.1700    $1,156.19      $405.81      $231.24
28307               T................  ...................  Incision of metatarsal.....         0056      22.1700    $1,156.19      $405.81      $231.24
28308               T................  ...................  Incision of metatarsal.....         0056      22.1700    $1,156.19      $405.81      $231.24
28309               T................  ...................  Incision of metatarsals....         0056      22.1700    $1,156.19      $405.81      $231.24
28310               T................  ...................  Revision of big toe........         0055      17.6740      $921.72      $355.34      $184.34
28312               T................  ...................  Revision of toe............         0055      17.6740      $921.72      $355.34      $184.34
28313               T................  ...................  Repair deformity of toe....         0055      17.6740      $921.72      $355.34      $184.34
28315               T................  ...................  Removal of sesamoid bone...         0055      17.6740      $921.72      $355.34      $184.34
28320               T................  ...................  Repair of foot bones.......         0056      22.1700    $1,156.19      $405.81      $231.24
28322               T................  ...................  Repair of metatarsals......         0056      22.1700    $1,156.19      $405.81      $231.24
28340               T................  ...................  Resect enlarged toe tissue.         0055      17.6740      $921.72      $355.34      $184.34
28341               T................  ...................  Resect enlarged toe........         0055      17.6740      $921.72      $355.34      $184.34
28344               T................  ...................  Repair extra toe(s)........         0056      22.1700    $1,156.19      $405.81      $231.24
28345               T................  ...................  Repair webbed toe(s).......         0056      22.1700    $1,156.19      $405.81      $231.24

[[Page 66854]]

 
28360               T................  ...................  Reconstruct cleft foot.....         0056      22.1700    $1,156.19      $405.81      $231.24
28400               T................  ...................  Treatment of heel fracture.         0043       2.4999      $130.37  ...........       $26.07
28405               T................  ...................  Treatment of heel fracture.         0043       2.4999      $130.37  ...........       $26.07
28406               T................  ...................  Treatment of heel fracture.         0046      29.2920    $1,527.61      $535.76      $305.52
28415               T................  ...................  Treat heel fracture........         0046      29.2920    $1,527.61      $535.76      $305.52
28420               T................  ...................  Treat/graft heel fracture..         0046      29.2920    $1,527.61      $535.76      $305.52
28430               T................  ...................  Treatment of ankle fracture         0043       2.4999      $130.37  ...........       $26.07
28435               T................  ...................  Treatment of ankle fracture         0043       2.4999      $130.37  ...........       $26.07
28436               T................  ...................  Treatment of ankle fracture         0046      29.2920    $1,527.61      $535.76      $305.52
28445               T................  ...................  Treat ankle fracture.......         0046      29.2920    $1,527.61      $535.76      $305.52
28450               T................  ...................  Treat midfoot fracture,             0043       2.4999      $130.37  ...........       $26.07
                                                             each.
28455               T................  ...................  Treat midfoot fracture,             0043       2.4999      $130.37  ...........       $26.07
                                                             each.
28456               T................  ...................  Treat midfoot fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
28465               T................  ...................  Treat midfoot fracture,             0046      29.2920    $1,527.61      $535.76      $305.52
                                                             each.
28470               T................  ...................  Treat metatarsal fracture..         0043       2.4999      $130.37  ...........       $26.07
28475               T................  ...................  Treat metatarsal fracture..         0043       2.4999      $130.37  ...........       $26.07
28476               T................  ...................  Treat metatarsal fracture..         0046      29.2920    $1,527.61      $535.76      $305.52
28485               T................  ...................  Treat metatarsal fracture..         0046      29.2920    $1,527.61      $535.76      $305.52
28490               T................  ...................  Treat big toe fracture.....         0043       2.4999      $130.37  ...........       $26.07
28495               T................  ...................  Treat big toe fracture.....         0043       2.4999      $130.37  ...........       $26.07
28496               T................  ...................  Treat big toe fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
28505               T................  ...................  Treat big toe fracture.....         0046      29.2920    $1,527.61      $535.76      $305.52
28510               T................  ...................  Treatment of toe fracture..         0043       2.4999      $130.37  ...........       $26.07
28515               T................  ...................  Treatment of toe fracture..         0043       2.4999      $130.37  ...........       $26.07
28525               T................  ...................  Treat toe fracture.........         0046      29.2920    $1,527.61      $535.76      $305.52
28530               T................  ...................  Treat sesamoid bone                 0043       2.4999      $130.37  ...........       $26.07
                                                             fracture.
28531               T................  ...................  Treat sesamoid bone                 0046      29.2920    $1,527.61      $535.76      $305.52
                                                             fracture.
28540               T................  ...................  Treat foot dislocation.....         0043       2.4999      $130.37  ...........       $26.07
28545               T................  ...................  Treat foot dislocation.....         0045      12.9357      $674.61      $268.47      $134.92
28546               T................  ...................  Treat foot dislocation.....         0046      29.2920    $1,527.61      $535.76      $305.52
28555               T................  ...................  Repair foot dislocation....         0046      29.2920    $1,527.61      $535.76      $305.52
28570               T................  ...................  Treat foot dislocation.....         0043       2.4999      $130.37  ...........       $26.07
28575               T................  ...................  Treat foot dislocation.....         0043       2.4999      $130.37  ...........       $26.07
28576               T................  ...................  Treat foot dislocation.....         0046      29.2920    $1,527.61      $535.76      $305.52
28585               T................  ...................  Repair foot dislocation....         0046      29.2920    $1,527.61      $535.76      $305.52
28600               T................  ...................  Treat foot dislocation.....         0043       2.4999      $130.37  ...........       $26.07
28605               T................  ...................  Treat foot dislocation.....         0043       2.4999      $130.37  ...........       $26.07
28606               T................  ...................  Treat foot dislocation.....         0046      29.2920    $1,527.61      $535.76      $305.52
28615               T................  ...................  Repair foot dislocation....         0046      29.2920    $1,527.61      $535.76      $305.52
28630               T................  ...................  Treat toe dislocation......         0043       2.4999      $130.37  ...........       $26.07
28635               T................  ...................  Treat toe dislocation......         0045      12.9357      $674.61      $268.47      $134.92
28636               T................  ...................  Treat toe dislocation......         0046      29.2920    $1,527.61      $535.76      $305.52
28645               T................  ...................  Repair toe dislocation.....         0046      29.2920    $1,527.61      $535.76      $305.52
28660               T................  ...................  Treat toe dislocation......         0043       2.4999      $130.37  ...........       $26.07
28665               T................  ...................  Treat toe dislocation......         0045      12.9357      $674.61      $268.47      $134.92
28666               T................  ...................  Treat toe dislocation......         0046      29.2920    $1,527.61      $535.76      $305.52
28675               T................  ...................  Repair of toe dislocation..         0046      29.2920    $1,527.61      $535.76      $305.52
28705               T................  ...................  Fusion of foot bones.......         0056      22.1700    $1,156.19      $405.81      $231.24
28715               T................  ...................  Fusion of foot bones.......         0056      22.1700    $1,156.19      $405.81      $231.24
28725               T................  ...................  Fusion of foot bones.......         0056      22.1700    $1,156.19      $405.81      $231.24
28730               T................  ...................  Fusion of foot bones.......         0056      22.1700    $1,156.19      $405.81      $231.24
28735               T................  ...................  Fusion of foot bones.......         0056      22.1700    $1,156.19      $405.81      $231.24
28737               T................  ...................  Revision of foot bones.....         0055      17.6740      $921.72      $355.34      $184.34
28740               T................  ...................  Fusion of foot bones.......         0056      22.1700    $1,156.19      $405.81      $231.24
28750               T................  ...................  Fusion of big toe joint....         0055      17.6740      $921.72      $355.34      $184.34
28755               T................  ...................  Fusion of big toe joint....         0055      17.6740      $921.72      $355.34      $184.34
28760               T................  ...................  Fusion of big toe joint....         0056      22.1700    $1,156.19      $405.81      $231.24
28800               C................  ...................  Amputation of midfoot......  ...........  ...........  ...........  ...........  ...........
28805               C................  ...................  Amputation thru metatarsal.  ...........  ...........  ...........  ...........  ...........
28810               T................  ...................  Amputation toe & metatarsal         0055      17.6740      $921.72      $355.34      $184.34
28820               T................  ...................  Amputation of toe..........         0055      17.6740      $921.72      $355.34      $184.34
28825               T................  ...................  Partial amputation of toe..         0055      17.6740      $921.72      $355.34      $184.34
28899               T................  ...................  Foot/toes surgery procedure         0043       2.4999      $130.37  ...........       $26.07
29000               S................  ...................  Application of body cast...         0058       1.0368       $54.07  ...........       $10.81
29010               S................  ...................  Application of body cast...         0058       1.0368       $54.07  ...........       $10.81

[[Page 66855]]

 
29015               S................  ...................  Application of body cast...         0058       1.0368       $54.07  ...........       $10.81
29020               S................  ...................  Application of body cast...         0058       1.0368       $54.07  ...........       $10.81
29025               S................  ...................  Application of body cast...         0058       1.0368       $54.07  ...........       $10.81
29035               S................  ...................  Application of body cast...         0058       1.0368       $54.07  ...........       $10.81
29040               S................  ...................  Application of body cast...         0058       1.0368       $54.07  ...........       $10.81
29044               S................  ...................  Application of body cast...         0058       1.0368       $54.07  ...........       $10.81
29046               S................  ...................  Application of body cast...         0058       1.0368       $54.07  ...........       $10.81
29049               S................  ...................  Application of figure eight         0058       1.0368       $54.07  ...........       $10.81
29055               S................  ...................  Application of shoulder             0058       1.0368       $54.07  ...........       $10.81
                                                             cast.
29058               S................  ...................  Application of shoulder             0058       1.0368       $54.07  ...........       $10.81
                                                             cast.
29065               S................  ...................  Application of long arm             0058       1.0368       $54.07  ...........       $10.81
                                                             cast.
29075               S................  ...................  Application of forearm cast         0058       1.0368       $54.07  ...........       $10.81
29085               S................  ...................  Apply hand/wrist cast......         0058       1.0368       $54.07  ...........       $10.81
29086               S................  ...................  Apply finger cast..........         0058       1.0368       $54.07  ...........       $10.81
29105               S................  ...................  Apply long arm splint......         0058       1.0368       $54.07  ...........       $10.81
29125               S................  ...................  Apply forearm splint.......         0058       1.0368       $54.07  ...........       $10.81
29126               S................  ...................  Apply forearm splint.......         0058       1.0368       $54.07  ...........       $10.81
29130               S................  ...................  Application of finger               0058       1.0368       $54.07  ...........       $10.81
                                                             splint.
29131               S................  ...................  Application of finger               0058       1.0368       $54.07  ...........       $10.81
                                                             splint.
29200               S................  ...................  Strapping of chest.........         0058       1.0368       $54.07  ...........       $10.81
29220               S................  ...................  Strapping of low back......         0058       1.0368       $54.07  ...........       $10.81
29240               S................  ...................  Strapping of shoulder......         0058       1.0368       $54.07  ...........       $10.81
29260               S................  ...................  Strapping of elbow or wrist         0058       1.0368       $54.07  ...........       $10.81
29280               S................  ...................  Strapping of hand or finger         0058       1.0368       $54.07  ...........       $10.81
29305               S................  ...................  Application of hip cast....         0058       1.0368       $54.07  ...........       $10.81
29325               S................  ...................  Application of hip casts...         0058       1.0368       $54.07  ...........       $10.81
29345               S................  ...................  Application of long leg             0058       1.0368       $54.07  ...........       $10.81
                                                             cast.
29355               S................  ...................  Application of long leg             0058       1.0368       $54.07  ...........       $10.81
                                                             cast.
29358               S................  ...................  Apply long leg cast brace..         0058       1.0368       $54.07  ...........       $10.81
29365               S................  ...................  Application of long leg             0058       1.0368       $54.07  ...........       $10.81
                                                             cast.
29405               S................  ...................  Apply short leg cast.......         0058       1.0368       $54.07  ...........       $10.81
29425               S................  ...................  Apply short leg cast.......         0058       1.0368       $54.07  ...........       $10.81
29435               S................  ...................  Apply short leg cast.......         0058       1.0368       $54.07  ...........       $10.81
29440               S................  ...................  Addition of walker to cast.         0058       1.0368       $54.07  ...........       $10.81
29445               S................  ...................  Apply rigid leg cast.......         0058       1.0368       $54.07  ...........       $10.81
29450               S................  ...................  Application of leg cast....         0058       1.0368       $54.07  ...........       $10.81
29505               S................  ...................  Application, long leg               0058       1.0368       $54.07  ...........       $10.81
                                                             splint.
29515               S................  ...................  Application lower leg               0058       1.0368       $54.07  ...........       $10.81
                                                             splint.
29520               S................  ...................  Strapping of hip...........         0058       1.0368       $54.07  ...........       $10.81
29530               S................  ...................  Strapping of knee..........         0058       1.0368       $54.07  ...........       $10.81
29540               S................  ...................  Strapping of ankle.........         0058       1.0368       $54.07  ...........       $10.81
29550               S................  ...................  Strapping of toes..........         0058       1.0368       $54.07  ...........       $10.81
29580               S................  ...................  Application of paste boot..         0058       1.0368       $54.07  ...........       $10.81
29590               S................  ...................  Application of foot splint.         0058       1.0368       $54.07  ...........       $10.81
29700               S................  ...................  Removal/revision of cast...         0058       1.0368       $54.07  ...........       $10.81
29705               S................  ...................  Removal/revision of cast...         0058       1.0368       $54.07  ...........       $10.81
29710               S................  ...................  Removal/revision of cast...         0058       1.0368       $54.07  ...........       $10.81
29715               S................  ...................  Removal/revision of cast...         0058       1.0368       $54.07  ...........       $10.81
29720               S................  ...................  Repair of body cast........         0058       1.0368       $54.07  ...........       $10.81
29730               S................  ...................  Windowing of cast..........         0058       1.0368       $54.07  ...........       $10.81
29740               S................  ...................  Wedging of cast............         0058       1.0368       $54.07  ...........       $10.81
29750               S................  ...................  Wedging of clubfoot cast...         0058       1.0368       $54.07  ...........       $10.81
29799               S................  ...................  Casting/strapping procedure         0058       1.0368       $54.07  ...........       $10.81
29800               T................  ...................  Jaw arthroscopy/surgery....         0041      26.1234    $1,362.36  ...........      $272.47
29804               T................  ...................  Jaw arthroscopy/surgery....         0041      26.1234    $1,362.36  ...........      $272.47
29805               T................  ...................  Shoulder arthroscopy, dx...         0041      26.1234    $1,362.36  ...........      $272.47
29806               T................  ...................  Shoulder arthroscopy/               0041      26.1234    $1,362.36  ...........      $272.47
                                                             surgery.
29807               T................  ...................  Shoulder arthroscopy/               0041      26.1234    $1,362.36  ...........      $272.47
                                                             surgery.
29819               T................  ...................  Shoulder arthroscopy/               0041      26.1234    $1,362.36  ...........      $272.47
                                                             surgery.
29820               T................  ...................  Shoulder arthroscopy/               0041      26.1234    $1,362.36  ...........      $272.47
                                                             surgery.
29821               T................  ...................  Shoulder arthroscopy/               0041      26.1234    $1,362.36  ...........      $272.47
                                                             surgery.
29822               T................  ...................  Shoulder arthroscopy/               0041      26.1234    $1,362.36  ...........      $272.47
                                                             surgery.
29823               T................  ...................  Shoulder arthroscopy/               0041      26.1234    $1,362.36  ...........      $272.47
                                                             surgery.
29824               T................  ...................  Shoulder arthroscopy/               0041      26.1234    $1,362.36  ...........      $272.47
                                                             surgery.
29825               T................  ...................  Shoulder arthroscopy/               0041      26.1234    $1,362.36  ...........      $272.47
                                                             surgery.

[[Page 66856]]

 
29826               T................  ...................  Shoulder arthroscopy/               0042      40.9680    $2,136.52      $804.74      $427.30
                                                             surgery.
29827               T................  NI.................  Arthroscop rotator cuff             0041      26.1234    $1,362.36  ...........      $272.47
                                                             repr.
29830               T................  ...................  Elbow arthroscopy..........         0041      26.1234    $1,362.36  ...........      $272.47
29834               T................  ...................  Elbow arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29835               T................  ...................  Elbow arthroscopy/surgery..         0042      40.9680    $2,136.52      $804.74      $427.30
29836               T................  ...................  Elbow arthroscopy/surgery..         0042      40.9680    $2,136.52      $804.74      $427.30
29837               T................  ...................  Elbow arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29838               T................  ...................  Elbow arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29840               T................  ...................  Wrist arthroscopy..........         0041      26.1234    $1,362.36  ...........      $272.47
29843               T................  ...................  Wrist arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29844               T................  ...................  Wrist arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29845               T................  ...................  Wrist arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29846               T................  ...................  Wrist arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29847               T................  ...................  Wrist arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29848               T................  ...................  Wrist endoscopy/surgery....         0041      26.1234    $1,362.36  ...........      $272.47
29850               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29851               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29855               T................  ...................  Tibial arthroscopy/surgery.         0042      40.9680    $2,136.52      $804.74      $427.30
29856               T................  ...................  Tibial arthroscopy/surgery.         0041      26.1234    $1,362.36  ...........      $272.47
29860               T................  ...................  Hip arthroscopy, dx........         0041      26.1234    $1,362.36  ...........      $272.47
29861               T................  ...................  Hip arthroscopy/surgery....         0041      26.1234    $1,362.36  ...........      $272.47
29862               T................  ...................  Hip arthroscopy/surgery....         0042      40.9680    $2,136.52      $804.74      $427.30
29863               T................  ...................  Hip arthroscopy/surgery....         0042      40.9680    $2,136.52      $804.74      $427.30
29870               T................  ...................  Knee arthroscopy, dx.......         0041      26.1234    $1,362.36  ...........      $272.47
29871               T................  ...................  Knee arthroscopy/drainage..         0041      26.1234    $1,362.36  ...........      $272.47
29873               T................  NI.................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29874               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29875               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29876               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29877               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29879               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29880               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29881               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29882               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29883               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29884               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29885               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29886               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29887               T................  ...................  Knee arthroscopy/surgery...         0041      26.1234    $1,362.36  ...........      $272.47
29888               T................  ...................  Knee arthroscopy/surgery...         0042      40.9680    $2,136.52      $804.74      $427.30
29889               T................  ...................  Knee arthroscopy/surgery...         0042      40.9680    $2,136.52      $804.74      $427.30
29891               T................  ...................  Ankle arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29892               T................  ...................  Ankle arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29893               T................  ...................  Scope, plantar fasciotomy..         0055      17.6740      $921.72      $355.34      $184.34
29894               T................  ...................  Ankle arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29895               T................  ...................  Ankle arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29897               T................  ...................  Ankle arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29898               T................  ...................  Ankle arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29899               T................  NI.................  Ankle arthroscopy/surgery..         0041      26.1234    $1,362.36  ...........      $272.47
29900               T................  ...................  Mcp joint arthroscopy, dx..         0053      14.1760      $739.29      $253.49      $147.86
29901               T................  ...................  Mcp joint arthroscopy, surg         0053      14.1760      $739.29      $253.49      $147.86
29902               T................  ...................  Mcp joint arthroscopy, surg         0053      14.1760      $739.29      $253.49      $147.86
29999               T................  ...................  Arthroscopy of joint.......         0041      26.1234    $1,362.36  ...........      $272.47
30000               T................  ...................  Drainage of nose lesion....         0251       1.9089       $99.55  ...........       $19.91
30020               T................  ...................  Drainage of nose lesion....         0251       1.9089       $99.55  ...........       $19.91
30100               T................  ...................  Intranasal biopsy..........         0252       5.8041      $302.69      $113.41       $60.54
30110               T................  ...................  Removal of nose polyp(s)...         0253      14.4473      $753.44      $282.29      $150.69
30115               T................  ...................  Removal of nose polyp(s)...         0253      14.4473      $753.44      $282.29      $150.69
30117               T................  ...................  Removal of intranasal               0253      14.4473      $753.44      $282.29      $150.69
                                                             lesion.
30118               T................  ...................  Removal of intranasal               0254      20.1158    $1,049.06      $321.35      $209.81
                                                             lesion.
30120               T................  ...................  Revision of nose...........         0253      14.4473      $753.44      $282.29      $150.69
30124               T................  ...................  Removal of nose lesion.....         0252       5.8041      $302.69      $113.41       $60.54
30125               T................  ...................  Removal of nose lesion.....         0256      34.0302    $1,774.71  ...........      $354.94
30130               T................  ...................  Removal of turbinate bones.         0253      14.4473      $753.44      $282.29      $150.69
30140               T................  ...................  Removal of turbinate bones.         0254      20.1158    $1,049.06      $321.35      $209.81

[[Page 66857]]

 
30150               T................  ...................  Partial removal of nose....         0256      34.0302    $1,774.71  ...........      $354.94
30160               T................  ...................  Removal of nose............         0256      34.0302    $1,774.71  ...........      $354.94
30200               T................  ...................  Injection treatment of nose         0253      14.4473      $753.44      $282.29      $150.69
30210               T................  ...................  Nasal sinus therapy........         0252       5.8041      $302.69      $113.41       $60.54
30220               T................  ...................  Insert nasal septal button.         0252       5.8041      $302.69      $113.41       $60.54
30300               X................  ...................  Remove nasal foreign body..         0340       0.6492       $33.86  ...........        $6.77
30310               T................  ...................  Remove nasal foreign body..         0253      14.4473      $753.44      $282.29      $150.69
30320               T................  ...................  Remove nasal foreign body..         0253      14.4473      $753.44      $282.29      $150.69
30400               T................  ...................  Reconstruction of nose.....         0256      34.0302    $1,774.71  ...........      $354.94
30410               T................  ...................  Reconstruction of nose.....         0256      34.0302    $1,774.71  ...........      $354.94
30420               T................  ...................  Reconstruction of nose.....         0256      34.0302    $1,774.71  ...........      $354.94
30430               T................  ...................  Revision of nose...........         0254      20.1158    $1,049.06      $321.35      $209.81
30435               T................  ...................  Revision of nose...........         0256      34.0302    $1,774.71  ...........      $354.94
30450               T................  ...................  Revision of nose...........         0256      34.0302    $1,774.71  ...........      $354.94
30460               T................  ...................  Revision of nose...........         0256      34.0302    $1,774.71  ...........      $354.94
30462               T................  ...................  Revision of nose...........         0256      34.0302    $1,774.71  ...........      $354.94
30465               T................  ...................  Repair nasal stenosis......         0256      34.0302    $1,774.71  ...........      $354.94
30520               T................  ...................  Repair of nasal septum.....         0254      20.1158    $1,049.06      $321.35      $209.81
30540               T................  ...................  Repair nasal defect........         0256      34.0302    $1,774.71  ...........      $354.94
30545               T................  ...................  Repair nasal defect........         0256      34.0302    $1,774.71  ...........      $354.94
30560               T................  ...................  Release of nasal adhesions.         0251       1.9089       $99.55  ...........       $19.91
30580               T................  ...................  Repair upper jaw fistula...         0256      34.0302    $1,774.71  ...........      $354.94
30600               T................  ...................  Repair mouth/nose fistula..         0256      34.0302    $1,774.71  ...........      $354.94
30620               T................  ...................  Intranasal reconstruction..         0256      34.0302    $1,774.71  ...........      $354.94
30630               T................  ...................  Repair nasal septum defect.         0254      20.1158    $1,049.06      $321.35      $209.81
30801               T................  ...................  Cauterization, inner nose..         0252       5.8041      $302.69      $113.41       $60.54
30802               T................  ...................  Cauterization, inner nose..         0253      14.4473      $753.44      $282.29      $150.69
30901               T................  ...................  Control of nosebleed.......         0250       1.6376       $85.40       $29.89       $17.08
30903               T................  ...................  Control of nosebleed.......         0250       1.6376       $85.40       $29.89       $17.08
30905               T................  ...................  Control of nosebleed.......         0250       1.6376       $85.40       $29.89       $17.08
30906               T................  ...................  Repeat control of nosebleed         0250       1.6376       $85.40       $29.89       $17.08
30915               T................  ...................  Ligation, nasal sinus               0091      26.7048    $1,392.68      $348.23      $278.54
                                                             artery.
30920               T................  ...................  Ligation, upper jaw artery.         0092      23.7882    $1,240.58      $505.37      $248.12
30930               T................  ...................  Therapy, fracture of nose..         0253      14.4473      $753.44      $282.29      $150.69
30999               T................  ...................  Nasal surgery procedure....         0251       1.9089       $99.55  ...........       $19.91
31000               T................  ...................  Irrigation, maxillary sinus         0251       1.9089       $99.55  ...........       $19.91
31002               T................  ...................  Irrigation, sphenoid sinus.         0252       5.8041      $302.69      $113.41       $60.54
31020               T................  ...................  Exploration, maxillary              0254      20.1158    $1,049.06      $321.35      $209.81
                                                             sinus.
31030               T................  ...................  Exploration, maxillary              0256      34.0302    $1,774.71  ...........      $354.94
                                                             sinus.
31032               T................  ...................  Explore sinus, remove               0256      34.0302    $1,774.71  ...........      $354.94
                                                             polyps.
31040               T................  ...................  Exploration behind upper            0254      20.1158    $1,049.06      $321.35      $209.81
                                                             jaw.
31050               T................  ...................  Exploration, sphenoid sinus         0256      34.0302    $1,774.71  ...........      $354.94
31051               T................  ...................  Sphenoid sinus surgery.....         0256      34.0302    $1,774.71  ...........      $354.94
31070               T................  ...................  Exploration of frontal              0254      20.1158    $1,049.06      $321.35      $209.81
                                                             sinus.
31075               T................  ...................  Exploration of frontal              0256      34.0302    $1,774.71  ...........      $354.94
                                                             sinus.
31080               T................  ...................  Removal of frontal sinus...         0256      34.0302    $1,774.71  ...........      $354.94
31081               T................  ...................  Removal of frontal sinus...         0256      34.0302    $1,774.71  ...........      $354.94
31084               T................  ...................  Removal of frontal sinus...         0256      34.0302    $1,774.71  ...........      $354.94
31085               T................  ...................  Removal of frontal sinus...         0256      34.0302    $1,774.71  ...........      $354.94
31086               T................  ...................  Removal of frontal sinus...         0256      34.0302    $1,774.71  ...........      $354.94
31087               T................  ...................  Removal of frontal sinus...         0256      34.0302    $1,774.71  ...........      $354.94
31090               T................  ...................  Exploration of sinuses.....         0256      34.0302    $1,774.71  ...........      $354.94
31200               T................  ...................  Removal of ethmoid sinus...         0256      34.0302    $1,774.71  ...........      $354.94
31201               T................  ...................  Removal of ethmoid sinus...         0256      34.0302    $1,774.71  ...........      $354.94
31205               T................  ...................  Removal of ethmoid sinus...         0256      34.0302    $1,774.71  ...........      $354.94
31225               C................  ...................  Removal of upper jaw.......  ...........  ...........  ...........  ...........  ...........
31230               C................  ...................  Removal of upper jaw.......  ...........  ...........  ...........  ...........  ...........
31231               T................  ...................  Nasal endoscopy, dx........         0071       0.9205       $48.00       $12.89        $9.60
31233               T................  ...................  Nasal/sinus endoscopy, dx..         0073       3.1976      $166.76       $73.38       $33.35
31235               T................  ...................  Nasal/sinus endoscopy, dx..         0074      12.8582      $670.57      $295.70      $134.11
31237               T................  ...................  Nasal/sinus endoscopy, surg         0075      19.6604    $1,025.31      $445.92      $205.06
31238               T................  ...................  Nasal/sinus endoscopy, surg         0074      12.8582      $670.57      $295.70      $134.11
31239               T................  ...................  Nasal/sinus endoscopy, surg         0075      19.6604    $1,025.31      $445.92      $205.06
31240               T................  ...................  Nasal/sinus endoscopy, surg         0074      12.8582      $670.57      $295.70      $134.11
31254               T................  ...................  Revision of ethmoid sinus..         0075      19.6604    $1,025.31      $445.92      $205.06

[[Page 66858]]

 
31255               T................  ...................  Removal of ethmoid sinus...         0075      19.6604    $1,025.31      $445.92      $205.06
31256               T................  ...................  Exploration maxillary sinus         0075      19.6604    $1,025.31      $445.92      $205.06
31267               T................  ...................  Endoscopy, maxillary sinus.         0075      19.6604    $1,025.31      $445.92      $205.06
31276               T................  ...................  Sinus endoscopy, surgical..         0075      19.6604    $1,025.31      $445.92      $205.06
31287               T................  ...................  Nasal/sinus endoscopy, surg         0075      19.6604    $1,025.31      $445.92      $205.06
31288               T................  ...................  Nasal/sinus endoscopy, surg         0075      19.6604    $1,025.31      $445.92      $205.06
31290               C................  ...................  Nasal/sinus endoscopy, surg  ...........  ...........  ...........  ...........  ...........
31291               C................  ...................  Nasal/sinus endoscopy, surg  ...........  ...........  ...........  ...........  ...........
31292               C................  ...................  Nasal/sinus endoscopy, surg  ...........  ...........  ...........  ...........  ...........
31293               C................  ...................  Nasal/sinus endoscopy, surg  ...........  ...........  ...........  ...........  ...........
31294               C................  ...................  Nasal/sinus endoscopy, surg  ...........  ...........  ...........  ...........  ...........
31299               T................  ...................  Sinus surgery procedure....         0252       5.8041      $302.69      $113.41       $60.54
31300               T................  ...................  Removal of larynx lesion...         0256      34.0302    $1,774.71  ...........      $354.94
31320               T................  ...................  Diagnostic incision, larynx         0256      34.0302    $1,774.71  ...........      $354.94
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      34.0302    $1,774.71  ...........      $354.94
31420               T................  ...................  Removal of epiglottis......         0256      34.0302    $1,774.71  ...........      $354.94
31500               S................  ...................  Insert emergency airway....         0094       3.8371      $200.11       $67.63       $40.02
31502               T................  ...................  Change of windpipe airway..         0121       2.0833      $108.65       $43.80       $21.73
31505               T................  ...................  Diagnostic laryngoscopy....         0072       1.1628       $60.64       $26.68       $12.13
31510               T................  ...................  Laryngoscopy with biopsy...         0074      12.8582      $670.57      $295.70      $134.11
31511               T................  ...................  Remove foreign body, larynx         0072       1.1628       $60.64       $26.68       $12.13
31512               T................  ...................  Removal of larynx lesion...         0074      12.8582      $670.57      $295.70      $134.11
31513               T................  ...................  Injection into vocal cord..         0072       1.1628       $60.64       $26.68       $12.13
31515               T................  ...................  Laryngoscopy for aspiration         0074      12.8582      $670.57      $295.70      $134.11
31520               T................  ...................  Diagnostic laryngoscopy....         0072       1.1628       $60.64       $26.68       $12.13
31525               T................  ...................  Diagnostic laryngoscopy....         0074      12.8582      $670.57      $295.70      $134.11
31526               T................  ...................  Diagnostic laryngoscopy....         0075      19.6604    $1,025.31      $445.92      $205.06
31527               T................  ...................  Laryngoscopy for treatment.         0075      19.6604    $1,025.31      $445.92      $205.06
31528               T................  ...................  Laryngoscopy and dilation..         0074      12.8582      $670.57      $295.70      $134.11
31529               T................  ...................  Laryngoscopy and dilation..         0074      12.8582      $670.57      $295.70      $134.11
31530               T................  ...................  Operative laryngoscopy.....         0075      19.6604    $1,025.31      $445.92      $205.06
31531               T................  ...................  Operative laryngoscopy.....         0075      19.6604    $1,025.31      $445.92      $205.06
31535               T................  ...................  Operative laryngoscopy.....         0075      19.6604    $1,025.31      $445.92      $205.06
31536               T................  ...................  Operative laryngoscopy.....         0075      19.6604    $1,025.31      $445.92      $205.06
31540               T................  ...................  Operative laryngoscopy.....         0075      19.6604    $1,025.31      $445.92      $205.06
31541               T................  ...................  Operative laryngoscopy.....         0075      19.6604    $1,025.31      $445.92      $205.06
31560               T................  ...................  Operative laryngoscopy.....         0075      19.6604    $1,025.31      $445.92      $205.06
31561               T................  ...................  Operative laryngoscopy.....         0075      19.6604    $1,025.31      $445.92      $205.06
31570               T................  ...................  Laryngoscopy with injection         0074      12.8582      $670.57      $295.70      $134.11
31571               T................  ...................  Laryngoscopy with injection         0075      19.6604    $1,025.31      $445.92      $205.06
31575               T................  ...................  Diagnostic laryngoscopy....         0071       0.9205       $48.00       $12.89        $9.60
31576               T................  ...................  Laryngoscopy with biopsy...         0075      19.6604    $1,025.31      $445.92      $205.06
31577               T................  ...................  Remove foreign body, larynx         0073       3.1976      $166.76       $73.38       $33.35
31578               T................  ...................  Removal of larynx lesion...         0075      19.6604    $1,025.31      $445.92      $205.06
31579               T................  ...................  Diagnostic laryngoscopy....         0073       3.1976      $166.76       $73.38       $33.35
31580               T................  ...................  Revision of larynx.........         0256      34.0302    $1,774.71  ...........      $354.94
31582               T................  ...................  Revision of larynx.........         0256      34.0302    $1,774.71  ...........      $354.94
31584               C................  ...................  Treat larynx fracture......  ...........  ...........  ...........  ...........  ...........
31585               T................  ...................  Treat larynx fracture......         0253      14.4473      $753.44      $282.29      $150.69
31586               T................  ...................  Treat larynx fracture......         0256      34.0302    $1,774.71  ...........      $354.94
31587               C................  ...................  Revision of larynx.........  ...........  ...........  ...........  ...........  ...........
31588               T................  ...................  Revision of larynx.........         0256      34.0302    $1,774.71  ...........      $354.94
31590               T................  ...................  Reinnervate larynx.........         0256      34.0302    $1,774.71  ...........      $354.94
31595               T................  ...................  Larynx nerve surgery.......         0256      34.0302    $1,774.71  ...........      $354.94
31599               T................  ...................  Larynx surgery procedure...         0254      20.1158    $1,049.06      $321.35      $209.81

[[Page 66859]]

 
31600               T................  ...................  Incision of windpipe.......         0254      20.1158    $1,049.06      $321.35      $209.81
31601               T................  ...................  Incision of windpipe.......         0254      20.1158    $1,049.06      $321.35      $209.81
31603               T................  ...................  Incision of windpipe.......         0252       5.8041      $302.69      $113.41       $60.54
31605               T................  ...................  Incision of windpipe.......         0253      14.4473      $753.44      $282.29      $150.69
31610               T................  ...................  Incision of windpipe.......         0254      20.1158    $1,049.06      $321.35      $209.81
31611               T................  ...................  Surgery/speech prosthesis..         0254      20.1158    $1,049.06      $321.35      $209.81
31612               T................  ...................  Puncture/clear windpipe....         0254      20.1158    $1,049.06      $321.35      $209.81
31613               T................  ...................  Repair windpipe opening....         0254      20.1158    $1,049.06      $321.35      $209.81
31614               T................  ...................  Repair windpipe opening....         0256      34.0302    $1,774.71  ...........      $354.94
31615               T................  ...................  Visualization of windpipe..         0076       8.9533      $466.92      $189.82       $93.38
31622               T................  ...................  Dx bronchoscope/wash.......         0076       8.9533      $466.92      $189.82       $93.38
31623               T................  ...................  Dx bronchoscope/brush......         0076       8.9533      $466.92      $189.82       $93.38
31624               T................  ...................  Dx bronchoscope/lavage.....         0076       8.9533      $466.92      $189.82       $93.38
31625               T................  ...................  Bronchoscopy w/biopsy(s)...         0076       8.9533      $466.92      $189.82       $93.38
31628               T................  ...................  Bronchoscopy/lung bx, each.         0076       8.9533      $466.92      $189.82       $93.38
31629               T................  ...................  Bronchoscopy/needle bx,             0076       8.9533      $466.92      $189.82       $93.38
                                                             each.
31630               T................  ...................  Bronchoscopy dilate/fx repr         0076       8.9533      $466.92      $189.82       $93.38
31631               T................  ...................  Bronchoscopy, dilate w/             0076       8.9533      $466.92      $189.82       $93.38
                                                             stent.
31635               T................  ...................  Bronchoscopy w/fb removal..         0076       8.9533      $466.92      $189.82       $93.38
31640               T................  ...................  Bronchoscopy w/tumor excise         0076       8.9533      $466.92      $189.82       $93.38
31641               T................  ...................  Bronchoscopy, treat                 0076       8.9533      $466.92      $189.82       $93.38
                                                             blockage.
31643               T................  ...................  Diag bronchoscope/catheter.         0076       8.9533      $466.92      $189.82       $93.38
31645               T................  ...................  Bronchoscopy, clear airways         0076       8.9533      $466.92      $189.82       $93.38
31646               T................  ...................  Bronchoscopy, reclear               0076       8.9533      $466.92      $189.82       $93.38
                                                             airway.
31656               T................  ...................  Bronchoscopy, inj for x-ray         0076       8.9533      $466.92      $189.82       $93.38
31700               T................  ...................  Insertion of airway                 0072       1.1628       $60.64       $26.68       $12.13
                                                             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       3.1976      $166.76       $73.38       $33.35
31720               T................  ...................  Clearance of airways.......         0072       1.1628       $60.64       $26.68       $12.13
31725               C................  ...................  Clearance of airways.......  ...........  ...........  ...........  ...........  ...........
31730               T................  ...................  Intro, windpipe wire/tube..         0073       3.1976      $166.76       $73.38       $33.35
31750               T................  ...................  Repair of windpipe.........         0256      34.0302    $1,774.71  ...........      $354.94
31755               T................  ...................  Repair of windpipe.........         0256      34.0302    $1,774.71  ...........      $354.94
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      20.1158    $1,049.06      $321.35      $209.81
31786               C................  ...................  Remove windpipe lesion.....  ...........  ...........  ...........  ...........  ...........
31800               C................  ...................  Repair of windpipe injury..  ...........  ...........  ...........  ...........  ...........
31805               C................  ...................  Repair of windpipe injury..  ...........  ...........  ...........  ...........  ...........
31820               T................  ...................  Closure of windpipe lesion.         0253      14.4473      $753.44      $282.29      $150.69
31825               T................  ...................  Repair of windpipe defect..         0254      20.1158    $1,049.06      $321.35      $209.81
31830               T................  ...................  Revise windpipe scar.......         0254      20.1158    $1,049.06      $321.35      $209.81
31899               T................  ...................  Airways surgical procedure.         0076       8.9533      $466.92      $189.82       $93.38
32000               T................  ...................  Drainage of chest..........         0070       3.3623      $175.35  ...........       $35.07
32002               T................  ...................  Treatment of collapsed lung         0070       3.3623      $175.35  ...........       $35.07
32005               T................  ...................  Treat lung lining                   0070       3.3623      $175.35  ...........       $35.07
                                                             chemically.
32020               T................  ...................  Insertion of chest tube....         0070       3.3623      $175.35  ...........       $35.07
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...  ...........  ...........  ...........  ...........  ...........

[[Page 66860]]

 
32200               C................  ...................  Drain, open, lung lesion...  ...........  ...........  ...........  ...........  ...........
32201               T................  ...................  Drain, percut, lung lesion.         0070       3.3623      $175.35  ...........       $35.07
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       3.1201      $162.72       $71.59       $32.54
32402               C................  ...................  Open biopsy chest lining...  ...........  ...........  ...........  ...........  ...........
32405               T................  ...................  Biopsy, lung or mediastinum         0685       5.9882      $312.29      $137.40       $62.46
32420               T................  ...................  Puncture/clear lung........         0070       3.3623      $175.35  ...........       $35.07
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      27.5575    $1,437.15      $591.64      $287.43
32602               T................  ...................  Thoracoscopy, diagnostic...         0069      27.5575    $1,437.15      $591.64      $287.43
32603               T................  ...................  Thoracoscopy, diagnostic...         0069      27.5575    $1,437.15      $591.64      $287.43
32604               T................  ...................  Thoracoscopy, diagnostic...         0069      27.5575    $1,437.15      $591.64      $287.43
32605               T................  ...................  Thoracoscopy, diagnostic...         0069      27.5575    $1,437.15      $591.64      $287.43
32606               T................  ...................  Thoracoscopy, diagnostic...         0069      27.5575    $1,437.15      $591.64      $287.43
32650               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32651               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32652               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32653               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32654               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32655               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32656               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32657               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32658               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32659               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32660               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32661               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32662               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32663               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32664               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32665               C................  ...................  Thoracoscopy, surgical.....  ...........  ...........  ...........  ...........  ...........
32800               C................  ...................  Repair lung hernia.........  ...........  ...........  ...........  ...........  ...........
32810               C................  ...................  Close chest after drainage.  ...........  ...........  ...........  ...........  ...........
32815               C................  ...................  Close bronchial fistula....  ...........  ...........  ...........  ...........  ...........
32820               C................  ...................  Reconstruct injured chest..  ...........  ...........  ...........  ...........  ...........
32850               C................  ...................  Donor pneumonectomy........  ...........  ...........  ...........  ...........  ...........
32851               C................  ...................  Lung transplant, single....  ...........  ...........  ...........  ...........  ...........
32852               C................  ...................  Lung transplant with bypass  ...........  ...........  ...........  ...........  ...........
32853               C................  ...................  Lung transplant, double....  ...........  ...........  ...........  ...........  ...........
32854               C................  ...................  Lung transplant with bypass  ...........  ...........  ...........  ...........  ...........
32900               C................  ...................  Removal of rib(s)..........  ...........  ...........  ...........  ...........  ...........
32905               C................  ...................  Revise & repair chest wall.  ...........  ...........  ...........  ...........  ...........
32906               C................  ...................  Revise & repair chest wall.  ...........  ...........  ...........  ...........  ...........
32940               C................  ...................  Revision of lung...........  ...........  ...........  ...........  ...........  ...........
32960               T................  ...................  Therapeutic pneumothorax...         0070       3.3623      $175.35  ...........       $35.07
32997               C................  ...................  Total lung lavage..........  ...........  ...........  ...........  ...........  ...........
32999               T................  ...................  Chest surgery procedure....         0070       3.3623      $175.35  ...........       $35.07
33010               T................  ...................  Drainage of heart sac......         0070       3.3623      $175.35  ...........       $35.07

[[Page 66861]]

 
33011               T................  ...................  Repeat drainage of heart            0070       3.3623      $175.35  ...........       $35.07
                                                             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     112.5555    $5,869.88    $1,722.59    $1,173.98
                                                             pacemaker.
33207               T................  ...................  Insertion of heart                  0089     112.5555    $5,869.88    $1,722.59    $1,173.98
                                                             pacemaker.
33208               T................  ...................  Insertion of heart                  0655     122.8654    $6,407.55  ...........    $1,281.51
                                                             pacemaker.
33210               T................  ...................  Insertion of heart                  0106      54.8243    $2,859.14  ...........      $571.83
                                                             electrode.
33211               T................  ...................  Insertion of heart                  0106      54.8243    $2,859.14  ...........      $571.83
                                                             electrode.
33212               T................  ...................  Insertion of pulse                  0090      87.9631    $4,587.36    $1,651.45      $917.47
                                                             generator.
33213               T................  ...................  Insertion of pulse                  0654      91.8583    $4,790.50  ...........      $958.10
                                                             generator.
33214               T................  ...................  Upgrade of pacemaker system         0655     122.8654    $6,407.55  ...........    $1,281.51
33215               T................  NI.................  Reposition pacing-defib             0105      18.5945      $969.72      $370.40      $193.94
                                                             lead.
33216               T................  ...................  Revise eltrd pacing-defib..         0106      54.8243    $2,859.14  ...........      $571.83
33217               T................  ...................  Insert lead pace-defib,             0106      54.8243    $2,859.14  ...........      $571.83
                                                             dual.
33218               T................  ...................  Repair lead pace-defib, one         0106      54.8243    $2,859.14  ...........      $571.83
33220               T................  ...................  Repair lead pace-defib,             0106      54.8243    $2,859.14  ...........      $571.83
                                                             dual.
33222               T................  ...................  Revise pocket, pacemaker...         0027      15.2225      $793.87      $329.72      $158.77
33223               T................  ...................  Revise pocket, pacing-defib         0027      15.2225      $793.87      $329.72      $158.77
33224               T................  NI.................  Insert pacing lead &                0976  ...........      $875.00  ...........      $175.00
                                                             connect.
33225               T................  NI.................  L ventric pacing lead add-          0977  ...........    $1,125.00  ...........      $225.00
                                                             on.
33226               T................  NI.................  Reposition l ventric lead..         0105      18.5945      $969.72      $370.40      $193.94
33233               T................  ...................  Removal of pacemaker system         0105      18.5945      $969.72      $370.40      $193.94
33234               T................  ...................  Removal of pacemaker system         0105      18.5945      $969.72      $370.40      $193.94
33235               T................  ...................  Removal pacemaker electrode         0105      18.5945      $969.72      $370.40      $193.94
33236               C................  ...................  Remove electrode/            ...........  ...........  ...........  ...........  ...........
                                                             thoracotomy.
33237               C................  ...................  Remove electrode/            ...........  ...........  ...........  ...........  ...........
                                                             thoracotomy.
33238               C................  ...................  Remove electrode/            ...........  ...........  ...........  ...........  ...........
                                                             thoracotomy.
33240               T................  ...................  Insert pulse generator.....         0107     326.2231   $17,012.86    $3,699.14    $3,402.57
33241               T................  ...................  Remove pulse generator.....         0105      18.5945      $969.72      $370.40      $193.94
33243               C................  ...................  Remove eltrd/thoracotomy...  ...........  ...........  ...........  ...........  ...........
33244               T................  ...................  Remove eltrd, transven.....         0105      18.5945      $969.72      $370.40      $193.94
33245               C................  ...................  Insert epic eltrd pace-      ...........  ...........  ...........  ...........  ...........
                                                             defib.
33246               C................  ...................  Insert epic eltrd/generator  ...........  ...........  ...........  ...........  ...........
33249               T................  ...................  Eltrd/insert pace-defib....         0108     443.5460   $23,131.37  ...........    $4,626.27
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      56.1324    $2,927.36  ...........      $585.47
                                                             record.
33284               T................  ...................  Remove pat-active ht record         0109       7.4708      $389.61      $131.49       $77.92
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 66862]]

 
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.
33508               N................  NI.................  Endoscopic vein harvest....  ...........  ...........  ...........  ...........  ...........
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....  ...........  ...........  ...........  ...........  ...........

[[Page 66863]]

 
33619               C................  ...................  Repair single ventricle....  ...........  ...........  ...........  ...........  ...........
33641               C................  ...................  Repair heart septum defect.  ...........  ...........  ...........  ...........  ...........
33645               C................  ...................  Revision of heart veins....  ...........  ...........  ...........  ...........  ...........
33647               C................  ...................  Repair heart septum defects  ...........  ...........  ...........  ...........  ...........
33660               C................  ...................  Repair of heart defects....  ...........  ...........  ...........  ...........  ...........
33665               C................  ...................  Repair of heart defects....  ...........  ...........  ...........  ...........  ...........
33670               C................  ...................  Repair of heart chambers...  ...........  ...........  ...........  ...........  ...........
33681               C................  ...................  Repair heart septum defect.  ...........  ...........  ...........  ...........  ...........
33684               C................  ...................  Repair heart septum defect.  ...........  ...........  ...........  ...........  ...........
33688               C................  ...................  Repair heart septum defect.  ...........  ...........  ...........  ...........  ...........
33690               C................  ...................  Reinforce pulmonary artery.  ...........  ...........  ...........  ...........  ...........
33692               C................  ...................  Repair of heart defects....  ...........  ...........  ...........  ...........  ...........
33694               C................  ...................  Repair of heart defects....  ...........  ...........  ...........  ...........  ...........
33697               C................  ...................  Repair of heart defects....  ...........  ...........  ...........  ...........  ...........
33702               C................  ...................  Repair of heart defects....  ...........  ...........  ...........  ...........  ...........
33710               C................  ...................  Repair of heart defects....  ...........  ...........  ...........  ...........  ...........
33720               C................  ...................  Repair of heart defect.....  ...........  ...........  ...........  ...........  ...........
33722               C................  ...................  Repair of heart defect.....  ...........  ...........  ...........  ...........  ...........
33730               C................  ...................  Repair heart-vein defect(s)  ...........  ...........  ...........  ...........  ...........
33732               C................  ...................  Repair heart-vein defect...  ...........  ...........  ...........  ...........  ...........
33735               C................  ...................  Revision of heart chamber..  ...........  ...........  ...........  ...........  ...........
33736               C................  ...................  Revision of heart chamber..  ...........  ...........  ...........  ...........  ...........
33737               C................  ...................  Revision of heart chamber..  ...........  ...........  ...........  ...........  ...........
33750               C................  ...................  Major vessel shunt.........  ...........  ...........  ...........  ...........  ...........
33755               C................  ...................  Major vessel shunt.........  ...........  ...........  ...........  ...........  ...........
33762               C................  ...................  Major vessel shunt.........  ...........  ...........  ...........  ...........  ...........
33764               C................  ...................  Major vessel shunt & graft.  ...........  ...........  ...........  ...........  ...........
33766               C................  ...................  Major vessel shunt.........  ...........  ...........  ...........  ...........  ...........
33767               C................  ...................  Major vessel shunt.........  ...........  ...........  ...........  ...........  ...........
33770               C................  ...................  Repair great vessels defect  ...........  ...........  ...........  ...........  ...........
33771               C................  ...................  Repair great vessels defect  ...........  ...........  ...........  ...........  ...........
33774               C................  ...................  Repair great vessels defect  ...........  ...........  ...........  ...........  ...........
33775               C................  ...................  Repair great vessels defect  ...........  ...........  ...........  ...........  ...........
33776               C................  ...................  Repair great vessels defect  ...........  ...........  ...........  ...........  ...........
33777               C................  ...................  Repair great vessels defect  ...........  ...........  ...........  ...........  ...........
33778               C................  ...................  Repair great vessels defect  ...........  ...........  ...........  ...........  ...........
33779               C................  ...................  Repair great vessels defect  ...........  ...........  ...........  ...........  ...........
33780               C................  ...................  Repair great vessels defect  ...........  ...........  ...........  ...........  ...........
33781               C................  ...................  Repair great vessels defect  ...........  ...........  ...........  ...........  ...........
33786               C................  ...................  Repair arterial trunk......  ...........  ...........  ...........  ...........  ...........
33788               C................  ...................  Revision of pulmonary        ...........  ...........  ...........  ...........  ...........
                                                             artery.
33800               C................  ...................  Aortic suspension..........  ...........  ...........  ...........  ...........  ...........
33802               C................  ...................  Repair vessel defect.......  ...........  ...........  ...........  ...........  ...........
33803               C................  ...................  Repair vessel defect.......  ...........  ...........  ...........  ...........  ...........
33813               C................  ...................  Repair septal defect.......  ...........  ...........  ...........  ...........  ...........
33814               C................  ...................  Repair septal defect.......  ...........  ...........  ...........  ...........  ...........
33820               C................  ...................  Revise major vessel........  ...........  ...........  ...........  ...........  ...........
33822               C................  ...................  Revise major vessel........  ...........  ...........  ...........  ...........  ...........
33824               C................  ...................  Revise major vessel........  ...........  ...........  ...........  ...........  ...........
33840               C................  ...................  Remove aorta constriction..  ...........  ...........  ...........  ...........  ...........
33845               C................  ...................  Remove aorta constriction..  ...........  ...........  ...........  ...........  ...........
33851               C................  ...................  Remove aorta constriction..  ...........  ...........  ...........  ...........  ...........
33852               C................  ...................  Repair septal defect.......  ...........  ...........  ...........  ...........  ...........
33853               C................  ...................  Repair septal defect.......  ...........  ...........  ...........  ...........  ...........
33860               C................  ...................  Ascending aortic graft.....  ...........  ...........  ...........  ...........  ...........
33861               C................  ...................  Ascending aortic graft.....  ...........  ...........  ...........  ...........  ...........
33863               C................  ...................  Ascending aortic graft.....  ...........  ...........  ...........  ...........  ...........
33870               C................  ...................  Transverse aortic arch       ...........  ...........  ...........  ...........  ...........
                                                             graft.
33875               C................  ...................  Thoracic aortic graft......  ...........  ...........  ...........  ...........  ...........
33877               C................  ...................  Thoracoabdominal graft.....  ...........  ...........  ...........  ...........  ...........
33910               C................  ...................  Remove lung artery emboli..  ...........  ...........  ...........  ...........  ...........
33915               C................  ...................  Remove lung artery emboli..  ...........  ...........  ...........  ...........  ...........
33916               C................  ...................  Surgery of great vessel....  ...........  ...........  ...........  ...........  ...........
33917               C................  ...................  Repair pulmonary artery....  ...........  ...........  ...........  ...........  ...........
33918               C................  ...................  Repair pulmonary atresia...  ...........  ...........  ...........  ...........  ...........

[[Page 66864]]

 
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.
33980               C................  ...................  Remove intracorporeal        ...........  ...........  ...........  ...........  ...........
                                                             device.
33999               T................  ...................  Cardiac surgery procedure..         0070       3.3623      $175.35  ...........       $35.07
34001               C................  ...................  Removal of artery clot.....  ...........  ...........  ...........  ...........  ...........
34051               C................  ...................  Removal of artery clot.....  ...........  ...........  ...........  ...........  ...........
34101               T................  ...................  Removal of artery clot.....         0088      32.5768    $1,698.91      $655.22      $339.78
34111               T................  ...................  Removal of arm artery clot.         0088      32.5768    $1,698.91      $655.22      $339.78
34151               C................  ...................  Removal of artery clot.....  ...........  ...........  ...........  ...........  ...........
34201               T................  ...................  Removal of artery clot.....         0088      32.5768    $1,698.91      $655.22      $339.78
34203               T................  ...................  Removal of leg artery clot.         0088      32.5768    $1,698.91      $655.22      $339.78
34401               C................  ...................  Removal of vein clot.......  ...........  ...........  ...........  ...........  ...........
34421               T................  ...................  Removal of vein clot.......         0088      32.5768    $1,698.91      $655.22      $339.78
34451               C................  ...................  Removal of vein clot.......  ...........  ...........  ...........  ...........  ...........
34471               T................  ...................  Removal of vein clot.......         0088      32.5768    $1,698.91      $655.22      $339.78
34490               T................  ...................  Removal of vein clot.......         0088      32.5768    $1,698.91      $655.22      $339.78
34501               T................  ...................  Repair valve, femoral vein.         0088      32.5768    $1,698.91      $655.22      $339.78
34502               C................  ...................  Reconstruct vena cava......  ...........  ...........  ...........  ...........  ...........
34510               T................  ...................  Transposition of vein valve         0088      32.5768    $1,698.91      $655.22      $339.78
34520               T................  ...................  Cross-over vein graft......         0088      32.5768    $1,698.91      $655.22      $339.78
34530               T................  ...................  Leg vein fusion............         0088      32.5768    $1,698.91      $655.22      $339.78
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................  ...................  Femoral endovas graft add-   ...........  ...........  ...........  ...........  ...........
                                                             on.
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  ...........  ...........  ...........  ...........  ...........
34833               C................  NI.................  Xpose for endoprosth, iliac  ...........  ...........  ...........  ...........  ...........
34834               C................  NI.................  Xpose, endoprosth, brachial  ...........  ...........  ...........  ...........  ...........
34900               C................  NI.................  Endovasc iliac repr w/graft  ...........  ...........  ...........  ...........  ...........
35001               C................  ...................  Repair defect of artery....  ...........  ...........  ...........  ...........  ...........
35002               C................  ...................  Repair artery rupture, neck  ...........  ...........  ...........  ...........  ...........
35005               C................  ...................  Repair defect of artery....  ...........  ...........  ...........  ...........  ...........
35011               T................  ...................  Repair defect of artery....         0653      30.0284    $1,566.01  ...........      $313.20
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.

[[Page 66865]]

 
35091               C................  ...................  Repair defect of artery....  ...........  ...........  ...........  ...........  ...........
35092               C................  ...................  Repair artery rupture,       ...........  ...........  ...........  ...........  ...........
                                                             aorta.
35102               C................  ...................  Repair defect of artery....  ...........  ...........  ...........  ...........  ...........
35103               C................  ...................  Repair artery rupture,       ...........  ...........  ...........  ...........  ...........
                                                             groin.
35111               C................  ...................  Repair defect of artery....  ...........  ...........  ...........  ...........  ...........
35112               C................  ...................  Repair artery                ...........  ...........  ...........  ...........  ...........
                                                             rupture,spleen.
35121               C................  ...................  Repair defect of artery....  ...........  ...........  ...........  ...........  ...........
35122               C................  ...................  Repair artery rupture,       ...........  ...........  ...........  ...........  ...........
                                                             belly.
35131               C................  ...................  Repair defect of artery....  ...........  ...........  ...........  ...........  ...........
35132               C................  ...................  Repair artery rupture,       ...........  ...........  ...........  ...........  ...........
                                                             groin.
35141               C................  ...................  Repair defect of artery....  ...........  ...........  ...........  ...........  ...........
35142               C................  ...................  Repair artery rupture,       ...........  ...........  ...........  ...........  ...........
                                                             thigh.
35151               C................  ...................  Repair defect of artery....  ...........  ...........  ...........  ...........  ...........
35152               C................  ...................  Repair artery rupture, knee  ...........  ...........  ...........  ...........  ...........
35161               C................  ...................  Repair defect of artery....  ...........  ...........  ...........  ...........  ...........
35162               C................  ...................  Repair artery rupture......  ...........  ...........  ...........  ...........  ...........
35180               T................  ...................  Repair blood vessel lesion.         0093      20.6294    $1,075.84      $277.34      $215.17
35182               C................  ...................  Repair blood vessel lesion.  ...........  ...........  ...........  ...........  ...........
35184               T................  ...................  Repair blood vessel lesion.         0093      20.6294    $1,075.84      $277.34      $215.17
35188               T................  ...................  Repair blood vessel lesion.         0088      32.5768    $1,698.91      $655.22      $339.78
35189               C................  ...................  Repair blood vessel lesion.  ...........  ...........  ...........  ...........  ...........
35190               T................  ...................  Repair blood vessel lesion.         0093      20.6294    $1,075.84      $277.34      $215.17
35201               T................  ...................  Repair blood vessel lesion.         0093      20.6294    $1,075.84      $277.34      $215.17
35206               T................  ...................  Repair blood vessel lesion.         0093      20.6294    $1,075.84      $277.34      $215.17
35207               T................  ...................  Repair blood vessel lesion.         0088      32.5768    $1,698.91      $655.22      $339.78
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      20.6294    $1,075.84      $277.34      $215.17
35231               T................  ...................  Repair blood vessel lesion.         0093      20.6294    $1,075.84      $277.34      $215.17
35236               T................  ...................  Repair blood vessel lesion.         0093      20.6294    $1,075.84      $277.34      $215.17
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      20.6294    $1,075.84      $277.34      $215.17
35261               T................  ...................  Repair blood vessel lesion.         0653      30.0284    $1,566.01  ...........      $313.20
35266               T................  ...................  Repair blood vessel lesion.         0653      30.0284    $1,566.01  ...........      $313.20
35271               C................  ...................  Repair blood vessel lesion.  ...........  ...........  ...........  ...........  ...........
35276               C................  ...................  Repair blood vessel lesion.  ...........  ...........  ...........  ...........  ...........
35281               C................  ...................  Repair blood vessel lesion.  ...........  ...........  ...........  ...........  ...........
35286               T................  ...................  Repair blood vessel lesion.         0653      30.0284    $1,566.01  ...........      $313.20
35301               C................  ...................  Rechanneling of artery.....  ...........  ...........  ...........  ...........  ...........
35311               C................  ...................  Rechanneling of artery.....  ...........  ...........  ...........  ...........  ...........
35321               T................  ...................  Rechanneling of artery.....         0093      20.6294    $1,075.84      $277.34      $215.17
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      43.5067    $2,268.92  ...........      $453.78
35459               T................  ...................  Repair arterial blockage...         0081      43.5067    $2,268.92  ...........      $453.78
35460               T................  ...................  Repair venous blockage.....         0081      43.5067    $2,268.92  ...........      $453.78
35470               T................  ...................  Repair arterial blockage...         0081      43.5067    $2,268.92  ...........      $453.78
35471               T................  ...................  Repair arterial blockage...         0081      43.5067    $2,268.92  ...........      $453.78
35472               T................  ...................  Repair arterial blockage...         0081      43.5067    $2,268.92  ...........      $453.78

[[Page 66866]]

 
35473               T................  ...................  Repair arterial blockage...         0081      43.5067    $2,268.92  ...........      $453.78
35474               T................  ...................  Repair arterial blockage...         0081      43.5067    $2,268.92  ...........      $453.78
35475               T................  ...................  Repair arterial blockage...         0081      43.5067    $2,268.92  ...........      $453.78
35476               T................  ...................  Repair venous blockage.....         0081      43.5067    $2,268.92  ...........      $453.78
35480               C................  ...................  Atherectomy, open..........  ...........  ...........  ...........  ...........  ...........
35481               C................  ...................  Atherectomy, open..........  ...........  ...........  ...........  ...........  ...........
35482               C................  ...................  Atherectomy, open..........  ...........  ...........  ...........  ...........  ...........
35483               C................  ...................  Atherectomy, open..........  ...........  ...........  ...........  ...........  ...........
35484               T................  ...................  Atherectomy, open..........         0081      43.5067    $2,268.92  ...........      $453.78
35485               T................  ...................  Atherectomy, open..........         0081      43.5067    $2,268.92  ...........      $453.78
35490               T................  ...................  Atherectomy, percutaneous..         0081      43.5067    $2,268.92  ...........      $453.78
35491               T................  ...................  Atherectomy, percutaneous..         0081      43.5067    $2,268.92  ...........      $453.78
35492               T................  ...................  Atherectomy, percutaneous..         0081      43.5067    $2,268.92  ...........      $453.78
35493               T................  ...................  Atherectomy, percutaneous..         0081      43.5067    $2,268.92  ...........      $453.78
35494               T................  ...................  Atherectomy, percutaneous..         0081      43.5067    $2,268.92  ...........      $453.78
35495               T................  ...................  Atherectomy, percutaneous..         0081      43.5067    $2,268.92  ...........      $453.78
35500               T................  ...................  Harvest vein for bypass....         0081      43.5067    $2,268.92  ...........      $453.78
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........  ...........  ...........  ...........  ...........  ...........
35572               N................  NI.................  Harvest femoropopliteal      ...........  ...........  ...........  ...........  ...........
                                                             vein.
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........  ...........  ...........  ...........  ...........  ...........

[[Page 66867]]

 
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.....  ...........  ...........  ...........  ...........  ...........
35685               T................  ...................  Bypass graft patency/patch.         0093      20.6294    $1,075.84      $277.34      $215.17
35686               T................  ...................  Bypass graft/av fist                0093      20.6294    $1,075.84      $277.34      $215.17
                                                             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      24.3211    $1,268.37      $459.35      $253.67
35800               C................  ...................  Explore neck vessels.......  ...........  ...........  ...........  ...........  ...........
35820               C................  ...................  Explore chest vessels......  ...........  ...........  ...........  ...........  ...........
35840               C................  ...................  Explore abdominal vessels..  ...........  ...........  ...........  ...........  ...........
35860               T................  ...................  Explore limb vessels.......         0093      20.6294    $1,075.84      $277.34      $215.17
35870               C................  ...................  Repair vessel graft defect.  ...........  ...........  ...........  ...........  ...........
35875               T................  ...................  Removal of clot in graft...         0088      32.5768    $1,698.91      $655.22      $339.78
35876               T................  ...................  Removal of clot in graft...         0088      32.5768    $1,698.91      $655.22      $339.78
35879               T................  ...................  Revise graft w/vein........         0088      32.5768    $1,698.91      $655.22      $339.78
35881               T................  ...................  Revise graft w/vein........         0088      32.5768    $1,698.91      $655.22      $339.78
35901               C................  ...................  Excision, graft, neck......  ...........  ...........  ...........  ...........  ...........
35903               T................  ...................  Excision, graft, extremity.         0115      24.3211    $1,268.37      $459.35      $253.67
35905               C................  ...................  Excision, graft, thorax....  ...........  ...........  ...........  ...........  ...........
35907               C................  ...................  Excision, graft, abdomen...  ...........  ...........  ...........  ...........  ...........
36000               N................  ...................  Place needle in vein.......  ...........  ...........  ...........  ...........  ...........
36002               S................  ...................  Pseudoaneurysm injection            0267       2.4418      $127.34       $65.52       $25.47
                                                             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      89.3100    $4,657.61  ...........      $931.52
36261               T................  ...................  Revision of infusion pump..         0124      50.0861    $2,612.04  ...........      $522.41
36262               T................  ...................  Removal of infusion pump...         0109       7.4708      $389.61      $131.49       $77.92
36299               N................  ...................  Vessel injection procedure.  ...........  ...........  ...........  ...........  ...........
36400               N................  ...................  Bl draw < 3 yrs fem/jugular  ...........  ...........  ...........  ...........  ...........
36405               N................  ...................  Bl draw < 3 yrs scalp vein.  ...........  ...........  ...........  ...........  ...........
36406               N................  ...................  Bl draw < 3 yrs other vein.  ...........  ...........  ...........  ...........  ...........
36410               N................  ...................  Non-routine bl draw  3 yrs.

[[Page 66868]]

 
36415               E................  ...................  Drawing blood..............  ...........  ...........  ...........  ...........  ...........
36416               E................  NI.................  Capillary blood draw.......  ...........  ...........  ...........  ...........  ...........
36420               T................  ...................  Vein access cutdown < 1 yr.         0035       0.2229       $11.62        $3.51        $2.32
36425               T................  ...................  Vein access cutdown  1 yr.
36430               S................  ...................  Blood transfusion service..         0110       4.0309      $210.22  ...........       $42.04
36440               S................  ...................  Bl push transfuse, 2 yr or          0110       4.0309      $210.22  ...........       $42.04
                                                             <.
36450               S................  ...................  Bl exchange/transfuse, nb..         0110       4.0309      $210.22  ...........       $42.04
36455               S................  ...................  Bl exchange/transfuse non-          0110       4.0309      $210.22  ...........       $42.04
                                                             nb.
36460               S................  ...................  Transfusion service, fetal.         0110       4.0309      $210.22  ...........       $42.04
36468               T................  ...................  Injection(s), spider veins.         0098       1.6666       $86.91       $20.88       $17.38
36469               T................  ...................  Injection(s), spider veins.         0098       1.6666       $86.91       $20.88       $17.38
36470               T................  ...................  Injection therapy of vein..         0098       1.6666       $86.91       $20.88       $17.38
36471               T................  ...................  Injection therapy of veins.         0098       1.6666       $86.91       $20.88       $17.38
36481               N................  ...................  Insertion of catheter, vein  ...........  ...........  ...........  ...........  ...........
36488               T................  ...................  Insertion of catheter, vein         0032      11.4726      $598.31  ...........      $119.66
36489               T................  ...................  Insertion of catheter, vein         0032      11.4726      $598.31  ...........      $119.66
36490               T................  ...................  Insertion of catheter, vein         0032      11.4726      $598.31  ...........      $119.66
36491               T................  ...................  Insertion of catheter, vein         0032      11.4726      $598.31  ...........      $119.66
36493               X................  ...................  Repositioning of cvc.......         0187       3.9534      $206.17       $90.71       $41.23
36500               N................  ...................  Insertion of catheter, vein  ...........  ...........  ...........  ...........  ...........
36510               C................  ...................  Insertion of catheter, vein  ...........  ...........  ...........  ...........  ...........
36511               S................  NI.................  Apheresis wbc..............         0111      14.9803      $781.24      $217.61      $156.25
36512               S................  NI.................  Apheresis rbc..............         0111      14.9803      $781.24      $217.61      $156.25
36513               S................  NI.................  Apheresis platelets........         0111      14.9803      $781.24      $217.61      $156.25
36514               S................  NI.................  Apheresis plasma...........         0111      14.9803      $781.24      $217.61      $156.25
36515               S................  NI.................  Apheresis, adsorp/reinfuse.         0112      36.4236    $1,899.53      $612.47      $379.91
36516               S................  NI.................  Apheresis, selective.......         0112      36.4236    $1,899.53      $612.47      $379.91
36520               S................  DG.................  Plasma and/or cell exchange         0111      14.9803      $781.24      $217.61      $156.25
36521               S................  DG.................  Apheresis w/ adsorp/                0112      36.4236    $1,899.53      $612.47      $379.91
                                                             reinfuse.
36522               S................  ...................  Photopheresis..............         0112      36.4236    $1,899.53      $612.47      $379.91
36530               T................  ...................  Insertion of infusion pump.         0119      89.3100    $4,657.61  ...........      $931.52
36531               T................  ...................  Revision of infusion pump..         0124      50.0861    $2,612.04  ...........      $522.41
36532               T................  ...................  Removal of infusion pump...         0109       7.4708      $389.61      $131.49       $77.92
36533               T................  ...................  Insertion of access device.         0115      24.3211    $1,268.37      $459.35      $253.67
36534               T................  ...................  Revision of access device..         0109       7.4708      $389.61      $131.49       $77.92
36535               T................  ...................  Removal of access device...         0109       7.4708      $389.61      $131.49       $77.92
36536               T................  NI.................  Remove cva device obstruct.         0973  ...........      $250.00  ...........       $50.00
36537               T................  NI.................  Remove cva lumen obstruct..         0973  ...........      $250.00  ...........       $50.00
36540               N................  ...................  Collect blood venous device  ...........  ...........  ...........  ...........  ...........
36550               T................  ...................  Declot vascular device.....         0677       2.6453      $137.96  ...........       $27.59
36600               N................  ...................  Withdrawal of arterial       ...........  ...........  ...........  ...........  ...........
                                                             blood.
36620               N................  ...................  Insertion catheter, artery.  ...........  ...........  ...........  ...........  ...........
36625               N................  ...................  Insertion catheter, artery.  ...........  ...........  ...........  ...........  ...........
36640               T................  ...................  Insertion catheter, artery.         0032      11.4726      $598.31  ...........      $119.66
36660               C................  ...................  Insertion catheter, artery.  ...........  ...........  ...........  ...........  ...........
36680               T................  ...................  Insert needle, bone cavity.         0120       2.1802      $113.70       $30.75       $22.74
36800               T................  ...................  Insertion of cannula.......         0115      24.3211    $1,268.37      $459.35      $253.67
36810               T................  ...................  Insertion of cannula.......         0115      24.3211    $1,268.37      $459.35      $253.67
36815               T................  ...................  Insertion of cannula.......         0115      24.3211    $1,268.37      $459.35      $253.67
36819               T................  ...................  Av fusion/uppr arm vein....         0088      32.5768    $1,698.91      $655.22      $339.78
36820               T................  ...................  Av fusion/forearm vein.....         0088      32.5768    $1,698.91      $655.22      $339.78
36821               T................  ...................  Av fusion direct any site..         0088      32.5768    $1,698.91      $655.22      $339.78
36822               C................  ...................  Insertion of cannula(s)....  ...........  ...........  ...........  ...........  ...........
36823               C................  ...................  Insertion of cannula(s)....  ...........  ...........  ...........  ...........  ...........
36825               T................  ...................  Artery-vein autograft......         0088      32.5768    $1,698.91      $655.22      $339.78
36830               T................  ...................  Artery-vein graft..........         0088      32.5768    $1,698.91      $655.22      $339.78
36831               T................  ...................  Open thrombect av fistula..         0088      32.5768    $1,698.91      $655.22      $339.78
36832               T................  ...................  Av fistula revision, open..         0088      32.5768    $1,698.91      $655.22      $339.78
36833               T................  ...................  Av fistula revision........         0088      32.5768    $1,698.91      $655.22      $339.78
36834               T................  ...................  Repair A-V aneurysm........         0088      32.5768    $1,698.91      $655.22      $339.78
36835               T................  ...................  Artery to vein shunt.......         0115      24.3211    $1,268.37      $459.35      $253.67
36860               T................  ...................  External cannula declotting         0103      11.8408      $617.51      $223.63      $123.50
36861               T................  ...................  Cannula declotting.........         0115      24.3211    $1,268.37      $459.35      $253.67
36870               T................  ...................  Percut thrombect av fistula         0653      30.0284    $1,566.01  ...........      $313.20
37140               C................  ...................  Revision of circulation....  ...........  ...........  ...........  ...........  ...........

[[Page 66869]]

 
37145               C................  ...................  Revision of circulation....  ...........  ...........  ...........  ...........  ...........
37160               C................  ...................  Revision of circulation....  ...........  ...........  ...........  ...........  ...........
37180               C................  ...................  Revision of circulation....  ...........  ...........  ...........  ...........  ...........
37181               C................  ...................  Splice spleen/kidney veins.  ...........  ...........  ...........  ...........  ...........
37182               C................  NI.................  Insert hepatic shunt (tips)  ...........  ...........  ...........  ...........  ...........
37183               C................  NI.................  Remove hepatic shunt (tips)  ...........  ...........  ...........  ...........  ...........
37195               C................  ...................  Thrombolytic therapy,        ...........  ...........  ...........  ...........  ...........
                                                             stroke.
37200               T................  ...................  Transcatheter biopsy.......         0685       5.9882      $312.29      $137.40       $62.46
37201               T................  ...................  Transcatheter therapy               0676       4.1278      $215.27       $58.21       $43.05
                                                             infuse.
37202               T................  ...................  Transcatheter therapy               0677       2.6453      $137.96  ...........       $27.59
                                                             infuse.
37203               T................  ...................  Transcatheter retrieval....         0103      11.8408      $617.51      $223.63      $123.50
37204               T................  ...................  Transcatheter occlusion....         0115      24.3211    $1,268.37      $459.35      $253.67
37205               T................  ...................  Transcatheter stent........         0229      57.4599    $2,996.59      $771.23      $599.32
37206               T................  ...................  Transcatheter stent add-on.         0229      57.4599    $2,996.59      $771.23      $599.32
37207               T................  ...................  Transcatheter stent........         0229      57.4599    $2,996.59      $771.23      $599.32
37208               T................  ...................  Transcatheter stent add-on.         0229      57.4599    $2,996.59      $771.23      $599.32
37209               T................  ...................  Exchange arterial catheter.         0103      11.8408      $617.51      $223.63      $123.50
37250               S................  ...................  Iv us first vessel add-on..         0670      30.2416    $1,577.13      $571.17      $315.43
37251               S................  ...................  Iv us each add vessel add-          0670      30.2416    $1,577.13      $571.17      $315.43
                                                             on.
37500               T................  NI.................  Endoscopy ligate perf veins         0092      23.7882    $1,240.58      $505.37      $248.12
37501               T................  NI.................  Vascular endoscopy                  0092      23.7882    $1,240.58      $505.37      $248.12
                                                             procedure.
37565               T................  ...................  Ligation of neck vein......         0093      20.6294    $1,075.84      $277.34      $215.17
37600               T................  ...................  Ligation of neck artery....         0093      20.6294    $1,075.84      $277.34      $215.17
37605               T................  ...................  Ligation of neck artery....         0091      26.7048    $1,392.68      $348.23      $278.54
37606               T................  ...................  Ligation of neck artery....         0091      26.7048    $1,392.68      $348.23      $278.54
37607               T................  ...................  Ligation of a-v fistula....         0092      23.7882    $1,240.58      $505.37      $248.12
37609               T................  ...................  Temporal artery procedure..         0021      13.9338      $726.66      $219.48      $145.33
37615               T................  ...................  Ligation of neck artery....         0091      26.7048    $1,392.68      $348.23      $278.54
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      26.7048    $1,392.68      $348.23      $278.54
37650               T................  ...................  Revision of major vein.....         0091      26.7048    $1,392.68      $348.23      $278.54
37660               C................  ...................  Revision of major vein.....  ...........  ...........  ...........  ...........  ...........
37700               T................  ...................  Revise leg vein............         0091      26.7048    $1,392.68      $348.23      $278.54
37720               T................  ...................  Removal of leg vein........         0092      23.7882    $1,240.58      $505.37      $248.12
37730               T................  ...................  Removal of leg veins.......         0092      23.7882    $1,240.58      $505.37      $248.12
37735               T................  ...................  Removal of leg veins/lesion         0092      23.7882    $1,240.58      $505.37      $248.12
37760               T................  ...................  Revision of leg veins......         0091      26.7048    $1,392.68      $348.23      $278.54
37780               T................  ...................  Revision of leg vein.......         0091      26.7048    $1,392.68      $348.23      $278.54
37785               T................  ...................  Revise secondary varicosity         0091      26.7048    $1,392.68      $348.23      $278.54
37788               C................  ...................  Revascularization, penis...  ...........  ...........  ...........  ...........  ...........
37790               T................  ...................  Penile venous occlusion....         0181      29.2435    $1,525.08      $621.82      $305.02
37799               T................  ...................  Vascular surgery procedure.         0035       0.2229       $11.62        $3.51        $2.32
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      40.2026    $2,096.61    $1,001.89      $419.32
38129               T................  ...................  Laparoscope proc, spleen...         0130      30.4644    $1,588.75      $659.53      $317.75
38200               N................  ...................  Injection for spleen x-ray.  ...........  ...........  ...........  ...........  ...........
38204               E................  NI.................  Bl donor search management.  ...........  ...........  ...........  ...........  ...........
38205               S................  NI.................  Harvest allogenic stem              0111      14.9803      $781.24      $217.61      $156.25
                                                             cells.
38206               S................  NI.................  Harvest auto stem cells....         0111      14.9803      $781.24      $217.61      $156.25
38207               E................  NI.................  Cryopreserve stem cells....  ...........  ...........  ...........  ...........  ...........
38208               E................  NI.................  Thaw preserved stem cells..  ...........  ...........  ...........  ...........  ...........
38209               E................  NI.................  Wash harvest stem cells....  ...........  ...........  ...........  ...........  ...........
38210               E................  NI.................  T-cell depletion of harvest  ...........  ...........  ...........  ...........  ...........
38211               E................  NI.................  Tumor cell deplete of        ...........  ...........  ...........  ...........  ...........
                                                             harvst.
38212               E................  NI.................  Rbc depletion of harvest...  ...........  ...........  ...........  ...........  ...........
38213               E................  NI.................  Platelet deplete of harvest  ...........  ...........  ...........  ...........  ...........
38214               E................  NI.................  Volume deplete of harvest..  ...........  ...........  ...........  ...........  ...........
38215               E................  NI.................  Harvest stem cell            ...........  ...........  ...........  ...........  ...........
                                                             concentrte.
38220               T................  ...................  Bone marrow aspiration.....         0003       1.2306       $64.18  ...........       $12.84
38221               T................  ...................  Bone marrow biopsy.........         0003       1.2306       $64.18  ...........       $12.84

[[Page 66870]]

 
38230               S................  ...................  Bone marrow collection.....         0123       6.4049      $334.02  ...........       $66.80
38231               S................  DG.................  Stem cell collection.......         0111      14.9803      $781.24      $217.61      $156.25
38240               S................  ...................  Bone marrow/stem transplant         0123       6.4049      $334.02  ...........       $66.80
38241               S................  ...................  Bone marrow/stem transplant         0123       6.4049      $334.02  ...........       $66.80
38242               S................  NI.................  Lymphocyte infuse                   0111      14.9803      $781.24      $217.61      $156.25
                                                             transplant.
38300               T................  ...................  Drainage, lymph node lesion         0008      16.1430      $841.87  ...........      $168.37
38305               T................  ...................  Drainage, lymph node lesion         0008      16.1430      $841.87  ...........      $168.37
38308               T................  ...................  Incision of lymph channels.         0113      18.7496      $977.81  ...........      $195.56
38380               C................  ...................  Thoracic duct procedure....  ...........  ...........  ...........  ...........  ...........
38381               C................  ...................  Thoracic duct procedure....  ...........  ...........  ...........  ...........  ...........
38382               C................  ...................  Thoracic duct procedure....  ...........  ...........  ...........  ...........  ...........
38500               T................  ...................  Biopsy/removal, lymph nodes         0113      18.7496      $977.81  ...........      $195.56
38505               T................  ...................  Needle biopsy, lymph nodes.         0005       3.1201      $162.72       $71.59       $32.54
38510               T................  ...................  Biopsy/removal, lymph nodes         0113      18.7496      $977.81  ...........      $195.56
38520               T................  ...................  Biopsy/removal, lymph nodes         0113      18.7496      $977.81  ...........      $195.56
38525               T................  ...................  Biopsy/removal, lymph nodes         0113      18.7496      $977.81  ...........      $195.56
38530               T................  ...................  Biopsy/removal, lymph nodes         0113      18.7496      $977.81  ...........      $195.56
38542               T................  ...................  Explore deep node(s), neck.         0114      36.1135    $1,883.36      $485.91      $376.67
38550               T................  ...................  Removal, neck/armpit lesion         0113      18.7496      $977.81  ...........      $195.56
38555               T................  ...................  Removal, neck/armpit lesion         0113      18.7496      $977.81  ...........      $195.56
38562               C................  ...................  Removal, pelvic lymph nodes  ...........  ...........  ...........  ...........  ...........
38564               C................  ...................  Removal, abdomen lymph       ...........  ...........  ...........  ...........  ...........
                                                             nodes.
38570               T................  ...................  Laparoscopy, lymph node             0131      40.2026    $2,096.61    $1,001.89      $419.32
                                                             biop.
38571               T................  ...................  Laparoscopy,                        0132      56.9948    $2,972.34    $1,239.22      $594.47
                                                             lymphadenectomy.
38572               T................  ...................  Laparoscopy,                        0131      40.2026    $2,096.61    $1,001.89      $419.32
                                                             lymphadenectomy.
38589               T................  ...................  Laparoscope proc, lymphatic         0130      30.4644    $1,588.75      $659.53      $317.75
38700               T................  ...................  Removal of lymph nodes,             0113      18.7496      $977.81  ...........      $195.56
                                                             neck.
38720               T................  ...................  Removal of lymph nodes,             0113      18.7496      $977.81  ...........      $195.56
                                                             neck.
38724               C................  ...................  Removal of lymph nodes,      ...........  ...........  ...........  ...........  ...........
                                                             neck.
38740               T................  ...................  Remove armpit lymph nodes..         0114      36.1135    $1,883.36      $485.91      $376.67
38745               T................  ...................  Remove armpit lymph nodes..         0114      36.1135    $1,883.36      $485.91      $376.67
38746               C................  ...................  Remove thoracic lymph nodes  ...........  ...........  ...........  ...........  ...........
38747               C................  ...................  Remove abdominal lymph       ...........  ...........  ...........  ...........  ...........
                                                             nodes.
38760               T................  ...................  Remove groin lymph nodes...         0113      18.7496      $977.81  ...........      $195.56
38765               C................  ...................  Remove groin lymph nodes...  ...........  ...........  ...........  ...........  ...........
38770               C................  ...................  Remove pelvis lymph nodes..  ...........  ...........  ...........  ...........  ...........
38780               C................  ...................  Remove abdomen lymph nodes.  ...........  ...........  ...........  ...........  ...........
38790               N................  ...................  Inject for lymphatic x-ray.  ...........  ...........  ...........  ...........  ...........
38792               N................  ...................  Identify sentinel node.....  ...........  ...........  ...........  ...........  ...........
38794               N................  ...................  Access thoracic lymph duct.  ...........  ...........  ...........  ...........  ...........
38999               S................  ...................  Blood/lymph system                  0110       4.0309      $210.22  ...........       $42.04
                                                             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      27.5575    $1,437.15      $591.64      $287.43
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       1.9089       $99.55  ...........       $19.91
40500               T................  ...................  Partial excision of lip....         0253      14.4473      $753.44      $282.29      $150.69
40510               T................  ...................  Partial excision of lip....         0254      20.1158    $1,049.06      $321.35      $209.81
40520               T................  ...................  Partial excision of lip....         0253      14.4473      $753.44      $282.29      $150.69
40525               T................  ...................  Reconstruct lip with flap..         0254      20.1158    $1,049.06      $321.35      $209.81
40527               T................  ...................  Reconstruct lip with flap..         0254      20.1158    $1,049.06      $321.35      $209.81

[[Page 66871]]

 
40530               T................  ...................  Partial removal of lip.....         0254      20.1158    $1,049.06      $321.35      $209.81
40650               T................  ...................  Repair lip.................         0252       5.8041      $302.69      $113.41       $60.54
40652               T................  ...................  Repair lip.................         0252       5.8041      $302.69      $113.41       $60.54
40654               T................  ...................  Repair lip.................         0252       5.8041      $302.69      $113.41       $60.54
40700               T................  ...................  Repair cleft lip/nasal.....         0256      34.0302    $1,774.71  ...........      $354.94
40701               T................  ...................  Repair cleft lip/nasal.....         0256      34.0302    $1,774.71  ...........      $354.94
40702               T................  ...................  Repair cleft lip/nasal.....         0256      34.0302    $1,774.71  ...........      $354.94
40720               T................  ...................  Repair cleft lip/nasal.....         0256      34.0302    $1,774.71  ...........      $354.94
40761               T................  ...................  Repair cleft lip/nasal.....         0256      34.0302    $1,774.71  ...........      $354.94
40799               T................  ...................  Lip surgery procedure......         0253      14.4473      $753.44      $282.29      $150.69
40800               T................  ...................  Drainage of mouth lesion...         0251       1.9089       $99.55  ...........       $19.91
40801               T................  ...................  Drainage of mouth lesion...         0252       5.8041      $302.69      $113.41       $60.54
40804               X................  ...................  Removal, foreign body,              0340       0.6492       $33.86  ...........        $6.77
                                                             mouth.
40805               T................  ...................  Removal, foreign body,              0252       5.8041      $302.69      $113.41       $60.54
                                                             mouth.
40806               T................  ...................  Incision of lip fold.......         0251       1.9089       $99.55  ...........       $19.91
40808               T................  ...................  Biopsy of mouth lesion.....         0251       1.9089       $99.55  ...........       $19.91
40810               T................  ...................  Excision of mouth lesion...         0253      14.4473      $753.44      $282.29      $150.69
40812               T................  ...................  Excise/repair mouth lesion.         0253      14.4473      $753.44      $282.29      $150.69
40814               T................  ...................  Excise/repair mouth lesion.         0253      14.4473      $753.44      $282.29      $150.69
40816               T................  ...................  Excision of mouth lesion...         0254      20.1158    $1,049.06      $321.35      $209.81
40818               T................  ...................  Excise oral mucosa for              0251       1.9089       $99.55  ...........       $19.91
                                                             graft.
40819               T................  ...................  Excise lip or cheek fold...         0252       5.8041      $302.69      $113.41       $60.54
40820               T................  ...................  Treatment of mouth lesion..         0253      14.4473      $753.44      $282.29      $150.69
40830               T................  ...................  Repair mouth laceration....         0251       1.9089       $99.55  ...........       $19.91
40831               T................  ...................  Repair mouth laceration....         0252       5.8041      $302.69      $113.41       $60.54
40840               T................  ...................  Reconstruction of mouth....         0254      20.1158    $1,049.06      $321.35      $209.81
40842               T................  ...................  Reconstruction of mouth....         0254      20.1158    $1,049.06      $321.35      $209.81
40843               T................  ...................  Reconstruction of mouth....         0254      20.1158    $1,049.06      $321.35      $209.81
40844               T................  ...................  Reconstruction of mouth....         0256      34.0302    $1,774.71  ...........      $354.94
40845               T................  ...................  Reconstruction of mouth....         0256      34.0302    $1,774.71  ...........      $354.94
40899               T................  ...................  Mouth surgery procedure....         0252       5.8041      $302.69      $113.41       $60.54
41000               T................  ...................  Drainage of mouth lesion...         0253      14.4473      $753.44      $282.29      $150.69
41005               T................  ...................  Drainage of mouth lesion...         0251       1.9089       $99.55  ...........       $19.91
41006               T................  ...................  Drainage of mouth lesion...         0254      20.1158    $1,049.06      $321.35      $209.81
41007               T................  ...................  Drainage of mouth lesion...         0253      14.4473      $753.44      $282.29      $150.69
41008               T................  ...................  Drainage of mouth lesion...         0253      14.4473      $753.44      $282.29      $150.69
41009               T................  ...................  Drainage of mouth lesion...         0251       1.9089       $99.55  ...........       $19.91
41010               T................  ...................  Incision of tongue fold....         0253      14.4473      $753.44      $282.29      $150.69
41015               T................  ...................  Drainage of mouth lesion...         0251       1.9089       $99.55  ...........       $19.91
41016               T................  ...................  Drainage of mouth lesion...         0252       5.8041      $302.69      $113.41       $60.54
41017               T................  ...................  Drainage of mouth lesion...         0252       5.8041      $302.69      $113.41       $60.54
41018               T................  ...................  Drainage of mouth lesion...         0252       5.8041      $302.69      $113.41       $60.54
41100               T................  ...................  Biopsy of tongue...........         0252       5.8041      $302.69      $113.41       $60.54
41105               T................  ...................  Biopsy of tongue...........         0253      14.4473      $753.44      $282.29      $150.69
41108               T................  ...................  Biopsy of floor of mouth...         0252       5.8041      $302.69      $113.41       $60.54
41110               T................  ...................  Excision of tongue lesion..         0253      14.4473      $753.44      $282.29      $150.69
41112               T................  ...................  Excision of tongue lesion..         0253      14.4473      $753.44      $282.29      $150.69
41113               T................  ...................  Excision of tongue lesion..         0253      14.4473      $753.44      $282.29      $150.69
41114               T................  ...................  Excision of tongue lesion..         0254      20.1158    $1,049.06      $321.35      $209.81
41115               T................  ...................  Excision of tongue fold....         0252       5.8041      $302.69      $113.41       $60.54
41116               T................  ...................  Excision of mouth lesion...         0253      14.4473      $753.44      $282.29      $150.69
41120               T................  ...................  Partial removal of tongue..         0254      20.1158    $1,049.06      $321.35      $209.81
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       1.9089       $99.55  ...........       $19.91
41251               T................  ...................  Repair tongue laceration...         0252       5.8041      $302.69      $113.41       $60.54
41252               T................  ...................  Repair tongue laceration...         0252       5.8041      $302.69      $113.41       $60.54
41500               T................  ...................  Fixation of tongue.........         0254      20.1158    $1,049.06      $321.35      $209.81
41510               T................  ...................  Tongue to lip surgery......         0253      14.4473      $753.44      $282.29      $150.69
41520               T................  ...................  Reconstruction, tongue fold         0252       5.8041      $302.69      $113.41       $60.54

[[Page 66872]]

 
41599               T................  ...................  Tongue and mouth surgery...         0251       1.9089       $99.55  ...........       $19.91
41800               T................  ...................  Drainage of gum lesion.....         0251       1.9089       $99.55  ...........       $19.91
41805               T................  ...................  Removal foreign body, gum..         0254      20.1158    $1,049.06      $321.35      $209.81
41806               T................  ...................  Removal foreign                     0253      14.4473      $753.44      $282.29      $150.69
                                                             body,jawbone.
41820               T................  ...................  Excision, gum, each                 0252       5.8041      $302.69      $113.41       $60.54
                                                             quadrant.
41821               T................  ...................  Excision of gum flap.......         0252       5.8041      $302.69      $113.41       $60.54
41822               T................  ...................  Excision of gum lesion.....         0253      14.4473      $753.44      $282.29      $150.69
41823               T................  ...................  Excision of gum lesion.....         0254      20.1158    $1,049.06      $321.35      $209.81
41825               T................  ...................  Excision of gum lesion.....         0253      14.4473      $753.44      $282.29      $150.69
41826               T................  ...................  Excision of gum lesion.....         0253      14.4473      $753.44      $282.29      $150.69
41827               T................  ...................  Excision of gum lesion.....         0254      20.1158    $1,049.06      $321.35      $209.81
41828               T................  ...................  Excision of gum lesion.....         0253      14.4473      $753.44      $282.29      $150.69
41830               T................  ...................  Removal of gum tissue......         0253      14.4473      $753.44      $282.29      $150.69
41850               T................  ...................  Treatment of gum lesion....         0253      14.4473      $753.44      $282.29      $150.69
41870               T................  ...................  Gum graft..................         0254      20.1158    $1,049.06      $321.35      $209.81
41872               T................  ...................  Repair gum.................         0253      14.4473      $753.44      $282.29      $150.69
41874               T................  ...................  Repair tooth socket........         0254      20.1158    $1,049.06      $321.35      $209.81
41899               T................  ...................  Dental surgery procedure...         0253      14.4473      $753.44      $282.29      $150.69
42000               T................  ...................  Drainage mouth roof lesion.         0251       1.9089       $99.55  ...........       $19.91
42100               T................  ...................  Biopsy roof of mouth.......         0252       5.8041      $302.69      $113.41       $60.54
42104               T................  ...................  Excision lesion, mouth roof         0253      14.4473      $753.44      $282.29      $150.69
42106               T................  ...................  Excision lesion, mouth roof         0253      14.4473      $753.44      $282.29      $150.69
42107               T................  ...................  Excision lesion, mouth roof         0254      20.1158    $1,049.06      $321.35      $209.81
42120               T................  ...................  Remove palate/lesion.......         0256      34.0302    $1,774.71  ...........      $354.94
42140               T................  ...................  Excision of uvula..........         0252       5.8041      $302.69      $113.41       $60.54
42145               T................  ...................  Repair palate, pharynx/             0254      20.1158    $1,049.06      $321.35      $209.81
                                                             uvula.
42160               T................  ...................  Treatment mouth roof lesion         0253      14.4473      $753.44      $282.29      $150.69
42180               T................  ...................  Repair palate..............         0251       1.9089       $99.55  ...........       $19.91
42182               T................  ...................  Repair palate..............         0256      34.0302    $1,774.71  ...........      $354.94
42200               T................  ...................  Reconstruct cleft palate...         0256      34.0302    $1,774.71  ...........      $354.94
42205               T................  ...................  Reconstruct cleft palate...         0256      34.0302    $1,774.71  ...........      $354.94
42210               T................  ...................  Reconstruct cleft palate...         0256      34.0302    $1,774.71  ...........      $354.94
42215               T................  ...................  Reconstruct cleft palate...         0256      34.0302    $1,774.71  ...........      $354.94
42220               T................  ...................  Reconstruct cleft palate...         0256      34.0302    $1,774.71  ...........      $354.94
42225               T................  ...................  Reconstruct cleft palate...         0256      34.0302    $1,774.71  ...........      $354.94
42226               T................  ...................  Lengthening of palate......         0256      34.0302    $1,774.71  ...........      $354.94
42227               T................  ...................  Lengthening of palate......         0256      34.0302    $1,774.71  ...........      $354.94
42235               T................  ...................  Repair palate..............         0253      14.4473      $753.44      $282.29      $150.69
42260               T................  ...................  Repair nose to lip fistula.         0254      20.1158    $1,049.06      $321.35      $209.81
42280               T................  ...................  Preparation, palate mold...         0251       1.9089       $99.55  ...........       $19.91
42281               T................  ...................  Insertion, palate                   0253      14.4473      $753.44      $282.29      $150.69
                                                             prosthesis.
42299               T................  ...................  Palate/uvula surgery.......         0251       1.9089       $99.55  ...........       $19.91
42300               T................  ...................  Drainage of salivary gland.         0253      14.4473      $753.44      $282.29      $150.69
42305               T................  ...................  Drainage of salivary gland.         0253      14.4473      $753.44      $282.29      $150.69
42310               T................  ...................  Drainage of salivary gland.         0251       1.9089       $99.55  ...........       $19.91
42320               T................  ...................  Drainage of salivary gland.         0251       1.9089       $99.55  ...........       $19.91
42325               T................  ...................  Create salivary cyst drain.         0251       1.9089       $99.55  ...........       $19.91
42326               T................  ...................  Create salivary cyst drain.         0252       5.8041      $302.69      $113.41       $60.54
42330               T................  ...................  Removal of salivary stone..         0253      14.4473      $753.44      $282.29      $150.69
42335               T................  ...................  Removal of salivary stone..         0253      14.4473      $753.44      $282.29      $150.69
42340               T................  ...................  Removal of salivary stone..         0253      14.4473      $753.44      $282.29      $150.69
42400               T................  ...................  Biopsy of salivary gland...         0005       3.1201      $162.72       $71.59       $32.54
42405               T................  ...................  Biopsy of salivary gland...         0253      14.4473      $753.44      $282.29      $150.69
42408               T................  ...................  Excision of salivary cyst..         0253      14.4473      $753.44      $282.29      $150.69
42409               T................  ...................  Drainage of salivary cyst..         0253      14.4473      $753.44      $282.29      $150.69
42410               T................  ...................  Excise parotid gland/lesion         0256      34.0302    $1,774.71  ...........      $354.94
42415               T................  ...................  Excise parotid gland/lesion         0256      34.0302    $1,774.71  ...........      $354.94
42420               T................  ...................  Excise parotid gland/lesion         0256      34.0302    $1,774.71  ...........      $354.94
42425               T................  ...................  Excise parotid gland/lesion         0256      34.0302    $1,774.71  ...........      $354.94
42426               C................  ...................  Excise parotid gland/lesion  ...........  ...........  ...........  ...........  ...........
42440               T................  ...................  Excise submaxillary gland..         0256      34.0302    $1,774.71  ...........      $354.94
42450               T................  ...................  Excise sublingual gland....         0254      20.1158    $1,049.06      $321.35      $209.81
42500               T................  ...................  Repair salivary duct.......         0254      20.1158    $1,049.06      $321.35      $209.81
42505               T................  ...................  Repair salivary duct.......         0256      34.0302    $1,774.71  ...........      $354.94
42507               T................  ...................  Parotid duct diversion.....         0256      34.0302    $1,774.71  ...........      $354.94

[[Page 66873]]

 
42508               T................  ...................  Parotid duct diversion.....         0256      34.0302    $1,774.71  ...........      $354.94
42509               T................  ...................  Parotid duct diversion.....         0256      34.0302    $1,774.71  ...........      $354.94
42510               T................  ...................  Parotid duct diversion.....         0256      34.0302    $1,774.71  ...........      $354.94
42550               N................  ...................  Injection for salivary x-    ...........  ...........  ...........  ...........  ...........
                                                             ray.
42600               T................  ...................  Closure of salivary fistula         0253      14.4473      $753.44      $282.29      $150.69
42650               T................  ...................  Dilation of salivary duct..         0252       5.8041      $302.69      $113.41       $60.54
42660               T................  ...................  Dilation of salivary duct..         0252       5.8041      $302.69      $113.41       $60.54
42665               T................  ...................  Ligation of salivary duct..         0254      20.1158    $1,049.06      $321.35      $209.81
42699               T................  ...................  Salivary surgery procedure.         0253      14.4473      $753.44      $282.29      $150.69
42700               T................  ...................  Drainage of tonsil abscess.         0251       1.9089       $99.55  ...........       $19.91
42720               T................  ...................  Drainage of throat abscess.         0253      14.4473      $753.44      $282.29      $150.69
42725               T................  ...................  Drainage of throat abscess.         0256      34.0302    $1,774.71  ...........      $354.94
42800               T................  ...................  Biopsy of throat...........         0252       5.8041      $302.69      $113.41       $60.54
42802               T................  ...................  Biopsy of throat...........         0253      14.4473      $753.44      $282.29      $150.69
42804               T................  ...................  Biopsy of upper nose/throat         0253      14.4473      $753.44      $282.29      $150.69
42806               T................  ...................  Biopsy of upper nose/throat         0254      20.1158    $1,049.06      $321.35      $209.81
42808               T................  ...................  Excise pharynx lesion......         0253      14.4473      $753.44      $282.29      $150.69
42809               X................  ...................  Remove pharynx foreign body         0340       0.6492       $33.86  ...........        $6.77
42810               T................  ...................  Excision of neck cyst......         0254      20.1158    $1,049.06      $321.35      $209.81
42815               T................  ...................  Excision of neck cyst......         0256      34.0302    $1,774.71  ...........      $354.94
42820               T................  ...................  Remove tonsils and adenoids         0258      19.8736    $1,036.43      $437.25      $207.29
42821               T................  ...................  Remove tonsils and adenoids         0258      19.8736    $1,036.43      $437.25      $207.29
42825               T................  ...................  Removal of tonsils.........         0258      19.8736    $1,036.43      $437.25      $207.29
42826               T................  ...................  Removal of tonsils.........         0258      19.8736    $1,036.43      $437.25      $207.29
42830               T................  ...................  Removal of adenoids........         0258      19.8736    $1,036.43      $437.25      $207.29
42831               T................  ...................  Removal of adenoids........         0258      19.8736    $1,036.43      $437.25      $207.29
42835               T................  ...................  Removal of adenoids........         0258      19.8736    $1,036.43      $437.25      $207.29
42836               T................  ...................  Removal of adenoids........         0258      19.8736    $1,036.43      $437.25      $207.29
42842               T................  ...................  Extensive surgery of throat         0254      20.1158    $1,049.06      $321.35      $209.81
42844               T................  ...................  Extensive surgery of throat         0256      34.0302    $1,774.71  ...........      $354.94
42845               C................  ...................  Extensive surgery of throat  ...........  ...........  ...........  ...........  ...........
42860               T................  ...................  Excision of tonsil tags....         0258      19.8736    $1,036.43      $437.25      $207.29
42870               T................  ...................  Excision of lingual tonsil.         0258      19.8736    $1,036.43      $437.25      $207.29
42890               T................  ...................  Partial removal of pharynx.         0256      34.0302    $1,774.71  ...........      $354.94
42892               T................  ...................  Revision of pharyngeal              0256      34.0302    $1,774.71  ...........      $354.94
                                                             walls.
42894               C................  ...................  Revision of pharyngeal       ...........  ...........  ...........  ...........  ...........
                                                             walls.
42900               T................  ...................  Repair throat wound........         0252       5.8041      $302.69      $113.41       $60.54
42950               T................  ...................  Reconstruction of throat...         0254      20.1158    $1,049.06      $321.35      $209.81
42953               C................  ...................  Repair throat, esophagus...  ...........  ...........  ...........  ...........  ...........
42955               T................  ...................  Surgical opening of throat.         0254      20.1158    $1,049.06      $321.35      $209.81
42960               T................  ...................  Control throat bleeding....         0250       1.6376       $85.40       $29.89       $17.08
42961               C................  ...................  Control throat bleeding....  ...........  ...........  ...........  ...........  ...........
42962               T................  ...................  Control throat bleeding....         0256      34.0302    $1,774.71  ...........      $354.94
42970               T................  ...................  Control nose/throat                 0250       1.6376       $85.40       $29.89       $17.08
                                                             bleeding.
42971               C................  ...................  Control nose/throat          ...........  ...........  ...........  ...........  ...........
                                                             bleeding.
42972               T................  ...................  Control nose/throat                 0253      14.4473      $753.44      $282.29      $150.69
                                                             bleeding.
42999               T................  ...................  Throat surgery procedure...         0252       5.8041      $302.69      $113.41       $60.54
43020               T................  ...................  Incision of esophagus......         0252       5.8041      $302.69      $113.41       $60.54
43030               T................  ...................  Throat muscle surgery......         0253      14.4473      $753.44      $282.29      $150.69
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................  ...................  Partial removal of           ...........  ...........  ...........  ...........  ...........
                                                             esophagus.
43123               C................  ...................  Partial removal of           ...........  ...........  ...........  ...........  ...........
                                                             esophagus.
43124               C................  ...................  Removal of esophagus.......  ...........  ...........  ...........  ...........  ...........
43130               T................  ...................  Removal of esophagus pouch.         0254      20.1158    $1,049.06      $321.35      $209.81
43135               C................  ...................  Removal of esophagus pouch.  ...........  ...........  ...........  ...........  ...........

[[Page 66874]]

 
43200               T................  ...................  Esophagus endoscopy........         0141       7.4126      $386.57      $143.38       $77.31
43201               T................  NI.................  Esoph scope w/submucous inj         0141       7.4126      $386.57      $143.38       $77.31
43202               T................  ...................  Esophagus endoscopy, biopsy         0141       7.4126      $386.57      $143.38       $77.31
43204               T................  ...................  Esoph scope w/sclerosis inj         0141       7.4126      $386.57      $143.38       $77.31
43205               T................  ...................  Esophagus endoscopy/                0141       7.4126      $386.57      $143.38       $77.31
                                                             ligation.
43215               T................  ...................  Esophagus endoscopy........         0141       7.4126      $386.57      $143.38       $77.31
43216               T................  ...................  Esophagus endoscopy/lesion.         0141       7.4126      $386.57      $143.38       $77.31
43217               T................  ...................  Esophagus endoscopy........         0141       7.4126      $386.57      $143.38       $77.31
43219               T................  ...................  Esophagus endoscopy........         0141       7.4126      $386.57      $143.38       $77.31
43220               T................  ...................  Esoph endoscopy, dilation..         0141       7.4126      $386.57      $143.38       $77.31
43226               T................  ...................  Esoph endoscopy, dilation..         0141       7.4126      $386.57      $143.38       $77.31
43227               T................  ...................  Esoph endoscopy, repair....         0141       7.4126      $386.57      $143.38       $77.31
43228               T................  ...................  Esoph endoscopy, ablation..         0141       7.4126      $386.57      $143.38       $77.31
43231               T................  ...................  Esoph endoscopy w/us exam..         0141       7.4126      $386.57      $143.38       $77.31
43232               T................  ...................  Esoph endoscopy w/us fn bx.         0141       7.4126      $386.57      $143.38       $77.31
43234               T................  ...................  Upper GI endoscopy, exam...         0141       7.4126      $386.57      $143.38       $77.31
43235               T................  ...................  Uppr gi endoscopy,                  0141       7.4126      $386.57      $143.38       $77.31
                                                             diagnosis.
43236               T................  NI.................  Uppr gi scope w/submuc inj.         0141       7.4126      $386.57      $143.38       $77.31
43239               T................  ...................  Upper GI endoscopy, biopsy.         0141       7.4126      $386.57      $143.38       $77.31
43240               T................  ...................  Esoph endoscope w/drain             0141       7.4126      $386.57      $143.38       $77.31
                                                             cyst.
43241               T................  ...................  Upper GI endoscopy with             0141       7.4126      $386.57      $143.38       $77.31
                                                             tube.
43242               T................  ...................  Uppr gi endoscopy w/us fn           0141       7.4126      $386.57      $143.38       $77.31
                                                             bx.
43243               T................  ...................  Upper gi endoscopy & inject         0141       7.4126      $386.57      $143.38       $77.31
43244               T................  ...................  Upper GI endoscopy/ligation         0141       7.4126      $386.57      $143.38       $77.31
43245               T................  ...................  Uppr gi scope dilate                0141       7.4126      $386.57      $143.38       $77.31
                                                             strictr.
43246               T................  ...................  Place gastrostomy tube.....         0141       7.4126      $386.57      $143.38       $77.31
43247               T................  ...................  Operative upper GI                  0141       7.4126      $386.57      $143.38       $77.31
                                                             endoscopy.
43248               T................  ...................  Uppr gi endoscopy/guide             0141       7.4126      $386.57      $143.38       $77.31
                                                             wire.
43249               T................  ...................  Esoph endoscopy, dilation..         0141       7.4126      $386.57      $143.38       $77.31
43250               T................  ...................  Upper GI endoscopy/tumor...         0141       7.4126      $386.57      $143.38       $77.31
43251               T................  ...................  Operative upper GI                  0141       7.4126      $386.57      $143.38       $77.31
                                                             endoscopy.
43255               T................  ...................  Operative upper GI                  0141       7.4126      $386.57      $143.38       $77.31
                                                             endoscopy.
43256               T................  ...................  Uppr gi endoscopy w stent..         0141       7.4126      $386.57      $143.38       $77.31
43258               T................  ...................  Operative upper GI                  0141       7.4126      $386.57      $143.38       $77.31
                                                             endoscopy.
43259               T................  ...................  Endoscopic ultrasound exam.         0141       7.4126      $386.57      $143.38       $77.31
43260               T................  ...................  Endo                                0151      17.5093      $913.13      $245.46      $182.63
                                                             cholangiopancreatograph.
43261               T................  ...................  Endo                                0151      17.5093      $913.13      $245.46      $182.63
                                                             cholangiopancreatograph.
43262               T................  ...................  Endo                                0151      17.5093      $913.13      $245.46      $182.63
                                                             cholangiopancreatograph.
43263               T................  ...................  Endo                                0151      17.5093      $913.13      $245.46      $182.63
                                                             cholangiopancreatograph.
43264               T................  ...................  Endo                                0151      17.5093      $913.13      $245.46      $182.63
                                                             cholangiopancreatograph.
43265               T................  ...................  Endo                                0151      17.5093      $913.13      $245.46      $182.63
                                                             cholangiopancreatograph.
43267               T................  ...................  Endo                                0151      17.5093      $913.13      $245.46      $182.63
                                                             cholangiopancreatograph.
43268               T................  ...................  Endo                                0151      17.5093      $913.13      $245.46      $182.63
                                                             cholangiopancreatograph.
43269               T................  ...................  Endo                                0151      17.5093      $913.13      $245.46      $182.63
                                                             cholangiopancreatograph.
43271               T................  ...................  Endo                                0151      17.5093      $913.13      $245.46      $182.63
                                                             cholangiopancreatograph.
43272               T................  ...................  Endo                                0151      17.5093      $913.13      $245.46      $182.63
                                                             cholangiopancreatograph.
43280               T................  ...................  Laparoscopy, fundoplasty...         0132      56.9948    $2,972.34    $1,239.22      $594.47
43289               T................  ...................  Laparoscope proc, esoph....         0130      30.4644    $1,588.75      $659.53      $317.75
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 congenital..  ...........  ...........  ...........  ...........  ...........
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  ...........  ...........  ...........  ...........  ...........

[[Page 66875]]

 
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       6.0948      $317.85      $107.24       $63.57
43453               T................  ...................  Dilate esophagus...........         0140       6.0948      $317.85      $107.24       $63.57
43456               T................  ...................  Dilate esophagus...........         0140       6.0948      $317.85      $107.24       $63.57
43458               T................  ...................  Dilate esophagus...........         0140       6.0948      $317.85      $107.24       $63.57
43460               C................  ...................  Pressure treatment           ...........  ...........  ...........  ...........  ...........
                                                             esophagus.
43496               C................  ...................  Free jejunum flap,           ...........  ...........  ...........  ...........  ...........
                                                             microvasc.
43499               T................  ...................  Esophagus surgery procedure         0141       7.4126      $386.57      $143.38       $77.31
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       7.4126      $386.57      $143.38       $77.31
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      56.9948    $2,972.34    $1,239.22      $594.47
43652               T................  ...................  Laparoscopy, vagus nerve...         0132      56.9948    $2,972.34    $1,239.22      $594.47
43653               T................  ...................  Laparoscopy, gastrostomy...         0131      40.2026    $2,096.61    $1,001.89      $419.32
43659               T................  ...................  Laparoscope proc, stom.....         0130      30.4644    $1,588.75      $659.53      $317.75
43750               T................  ...................  Place gastrostomy tube.....         0141       7.4126      $386.57      $143.38       $77.31
43752               E................  ...................  Nasal/orogastric w/stent...  ...........  ...........  ...........  ...........  ...........
43760               T................  ...................  Change gastrostomy tube....         0121       2.0833      $108.65       $43.80       $21.73
43761               T................  ...................  Reposition gastrostomy tube         0121       2.0833      $108.65       $43.80       $21.73
43800               C................  ...................  Reconstruction of pylorus..  ...........  ...........  ...........  ...........  ...........
43810               C................  ...................  Fusion of stomach and bowel  ...........  ...........  ...........  ...........  ...........
43820               C................  ...................  Fusion of stomach and bowel  ...........  ...........  ...........  ...........  ...........
43825               C................  ...................  Fusion of stomach and bowel  ...........  ...........  ...........  ...........  ...........
43830               T................  ...................  Place gastrostomy tube.....         0141       7.4126      $386.57      $143.38       $77.31
43831               T................  ...................  Place gastrostomy tube.....         0141       7.4126      $386.57      $143.38       $77.31
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       7.4126      $386.57      $143.38       $77.31
43880               C................  ...................  Repair stomach-bowel         ...........  ...........  ...........  ...........  ...........
                                                             fistula.
43999               T................  ...................  Stomach surgery procedure..         0141       7.4126      $386.57      $143.38       $77.31

[[Page 66876]]

 
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       7.4126      $386.57      $143.38       $77.31
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/o taper, cong  ...........  ...........  ...........  ...........  ...........
44127               C................  ...................  Enterectomy w/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      40.2026    $2,096.61    $1,001.89      $419.32
44201               T................  ...................  Laparoscopy, jejunostomy...         0131      40.2026    $2,096.61    $1,001.89      $419.32
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.  ...........  ...........  ...........  ...........  ...........
44206               T................  NI.................  Lap part colectomy w/stoma.         0132      56.9948    $2,972.34    $1,239.22      $594.47
44207               T................  NI.................  L colectomy/coloproctostomy         0132      56.9948    $2,972.34    $1,239.22      $594.47
44208               T................  NI.................  L colectomy/coloproctostomy         0132      56.9948    $2,972.34    $1,239.22      $594.47
44209               T................  DG.................  Laparoscope proc, intestine         0130      30.4644    $1,588.75      $659.53      $317.75
44210               C................  NI.................  Laparo total                 ...........  ...........  ...........  ...........  ...........
                                                             proctocolectomy.
44211               C................  NI.................  Laparo total                 ...........  ...........  ...........  ...........  ...........
                                                             proctocolectomy.
44212               C................  NI.................  Laparo total                 ...........  ...........  ...........  ...........  ...........
                                                             proctocolectomy.
44238               T................  NI.................  Laparoscope proc, intestine         0130      30.4644    $1,588.75      $659.53      $317.75
44239               T................  NI.................  Laparoscope proc, rectum...         0130      30.4644    $1,588.75      $659.53      $317.75
44300               C................  ...................  Open bowel to skin.........  ...........  ...........  ...........  ...........  ...........
44310               C................  ...................  Ileostomy/jejunostomy......  ...........  ...........  ...........  ...........  ...........
44312               T................  ...................  Revision of ileostomy......         0027      15.2225      $793.87      $329.72      $158.77
44314               C................  ...................  Revision of ileostomy......  ...........  ...........  ...........  ...........  ...........
44316               C................  ...................  Devise bowel pouch.........  ...........  ...........  ...........  ...........  ...........
44320               C................  ...................  Colostomy..................  ...........  ...........  ...........  ...........  ...........
44322               C................  ...................  Colostomy with biopsies....  ...........  ...........  ...........  ...........  ...........
44340               T................  ...................  Revision of colostomy......         0027      15.2225      $793.87      $329.72      $158.77
44345               C................  ...................  Revision of colostomy......  ...........  ...........  ...........  ...........  ...........
44346               C................  ...................  Revision of colostomy......  ...........  ...........  ...........  ...........  ...........
44360               T................  ...................  Small bowel endoscopy......         0142       8.1393      $424.47      $152.78       $84.89
44361               T................  ...................  Small bowel endoscopy/              0142       8.1393      $424.47      $152.78       $84.89
                                                             biopsy.
44363               T................  ...................  Small bowel endoscopy......         0142       8.1393      $424.47      $152.78       $84.89

[[Page 66877]]

 
44364               T................  ...................  Small bowel endoscopy......         0142       8.1393      $424.47      $152.78       $84.89
44365               T................  ...................  Small bowel endoscopy......         0142       8.1393      $424.47      $152.78       $84.89
44366               T................  ...................  Small bowel endoscopy......         0142       8.1393      $424.47      $152.78       $84.89
44369               T................  ...................  Small bowel endoscopy......         0142       8.1393      $424.47      $152.78       $84.89
44370               T................  ...................  Small bowel endoscopy/stent         0142       8.1393      $424.47      $152.78       $84.89
44372               T................  ...................  Small bowel endoscopy......         0142       8.1393      $424.47      $152.78       $84.89
44373               T................  ...................  Small bowel endoscopy......         0142       8.1393      $424.47      $152.78       $84.89
44376               T................  ...................  Small bowel endoscopy......         0142       8.1393      $424.47      $152.78       $84.89
44377               T................  ...................  Small bowel endoscopy/              0142       8.1393      $424.47      $152.78       $84.89
                                                             biopsy.
44378               T................  ...................  Small bowel endoscopy......         0142       8.1393      $424.47      $152.78       $84.89
44379               T................  ...................  S bowel endoscope w/stent..         0142       8.1393      $424.47      $152.78       $84.89
44380               T................  ...................  Small bowel endoscopy......         0142       8.1393      $424.47      $152.78       $84.89
44382               T................  ...................  Small bowel endoscopy......         0142       8.1393      $424.47      $152.78       $84.89
44383               T................  ...................  Ileoscopy w/stent..........         0142       8.1393      $424.47      $152.78       $84.89
44385               T................  ...................  Endoscopy of bowel pouch...         0143       7.9165      $412.85      $186.06       $82.57
44386               T................  ...................  Endoscopy, bowel pouch/biop         0143       7.9165      $412.85      $186.06       $82.57
44388               T................  ...................  Colon endoscopy............         0143       7.9165      $412.85      $186.06       $82.57
44389               T................  ...................  Colonoscopy with biopsy....         0143       7.9165      $412.85      $186.06       $82.57
44390               T................  ...................  Colonoscopy for foreign             0143       7.9165      $412.85      $186.06       $82.57
                                                             body.
44391               T................  ...................  Colonoscopy for bleeding...         0143       7.9165      $412.85      $186.06       $82.57
44392               T................  ...................  Colonoscopy & polypectomy..         0143       7.9165      $412.85      $186.06       $82.57
44393               T................  ...................  Colonoscopy, lesion removal         0143       7.9165      $412.85      $186.06       $82.57
44394               T................  ...................  Colonoscopy w/snare........         0143       7.9165      $412.85      $186.06       $82.57
44397               T................  ...................  Colonoscopy w/stent........         0143       7.9165      $412.85      $186.06       $82.57
44500               T................  ...................  Intro, gastrointestinal             0121       2.0833      $108.65       $43.80       $21.73
                                                             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.  ...........  ...........  ...........  ...........  ...........
44701               N................  NI.................  Intraop colon lavage add-on  ...........  ...........  ...........  ...........  ...........
44799               T................  ...................  Intestine surgery procedure         0142       8.1393      $424.47      $152.78       $84.89
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      30.4644    $1,588.75      $659.53      $317.75
44979               T................  ...................  Laparoscope proc, app......         0130      30.4644    $1,588.75      $659.53      $317.75
45000               T................  ...................  Drainage of pelvic abscess.         0149      16.3756      $854.00      $293.06      $170.80
45005               T................  ...................  Drainage of rectal abscess.         0148       3.4205      $178.38       $63.38       $35.68
45020               T................  ...................  Drainage of rectal abscess.         0149      16.3756      $854.00      $293.06      $170.80
45100               T................  ...................  Biopsy of rectum...........         0149      16.3756      $854.00      $293.06      $170.80
45108               T................  ...................  Removal of anorectal lesion         0150      21.2398    $1,107.68      $437.12      $221.54
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..........  ...........  ...........  ...........  ...........  ...........

[[Page 66878]]

 
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 reservior..  ...........  ...........  ...........  ...........  ...........
45150               T................  ...................  Excision of rectal                  0150      21.2398    $1,107.68      $437.12      $221.54
                                                             stricture.
45160               T................  ...................  Excision of rectal lesion..         0150      21.2398    $1,107.68      $437.12      $221.54
45170               T................  ...................  Excision of rectal lesion..         0150      21.2398    $1,107.68      $437.12      $221.54
45190               T................  ...................  Destruction, rectal tumor..         0150      21.2398    $1,107.68      $437.12      $221.54
45300               T................  ...................  Proctosigmoidoscopy dx.....         0146       3.4302      $178.89       $64.40       $35.78
45303               T................  ...................  Proctosigmoidoscopy dilate.         0146       3.4302      $178.89       $64.40       $35.78
45305               T................  ...................  Proctosigmoidoscopy w/bx...         0146       3.4302      $178.89       $64.40       $35.78
45307               T................  ...................  Proctosigmoidoscopy fb.....         0146       3.4302      $178.89       $64.40       $35.78
45308               T................  ...................  Proctosigmoidoscopy removal         0147       7.0153      $365.85       $79.46       $73.17
45309               T................  ...................  Proctosigmoidoscopy removal         0147       7.0153      $365.85       $79.46       $73.17
45315               T................  ...................  Proctosigmoidoscopy removal         0147       7.0153      $365.85       $79.46       $73.17
45317               T................  ...................  Proctosigmoidoscopy bleed..         0146       3.4302      $178.89       $64.40       $35.78
45320               T................  ...................  Proctosigmoidoscopy ablate.         0147       7.0153      $365.85       $79.46       $73.17
45321               T................  ...................  Proctosigmoidoscopy volvul.         0147       7.0153      $365.85       $79.46       $73.17
45327               T................  ...................  Proctosigmoidoscopy w/stent         0147       7.0153      $365.85       $79.46       $73.17
45330               T................  ...................  Diagnostic sigmoidoscopy...         0146       3.4302      $178.89       $64.40       $35.78
45331               T................  ...................  Sigmoidoscopy and biopsy...         0146       3.4302      $178.89       $64.40       $35.78
45332               T................  ...................  Sigmoidoscopy w/fb removal.         0146       3.4302      $178.89       $64.40       $35.78
45333               T................  ...................  Sigmoidoscopy & polypectomy         0147       7.0153      $365.85       $79.46       $73.17
45334               T................  ...................  Sigmoidoscopy for bleeding.         0147       7.0153      $365.85       $79.46       $73.17
45335               T................  NI.................  Sigmoidoscope w/submuc inj.         0147       7.0153      $365.85       $79.46       $73.17
45337               T................  ...................  Sigmoidoscopy & decompress.         0147       7.0153      $365.85       $79.46       $73.17
45338               T................  ...................  Sigmoidoscpy w/tumr remove.         0147       7.0153      $365.85       $79.46       $73.17
45339               T................  ...................  Sigmoidoscopy w/ablate tumr         0147       7.0153      $365.85       $79.46       $73.17
45340               T................  NI.................  Sig w/balloon dilation.....         0147       7.0153      $365.85       $79.46       $73.17
45341               T................  ...................  Sigmoidoscopy w/ultrasound.         0147       7.0153      $365.85       $79.46       $73.17
45342               T................  ...................  Sigmoidoscopy w/us guide bx         0147       7.0153      $365.85       $79.46       $73.17
45345               T................  ...................  Sigmoidoscopy w/stent......         0147       7.0153      $365.85       $79.46       $73.17
45355               T................  ...................  Surgical colonoscopy.......         0143       7.9165      $412.85      $186.06       $82.57
45378               T................  ...................  Diagnostic colonoscopy.....         0143       7.9165      $412.85      $186.06       $82.57
45379               T................  ...................  Colonoscopy w/fb removal...         0143       7.9165      $412.85      $186.06       $82.57
45380               T................  ...................  Colonoscopy and biopsy.....         0143       7.9165      $412.85      $186.06       $82.57
45381               T................  NI.................  Colonoscope, submucous inj.         0143       7.9165      $412.85      $186.06       $82.57
45382               T................  ...................  Colonoscopy/control                 0143       7.9165      $412.85      $186.06       $82.57
                                                             bleeding.
45383               T................  ...................  Lesion removal colonoscopy.         0143       7.9165      $412.85      $186.06       $82.57
45384               T................  ...................  Lesion remove colonoscopy..         0143       7.9165      $412.85      $186.06       $82.57
45385               T................  ...................  Lesion removal colonoscopy.         0143       7.9165      $412.85      $186.06       $82.57
45386               T................  NI.................  Colonoscope dilate                  0143       7.9165      $412.85      $186.06       $82.57
                                                             stricture.
45387               T................  ...................  Colonoscopy w/stent........         0143       7.9165      $412.85      $186.06       $82.57
45500               T................  ...................  Repair of rectum...........         0150      21.2398    $1,107.68      $437.12      $221.54
45505               T................  ...................  Repair of rectum...........         0150      21.2398    $1,107.68      $437.12      $221.54
45520               T................  ...................  Treatment of rectal                 0098       1.6666       $86.91       $20.88       $17.38
                                                             prolapse.
45540               C................  ...................  Correct rectal prolapse....  ...........  ...........  ...........  ...........  ...........
45541               C................  ...................  Correct rectal prolapse....  ...........  ...........  ...........  ...........  ...........
45550               C................  ...................  Repair rectum/remove         ...........  ...........  ...........  ...........  ...........
                                                             sigmoid.
45560               T................  ...................  Repair of rectocele........         0150      21.2398    $1,107.68      $437.12      $221.54
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       3.4205      $178.38       $63.38       $35.68
                                                             prolapse.
45905               T................  ...................  Dilation of anal sphincter.         0149      16.3756      $854.00      $293.06      $170.80
45910               T................  ...................  Dilation of rectal                  0149      16.3756      $854.00      $293.06      $170.80
                                                             narrowing.
45915               T................  ...................  Remove rectal obstruction..         0148       3.4205      $178.38       $63.38       $35.68
45999               T................  ...................  Rectum surgery procedure...         0148       3.4205      $178.38       $63.38       $35.68
46020               T................  ...................  Placement of seton.........         0148       3.4205      $178.38       $63.38       $35.68
46030               T................  ...................  Removal of rectal marker...         0148       3.4205      $178.38       $63.38       $35.68

[[Page 66879]]

 
46040               T................  ...................  Incision of rectal abscess.         0155      10.1936      $531.61      $188.89      $106.32
46045               T................  ...................  Incision of rectal abscess.         0150      21.2398    $1,107.68      $437.12      $221.54
46050               T................  ...................  Incision of anal abscess...         0148       3.4205      $178.38       $63.38       $35.68
46060               T................  ...................  Incision of rectal abscess.         0150      21.2398    $1,107.68      $437.12      $221.54
46070               T................  ...................  Incision of anal septum....         0155      10.1936      $531.61      $188.89      $106.32
46080               T................  ...................  Incision of anal sphincter.         0149      16.3756      $854.00      $293.06      $170.80
46083               T................  ...................  Incise external hemorrhoid.         0148       3.4205      $178.38       $63.38       $35.68
46200               T................  ...................  Removal of anal fissure....         0150      21.2398    $1,107.68      $437.12      $221.54
46210               T................  ...................  Removal of anal crypt......         0149      16.3756      $854.00      $293.06      $170.80
46211               T................  ...................  Removal of anal crypts.....         0150      21.2398    $1,107.68      $437.12      $221.54
46220               T................  ...................  Removal of anal tag........         0149      16.3756      $854.00      $293.06      $170.80
46221               T................  ...................  Ligation of hemorrhoid(s)..         0148       3.4205      $178.38       $63.38       $35.68
46230               T................  ...................  Removal of anal tags.......         0149      16.3756      $854.00      $293.06      $170.80
46250               T................  ...................  Hemorrhoidectomy...........         0150      21.2398    $1,107.68      $437.12      $221.54
46255               T................  ...................  Hemorrhoidectomy...........         0150      21.2398    $1,107.68      $437.12      $221.54
46257               T................  ...................  Remove hemorrhoids &                0150      21.2398    $1,107.68      $437.12      $221.54
                                                             fissure.
46258               T................  ...................  Remove hemorrhoids &                0150      21.2398    $1,107.68      $437.12      $221.54
                                                             fistula.
46260               T................  ...................  Hemorrhoidectomy...........         0150      21.2398    $1,107.68      $437.12      $221.54
46261               T................  ...................  Remove hemorrhoids &                0150      21.2398    $1,107.68      $437.12      $221.54
                                                             fissure.
46262               T................  ...................  Remove hemorrhoids &                0150      21.2398    $1,107.68      $437.12      $221.54
                                                             fistula.
46270               T................  ...................  Removal of anal fistula....         0150      21.2398    $1,107.68      $437.12      $221.54
46275               T................  ...................  Removal of anal fistula....         0150      21.2398    $1,107.68      $437.12      $221.54
46280               T................  ...................  Removal of anal fistula....         0150      21.2398    $1,107.68      $437.12      $221.54
46285               T................  ...................  Removal of anal fistula....         0150      21.2398    $1,107.68      $437.12      $221.54
46288               T................  ...................  Repair anal fistula........         0150      21.2398    $1,107.68      $437.12      $221.54
46320               T................  ...................  Removal of hemorrhoid clot.         0148       3.4205      $178.38       $63.38       $35.68
46500               T................  ...................  Injection into                      0155      10.1936      $531.61      $188.89      $106.32
                                                             hemorrhoid(s).
46600               X................  ...................  Diagnostic anoscopy........         0340       0.6492       $33.86  ...........        $6.77
46604               T................  ...................  Anoscopy and dilation......         0147       7.0153      $365.85       $79.46       $73.17
46606               T................  ...................  Anoscopy and biopsy........         0147       7.0153      $365.85       $79.46       $73.17
46608               T................  ...................  Anoscopy, remove for body..         0147       7.0153      $365.85       $79.46       $73.17
46610               T................  ...................  Anoscopy, remove lesion....         0147       7.0153      $365.85       $79.46       $73.17
46611               T................  ...................  Anoscopy...................         0147       7.0153      $365.85       $79.46       $73.17
46612               T................  ...................  Anoscopy, remove lesions...         0147       7.0153      $365.85       $79.46       $73.17
46614               T................  ...................  Anoscopy, control bleeding.         0147       7.0153      $365.85       $79.46       $73.17
46615               T................  ...................  Anoscopy...................         0147       7.0153      $365.85       $79.46       $73.17
46700               T................  ...................  Repair of anal stricture...         0150      21.2398    $1,107.68      $437.12      $221.54
46705               C................  ...................  Repair of anal stricture...  ...........  ...........  ...........  ...........  ...........
46706               T................  NI.................  Repr of anal fistula w/glue         0148       3.4205      $178.38       $63.38       $35.68
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      21.2398    $1,107.68      $437.12      $221.54
46751               C................  ...................  Repair of anal sphincter...  ...........  ...........  ...........  ...........  ...........
46753               T................  ...................  Reconstruction of anus.....         0150      21.2398    $1,107.68      $437.12      $221.54
46754               T................  ...................  Removal of suture from anus         0149      16.3756      $854.00      $293.06      $170.80
46760               T................  ...................  Repair of anal sphincter...         0150      21.2398    $1,107.68      $437.12      $221.54
46761               T................  ...................  Repair of anal sphincter...         0150      21.2398    $1,107.68      $437.12      $221.54
46762               T................  ...................  Implant artificial                  0150      21.2398    $1,107.68      $437.12      $221.54
                                                             sphincter.
46900               T................  ...................  Destruction, anal lesion(s)         0016       2.6162      $136.44       $57.31       $27.29
46910               T................  ...................  Destruction, anal lesion(s)         0017      15.8233      $825.20      $227.84      $165.04
46916               T................  ...................  Cryosurgery, anal lesion(s)         0013       1.0756       $56.09       $14.20       $11.22
46917               T................  ...................  Laser surgery, anal lesions         0695      18.6817      $974.27      $266.59      $194.85
46922               T................  ...................  Excision of anal lesion(s).         0695      18.6817      $974.27      $266.59      $194.85
46924               T................  ...................  Destruction, anal lesion(s)         0695      18.6817      $974.27      $266.59      $194.85
46934               T................  ...................  Destruction of hemorrhoids.         0155      10.1936      $531.61      $188.89      $106.32
46935               T................  ...................  Destruction of hemorrhoids.         0155      10.1936      $531.61      $188.89      $106.32
46936               T................  ...................  Destruction of hemorrhoids.         0149      16.3756      $854.00      $293.06      $170.80
46937               T................  ...................  Cryotherapy of rectal               0149      16.3756      $854.00      $293.06      $170.80
                                                             lesion.

[[Page 66880]]

 
46938               T................  ...................  Cryotherapy of rectal               0150      21.2398    $1,107.68      $437.12      $221.54
                                                             lesion.
46940               T................  ...................  Treatment of anal fissure..         0149      16.3756      $854.00      $293.06      $170.80
46942               T................  ...................  Treatment of anal fissure..         0148       3.4205      $178.38       $63.38       $35.68
46945               T................  ...................  Ligation of hemorrhoids....         0155      10.1936      $531.61      $188.89      $106.32
46946               T................  ...................  Ligation of hemorrhoids....         0155      10.1936      $531.61      $188.89      $106.32
46999               T................  ...................  Anus surgery procedure.....         0148       3.4205      $178.38       $63.38       $35.68
47000               T................  ...................  Needle biopsy of liver.....         0685       5.9882      $312.29      $137.40       $62.46
47001               N................  ...................  Needle biopsy, liver add-on  ...........  ...........  ...........  ...........  ...........
47010               C................  ...................  Open drainage, liver lesion  ...........  ...........  ...........  ...........  ...........
47011               T................  ...................  Percut drain, liver lesion.         0005       3.1201      $162.72       $71.59       $32.54
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      30.4644    $1,588.75      $659.53      $317.75
                                                             rf.
47371               T................  ...................  Laparo ablate liver                 0130      30.4644    $1,588.75      $659.53      $317.75
                                                             cryosurg.
47379               T................  ...................  Laparoscope procedure,              0130      30.4644    $1,588.75      $659.53      $317.75
                                                             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       3.1201      $162.72       $71.59       $32.54
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      10.0288      $523.01      $131.28      $104.60
47500               N................  ...................  Injection for liver x-rays.  ...........  ...........  ...........  ...........  ...........
47505               N................  ...................  Injection for liver x-rays.  ...........  ...........  ...........  ...........  ...........
47510               T................  ...................  Insert catheter, bile duct.         0152      10.0288      $523.01      $131.28      $104.60
47511               T................  ...................  Insert bile duct drain.....         0152      10.0288      $523.01      $131.28      $104.60
47525               T................  ...................  Change bile duct catheter..         0122      10.7459      $560.41      $114.93      $112.08
47530               T................  ...................  Revise/reinsert bile tube..         0121       2.0833      $108.65       $43.80       $21.73
47550               C................  ...................  Bile duct endoscopy add-on.  ...........  ...........  ...........  ...........  ...........
47552               T................  ...................  Biliary endoscopy thru skin         0152      10.0288      $523.01      $131.28      $104.60
47553               T................  ...................  Biliary endoscopy thru skin         0152      10.0288      $523.01      $131.28      $104.60
47554               T................  ...................  Biliary endoscopy thru skin         0152      10.0288      $523.01      $131.28      $104.60
47555               T................  ...................  Biliary endoscopy thru skin         0152      10.0288      $523.01      $131.28      $104.60
47556               T................  ...................  Biliary endoscopy thru skin         0152      10.0288      $523.01      $131.28      $104.60
47560               T................  ...................  Laparoscopy w/cholangio....         0130      30.4644    $1,588.75      $659.53      $317.75
47561               T................  ...................  Laparo w/cholangio/biopsy..         0130      30.4644    $1,588.75      $659.53      $317.75
47562               T................  ...................  Laparoscopic                        0131      40.2026    $2,096.61    $1,001.89      $419.32
                                                             cholecystectomy.
47563               T................  ...................  Laparo cholecystectomy/             0131      40.2026    $2,096.61    $1,001.89      $419.32
                                                             graph.
47564               T................  ...................  Laparo cholecystectomy/             0131      40.2026    $2,096.61    $1,001.89      $419.32
                                                             explr.
47570               C................  ...................  Laparo                       ...........  ...........  ...........  ...........  ...........
                                                             cholecystoenterostomy.
47579               T................  ...................  Laparoscope proc, biliary..         0130      30.4644    $1,588.75      $659.53      $317.75
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      10.0288      $523.01      $131.28      $104.60
47700               C................  ...................  Exploration of bile ducts..  ...........  ...........  ...........  ...........  ...........
47701               C................  ...................  Bile duct revision.........  ...........  ...........  ...........  ...........  ...........

[[Page 66881]]

 
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      10.0288      $523.01      $131.28      $104.60
                                                             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       5.9882      $312.29      $137.40       $62.46
48120               C................  ...................  Removal of pancreas lesion.  ...........  ...........  ...........  ...........  ...........
48140               C................  ...................  Partial removal of pancreas  ...........  ...........  ...........  ...........  ...........
48145               C................  ...................  Partial removal of pancreas  ...........  ...........  ...........  ...........  ...........
48146               C................  ...................  Pancreatectomy.............  ...........  ...........  ...........  ...........  ...........
48148               C................  ...................  Removal of pancreatic duct.  ...........  ...........  ...........  ...........  ...........
48150               C................  ...................  Partial removal of pancreas  ...........  ...........  ...........  ...........  ...........
48152               C................  ...................  Pancreatectomy.............  ...........  ...........  ...........  ...........  ...........
48153               C................  ...................  Pancreatectomy.............  ...........  ...........  ...........  ...........  ...........
48154               C................  ...................  Pancreatectomy.............  ...........  ...........  ...........  ...........  ...........
48155               C................  ...................  Removal of pancreas........  ...........  ...........  ...........  ...........  ...........
48160               E................  ...................  Pancreas removal/transplant  ...........  ...........  ...........  ...........  ...........
48180               C................  ...................  Fuse pancreas and bowel....  ...........  ...........  ...........  ...........  ...........
48400               C................  ...................  Injection, intraop add-on..  ...........  ...........  ...........  ...........  ...........
48500               C................  ...................  Surgery of pancreatic cyst.  ...........  ...........  ...........  ...........  ...........
48510               C................  ...................  Drain pancreatic pseudocyst  ...........  ...........  ...........  ...........  ...........
48511               T................  ...................  Drain pancreatic pseudocyst         0005       3.1201      $162.72       $71.59       $32.54
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       3.1201      $162.72       $71.59       $32.54
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       3.3623      $175.35  ...........       $35.07
49081               T................  ...................  Removal of abdominal fluid.         0070       3.3623      $175.35  ...........       $35.07
49085               T................  ...................  Remove abdomen foreign body         0153      19.5441    $1,019.24      $410.87      $203.85
49180               T................  ...................  Biopsy, abdominal mass.....         0685       5.9882      $312.29      $137.40       $62.46
49200               T................  ...................  Removal of abdominal lesion         0130      30.4644    $1,588.75      $659.53      $317.75
49201               C................  ...................  Remove abdom lesion,         ...........  ...........  ...........  ...........  ...........
                                                             complex.
49215               C................  ...................  Excise sacral spine tumor..  ...........  ...........  ...........  ...........  ...........
49220               C................  ...................  Multiple surgery, abdomen..  ...........  ...........  ...........  ...........  ...........

[[Page 66882]]

 
49250               T................  ...................  Excision of umbilicus......         0153      19.5441    $1,019.24      $410.87      $203.85
49255               C................  ...................  Removal of omentum.........  ...........  ...........  ...........  ...........  ...........
49320               T................  ...................  Diag laparo separate proc..         0130      30.4644    $1,588.75      $659.53      $317.75
49321               T................  ...................  Laparoscopy, biopsy........         0130      30.4644    $1,588.75      $659.53      $317.75
49322               T................  ...................  Laparoscopy, aspiration....         0130      30.4644    $1,588.75      $659.53      $317.75
49323               T................  ...................  Laparo drain lymphocele....         0130      30.4644    $1,588.75      $659.53      $317.75
49329               T................  ...................  Laparo proc, abdm/per/oment         0130      30.4644    $1,588.75      $659.53      $317.75
49400               N................  ...................  Air injection into abdomen.  ...........  ...........  ...........  ...........  ...........
49419               T................  NI.................  Insrt abdom cath for                0119      89.3100    $4,657.61  ...........      $931.52
                                                             chemotx.
49420               T................  ...................  Insert abdom drain, temp...         0652      28.1292    $1,466.97  ...........      $293.39
49421               T................  ...................  Insert abdom drain, perm...         0652      28.1292    $1,466.97  ...........      $293.39
49422               T................  ...................  Remove perm cannula/                0105      18.5945      $969.72      $370.40      $193.94
                                                             catheter.
49423               T................  ...................  Exchange drainage catheter.         0152      10.0288      $523.01      $131.28      $104.60
49424               N................  ...................  Assess cyst, contrast        ...........  ...........  ...........  ...........  ...........
                                                             inject.
49425               C................  ...................  Insert abdomen-venous drain  ...........  ...........  ...........  ...........  ...........
49426               T................  ...................  Revise abdomen-venous shunt         0153      19.5441    $1,019.24      $410.87      $203.85
49427               N................  ...................  Injection, abdominal shunt.  ...........  ...........  ...........  ...........  ...........
49428               C................  ...................  Ligation of shunt..........  ...........  ...........  ...........  ...........  ...........
49429               T................  ...................  Removal of shunt...........         0105      18.5945      $969.72      $370.40      $193.94
49491               T................  ...................  Rpr hern preemie reduc.....         0154      25.7262    $1,341.65      $464.85      $268.33
49492               T................  ...................  Rpr ing hern premie,                0154      25.7262    $1,341.65      $464.85      $268.33
                                                             blocked.
49495               T................  ...................  Rpr ing hernia baby, reduc.         0154      25.7262    $1,341.65      $464.85      $268.33
49496               T................  ...................  Rpr ing hernia baby,                0154      25.7262    $1,341.65      $464.85      $268.33
                                                             blocked.
49500               T................  ...................  Rpr ing hernia, init,               0154      25.7262    $1,341.65      $464.85      $268.33
                                                             reduce.
49501               T................  ...................  Rpr ing hernia, init                0154      25.7262    $1,341.65      $464.85      $268.33
                                                             blocked.
49505               T................  ...................  Prp i/hern init reduc5 yr.
49507               T................  ...................  Prp i/hern init block5 yr.
49520               T................  ...................  Rerepair ing hernia, reduce         0154      25.7262    $1,341.65      $464.85      $268.33
49521               T................  ...................  Rerepair ing hernia,                0154      25.7262    $1,341.65      $464.85      $268.33
                                                             blocked.
49525               T................  ...................  Repair ing hernia, sliding.         0154      25.7262    $1,341.65      $464.85      $268.33
49540               T................  ...................  Repair lumbar hernia.......         0154      25.7262    $1,341.65      $464.85      $268.33
49550               T................  ...................  Rpr rem hernia, init,               0154      25.7262    $1,341.65      $464.85      $268.33
                                                             reduce.
49553               T................  ...................  Rpr fem hernia, init                0154      25.7262    $1,341.65      $464.85      $268.33
                                                             blocked.
49555               T................  ...................  Rerepair fem hernia, reduce         0154      25.7262    $1,341.65      $464.85      $268.33
49557               T................  ...................  Rerepair fem hernia,                0154      25.7262    $1,341.65      $464.85      $268.33
                                                             blocked.
49560               T................  ...................  Rpr ventral hern init,              0154      25.7262    $1,341.65      $464.85      $268.33
                                                             reduc.
49561               T................  ...................  Rpr ventral hern init,              0154      25.7262    $1,341.65      $464.85      $268.33
                                                             block.
49565               T................  ...................  Rerepair ventrl hern,               0154      25.7262    $1,341.65      $464.85      $268.33
                                                             reduce.
49566               T................  ...................  Rerepair ventrl hern, block         0154      25.7262    $1,341.65      $464.85      $268.33
49568               T................  ...................  Hernia repair w/mesh.......         0154      25.7262    $1,341.65      $464.85      $268.33
49570               T................  ...................  Rpr epigastric hern, reduce         0154      25.7262    $1,341.65      $464.85      $268.33
49572               T................  ...................  Rpr epigastric hern,                0154      25.7262    $1,341.65      $464.85      $268.33
                                                             blocked.
49580               T................  ...................  Rpr umbil hern, reduc < 5           0154      25.7262    $1,341.65      $464.85      $268.33
                                                             yr.
49582               T................  ...................  Rpr umbil hern, block < 5           0154      25.7262    $1,341.65      $464.85      $268.33
                                                             yr.
49585               T................  ...................  Rpr umbil hern, reduc  5 yr.
49587               T................  ...................  Rpr umbil hern, block  5 yr.
49590               T................  ...................  Repair spigilian hernia....         0154      25.7262    $1,341.65      $464.85      $268.33
49600               T................  ...................  Repair umbilical lesion....         0154      25.7262    $1,341.65      $464.85      $268.33
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      40.2026    $2,096.61    $1,001.89      $419.32
                                                             initial.
49651               T................  ...................  Laparo hernia repair recur.         0131      40.2026    $2,096.61    $1,001.89      $419.32
49659               T................  ...................  Laparo proc, hernia repair.         0131      40.2026    $2,096.61    $1,001.89      $419.32
49900               C................  ...................  Repair of abdominal wall...  ...........  ...........  ...........  ...........  ...........
49904               C................  NI.................  Omental flap, extra-abdom..  ...........  ...........  ...........  ...........  ...........
49905               C................  ...................  Omental flap...............  ...........  ...........  ...........  ...........  ...........
49906               C................  ...................  Free omental flap,           ...........  ...........  ...........  ...........  ...........
                                                             microvasc.
49999               T................  ...................  Abdomen surgery procedure..         0153      19.5441    $1,019.24      $410.87      $203.85
50010               C................  ...................  Exploration of kidney......  ...........  ...........  ...........  ...........  ...........
50020               C................  ...................  Renal abscess, open drain..  ...........  ...........  ...........  ...........  ...........
50021               T................  ...................  Renal abscess, percut drain         0005       3.1201      $162.72       $71.59       $32.54
50040               C................  ...................  Drainage of kidney.........  ...........  ...........  ...........  ...........  ...........
50045               C................  ...................  Exploration of kidney......  ...........  ...........  ...........  ...........  ...........

[[Page 66883]]

 
50060               C................  ...................  Removal of kidney stone....  ...........  ...........  ...........  ...........  ...........
50065               C................  ...................  Incision of kidney.........  ...........  ...........  ...........  ...........  ...........
50070               C................  ...................  Incision of kidney.........  ...........  ...........  ...........  ...........  ...........
50075               C................  ...................  Removal of kidney stone....  ...........  ...........  ...........  ...........  ...........
50080               T................  ...................  Removal of kidney stone....         0163      28.3714    $1,479.60  ...........      $295.92
50081               T................  ...................  Removal of kidney stone....         0163      28.3714    $1,479.60  ...........      $295.92
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       5.9882      $312.29      $137.40       $62.46
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       5.9882      $312.29      $137.40       $62.46
50392               T................  ...................  Insert kidney drain........         0161      15.7070      $819.14      $249.36      $163.83
50393               T................  ...................  Insert ureteral tube.......         0161      15.7070      $819.14      $249.36      $163.83
50394               N................  ...................  Injection for kidney x-ray.  ...........  ...........  ...........  ...........  ...........
50395               T................  ...................  Create passage to kidney...         0161      15.7070      $819.14      $249.36      $163.83
50396               T................  ...................  Measure kidney pressure....         0164       1.1240       $58.62       $17.59       $11.72
50398               T................  ...................  Change kidney tube.........         0122      10.7459      $560.41      $114.93      $112.08
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      30.4644    $1,588.75      $659.53      $317.75
50542               T................  NI.................  Laparo ablate renal mass...         0131      40.2026    $2,096.61    $1,001.89      $419.32
50543               T................  NI.................  Laparo partial nephrectomy.         0131      40.2026    $2,096.61    $1,001.89      $419.32
50544               T................  ...................  Laparoscopy, pyeloplasty...         0130      30.4644    $1,588.75      $659.53      $317.75
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      30.4644    $1,588.75      $659.53      $317.75
50551               T................  ...................  Kidney endoscopy...........         0160       6.3080      $328.97      $105.06       $65.79
50553               T................  ...................  Kidney endoscopy...........         0161      15.7070      $819.14      $249.36      $163.83
50555               T................  ...................  Kidney endoscopy & biopsy..         0160       6.3080      $328.97      $105.06       $65.79
50557               T................  ...................  Kidney endoscopy &                  0162      20.5906    $1,073.82  ...........      $214.76
                                                             treatment.
50559               T................  ...................  Renal endoscopy/radiotracer         0160       6.3080      $328.97      $105.06       $65.79
50561               T................  ...................  Kidney endoscopy &                  0161      15.7070      $819.14      $249.36      $163.83
                                                             treatment.
50562               T................  NI.................  Renal scope w/tumor resect.         0160       6.3080      $328.97      $105.06       $65.79
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.

[[Page 66884]]

 
50590               T................  ...................  Fragmenting of kidney stone         0169      44.0978    $2,299.74    $1,115.69      $459.95
50600               C................  ...................  Exploration of ureter......  ...........  ...........  ...........  ...........  ...........
50605               C................  ...................  Insert ureteral support....  ...........  ...........  ...........  ...........  ...........
50610               C................  ...................  Removal of ureter stone....  ...........  ...........  ...........  ...........  ...........
50620               C................  ...................  Removal of ureter stone....  ...........  ...........  ...........  ...........  ...........
50630               C................  ...................  Removal of ureter stone....  ...........  ...........  ...........  ...........  ...........
50650               C................  ...................  Removal of ureter..........  ...........  ...........  ...........  ...........  ...........
50660               C................  ...................  Removal of ureter..........  ...........  ...........  ...........  ...........  ...........
50684               N................  ...................  Injection for ureter x-ray.  ...........  ...........  ...........  ...........  ...........
50686               T................  ...................  Measure ureter pressure....         0164       1.1240       $58.62       $17.59       $11.72
50688               T................  ...................  Change of ureter tube......         0121       2.0833      $108.65       $43.80       $21.73
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      40.2026    $2,096.61    $1,001.89      $419.32
                                                             ureterolithotomy.
50947               T................  ...................  Laparo new ureter/bladder..         0131      40.2026    $2,096.61    $1,001.89      $419.32
50948               T................  ...................  Laparo new ureter/bladder..         0131      40.2026    $2,096.61    $1,001.89      $419.32
50949               T................  ...................  Laparoscope proc, ureter...         0130      30.4644    $1,588.75      $659.53      $317.75
50951               T................  ...................  Endoscopy of ureter........         0160       6.3080      $328.97      $105.06       $65.79
50953               T................  ...................  Endoscopy of ureter........         0160       6.3080      $328.97      $105.06       $65.79
50955               T................  ...................  Ureter endoscopy & biopsy..         0161      15.7070      $819.14      $249.36      $163.83
50957               T................  ...................  Ureter endoscopy &                  0161      15.7070      $819.14      $249.36      $163.83
                                                             treatment.
50959               T................  ...................  Ureter endoscopy & tracer..         0161      15.7070      $819.14      $249.36      $163.83
50961               T................  ...................  Ureter endoscopy &                  0161      15.7070      $819.14      $249.36      $163.83
                                                             treatment.
50970               T................  ...................  Ureter endoscopy...........         0160       6.3080      $328.97      $105.06       $65.79
50972               T................  ...................  Ureter endoscopy & catheter         0160       6.3080      $328.97      $105.06       $65.79
50974               T................  ...................  Ureter endoscopy & biopsy..         0161      15.7070      $819.14      $249.36      $163.83
50976               T................  ...................  Ureter endoscopy &                  0161      15.7070      $819.14      $249.36      $163.83
                                                             treatment.
50978               T................  ...................  Ureter endoscopy & tracer..         0161      15.7070      $819.14      $249.36      $163.83
50980               T................  ...................  Ureter endoscopy &                  0161      15.7070      $819.14      $249.36      $163.83
                                                             treatment.
51000               T................  ...................  Drainage of bladder........         0165      12.2672      $639.75  ...........      $127.95
51005               T................  ...................  Drainage of bladder........         0164       1.1240       $58.62       $17.59       $11.72
51010               T................  ...................  Drainage of bladder........         0165      12.2672      $639.75  ...........      $127.95
51020               T................  ...................  Incise & treat bladder.....         0162      20.5906    $1,073.82  ...........      $214.76
51030               T................  ...................  Incise & treat bladder.....         0162      20.5906    $1,073.82  ...........      $214.76
51040               T................  ...................  Incise & drain bladder.....         0162      20.5906    $1,073.82  ...........      $214.76
51045               T................  ...................  Incise bladder/drain ureter         0160       6.3080      $328.97      $105.06       $65.79
51050               T................  ...................  Removal of bladder stone...         0162      20.5906    $1,073.82  ...........      $214.76
51060               C................  ...................  Removal of ureter stone....  ...........  ...........  ...........  ...........  ...........
51065               T................  ...................  Remove ureter calculus.....         0162      20.5906    $1,073.82  ...........      $214.76

[[Page 66885]]

 
51080               T................  ...................  Drainage of bladder abscess         0007      10.0191      $522.51      $108.89      $104.50
51500               T................  ...................  Removal of bladder cyst....         0154      25.7262    $1,341.65      $464.85      $268.33
51520               T................  ...................  Removal of bladder lesion..         0162      20.5906    $1,073.82  ...........      $214.76
51525               C................  ...................  Removal of bladder lesion..  ...........  ...........  ...........  ...........  ...........
51530               C................  ...................  Removal of bladder lesion..  ...........  ...........  ...........  ...........  ...........
51535               C................  ...................  Repair of ureter lesion....  ...........  ...........  ...........  ...........  ...........
51550               C................  ...................  Partial removal of bladder.  ...........  ...........  ...........  ...........  ...........
51555               C................  ...................  Partial removal of bladder.  ...........  ...........  ...........  ...........  ...........
51565               C................  ...................  Revise bladder & ureter(s).  ...........  ...........  ...........  ...........  ...........
51570               C................  ...................  Removal of bladder.........  ...........  ...........  ...........  ...........  ...........
51575               C................  ...................  Removal of bladder & nodes.  ...........  ...........  ...........  ...........  ...........
51580               C................  ...................  Remove bladder/revise tract  ...........  ...........  ...........  ...........  ...........
51585               C................  ...................  Removal of bladder & nodes.  ...........  ...........  ...........  ...........  ...........
51590               C................  ...................  Remove bladder/revise tract  ...........  ...........  ...........  ...........  ...........
51595               C................  ...................  Remove bladder/revise tract  ...........  ...........  ...........  ...........  ...........
51596               C................  ...................  Remove bladder/create pouch  ...........  ...........  ...........  ...........  ...........
51597               C................  ...................  Removal of pelvic            ...........  ...........  ...........  ...........  ...........
                                                             structures.
51600               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       1.1240       $58.62       $17.59       $11.72
51701               N................  NI.................  Insert bladder catheter....  ...........  ...........  ...........  ...........  ...........
51702               N................  NI.................  Insert temp bladder cath...  ...........  ...........  ...........  ...........  ...........
51703               N................  NI.................  Insert bladder cath,         ...........  ...........  ...........  ...........  ...........
                                                             complex.
51705               T................  ...................  Change of bladder tube.....         0121       2.0833      $108.65       $43.80       $21.73
51710               T................  ...................  Change of bladder tube.....         0121       2.0833      $108.65       $43.80       $21.73
51715               T................  ...................  Endoscopic injection/               0167      28.3230    $1,477.07      $555.84      $295.41
                                                             implant.
51720               T................  ...................  Treatment of bladder lesion         0156       2.9747      $155.13       $46.55       $31.03
51725               T................  ...................  Simple cystometrogram......         0156       2.9747      $155.13       $46.55       $31.03
51726               T................  ...................  Complex cystometrogram.....         0156       2.9747      $155.13       $46.55       $31.03
51736               T................  ...................  Urine flow measurement.....         0164       1.1240       $58.62       $17.59       $11.72
51741               T................  ...................  Electro-uroflowmetry, first         0164       1.1240       $58.62       $17.59       $11.72
51772               T................  ...................  Urethra pressure profile...         0164       1.1240       $58.62       $17.59       $11.72
51784               T................  ...................  Anal/urinary muscle study..         0164       1.1240       $58.62       $17.59       $11.72
51785               T................  ...................  Anal/urinary muscle study..         0164       1.1240       $58.62       $17.59       $11.72
51792               T................  ...................  Urinary reflex study.......         0164       1.1240       $58.62       $17.59       $11.72
51795               T................  ...................  Urine voiding pressure              0164       1.1240       $58.62       $17.59       $11.72
                                                             study.
51797               T................  ...................  Intraabdominal pressure             0164       1.1240       $58.62       $17.59       $11.72
                                                             test.
51798               X................  NI.................  Us urine capacity measure..         0340       0.6492       $33.86  ...........        $6.77
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      20.5906    $1,073.82  ...........      $214.76
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      40.2026    $2,096.61    $1,001.89      $419.32
51992               T................  ...................  Laparo sling operation.....         0132      56.9948    $2,972.34    $1,239.22      $594.47
52000               T................  ...................  Cystoscopy.................         0160       6.3080      $328.97      $105.06       $65.79
52001               T................  ...................  Cystoscopy, removal of              0160       6.3080      $328.97      $105.06       $65.79
                                                             clots.
52005               T................  ...................  Cystoscopy & ureter                 0161      15.7070      $819.14      $249.36      $163.83
                                                             catheter.
52007               T................  ...................  Cystoscopy and biopsy......         0161      15.7070      $819.14      $249.36      $163.83
52010               T................  ...................  Cystoscopy & duct catheter.         0160       6.3080      $328.97      $105.06       $65.79
52204               T................  ...................  Cystoscopy.................         0161      15.7070      $819.14      $249.36      $163.83
52214               T................  ...................  Cystoscopy and treatment...         0162      20.5906    $1,073.82  ...........      $214.76
52224               T................  ...................  Cystoscopy and treatment...         0162      20.5906    $1,073.82  ...........      $214.76
52234               T................  ...................  Cystoscopy and treatment...         0162      20.5906    $1,073.82  ...........      $214.76
52235               T................  ...................  Cystoscopy and treatment...         0162      20.5906    $1,073.82  ...........      $214.76

[[Page 66886]]

 
52240               T................  ...................  Cystoscopy and treatment...         0162      20.5906    $1,073.82  ...........      $214.76
52250               T................  ...................  Cystoscopy and radiotracer.         0162      20.5906    $1,073.82  ...........      $214.76
52260               T................  ...................  Cystoscopy and treatment...         0161      15.7070      $819.14      $249.36      $163.83
52265               T................  ...................  Cystoscopy and treatment...         0160       6.3080      $328.97      $105.06       $65.79
52270               T................  ...................  Cystoscopy & revise urethra         0161      15.7070      $819.14      $249.36      $163.83
52275               T................  ...................  Cystoscopy & revise urethra         0161      15.7070      $819.14      $249.36      $163.83
52276               T................  ...................  Cystoscopy and treatment...         0161      15.7070      $819.14      $249.36      $163.83
52277               T................  ...................  Cystoscopy and treatment...         0162      20.5906    $1,073.82  ...........      $214.76
52281               T................  ...................  Cystoscopy and treatment...         0161      15.7070      $819.14      $249.36      $163.83
52282               T................  ...................  Cystoscopy, implant stent..         0163      28.3714    $1,479.60  ...........      $295.92
52283               T................  ...................  Cystoscopy and treatment...         0161      15.7070      $819.14      $249.36      $163.83
52285               T................  ...................  Cystoscopy and treatment...         0161      15.7070      $819.14      $249.36      $163.83
52290               T................  ...................  Cystoscopy and treatment...         0161      15.7070      $819.14      $249.36      $163.83
52300               T................  ...................  Cystoscopy and treatment...         0161      15.7070      $819.14      $249.36      $163.83
52301               T................  ...................  Cystoscopy and treatment...         0161      15.7070      $819.14      $249.36      $163.83
52305               T................  ...................  Cystoscopy and treatment...         0161      15.7070      $819.14      $249.36      $163.83
52310               T................  ...................  Cystoscopy and treatment...         0160       6.3080      $328.97      $105.06       $65.79
52315               T................  ...................  Cystoscopy and treatment...         0161      15.7070      $819.14      $249.36      $163.83
52317               T................  ...................  Remove bladder stone.......         0162      20.5906    $1,073.82  ...........      $214.76
52318               T................  ...................  Remove bladder stone.......         0162      20.5906    $1,073.82  ...........      $214.76
52320               T................  ...................  Cystoscopy and treatment...         0162      20.5906    $1,073.82  ...........      $214.76
52325               T................  ...................  Cystoscopy, stone removal..         0162      20.5906    $1,073.82  ...........      $214.76
52327               T................  ...................  Cystoscopy, inject material         0162      20.5906    $1,073.82  ...........      $214.76
52330               T................  ...................  Cystoscopy and treatment...         0162      20.5906    $1,073.82  ...........      $214.76
52332               T................  ...................  Cystoscopy and treatment...         0162      20.5906    $1,073.82  ...........      $214.76
52334               T................  ...................  Create passage to kidney...         0162      20.5906    $1,073.82  ...........      $214.76
52341               T................  ...................  Cysto w/ureter stricture tx         0162      20.5906    $1,073.82  ...........      $214.76
52342               T................  ...................  Cysto w/up stricture tx....         0162      20.5906    $1,073.82  ...........      $214.76
52343               T................  ...................  Cysto w/renal stricture tx.         0162      20.5906    $1,073.82  ...........      $214.76
52344               T................  ...................  Cysto/uretero, stone remove         0162      20.5906    $1,073.82  ...........      $214.76
52345               T................  ...................  Cysto/uretero w/up                  0162      20.5906    $1,073.82  ...........      $214.76
                                                             stricture.
52346               T................  ...................  Cystouretero w/renal strict         0162      20.5906    $1,073.82  ...........      $214.76
52347               T................  ...................  Cystoscopy, resect ducts...         0160       6.3080      $328.97      $105.06       $65.79
52351               T................  ...................  Cystouretero & or                   0160       6.3080      $328.97      $105.06       $65.79
                                                             pyeloscope.
52352               T................  ...................  Cystouretero w/stone remove         0162      20.5906    $1,073.82  ...........      $214.76
52353               T................  ...................  Cystouretero w/lithotripsy.         0163      28.3714    $1,479.60  ...........      $295.92
52354               T................  ...................  Cystouretero w/biopsy......         0162      20.5906    $1,073.82  ...........      $214.76
52355               T................  ...................  Cystouretero w/excise tumor         0162      20.5906    $1,073.82  ...........      $214.76
52400               T................  ...................  Cystouretero w/congen repr.         0162      20.5906    $1,073.82  ...........      $214.76
52450               T................  ...................  Incision of prostate.......         0162      20.5906    $1,073.82  ...........      $214.76
52500               T................  ...................  Revision of bladder neck...         0162      20.5906    $1,073.82  ...........      $214.76
52510               T................  ...................  Dilation prostatic urethra.         0161      15.7070      $819.14      $249.36      $163.83
52601               T................  ...................  Prostatectomy (TURP).......         0163      28.3714    $1,479.60  ...........      $295.92
52606               T................  ...................  Control postop bleeding....         0162      20.5906    $1,073.82  ...........      $214.76
52612               T................  ...................  Prostatectomy, first stage.         0163      28.3714    $1,479.60  ...........      $295.92
52614               T................  ...................  Prostatectomy, second stage         0163      28.3714    $1,479.60  ...........      $295.92
52620               T................  ...................  Remove residual prostate...         0163      28.3714    $1,479.60  ...........      $295.92
52630               T................  ...................  Remove prostate regrowth...         0163      28.3714    $1,479.60  ...........      $295.92
52640               T................  ...................  Relieve bladder contracture         0162      20.5906    $1,073.82  ...........      $214.76
52647               T................  ...................  Laser surgery of prostate..         0163      28.3714    $1,479.60  ...........      $295.92
52648               T................  ...................  Laser surgery of prostate..         0163      28.3714    $1,479.60  ...........      $295.92
52700               T................  ...................  Drainage of prostate                0162      20.5906    $1,073.82  ...........      $214.76
                                                             abscess.
53000               T................  ...................  Incision of urethra........         0166      15.4163      $803.98      $218.73      $160.80
53010               T................  ...................  Incision of urethra........         0166      15.4163      $803.98      $218.73      $160.80
53020               T................  ...................  Incision of urethra........         0166      15.4163      $803.98      $218.73      $160.80
53025               T................  ...................  Incision of urethra........         0166      15.4163      $803.98      $218.73      $160.80
53040               T................  ...................  Drainage of urethra abscess         0166      15.4163      $803.98      $218.73      $160.80
53060               T................  ...................  Drainage of urethra abscess         0166      15.4163      $803.98      $218.73      $160.80
53080               T................  ...................  Drainage of urinary leakage         0166      15.4163      $803.98      $218.73      $160.80
53085               C................  ...................  Drainage of urinary leakage  ...........  ...........  ...........  ...........  ...........
53200               T................  ...................  Biopsy of urethra..........         0166      15.4163      $803.98      $218.73      $160.80
53210               T................  ...................  Removal of urethra.........         0168      24.4665    $1,275.95      $405.60      $255.19
53215               T................  ...................  Removal of urethra.........         0168      24.4665    $1,275.95      $405.60      $255.19
53220               T................  ...................  Treatment of urethra lesion         0168      24.4665    $1,275.95      $405.60      $255.19
53230               T................  ...................  Removal of urethra lesion..         0168      24.4665    $1,275.95      $405.60      $255.19

[[Page 66887]]

 
53235               T................  ...................  Removal of urethra lesion..         0168      24.4665    $1,275.95      $405.60      $255.19
53240               T................  ...................  Surgery for urethra pouch..         0168      24.4665    $1,275.95      $405.60      $255.19
53250               T................  ...................  Removal of urethra gland...         0166      15.4163      $803.98      $218.73      $160.80
53260               T................  ...................  Treatment of urethra lesion         0166      15.4163      $803.98      $218.73      $160.80
53265               T................  ...................  Treatment of urethra lesion         0166      15.4163      $803.98      $218.73      $160.80
53270               T................  ...................  Removal of urethra gland...         0167      28.3230    $1,477.07      $555.84      $295.41
53275               T................  ...................  Repair of urethra defect...         0166      15.4163      $803.98      $218.73      $160.80
53400               T................  ...................  Revise urethra, stage 1....         0168      24.4665    $1,275.95      $405.60      $255.19
53405               T................  ...................  Revise urethra, stage 2....         0168      24.4665    $1,275.95      $405.60      $255.19
53410               T................  ...................  Reconstruction of urethra..         0168      24.4665    $1,275.95      $405.60      $255.19
53415               C................  ...................  Reconstruction of urethra..  ...........  ...........  ...........  ...........  ...........
53420               T................  ...................  Reconstruct urethra, stage          0168      24.4665    $1,275.95      $405.60      $255.19
                                                             1.
53425               T................  ...................  Reconstruct urethra, stage          0168      24.4665    $1,275.95      $405.60      $255.19
                                                             2.
53430               T................  ...................  Reconstruction of urethra..         0168      24.4665    $1,275.95      $405.60      $255.19
53431               T................  ...................  Reconstruct urethra/bladder         0168      24.4665    $1,275.95      $405.60      $255.19
53440               T................  ...................  Correct bladder function...         0179     104.3581    $5,442.38    $2,340.22    $1,088.48
53442               T................  ...................  Remove perineal prosthesis.         0166      15.4163      $803.98      $218.73      $160.80
53444               T................  ...................  Insert tandem cuff.........         0179     104.3581    $5,442.38    $2,340.22    $1,088.48
53445               T................  ...................  Insert uro/ves nck                  0179     104.3581    $5,442.38    $2,340.22    $1,088.48
                                                             sphincter.
53446               T................  ...................  Remove uro sphincter.......         0168      24.4665    $1,275.95      $405.60      $255.19
53447               T................  ...................  Remove/replace ur sphincter         0179     104.3581    $5,442.38    $2,340.22    $1,088.48
53448               C................  ...................  Remov/replc ur sphinctr      ...........  ...........  ...........  ...........  ...........
                                                             comp.
53449               T................  ...................  Repair uro sphincter.......         0168      24.4665    $1,275.95      $405.60      $255.19
53450               T................  ...................  Revision of urethra........         0168      24.4665    $1,275.95      $405.60      $255.19
53460               T................  ...................  Revision of urethra........         0168      24.4665    $1,275.95      $405.60      $255.19
53502               T................  ...................  Repair of urethra injury...         0166      15.4163      $803.98      $218.73      $160.80
53505               T................  ...................  Repair of urethra injury...         0167      28.3230    $1,477.07      $555.84      $295.41
53510               T................  ...................  Repair of urethra injury...         0166      15.4163      $803.98      $218.73      $160.80
53515               T................  ...................  Repair of urethra injury...         0168      24.4665    $1,275.95      $405.60      $255.19
53520               T................  ...................  Repair of urethra defect...         0168      24.4665    $1,275.95      $405.60      $255.19
53600               T................  ...................  Dilate urethra stricture...         0156       2.9747      $155.13       $46.55       $31.03
53601               T................  ...................  Dilate urethra stricture...         0164       1.1240       $58.62       $17.59       $11.72
53605               T................  ...................  Dilate urethra stricture...         0161      15.7070      $819.14      $249.36      $163.83
53620               T................  ...................  Dilate urethra stricture...         0165      12.2672      $639.75  ...........      $127.95
53621               T................  ...................  Dilate urethra stricture...         0164       1.1240       $58.62       $17.59       $11.72
53660               T................  ...................  Dilation of urethra........         0164       1.1240       $58.62       $17.59       $11.72
53661               T................  ...................  Dilation of urethra........         0164       1.1240       $58.62       $17.59       $11.72
53665               T................  ...................  Dilation of urethra........         0166      15.4163      $803.98      $218.73      $160.80
53670               N................  DG.................  Insert urinary catheter....  ...........  ...........  ...........  ...........  ...........
53675               T................  DG.................  Insert urinary catheter....         0164       1.1240       $58.62       $17.59       $11.72
53850               T................  ...................  Prostatic microwave                 0675      48.5648    $2,532.70  ...........      $506.54
                                                             thermotx.
53852               T................  ...................  Prostatic rf thermotx......         0675      48.5648    $2,532.70  ...........      $506.54
53853               T................  ...................  Prostatic water thermother.         0977  ...........    $1,125.00  ...........      $225.00
53899               T................  ...................  Urology surgery procedure..         0164       1.1240       $58.62       $17.59       $11.72
54000               T................  ...................  Slitting of prepuce........         0166      15.4163      $803.98      $218.73      $160.80
54001               T................  ...................  Slitting of prepuce........         0166      15.4163      $803.98      $218.73      $160.80
54015               T................  ...................  Drain penis lesion.........         0007      10.0191      $522.51      $108.89      $104.50
54050               T................  ...................  Destruction, penis                  0013       1.0756       $56.09       $14.20       $11.22
                                                             lesion(s).
54055               T................  ...................  Destruction, penis                  0017      15.8233      $825.20      $227.84      $165.04
                                                             lesion(s).
54056               T................  ...................  Cryosurgery, penis                  0012       0.7849       $40.93       $11.18        $8.19
                                                             lesion(s).
54057               T................  ...................  Laser surg, penis lesion(s)         0017      15.8233      $825.20      $227.84      $165.04
54060               T................  ...................  Excision of penis lesion(s)         0017      15.8233      $825.20      $227.84      $165.04
54065               T................  ...................  Destruction, penis                  0695      18.6817      $974.27      $266.59      $194.85
                                                             lesion(s).
54100               T................  ...................  Biopsy of penis............         0021      13.9338      $726.66      $219.48      $145.33
54105               T................  ...................  Biopsy of penis............         0022      17.3930      $907.06      $354.45      $181.41
54110               T................  ...................  Treatment of penis lesion..         0181      29.2435    $1,525.08      $621.82      $305.02
54111               T................  ...................  Treat penis lesion, graft..         0181      29.2435    $1,525.08      $621.82      $305.02
54112               T................  ...................  Treat penis lesion, graft..         0181      29.2435    $1,525.08      $621.82      $305.02
54115               T................  ...................  Treatment of penis lesion..         0008      16.1430      $841.87  ...........      $168.37
54120               T................  ...................  Partial removal of penis...         0181      29.2435    $1,525.08      $621.82      $305.02
54125               C................  ...................  Removal of penis...........  ...........  ...........  ...........  ...........  ...........
54130               C................  ...................  Remove penis & nodes.......  ...........  ...........  ...........  ...........  ...........
54135               C................  ...................  Remove penis & nodes.......  ...........  ...........  ...........  ...........  ...........
54150               T................  ...................  Circumcision...............         0180      18.1004      $943.95      $304.87      $188.79
54152               T................  ...................  Circumcision...............         0180      18.1004      $943.95      $304.87      $188.79

[[Page 66888]]

 
54160               T................  ...................  Circumcision...............         0180      18.1004      $943.95      $304.87      $188.79
54161               T................  ...................  Circumcision...............         0180      18.1004      $943.95      $304.87      $188.79
54162               T................  ...................  Lysis penil circumic lesion         0180      18.1004      $943.95      $304.87      $188.79
54163               T................  ...................  Repair of circumcision.....         0180      18.1004      $943.95      $304.87      $188.79
54164               T................  ...................  Frenulotomy of penis.......         0180      18.1004      $943.95      $304.87      $188.79
54200               T................  ...................  Treatment of penis lesion..         0156       2.9747      $155.13       $46.55       $31.03
54205               T................  ...................  Treatment of penis lesion..         0181      29.2435    $1,525.08      $621.82      $305.02
54220               T................  ...................  Treatment of penis lesion..         0156       2.9747      $155.13       $46.55       $31.03
54230               N................  ...................  Prepare penis study........  ...........  ...........  ...........  ...........  ...........
54231               T................  ...................  Dynamic cavernosometry.....         0165      12.2672      $639.75  ...........      $127.95
54235               T................  ...................  Penile injection...........         0164       1.1240       $58.62       $17.59       $11.72
54240               T................  ...................  Penis study................         0164       1.1240       $58.62       $17.59       $11.72
54250               T................  ...................  Penis study................         0165      12.2672      $639.75  ...........      $127.95
54300               T................  ...................  Revision of penis..........         0181      29.2435    $1,525.08      $621.82      $305.02
54304               T................  ...................  Revision of penis..........         0181      29.2435    $1,525.08      $621.82      $305.02
54308               T................  ...................  Reconstruction of urethra..         0181      29.2435    $1,525.08      $621.82      $305.02
54312               T................  ...................  Reconstruction of urethra..         0181      29.2435    $1,525.08      $621.82      $305.02
54316               T................  ...................  Reconstruction of urethra..         0181      29.2435    $1,525.08      $621.82      $305.02
54318               T................  ...................  Reconstruction of urethra..         0181      29.2435    $1,525.08      $621.82      $305.02
54322               T................  ...................  Reconstruction of urethra..         0181      29.2435    $1,525.08      $621.82      $305.02
54324               T................  ...................  Reconstruction of urethra..         0181      29.2435    $1,525.08      $621.82      $305.02
54326               T................  ...................  Reconstruction of urethra..         0181      29.2435    $1,525.08      $621.82      $305.02
54328               T................  ...................  Revise penis/urethra.......         0181      29.2435    $1,525.08      $621.82      $305.02
54332               C................  ...................  Revise penis/urethra.......  ...........  ...........  ...........  ...........  ...........
54336               C................  ...................  Revise penis/urethra.......  ...........  ...........  ...........  ...........  ...........
54340               T................  ...................  Secondary urethral surgery.         0181      29.2435    $1,525.08      $621.82      $305.02
54344               T................  ...................  Secondary urethral surgery.         0181      29.2435    $1,525.08      $621.82      $305.02
54348               T................  ...................  Secondary urethral surgery.         0181      29.2435    $1,525.08      $621.82      $305.02
54352               T................  ...................  Reconstruct urethra/penis..         0181      29.2435    $1,525.08      $621.82      $305.02
54360               T................  ...................  Penis plastic surgery......         0181      29.2435    $1,525.08      $621.82      $305.02
54380               T................  ...................  Repair penis...............         0181      29.2435    $1,525.08      $621.82      $305.02
54385               T................  ...................  Repair penis...............         0181      29.2435    $1,525.08      $621.82      $305.02
54390               C................  ...................  Repair penis and bladder...  ...........  ...........  ...........  ...........  ...........
54400               T................  ...................  Insert semi-rigid                   0182      95.4145    $4,975.96  ...........      $995.19
                                                             prosthesis.
54401               T................  ...................  Insert self-contd                   0182      95.4145    $4,975.96  ...........      $995.19
                                                             prosthesis.
54405               T................  ...................  Insert multi-comp penis             0182      95.4145    $4,975.96  ...........      $995.19
                                                             pros.
54406               T................  ...................  Remove muti-comp penis pros         0181      29.2435    $1,525.08      $621.82      $305.02
54408               T................  ...................  Repair multi-comp penis             0181      29.2435    $1,525.08      $621.82      $305.02
                                                             pros.
54410               T................  ...................  Remove/replace penis prosth         0182      95.4145    $4,975.96  ...........      $995.19
54411               C................  ...................  Remov/replc penis pros,      ...........  ...........  ...........  ...........  ...........
                                                             comp.
54415               T................  ...................  Remove self-contd penis             0181      29.2435    $1,525.08      $621.82      $305.02
                                                             pros.
54416               T................  ...................  Remv/repl penis contain             0182      95.4145    $4,975.96  ...........      $995.19
                                                             pros.
54417               C................  ...................  Remv/replc penis pros,       ...........  ...........  ...........  ...........  ...........
                                                             compl.
54420               T................  ...................  Revision of penis..........         0181      29.2435    $1,525.08      $621.82      $305.02
54430               C................  ...................  Revision of penis..........  ...........  ...........  ...........  ...........  ...........
54435               T................  ...................  Revision of penis..........         0181      29.2435    $1,525.08      $621.82      $305.02
54440               T................  ...................  Repair of penis............         0181      29.2435    $1,525.08      $621.82      $305.02
54450               T................  ...................  Preputial stretching.......         0156       2.9747      $155.13       $46.55       $31.03
54500               T................  ...................  Biopsy of testis...........         0005       3.1201      $162.72       $71.59       $32.54
54505               T................  ...................  Biopsy of testis...........         0183      21.2592    $1,108.69  ...........      $221.74
54512               T................  ...................  Excise lesion testis.......         0183      21.2592    $1,108.69  ...........      $221.74
54520               T................  ...................  Removal of testis..........         0183      21.2592    $1,108.69  ...........      $221.74
54522               T................  ...................  Orchiectomy, partial.......         0183      21.2592    $1,108.69  ...........      $221.74
54530               T................  ...................  Removal of testis..........         0154      25.7262    $1,341.65      $464.85      $268.33
54535               C................  ...................  Extensive testis surgery...  ...........  ...........  ...........  ...........  ...........
54550               T................  ...................  Exploration for testis.....         0154      25.7262    $1,341.65      $464.85      $268.33
54560               C................  ...................  Exploration for testis.....  ...........  ...........  ...........  ...........  ...........
54600               T................  ...................  Reduce testis torsion......         0183      21.2592    $1,108.69  ...........      $221.74
54620               T................  ...................  Suspension of testis.......         0183      21.2592    $1,108.69  ...........      $221.74
54640               T................  ...................  Suspension of testis.......         0154      25.7262    $1,341.65      $464.85      $268.33
54650               C................  ...................  Orchiopexy (Fowler-          ...........  ...........  ...........  ...........  ...........
                                                             Stephens).
54660               T................  ...................  Revision of testis.........         0183      21.2592    $1,108.69  ...........      $221.74
54670               T................  ...................  Repair testis injury.......         0183      21.2592    $1,108.69  ...........      $221.74
54680               T................  ...................  Relocation of testis(es)...         0183      21.2592    $1,108.69  ...........      $221.74
54690               T................  ...................  Laparoscopy, orchiectomy...         0131      40.2026    $2,096.61    $1,001.89      $419.32

[[Page 66889]]

 
54692               T................  ...................  Laparoscopy, orchiopexy....         0132      56.9948    $2,972.34    $1,239.22      $594.47
54699               T................  ...................  Laparoscope proc, testis...         0130      30.4644    $1,588.75      $659.53      $317.75
54700               T................  ...................  Drainage of scrotum........         0183      21.2592    $1,108.69  ...........      $221.74
54800               T................  ...................  Biopsy of epididymis.......         0004       1.7441       $90.96       $23.47       $18.19
54820               T................  ...................  Exploration of epididymis..         0183      21.2592    $1,108.69  ...........      $221.74
54830               T................  ...................  Remove epididymis lesion...         0183      21.2592    $1,108.69  ...........      $221.74
54840               T................  ...................  Remove epididymis lesion...         0183      21.2592    $1,108.69  ...........      $221.74
54860               T................  ...................  Removal of epididymis......         0183      21.2592    $1,108.69  ...........      $221.74
54861               T................  ...................  Removal of epididymis......         0183      21.2592    $1,108.69  ...........      $221.74
54900               T................  ...................  Fusion of spermatic ducts..         0183      21.2592    $1,108.69  ...........      $221.74
54901               T................  ...................  Fusion of spermatic ducts..         0183      21.2592    $1,108.69  ...........      $221.74
55000               T................  ...................  Drainage of hydrocele......         0004       1.7441       $90.96       $23.47       $18.19
55040               T................  ...................  Removal of hydrocele.......         0154      25.7262    $1,341.65      $464.85      $268.33
55041               T................  ...................  Removal of hydroceles......         0154      25.7262    $1,341.65      $464.85      $268.33
55060               T................  ...................  Repair of hydrocele........         0183      21.2592    $1,108.69  ...........      $221.74
55100               T................  ...................  Drainage of scrotum abscess         0007      10.0191      $522.51      $108.89      $104.50
55110               T................  ...................  Explore scrotum............         0183      21.2592    $1,108.69  ...........      $221.74
55120               T................  ...................  Removal of scrotum lesion..         0183      21.2592    $1,108.69  ...........      $221.74
55150               T................  ...................  Removal of scrotum.........         0183      21.2592    $1,108.69  ...........      $221.74
55175               T................  ...................  Revision of scrotum........         0183      21.2592    $1,108.69  ...........      $221.74
55180               T................  ...................  Revision of scrotum........         0183      21.2592    $1,108.69  ...........      $221.74
55200               T................  ...................  Incision of sperm duct.....         0183      21.2592    $1,108.69  ...........      $221.74
55250               T................  ...................  Removal of sperm duct(s)...         0183      21.2592    $1,108.69  ...........      $221.74
55300               N................  ...................  Prepare, sperm duct x-ray..  ...........  ...........  ...........  ...........  ...........
55400               T................  ...................  Repair of sperm duct.......         0183      21.2592    $1,108.69  ...........      $221.74
55450               T................  ...................  Ligation of sperm duct.....         0183      21.2592    $1,108.69  ...........      $221.74
55500               T................  ...................  Removal of hydrocele.......         0183      21.2592    $1,108.69  ...........      $221.74
55520               T................  ...................  Removal of sperm cord               0183      21.2592    $1,108.69  ...........      $221.74
                                                             lesion.
55530               T................  ...................  Revise spermatic cord veins         0183      21.2592    $1,108.69  ...........      $221.74
55535               T................  ...................  Revise spermatic cord veins         0154      25.7262    $1,341.65      $464.85      $268.33
55540               T................  ...................  Revise hernia & sperm veins         0154      25.7262    $1,341.65      $464.85      $268.33
55550               T................  ...................  Laparo ligate spermatic             0131      40.2026    $2,096.61    $1,001.89      $419.32
                                                             vein.
55559               T................  ...................  Laparo proc, spermatic cord         0130      30.4644    $1,588.75      $659.53      $317.75
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      21.2592    $1,108.69  ...........      $221.74
55700               T................  ...................  Biopsy of prostate.........         0184       3.6918      $192.53       $96.27       $38.51
55705               T................  ...................  Biopsy of prostate.........         0184       3.6918      $192.53       $96.27       $38.51
55720               T................  ...................  Drainage of prostate                0162      20.5906    $1,073.82  ...........      $214.76
                                                             abscess.
55725               T................  ...................  Drainage of prostate                0162      20.5906    $1,073.82  ...........      $214.76
                                                             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      28.3714    $1,479.60  ...........      $295.92
55860               T................  ...................  Surgical exposure, prostate         0165      12.2672      $639.75  ...........      $127.95
55862               C................  ...................  Extensive prostate surgery.  ...........  ...........  ...........  ...........  ...........
55865               C................  ...................  Extensive prostate surgery.  ...........  ...........  ...........  ...........  ...........
55866               C................  NI.................  Laparo radical               ...........  ...........  ...........  ...........  ...........
                                                             prostatectomy.
55870               T................  ...................  Vag hyst w/enterocele               0197       1.5697       $81.86       $33.06       $16.37
                                                             repair.
55873               T................  ...................  Cryoablate prostate........         0674      62.9152    $3,281.09  ...........      $656.22
55899               T................  ...................  Genital surgery procedure..         0164       1.1240       $58.62       $17.59       $11.72
55970               E................  ...................  Sex transformation, M to F.  ...........  ...........  ...........  ...........  ...........
55980               E................  ...................  Sex transformation, F to M.  ...........  ...........  ...........  ...........  ...........
56405               T................  ...................  I & D of vulva/perineum....         0192       2.7228      $142.00       $39.11       $28.40
56420               T................  ...................  Drainage of gland abscess..         0192       2.7228      $142.00       $39.11       $28.40
56440               T................  ...................  Surgery for vulva lesion...         0194      18.0228      $939.91      $397.84      $187.98
56441               T................  ...................  Lysis of labial lesion(s)..         0193      14.4764      $754.96      $171.13      $150.99
56501               T................  ...................  Destroy, vulva lesions, sim         0017      15.8233      $825.20      $227.84      $165.04

[[Page 66890]]

 
56515               T................  ...................  Destroy vulva lesion/s              0695      18.6817      $974.27      $266.59      $194.85
                                                             compl.
56605               T................  ...................  Biopsy of vulva/perineum...         0019       3.7693      $196.57       $71.87       $39.31
56606               T................  ...................  Biopsy of vulva/perineum...         0019       3.7693      $196.57       $71.87       $39.31
56620               T................  ...................  Partial removal of vulva...         0195      23.7301    $1,237.55      $483.80      $247.51
56625               T................  ...................  Complete removal of vulva..         0195      23.7301    $1,237.55      $483.80      $247.51
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      18.0228      $939.91      $397.84      $187.98
56720               T................  ...................  Incision of hymen..........         0193      14.4764      $754.96      $171.13      $150.99
56740               T................  ...................  Remove vagina gland lesion.         0194      18.0228      $939.91      $397.84      $187.98
56800               T................  ...................  Repair of vagina...........         0194      18.0228      $939.91      $397.84      $187.98
56805               T................  ...................  Repair clitoris............         0194      18.0228      $939.91      $397.84      $187.98
56810               T................  ...................  Repair of perineum.........         0194      18.0228      $939.91      $397.84      $187.98
56820               T................  NI.................  Exam of vulva w/scope......         0188       1.0465       $54.58       $11.95       $10.92
56821               T................  NI.................  Exam/biopsy of vulva w/             0189       1.5310       $79.84       $18.60       $15.97
                                                             scope.
57000               T................  ...................  Exploration of vagina......         0194      18.0228      $939.91      $397.84      $187.98
57010               T................  ...................  Drainage of pelvic abscess.         0194      18.0228      $939.91      $397.84      $187.98
57020               T................  ...................  Drainage of pelvic fluid...         0192       2.7228      $142.00       $39.11       $28.40
57022               T................  ...................  I & d vaginal hematoma, pp.         0007      10.0191      $522.51      $108.89      $104.50
57023               T................  ...................  I & d vag hematoma, non-ob.         0007      10.0191      $522.51      $108.89      $104.50
57061               T................  ...................  Destroy vag lesions, simple         0194      18.0228      $939.91      $397.84      $187.98
57065               T................  ...................  Destroy vag lesions,                0194      18.0228      $939.91      $397.84      $187.98
                                                             complex.
57100               T................  ...................  Biopsy of vagina...........         0192       2.7228      $142.00       $39.11       $28.40
57105               T................  ...................  Biopsy of vagina...........         0194      18.0228      $939.91      $397.84      $187.98
57106               T................  ...................  Remove vagina wall, partial         0194      18.0228      $939.91      $397.84      $187.98
57107               T................  ...................  Remove vagina tissue, part.         0195      23.7301    $1,237.55      $483.80      $247.51
57109               T................  ...................  Vaginectomy partial w/nodes         0202      45.5610    $2,376.05    $1,164.26      $475.21
57110               C................  ...................  Remove vagina wall,          ...........  ...........  ...........  ...........  ...........
                                                             complete.
57111               C................  ...................  Remove vagina tissue, compl  ...........  ...........  ...........  ...........  ...........
57112               C................  ...................  Vaginectomy w/nodes, compl.  ...........  ...........  ...........  ...........  ...........
57120               T................  ...................  Closure of vagina..........         0194      18.0228      $939.91      $397.84      $187.98
57130               T................  ...................  Remove vagina lesion.......         0194      18.0228      $939.91      $397.84      $187.98
57135               T................  ...................  Remove vagina lesion.......         0194      18.0228      $939.91      $397.84      $187.98
57150               T................  ...................  Treat vagina infection.....         0191       0.2035       $10.61        $3.08        $2.12
57155               T................  ...................  Insert uteri tandems/ovoids         0192       2.7228      $142.00       $39.11       $28.40
57160               T................  ...................  Insert pessary/other device         0188       1.0465       $54.58       $11.95       $10.92
57170               T................  ...................  Fitting of diaphragm/cap...         0191       0.2035       $10.61        $3.08        $2.12
57180               T................  ...................  Treat vaginal bleeding.....         0192       2.7228      $142.00       $39.11       $28.40
57200               T................  ...................  Repair of vagina...........         0194      18.0228      $939.91      $397.84      $187.98
57210               T................  ...................  Repair vagina/perineum.....         0194      18.0228      $939.91      $397.84      $187.98
57220               T................  ...................  Revision of urethra........         0195      23.7301    $1,237.55      $483.80      $247.51
57230               T................  ...................  Repair of urethral lesion..         0194      18.0228      $939.91      $397.84      $187.98
57240               T................  ...................  Repair bladder & vagina....         0195      23.7301    $1,237.55      $483.80      $247.51
57250               T................  ...................  Repair rectum & vagina.....         0195      23.7301    $1,237.55      $483.80      $247.51
57260               T................  ...................  Repair of vagina...........         0195      23.7301    $1,237.55      $483.80      $247.51
57265               T................  ...................  Extensive repair of vagina.         0195      23.7301    $1,237.55      $483.80      $247.51
57268               T................  ...................  Repair of bowel bulge......         0195      23.7301    $1,237.55      $483.80      $247.51
57270               C................  ...................  Repair of bowel pouch......  ...........  ...........  ...........  ...........  ...........
57280               C................  ...................  Suspension of vagina.......  ...........  ...........  ...........  ...........  ...........
57282               C................  ...................  Repair of vaginal prolapse.  ...........  ...........  ...........  ...........  ...........
57284               T................  ...................  Repair paravaginal defect..         0195      23.7301    $1,237.55      $483.80      $247.51
57287               T................  ...................  Revise/remove sling repair.         0202      45.5610    $2,376.05    $1,164.26      $475.21
57288               T................  ...................  Repair bladder defect......         0202      45.5610    $2,376.05    $1,164.26      $475.21
57289               T................  ...................  Repair bladder & vagina....         0195      23.7301    $1,237.55      $483.80      $247.51
57291               T................  ...................  Construction of vagina.....         0195      23.7301    $1,237.55      $483.80      $247.51
57292               C................  ...................  Construct vagina with graft  ...........  ...........  ...........  ...........  ...........
57300               T................  ...................  Repair rectum-vagina                0195      23.7301    $1,237.55      $483.80      $247.51
                                                             fistula.
57305               C................  ...................  Repair rectum-vagina         ...........  ...........  ...........  ...........  ...........
                                                             fistula.
57307               C................  ...................  Fistula repair & colostomy.  ...........  ...........  ...........  ...........  ...........
57308               C................  ...................  Fistula repair, transperine  ...........  ...........  ...........  ...........  ...........

[[Page 66891]]

 
57310               T................  ...................  Repair urethrovaginal               0195      23.7301    $1,237.55      $483.80      $247.51
                                                             lesion.
57311               C................  ...................  Repair urethrovaginal        ...........  ...........  ...........  ...........  ...........
                                                             lesion.
57320               T................  ...................  Repair bladder-vagina               0195      23.7301    $1,237.55      $483.80      $247.51
                                                             lesion.
57330               T................  ...................  Repair bladder-vagina               0195      23.7301    $1,237.55      $483.80      $247.51
                                                             lesion.
57335               C................  ...................  Repair vagina..............  ...........  ...........  ...........  ...........  ...........
57400               T................  ...................  Dilation of vagina.........         0194      18.0228      $939.91      $397.84      $187.98
57410               T................  ...................  Pelvic examination.........         0194      18.0228      $939.91      $397.84      $187.98
57415               T................  ...................  Remove vaginal foreign body         0194      18.0228      $939.91      $397.84      $187.98
57420               T................  NI.................  Exam of vagina w/scope.....         0192       2.7228      $142.00       $39.11       $28.40
57421               T................  NI.................  Exam/biopsy of vag w/scope.         0192       2.7228      $142.00       $39.11       $28.40
57452               T................  ...................  Examination of vagina......         0189       1.5310       $79.84       $18.60       $15.97
57454               T................  ...................  Vagina examination & biopsy         0192       2.7228      $142.00       $39.11       $28.40
57455               T................  NI.................  Biopsy of cervix w/scope...         0192       2.7228      $142.00       $39.11       $28.40
57456               T................  NI.................  Endocerv curettage w/scope.         0192       2.7228      $142.00       $39.11       $28.40
57460               T................  ...................  Cervix excision............         0193      14.4764      $754.96      $171.13      $150.99
57461               T................  NI.................  Conz of cervix w/scope,             0194      18.0228      $939.91      $397.84      $187.98
                                                             leep.
57500               T................  ...................  Biopsy of cervix...........         0192       2.7228      $142.00       $39.11       $28.40
57505               T................  ...................  Endocervical curettage.....         0192       2.7228      $142.00       $39.11       $28.40
57510               T................  ...................  Cauterization of cervix....         0193      14.4764      $754.96      $171.13      $150.99
57511               T................  ...................  Cryocautery of cervix......         0189       1.5310       $79.84       $18.60       $15.97
57513               T................  ...................  Laser surgery of cervix....         0193      14.4764      $754.96      $171.13      $150.99
57520               T................  ...................  Conization of cervix.......         0194      18.0228      $939.91      $397.84      $187.98
57522               T................  ...................  Conization of cervix.......         0195      23.7301    $1,237.55      $483.80      $247.51
57530               T................  ...................  Removal of cervix..........         0195      23.7301    $1,237.55      $483.80      $247.51
57531               C................  ...................  Removal of cervix, radical.  ...........  ...........  ...........  ...........  ...........
57540               C................  ...................  Removal of residual cervix.  ...........  ...........  ...........  ...........  ...........
57545               C................  ...................  Remove cervix/repair pelvis  ...........  ...........  ...........  ...........  ...........
57550               T................  ...................  Removal of residual cervix.         0195      23.7301    $1,237.55      $483.80      $247.51
57555               T................  ...................  Remove cervix/repair vagina         0195      23.7301    $1,237.55      $483.80      $247.51
57556               T................  ...................  Remove cervix, repair bowel         0195      23.7301    $1,237.55      $483.80      $247.51
57700               T................  ...................  Revision of cervix.........         0194      18.0228      $939.91      $397.84      $187.98
57720               T................  ...................  Revision of cervix.........         0194      18.0228      $939.91      $397.84      $187.98
57800               T................  ...................  Dilation of cervical canal.         0193      14.4764      $754.96      $171.13      $150.99
57820               T................  ...................  D & c of residual cervix...         0196      15.5035      $808.52      $338.23      $161.70
58100               T................  ...................  Biopsy of uterus lining....         0188       1.0465       $54.58       $11.95       $10.92
58120               T................  ...................  Dilation and curettage.....         0196      15.5035      $808.52      $338.23      $161.70
58140               C................  ...................  Removal of uterus lesion...  ...........  ...........  ...........  ...........  ...........
58145               T................  ...................  Myomectomy vag method......         0195      23.7301    $1,237.55      $483.80      $247.51
58146               C................  NI.................  Myomectomy abdom complex...  ...........  ...........  ...........  ...........  ...........
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................  ...................  Vag hyst including t/o.....  ...........  ...........  ...........  ...........  ...........
58263               C................  ...................  Vag hyst w/t/o & vag repair  ...........  ...........  ...........  ...........  ...........
58267               C................  ...................  Vag hyst w/urinary repair..  ...........  ...........  ...........  ...........  ...........
58270               C................  ...................  Vag hyst w/enterocele        ...........  ...........  ...........  ...........  ...........
                                                             repair.
58275               C................  ...................  Hysterectomy/revise vagina.  ...........  ...........  ...........  ...........  ...........
58280               C................  ...................  Hysterectomy/revise vagina.  ...........  ...........  ...........  ...........  ...........
58285               C................  ...................  Extensive hysterectomy.....  ...........  ...........  ...........  ...........  ...........
58290               C................  NI.................  Vag hyst complex...........  ...........  ...........  ...........  ...........  ...........
58291               C................  NI.................  Vag hyst incl t/o, complex.  ...........  ...........  ...........  ...........  ...........
58292               C................  NI.................  Vag hyst t/o & repair,       ...........  ...........  ...........  ...........  ...........
                                                             compl.
58293               C................  NI.................  Vag hyst w/uro repair,       ...........  ...........  ...........  ...........  ...........
                                                             compl.
58294               C................  NI.................  Vag hyst w/enterocele,       ...........  ...........  ...........  ...........  ...........
                                                             compl.
58300               E................  ...................  Insert intrauterine device.  ...........  ...........  ...........  ...........  ...........
58301               T................  ...................  Remove intrauterine device.         0189       1.5310       $79.84       $18.60       $15.97
58321               T................  ...................  Artificial insemination....         0197       1.5697       $81.86       $33.06       $16.37
58322               T................  ...................  Artificial insemination....         0197       1.5697       $81.86       $33.06       $16.37
58323               T................  ...................  Sperm washing..............         0197       1.5697       $81.86       $33.06       $16.37
58340               N................  ...................  Catheter for hysterography.  ...........  ...........  ...........  ...........  ...........
58345               T................  ...................  Reopen fallopian tube......         0194      18.0228      $939.91      $397.84      $187.98

[[Page 66892]]

 
58346               T................  ...................  Insert heyman uteri capsule         0192       2.7228      $142.00       $39.11       $28.40
58350               T................  ...................  Reopen fallopian tube......         0194      18.0228      $939.91      $397.84      $187.98
58353               T................  ...................  Endometr ablate, thermal...         0193      14.4764      $754.96      $171.13      $150.99
58400               C................  ...................  Suspension of uterus.......  ...........  ...........  ...........  ...........  ...........
58410               C................  ...................  Suspension of uterus.......  ...........  ...........  ...........  ...........  ...........
58520               C................  ...................  Repair of ruptured uterus..  ...........  ...........  ...........  ...........  ...........
58540               C................  ...................  Revision of uterus.........  ...........  ...........  ...........  ...........  ...........
58545               T................  NI.................  Laparoscopic myomectomy....         0130      30.4644    $1,588.75      $659.53      $317.75
58546               T................  NI.................  Laparo-myomectomy, complex.         0131      40.2026    $2,096.61    $1,001.89      $419.32
58550               T................  ...................  Laparo-asst vag                     0132      56.9948    $2,972.34    $1,239.22      $594.47
                                                             hysterectomy.
58551               T................  DG.................  Laparoscopy, remove myoma..         0131      40.2026    $2,096.61    $1,001.89      $419.32
58552               T................  NI.................  Laparo-vag hyst incl t/o...         0131      40.2026    $2,096.61    $1,001.89      $419.32
58553               T................  NI.................  Laparo-vag hyst, complex...         0131      40.2026    $2,096.61    $1,001.89      $419.32
58554               T................  NI.................  Laparo-vag hyst w/t/o,              0131      40.2026    $2,096.61    $1,001.89      $419.32
                                                             compl.
58555               T................  ...................  Hysteroscopy, dx, sep proc.         0194      18.0228      $939.91      $397.84      $187.98
58558               T................  ...................  Hysteroscopy, biopsy.......         0190      19.0596      $993.98      $424.28      $198.80
58559               T................  ...................  Hysteroscopy, lysis........         0190      19.0596      $993.98      $424.28      $198.80
58560               T................  ...................  Hysteroscopy, resect septum         0190      19.0596      $993.98      $424.28      $198.80
58561               T................  ...................  Hysteroscopy, remove myoma.         0190      19.0596      $993.98      $424.28      $198.80
58562               T................  ...................  Hysteroscopy, remove fb....         0190      19.0596      $993.98      $424.28      $198.80
58563               T................  ...................  Hysteroscopy, ablation.....         0190      19.0596      $993.98      $424.28      $198.80
58578               T................  ...................  Laparo proc, uterus........         0190      19.0596      $993.98      $424.28      $198.80
58579               T................  ...................  Hysteroscope procedure.....         0190      19.0596      $993.98      $424.28      $198.80
58600               T................  ...................  Division of fallopian tube.         0194      18.0228      $939.91      $397.84      $187.98
58605               C................  ...................  Division of fallopian tube.  ...........  ...........  ...........  ...........  ...........
58611               C................  ...................  Ligate oviduct(s) add-on...  ...........  ...........  ...........  ...........  ...........
58615               T................  ...................  Occlude fallopian tube(s)..         0194      18.0228      $939.91      $397.84      $187.98
58660               T................  ...................  Laparoscopy, lysis.........         0131      40.2026    $2,096.61    $1,001.89      $419.32
58661               T................  ...................  Laparoscopy, remove adnexa.         0131      40.2026    $2,096.61    $1,001.89      $419.32
58662               T................  ...................  Laparoscopy, excise lesions         0131      40.2026    $2,096.61    $1,001.89      $419.32
58670               T................  ...................  Laparoscopy, tubal cautery.         0131      40.2026    $2,096.61    $1,001.89      $419.32
58671               T................  ...................  Laparoscopy, tubal block...         0131      40.2026    $2,096.61    $1,001.89      $419.32
58672               T................  ...................  Laparoscopy, fimbrioplasty.         0131      40.2026    $2,096.61    $1,001.89      $419.32
58673               T................  ...................  Laparoscopy, salpingostomy.         0131      40.2026    $2,096.61    $1,001.89      $419.32
58679               T................  ...................  Laparo proc, oviduct-ovary.         0130      30.4644    $1,588.75      $659.53      $317.75
58700               C................  ...................  Removal of fallopian tube..  ...........  ...........  ...........  ...........  ...........
58720               C................  ...................  Removal of ovary/tube(s)...  ...........  ...........  ...........  ...........  ...........
58740               C................  ...................  Revise fallopian tube(s)...  ...........  ...........  ...........  ...........  ...........
58750               C................  ...................  Repair oviduct.............  ...........  ...........  ...........  ...........  ...........
58752               C................  ...................  Revise ovarian tube(s).....  ...........  ...........  ...........  ...........  ...........
58760               C................  ...................  Remove tubal obstruction...  ...........  ...........  ...........  ...........  ...........
58770               C................  ...................  Create new tubal opening...  ...........  ...........  ...........  ...........  ...........
58800               T................  ...................  Drainage of ovarian cyst(s)         0195      23.7301    $1,237.55      $483.80      $247.51
58805               C................  ...................  Drainage of ovarian cyst(s)  ...........  ...........  ...........  ...........  ...........
58820               T................  ...................  Drain ovary abscess, open..         0195      23.7301    $1,237.55      $483.80      $247.51
58822               C................  ...................  Drain ovary abscess, percut  ...........  ...........  ...........  ...........  ...........
58823               T................  ...................  Drain pelvic abscess,               0193      14.4764      $754.96      $171.13      $150.99
                                                             percut.
58825               C................  ...................  Transposition, ovary(s)....  ...........  ...........  ...........  ...........  ...........
58900               T................  ...................  Biopsy of ovary(s).........         0195      23.7301    $1,237.55      $483.80      $247.51
58920               T................  ...................  Partial removal of ovary(s)         0202      45.5610    $2,376.05    $1,164.26      $475.21
58925               T................  ...................  Removal of ovarian cyst(s).         0202      45.5610    $2,376.05    $1,164.26      $475.21
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      18.0228      $939.91      $397.84      $187.98
58974               T................  ...................  Transfer of embryo.........         0197       1.5697       $81.86       $33.06       $16.37
58976               T................  ...................  Transfer of embryo.........         0197       1.5697       $81.86       $33.06       $16.37
58999               T................  ...................  Genital surgery procedure..         0191       0.2035       $10.61        $3.08        $2.12
59000               T................  ...................  Amniocentesis, diagnostic..         0198       1.2597       $65.69       $32.19       $13.14
59001               T................  ...................  Amniocentesis, therapeutic.         0198       1.2597       $65.69       $32.19       $13.14

[[Page 66893]]

 
59012               T................  ...................  Fetal cord                          0198       1.2597       $65.69       $32.19       $13.14
                                                             puncture,prenatal.
59015               T................  ...................  Chorion biopsy.............         0198       1.2597       $65.69       $32.19       $13.14
59020               T................  ...................  Fetal contract stress test.         0198       1.2597       $65.69       $32.19       $13.14
59025               T................  ...................  Fetal non-stress test......         0198       1.2597       $65.69       $32.19       $13.14
59030               T................  ...................  Fetal scalp blood sample...         0198       1.2597       $65.69       $32.19       $13.14
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      40.2026    $2,096.61    $1,001.89      $419.32
59151               T................  ...................  Treat ectopic pregnancy....         0131      40.2026    $2,096.61    $1,001.89      $419.32
59160               T................  ...................  D & c after delivery.......         0196      15.5035      $808.52      $338.23      $161.70
59200               T................  ...................  Insert cervical dilator....         0189       1.5310       $79.84       $18.60       $15.97
59300               T................  ...................  Episiotomy or vaginal               0193      14.4764      $754.96      $171.13      $150.99
                                                             repair.
59320               T................  ...................  Revision of cervix.........         0194      18.0228      $939.91      $397.84      $187.98
59325               C................  ...................  Revision of cervix.........  ...........  ...........  ...........  ...........  ...........
59350               C................  ...................  Repair of uterus...........  ...........  ...........  ...........  ...........  ...........
59400               E................  ...................  Obstetrical care...........  ...........  ...........  ...........  ...........  ...........
59409               T................  ...................  Obstetrical care...........         0199       3.9146      $204.15       $57.16       $40.83
59410               E................  ...................  Obstetrical care...........  ...........  ...........  ...........  ...........  ...........
59412               T................  ...................  Antepartum manipulation....         0199       3.9146      $204.15       $57.16       $40.83
59414               T................  ...................  Deliver placenta...........         0199       3.9146      $204.15       $57.16       $40.83
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       3.9146      $204.15       $57.16       $40.83
59614               E................  ...................  Vbac care after delivery...  ...........  ...........  ...........  ...........  ...........
59618               E................  ...................  Attempted vbac delivery....  ...........  ...........  ...........  ...........  ...........
59620               C................  ...................  Attempted vbac delivery      ...........  ...........  ...........  ...........  ...........
                                                             only.
59622               E................  ...................  Attempted vbac after care..  ...........  ...........  ...........  ...........  ...........
59812               T................  ...................  Treatment of miscarriage...         0201      15.3097      $798.42      $329.65      $159.68
59820               T................  ...................  Care of miscarriage........         0201      15.3097      $798.42      $329.65      $159.68
59821               T................  ...................  Treatment of miscarriage...         0201      15.3097      $798.42      $329.65      $159.68
59830               C................  ...................  Treat uterus infection.....  ...........  ...........  ...........  ...........  ...........
59840               T................  ...................  Abortion...................         0200      15.1838      $791.85      $307.83      $158.37
59841               T................  ...................  Abortion...................         0200      15.1838      $791.85      $307.83      $158.37
59850               C................  ...................  Abortion...................  ...........  ...........  ...........  ...........  ...........
59851               C................  ...................  Abortion...................  ...........  ...........  ...........  ...........  ...........
59852               C................  ...................  Abortion...................  ...........  ...........  ...........  ...........  ...........
59855               C................  ...................  Abortion...................  ...........  ...........  ...........  ...........  ...........
59856               C................  ...................  Abortion...................  ...........  ...........  ...........  ...........  ...........
59857               C................  ...................  Abortion...................  ...........  ...........  ...........  ...........  ...........
59866               T................  ...................  Abortion (mpr).............         0198       1.2597       $65.69       $32.19       $13.14
59870               T................  ...................  Evacuate mole of uterus....         0201      15.3097      $798.42      $329.65      $159.68
59871               T................  ...................  Remove cerclage suture.....         0194      18.0228      $939.91      $397.84      $187.98
59898               T................  ...................  Laparo proc, ob care/               0130      30.4644    $1,588.75      $659.53      $317.75
                                                             deliver.
59899               T................  ...................  Maternity care procedure...         0198       1.2597       $65.69       $32.19       $13.14
60000               T................  ...................  Drain thyroid/tongue cyst..         0252       5.8041      $302.69      $113.41       $60.54
60001               T................  ...................  Aspirate/inject thyriod             0004       1.7441       $90.96       $23.47       $18.19
                                                             cyst.
60100               T................  ...................  Biopsy of thyroid..........         0004       1.7441       $90.96       $23.47       $18.19
60200               T................  ...................  Remove thyroid lesion......         0114      36.1135    $1,883.36      $485.91      $376.67
60210               T................  ...................  Partial thyroid excision...         0114      36.1135    $1,883.36      $485.91      $376.67
60212               T................  ...................  Partial thyroid excision...         0114      36.1135    $1,883.36      $485.91      $376.67
60220               T................  ...................  Partial removal of thyroid.         0114      36.1135    $1,883.36      $485.91      $376.67
60225               T................  ...................  Partial removal of thyroid.         0114      36.1135    $1,883.36      $485.91      $376.67

[[Page 66894]]

 
60240               T................  ...................  Removal of thyroid.........         0114      36.1135    $1,883.36      $485.91      $376.67
60252               T................  ...................  Removal of thyroid.........         0256      34.0302    $1,774.71  ...........      $354.94
60254               C................  ...................  Extensive thyroid surgery..  ...........  ...........  ...........  ...........  ...........
60260               T................  ...................  Repeat thyroid surgery.....         0256      34.0302    $1,774.71  ...........      $354.94
60270               C................  ...................  Removal of thyroid.........  ...........  ...........  ...........  ...........  ...........
60271               C................  ...................  Removal of thyroid.........  ...........  ...........  ...........  ...........  ...........
60280               T................  ...................  Remove thyroid duct lesion.         0114      36.1135    $1,883.36      $485.91      $376.67
60281               T................  ...................  Remove thyroid duct lesion.         0114      36.1135    $1,883.36      $485.91      $376.67
60500               T................  ...................  Explore parathyroid glands.         0256      34.0302    $1,774.71  ...........      $354.94
60502               C................  ...................  Re-explore parathyroids....  ...........  ...........  ...........  ...........  ...........
60505               C................  ...................  Explore parathyroid glands.  ...........  ...........  ...........  ...........  ...........
60512               T................  ...................  Autotransplant parathyroid.         0022      17.3930      $907.06      $354.45      $181.41
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      30.4644    $1,588.75      $659.53      $317.75
60699               T................  ...................  Endocrine surgery procedure         0114      36.1135    $1,883.36      $485.91      $376.67
61000               T................  ...................  Remove cranial cavity fluid         0212       3.3139      $172.82       $79.53       $34.56
61001               T................  ...................  Remove cranial cavity fluid         0212       3.3139      $172.82       $79.53       $34.56
61020               T................  ...................  Remove brain cavity fluid..         0212       3.3139      $172.82       $79.53       $34.56
61026               T................  ...................  Injection into brain canal.         0212       3.3139      $172.82       $79.53       $34.56
61050               T................  ...................  Remove brain canal fluid...         0212       3.3139      $172.82       $79.53       $34.56
61055               T................  ...................  Injection into brain canal.         0212       3.3139      $172.82       $79.53       $34.56
61070               T................  ...................  Brain canal shunt procedure         0212       3.3139      $172.82       $79.53       $34.56
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      34.0302    $1,774.71      $453.41      $354.94
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....  ...........  ...........  ...........  ...........  ...........
61316               N................  NI.................  Implt cran bone flap to      ...........  ...........  ...........  ...........  ...........
                                                             abdo.
61320               C................  ...................  Open skull for drainage....  ...........  ...........  ...........  ...........  ...........
61321               C................  ...................  Open skull for drainage....  ...........  ...........  ...........  ...........  ...........
61322               C................  NI.................  Decompressive craniotomy...  ...........  ...........  ...........  ...........  ...........
61323               C................  NI.................  Decompressive lobectomy....  ...........  ...........  ...........  ...........  ...........
61330               T................  ...................  Decompress eye socket......         0256      34.0302    $1,774.71  ...........      $354.94
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...  ...........  ...........  ...........  ...........  ...........

[[Page 66895]]

 
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....  ...........  ...........  ...........  ...........  ...........
61517               N................  NI.................  Implt brain chemotx add-on.  ...........  ...........  ...........  ...........  ...........
61518               C................  ...................  Removal of brain lesion....  ...........  ...........  ...........  ...........  ...........
61519               C................  ...................  Remove brain lining lesion.  ...........  ...........  ...........  ...........  ...........
61520               C................  ...................  Removal of brain lesion....  ...........  ...........  ...........  ...........  ...........
61521               C................  ...................  Removal of brain lesion....  ...........  ...........  ...........  ...........  ...........
61522               C................  ...................  Removal of brain abscess...  ...........  ...........  ...........  ...........  ...........
61524               C................  ...................  Removal of brain lesion....  ...........  ...........  ...........  ...........  ...........
61526               C................  ...................  Removal of brain lesion....  ...........  ...........  ...........  ...........  ...........
61530               C................  ...................  Removal of brain lesion....  ...........  ...........  ...........  ...........  ...........
61531               C................  ...................  Implant brain electrodes...  ...........  ...........  ...........  ...........  ...........
61533               C................  ...................  Implant brain electrodes...  ...........  ...........  ...........  ...........  ...........
61534               C................  ...................  Removal of brain lesion....  ...........  ...........  ...........  ...........  ...........
61535               C................  ...................  Remove brain electrodes....  ...........  ...........  ...........  ...........  ...........
61536               C................  ...................  Removal of brain lesion....  ...........  ...........  ...........  ...........  ...........
61538               C................  ...................  Removal of brain tissue....  ...........  ...........  ...........  ...........  ...........
61539               C................  ...................  Removal of brain tissue....  ...........  ...........  ...........  ...........  ...........
61541               C................  ...................  Incision of brain tissue...  ...........  ...........  ...........  ...........  ...........
61542               C................  ...................  Removal of brain tissue....  ...........  ...........  ...........  ...........  ...........
61543               C................  ...................  Removal of brain tissue....  ...........  ...........  ...........  ...........  ...........
61544               C................  ...................  Remove & treat brain lesion  ...........  ...........  ...........  ...........  ...........
61545               C................  ...................  Excision of brain tumor....  ...........  ...........  ...........  ...........  ...........
61546               C................  ...................  Removal of pituitary gland.  ...........  ...........  ...........  ...........  ...........
61548               C................  ...................  Removal of pituitary gland.  ...........  ...........  ...........  ...........  ...........
61550               C................  ...................  Release of skull seams.....  ...........  ...........  ...........  ...........  ...........
61552               C................  ...................  Release of skull seams.....  ...........  ...........  ...........  ...........  ...........
61556               C................  ...................  Incise skull/sutures.......  ...........  ...........  ...........  ...........  ...........
61557               C................  ...................  Incise skull/sutures.......  ...........  ...........  ...........  ...........  ...........
61558               C................  ...................  Excision of skull/sutures..  ...........  ...........  ...........  ...........  ...........
61559               C................  ...................  Excision of skull/sutures..  ...........  ...........  ...........  ...........  ...........
61563               C................  ...................  Excision of skull tumor....  ...........  ...........  ...........  ...........  ...........
61564               C................  ...................  Excision of skull tumor....  ...........  ...........  ...........  ...........  ...........
61570               C................  ...................  Remove foreign body, brain.  ...........  ...........  ...........  ...........  ...........
61571               C................  ...................  Incise skull for brain       ...........  ...........  ...........  ...........  ...........
                                                             wound.
61575               C................  ...................  Skull base/brainstem         ...........  ...........  ...........  ...........  ...........
                                                             surgery.
61576               C................  ...................  Skull base/brainstem         ...........  ...........  ...........  ...........  ...........
                                                             surgery.
61580               C................  ...................  Craniofacial approach,       ...........  ...........  ...........  ...........  ...........
                                                             skull.
61581               C................  ...................  Craniofacial approach,       ...........  ...........  ...........  ...........  ...........
                                                             skull.
61582               C................  ...................  Craniofacial approach,       ...........  ...........  ...........  ...........  ...........
                                                             skull.
61583               C................  ...................  Craniofacial approach,       ...........  ...........  ...........  ...........  ...........
                                                             skull.
61584               C................  ...................  Orbitocranial approach/      ...........  ...........  ...........  ...........  ...........
                                                             skull.
61585               C................  ...................  Orbitocranial approach/      ...........  ...........  ...........  ...........  ...........
                                                             skull.
61586               C................  ...................  Resect nasopharynx, skull..  ...........  ...........  ...........  ...........  ...........
61590               C................  ...................  Infratemporal approach/      ...........  ...........  ...........  ...........  ...........
                                                             skull.
61591               C................  ...................  Infratemporal approach/      ...........  ...........  ...........  ...........  ...........
                                                             skull.
61592               C................  ...................  Orbitocranial approach/      ...........  ...........  ...........  ...........  ...........
                                                             skull.
61595               C................  ...................  Transtemporal approach/      ...........  ...........  ...........  ...........  ...........
                                                             skull.
61596               C................  ...................  Transcochlear approach/      ...........  ...........  ...........  ...........  ...........
                                                             skull.
61597               C................  ...................  Transcondylar approach/      ...........  ...........  ...........  ...........  ...........
                                                             skull.
61598               C................  ...................  Transpetrosal approach/      ...........  ...........  ...........  ...........  ...........
                                                             skull.
61600               C................  ...................  Resect/excise cranial        ...........  ...........  ...........  ...........  ...........
                                                             lesion.
61601               C................  ...................  Resect/excise cranial        ...........  ...........  ...........  ...........  ...........
                                                             lesion.
61605               C................  ...................  Resect/excise cranial        ...........  ...........  ...........  ...........  ...........
                                                             lesion.
61606               C................  ...................  Resect/excise cranial        ...........  ...........  ...........  ...........  ...........
                                                             lesion.
61607               C................  ...................  Resect/excise cranial        ...........  ...........  ...........  ...........  ...........
                                                             lesion.
61608               C................  ...................  Resect/excise cranial        ...........  ...........  ...........  ...........  ...........
                                                             lesion.
61609               C................  ...................  Transect artery, sinus.....  ...........  ...........  ...........  ...........  ...........
61610               C................  ...................  Transect artery, sinus.....  ...........  ...........  ...........  ...........  ...........

[[Page 66896]]

 
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................  ...........  ...........  ...........  ...........  ...........
61623               T................  NI.................  Endovasc tempory vessel             0979  ...........    $1,625.00  ...........      $325.00
                                                             occl.
61624               C................  ...................  Occlusion/embolization cath  ...........  ...........  ...........  ...........  ...........
61626               T................  ...................  Transcath occlusion, non-           0081      43.5067    $2,268.92  ...........      $453.78
                                                             cns.
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      15.8136      $824.70  ...........      $164.94
61791               T................  ...................  Treat trigeminal tract.....         0204       2.0251      $105.61       $40.13       $21.12
61793               E................  ...................  Focus radiation beam.......  ...........  ...........  ...........  ...........  ...........
61795               S................  ...................  Brain surgery using                 0302       9.2343      $481.58      $182.43       $96.32
                                                             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      25.8424    $1,347.71      $619.95      $269.54
                                                             neuroelectrode.
61885               T................  ...................  Implant neurostim one array         0222     227.7370   $11,876.71  ...........    $2,375.34
61886               T................  ...................  Implant neurostim arrays...         0222     227.7370   $11,876.71  ...........    $2,375.34
61888               T................  ...................  Revise/remove neuroreceiver         0688      74.5719    $3,889.00    $1,905.61      $777.80
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.  ...........  ...........  ...........  ...........  ...........
62148               N................  NI.................  Retr bone flap to fix skull  ...........  ...........  ...........  ...........  ...........
62160               N................  NI.................  Neuroendoscopy add-on......  ...........  ...........  ...........  ...........  ...........
62161               C................  NI.................  Dissect brain w/scope......  ...........  ...........  ...........  ...........  ...........
62162               C................  NI.................  Remove colloid cyst w/scope  ...........  ...........  ...........  ...........  ...........
62163               C................  NI.................  Neuroendoscopy w/fb removal  ...........  ...........  ...........  ...........  ...........

[[Page 66897]]

 
62164               C................  NI.................  Remove brain tumor w/scope.  ...........  ...........  ...........  ...........  ...........
62165               C................  NI.................  Remove pituit tumor w/scope  ...........  ...........  ...........  ...........  ...........
62180               C................  ...................  Establish brain cavity       ...........  ...........  ...........  ...........  ...........
                                                             shunt.
62190               C................  ...................  Establish brain cavity       ...........  ...........  ...........  ...........  ...........
                                                             shunt.
62192               C................  ...................  Establish brain cavity       ...........  ...........  ...........  ...........  ...........
                                                             shunt.
62194               T................  ...................  Replace/irrigate catheter..         0121       2.0833      $108.65       $43.80       $21.73
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       2.0833      $108.65       $43.80       $21.73
62230               T................  ...................  Replace/revise brain shunt.         0224      34.0302    $1,774.71      $453.41      $354.94
62252               S................  ...................  Csf shunt reprogram........         0691       2.9166      $152.10       $83.65       $30.42
62256               C................  ...................  Remove brain cavity shunt..  ...........  ...........  ...........  ...........  ...........
62258               C................  ...................  Replace brain cavity shunt.  ...........  ...........  ...........  ...........  ...........
62263               T................  ...................  Lysis epidural adhesions...         0203      11.7924      $614.99      $276.76      $123.00
62264               T................  NI.................  Epidural lysis on single            0203      11.7924      $614.99      $276.76      $123.00
                                                             day.
62268               T................  ...................  Drain spinal cord cyst.....         0212       3.3139      $172.82       $79.53       $34.56
62269               T................  ...................  Needle biopsy, spinal cord.         0005       3.1201      $162.72       $71.59       $32.54
62270               T................  ...................  Spinal fluid tap,                   0206       4.7867      $249.63       $75.55       $49.93
                                                             diagnostic.
62272               T................  ...................  Drain cerebro spinal fluid.         0206       4.7867      $249.63       $75.55       $49.93
62273               T................  ...................  Treat epidural spine lesion         0206       4.7867      $249.63       $75.55       $49.93
62280               T................  ...................  Treat spinal cord lesion...         0207       5.7654      $300.67      $123.69       $60.13
62281               T................  ...................  Treat spinal cord lesion...         0207       5.7654      $300.67      $123.69       $60.13
62282               T................  ...................  Treat spinal canal lesion..         0207       5.7654      $300.67      $123.69       $60.13
62284               N................  ...................  Injection for myelogram....  ...........  ...........  ...........  ...........  ...........
62287               T................  ...................  Percutaneous diskectomy....         0220      15.8136      $824.70  ...........      $164.94
62290               N................  ...................  Inject for spine disk x-ray  ...........  ...........  ...........  ...........  ...........
62291               N................  ...................  Inject for spine disk x-ray  ...........  ...........  ...........  ...........  ...........
62292               T................  ...................  Injection into disk lesion.         0212       3.3139      $172.82       $79.53       $34.56
62294               T................  ...................  Injection into spinal               0212       3.3139      $172.82       $79.53       $34.56
                                                             artery.
62310               T................  ...................  Inject spine c/t...........         0206       4.7867      $249.63       $75.55       $49.93
62311               T................  ...................  Inject spine l/s (cd)......         0206       4.7867      $249.63       $75.55       $49.93
62318               T................  ...................  Inject spine w/cath, c/t...         0206       4.7867      $249.63       $75.55       $49.93
62319               T................  ...................  Inject spine w/cath l/s             0206       4.7867      $249.63       $75.55       $49.93
                                                             (cd).
62350               T................  ...................  Implant spinal canal cath..         0223      41.0262    $2,139.56  ...........      $427.91
62351               T................  ...................  Implant spinal canal cath..         0208      38.4487    $2,005.14  ...........      $401.03
62355               T................  ...................  Remove spinal canal                 0203      11.7924      $614.99      $276.76      $123.00
                                                             catheter.
62360               T................  ...................  Insert spine infusion               0226     144.3474    $7,527.86  ...........    $1,505.57
                                                             device.
62361               T................  ...................  Implant spine infusion pump         0227     144.5122    $7,536.46  ...........    $1,507.29
62362               T................  ...................  Implant spine infusion pump         0227     144.5122    $7,536.46  ...........    $1,507.29
62365               T................  ...................  Remove spine infusion               0203      11.7924      $614.99      $276.76      $123.00
                                                             device.
62367               S................  ...................  Analyze spine infusion pump         0691       2.9166      $152.10       $83.65       $30.42
62368               S................  ...................  Analyze spine infusion pump         0691       2.9166      $152.10       $83.65       $30.42
63001               T................  ...................  Removal of spinal lamina...         0208      38.4487    $2,005.14  ...........      $401.03
63003               T................  ...................  Removal of spinal lamina...         0208      38.4487    $2,005.14  ...........      $401.03
63005               T................  ...................  Removal of spinal lamina...         0208      38.4487    $2,005.14  ...........      $401.03
63011               T................  ...................  Removal of spinal lamina...         0208      38.4487    $2,005.14  ...........      $401.03
63012               T................  ...................  Removal of spinal lamina...         0208      38.4487    $2,005.14  ...........      $401.03
63015               T................  ...................  Removal of spinal lamina...         0208      38.4487    $2,005.14  ...........      $401.03
63016               T................  ...................  Removal of spinal lamina...         0208      38.4487    $2,005.14  ...........      $401.03
63017               T................  ...................  Removal of spinal lamina...         0208      38.4487    $2,005.14  ...........      $401.03
63020               T................  ...................  Neck spine disk surgery....         0208      38.4487    $2,005.14  ...........      $401.03
63030               T................  ...................  Low back disk surgery......         0208      38.4487    $2,005.14  ...........      $401.03
63035               T................  ...................  Spinal disk surgery add-on.         0208      38.4487    $2,005.14  ...........      $401.03
63040               T................  ...................  Laminotomy, single cervical         0208      38.4487    $2,005.14  ...........      $401.03
63042               T................  ...................  Laminotomy, single lumbar..         0208      38.4487    $2,005.14  ...........      $401.03
63043               C................  ...................  Laminotomy, addl cervical..  ...........  ...........  ...........  ...........  ...........
63044               C................  ...................  Laminotomy, addl lumbar....  ...........  ...........  ...........  ...........  ...........
63045               T................  ...................  Removal of spinal lamina...         0208      38.4487    $2,005.14  ...........      $401.03
63046               T................  ...................  Removal of spinal lamina...         0208      38.4487    $2,005.14  ...........      $401.03
63047               T................  ...................  Removal of spinal lamina...         0208      38.4487    $2,005.14  ...........      $401.03
63048               T................  ...................  Remove spinal lamina add-on         0208      38.4487    $2,005.14  ...........      $401.03
63055               T................  ...................  Decompress spinal cord.....         0208      38.4487    $2,005.14  ...........      $401.03
63056               T................  ...................  Decompress spinal cord.....         0208      38.4487    $2,005.14  ...........      $401.03

[[Page 66898]]

 
63057               T................  ...................  Decompress spine cord add-          0208      38.4487    $2,005.14  ...........      $401.03
                                                             on.
63064               T................  ...................  Decompress spinal cord.....         0208      38.4487    $2,005.14  ...........      $401.03
63066               T................  ...................  Decompress spine cord add-          0208      38.4487    $2,005.14  ...........      $401.03
                                                             on.
63075               C................  ...................  Neck spine disk surgery....  ...........  ...........  ...........  ...........  ...........
63076               C................  ...................  Neck spine disk surgery....  ...........  ...........  ...........  ...........  ...........
63077               C................  ...................  Spine disk surgery, thorax.  ...........  ...........  ...........  ...........  ...........
63078               C................  ...................  Spine disk surgery, thorax.  ...........  ...........  ...........  ...........  ...........
63081               C................  ...................  Removal of vertebral body..  ...........  ...........  ...........  ...........  ...........
63082               C................  ...................  Remove vertebral body add-   ...........  ...........  ...........  ...........  ...........
                                                             on.
63085               C................  ...................  Removal of vertebral body..  ...........  ...........  ...........  ...........  ...........
63086               C................  ...................  Remove vertebral body add-   ...........  ...........  ...........  ...........  ...........
                                                             on.
63087               C................  ...................  Removal of vertebral body..  ...........  ...........  ...........  ...........  ...........
63088               C................  ...................  Remove vertebral body add-   ...........  ...........  ...........  ...........  ...........
                                                             on.
63090               C................  ...................  Removal of vertebral body..  ...........  ...........  ...........  ...........  ...........
63091               C................  ...................  Remove vertebral body add-   ...........  ...........  ...........  ...........  ...........
                                                             on.
63170               C................  ...................  Incise spinal cord tract(s)  ...........  ...........  ...........  ...........  ...........
63172               C................  ...................  Drainage of spinal cyst....  ...........  ...........  ...........  ...........  ...........
63173               C................  ...................  Drainage of spinal cyst....  ...........  ...........  ...........  ...........  ...........
63180               C................  ...................  Revise spinal cord           ...........  ...........  ...........  ...........  ...........
                                                             ligaments.
63182               C................  ...................  Revise spinal cord           ...........  ...........  ...........  ...........  ...........
                                                             ligaments.
63185               C................  ...................  Incise spinal column/nerves  ...........  ...........  ...........  ...........  ...........
63190               C................  ...................  Incise spinal column/nerves  ...........  ...........  ...........  ...........  ...........
63191               C................  ...................  Incise spinal column/nerves  ...........  ...........  ...........  ...........  ...........
63194               C................  ...................  Incise spinal column & cord  ...........  ...........  ...........  ...........  ...........
63195               C................  ...................  Incise spinal column & cord  ...........  ...........  ...........  ...........  ...........
63196               C................  ...................  Incise spinal column & cord  ...........  ...........  ...........  ...........  ...........
63197               C................  ...................  Incise spinal column & cord  ...........  ...........  ...........  ...........  ...........
63198               C................  ...................  Incise spinal column & cord  ...........  ...........  ...........  ...........  ...........
63199               C................  ...................  Incise spinal column & cord  ...........  ...........  ...........  ...........  ...........
63200               C................  ...................  Release of spinal cord.....  ...........  ...........  ...........  ...........  ...........
63250               C................  ...................  Revise spinal cord vessels.  ...........  ...........  ...........  ...........  ...........
63251               C................  ...................  Revise spinal cord vessels.  ...........  ...........  ...........  ...........  ...........
63252               C................  ...................  Revise spinal cord vessels.  ...........  ...........  ...........  ...........  ...........
63265               C................  ...................  Excise intraspinal lesion..  ...........  ...........  ...........  ...........  ...........
63266               C................  ...................  Excise intraspinal lesion..  ...........  ...........  ...........  ...........  ...........
63267               C................  ...................  Excise intraspinal lesion..  ...........  ...........  ...........  ...........  ...........
63268               C................  ...................  Excise intraspinal lesion..  ...........  ...........  ...........  ...........  ...........
63270               C................  ...................  Excise intraspinal lesion..  ...........  ...........  ...........  ...........  ...........
63271               C................  ...................  Excise intraspinal lesion..  ...........  ...........  ...........  ...........  ...........
63272               C................  ...................  Excise intraspinal lesion..  ...........  ...........  ...........  ...........  ...........
63273               C................  ...................  Excise intraspinal lesion..  ...........  ...........  ...........  ...........  ...........
63275               C................  ...................  Biopsy/excise spinal tumor.  ...........  ...........  ...........  ...........  ...........
63276               C................  ...................  Biopsy/excise spinal tumor.  ...........  ...........  ...........  ...........  ...........
63277               C................  ...................  Biopsy/excise spinal tumor.  ...........  ...........  ...........  ...........  ...........
63278               C................  ...................  Biopsy/excise spinal tumor.  ...........  ...........  ...........  ...........  ...........
63280               C................  ...................  Biopsy/excise spinal tumor.  ...........  ...........  ...........  ...........  ...........
63281               C................  ...................  Biopsy/excise spinal tumor.  ...........  ...........  ...........  ...........  ...........
63282               C................  ...................  Biopsy/excise spinal tumor.  ...........  ...........  ...........  ...........  ...........
63283               C................  ...................  Biopsy/excise spinal tumor.  ...........  ...........  ...........  ...........  ...........
63285               C................  ...................  Biopsy/excise spinal tumor.  ...........  ...........  ...........  ...........  ...........
63286               C................  ...................  Biopsy/excise spinal tumor.  ...........  ...........  ...........  ...........  ...........
63287               C................  ...................  Biopsy/excise spinal tumor.  ...........  ...........  ...........  ...........  ...........
63290               C................  ...................  Biopsy/excise spinal tumor.  ...........  ...........  ...........  ...........  ...........
63300               C................  ...................  Removal of vertebral body..  ...........  ...........  ...........  ...........  ...........
63301               C................  ...................  Removal of vertebral body..  ...........  ...........  ...........  ...........  ...........
63302               C................  ...................  Removal of vertebral body..  ...........  ...........  ...........  ...........  ...........
63303               C................  ...................  Removal of vertebral body..  ...........  ...........  ...........  ...........  ...........
63304               C................  ...................  Removal of vertebral body..  ...........  ...........  ...........  ...........  ...........
63305               C................  ...................  Removal of vertebral body..  ...........  ...........  ...........  ...........  ...........
63306               C................  ...................  Removal of vertebral body..  ...........  ...........  ...........  ...........  ...........
63307               C................  ...................  Removal of vertebral body..  ...........  ...........  ...........  ...........  ...........
63308               C................  ...................  Remove vertebral body add-   ...........  ...........  ...........  ...........  ...........
                                                             on.
63600               T................  ...................  Remove spinal cord lesion..         0220      15.8136      $824.70  ...........      $164.94
63610               T................  ...................  Stimulation of spinal cord.         0220      15.8136      $824.70  ...........      $164.94
63615               T................  ...................  Remove lesion of spinal             0220      15.8136      $824.70  ...........      $164.94
                                                             cord.

[[Page 66899]]

 
63650               S................  ...................  Implant neuroelectrodes....         0225     139.3379    $7,266.61  ...........    $1,453.32
63655               S................  ...................  Implant neuroelectrodes....         0225     139.3379    $7,266.61  ...........    $1,453.32
63660               T................  ...................  Revise/remove                       0687      25.8424    $1,347.71      $619.95      $269.54
                                                             neuroelectrode.
63685               T................  ...................  Implant neuroreceiver......         0222     227.7370   $11,876.71  ...........    $2,375.34
63688               T................  ...................  Revise/remove neuroreceiver         0688      74.5719    $3,889.00    $1,905.61      $777.80
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      59.6207    $3,109.28      $696.46      $621.86
63744               T................  ...................  Revision of spinal shunt...         0228      59.6207    $3,109.28      $696.46      $621.86
63746               T................  ...................  Removal of spinal shunt....         0109       7.4708      $389.61      $131.49       $77.92
64400               T................  ...................  N block inj, trigeminal....         0204       2.0251      $105.61       $40.13       $21.12
64402               T................  ...................  N block inj, facial........         0204       2.0251      $105.61       $40.13       $21.12
64405               T................  ...................  N block inj, occipital.....         0204       2.0251      $105.61       $40.13       $21.12
64408               T................  ...................  N block inj, vagus.........         0204       2.0251      $105.61       $40.13       $21.12
64410               T................  ...................  N block inj, phrenic.......         0204       2.0251      $105.61       $40.13       $21.12
64412               T................  ...................  N block inj, spinal                 0204       2.0251      $105.61       $40.13       $21.12
                                                             accessor.
64413               T................  ...................  N block inj, cervical               0204       2.0251      $105.61       $40.13       $21.12
                                                             plexus.
64415               T................  ...................  Injection for nerve block..         0204       2.0251      $105.61       $40.13       $21.12
64416               T................  NI.................  N block cont infuse, b plex         0204       2.0251      $105.61       $40.13       $21.12
64417               T................  ...................  N block inj, axillary......         0204       2.0251      $105.61       $40.13       $21.12
64418               T................  ...................  N block inj, suprascapular.         0204       2.0251      $105.61       $40.13       $21.12
64420               T................  ...................  N block inj, intercost, sng         0207       5.7654      $300.67      $123.69       $60.13
64421               T................  ...................  N block inj, intercost, mlt         0207       5.7654      $300.67      $123.69       $60.13
64425               T................  ...................  N block inj ilio-ing/hypogi         0204       2.0251      $105.61       $40.13       $21.12
64430               T................  ...................  N block inj, pudendal......         0204       2.0251      $105.61       $40.13       $21.12
64435               T................  ...................  N block inj, paracervical..         0204       2.0251      $105.61       $40.13       $21.12
64445               T................  ...................  Injection for nerve block..         0204       2.0251      $105.61       $40.13       $21.12
64446               T................  NI.................  N blk inj, sciatic, cont            0204       2.0251      $105.61       $40.13       $21.12
                                                             inf.
64447               T................  NI.................  N block inj fem, single....         0204       2.0251      $105.61       $40.13       $21.12
64448               T................  NI.................  N block inj fem, cont inf..         0204       2.0251      $105.61       $40.13       $21.12
64450               T................  ...................  N block, other peripheral..         0204       2.0251      $105.61       $40.13       $21.12
64470               T................  ...................  Inj paravertebral c/t......         0207       5.7654      $300.67      $123.69       $60.13
64472               T................  ...................  Inj paravertebral c/t add-          0207       5.7654      $300.67      $123.69       $60.13
                                                             on.
64475               T................  ...................  Inj paravertebral l/s......         0207       5.7654      $300.67      $123.69       $60.13
64476               T................  ...................  Inj paravertebral l/s add-          0207       5.7654      $300.67      $123.69       $60.13
                                                             on.
64479               T................  ...................  Inj foramen epidural c/t...         0207       5.7654      $300.67      $123.69       $60.13
64480               T................  ...................  Inj foramen epidural add-on         0207       5.7654      $300.67      $123.69       $60.13
64483               T................  ...................  Inj foramen epidural l/s...         0207       5.7654      $300.67      $123.69       $60.13
64484               T................  ...................  Inj foramen epidural add-on         0207       5.7654      $300.67      $123.69       $60.13
64505               T................  ...................  N block, spenopalatine              0204       2.0251      $105.61       $40.13       $21.12
                                                             gangl.
64508               T................  ...................  N block, carotid sinus s/p.         0204       2.0251      $105.61       $40.13       $21.12
64510               T................  ...................  N block, stellate ganglion.         0207       5.7654      $300.67      $123.69       $60.13
64520               T................  ...................  N block, lumbar/thoracic...         0207       5.7654      $300.67      $123.69       $60.13
64530               T................  ...................  N block inj, celiac pelus..         0207       5.7654      $300.67      $123.69       $60.13
64550               A................  ...................  Apply neurostimulator......  ...........  ...........  ...........  ...........  ...........
64553               S................  ...................  Implant neuroelectrodes....         0225     139.3379    $7,266.61  ...........    $1,453.32
64555               S................  ...................  Implant neuroelectrodes....         0225     139.3379    $7,266.61  ...........    $1,453.32
64560               S................  ...................  Implant neuroelectrodes....         0225     139.3379    $7,266.61  ...........    $1,453.32
64561               S................  ...................  Implant neuroelectrodes....         0225     139.3379    $7,266.61  ...........    $1,453.32
64565               S................  ...................  Implant neuroelectrodes....         0225     139.3379    $7,266.61  ...........    $1,453.32
64573               S................  ...................  Implant neuroelectrodes....         0225     139.3379    $7,266.61  ...........    $1,453.32
64575               S................  ...................  Implant neuroelectrodes....         0225     139.3379    $7,266.61  ...........    $1,453.32
64577               S................  ...................  Implant neuroelectrodes....         0225     139.3379    $7,266.61  ...........    $1,453.32
64580               S................  ...................  Implant neuroelectrodes....         0225     139.3379    $7,266.61  ...........    $1,453.32
64581               S................  ...................  Implant neuroelectrodes....         0225     139.3379    $7,266.61  ...........    $1,453.32
64585               T................  ...................  Revise/remove                       0687      25.8424    $1,347.71      $619.95      $269.54
                                                             neuroelectrode.
64590               T................  ...................  Implant neuroreceiver......         0222     227.7370   $11,876.71  ...........    $2,375.34
64595               T................  ...................  Revise/remove neuroreceiver         0688      74.5719    $3,889.00    $1,905.61      $777.80
64600               T................  ...................  Injection treatment of              0203      11.7924      $614.99      $276.76      $123.00
                                                             nerve.

[[Page 66900]]

 
64605               T................  ...................  Injection treatment of              0203      11.7924      $614.99      $276.76      $123.00
                                                             nerve.
64610               T................  ...................  Injection treatment of              0203      11.7924      $614.99      $276.76      $123.00
                                                             nerve.
64612               T................  ...................  Destroy nerve, face muscle.         0204       2.0251      $105.61       $40.13       $21.12
64613               T................  ...................  Destroy nerve, spine muscle         0204       2.0251      $105.61       $40.13       $21.12
64614               T................  ...................  Destroy nerve, extrem musc.         0204       2.0251      $105.61       $40.13       $21.12
64620               T................  ...................  Injection treatment of              0203      11.7924      $614.99      $276.76      $123.00
                                                             nerve.
64622               T................  ...................  Destr paravertebrl nerve l/         0203      11.7924      $614.99      $276.76      $123.00
                                                             s.
64623               T................  ...................  Destr paravertebral n add-          0203      11.7924      $614.99      $276.76      $123.00
                                                             on.
64626               T................  ...................  Destr paravertebrl nerve c/         0203      11.7924      $614.99      $276.76      $123.00
                                                             t.
64627               T................  ...................  Destr paravertebral n add-          0203      11.7924      $614.99      $276.76      $123.00
                                                             on.
64630               T................  ...................  Injection treatment of              0207       5.7654      $300.67      $123.69       $60.13
                                                             nerve.
64640               T................  ...................  Injection treatment of              0207       5.7654      $300.67      $123.69       $60.13
                                                             nerve.
64680               T................  ...................  Injection treatment of              0203      11.7924      $614.99      $276.76      $123.00
                                                             nerve.
64702               T................  ...................  Revise finger/toe nerve....         0220      15.8136      $824.70  ...........      $164.94
64704               T................  ...................  Revise hand/foot nerve.....         0220      15.8136      $824.70  ...........      $164.94
64708               T................  ...................  Revise arm/leg nerve.......         0220      15.8136      $824.70  ...........      $164.94
64712               T................  ...................  Revision of sciatic nerve..         0220      15.8136      $824.70  ...........      $164.94
64713               T................  ...................  Revision of arm nerve(s)...         0220      15.8136      $824.70  ...........      $164.94
64714               T................  ...................  Revise low back nerve(s)...         0220      15.8136      $824.70  ...........      $164.94
64716               T................  ...................  Revision of cranial nerve..         0220      15.8136      $824.70  ...........      $164.94
64718               T................  ...................  Revise ulnar nerve at elbow         0220      15.8136      $824.70  ...........      $164.94
64719               T................  ...................  Revise ulnar nerve at wrist         0220      15.8136      $824.70  ...........      $164.94
64721               T................  ...................  Carpal tunnel surgery......         0220      15.8136      $824.70  ...........      $164.94
64722               T................  ...................  Relieve pressure on                 0220      15.8136      $824.70  ...........      $164.94
                                                             nerve(s).
64726               T................  ...................  Release foot/toe nerve.....         0220      15.8136      $824.70  ...........      $164.94
64727               T................  ...................  Internal nerve revision....         0220      15.8136      $824.70  ...........      $164.94
64732               T................  ...................  Incision of brow nerve.....         0220      15.8136      $824.70  ...........      $164.94
64734               T................  ...................  Incision of cheek nerve....         0220      15.8136      $824.70  ...........      $164.94
64736               T................  ...................  Incision of chin nerve.....         0220      15.8136      $824.70  ...........      $164.94
64738               T................  ...................  Incision of jaw nerve......         0220      15.8136      $824.70  ...........      $164.94
64740               T................  ...................  Incision of tongue nerve...         0220      15.8136      $824.70  ...........      $164.94
64742               T................  ...................  Incision of facial nerve...         0220      15.8136      $824.70  ...........      $164.94
64744               T................  ...................  Incise nerve, back of head.         0220      15.8136      $824.70  ...........      $164.94
64746               T................  ...................  Incise diaphragm nerve.....         0220      15.8136      $824.70  ...........      $164.94
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      15.8136      $824.70  ...........      $164.94
64763               C................  ...................  Incise hip/thigh nerve.....  ...........  ...........  ...........  ...........  ...........
64766               C................  ...................  Incise hip/thigh nerve.....  ...........  ...........  ...........  ...........  ...........
64771               T................  ...................  Sever cranial nerve........         0220      15.8136      $824.70  ...........      $164.94
64772               T................  ...................  Incision of spinal nerve...         0220      15.8136      $824.70  ...........      $164.94
64774               T................  ...................  Remove skin nerve lesion...         0220      15.8136      $824.70  ...........      $164.94
64776               T................  ...................  Remove digit nerve lesion..         0220      15.8136      $824.70  ...........      $164.94
64778               T................  ...................  Digit nerve surgery add-on.         0220      15.8136      $824.70  ...........      $164.94
64782               T................  ...................  Remove limb nerve lesion...         0220      15.8136      $824.70  ...........      $164.94
64783               T................  ...................  Limb nerve surgery add-on..         0220      15.8136      $824.70  ...........      $164.94
64784               T................  ...................  Remove nerve lesion........         0220      15.8136      $824.70  ...........      $164.94
64786               T................  ...................  Remove sciatic nerve lesion         0221      21.5208    $1,122.33      $463.62      $224.47
64787               T................  ...................  Implant nerve end..........         0220      15.8136      $824.70  ...........      $164.94
64788               T................  ...................  Remove skin nerve lesion...         0220      15.8136      $824.70  ...........      $164.94
64790               T................  ...................  Removal of nerve lesion....         0220      15.8136      $824.70  ...........      $164.94
64792               T................  ...................  Removal of nerve lesion....         0221      21.5208    $1,122.33      $463.62      $224.47
64795               T................  ...................  Biopsy of nerve............         0220      15.8136      $824.70  ...........      $164.94
64802               T................  ...................  Remove sympathetic nerves..         0220      15.8136      $824.70  ...........      $164.94
64804               C................  ...................  Remove sympathetic nerves..  ...........  ...........  ...........  ...........  ...........
64809               C................  ...................  Remove sympathetic nerves..  ...........  ...........  ...........  ...........  ...........
64818               C................  ...................  Remove sympathetic nerves..  ...........  ...........  ...........  ...........  ...........
64820               T................  ...................  Remove sympathetic nerves..         0220      15.8136      $824.70  ...........      $164.94
64821               T................  ...................  Remove sympathestic nerves.         0054      22.7223    $1,184.99  ...........      $237.00
64822               T................  ...................  Remove sympathetic nerves..         0054      22.7223    $1,184.99  ...........      $237.00
64823               T................  ...................  Remove sympathetic nerves..         0054      22.7223    $1,184.99  ...........      $237.00
64831               T................  ...................  Repair of digit nerve......         0221      21.5208    $1,122.33      $463.62      $224.47
64832               T................  ...................  Repair nerve add-on........         0221      21.5208    $1,122.33      $463.62      $224.47
64834               T................  ...................  Repair of hand or foot              0221      21.5208    $1,122.33      $463.62      $224.47
                                                             nerve.

[[Page 66901]]

 
64835               T................  ...................  Repair of hand or foot              0221      21.5208    $1,122.33      $463.62      $224.47
                                                             nerve.
64836               T................  ...................  Repair of hand or foot              0221      21.5208    $1,122.33      $463.62      $224.47
                                                             nerve.
64837               T................  ...................  Repair nerve add-on........         0221      21.5208    $1,122.33      $463.62      $224.47
64840               T................  ...................  Repair of leg nerve........         0221      21.5208    $1,122.33      $463.62      $224.47
64856               T................  ...................  Repair/transpose nerve.....         0221      21.5208    $1,122.33      $463.62      $224.47
64857               T................  ...................  Repair arm/leg nerve.......         0221      21.5208    $1,122.33      $463.62      $224.47
64858               T................  ...................  Repair sciatic nerve.......         0221      21.5208    $1,122.33      $463.62      $224.47
64859               T................  ...................  Nerve surgery..............         0221      21.5208    $1,122.33      $463.62      $224.47
64861               T................  ...................  Repair of arm nerves.......         0221      21.5208    $1,122.33      $463.62      $224.47
64862               T................  ...................  Repair of low back nerves..         0221      21.5208    $1,122.33      $463.62      $224.47
64864               T................  ...................  Repair of facial nerve.....         0221      21.5208    $1,122.33      $463.62      $224.47
64865               T................  ...................  Repair of facial nerve.....         0221      21.5208    $1,122.33      $463.62      $224.47
64866               C................  ...................  Fusion of facial/other       ...........  ...........  ...........  ...........  ...........
                                                             nerve.
64868               C................  ...................  Fusion of facial/other       ...........  ...........  ...........  ...........  ...........
                                                             nerve.
64870               T................  ...................  Fusion of facial/other              0221      21.5208    $1,122.33      $463.62      $224.47
                                                             nerve.
64872               T................  ...................  Subsequent repair of nerve.         0221      21.5208    $1,122.33      $463.62      $224.47
64874               T................  ...................  Repair & revise nerve add-          0221      21.5208    $1,122.33      $463.62      $224.47
                                                             on.
64876               T................  ...................  Repair nerve/shorten bone..         0221      21.5208    $1,122.33      $463.62      $224.47
64885               T................  ...................  Nerve graft, head or neck..         0221      21.5208    $1,122.33      $463.62      $224.47
64886               T................  ...................  Nerve graft, head or neck..         0221      21.5208    $1,122.33      $463.62      $224.47
64890               T................  ...................  Nerve graft, hand or foot..         0221      21.5208    $1,122.33      $463.62      $224.47
64891               T................  ...................  Nerve graft, hand or foot..         0221      21.5208    $1,122.33      $463.62      $224.47
64892               T................  ...................  Nerve graft, arm or leg....         0221      21.5208    $1,122.33      $463.62      $224.47
64893               T................  ...................  Nerve graft, arm or leg....         0221      21.5208    $1,122.33      $463.62      $224.47
64895               T................  ...................  Nerve graft, hand or foot..         0221      21.5208    $1,122.33      $463.62      $224.47
64896               T................  ...................  Nerve graft, hand or foot..         0221      21.5208    $1,122.33      $463.62      $224.47
64897               T................  ...................  Nerve graft, arm or leg....         0221      21.5208    $1,122.33      $463.62      $224.47
64898               T................  ...................  Nerve graft, arm or leg....         0221      21.5208    $1,122.33      $463.62      $224.47
64901               T................  ...................  Nerve graft add-on.........         0221      21.5208    $1,122.33      $463.62      $224.47
64902               T................  ...................  Nerve graft add-on.........         0221      21.5208    $1,122.33      $463.62      $224.47
64905               T................  ...................  Nerve pedicle transfer.....         0221      21.5208    $1,122.33      $463.62      $224.47
64907               T................  ...................  Nerve pedicle transfer.....         0221      21.5208    $1,122.33      $463.62      $224.47
64999               T................  ...................  Nervous system surgery.....         0204       2.0251      $105.61       $40.13       $21.12
65091               T................  ...................  Revise eye.................         0242      28.0517    $1,462.92      $597.36      $292.58
65093               T................  ...................  Revise eye with implant....         0241      20.6294    $1,075.84      $384.47      $215.17
65101               T................  ...................  Removal of eye.............         0242      28.0517    $1,462.92      $597.36      $292.58
65103               T................  ...................  Remove eye/insert implant..         0242      28.0517    $1,462.92      $597.36      $292.58
65105               T................  ...................  Remove eye/attach implant..         0242      28.0517    $1,462.92      $597.36      $292.58
65110               T................  ...................  Removal of eye.............         0242      28.0517    $1,462.92      $597.36      $292.58
65112               T................  ...................  Remove eye/revise socket...         0242      28.0517    $1,462.92      $597.36      $292.58
65114               T................  ...................  Remove eye/revise socket...         0242      28.0517    $1,462.92      $597.36      $292.58
65125               T................  ...................  Revise ocular implant......         0240      16.3078      $850.47      $315.31      $170.09
65130               T................  ...................  Insert ocular implant......         0241      20.6294    $1,075.84      $384.47      $215.17
65135               T................  ...................  Insert ocular implant......         0241      20.6294    $1,075.84      $384.47      $215.17
65140               T................  ...................  Attach ocular implant......         0242      28.0517    $1,462.92      $597.36      $292.58
65150               T................  ...................  Revise ocular implant......         0241      20.6294    $1,075.84      $384.47      $215.17
65155               T................  ...................  Reinsert ocular implant....         0242      28.0517    $1,462.92      $597.36      $292.58
65175               T................  ...................  Removal of ocular implant..         0240      16.3078      $850.47      $315.31      $170.09
65205               S................  ...................  Remove foreign body from            0698       0.9205       $48.00       $18.72        $9.60
                                                             eye.
65210               S................  ...................  Remove foreign body from            0231       2.1705      $113.19       $50.94       $22.64
                                                             eye.
65220               S................  ...................  Remove foreign body from            0231       2.1705      $113.19       $50.94       $22.64
                                                             eye.
65222               S................  ...................  Remove foreign body from            0231       2.1705      $113.19       $50.94       $22.64
                                                             eye.
65235               T................  ...................  Remove foreign body from            0233      13.4202      $699.88      $266.33      $139.98
                                                             eye.
65260               T................  ...................  Remove foreign body from            0236      19.4278    $1,013.18  ...........      $202.64
                                                             eye.
65265               T................  ...................  Remove foreign body from            0236      19.4278    $1,013.18  ...........      $202.64
                                                             eye.
65270               T................  ...................  Repair of eye wound........         0240      16.3078      $850.47      $315.31      $170.09
65272               T................  ...................  Repair of eye wound........         0233      13.4202      $699.88      $266.33      $139.98
65273               C................  ...................  Repair of eye wound........  ...........  ...........  ...........  ...........  ...........
65275               T................  ...................  Repair of eye wound........         0233      13.4202      $699.88      $266.33      $139.98
65280               T................  ...................  Repair of eye wound........         0234      20.4259    $1,065.23      $511.31      $213.05
65285               T................  ...................  Repair of eye wound........         0234      20.4259    $1,065.23      $511.31      $213.05
65286               T................  ...................  Repair of eye wound........         0233      13.4202      $699.88      $266.33      $139.98
65290               T................  ...................  Repair of eye socket wound.         0243      19.9705    $1,041.48      $431.39      $208.30
65400               T................  ...................  Removal of eye lesion......         0233      13.4202      $699.88      $266.33      $139.98
65410               T................  ...................  Biopsy of cornea...........         0233      13.4202      $699.88      $266.33      $139.98

[[Page 66902]]

 
65420               T................  ...................  Removal of eye lesion......         0233      13.4202      $699.88      $266.33      $139.98
65426               T................  ...................  Removal of eye lesion......         0234      20.4259    $1,065.23      $511.31      $213.05
65430               S................  ...................  Corneal smear..............         0230       0.7364       $38.40       $14.97        $7.68
65435               T................  ...................  Curette/treat cornea.......         0239       6.8119      $355.25      $115.94       $71.05
65436               T................  ...................  Curette/treat cornea.......         0233      13.4202      $699.88      $266.33      $139.98
65450               S................  ...................  Treatment of corneal lesion         0231       2.1705      $113.19       $50.94       $22.64
65600               T................  ...................  Revision of cornea.........         0240      16.3078      $850.47      $315.31      $170.09
65710               T................  ...................  Corneal transplant.........         0244      35.6290    $1,858.09      $803.26      $371.62
65730               T................  ...................  Corneal transplant.........         0244      35.6290    $1,858.09      $803.26      $371.62
65750               T................  ...................  Corneal transplant.........         0244      35.6290    $1,858.09      $803.26      $371.62
65755               T................  ...................  Corneal transplant.........         0244      35.6290    $1,858.09      $803.26      $371.62
65760               E................  ...................  Revision of cornea.........  ...........  ...........  ...........  ...........  ...........
65765               E................  ...................  Revision of cornea.........  ...........  ...........  ...........  ...........  ...........
65767               E................  ...................  Corneal tissue transplant..  ...........  ...........  ...........  ...........  ...........
65770               T................  ...................  Revise cornea with implant.         0244      35.6290    $1,858.09      $803.26      $371.62
65771               E................  ...................  Radial keratotomy..........  ...........  ...........  ...........  ...........  ...........
65772               T................  ...................  Correction of astigmatism..         0233      13.4202      $699.88      $266.33      $139.98
65775               T................  ...................  Correction of astigmatism..         0233      13.4202      $699.88      $266.33      $139.98
65800               T................  ...................  Drainage of eye............         0233      13.4202      $699.88      $266.33      $139.98
65805               T................  ...................  Drainage of eye............         0233      13.4202      $699.88      $266.33      $139.98
65810               T................  ...................  Drainage of eye............         0234      20.4259    $1,065.23      $511.31      $213.05
65815               T................  ...................  Drainage of eye............         0234      20.4259    $1,065.23      $511.31      $213.05
65820               T................  ...................  Relieve inner eye pressure.         0232       4.4960      $234.47      $103.17       $46.89
65850               T................  ...................  Incision of eye............         0234      20.4259    $1,065.23      $511.31      $213.05
65855               T................  ...................  Laser surgery of eye.......         0247       4.7092      $245.59      $104.31       $49.12
65860               T................  ...................  Incise inner eye adhesions.         0247       4.7092      $245.59      $104.31       $49.12
65865               T................  ...................  Incise inner eye adhesions.         0233      13.4202      $699.88      $266.33      $139.98
65870               T................  ...................  Incise inner eye adhesions.         0234      20.4259    $1,065.23      $511.31      $213.05
65875               T................  ...................  Incise inner eye adhesions.         0234      20.4259    $1,065.23      $511.31      $213.05
65880               T................  ...................  Incise inner eye adhesions.         0233      13.4202      $699.88      $266.33      $139.98
65900               T................  ...................  Remove eye lesion..........         0233      13.4202      $699.88      $266.33      $139.98
65920               T................  ...................  Remove implant of eye......         0233      13.4202      $699.88      $266.33      $139.98
65930               T................  ...................  Remove blood clot from eye.         0234      20.4259    $1,065.23      $511.31      $213.05
66020               T................  ...................  Injection treatment of eye.         0233      13.4202      $699.88      $266.33      $139.98
66030               T................  ...................  Injection treatment of eye.         0233      13.4202      $699.88      $266.33      $139.98
66130               T................  ...................  Remove eye lesion..........         0234      20.4259    $1,065.23      $511.31      $213.05
66150               T................  ...................  Glaucoma surgery...........         0233      13.4202      $699.88      $266.33      $139.98
66155               T................  ...................  Glaucoma surgery...........         0234      20.4259    $1,065.23      $511.31      $213.05
66160               T................  ...................  Glaucoma surgery...........         0234      20.4259    $1,065.23      $511.31      $213.05
66165               T................  ...................  Glaucoma surgery...........         0234      20.4259    $1,065.23      $511.31      $213.05
66170               T................  ...................  Glaucoma surgery...........         0234      20.4259    $1,065.23      $511.31      $213.05
66172               T................  ...................  Incision of eye............         0673      25.9490    $1,353.27      $649.56      $270.65
66180               T................  ...................  Implant eye shunt..........         0673      25.9490    $1,353.27      $649.56      $270.65
66185               T................  ...................  Revise eye shunt...........         0673      25.9490    $1,353.27      $649.56      $270.65
66220               T................  ...................  Repair eye lesion..........         0236      19.4278    $1,013.18  ...........      $202.64
66225               T................  ...................  Repair/graft eye lesion....         0673      25.9490    $1,353.27      $649.56      $270.65
66250               T................  ...................  Follow-up surgery of eye...         0233      13.4202      $699.88      $266.33      $139.98
66500               T................  ...................  Incision of iris...........         0232       4.4960      $234.47      $103.17       $46.89
66505               T................  ...................  Incision of iris...........         0232       4.4960      $234.47      $103.17       $46.89
66600               T................  ...................  Remove iris and lesion.....         0233      13.4202      $699.88      $266.33      $139.98
66605               T................  ...................  Removal of iris............         0234      20.4259    $1,065.23      $511.31      $213.05
66625               T................  ...................  Removal of iris............         0233      13.4202      $699.88      $266.33      $139.98
66630               T................  ...................  Removal of iris............         0233      13.4202      $699.88      $266.33      $139.98
66635               T................  ...................  Removal of iris............         0234      20.4259    $1,065.23      $511.31      $213.05
66680               T................  ...................  Repair iris & ciliary body.         0234      20.4259    $1,065.23      $511.31      $213.05
66682               T................  ...................  Repair iris & ciliary body.         0234      20.4259    $1,065.23      $511.31      $213.05
66700               T................  ...................  Destruction, ciliary body..         0233      13.4202      $699.88      $266.33      $139.98
66710               T................  ...................  Destruction, ciliary body..         0233      13.4202      $699.88      $266.33      $139.98
66720               T................  ...................  Destruction, ciliary body..         0233      13.4202      $699.88      $266.33      $139.98
66740               T................  ...................  Destruction, ciliary body..         0233      13.4202      $699.88      $266.33      $139.98
66761               T................  ...................  Revision of iris...........         0247       4.7092      $245.59      $104.31       $49.12
66762               T................  ...................  Revision of iris...........         0247       4.7092      $245.59      $104.31       $49.12
66770               T................  ...................  Removal of inner eye lesion         0247       4.7092      $245.59      $104.31       $49.12
66820               T................  ...................  Incision, secondary                 0232       4.4960      $234.47      $103.17       $46.89
                                                             cataract.
66821               T................  ...................  After cataract laser                0247       4.7092      $245.59      $104.31       $49.12
                                                             surgery.

[[Page 66903]]

 
66825               T................  ...................  Reposition intraocular lens         0234      20.4259    $1,065.23      $511.31      $213.05
66830               T................  ...................  Removal of lens lesion.....         0232       4.4960      $234.47      $103.17       $46.89
66840               T................  ...................  Removal of lens material...         0245      14.5442      $758.49      $251.21      $151.70
66850               T................  ...................  Removal of lens material...         0249      26.7242    $1,393.69      $524.67      $278.74
66852               T................  ...................  Removal of lens material...         0249      26.7242    $1,393.69      $524.67      $278.74
66920               T................  ...................  Extraction of lens.........         0249      26.7242    $1,393.69      $524.67      $278.74
66930               T................  ...................  Extraction of lens.........         0249      26.7242    $1,393.69      $524.67      $278.74
66940               T................  ...................  Extraction of lens.........         0245      14.5442      $758.49      $251.21      $151.70
66982               T................  ...................  Cataract surgery, complex..         0246      22.2379    $1,159.73      $495.96      $231.95
66983               T................  ...................  Cataract surg w/iol, 1              0246      22.2379    $1,159.73      $495.96      $231.95
                                                             stage.
66984               T................  ...................  Cataract surg w/iol, 1              0246      22.2379    $1,159.73      $495.96      $231.95
                                                             stage.
66985               T................  ...................  Insert lens prosthesis.....         0246      22.2379    $1,159.73      $495.96      $231.95
66986               T................  ...................  Exchange lens prosthesis...         0246      22.2379    $1,159.73      $495.96      $231.95
66990               N................  NI.................  Ophthalmic endoscope add-on  ...........  ...........  ...........  ...........  ...........
66999               T................  ...................  Eye surgery procedure......         0232       4.4960      $234.47      $103.17       $46.89
67005               T................  ...................  Partial removal of eye              0237      33.2647    $1,734.79      $818.54      $346.96
                                                             fluid.
67010               T................  ...................  Partial removal of eye              0237      33.2647    $1,734.79      $818.54      $346.96
                                                             fluid.
67015               T................  ...................  Release of eye fluid.......         0237      33.2647    $1,734.79      $818.54      $346.96
67025               T................  ...................  Replace eye fluid..........         0236      19.4278    $1,013.18  ...........      $202.64
67027               T................  ...................  Implant eye drug system....         0237      33.2647    $1,734.79      $818.54      $346.96
67028               T................  ...................  Injection eye drug.........         0235       5.0871      $265.30       $73.44       $53.06
67030               T................  ...................  Incise inner eye strands...         0236      19.4278    $1,013.18  ...........      $202.64
67031               T................  ...................  Laser surgery, eye strands.         0247       4.7092      $245.59      $104.31       $49.12
67036               T................  ...................  Removal of inner eye fluid.         0237      33.2647    $1,734.79      $818.54      $346.96
67038               T................  ...................  Strip retinal membrane.....         0237      33.2647    $1,734.79      $818.54      $346.96
67039               T................  ...................  Laser treatment of retina..         0237      33.2647    $1,734.79      $818.54      $346.96
67040               T................  ...................  Laser treatment of retina..         0672      37.9061    $1,976.84      $988.43      $395.37
67101               T................  ...................  Repair detached retina.....         0235       5.0871      $265.30       $73.44       $53.06
67105               T................  ...................  Repair detached retina.....         0248       4.2925      $223.86       $95.08       $44.77
67107               T................  ...................  Repair detached retina.....         0672      37.9061    $1,976.84      $988.43      $395.37
67108               T................  ...................  Repair detached retina.....         0672      37.9061    $1,976.84      $988.43      $395.37
67110               T................  ...................  Repair detached retina.....         0235       5.0871      $265.30       $73.44       $53.06
67112               T................  ...................  Rerepair detached retina...         0672      37.9061    $1,976.84      $988.43      $395.37
67115               T................  ...................  Release encircling material         0236      19.4278    $1,013.18  ...........      $202.64
67120               T................  ...................  Remove eye implant material         0236      19.4278    $1,013.18  ...........      $202.64
67121               T................  ...................  Remove eye implant material         0237      33.2647    $1,734.79      $818.54      $346.96
67141               T................  ...................  Treatment of retina........         0235       5.0871      $265.30       $73.44       $53.06
67145               T................  ...................  Treatment of retina........         0248       4.2925      $223.86       $95.08       $44.77
67208               T................  ...................  Treatment of retinal lesion         0235       5.0871      $265.30       $73.44       $53.06
67210               T................  ...................  Treatment of retinal lesion         0248       4.2925      $223.86       $95.08       $44.77
67218               T................  ...................  Treatment of retinal lesion         0236      19.4278    $1,013.18  ...........      $202.64
67220               T................  ...................  Treatment of choroid lesion         0235       5.0871      $265.30       $73.44       $53.06
67221               T................  ...................  Ocular photodynamic ther...         0235       5.0871      $265.30       $73.44       $53.06
67225               T................  ...................  Eye photodynamic ther add-          0235       5.0871      $265.30       $73.44       $53.06
                                                             on.
67227               T................  ...................  Treatment of retinal lesion         0235       5.0871      $265.30       $73.44       $53.06
67228               T................  ...................  Treatment of retinal lesion         0248       4.2925      $223.86       $95.08       $44.77
67250               T................  ...................  Reinforce eye wall.........         0240      16.3078      $850.47      $315.31      $170.09
67255               T................  ...................  Reinforce/graft eye wall...         0237      33.2647    $1,734.79      $818.54      $346.96
67299               T................  ...................  Eye surgery procedure......         0235       5.0871      $265.30       $73.44       $53.06
67311               T................  ...................  Revise eye muscle..........         0243      19.9705    $1,041.48      $431.39      $208.30
67312               T................  ...................  Revise two eye muscles.....         0243      19.9705    $1,041.48      $431.39      $208.30
67314               T................  ...................  Revise eye muscle..........         0243      19.9705    $1,041.48      $431.39      $208.30
67316               T................  ...................  Revise two eye muscles.....         0243      19.9705    $1,041.48      $431.39      $208.30
67318               T................  ...................  Revise eye muscle(s).......         0243      19.9705    $1,041.48      $431.39      $208.30
67320               T................  ...................  Revise eye muscle(s) add-on         0243      19.9705    $1,041.48      $431.39      $208.30
67331               T................  ...................  Eye surgery follow-up add-          0243      19.9705    $1,041.48      $431.39      $208.30
                                                             on.
67332               T................  ...................  Rerevise eye muscles add-on         0243      19.9705    $1,041.48      $431.39      $208.30
67334               T................  ...................  Revise eye muscle w/suture.         0243      19.9705    $1,041.48      $431.39      $208.30
67335               T................  ...................  Eye suture during surgery..         0243      19.9705    $1,041.48      $431.39      $208.30
67340               T................  ...................  Revise eye muscle add-on...         0243      19.9705    $1,041.48      $431.39      $208.30
67343               T................  ...................  Release eye tissue.........         0243      19.9705    $1,041.48      $431.39      $208.30
67345               T................  ...................  Destroy nerve of eye muscle         0238       2.9747      $155.13       $58.96       $31.03
67350               T................  ...................  Biopsy eye muscle..........         0699       3.7596      $196.07       $88.23       $39.21
67399               T................  ...................  Eye muscle surgery                  0243      19.9705    $1,041.48      $431.39      $208.30
                                                             procedure.
67400               T................  ...................  Explore/biopsy eye socket..         0241      20.6294    $1,075.84      $384.47      $215.17

[[Page 66904]]

 
67405               T................  ...................  Explore/drain eye socket...         0241      20.6294    $1,075.84      $384.47      $215.17
67412               T................  ...................  Explore/treat eye socket...         0241      20.6294    $1,075.84      $384.47      $215.17
67413               T................  ...................  Explore/treat eye socket...         0241      20.6294    $1,075.84      $384.47      $215.17
67414               T................  ...................  Explr/decompress eye socket         0242      28.0517    $1,462.92      $597.36      $292.58
67415               T................  ...................  Aspiration, orbital                 0239       6.8119      $355.25      $115.94       $71.05
                                                             contents.
67420               T................  ...................  Explore/treat eye socket...         0242      28.0517    $1,462.92      $597.36      $292.58
67430               T................  ...................  Explore/treat eye socket...         0242      28.0517    $1,462.92      $597.36      $292.58
67440               T................  ...................  Explore/drain eye socket...         0242      28.0517    $1,462.92      $597.36      $292.58
67445               T................  ...................  Explr/decompress eye socket         0242      28.0517    $1,462.92      $597.36      $292.58
67450               T................  ...................  Explore/biopsy eye socket..         0242      28.0517    $1,462.92      $597.36      $292.58
67500               S................  ...................  Inject/treat eye socket....         0231       2.1705      $113.19       $50.94       $22.64
67505               T................  ...................  Inject/treat eye socket....         0238       2.9747      $155.13       $58.96       $31.03
67515               T................  ...................  Inject/treat eye socket....         0239       6.8119      $355.25      $115.94       $71.05
67550               T................  ...................  Insert eye socket implant..         0242      28.0517    $1,462.92      $597.36      $292.58
67560               T................  ...................  Revise eye socket implant..         0241      20.6294    $1,075.84      $384.47      $215.17
67570               T................  ...................  Decompress optic nerve.....         0242      28.0517    $1,462.92      $597.36      $292.58
67599               T................  ...................  Orbit surgery procedure....         0239       6.8119      $355.25      $115.94       $71.05
67700               T................  ...................  Drainage of eyelid abscess.         0238       2.9747      $155.13       $58.96       $31.03
67710               T................  ...................  Incision of eyelid.........         0239       6.8119      $355.25      $115.94       $71.05
67715               T................  ...................  Incision of eyelid fold....         0240      16.3078      $850.47      $315.31      $170.09
67800               T................  ...................  Remove eyelid lesion.......         0238       2.9747      $155.13       $58.96       $31.03
67801               T................  ...................  Remove eyelid lesions......         0239       6.8119      $355.25      $115.94       $71.05
67805               T................  ...................  Remove eyelid lesions......         0238       2.9747      $155.13       $58.96       $31.03
67808               T................  ...................  Remove eyelid lesion(s)....         0240      16.3078      $850.47      $315.31      $170.09
67810               T................  ...................  Biopsy of eyelid...........         0238       2.9747      $155.13       $58.96       $31.03
67820               S................  ...................  Revise eyelashes...........         0230       0.7364       $38.40       $14.97        $7.68
67825               T................  ...................  Revise eyelashes...........         0238       2.9747      $155.13       $58.96       $31.03
67830               T................  ...................  Revise eyelashes...........         0239       6.8119      $355.25      $115.94       $71.05
67835               T................  ...................  Revise eyelashes...........         0240      16.3078      $850.47      $315.31      $170.09
67840               T................  ...................  Remove eyelid lesion.......         0239       6.8119      $355.25      $115.94       $71.05
67850               T................  ...................  Treat eyelid lesion........         0239       6.8119      $355.25      $115.94       $71.05
67875               T................  ...................  Closure of eyelid by suture         0239       6.8119      $355.25      $115.94       $71.05
67880               T................  ...................  Revision of eyelid.........         0233      13.4202      $699.88      $266.33      $139.98
67882               T................  ...................  Revision of eyelid.........         0240      16.3078      $850.47      $315.31      $170.09
67900               T................  ...................  Repair brow defect.........         0240      16.3078      $850.47      $315.31      $170.09
67901               T................  ...................  Repair eyelid defect.......         0240      16.3078      $850.47      $315.31      $170.09
67902               T................  ...................  Repair eyelid defect.......         0240      16.3078      $850.47      $315.31      $170.09
67903               T................  ...................  Repair eyelid defect.......         0240      16.3078      $850.47      $315.31      $170.09
67904               T................  ...................  Repair eyelid defect.......         0240      16.3078      $850.47      $315.31      $170.09
67906               T................  ...................  Repair eyelid defect.......         0240      16.3078      $850.47      $315.31      $170.09
67908               T................  ...................  Repair eyelid defect.......         0240      16.3078      $850.47      $315.31      $170.09
67909               T................  ...................  Revise eyelid defect.......         0240      16.3078      $850.47      $315.31      $170.09
67911               T................  ...................  Revise eyelid defect.......         0240      16.3078      $850.47      $315.31      $170.09
67914               T................  ...................  Repair eyelid defect.......         0240      16.3078      $850.47      $315.31      $170.09
67915               T................  ...................  Repair eyelid defect.......         0239       6.8119      $355.25      $115.94       $71.05
67916               T................  ...................  Repair eyelid defect.......         0240      16.3078      $850.47      $315.31      $170.09
67917               T................  ...................  Repair eyelid defect.......         0240      16.3078      $850.47      $315.31      $170.09
67921               T................  ...................  Repair eyelid defect.......         0240      16.3078      $850.47      $315.31      $170.09
67922               T................  ...................  Repair eyelid defect.......         0239       6.8119      $355.25      $115.94       $71.05
67923               T................  ...................  Repair eyelid defect.......         0240      16.3078      $850.47      $315.31      $170.09
67924               T................  ...................  Repair eyelid defect.......         0240      16.3078      $850.47      $315.31      $170.09
67930               T................  ...................  Repair eyelid wound........         0240      16.3078      $850.47      $315.31      $170.09
67935               T................  ...................  Repair eyelid wound........         0240      16.3078      $850.47      $315.31      $170.09
67938               S................  ...................  Remove eyelid foreign body.         0698       0.9205       $48.00       $18.72        $9.60
67950               T................  ...................  Revision of eyelid.........         0240      16.3078      $850.47      $315.31      $170.09
67961               T................  ...................  Revision of eyelid.........         0240      16.3078      $850.47      $315.31      $170.09
67966               T................  ...................  Revision of eyelid.........         0240      16.3078      $850.47      $315.31      $170.09
67971               T................  ...................  Reconstruction of eyelid...         0241      20.6294    $1,075.84      $384.47      $215.17
67973               T................  ...................  Reconstruction of eyelid...         0241      20.6294    $1,075.84      $384.47      $215.17
67974               T................  ...................  Reconstruction of eyelid...         0241      20.6294    $1,075.84      $384.47      $215.17
67975               T................  ...................  Reconstruction of eyelid...         0240      16.3078      $850.47      $315.31      $170.09
67999               T................  ...................  Revision of eyelid.........         0240      16.3078      $850.47      $315.31      $170.09
68020               T................  ...................  Incise/drain eyelid lining.         0240      16.3078      $850.47      $315.31      $170.09
68040               S................  ...................  Treatment of eyelid lesions         0698       0.9205       $48.00       $18.72        $9.60
68100               T................  ...................  Biopsy of eyelid lining....         0232       4.4960      $234.47      $103.17       $46.89

[[Page 66905]]

 
68110               T................  ...................  Remove eyelid lining lesion         0699       3.7596      $196.07       $88.23       $39.21
68115               T................  ...................  Remove eyelid lining lesion         0239       6.8119      $355.25      $115.94       $71.05
68130               T................  ...................  Remove eyelid lining lesion         0233      13.4202      $699.88      $266.33      $139.98
68135               T................  ...................  Remove eyelid lining lesion         0239       6.8119      $355.25      $115.94       $71.05
68200               S................  ...................  Treat eyelid by injection..         0698       0.9205       $48.00       $18.72        $9.60
68320               T................  ...................  Revise/graft eyelid lining.         0240      16.3078      $850.47      $315.31      $170.09
68325               T................  ...................  Revise/graft eyelid lining.         0242      28.0517    $1,462.92      $597.36      $292.58
68326               T................  ...................  Revise/graft eyelid lining.         0241      20.6294    $1,075.84      $384.47      $215.17
68328               T................  ...................  Revise/graft eyelid lining.         0241      20.6294    $1,075.84      $384.47      $215.17
68330               T................  ...................  Revise eyelid lining.......         0233      13.4202      $699.88      $266.33      $139.98
68335               T................  ...................  Revise/graft eyelid lining.         0241      20.6294    $1,075.84      $384.47      $215.17
68340               T................  ...................  Separate eyelid adhesions..         0240      16.3078      $850.47      $315.31      $170.09
68360               T................  ...................  Revise eyelid lining.......         0234      20.4259    $1,065.23      $511.31      $213.05
68362               T................  ...................  Revise eyelid lining.......         0234      20.4259    $1,065.23      $511.31      $213.05
68399               T................  ...................  Eyelid lining surgery......         0239       6.8119      $355.25      $115.94       $71.05
68400               T................  ...................  Incise/drain tear gland....         0238       2.9747      $155.13       $58.96       $31.03
68420               T................  ...................  Incise/drain tear sac......         0240      16.3078      $850.47      $315.31      $170.09
68440               T................  ...................  Incise tear duct opening...         0238       2.9747      $155.13       $58.96       $31.03
68500               T................  ...................  Removal of tear gland......         0241      20.6294    $1,075.84      $384.47      $215.17
68505               T................  ...................  Partial removal, tear gland         0241      20.6294    $1,075.84      $384.47      $215.17
68510               T................  ...................  Biopsy of tear gland.......         0240      16.3078      $850.47      $315.31      $170.09
68520               T................  ...................  Removal of tear sac........         0241      20.6294    $1,075.84      $384.47      $215.17
68525               T................  ...................  Biopsy of tear sac.........         0240      16.3078      $850.47      $315.31      $170.09
68530               T................  ...................  Clearance of tear duct.....         0240      16.3078      $850.47      $315.31      $170.09
68540               T................  ...................  Remove tear gland lesion...         0241      20.6294    $1,075.84      $384.47      $215.17
68550               T................  ...................  Remove tear gland lesion...         0242      28.0517    $1,462.92      $597.36      $292.58
68700               T................  ...................  Repair tear ducts..........         0241      20.6294    $1,075.84      $384.47      $215.17
68705               T................  ...................  Revise tear duct opening...         0238       2.9747      $155.13       $58.96       $31.03
68720               T................  ...................  Create tear sac drain......         0242      28.0517    $1,462.92      $597.36      $292.58
68745               T................  ...................  Create tear duct drain.....         0241      20.6294    $1,075.84      $384.47      $215.17
68750               T................  ...................  Create tear duct drain.....         0242      28.0517    $1,462.92      $597.36      $292.58
68760               S................  ...................  Close tear duct opening....         0698       0.9205       $48.00       $18.72        $9.60
68761               S................  ...................  Close tear duct opening....         0231       2.1705      $113.19       $50.94       $22.64
68770               T................  ...................  Close tear system fistula..         0240      16.3078      $850.47      $315.31      $170.09
68801               S................  ...................  Dilate tear duct opening...         0231       2.1705      $113.19       $50.94       $22.64
68810               T................  ...................  Probe nasolacrimal duct....         0699       3.7596      $196.07       $88.23       $39.21
68811               T................  ...................  Probe nasolacrimal duct....         0240      16.3078      $850.47      $315.31      $170.09
68815               T................  ...................  Probe nasolacrimal duct....         0240      16.3078      $850.47      $315.31      $170.09
68840               T................  ...................  Explore/irrigate tear ducts         0699       3.7596      $196.07       $88.23       $39.21
68850               N................  ...................  Injection for tear sac x-    ...........  ...........  ...........  ...........  ...........
                                                             ray.
68899               T................  ...................  Tear duct system surgery...         0699       3.7596      $196.07       $88.23       $39.21
69000               T................  ...................  Drain external ear lesion..         0006       1.7926       $93.49       $24.12       $18.70
69005               T................  ...................  Drain external ear lesion..         0007      10.0191      $522.51      $108.89      $104.50
69020               T................  ...................  Drain outer ear canal               0006       1.7926       $93.49       $24.12       $18.70
                                                             lesion.
69090               E................  ...................  Pierce earlobes............  ...........  ...........  ...........  ...........  ...........
69100               T................  ...................  Biopsy of external ear.....         0019       3.7693      $196.57       $71.87       $39.31
69105               T................  ...................  Biopsy of external ear              0253      14.4473      $753.44      $282.29      $150.69
                                                             canal.
69110               T................  ...................  Remove external ear,                0021      13.9338      $726.66      $219.48      $145.33
                                                             partial.
69120               T................  ...................  Removal of external ear....         0254      20.1158    $1,049.06      $321.35      $209.81
69140               T................  ...................  Remove ear canal lesion(s).         0254      20.1158    $1,049.06      $321.35      $209.81
69145               T................  ...................  Remove ear canal lesion(s).         0021      13.9338      $726.66      $219.48      $145.33
69150               T................  ...................  Extensive ear canal surgery         0252       5.8041      $302.69      $113.41       $60.54
69155               C................  ...................  Extensive ear/neck surgery.  ...........  ...........  ...........  ...........  ...........
69200               X................  ...................  Clear outer ear canal......         0340       0.6492       $33.86  ...........        $6.77
69205               T................  ...................  Clear outer ear canal......         0022      17.3930      $907.06      $354.45      $181.41
69210               X................  ...................  Remove impacted ear wax....         0340       0.6492       $33.86  ...........        $6.77
69220               T................  ...................  Clean out mastoid cavity...         0012       0.7849       $40.93       $11.18        $8.19
69222               T................  ...................  Clean out mastoid cavity...         0253      14.4473      $753.44      $282.29      $150.69
69300               T................  ...................  Revise external ear........         0254      20.1158    $1,049.06      $321.35      $209.81
69310               T................  ...................  Rebuild outer ear canal....         0256      34.0302    $1,774.71  ...........      $354.94
69320               T................  ...................  Rebuild outer ear canal....         0256      34.0302    $1,774.71  ...........      $354.94
69399               T................  ...................  Outer ear surgery procedure         0251       1.9089       $99.55  ...........       $19.91
69400               T................  ...................  Inflate middle ear canal...         0251       1.9089       $99.55  ...........       $19.91
69401               T................  ...................  Inflate middle ear canal...         0251       1.9089       $99.55  ...........       $19.91
69405               T................  ...................  Catheterize middle ear              0252       5.8041      $302.69      $113.41       $60.54
                                                             canal.

[[Page 66906]]

 
69410               T................  ...................  Inset middle ear (baffle)..         0252       5.8041      $302.69      $113.41       $60.54
69420               T................  ...................  Incision of eardrum........         0251       1.9089       $99.55  ...........       $19.91
69421               T................  ...................  Incision of eardrum........         0253      14.4473      $753.44      $282.29      $150.69
69424               T................  ...................  Remove ventilating tube....         0252       5.8041      $302.69      $113.41       $60.54
69433               T................  ...................  Create eardrum opening.....         0252       5.8041      $302.69      $113.41       $60.54
69436               T................  ...................  Create eardrum opening.....         0253      14.4473      $753.44      $282.29      $150.69
69440               T................  ...................  Exploration of middle ear..         0254      20.1158    $1,049.06      $321.35      $209.81
69450               T................  ...................  Eardrum revision...........         0256      34.0302    $1,774.71  ...........      $354.94
69501               T................  ...................  Mastoidectomy..............         0256      34.0302    $1,774.71  ...........      $354.94
69502               T................  ...................  Mastoidectomy..............         0254      20.1158    $1,049.06      $321.35      $209.81
69505               T................  ...................  Remove mastoid structures..         0256      34.0302    $1,774.71  ...........      $354.94
69511               T................  ...................  Extensive mastoid surgery..         0256      34.0302    $1,774.71  ...........      $354.94
69530               T................  ...................  Extensive mastoid surgery..         0256      34.0302    $1,774.71  ...........      $354.94
69535               C................  ...................  Remove part of temporal      ...........  ...........  ...........  ...........  ...........
                                                             bone.
69540               T................  ...................  Remove ear lesion..........         0253      14.4473      $753.44      $282.29      $150.69
69550               T................  ...................  Remove ear lesion..........         0256      34.0302    $1,774.71  ...........      $354.94
69552               T................  ...................  Remove ear lesion..........         0256      34.0302    $1,774.71  ...........      $354.94
69554               C................  ...................  Remove ear lesion..........  ...........  ...........  ...........  ...........  ...........
69601               T................  ...................  Mastoid surgery revision...         0256      34.0302    $1,774.71  ...........      $354.94
69602               T................  ...................  Mastoid surgery revision...         0256      34.0302    $1,774.71  ...........      $354.94
69603               T................  ...................  Mastoid surgery revision...         0256      34.0302    $1,774.71  ...........      $354.94
69604               T................  ...................  Mastoid surgery revision...         0256      34.0302    $1,774.71  ...........      $354.94
69605               T................  ...................  Mastoid surgery revision...         0256      34.0302    $1,774.71  ...........      $354.94
69610               T................  ...................  Repair of eardrum..........         0254      20.1158    $1,049.06      $321.35      $209.81
69620               T................  ...................  Repair of eardrum..........         0254      20.1158    $1,049.06      $321.35      $209.81
69631               T................  ...................  Repair eardrum structures..         0256      34.0302    $1,774.71  ...........      $354.94
69632               T................  ...................  Rebuild eardrum structures.         0256      34.0302    $1,774.71  ...........      $354.94
69633               T................  ...................  Rebuild eardrum structures.         0256      34.0302    $1,774.71  ...........      $354.94
69635               T................  ...................  Repair eardrum structures..         0256      34.0302    $1,774.71  ...........      $354.94
69636               T................  ...................  Rebuild eardrum structures.         0256      34.0302    $1,774.71  ...........      $354.94
69637               T................  ...................  Rebuild eardrum structures.         0256      34.0302    $1,774.71  ...........      $354.94
69641               T................  ...................  Revise middle ear & mastoid         0256      34.0302    $1,774.71  ...........      $354.94
69642               T................  ...................  Revise middle ear & mastoid         0256      34.0302    $1,774.71  ...........      $354.94
69643               T................  ...................  Revise middle ear & mastoid         0256      34.0302    $1,774.71  ...........      $354.94
69644               T................  ...................  Revise middle ear & mastoid         0256      34.0302    $1,774.71  ...........      $354.94
69645               T................  ...................  Revise middle ear & mastoid         0256      34.0302    $1,774.71  ...........      $354.94
69646               T................  ...................  Revise middle ear & mastoid         0256      34.0302    $1,774.71  ...........      $354.94
69650               T................  ...................  Release middle ear bone....         0254      20.1158    $1,049.06      $321.35      $209.81
69660               T................  ...................  Revise middle ear bone.....         0256      34.0302    $1,774.71  ...........      $354.94
69661               T................  ...................  Revise middle ear bone.....         0256      34.0302    $1,774.71  ...........      $354.94
69662               T................  ...................  Revise middle ear bone.....         0256      34.0302    $1,774.71  ...........      $354.94
69666               T................  ...................  Repair middle ear                   0256      34.0302    $1,774.71  ...........      $354.94
                                                             structures.
69667               T................  ...................  Repair middle ear                   0256      34.0302    $1,774.71  ...........      $354.94
                                                             structures.
69670               T................  ...................  Remove mastoid air cells...         0256      34.0302    $1,774.71  ...........      $354.94
69676               T................  ...................  Remove middle ear nerve....         0256      34.0302    $1,774.71  ...........      $354.94
69700               T................  ...................  Close mastoid fistula......         0256      34.0302    $1,774.71  ...........      $354.94
69710               E................  ...................  Implant/replace hearing aid  ...........  ...........  ...........  ...........  ...........
69711               T................  ...................  Remove/repair hearing aid..         0256      34.0302    $1,774.71  ...........      $354.94
69714               T................  ...................  Implant temple bone w/              0256      34.0302    $1,774.71  ...........      $354.94
                                                             stimul.
69715               T................  ...................  Temple bne implnt w/                0256      34.0302    $1,774.71  ...........      $354.94
                                                             stimulat.
69717               T................  ...................  Temple bone implant                 0256      34.0302    $1,774.71  ...........      $354.94
                                                             revision.
69718               T................  ...................  Revise temple bone implant.         0256      34.0302    $1,774.71  ...........      $354.94
69720               T................  ...................  Release facial nerve.......         0256      34.0302    $1,774.71  ...........      $354.94
69725               T................  ...................  Release facial nerve.......         0256      34.0302    $1,774.71  ...........      $354.94
69740               T................  ...................  Repair facial nerve........         0256      34.0302    $1,774.71  ...........      $354.94
69745               T................  ...................  Repair facial nerve........         0256      34.0302    $1,774.71  ...........      $354.94
69799               T................  ...................  Middle ear surgery                  0253      14.4473      $753.44      $282.29      $150.69
                                                             procedure.
69801               T................  ...................  Incise inner ear...........         0256      34.0302    $1,774.71  ...........      $354.94
69802               T................  ...................  Incise inner ear...........         0256      34.0302    $1,774.71  ...........      $354.94
69805               T................  ...................  Explore inner ear..........         0256      34.0302    $1,774.71  ...........      $354.94
69806               T................  ...................  Explore inner ear..........         0256      34.0302    $1,774.71  ...........      $354.94
69820               T................  ...................  Establish inner ear window.         0256      34.0302    $1,774.71  ...........      $354.94
69840               T................  ...................  Revise inner ear window....         0256      34.0302    $1,774.71  ...........      $354.94
69905               T................  ...................  Remove inner ear...........         0256      34.0302    $1,774.71  ...........      $354.94
69910               T................  ...................  Remove inner ear & mastoid.         0256      34.0302    $1,774.71  ...........      $354.94

[[Page 66907]]

 
69915               T................  ...................  Incise inner ear nerve.....         0256      34.0302    $1,774.71  ...........      $354.94
69930               T................  ...................  Implant cochlear device....         0259     367.6466   $19,173.14    $9,394.83    $3,834.63
69949               T................  ...................  Inner ear surgery procedure         0253      14.4473      $753.44      $282.29      $150.69
69950               C................  ...................  Incise inner ear nerve.....  ...........  ...........  ...........  ...........  ...........
69955               T................  ...................  Release facial nerve.......         0256      34.0302    $1,774.71  ...........      $354.94
69960               T................  ...................  Release inner ear canal....         0256      34.0302    $1,774.71  ...........      $354.94
69970               C................  ...................  Remove inner ear lesion....  ...........  ...........  ...........  ...........  ...........
69979               T................  ...................  Temporal bone surgery......         0251       1.9089       $99.55  ...........       $19.91
69990               N................  ...................  Microsurgery add-on........  ...........  ...........  ...........  ...........  ...........
70010               S................  ...................  Contrast x-ray of brain....         0274       3.8759      $202.13       $96.54       $40.43
70015               S................  ...................  Contrast x-ray of brain....         0274       3.8759      $202.13       $96.54       $40.43
70030               X................  ...................  X-ray eye for foreign body.         0260       0.7655       $39.92       $21.95        $7.98
70100               X................  ...................  X-ray exam of jaw..........         0260       0.7655       $39.92       $21.95        $7.98
70110               X................  ...................  X-ray exam of jaw..........         0260       0.7655       $39.92       $21.95        $7.98
70120               X................  ...................  X-ray exam of mastoids.....         0260       0.7655       $39.92       $21.95        $7.98
70130               X................  ...................  X-ray exam of mastoids.....         0260       0.7655       $39.92       $21.95        $7.98
70134               X................  ...................  X-ray exam of middle ear...         0261       1.2887       $67.21  ...........       $13.44
70140               X................  ...................  X-ray exam of facial bones.         0260       0.7655       $39.92       $21.95        $7.98
70150               X................  ...................  X-ray exam of facial bones.         0260       0.7655       $39.92       $21.95        $7.98
70160               X................  ...................  X-ray exam of nasal bones..         0260       0.7655       $39.92       $21.95        $7.98
70170               X................  ...................  X-ray exam of tear duct....         0263       1.8992       $99.05       $43.58       $19.81
70190               X................  ...................  X-ray exam of eye sockets..         0260       0.7655       $39.92       $21.95        $7.98
70200               X................  ...................  X-ray exam of eye sockets..         0260       0.7655       $39.92       $21.95        $7.98
70210               X................  ...................  X-ray exam of sinuses......         0260       0.7655       $39.92       $21.95        $7.98
70220               X................  ...................  X-ray exam of sinuses......         0260       0.7655       $39.92       $21.95        $7.98
70240               X................  ...................  X-ray exam, pituitary               0260       0.7655       $39.92       $21.95        $7.98
                                                             saddle.
70250               X................  ...................  X-ray exam of skull........         0260       0.7655       $39.92       $21.95        $7.98
70260               X................  ...................  X-ray exam of skull........         0261       1.2887       $67.21  ...........       $13.44
70300               X................  ...................  X-ray exam of teeth........         0262       0.5717       $29.81        $9.82        $5.96
70310               X................  ...................  X-ray exam of teeth........         0262       0.5717       $29.81        $9.82        $5.96
70320               X................  ...................  Full mouth x-ray of teeth..         0262       0.5717       $29.81        $9.82        $5.96
70328               X................  ...................  X-ray exam of jaw joint....         0260       0.7655       $39.92       $21.95        $7.98
70330               X................  ...................  X-ray exam of jaw joints...         0260       0.7655       $39.92       $21.95        $7.98
70332               S................  ...................  X-ray exam of jaw joint....         0275       2.9747      $155.13       $69.09       $31.03
70336               S................  ...................  Magnetic image, jaw joint..         0335       6.2983      $328.46      $151.46       $65.69
70350               X................  ...................  X-ray head for orthodontia.         0260       0.7655       $39.92       $21.95        $7.98
70355               X................  ...................  Panoramic x-ray of jaws....         0260       0.7655       $39.92       $21.95        $7.98
70360               X................  ...................  X-ray exam of neck.........         0260       0.7655       $39.92       $21.95        $7.98
70370               X................  ...................  Throat x-ray & fluoroscopy.         0272       1.3372       $69.74       $38.36       $13.95
70371               X................  ...................  Speech evaluation, complex.         0272       1.3372       $69.74       $38.36       $13.95
70373               X................  ...................  Contrast x-ray of larynx...         0263       1.8992       $99.05       $43.58       $19.81
70380               X................  ...................  X-ray exam of salivary              0260       0.7655       $39.92       $21.95        $7.98
                                                             gland.
70390               X................  ...................  X-ray exam of salivary duct         0264       2.8197      $147.05       $79.41       $29.41
70450               S................  ...................  Ct head/brain w/o dye......         0332       3.4398      $179.39       $91.27       $35.88
70460               S................  ...................  Ct head/brain w/dye........         0283       4.5057      $234.98      $126.27       $47.00
70470               S................  ...................  Ct head/brain w/o&w dye....         0333       5.3681      $279.95      $146.98       $55.99
70480               S................  ...................  Ct orbit/ear/fossa w/o dye.         0332       3.4398      $179.39       $91.27       $35.88
70481               S................  ...................  Ct orbit/ear/fossa w/dye...         0283       4.5057      $234.98      $126.27       $47.00
70482               S................  ...................  Ct orbit/ear/fossa w/o&w            0333       5.3681      $279.95      $146.98       $55.99
                                                             dye.
70486               S................  ...................  Ct maxillofacial w/o dye...         0332       3.4398      $179.39       $91.27       $35.88
70487               S................  ...................  Ct maxillofacial w/dye.....         0283       4.5057      $234.98      $126.27       $47.00
70488               S................  ...................  Ct maxillofacial w/o&w dye.         0333       5.3681      $279.95      $146.98       $55.99
70490               S................  ...................  Ct soft tissue neck w/o dye         0332       3.4398      $179.39       $91.27       $35.88
70491               S................  ...................  Ct soft tissue neck w/dye..         0283       4.5057      $234.98      $126.27       $47.00
70492               S................  ...................  Ct sft tsue nck w/o & w/dye         0333       5.3681      $279.95      $146.98       $55.99
70496               S................  ...................  Ct angiography, head.......         0662       5.4553      $284.50      $156.47       $56.90
70498               S................  ...................  Ct angiography, neck.......         0662       5.4553      $284.50      $156.47       $56.90
70540               S................  ...................  Mri orbit/face/neck w/o dye         0336       6.5987      $344.13      $176.94       $68.83
70542               S................  ...................  Mri orbit/face/neck w/dye..         0284       7.2382      $377.48      $201.02       $75.50
70543               S................  ...................  Mri orbt/fac/nck w/o&w dye.         0337       9.2440      $482.08      $240.77       $96.42
70544               S................  ...................  Mr angiography head w/o dye         0336       6.5987      $344.13      $176.94       $68.83
70545               S................  ...................  Mr angiography head w/dye..         0284       7.2382      $377.48      $201.02       $75.50
70546               S................  ...................  Mr angiograph head w/o&w            0337       9.2440      $482.08      $240.77       $96.42
                                                             dye.
70547               S................  ...................  Mr angiography neck w/o dye         0336       6.5987      $344.13      $176.94       $68.83
70548               S................  ...................  Mr angiography neck w/dye..         0284       7.2382      $377.48      $201.02       $75.50

[[Page 66908]]

 
70549               S................  ...................  Mr angiograph neck w/o&w            0337       9.2440      $482.08      $240.77       $96.42
                                                             dye.
70551               S................  ...................  Mri brain w/o dye..........         0336       6.5987      $344.13      $176.94       $68.83
70552               S................  ...................  Mri brain w/dye............         0284       7.2382      $377.48      $201.02       $75.50
70553               S................  ...................  Mri brain w/o&w dye........         0337       9.2440      $482.08      $240.77       $96.42
71010               X................  ...................  Chest x-ray................         0260       0.7655       $39.92       $21.95        $7.98
71015               X................  ...................  Chest x-ray................         0260       0.7655       $39.92       $21.95        $7.98
71020               X................  ...................  Chest x-ray................         0260       0.7655       $39.92       $21.95        $7.98
71021               X................  ...................  Chest x-ray................         0260       0.7655       $39.92       $21.95        $7.98
71022               X................  ...................  Chest x-ray................         0260       0.7655       $39.92       $21.95        $7.98
71023               X................  ...................  Chest x-ray and fluoroscopy         0272       1.3372       $69.74       $38.36       $13.95
71030               X................  ...................  Chest x-ray................         0260       0.7655       $39.92       $21.95        $7.98
71034               X................  ...................  Chest x-ray and fluoroscopy         0272       1.3372       $69.74       $38.36       $13.95
71035               X................  ...................  Chest x-ray................         0260       0.7655       $39.92       $21.95        $7.98
71040               X................  ...................  Contrast x-ray of bronchi..         0263       1.8992       $99.05       $43.58       $19.81
71060               X................  ...................  Contrast x-ray of bronchi..         0264       2.8197      $147.05       $79.41       $29.41
71090               X................  ...................  X-ray & pacemaker insertion         0272       1.3372       $69.74       $38.36       $13.95
71100               X................  ...................  X-ray exam of ribs.........         0260       0.7655       $39.92       $21.95        $7.98
71101               X................  ...................  X-ray exam of ribs/chest...         0260       0.7655       $39.92       $21.95        $7.98
71110               X................  ...................  X-ray exam of ribs.........         0260       0.7655       $39.92       $21.95        $7.98
71111               X................  ...................  X-ray exam of ribs/ chest..         0261       1.2887       $67.21  ...........       $13.44
71120               X................  ...................  X-ray exam of breastbone...         0260       0.7655       $39.92       $21.95        $7.98
71130               X................  ...................  X-ray exam of breastbone...         0260       0.7655       $39.92       $21.95        $7.98
71250               S................  ...................  Ct thorax w/o dye..........         0332       3.4398      $179.39       $91.27       $35.88
71260               S................  ...................  Ct thorax w/dye............         0283       4.5057      $234.98      $126.27       $47.00
71270               S................  ...................  Ct thorax w/o&w dye........         0333       5.3681      $279.95      $146.98       $55.99
71275               S................  ...................  Ct angiography, chest......         0662       5.4553      $284.50      $156.47       $56.90
71550               S................  ...................  Mri chest w/o dye..........         0336       6.5987      $344.13      $176.94       $68.83
71551               S................  ...................  Mri chest w/dye............         0284       7.2382      $377.48      $201.02       $75.50
71552               S................  ...................  Mri chest w/o&w/dye........         0337       9.2440      $482.08      $240.77       $96.42
71555               E................  ...................  Mri angio chest w or w/o     ...........  ...........  ...........  ...........  ...........
                                                             dye.
72010               X................  ...................  X-ray exam of spine........         0261       1.2887       $67.21  ...........       $13.44
72020               X................  ...................  X-ray exam of spine........         0260       0.7655       $39.92       $21.95        $7.98
72040               X................  ...................  X-ray exam of neck spine...         0260       0.7655       $39.92       $21.95        $7.98
72050               X................  ...................  X-ray exam of neck spine...         0261       1.2887       $67.21  ...........       $13.44
72052               X................  ...................  X-ray exam of neck spine...         0261       1.2887       $67.21  ...........       $13.44
72069               X................  ...................  X-ray exam of trunk spine..         0260       0.7655       $39.92       $21.95        $7.98
72070               X................  ...................  X-ray exam of thoracic              0260       0.7655       $39.92       $21.95        $7.98
                                                             spine.
72072               X................  ...................  X-ray exam of thoracic              0260       0.7655       $39.92       $21.95        $7.98
                                                             spine.
72074               X................  ...................  X-ray exam of thoracic              0260       0.7655       $39.92       $21.95        $7.98
                                                             spine.
72080               X................  ...................  X-ray exam of trunk spine..         0260       0.7655       $39.92       $21.95        $7.98
72090               X................  ...................  X-ray exam of trunk spine..         0261       1.2887       $67.21  ...........       $13.44
72100               X................  ...................  X-ray exam of lower spine..         0260       0.7655       $39.92       $21.95        $7.98
72110               X................  ...................  X-ray exam of lower spine..         0261       1.2887       $67.21  ...........       $13.44
72114               X................  ...................  X-ray exam of lower spine..         0261       1.2887       $67.21  ...........       $13.44
72120               X................  ...................  X-ray exam of lower spine..         0260       0.7655       $39.92       $21.95        $7.98
72125               S................  ...................  Ct neck spine w/o dye......         0332       3.4398      $179.39       $91.27       $35.88
72126               S................  ...................  Ct neck spine w/dye........         0283       4.5057      $234.98      $126.27       $47.00
72127               S................  ...................  Ct neck spine w/o&w/dye....         0333       5.3681      $279.95      $146.98       $55.99
72128               S................  ...................  Ct chest spine w/o dye.....         0332       3.4398      $179.39       $91.27       $35.88
72129               S................  ...................  Ct chest spine w/dye.......         0283       4.5057      $234.98      $126.27       $47.00
72130               S................  ...................  Ct chest spine w/o&w/dye...         0333       5.3681      $279.95      $146.98       $55.99
72131               S................  ...................  Ct lumbar spine w/o dye....         0332       3.4398      $179.39       $91.27       $35.88
72132               S................  ...................  Ct lumbar spine w/dye......         0283       4.5057      $234.98      $126.27       $47.00
72133               S................  ...................  Ct lumbar spine w/o&w/dye..         0333       5.3681      $279.95      $146.98       $55.99
72141               S................  ...................  Mri neck spine w/o dye.....         0336       6.5987      $344.13      $176.94       $68.83
72142               S................  ...................  Mri neck spine w/dye.......         0284       7.2382      $377.48      $201.02       $75.50
72146               S................  ...................  Mri chest spine w/o dye....         0336       6.5987      $344.13      $176.94       $68.83
72147               S................  ...................  Mri chest spine w/dye......         0284       7.2382      $377.48      $201.02       $75.50
72148               S................  ...................  Mri lumbar spine w/o dye...         0336       6.5987      $344.13      $176.94       $68.83
72149               S................  ...................  Mri lumbar spine w/dye.....         0284       7.2382      $377.48      $201.02       $75.50
72156               S................  ...................  Mri neck spine w/o&w/dye...         0337       9.2440      $482.08      $240.77       $96.42
72157               S................  ...................  Mri chest spine w/o&w/dye..         0337       9.2440      $482.08      $240.77       $96.42
72158               S................  ...................  Mri lumbar spine w/o&w/dye.         0337       9.2440      $482.08      $240.77       $96.42
72159               E................  ...................  Mr angio spine w/o&w/dye...  ...........  ...........  ...........  ...........  ...........
72170               X................  ...................  X-ray exam of pelvis.......         0260       0.7655       $39.92       $21.95        $7.98

[[Page 66909]]

 
72190               X................  ...................  X-ray exam of pelvis.......         0260       0.7655       $39.92       $21.95        $7.98
72191               S................  ...................  Ct angiograph pelv w/o&w/           0662       5.4553      $284.50      $156.47       $56.90
                                                             dye.
72192               S................  ...................  Ct pelvis w/o dye..........         0332       3.4398      $179.39       $91.27       $35.88
72193               S................  ...................  Ct pelvis w/dye............         0283       4.5057      $234.98      $126.27       $47.00
72194               S................  ...................  Ct pelvis w/o&w/dye........         0333       5.3681      $279.95      $146.98       $55.99
72195               S................  ...................  Mri pelvis w/o dye.........         0336       6.5987      $344.13      $176.94       $68.83
72196               S................  ...................  Mri pelvis w/dye...........         0284       7.2382      $377.48      $201.02       $75.50
72197               S................  ...................  Mri pelvis w/o & w/dye.....         0337       9.2440      $482.08      $240.77       $96.42
72198               E................  ...................  Mr angio pelvis w/o&w/dye..  ...........  ...........  ...........  ...........  ...........
72200               X................  ...................  X-ray exam sacroiliac               0260       0.7655       $39.92       $21.95        $7.98
                                                             joints.
72202               X................  ...................  X-ray exam sacroiliac               0260       0.7655       $39.92       $21.95        $7.98
                                                             joints.
72220               X................  ...................  X-ray exam of tailbone.....         0260       0.7655       $39.92       $21.95        $7.98
72240               S................  ...................  Contrast x-ray of neck              0274       3.8759      $202.13       $96.54       $40.43
                                                             spine.
72255               S................  ...................  Contrast x-ray, thorax              0274       3.8759      $202.13       $96.54       $40.43
                                                             spine.
72265               S................  ...................  Contrast x-ray, lower spine         0274       3.8759      $202.13       $96.54       $40.43
72270               S................  ...................  Contrast x-ray of spine....         0274       3.8759      $202.13       $96.54       $40.43
72275               S................  ...................  Epidurography..............         0274       3.8759      $202.13       $96.54       $40.43
72285               S................  ...................  X-ray c/t spine disk.......         0274       3.8759      $202.13       $96.54       $40.43
72295               S................  ...................  X-ray of lower spine disk..         0274       3.8759      $202.13       $96.54       $40.43
73000               X................  ...................  X-ray exam of collar bone..         0260       0.7655       $39.92       $21.95        $7.98
73010               X................  ...................  X-ray exam of shoulder              0260       0.7655       $39.92       $21.95        $7.98
                                                             blade.
73020               X................  ...................  X-ray exam of shoulder.....         0260       0.7655       $39.92       $21.95        $7.98
73030               X................  ...................  X-ray exam of shoulder.....         0260       0.7655       $39.92       $21.95        $7.98
73040               S................  ...................  Contrast x-ray of shoulder.         0275       2.9747      $155.13       $69.09       $31.03
73050               X................  ...................  X-ray exam of shoulders....         0260       0.7655       $39.92       $21.95        $7.98
73060               X................  ...................  X-ray exam of humerus......         0260       0.7655       $39.92       $21.95        $7.98
73070               X................  ...................  X-ray exam of elbow........         0260       0.7655       $39.92       $21.95        $7.98
73080               X................  ...................  X-ray exam of elbow........         0260       0.7655       $39.92       $21.95        $7.98
73085               S................  ...................  Contrast x-ray of elbow....         0275       2.9747      $155.13       $69.09       $31.03
73090               X................  ...................  X-ray exam of forearm......         0260       0.7655       $39.92       $21.95        $7.98
73092               X................  ...................  X-ray exam of arm, infant..         0260       0.7655       $39.92       $21.95        $7.98
73100               X................  ...................  X-ray exam of wrist........         0260       0.7655       $39.92       $21.95        $7.98
73110               X................  ...................  X-ray exam of wrist........         0260       0.7655       $39.92       $21.95        $7.98
73115               S................  ...................  Contrast x-ray of wrist....         0275       2.9747      $155.13       $69.09       $31.03
73120               X................  ...................  X-ray exam of hand.........         0260       0.7655       $39.92       $21.95        $7.98
73130               X................  ...................  X-ray exam of hand.........         0260       0.7655       $39.92       $21.95        $7.98
73140               X................  ...................  X-ray exam of finger(s)....         0260       0.7655       $39.92       $21.95        $7.98
73200               S................  ...................  Ct upper extremity w/o dye.         0332       3.4398      $179.39       $91.27       $35.88
73201               S................  ...................  Ct upper extremity w/dye...         0283       4.5057      $234.98      $126.27       $47.00
73202               S................  ...................  Ct uppr extremity w/o&w/dye         0333       5.3681      $279.95      $146.98       $55.99
73206               S................  ...................  Ct angio upr extrm w/o&w/           0662       5.4553      $284.50      $156.47       $56.90
                                                             dye.
73218               S................  ...................  Mri upper extremity w/o dye         0336       6.5987      $344.13      $176.94       $68.83
73219               S................  ...................  Mri upper extremity w/dye..         0284       7.2382      $377.48      $201.02       $75.50
73220               S................  ...................  Mri uppr extremity w/o&w/           0337       9.2440      $482.08      $240.77       $96.42
                                                             dye.
73221               S................  ...................  Mri joint upr extrem w/o            0336       6.5987      $344.13      $176.94       $68.83
                                                             dye.
73222               S................  ...................  Mri joint upr extrem w/dye.         0284       7.2382      $377.48      $201.02       $75.50
73223               S................  ...................  Mri joint upr extr w/o&w/           0337       9.2440      $482.08      $240.77       $96.42
                                                             dye.
73225               E................  ...................  Mr angio upr extr w/o&w/dye  ...........  ...........  ...........  ...........  ...........
73500               X................  ...................  X-ray exam of hip..........         0260       0.7655       $39.92       $21.95        $7.98
73510               X................  ...................  X-ray exam of hip..........         0260       0.7655       $39.92       $21.95        $7.98
73520               X................  ...................  X-ray exam of hips.........         0260       0.7655       $39.92       $21.95        $7.98
73525               S................  ...................  Contrast x-ray of hip......         0275       2.9747      $155.13       $69.09       $31.03
73530               X................  ...................  X-ray exam of hip..........         0261       1.2887       $67.21  ...........       $13.44
73540               X................  ...................  X-ray exam of pelvis & hips         0260       0.7655       $39.92       $21.95        $7.98
73542               S................  ...................  X-ray exam, sacroiliac              0275       2.9747      $155.13       $69.09       $31.03
                                                             joint.
73550               X................  ...................  X-ray exam of thigh........         0260       0.7655       $39.92       $21.95        $7.98
73560               X................  ...................  X-ray exam of knee, 1 or 2.         0260       0.7655       $39.92       $21.95        $7.98
73562               X................  ...................  X-ray exam of knee, 3......         0260       0.7655       $39.92       $21.95        $7.98
73564               X................  ...................  X-ray exam, knee, 4 or more         0260       0.7655       $39.92       $21.95        $7.98
73565               X................  ...................  X-ray exam of knees........         0260       0.7655       $39.92       $21.95        $7.98
73580               S................  ...................  Contrast x-ray of knee              0275       2.9747      $155.13       $69.09       $31.03
                                                             joint.
73590               X................  ...................  X-ray exam of lower leg....         0260       0.7655       $39.92       $21.95        $7.98
73592               X................  ...................  X-ray exam of leg, infant..         0260       0.7655       $39.92       $21.95        $7.98
73600               X................  ...................  X-ray exam of ankle........         0260       0.7655       $39.92       $21.95        $7.98
73610               X................  ...................  X-ray exam of ankle........         0260       0.7655       $39.92       $21.95        $7.98

[[Page 66910]]

 
73615               S................  ...................  Contrast x-ray of ankle....         0275       2.9747      $155.13       $69.09       $31.03
73620               X................  ...................  X-ray exam of foot.........         0260       0.7655       $39.92       $21.95        $7.98
73630               X................  ...................  X-ray exam of foot.........         0260       0.7655       $39.92       $21.95        $7.98
73650               X................  ...................  X-ray exam of heel.........         0260       0.7655       $39.92       $21.95        $7.98
73660               X................  ...................  X-ray exam of toe(s).......         0260       0.7655       $39.92       $21.95        $7.98
73700               S................  ...................  Ct lower extremity w/o dye.         0332       3.4398      $179.39       $91.27       $35.88
73701               S................  ...................  Ct lower extremity w/dye...         0283       4.5057      $234.98      $126.27       $47.00
73702               S................  ...................  Ct lwr extremity w/o&w/dye.         0333       5.3681      $279.95      $146.98       $55.99
73706               S................  ...................  Ct angio lwr extr w/o&w/dye         0662       5.4553      $284.50      $156.47       $56.90
73718               S................  ...................  Mri lower extremity w/o dye         0336       6.5987      $344.13      $176.94       $68.83
73719               S................  ...................  Mri lower extremity w/dye..         0284       7.2382      $377.48      $201.02       $75.50
73720               S................  ...................  Mri lwr extremity w/o&w/dye         0337       9.2440      $482.08      $240.77       $96.42
73721               S................  ...................  Mri jnt of lwr extre w/o            0336       6.5987      $344.13      $176.94       $68.83
                                                             dye.
73722               S................  ...................  Mri joint of lwr extr w/dye         0284       7.2382      $377.48      $201.02       $75.50
73723               S................  ...................  Mri joint lwr extr w/o&w/           0337       9.2440      $482.08      $240.77       $96.42
                                                             dye.
73725               E................  ...................  Mr ang lwr ext w or w/o dye  ...........  ...........  ...........  ...........  ...........
74000               X................  ...................  X-ray exam of abdomen......         0260       0.7655       $39.92       $21.95        $7.98
74010               X................  ...................  X-ray exam of abdomen......         0260       0.7655       $39.92       $21.95        $7.98
74020               X................  ...................  X-ray exam of abdomen......         0260       0.7655       $39.92       $21.95        $7.98
74022               X................  ...................  X-ray exam series, abdomen.         0261       1.2887       $67.21  ...........       $13.44
74150               S................  ...................  Ct abdomen w/o dye.........         0332       3.4398      $179.39       $91.27       $35.88
74160               S................  ...................  Ct abdomen w/dye...........         0283       4.5057      $234.98      $126.27       $47.00
74170               S................  ...................  Ct abdomen w/o&w/dye.......         0333       5.3681      $279.95      $146.98       $55.99
74175               S................  ...................  Ct angio abdom w/o&w/dye...         0662       5.4553      $284.50      $156.47       $56.90
74181               S................  ...................  Mri abdomen w/o dye........         0336       6.5987      $344.13      $176.94       $68.83
74182               S................  ...................  Mri abdomen w/dye..........         0284       7.2382      $377.48      $201.02       $75.50
74183               S................  ...................  Mri abdomen w/o&w/dye......         0337       9.2440      $482.08      $240.77       $96.42
74185               E................  ...................  Mri angio, abdom w or w/o    ...........  ...........  ...........  ...........  ...........
                                                             dy.
74190               X................  ...................  X-ray exam of peritoneum...         0263       1.8992       $99.05       $43.58       $19.81
74210               S................  ...................  Contrst x-ray exam of               0276       1.5891       $82.87       $41.72       $16.57
                                                             throat.
74220               S................  ...................  Contrast x-ray, esophagus..         0276       1.5891       $82.87       $41.72       $16.57
74230               S................  ...................  Cine/vid x-ray, throat/             0276       1.5891       $82.87       $41.72       $16.57
                                                             esoph.
74235               S................  ...................  Remove esophagus                    0296       2.4127      $125.82       $69.20       $25.16
                                                             obstruction.
74240               S................  ...................  X-ray exam, upper gi tract.         0276       1.5891       $82.87       $41.72       $16.57
74241               S................  ...................  X-ray exam, upper gi tract.         0276       1.5891       $82.87       $41.72       $16.57
74245               S................  ...................  X-ray exam, upper gi tract.         0277       2.3546      $122.79       $60.47       $24.56
74246               S................  ...................  Contrst x-ray uppr gi tract         0276       1.5891       $82.87       $41.72       $16.57
74247               S................  ...................  Contrst x-ray uppr gi tract         0276       1.5891       $82.87       $41.72       $16.57
74249               S................  ...................  Contrst x-ray uppr gi tract         0277       2.3546      $122.79       $60.47       $24.56
74250               S................  ...................  X-ray exam of small bowel..         0276       1.5891       $82.87       $41.72       $16.57
74251               S................  ...................  X-ray exam of small bowel..         0277       2.3546      $122.79       $60.47       $24.56
74260               S................  ...................  X-ray exam of small bowel..         0277       2.3546      $122.79       $60.47       $24.56
74270               S................  ...................  Contrast x-ray exam of              0276       1.5891       $82.87       $41.72       $16.57
                                                             colon.
74280               S................  ...................  Contrast x-ray exam of              0277       2.3546      $122.79       $60.47       $24.56
                                                             colon.
74283               S................  ...................  Contrast x-ray exam of              0276       1.5891       $82.87       $41.72       $16.57
                                                             colon.
74290               S................  ...................  Contrast x-ray, gallbladder         0276       1.5891       $82.87       $41.72       $16.57
74291               S................  ...................  Contrast x-rays,                    0276       1.5891       $82.87       $41.72       $16.57
                                                             gallbladder.
74300               X................  ...................  X-ray bile ducts/pancreas..         0263       1.8992       $99.05       $43.58       $19.81
74301               X................  ...................  X-rays at surgery add-on...         0263       1.8992       $99.05       $43.58       $19.81
74305               X................  ...................  X-ray bile ducts/pancreas..         0263       1.8992       $99.05       $43.58       $19.81
74320               X................  ...................  Contrast x-ray of bile              0264       2.8197      $147.05       $79.41       $29.41
                                                             ducts.
74327               S................  ...................  X-ray bile stone removal...         0296       2.4127      $125.82       $69.20       $25.16
74328               N................  ...................  X-ray 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       1.3372       $69.74       $38.36       $13.95
74350               X................  ...................  X-ray guide, stomach tube..         0263       1.8992       $99.05       $43.58       $19.81
74355               X................  ...................  X-ray guide, intestinal             0263       1.8992       $99.05       $43.58       $19.81
                                                             tube.
74360               S................  ...................  X-ray guide, GI dilation...         0296       2.4127      $125.82       $69.20       $25.16
74363               S................  ...................  X-ray, bile duct dilation..         0297       7.6839      $400.72      $172.51       $80.14
74400               S................  ...................  Contrst x-ray, urinary              0278       2.5290      $131.89       $66.07       $26.38
                                                             tract.
74410               S................  ...................  Contrst x-ray, urinary              0278       2.5290      $131.89       $66.07       $26.38
                                                             tract.
74415               S................  ...................  Contrst x-ray, urinary              0278       2.5290      $131.89       $66.07       $26.38
                                                             tract.
74420               S................  ...................  Contrst x-ray, urinary              0278       2.5290      $131.89       $66.07       $26.38
                                                             tract.
74425               S................  ...................  Contrst x-ray, urinary              0278       2.5290      $131.89       $66.07       $26.38
                                                             tract.

[[Page 66911]]

 
74430               S................  ...................  Contrast x-ray, bladder....         0278       2.5290      $131.89       $66.07       $26.38
74440               S................  ...................  X-ray, male genital tract..         0278       2.5290      $131.89       $66.07       $26.38
74445               S................  ...................  X-ray exam of penis........         0278       2.5290      $131.89       $66.07       $26.38
74450               S................  ...................  X-ray, urethra/bladder.....         0278       2.5290      $131.89       $66.07       $26.38
74455               S................  ...................  X-ray, urethra/bladder.....         0278       2.5290      $131.89       $66.07       $26.38
74470               X................  ...................  X-ray exam of kidney lesion         0264       2.8197      $147.05       $79.41       $29.41
74475               S................  ...................  X-ray control, cath insert.         0297       7.6839      $400.72      $172.51       $80.14
74480               S................  ...................  X-ray control, cath insert.         0296       2.4127      $125.82       $69.20       $25.16
74485               S................  ...................  X-ray guide, GU dilation...         0296       2.4127      $125.82       $69.20       $25.16
74710               X................  ...................  X-ray measurement of pelvis         0260       0.7655       $39.92       $21.95        $7.98
74740               X................  ...................  X-ray, female genital tract         0264       2.8197      $147.05       $79.41       $29.41
74742               X................  ...................  X-ray, fallopian tube......         0263       1.8992       $99.05       $43.58       $19.81
74775               S................  ...................  X-ray exam of perineum.....         0278       2.5290      $131.89       $66.07       $26.38
75552               S................  ...................  Heart mri for morph w/o dye         0336       6.5987      $344.13      $176.94       $68.83
75553               S................  ...................  Heart mri for morph w/dye..         0284       7.2382      $377.48      $201.02       $75.50
75554               S................  ...................  Cardiac MRI/function.......         0335       6.2983      $328.46      $151.46       $65.69
75555               S................  ...................  Cardiac MRI/limited study..         0335       6.2983      $328.46      $151.46       $65.69
75556               E................  ...................  Cardiac MRI/flow mapping...  ...........  ...........  ...........  ...........  ...........
75600               S................  ...................  Contrast x-ray exam of              0280      15.2128      $793.36      $353.85      $158.67
                                                             aorta.
75605               S................  ...................  Contrast x-ray exam of              0280      15.2128      $793.36      $353.85      $158.67
                                                             aorta.
75625               S................  ...................  Contrast x-ray exam of              0280      15.2128      $793.36      $353.85      $158.67
                                                             aorta.
75630               S................  ...................  X-ray aorta, leg arteries..         0280      15.2128      $793.36      $353.85      $158.67
75635               S................  ...................  Ct angio abdominal arteries         0662       5.4553      $284.50      $156.47       $56.90
75650               S................  ...................  Artery x-rays, head & neck.         0280      15.2128      $793.36      $353.85      $158.67
75658               S................  ...................  Artery x-rays, arm.........         0280      15.2128      $793.36      $353.85      $158.67
75660               S................  ...................  Artery x-rays, head & neck.         0279       8.6432      $450.75      $174.57       $90.15
75662               S................  ...................  Artery x-rays, head & neck.         0279       8.6432      $450.75      $174.57       $90.15
75665               S................  ...................  Artery x-rays, head & neck.         0280      15.2128      $793.36      $353.85      $158.67
75671               S................  ...................  Artery x-rays, head & neck.         0280      15.2128      $793.36      $353.85      $158.67
75676               S................  ...................  Artery x-rays, neck........         0280      15.2128      $793.36      $353.85      $158.67
75680               S................  ...................  Artery x-rays, neck........         0280      15.2128      $793.36      $353.85      $158.67
75685               S................  ...................  Artery x-rays, spine.......         0279       8.6432      $450.75      $174.57       $90.15
75705               S................  ...................  Artery x-rays, spine.......         0279       8.6432      $450.75      $174.57       $90.15
75710               S................  ...................  Artery x-rays, arm/leg.....         0280      15.2128      $793.36      $353.85      $158.67
75716               S................  ...................  Artery x-rays, arms/legs...         0280      15.2128      $793.36      $353.85      $158.67
75722               S................  ...................  Artery x-rays, kidney......         0280      15.2128      $793.36      $353.85      $158.67
75724               S................  ...................  Artery x-rays, kidneys.....         0280      15.2128      $793.36      $353.85      $158.67
75726               S................  ...................  Artery x-rays, abdomen.....         0280      15.2128      $793.36      $353.85      $158.67
75731               S................  ...................  Artery x-rays, adrenal              0280      15.2128      $793.36      $353.85      $158.67
                                                             gland.
75733               S................  ...................  Artery x-rays, adrenals....         0280      15.2128      $793.36      $353.85      $158.67
75736               S................  ...................  Artery x-rays, pelvis......         0280      15.2128      $793.36      $353.85      $158.67
75741               S................  ...................  Artery x-rays, lung........         0279       8.6432      $450.75      $174.57       $90.15
75743               S................  ...................  Artery x-rays, lungs.......         0280      15.2128      $793.36      $353.85      $158.67
75746               S................  ...................  Artery x-rays, lung........         0279       8.6432      $450.75      $174.57       $90.15
75756               S................  ...................  Artery x-rays, chest.......         0279       8.6432      $450.75      $174.57       $90.15
75774               S................  ...................  Artery x-ray, each vessel..         0668      10.3292      $538.68      $237.76      $107.74
75790               S................  ...................  Visualize A-V shunt........         0281       5.2227      $272.37      $115.16       $54.47
75801               X................  ...................  Lymph vessel x-ray, arm/leg         0264       2.8197      $147.05       $79.41       $29.41
75803               X................  ...................  Lymph vessel x-ray,arms/            0264       2.8197      $147.05       $79.41       $29.41
                                                             legs.
75805               X................  ...................  Lymph vessel x-ray, trunk..         0264       2.8197      $147.05       $79.41       $29.41
75807               X................  ...................  Lymph vessel x-ray, trunk..         0264       2.8197      $147.05       $79.41       $29.41
75809               X................  ...................  Nonvascular shunt, x-ray...         0263       1.8992       $99.05       $43.58       $19.81
75810               S................  ...................  Vein x-ray, spleen/liver...         0279       8.6432      $450.75      $174.57       $90.15
75820               S................  ...................  Vein x-ray, arm/leg........         0281       5.2227      $272.37      $115.16       $54.47
75822               S................  ...................  Vein x-ray, arms/legs......         0281       5.2227      $272.37      $115.16       $54.47
75825               S................  ...................  Vein x-ray, trunk..........         0279       8.6432      $450.75      $174.57       $90.15
75827               S................  ...................  Vein x-ray, chest..........         0279       8.6432      $450.75      $174.57       $90.15
75831               S................  ...................  Vein x-ray, kidney.........         0287       6.9863      $364.34      $114.51       $72.87
75833               S................  ...................  Vein x-ray, kidneys........         0279       8.6432      $450.75      $174.57       $90.15
75840               S................  ...................  Vein x-ray, adrenal gland..         0287       6.9863      $364.34      $114.51       $72.87
75842               S................  ...................  Vein x-ray, adrenal glands.         0287       6.9863      $364.34      $114.51       $72.87
75860               S................  ...................  Vein x-ray, neck...........         0287       6.9863      $364.34      $114.51       $72.87
75870               S................  ...................  Vein x-ray, skull..........         0287       6.9863      $364.34      $114.51       $72.87
75872               S................  ...................  Vein x-ray, skull..........         0287       6.9863      $364.34      $114.51       $72.87
75880               S................  ...................  Vein x-ray, eye socket.....         0287       6.9863      $364.34      $114.51       $72.87

[[Page 66912]]

 
75885               S................  ...................  Vein x-ray, liver..........         0279       8.6432      $450.75      $174.57       $90.15
75887               S................  ...................  Vein x-ray, liver..........         0280      15.2128      $793.36      $353.85      $158.67
75889               S................  ...................  Vein x-ray, liver..........         0279       8.6432      $450.75      $174.57       $90.15
75891               S................  ...................  Vein x-ray, liver..........         0279       8.6432      $450.75      $174.57       $90.15
75893               N................  ...................  Venous sampling by catheter  ...........  ...........  ...........  ...........  ...........
75894               S................  ...................  X-rays, transcath therapy..         0297       7.6839      $400.72      $172.51       $80.14
75896               S................  ...................  X-rays, transcath therapy..         0297       7.6839      $400.72      $172.51       $80.14
75898               X................  ...................  Follow-up angiography......         0264       2.8197      $147.05       $79.41       $29.41
75900               C................  ...................  Arterial catheter exchange.  ...........  ...........  ...........  ...........  ...........
75901               X................  NI.................  Remove cva device obstruct.         0264       2.8197      $147.05       $79.41       $29.41
75902               X................  NI.................  Remove cva lumen obstruct..         0263       1.8992       $99.05       $43.58       $19.81
75940               X................  ...................  X-ray placement, vein               0187       3.9534      $206.17       $90.71       $41.23
                                                             filter.
75945               S................  ...................  Intravascular us...........         0267       2.4418      $127.34       $65.52       $25.47
75946               S................  ...................  Intravascular us add-on....         0267       2.4418      $127.34       $65.52       $25.47
75952               C................  ...................  Endovasc repair abdom aorta  ...........  ...........  ...........  ...........  ...........
75953               C................  ...................  Abdom aneurysm endovas rpr.  ...........  ...........  ...........  ...........  ...........
75954               C................  NI.................  Iliac aneurysm endovas rpr.  ...........  ...........  ...........  ...........  ...........
75960               S................  ...................  Transcatheter intro, stent.         0280      15.2128      $793.36      $353.85      $158.67
75961               S................  ...................  Retrieval, broken catheter.         0280      15.2128      $793.36      $353.85      $158.67
75962               S................  ...................  Repair arterial blockage...         0280      15.2128      $793.36      $353.85      $158.67
75964               S................  ...................  Repair artery blockage,             0280      15.2128      $793.36      $353.85      $158.67
                                                             each.
75966               S................  ...................  Repair arterial blockage...         0280      15.2128      $793.36      $353.85      $158.67
75968               S................  ...................  Repair artery blockage,             0280      15.2128      $793.36      $353.85      $158.67
                                                             each.
75970               S................  ...................  Vascular biopsy............         0280      15.2128      $793.36      $353.85      $158.67
75978               S................  ...................  Repair venous blockage.....         0668      10.3292      $538.68      $237.76      $107.74
75980               S................  ...................  Contrast xray exam bile             0296       2.4127      $125.82       $69.20       $25.16
                                                             duct.
75982               S................  ...................  Contrast xray exam bile             0297       7.6839      $400.72      $172.51       $80.14
                                                             duct.
75984               X................  ...................  Xray control catheter               0264       2.8197      $147.05       $79.41       $29.41
                                                             change.
75989               N................  ...................  Abscess drainage under x-    ...........  ...........  ...........  ...........  ...........
                                                             ray.
75992               S................  ...................  Atherectomy, x-ray exam....         0280      15.2128      $793.36      $353.85      $158.67
75993               S................  ...................  Atherectomy, x-ray exam....         0280      15.2128      $793.36      $353.85      $158.67
75994               S................  ...................  Atherectomy, x-ray exam....         0280      15.2128      $793.36      $353.85      $158.67
75995               S................  ...................  Atherectomy, x-ray exam....         0280      15.2128      $793.36      $353.85      $158.67
75996               S................  ...................  Atherectomy, x-ray exam....         0280      15.2128      $793.36      $353.85      $158.67
76000               X................  ...................  Fluoroscope examination....         0272       1.3372       $69.74       $38.36       $13.95
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       0.7655       $39.92       $21.95        $7.98
76010               X................  ...................  X-ray, nose to rectum......         0260       0.7655       $39.92       $21.95        $7.98
76012               S................  ...................  Percut vertebroplasty fluor         0274       3.8759      $202.13       $96.54       $40.43
76013               S................  ...................  Percut vertebroplasty, ct..         0274       3.8759      $202.13       $96.54       $40.43
76020               X................  ...................  X-rays for bone age........         0260       0.7655       $39.92       $21.95        $7.98
76040               X................  ...................  X-rays, bone evaluation....         0260       0.7655       $39.92       $21.95        $7.98
76061               X................  ...................  X-rays, bone survey........         0261       1.2887       $67.21  ...........       $13.44
76062               X................  ...................  X-rays, bone survey........         0261       1.2887       $67.21  ...........       $13.44
76065               X................  ...................  X-rays, bone evaluation....         0261       1.2887       $67.21  ...........       $13.44
76066               X................  ...................  Joint survey, single view..         0260       0.7655       $39.92       $21.95        $7.98
76070               E................  ...................  CT scan, bone density study  ...........  ...........  ...........  ...........  ...........
76071               S................  NI.................  Ct bone density, peripheral         0282       1.6763       $87.42       $44.51       $17.48
76075               S................  ...................  Dexa, axial skeleton study.         0288       1.2984       $67.71  ...........       $13.54
76076               S................  ...................  Dexa, peripheral study.....         0665       0.8236       $42.95  ...........        $8.59
76078               X................  ...................  Radiographic absorptiometry         0261       1.2887       $67.21  ...........       $13.44
76080               X................  ...................  X-ray exam of fistula......         0263       1.8992       $99.05       $43.58       $19.81
76085               A................  ...................  Computer mammogram add-on..  ...........  ...........  ...........  ...........  ...........
76086               X................  ...................  X-ray of mammary duct......         0263       1.8992       $99.05       $43.58       $19.81
76088               X................  ...................  X-ray of mammary ducts.....         0263       1.8992       $99.05       $43.58       $19.81
76090               S................  ...................  Mammogram, one breast......         0271       0.6492       $33.86       $16.80        $6.77
76091               S................  ...................  Mammogram, both breasts....         0271       0.6492       $33.86       $16.80        $6.77
76092               A................  ...................  Mammogram, screening.......  ...........  ...........  ...........  ...........  ...........
76093               E................  ...................  Magnetic image, breast.....  ...........  ...........  ...........  ...........  ...........
76094               E................  ...................  Magnetic image, both         ...........  ...........  ...........  ...........  ...........
                                                             breasts.
76095               X................  ...................  Stereotactic breast biopsy.         0187       3.9534      $206.17       $90.71       $41.23
76096               X................  ...................  X-ray of needle wire,               0289       1.8992       $99.05       $44.80       $19.81
                                                             breast.
76098               X................  ...................  X-ray exam, breast specimen         0260       0.7655       $39.92       $21.95        $7.98

[[Page 66913]]

 
76100               X................  ...................  X-ray exam of body section.         0261       1.2887       $67.21  ...........       $13.44
76101               X................  ...................  Complex body section x-ray.         0264       2.8197      $147.05       $79.41       $29.41
76102               X................  ...................  Complex body section x-rays         0264       2.8197      $147.05       $79.41       $29.41
76120               X................  ...................  Cine/video x-rays..........         0260       0.7655       $39.92       $21.95        $7.98
76125               X................  ...................  Cine/video x-rays add-on...         0260       0.7655       $39.92       $21.95        $7.98
76140               E................  ...................  X-ray consultation.........  ...........  ...........  ...........  ...........  ...........
76150               X................  ...................  X-ray exam, dry process....         0260       0.7655       $39.92       $21.95        $7.98
76350               N................  ...................  Special x-ray contrast       ...........  ...........  ...........  ...........  ...........
                                                             study.
76355               S................  ...................  CAT scan for localization..         0283       4.5057      $234.98      $126.27       $47.00
76360               S................  ...................  CAT scan for needle biopsy.         0283       4.5057      $234.98      $126.27       $47.00
76362               N................  ...................  Cat scan for tissue          ...........  ...........  ...........  ...........  ...........
                                                             ablation.
76370               S................  ...................  CAT scan for therapy guide.         0282       1.6763       $87.42       $44.51       $17.48
76375               S................  ...................  3d/holograph reconstr add-          0282       1.6763       $87.42       $44.51       $17.48
                                                             on.
76380               S................  ...................  CAT scan follow-up study...         0282       1.6763       $87.42       $44.51       $17.48
76390               E................  ...................  Mr spectroscopy............  ...........  ...........  ...........  ...........  ...........
76393               N................  ...................  Mr guidance for needle       ...........  ...........  ...........  ...........  ...........
                                                             place.
76394               N................  ...................  Mri for tissue ablation....  ...........  ...........  ...........  ...........  ...........
76400               S................  ...................  Magnetic image, bone marrow         0335       6.2983      $328.46      $151.46       $65.69
76490               N................  ...................  Us for tissue ablation.....  ...........  ...........  ...........  ...........  ...........
76496               X................  NI.................  Fluoroscopic procedure.....         0272       1.3372       $69.74       $38.36       $13.95
76497               S................  NI.................  Ct procedure...............         0282       1.6763       $87.42       $44.51       $17.48
76498               S................  NI.................  Mri procedure..............         0335       6.2983      $328.46      $151.46       $65.69
76499               X................  ...................  Radiographic procedure.....         0260       0.7655       $39.92       $21.95        $7.98
76506               S................  ...................  Echo exam of head..........         0266       1.5988       $83.38       $45.86       $16.68
76511               S................  ...................  Echo exam of eye...........         0266       1.5988       $83.38       $45.86       $16.68
76512               S................  ...................  Echo exam of eye...........         0266       1.5988       $83.38       $45.86       $16.68
76513               S................  ...................  Echo exam of eye, water             0265       0.9787       $51.04       $28.07       $10.21
                                                             bath.
76516               S................  ...................  Echo exam of eye...........         0266       1.5988       $83.38       $45.86       $16.68
76519               S................  ...................  Echo exam of eye...........         0266       1.5988       $83.38       $45.86       $16.68
76529               S................  ...................  Echo exam of eye...........         0265       0.9787       $51.04       $28.07       $10.21
76536               S................  ...................  Us exam of head and neck...         0266       1.5988       $83.38       $45.86       $16.68
76604               S................  ...................  Us exam, chest, b-scan.....         0266       1.5988       $83.38       $45.86       $16.68
76645               S................  ...................  Us exam, breast(s).........         0265       0.9787       $51.04       $28.07       $10.21
76700               S................  ...................  Us exam, abdom, complete...         0266       1.5988       $83.38       $45.86       $16.68
76705               S................  ...................  Echo exam of abdomen.......         0266       1.5988       $83.38       $45.86       $16.68
76770               S................  ...................  Us exam abdo back wall,             0266       1.5988       $83.38       $45.86       $16.68
                                                             comp.
76775               S................  ...................  Us eam abdo back wall, lim.         0266       1.5988       $83.38       $45.86       $16.68
76778               S................  ...................  Us exam kidney transplant..         0266       1.5988       $83.38       $45.86       $16.68
76800               S................  ...................  Us exam, spinal canal......         0266       1.5988       $83.38       $45.86       $16.68
76801               S................  NI.................  Ob us < 14 wks, single              0265       0.9787       $51.04       $28.07       $10.21
                                                             fetus.
76802               S................  NI.................  Ob us < 14 wks, addl fetus.         0265       0.9787       $51.04       $28.07       $10.21
76805               S................  ...................  Us exam, pg uterus, compl..         0266       1.5988       $83.38       $45.86       $16.68
76810               S................  ...................  Us exam, pg uterus, mult...         0265       0.9787       $51.04       $28.07       $10.21
76811               S................  NI.................  Ob us, detailed, sngl fetus         0267       2.4418      $127.34       $65.52       $25.47
76812               S................  NI.................  Ob us, detailed, addl fetus         0266       1.5988       $83.38       $45.86       $16.68
76815               S................  ...................  Us exam, pg uterus limit...         0265       0.9787       $51.04       $28.07       $10.21
76816               S................  ...................  Us exam pg uterus repeat...         0265       0.9787       $51.04       $28.07       $10.21
76817               S................  NI.................  Transvaginal us, obstetric.         0265       0.9787       $51.04       $28.07       $10.21
76818               S................  ...................  Fetal biophys profile w/nst         0266       1.5988       $83.38       $45.86       $16.68
76819               S................  ...................  Fetal biophys profil w/o            0266       1.5988       $83.38       $45.86       $16.68
                                                             nst.
76825               S................  ...................  Echo exam of fetal heart...         0671       2.3643      $123.30       $64.12       $24.66
76826               S................  ...................  Echo exam of fetal heart...         0697       1.5697       $81.86       $42.57       $16.37
76827               S................  ...................  Echo exam of fetal heart...         0671       2.3643      $123.30       $64.12       $24.66
76828               S................  ...................  Echo exam of fetal heart...         0697       1.5697       $81.86       $42.57       $16.37
76830               S................  ...................  Transvaginal us, non-ob....         0266       1.5988       $83.38       $45.86       $16.68
76831               S................  ...................  Echo exam, uterus..........         0266       1.5988       $83.38       $45.86       $16.68
76856               S................  ...................  Us exam, pelvic, complete..         0266       1.5988       $83.38       $45.86       $16.68
76857               S................  ...................  Us exam, pelvic, limited...         0265       0.9787       $51.04       $28.07       $10.21
76870               S................  ...................  Us exam, scrotum...........         0266       1.5988       $83.38       $45.86       $16.68
76872               S................  ...................  Echo exam, transrectal.....         0266       1.5988       $83.38       $45.86       $16.68
76873               S................  ...................  Echograp trans r, pros              0266       1.5988       $83.38       $45.86       $16.68
                                                             study.
76880               S................  ...................  Us exam, extremity.........         0266       1.5988       $83.38       $45.86       $16.68
76885               S................  ...................  Us exam infant hips,                0266       1.5988       $83.38       $45.86       $16.68
                                                             dynamic.
76886               S................  ...................  Us exam infant hips, static         0266       1.5988       $83.38       $45.86       $16.68
76930               S................  ...................  Echo guide, cardiocentesis.         0268       1.3856       $72.26  ...........       $14.45

[[Page 66914]]

 
76932               S................  ...................  Echo guide for heart biopsy         0268       1.3856       $72.26  ...........       $14.45
76936               S................  ...................  Echo guide for artery               0268       1.3856       $72.26  ...........       $14.45
                                                             repair.
76941               S................  ...................  Echo guide for transfusion.         0268       1.3856       $72.26  ...........       $14.45
76942               S................  ...................  Echo guide for biopsy......         0268       1.3856       $72.26  ...........       $14.45
76945               S................  ...................  Echo guide, villus sampling         0268       1.3856       $72.26  ...........       $14.45
76946               S................  ...................  Echo guide for                      0268       1.3856       $72.26  ...........       $14.45
                                                             amniocentesis.
76948               S................  ...................  Echo guide, ova aspiration.         0268       1.3856       $72.26  ...........       $14.45
76950               S................  ...................  Echo guidance radiotherapy.         0268       1.3856       $72.26  ...........       $14.45
76965               S................  ...................  Echo guidance radiotherapy.         0268       1.3856       $72.26  ...........       $14.45
76970               S................  ...................  Ultrasound exam follow-up..         0265       0.9787       $51.04       $28.07       $10.21
76975               S................  ...................  GI endoscopic ultrasound...         0266       1.5988       $83.38       $45.86       $16.68
76977               S................  ...................  Us bone density measure....         0265       0.9787       $51.04       $28.07       $10.21
76986               S................  ...................  Ultrasound guide intraoper.         0266       1.5988       $83.38       $45.86       $16.68
76999               S................  ...................  Echo examination procedure.         0265       0.9787       $51.04       $28.07       $10.21
77261               E................  ...................  Radiation therapy planning.  ...........  ...........  ...........  ...........  ...........
77262               E................  ...................  Radiation therapy planning.  ...........  ...........  ...........  ...........  ...........
77263               E................  ...................  Radiation therapy planning.  ...........  ...........  ...........  ...........  ...........
77280               X................  ...................  Set radiation therapy field         0304       1.6182       $84.39       $41.52       $16.88
77285               X................  ...................  Set radiation therapy field         0305       3.6530      $190.51       $91.38       $38.10
77290               X................  ...................  Set radiation therapy field         0305       3.6530      $190.51       $91.38       $38.10
77295               X................  ...................  Set radiation therapy field         0310      13.6625      $712.51      $325.27      $142.50
77299               E................  ...................  Radiation therapy planning.  ...........  ...........  ...........  ...........  ...........
77300               X................  ...................  Radiation therapy dose plan         0304       1.6182       $84.39       $41.52       $16.88
77301               S................  ...................  Radiotherapy dose plan,             0712  ...........      $875.00  ...........      $175.00
                                                             imrt.
77305               X................  ...................  Teletx isodose plan simple.         0304       1.6182       $84.39       $41.52       $16.88
77310               X................  ...................  Teletx isodose plan                 0304       1.6182       $84.39       $41.52       $16.88
                                                             intermed.
77315               X................  ...................  Teletx isodose plan complex         0305       3.6530      $190.51       $91.38       $38.10
77321               X................  ...................  Special teletx port plan...         0305       3.6530      $190.51       $91.38       $38.10
77326               X................  ...................  Radiation therapy dose plan         0305       3.6530      $190.51       $91.38       $38.10
77327               X................  ...................  Brachytx isodose calc               0305       3.6530      $190.51       $91.38       $38.10
                                                             interm.
77328               X................  ...................  Brachytx isodose plan compl         0305       3.6530      $190.51       $91.38       $38.10
77331               X................  ...................  Special radiation dosimetry         0304       1.6182       $84.39       $41.52       $16.88
77332               X................  ...................  Radiation treatment aid(s).         0303       2.8391      $148.06       $66.95       $29.61
77333               X................  ...................  Radiation treatment aid(s).         0303       2.8391      $148.06       $66.95       $29.61
77334               X................  ...................  Radiation treatment aid(s).         0303       2.8391      $148.06       $66.95       $29.61
77336               X................  ...................  Radiation physics consult..         0304       1.6182       $84.39       $41.52       $16.88
77370               X................  ...................  Radiation physics consult..         0305       3.6530      $190.51       $91.38       $38.10
77399               X................  ...................  External radiation                  0304       1.6182       $84.39       $41.52       $16.88
                                                             dosimetry.
77401               S................  ...................  Radiation treatment                 0300       1.5794       $82.37  ...........       $16.47
                                                             delivery.
77402               S................  ...................  Radiation treatment                 0300       1.5794       $82.37  ...........       $16.47
                                                             delivery.
77403               S................  ...................  Radiation treatment                 0300       1.5794       $82.37  ...........       $16.47
                                                             delivery.
77404               S................  ...................  Radiation treatment                 0300       1.5794       $82.37  ...........       $16.47
                                                             delivery.
77406               S................  ...................  Radiation treatment                 0300       1.5794       $82.37  ...........       $16.47
                                                             delivery.
77407               S................  ...................  Radiation treatment                 0300       1.5794       $82.37  ...........       $16.47
                                                             delivery.
77408               S................  ...................  Radiation treatment                 0300       1.5794       $82.37  ...........       $16.47
                                                             delivery.
77409               S................  ...................  Radiation treatment                 0300       1.5794       $82.37  ...........       $16.47
                                                             delivery.
77411               S................  ...................  Radiation treatment                 0300       1.5794       $82.37  ...........       $16.47
                                                             delivery.
77412               S................  ...................  Radiation treatment                 0301       3.1588      $164.73  ...........       $32.95
                                                             delivery.
77413               S................  ...................  Radiation treatment                 0301       3.1588      $164.73  ...........       $32.95
                                                             delivery.
77414               S................  ...................  Radiation treatment                 0301       3.1588      $164.73  ...........       $32.95
                                                             delivery.
77416               S................  ...................  Radiation treatment                 0301       3.1588      $164.73  ...........       $32.95
                                                             delivery.
77417               X................  ...................  Radiology port film(s).....         0260       0.7655       $39.92       $21.95        $7.98
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       5.9785      $311.78  ...........       $62.36
77499               E................  ...................  Radiation therapy            ...........  ...........  ...........  ...........  ...........
                                                             management.
77520               S................  ...................  Proton trmt, simple w/o             0664      10.0482      $524.02  ...........      $104.80
                                                             comp.
77522               S................  ...................  Proton trmt, simple w/comp.         0664      10.0482      $524.02  ...........      $104.80
77523               S................  ...................  Proton trmt, intermediate..         0650      12.0152      $626.60  ...........      $125.32
77525               S................  ...................  Proton treatment, complex..         0650      12.0152      $626.60  ...........      $125.32
77600               S................  ...................  Hyperthermia treatment.....         0314       4.1763      $217.80      $101.77       $43.56
77605               S................  ...................  Hyperthermia treatment.....         0314       4.1763      $217.80      $101.77       $43.56
77610               S................  ...................  Hyperthermia treatment.....         0314       4.1763      $217.80      $101.77       $43.56

[[Page 66915]]

 
77615               S................  ...................  Hyperthermia treatment.....         0314       4.1763      $217.80      $101.77       $43.56
77620               S................  ...................  Hyperthermia treatment.....         0314       4.1763      $217.80      $101.77       $43.56
77750               S................  ...................  Infuse radioactive                  0300       1.5794       $82.37  ...........       $16.47
                                                             materials.
77761               S................  ...................  Apply intrcav radiat simple         0312      52.8864    $2,758.08  ...........      $551.62
77762               S................  ...................  Apply intrcav radiat interm         0312      52.8864    $2,758.08  ...........      $551.62
77763               S................  ...................  Apply intrcav radiat compl.         0312      52.8864    $2,758.08  ...........      $551.62
77776               S................  ...................  Apply interstit radiat              0312      52.8864    $2,758.08  ...........      $551.62
                                                             simpl.
77777               S................  ...................  Apply interstit radiat              0312      52.8864    $2,758.08  ...........      $551.62
                                                             inter.
77778               S................  ...................  Apply interstit radiat              0651      54.7177    $2,853.58  ...........      $570.72
                                                             compl.
77781               S................  ...................  High intensity                      0313      21.0363    $1,097.06  ...........      $219.41
                                                             brachytherapy.
77782               S................  ...................  High intensity                      0313      21.0363    $1,097.06  ...........      $219.41
                                                             brachytherapy.
77783               S................  ...................  High intensity                      0313      21.0363    $1,097.06  ...........      $219.41
                                                             brachytherapy.
77784               S................  ...................  High intensity                      0313      21.0363    $1,097.06  ...........      $219.41
                                                             brachytherapy.
77789               S................  ...................  Apply surface radiation....         0300       1.5794       $82.37  ...........       $16.47
77790               N................  ...................  Radiation handling.........  ...........  ...........  ...........  ...........  ...........
77799               S................  ...................  Radium/radioisotope therapy         0313      21.0363    $1,097.06  ...........      $219.41
78000               S................  ...................  Thyroid, single uptake.....         0290       2.0251      $105.61       $53.17       $21.12
78001               S................  ...................  Thyroid, multiple uptakes..         0290       2.0251      $105.61       $53.17       $21.12
78003               S................  ...................  Thyroid suppress/stimul....         0290       2.0251      $105.61       $53.17       $21.12
78006               S................  ...................  Thyroid imaging with uptake         0291       3.9825      $207.69      $104.55       $41.54
78007               S................  ...................  Thyroid image, mult uptakes         0292       4.2925      $223.86      $112.69       $44.77
78010               S................  ...................  Thyroid imaging............         0291       3.9825      $207.69      $104.55       $41.54
78011               S................  ...................  Thyroid imaging with flow..         0292       4.2925      $223.86      $112.69       $44.77
78015               S................  ...................  Thyroid met imaging........         0291       3.9825      $207.69      $104.55       $41.54
78016               S................  ...................  Thyroid met imaging/studies         0292       4.2925      $223.86      $112.69       $44.77
78018               S................  ...................  Thyroid met imaging, body..         0292       4.2925      $223.86      $112.69       $44.77
78020               S................  ...................  Thyroid met uptake.........         0666       2.9650      $154.63       $85.05       $30.93
78070               S................  ...................  Parathyroid nuclear imaging         0292       4.2925      $223.86      $112.69       $44.77
78075               S................  ...................  Adrenal nuclear imaging....         0292       4.2925      $223.86      $112.69       $44.77
78099               S................  ...................  Endocrine nuclear procedure         0291       3.9825      $207.69      $104.55       $41.54
78102               S................  ...................  Bone marrow imaging, ltd...         0291       3.9825      $207.69      $104.55       $41.54
78103               S................  ...................  Bone marrow imaging, mult..         0291       3.9825      $207.69      $104.55       $41.54
78104               S................  ...................  Bone marrow imaging, body..         0291       3.9825      $207.69      $104.55       $41.54
78110               S................  ...................  Plasma volume, single......         0290       2.0251      $105.61       $53.17       $21.12
78111               S................  ...................  Plasma volume, multiple....         0290       2.0251      $105.61       $53.17       $21.12
78120               S................  ...................  Red cell mass, single......         0290       2.0251      $105.61       $53.17       $21.12
78121               S................  ...................  Red cell mass, multiple....         0290       2.0251      $105.61       $53.17       $21.12
78122               S................  ...................  Blood volume...............         0290       2.0251      $105.61       $53.17       $21.12
78130               S................  ...................  Red cell survival study....         0290       2.0251      $105.61       $53.17       $21.12
78135               S................  ...................  Red cell survival kinetics.         0290       2.0251      $105.61       $53.17       $21.12
78140               S................  ...................  Red cell sequestration.....         0290       2.0251      $105.61       $53.17       $21.12
78160               S................  ...................  Plasma iron turnover.......         0290       2.0251      $105.61       $53.17       $21.12
78162               S................  ...................  Radioiron absorption exam..         0290       2.0251      $105.61       $53.17       $21.12
78170               S................  ...................  Red cell iron utilization..         0290       2.0251      $105.61       $53.17       $21.12
78172               S................  ...................  Total body iron estimation.         0290       2.0251      $105.61       $53.17       $21.12
78185               S................  ...................  Spleen imaging.............         0291       3.9825      $207.69      $104.55       $41.54
78190               S................  ...................  Platelet survival, kinetics         0290       2.0251      $105.61       $53.17       $21.12
78191               S................  ...................  Platelet survival..........         0292       4.2925      $223.86      $112.69       $44.77
78195               S................  ...................  Lymph system imaging.......         0292       4.2925      $223.86      $112.69       $44.77
78199               S................  ...................  Blood/lymph nuclear exam...         0291       3.9825      $207.69      $104.55       $41.54
78201               S................  ...................  Liver imaging..............         0291       3.9825      $207.69      $104.55       $41.54
78202               S................  ...................  Liver imaging with flow....         0291       3.9825      $207.69      $104.55       $41.54
78205               S................  ...................  Liver imaging (3D).........         0291       3.9825      $207.69      $104.55       $41.54
78206               S................  ...................  Liver image (3d) with flow.         0292       4.2925      $223.86      $112.69       $44.77
78215               S................  ...................  Liver and spleen imaging...         0291       3.9825      $207.69      $104.55       $41.54
78216               S................  ...................  Liver & spleen image/flow..         0291       3.9825      $207.69      $104.55       $41.54
78220               S................  ...................  Liver function study.......         0291       3.9825      $207.69      $104.55       $41.54
78223               S................  ...................  Hepatobiliary imaging......         0292       4.2925      $223.86      $112.69       $44.77
78230               S................  ...................  Salivary gland imaging.....         0292       4.2925      $223.86      $112.69       $44.77
78231               S................  ...................  Serial salivary imaging....         0292       4.2925      $223.86      $112.69       $44.77
78232               S................  ...................  Salivary gland function             0292       4.2925      $223.86      $112.69       $44.77
                                                             exam.
78258               S................  ...................  Esophageal motility study..         0291       3.9825      $207.69      $104.55       $41.54
78261               S................  ...................  Gastric mucosa imaging.....         0291       3.9825      $207.69      $104.55       $41.54
78262               S................  ...................  Gastroesophageal reflux             0292       4.2925      $223.86      $112.69       $44.77
                                                             exam.
78264               S................  ...................  Gastric emptying study.....         0292       4.2925      $223.86      $112.69       $44.77

[[Page 66916]]

 
78267               A................  ...................  Breath tst attain/anal c-14  ...........  ...........  ...........  ...........  ...........
78268               A................  ...................  Breath test analysis, c-14.  ...........  ...........  ...........  ...........  ...........
78270               S................  ...................  Vit B-12 absorption exam...         0290       2.0251      $105.61       $53.17       $21.12
78271               S................  ...................  Vit b-12 absrp exam, int            0290       2.0251      $105.61       $53.17       $21.12
                                                             fac.
78272               S................  ...................  Vit B-12 absorp, combined..         0290       2.0251      $105.61       $53.17       $21.12
78278               S................  ...................  Acute GI blood loss imaging         0292       4.2925      $223.86      $112.69       $44.77
78282               S................  ...................  GI protein loss exam.......         0290       2.0251      $105.61       $53.17       $21.12
78290               S................  ...................  Meckel's divert exam.......         0292       4.2925      $223.86      $112.69       $44.77
78291               S................  ...................  Leveen/shunt patency exam..         0292       4.2925      $223.86      $112.69       $44.77
78299               S................  ...................  GI nuclear procedure.......         0291       3.9825      $207.69      $104.55       $41.54
78300               S................  ...................  Bone imaging, limited area.         0291       3.9825      $207.69      $104.55       $41.54
78305               S................  ...................  Bone imaging, multiple              0291       3.9825      $207.69      $104.55       $41.54
                                                             areas.
78306               S................  ...................  Bone imaging, whole body...         0291       3.9825      $207.69      $104.55       $41.54
78315               S................  ...................  Bone imaging, 3 phase......         0292       4.2925      $223.86      $112.69       $44.77
78320               S................  ...................  Bone imaging (3D)..........         0291       3.9825      $207.69      $104.55       $41.54
78350               X................  ...................  Bone mineral, single photon         0261       1.2887       $67.21  ...........       $13.44
78351               E................  ...................  Bone mineral, dual photon..  ...........  ...........  ...........  ...........  ...........
78399               S................  ...................  Musculoskeletal nuclear             0291       3.9825      $207.69      $104.55       $41.54
                                                             exam.
78414               S................  ...................  Non-imaging heart function.         0290       2.0251      $105.61       $53.17       $21.12
78428               S................  ...................  Cardiac shunt imaging......         0291       3.9825      $207.69      $104.55       $41.54
78445               S................  ...................  Vascular flow imaging......         0291       3.9825      $207.69      $104.55       $41.54
78455               S................  ...................  Venous thrombosis study....         0290       2.0251      $105.61       $53.17       $21.12
78456               S................  ...................  Acute venous thrombus image         0292       4.2925      $223.86      $112.69       $44.77
78457               S................  ...................  Venous thrombosis imaging..         0291       3.9825      $207.69      $104.55       $41.54
78458               S................  ...................  Ven thrombosis images,              0292       4.2925      $223.86      $112.69       $44.77
                                                             bilat.
78459               E................  ...................  Heart muscle imaging (PET).  ...........  ...........  ...........  ...........  ...........
78460               S................  ...................  Heart muscle blood, single.         0286       6.5309      $340.59      $187.32       $68.12
78461               S................  ...................  Heart muscle blood,                 0286       6.5309      $340.59      $187.32       $68.12
                                                             multiple.
78464               S................  ...................  Heart image (3d), single...         0286       6.5309      $340.59      $187.32       $68.12
78465               S................  ...................  Heart image (3d), multiple.         0286       6.5309      $340.59      $187.32       $68.12
78466               S................  ...................  Heart infarct image........         0291       3.9825      $207.69      $104.55       $41.54
78468               S................  ...................  Heart infarct image (ef)...         0291       3.9825      $207.69      $104.55       $41.54
78469               S................  ...................  Heart infarct image (3D)...         0291       3.9825      $207.69      $104.55       $41.54
78472               S................  ...................  Gated heart, planar, single         0286       6.5309      $340.59      $187.32       $68.12
78473               S................  ...................  Gated heart, multiple......         0286       6.5309      $340.59      $187.32       $68.12
78478               S................  ...................  Heart wall motion add-on...         0666       2.9650      $154.63       $85.05       $30.93
78480               S................  ...................  Heart function add-on......         0666       2.9650      $154.63       $85.05       $30.93
78481               S................  ...................  Heart first pass, single...         0286       6.5309      $340.59      $187.32       $68.12
78483               S................  ...................  Heart first pass, multiple.         0286       6.5309      $340.59      $187.32       $68.12
78491               E................  ...................  Heart image (pet), single..  ...........  ...........  ...........  ...........  ...........
78492               E................  ...................  Heart image (pet), multiple  ...........  ...........  ...........  ...........  ...........
78494               S................  ...................  Heart image, spect.........         0286       6.5309      $340.59      $187.32       $68.12
78496               S................  ...................  Heart first pass add-on....         0666       2.9650      $154.63       $85.05       $30.93
78499               S................  ...................  Cardiovascular nuclear exam         0291       3.9825      $207.69      $104.55       $41.54
78580               S................  ...................  Lung perfusion imaging.....         0291       3.9825      $207.69      $104.55       $41.54
78584               S................  ...................  Lung V/Q image single               0292       4.2925      $223.86      $112.69       $44.77
                                                             breath.
78585               S................  ...................  Lung V/Q imaging...........         0292       4.2925      $223.86      $112.69       $44.77
78586               S................  ...................  Aerosol lung image, single.         0291       3.9825      $207.69      $104.55       $41.54
78587               S................  ...................  Aerosol lung image,                 0291       3.9825      $207.69      $104.55       $41.54
                                                             multiple.
78588               S................  ...................  Perfusion lung image.......         0292       4.2925      $223.86      $112.69       $44.77
78591               S................  ...................  Vent image, 1 breath, 1             0291       3.9825      $207.69      $104.55       $41.54
                                                             proj.
78593               S................  ...................  Vent image, 1 proj, gas....         0291       3.9825      $207.69      $104.55       $41.54
78594               S................  ...................  Vent image, mult proj, gas.         0291       3.9825      $207.69      $104.55       $41.54
78596               S................  ...................  Lung differential function.         0292       4.2925      $223.86      $112.69       $44.77
78599               S................  ...................  Respiratory nuclear exam...         0291       3.9825      $207.69      $104.55       $41.54
78600               S................  ...................  Brain imaging, ltd static..         0291       3.9825      $207.69      $104.55       $41.54
78601               S................  ...................  Brain imaging, ltd w/ flow.         0291       3.9825      $207.69      $104.55       $41.54
78605               S................  ...................  Brain imaging, complete....         0291       3.9825      $207.69      $104.55       $41.54
78606               S................  ...................  Brain imaging, compl w/flow         0291       3.9825      $207.69      $104.55       $41.54
78607               S................  ...................  Brain imaging (3D).........         0291       3.9825      $207.69      $104.55       $41.54
78608               E................  ...................  Brain imaging (PET)........  ...........  ...........  ...........  ...........  ...........
78609               E................  ...................  Brain imaging (PET)........  ...........  ...........  ...........  ...........  ...........
78610               S................  ...................  Brain flow imaging only....         0291       3.9825      $207.69      $104.55       $41.54
78615               S................  ...................  Cerebral vascular flow              0291       3.9825      $207.69      $104.55       $41.54
                                                             image.
78630               S................  ...................  Cerebrospinal fluid scan...         0292       4.2925      $223.86      $112.69       $44.77

[[Page 66917]]

 
78635               S................  ...................  CSF ventriculography.......         0292       4.2925      $223.86      $112.69       $44.77
78645               S................  ...................  CSF shunt evaluation.......         0292       4.2925      $223.86      $112.69       $44.77
78647               S................  ...................  Cerebrospinal fluid scan...         0292       4.2925      $223.86      $112.69       $44.77
78650               S................  ...................  CSF leakage imaging........         0292       4.2925      $223.86      $112.69       $44.77
78660               S................  ...................  Nuclear exam of tear flow..         0291       3.9825      $207.69      $104.55       $41.54
78699               S................  ...................  Nervous system nuclear exam         0291       3.9825      $207.69      $104.55       $41.54
78700               S................  ...................  Kidney imaging, static.....         0291       3.9825      $207.69      $104.55       $41.54
78701               S................  ...................  Kidney imaging with flow...         0291       3.9825      $207.69      $104.55       $41.54
78704               S................  ...................  Imaging renogram...........         0291       3.9825      $207.69      $104.55       $41.54
78707               S................  ...................  Kidney flow/function image.         0291       3.9825      $207.69      $104.55       $41.54
78708               S................  ...................  Kidney flow/function image.         0292       4.2925      $223.86      $112.69       $44.77
78709               S................  ...................  Kidney flow/function image.         0292       4.2925      $223.86      $112.69       $44.77
78710               S................  ...................  Kidney imaging (3D)........         0291       3.9825      $207.69      $104.55       $41.54
78715               S................  ...................  Renal vascular flow exam...         0291       3.9825      $207.69      $104.55       $41.54
78725               S................  ...................  Kidney function study......         0290       2.0251      $105.61       $53.17       $21.12
78730               S................  ...................  Urinary bladder retention..         0291       3.9825      $207.69      $104.55       $41.54
78740               S................  ...................  Ureteral reflux study......         0292       4.2925      $223.86      $112.69       $44.77
78760               S................  ...................  Testicular imaging.........         0291       3.9825      $207.69      $104.55       $41.54
78761               S................  ...................  Testicular imaging/flow....         0291       3.9825      $207.69      $104.55       $41.54
78799               S................  ...................  Genitourinary nuclear exam.         0291       3.9825      $207.69      $104.55       $41.54
78800               S................  ...................  Tumor imaging, limited area         0292       4.2925      $223.86      $112.69       $44.77
78801               S................  ...................  Tumor imaging, mult areas..         0292       4.2925      $223.86      $112.69       $44.77
78802               S................  ...................  Tumor imaging, whole body..         0292       4.2925      $223.86      $112.69       $44.77
78803               S................  ...................  Tumor imaging (3D).........         0292       4.2925      $223.86      $112.69       $44.77
78805               S................  ...................  Abscess imaging, ltd area..         0292       4.2925      $223.86      $112.69       $44.77
78806               S................  ...................  Abscess imaging, whole body         0292       4.2925      $223.86      $112.69       $44.77
78807               S................  ...................  Nuclear localization/               0292       4.2925      $223.86      $112.69       $44.77
                                                             abscess.
78810               E................  ...................  Tumor imaging (PET)........  ...........  ...........  ...........  ...........  ...........
78890               N................  ...................  Nuclear medicine data proc.  ...........  ...........  ...........  ...........  ...........
78891               N................  ...................  Nuclear med data proc......  ...........  ...........  ...........  ...........  ...........
78990               N................  ...................  Provide diag                 ...........  ...........  ...........  ...........  ...........
                                                             radionuclide(s).
78999               S................  ...................  Nuclear diagnostic exam....         0291       3.9825      $207.69      $104.55       $41.54
79000               S................  ...................  Init hyperthyroid therapy..         0294       4.0794      $212.74      $117.01       $42.55
79001               S................  ...................  Repeat hyperthyroid therapy         0294       4.0794      $212.74      $117.01       $42.55
79020               S................  ...................  Thyroid ablation...........         0294       4.0794      $212.74      $117.01       $42.55
79030               S................  ...................  Thyroid ablation, carcinoma         0294       4.0794      $212.74      $117.01       $42.55
79035               S................  ...................  Thyroid metastatic therapy.         0294       4.0794      $212.74      $117.01       $42.55
79100               S................  ...................  Hematopoetic nuclear                0294       4.0794      $212.74      $117.01       $42.55
                                                             therapy.
79200               S................  ...................  Intracavitary nuclear trmt.         0294       4.0794      $212.74      $117.01       $42.55
79300               S................  ...................  Interstitial nuclear                0294       4.0794      $212.74      $117.01       $42.55
                                                             therapy.
79400               S................  ...................  Nonhemato nuclear therapy..         0294       4.0794      $212.74      $117.01       $42.55
79420               S................  ...................  Intravascular nuclear ther.         0294       4.0794      $212.74      $117.01       $42.55
79440               S................  ...................  Nuclear joint therapy......         0294       4.0794      $212.74      $117.01       $42.55
79900               N................  ...................  Provide ther radiopharm(s).  ...........  ...........  ...........  ...........  ...........
79999               S................  ...................  Nuclear medicine therapy...         0294       4.0794      $212.74      $117.01       $42.55
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................  DG.................  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......  ...........  ...........  ...........  ...........  ...........

[[Page 66918]]

 
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.....  ...........  ...........  ...........  ...........  ...........
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       0.4457       $23.24       $12.55        $4.65
80502               X................  ...................  Lab pathology consultation.         0342       0.2132       $11.12        $5.88        $2.22
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.....  ...........  ...........  ...........  ...........  ...........

[[Page 66919]]

 
82009               A................  ...................  Test for acetone/ketones...  ...........  ...........  ...........  ...........  ...........
82010               A................  ...................  Acetone assay..............  ...........  ...........  ...........  ...........  ...........
82013               A................  ...................  Acetylcholinesterase assay.  ...........  ...........  ...........  ...........  ...........
82016               A................  ...................  Acylcarnitines, qual.......  ...........  ...........  ...........  ...........  ...........
82017               A................  ...................  Acylcarnitines, quant......  ...........  ...........  ...........  ...........  ...........
82024               A................  ...................  Assay of acth..............  ...........  ...........  ...........  ...........  ...........
82030               A................  ...................  Assay of adp & amp.........  ...........  ...........  ...........  ...........  ...........
82040               A................  ...................  Assay of serum albumin.....  ...........  ...........  ...........  ...........  ...........
82042               A................  ...................  Assay of urine albumin.....  ...........  ...........  ...........  ...........  ...........
82043               A................  ...................  Microalbumin, quantitative.  ...........  ...........  ...........  ...........  ...........
82044               A................  ...................  Microalbumin, semiquant....  ...........  ...........  ...........  ...........  ...........
82055               A................  ...................  Assay of ethanol...........  ...........  ...........  ...........  ...........  ...........
82075               A................  ...................  Assay of breath ethanol....  ...........  ...........  ...........  ...........  ...........
82085               A................  ...................  Assay of aldolase..........  ...........  ...........  ...........  ...........  ...........
82088               A................  ...................  Assay of aldosterone.......  ...........  ...........  ...........  ...........  ...........
82101               A................  ...................  Assay of urine alkaloids...  ...........  ...........  ...........  ...........  ...........
82103               A................  ...................  Alpha-1-antitrypsin, total.  ...........  ...........  ...........  ...........  ...........
82104               A................  ...................  Alpha-1-antitrypsin, pheno.  ...........  ...........  ...........  ...........  ...........
82105               A................  ...................  Alpha-fetoprotein, serum...  ...........  ...........  ...........  ...........  ...........
82106               A................  ...................  Alpha-fetoprotein, amniotic  ...........  ...........  ...........  ...........  ...........
82108               A................  ...................  Assay of aluminum..........  ...........  ...........  ...........  ...........  ...........
82120               A................  ...................  Amines, vaginal fluid qual.  ...........  ...........  ...........  ...........  ...........
82127               A................  ...................  Amino acid, single qual....  ...........  ...........  ...........  ...........  ...........
82128               A................  ...................  Amino acids, mult qual.....  ...........  ...........  ...........  ...........  ...........
82131               A................  ...................  Amino acids, single quant..  ...........  ...........  ...........  ...........  ...........
82135               A................  ...................  Assay, aminolevulinic acid.  ...........  ...........  ...........  ...........  ...........
82136               A................  ...................  Amino acids, quant, 2-5....  ...........  ...........  ...........  ...........  ...........
82139               A................  ...................  Amino acids, quan, 6 or      ...........  ...........  ...........  ...........  ...........
                                                             more.
82140               A................  ...................  Assay of ammonia...........  ...........  ...........  ...........  ...........  ...........
82143               A................  ...................  Amniotic fluid scan........  ...........  ...........  ...........  ...........  ...........
82145               A................  ...................  Assay of amphetamines......  ...........  ...........  ...........  ...........  ...........
82150               A................  ...................  Assay of amylase...........  ...........  ...........  ...........  ...........  ...........
82154               A................  ...................  Androstanediol glucuronide.  ...........  ...........  ...........  ...........  ...........
82157               A................  ...................  Assay of androstenedione...  ...........  ...........  ...........  ...........  ...........
82160               A................  ...................  Assay of androsterone......  ...........  ...........  ...........  ...........  ...........
82163               A................  ...................  Assay of angiotensin II....  ...........  ...........  ...........  ...........  ...........
82164               A................  ...................  Angiotensin I enzyme test..  ...........  ...........  ...........  ...........  ...........
82172               A................  ...................  Assay of apolipoprotein....  ...........  ...........  ...........  ...........  ...........
82175               A................  ...................  Assay of arsenic...........  ...........  ...........  ...........  ...........  ...........
82180               A................  ...................  Assay of ascorbic acid.....  ...........  ...........  ...........  ...........  ...........
82190               A................  ...................  Atomic absorption..........  ...........  ...........  ...........  ...........  ...........
82205               A................  ...................  Assay of barbiturates......  ...........  ...........  ...........  ...........  ...........
82232               A................  ...................  Assay of beta-2 protein....  ...........  ...........  ...........  ...........  ...........
82239               A................  ...................  Bile acids, total..........  ...........  ...........  ...........  ...........  ...........
82240               A................  ...................  Bile acids, cholylglycine..  ...........  ...........  ...........  ...........  ...........
82247               A................  ...................  Bilirubin, total...........  ...........  ...........  ...........  ...........  ...........
82248               A................  ...................  Bilirubin, direct..........  ...........  ...........  ...........  ...........  ...........
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......  ...........  ...........  ...........  ...........  ...........

[[Page 66920]]

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

[[Page 66921]]

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

[[Page 66922]]

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

[[Page 66923]]

 
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.........  ...........  ...........  ...........  ...........  ...........
83880               A................  NI.................  Natriuretic peptide........  ...........  ...........  ...........  ...........  ...........
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..........  ...........  ...........  ...........  ...........  ...........
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................  ...................  Oncoprotein, 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..  ...........  ...........  ...........  ...........  ...........

[[Page 66924]]

 
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  ...........  ...........  ...........  ...........  ...........
84275               A................  ...................  Assay of sialic acid.......  ...........  ...........  ...........  ...........  ...........
84285               A................  ...................  Assay of silica............  ...........  ...........  ...........  ...........  ...........
84295               A................  ...................  Assay of serum sodium......  ...........  ...........  ...........  ...........  ...........
84300               A................  ...................  Assay of urine sodium......  ...........  ...........  ...........  ...........  ...........
84302               A................  NI.................  Assay of sweat 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)...  ...........  ...........  ...........  ...........  ...........

[[Page 66925]]

 
84460               A................  ...................  Alanine amino (ALT) (SGPT).  ...........  ...........  ...........  ...........  ...........
84466               A................  ...................  Assay of transferrin.......  ...........  ...........  ...........  ...........  ...........
84478               A................  ...................  Assay of triglycerides.....  ...........  ...........  ...........  ...........  ...........
84479               A................  ...................  Assay of thyroid (t3 or t4)  ...........  ...........  ...........  ...........  ...........
84480               A................  ...................  Assay, triiodothyronine      ...........  ...........  ...........  ...........  ...........
                                                             (t3).
84481               A................  ...................  Free assay (FT-3)..........  ...........  ...........  ...........  ...........  ...........
84482               A................  ...................  T3 reverse.................  ...........  ...........  ...........  ...........  ...........
84484               A................  ...................  Assay of troponin, quant...  ...........  ...........  ...........  ...........  ...........
84485               A................  ...................  Assay duodenal fluid         ...........  ...........  ...........  ...........  ...........
                                                             trypsin.
84488               A................  ...................  Test feces for trypsin.....  ...........  ...........  ...........  ...........  ...........
84490               A................  ...................  Assay of feces for trypsin.  ...........  ...........  ...........  ...........  ...........
84510               A................  ...................  Assay of tyrosine..........  ...........  ...........  ...........  ...........  ...........
84512               A................  ...................  Assay of troponin, qual....  ...........  ...........  ...........  ...........  ...........
84520               A................  ...................  Assay of urea nitrogen.....  ...........  ...........  ...........  ...........  ...........
84525               A................  ...................  Urea nitrogen semi-quant...  ...........  ...........  ...........  ...........  ...........
84540               A................  ...................  Assay of urine/urea-n......  ...........  ...........  ...........  ...........  ...........
84545               A................  ...................  Urea-N clearance test......  ...........  ...........  ...........  ...........  ...........
84550               A................  ...................  Assay of blood/uric acid...  ...........  ...........  ...........  ...........  ...........
84560               A................  ...................  Assay of urine/uric acid...  ...........  ...........  ...........  ...........  ...........
84577               A................  ...................  Assay of feces/urobilinogen  ...........  ...........  ...........  ...........  ...........
84578               A................  ...................  Test urine urobilinogen....  ...........  ...........  ...........  ...........  ...........
84580               A................  ...................  Assay of urine urobilinogen  ...........  ...........  ...........  ...........  ...........
84583               A................  ...................  Assay of urine urobilinogen  ...........  ...........  ...........  ...........  ...........
84585               A................  ...................  Assay of urine vma.........  ...........  ...........  ...........  ...........  ...........
84586               A................  ...................  Assay of vip...............  ...........  ...........  ...........  ...........  ...........
84588               A................  ...................  Assay of vasopressin.......  ...........  ...........  ...........  ...........  ...........
84590               A................  ...................  Assay of vitamin a.........  ...........  ...........  ...........  ...........  ...........
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.........  ...........  ...........  ...........  ...........  ...........
85004               A................  NI.................  Automated diff wbc count...  ...........  ...........  ...........  ...........  ...........
85007               A................  ...................  Differential WBC count.....  ...........  ...........  ...........  ...........  ...........
85008               A................  ...................  Nondifferential WBC count..  ...........  ...........  ...........  ...........  ...........
85009               A................  ...................  Differential WBC count.....  ...........  ...........  ...........  ...........  ...........
85013               A................  ...................  Spun microhematocrit.......  ...........  ...........  ...........  ...........  ...........
85014               A................  ...................  Hematocrit.................  ...........  ...........  ...........  ...........  ...........
85018               A................  ...................  Hemoglobin.................  ...........  ...........  ...........  ...........  ...........
85021               A................  DG.................  Automated hemogram.........  ...........  ...........  ...........  ...........  ...........
85022               A................  DG.................  Automated hemogram.........  ...........  ...........  ...........  ...........  ...........
85023               A................  DG.................  Automated hemogram.........  ...........  ...........  ...........  ...........  ...........
85024               A................  DG.................  Automated hemogram.........  ...........  ...........  ...........  ...........  ...........
85025               A................  ...................  Automated hemogram.........  ...........  ...........  ...........  ...........  ...........
85027               A................  ...................  Automated hemogram.........  ...........  ...........  ...........  ...........  ...........
85031               A................  DG.................  Manual hemogram, cbc.......  ...........  ...........  ...........  ...........  ...........
85032               A................  NI.................  Manual cell count, each....  ...........  ...........  ...........  ...........  ...........
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.
85049               A................  NI.................  Automated platelet count...  ...........  ...........  ...........  ...........  ...........
85060               X................  ...................  Blood smear interpretation.         0342       0.2132       $11.12        $5.88        $2.22
85097               X................  ...................  Bone marrow interpretation.         0343       0.4457       $23.24       $12.55        $4.65
85130               A................  ...................  Chromogenic substrate assay  ...........  ...........  ...........  ...........  ...........
85170               A................  ...................  Blood clot retraction......  ...........  ...........  ...........  ...........  ...........
85175               A................  ...................  Blood clot lysis time......  ...........  ...........  ...........  ...........  ...........
85210               A................  ...................  Blood clot factor II test..  ...........  ...........  ...........  ...........  ...........

[[Page 66926]]

 
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, quant..  ...........  ...........  ...........  ...........  ...........
85380               A................  NI.................  Fibrin degradation, vte....  ...........  ...........  ...........  ...........  ...........
85384               A................  ...................  Fibrinogen.................  ...........  ...........  ...........  ...........  ...........
85385               A................  ...................  Fibrinogen.................  ...........  ...........  ...........  ...........  ...........
85390               A................  ...................  Fibrinolysins screen.......  ...........  ...........  ...........  ...........  ...........
85400               A................  ...................  Fibrinolytic plasmin.......  ...........  ...........  ...........  ...........  ...........
85410               A................  ...................  Fibrinolytic antiplasmin...  ...........  ...........  ...........  ...........  ...........
85415               A................  ...................  Fibrinolytic plasminogen...  ...........  ...........  ...........  ...........  ...........
85420               A................  ...................  Fibrinolytic plasminogen...  ...........  ...........  ...........  ...........  ...........
85421               A................  ...................  Fibrinolytic plasminogen...  ...........  ...........  ...........  ...........  ...........
85441               A................  ...................  Heinz bodies, direct.......  ...........  ...........  ...........  ...........  ...........
85445               A................  ...................  Heinz bodies, induced......  ...........  ...........  ...........  ...........  ...........
85460               A................  ...................  Hemoglobin, fetal..........  ...........  ...........  ...........  ...........  ...........
85461               A................  ...................  Hemoglobin, fetal..........  ...........  ...........  ...........  ...........  ...........
85475               A................  ...................  Hemolysin..................  ...........  ...........  ...........  ...........  ...........
85520               A................  ...................  Heparin assay..............  ...........  ...........  ...........  ...........  ...........
85525               A................  ...................  Heparin neutralization.....  ...........  ...........  ...........  ...........  ...........
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................  DG.................  Blood platelet estimation..  ...........  ...........  ...........  ...........  ...........
85590               A................  DG.................  Platelet count, manual.....  ...........  ...........  ...........  ...........  ...........
85595               A................  DG.................  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.

[[Page 66927]]

 
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       0.4457       $23.24       $12.55        $4.65
                                                             service.
86078               X................  ...................  Physician blood bank                0344       0.6201       $32.34       $17.46        $6.47
                                                             service.
86079               X................  ...................  Physician blood bank                0344       0.6201       $32.34       $17.46        $6.47
                                                             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.
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..................  ...........  ...........  ...........  ...........  ...........

[[Page 66928]]

 
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       0.1453        $7.58        $3.08        $1.52
86490               X................  ...................  Coccidioidomycosis skin             0341       0.1453        $7.58        $3.08        $1.52
                                                             test.
86510               X................  ...................  Histoplasmosis skin test...         0341       0.1453        $7.58        $3.08        $1.52
86580               X................  ...................  TB intradermal test........         0341       0.1453        $7.58        $3.08        $1.52
86585               X................  ...................  TB tine test...............         0341       0.1453        $7.58        $3.08        $1.52
86586               X................  ...................  Skin test, unlisted........         0341       0.1453        $7.58        $3.08        $1.52
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...............  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........

[[Page 66929]]

 
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........  ...........  ...........  ...........  ...........  ...........
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       0.1938       $10.11        $3.10        $2.02
86860               X................  ...................  RBC antibody elution.......         0346       0.5136       $26.78        $6.75        $5.36
86870               X................  ...................  RBC antibody identification         0346       0.5136       $26.78        $6.75        $5.36
86880               X................  ...................  Coombs test, direct........         0341       0.1453        $7.58        $3.08        $1.52
86885               X................  ...................  Coombs test, indirect, qual         0341       0.1453        $7.58        $3.08        $1.52
86886               X................  ...................  Coombs test, indirect,              0341       0.1453        $7.58        $3.08        $1.52
                                                             titer.
86890               X................  ...................  Autologous blood process...         0347       1.1240       $58.62       $14.76       $11.72

[[Page 66930]]

 
86891               X................  ...................  Autologous blood, op                0345       0.1938       $10.11        $3.10        $2.02
                                                             salvage.
86900               X................  ...................  Blood typing, ABO..........         0341       0.1453        $7.58        $3.08        $1.52
86901               X................  ...................  Blood typing, Rh (D).......         0345       0.1938       $10.11        $3.10        $2.02
86903               X................  ...................  Blood typing, antigen               0345       0.1938       $10.11        $3.10        $2.02
                                                             screen.
86904               X................  ...................  Blood typing, patient serum         0345       0.1938       $10.11        $3.10        $2.02
86905               X................  ...................  Blood typing, RBC antigens.         0345       0.1938       $10.11        $3.10        $2.02
86906               X................  ...................  Blood typing, Rh phenotype.         0345       0.1938       $10.11        $3.10        $2.02
86910               E................  ...................  Blood typing, paternity      ...........  ...........  ...........  ...........  ...........
                                                             test.
86911               E................  ...................  Blood typing, antigen        ...........  ...........  ...........  ...........  ...........
                                                             system.
86915               S................  DG.................  Bone marrow/stem cell prep.         0110       4.0309      $210.22  ...........       $42.04
86920               X................  ...................  Compatibility test.........         0346       0.5136       $26.78        $6.75        $5.36
86921               X................  ...................  Compatibility test.........         0345       0.1938       $10.11        $3.10        $2.02
86922               X................  ...................  Compatibility test.........         0346       0.5136       $26.78        $6.75        $5.36
86927               X................  ...................  Plasma, fresh frozen.......         0346       0.5136       $26.78        $6.75        $5.36
86930               X................  ...................  Frozen blood prep..........         0347       1.1240       $58.62       $14.76       $11.72
86931               X................  ...................  Frozen blood thaw..........         0347       1.1240       $58.62       $14.76       $11.72
86932               X................  ...................  Frozen blood freeze/thaw...         0347       1.1240       $58.62       $14.76       $11.72
86940               A................  ...................  Hemolysins/agglutinins,      ...........  ...........  ...........  ...........  ...........
                                                             auto.
86941               A................  ...................  Hemolysins/agglutinins.....  ...........  ...........  ...........  ...........  ...........
86945               X................  ...................  Blood product/irradiation..         0346       0.5136       $26.78        $6.75        $5.36
86950               X................  ...................  Leukacyte transfusion......         0347       1.1240       $58.62       $14.76       $11.72
86965               X................  ...................  Pooling blood platelets....         0346       0.5136       $26.78        $6.75        $5.36
86970               X................  ...................  RBC pretreatment...........         0345       0.1938       $10.11        $3.10        $2.02
86971               X................  ...................  RBC pretreatment...........         0345       0.1938       $10.11        $3.10        $2.02
86972               X................  ...................  RBC pretreatment...........         0345       0.1938       $10.11        $3.10        $2.02
86975               X................  ...................  RBC pretreatment, serum....         0345       0.1938       $10.11        $3.10        $2.02
86976               X................  ...................  RBC pretreatment, serum....         0345       0.1938       $10.11        $3.10        $2.02
86977               X................  ...................  RBC pretreatment, serum....         0345       0.1938       $10.11        $3.10        $2.02
86978               X................  ...................  RBC pretreatment, serum....         0345       0.1938       $10.11        $3.10        $2.02
86985               X................  ...................  Split blood or products....         0347       1.1240       $58.62       $14.76       $11.72
86999               X................  ...................  Transfusion procedure......         0345       0.1938       $10.11        $3.10        $2.02
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.....  ...........  ...........  ...........  ...........  ...........
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................  ...................  Culture 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.  ...........  ...........  ...........  ...........  ...........

[[Page 66931]]

 
87169               A................  ...................  Macroscopic 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................  DG.................  Cytomegalovirus antibody     ...........  ...........  ...........  ...........  ...........
                                                             dfa.
87199               A................  DG.................  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.
87255               A................  NI.................  Genet virus isolate, hsv...  ...........  ...........  ...........  ...........  ...........
87260               A................  ...................  Adenovirus ag, if..........  ...........  ...........  ...........  ...........  ...........
87265               A................  ...................  Pertussis ag, if...........  ...........  ...........  ...........  ...........  ...........
87267               A................  NI.................  Enterovirus antibody, dfa..  ...........  ...........  ...........  ...........  ...........
87270               A................  ...................  Chlamydia trachomatis ag,    ...........  ...........  ...........  ...........  ...........
                                                             if.
87271               A................  NI.................  Cryptosporidum/gardia 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....  ...........  ...........  ...........  ...........  ...........
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.....  ...........  ...........  ...........  ...........  ...........

[[Page 66932]]

 
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.
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.

[[Page 66933]]

 
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       0.4457       $23.24       $12.55        $4.65
88106               X................  ...................  Cytopathology, fluids......         0343       0.4457       $23.24       $12.55        $4.65
88107               X................  ...................  Cytopathology, fluids......         0343       0.4457       $23.24       $12.55        $4.65
88108               X................  ...................  Cytopath, concentrate tech.         0343       0.4457       $23.24       $12.55        $4.65
88125               X................  ...................  Forensic cytopathology.....         0342       0.2132       $11.12        $5.88        $2.22
88130               A................  ...................  Sex chromatin                ...........  ...........  ...........  ...........  ...........
                                                             identification.
88140               A................  ...................  Sex chromatin                ...........  ...........  ...........  ...........  ...........
                                                             identification.
88141               N................  ...................  Cytopath, c/v, interpret...  ...........  ...........  ...........  ...........  ...........
88142               A................  ...................  Cytopath, c/v, thin layer..  ...........  ...........  ...........  ...........  ...........
88143               A................  ...................  Cytopath c/v thin layer      ...........  ...........  ...........  ...........  ...........
                                                             redo.
88144               A................  DG.................  Cytopath, c/v, thin lyr      ...........  ...........  ...........  ...........  ...........
                                                             redo.
88145               A................  DG.................  Cytopath, c/v, thin lyr sel  ...........  ...........  ...........  ...........  ...........
88147               A................  ...................  Cytopath, c/v, automated...  ...........  ...........  ...........  ...........  ...........
88148               A................  ...................  Cytopath, c/v, auto          ...........  ...........  ...........  ...........  ...........
                                                             rescreen.
88150               A................  ...................  Cytopath, c/v, manual......  ...........  ...........  ...........  ...........  ...........
88152               A................  ...................  Cytopath, c/v, auto redo...  ...........  ...........  ...........  ...........  ...........
88153               A................  ...................  Cytopath, c/v, redo........  ...........  ...........  ...........  ...........  ...........
88154               A................  ...................  Cytopath, c/v, select......  ...........  ...........  ...........  ...........  ...........
88155               A................  ...................  Cytopath, c/v, index add-on  ...........  ...........  ...........  ...........  ...........
88160               X................  ...................  Cytopath smear, other               0342       0.2132       $11.12        $5.88        $2.22
                                                             source.
88161               X................  ...................  Cytopath smear, other               0343       0.4457       $23.24       $12.55        $4.65
                                                             source.
88162               X................  ...................  Cytopath smear, other               0343       0.4457       $23.24       $12.55        $4.65
                                                             source.
88164               A................  ...................  Cytopath tbs, c/v, manual..  ...........  ...........  ...........  ...........  ...........
88165               A................  ...................  Cytopath tbs, c/v, redo....  ...........  ...........  ...........  ...........  ...........
88166               A................  ...................  Cytopath tbs, c/v, auto      ...........  ...........  ...........  ...........  ...........
                                                             redo.

[[Page 66934]]

 
88167               A................  ...................  Cytopath tbs, c/v, select..  ...........  ...........  ...........  ...........  ...........
88172               X................  ...................  Cytopathology eval of fna..         0343       0.4457       $23.24       $12.55        $4.65
88173               X................  ...................  Cytopath eval, fna, report.         0343       0.4457       $23.24       $12.55        $4.65
88174               A................  NI.................  Cytopath, c/v auto, in       ...........  ...........  ...........  ...........  ...........
                                                             fluid.
88175               A................  NI.................  Cytopath c/v auto fluid      ...........  ...........  ...........  ...........  ...........
                                                             redo.
88180               X................  ...................  Cell marker study..........         0343       0.4457       $23.24       $12.55        $4.65
88182               X................  ...................  Cell marker study..........         0344       0.6201       $32.34       $17.46        $6.47
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       0.2132       $11.12        $5.88        $2.22
88300               X................  ...................  Surgical path, gross.......         0342       0.2132       $11.12        $5.88        $2.22
88302               X................  ...................  Tissue exam by pathologist.         0342       0.2132       $11.12        $5.88        $2.22
88304               X................  ...................  Tissue exam by pathologist.         0343       0.4457       $23.24       $12.55        $4.65
88305               X................  ...................  Tissue exam by pathologist.         0343       0.4457       $23.24       $12.55        $4.65
88307               X................  ...................  Tissue exam by pathologist.         0344       0.6201       $32.34       $17.46        $6.47
88309               X................  ...................  Tissue exam by pathologist.         0344       0.6201       $32.34       $17.46        $6.47
88311               X................  ...................  Decalcify tissue...........         0342       0.2132       $11.12        $5.88        $2.22
88312               X................  ...................  Special stains.............         0342       0.2132       $11.12        $5.88        $2.22
88313               X................  ...................  Special stains.............         0342       0.2132       $11.12        $5.88        $2.22
88314               X................  ...................  Histochemical stain........         0342       0.2132       $11.12        $5.88        $2.22
88318               X................  ...................  Chemical histochemistry....         0342       0.2132       $11.12        $5.88        $2.22
88319               X................  ...................  Enzyme histochemistry......         0342       0.2132       $11.12        $5.88        $2.22
88321               X................  ...................  Microslide consultation....         0342       0.2132       $11.12        $5.88        $2.22
88323               X................  ...................  Microslide consultation....         0343       0.4457       $23.24       $12.55        $4.65
88325               X................  ...................  Comprehensive review of             0344       0.6201       $32.34       $17.46        $6.47
                                                             data.
88329               X................  ...................  Path consult introp........         0342       0.2132       $11.12        $5.88        $2.22
88331               X................  ...................  Path consult intraop, 1             0343       0.4457       $23.24       $12.55        $4.65
                                                             bloc.
88332               X................  ...................  Path consult intraop, addl.         0342       0.2132       $11.12        $5.88        $2.22
88342               X................  ...................  Immunocytochemistry........         0344       0.6201       $32.34       $17.46        $6.47
88346               X................  ...................  Immunofluorescent study....         0343       0.4457       $23.24       $12.55        $4.65
88347               X................  ...................  Immunofluorescent study....         0344       0.6201       $32.34       $17.46        $6.47
88348               X................  ...................  Electron microscopy........         0661       3.5077      $182.93      $100.61       $36.59
88349               X................  ...................  Scanning electron                   0661       3.5077      $182.93      $100.61       $36.59
                                                             microscopy.
88355               X................  ...................  Analysis, skeletal muscle..         0344       0.6201       $32.34       $17.46        $6.47
88356               X................  ...................  Analysis, nerve............         0344       0.6201       $32.34       $17.46        $6.47
88358               X................  ...................  Analysis, tumor............         0344       0.6201       $32.34       $17.46        $6.47
88362               X................  ...................  Nerve teasing preparations.         0343       0.4457       $23.24       $12.55        $4.65
88365               X................  ...................  Tissue hybridization.......         0344       0.6201       $32.34       $17.46        $6.47
88371               A................  ...................  Protein, western blot        ...........  ...........  ...........  ...........  ...........
                                                             tissue.
88372               A................  ...................  Protein analysis w/probe...  ...........  ...........  ...........  ...........  ...........

[[Page 66935]]

 
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......  ...........  ...........  ...........  ...........  ...........
89055               A................  NI.................  Leukocyte count, fecal.....  ...........  ...........  ...........  ...........  ...........
89060               A................  ...................  Exam,synovial fluid          ...........  ...........  ...........  ...........  ...........
                                                             crystals.
89100               X................  ...................  Sample intestinal contents.         0360       1.6279       $84.90       $42.45       $16.98
89105               X................  ...................  Sample intestinal contents.         0360       1.6279       $84.90       $42.45       $16.98
89125               A................  ...................  Specimen fat stain.........  ...........  ...........  ...........  ...........  ...........
89130               X................  ...................  Sample stomach contents....         0360       1.6279       $84.90       $42.45       $16.98
89132               X................  ...................  Sample stomach contents....         0360       1.6279       $84.90       $42.45       $16.98
89135               X................  ...................  Sample stomach contents....         0360       1.6279       $84.90       $42.45       $16.98
89136               X................  ...................  Sample stomach contents....         0360       1.6279       $84.90       $42.45       $16.98
89140               X................  ...................  Sample stomach contents....         0360       1.6279       $84.90       $42.45       $16.98
89141               X................  ...................  Sample stomach contents....         0360       1.6279       $84.90       $42.45       $16.98
89160               A................  ...................  Exam feces for meat fibers.  ...........  ...........  ...........  ...........  ...........
89190               A................  ...................  Nasal smear for eosinophils  ...........  ...........  ...........  ...........  ...........
89250               X................  ...................  Fertilization of oocyte....         0348       0.5523       $28.80  ...........        $5.76
89251               X................  ...................  Culture oocyte w/embryos...         0348       0.5523       $28.80  ...........        $5.76
89252               X................  ...................  Assist oocyte fertilization         0348       0.5523       $28.80  ...........        $5.76
89253               X................  ...................  Embryo hatching............         0348       0.5523       $28.80  ...........        $5.76
89254               X................  ...................  Oocyte identification......         0348       0.5523       $28.80  ...........        $5.76
89255               X................  ...................  Prepare embryo for transfer         0348       0.5523       $28.80  ...........        $5.76
89256               X................  ...................  Prepare cryopreserved               0348       0.5523       $28.80  ...........        $5.76
                                                             embryo.
89257               X................  ...................  Sperm identification.......         0348       0.5523       $28.80  ...........        $5.76
89258               X................  ...................  Cryopreservation, embryo...         0348       0.5523       $28.80  ...........        $5.76
89259               X................  ...................  Cryopreservation, sperm....         0348       0.5523       $28.80  ...........        $5.76
89260               X................  ...................  Sperm isolation, simple....         0348       0.5523       $28.80  ...........        $5.76
89261               X................  ...................  Sperm isolation, complex...         0348       0.5523       $28.80  ...........        $5.76
89264               X................  ...................  Identify sperm tissue......         0348       0.5523       $28.80  ...........        $5.76
89300               A................  ...................  Semen analysis w/huhner....  ...........  ...........  ...........  ...........  ...........
89310               A................  ...................  Semen analysis.............  ...........  ...........  ...........  ...........  ...........
89320               A................  ...................  Semen analysis, complete...  ...........  ...........  ...........  ...........  ...........
89321               A................  ...................  Semen analysis & motility..  ...........  ...........  ...........  ...........  ...........
89325               A................  ...................  Sperm antibody test........  ...........  ...........  ...........  ...........  ...........
89329               A................  ...................  Sperm evaluation test......  ...........  ...........  ...........  ...........  ...........
89330               A................  ...................  Evaluation, cervical mucus.  ...........  ...........  ...........  ...........  ...........
89350               X................  ...................  Sputum specimen collection.         0344       0.6201       $32.34       $17.46        $6.47
89355               A................  ...................  Exam feces for starch......  ...........  ...........  ...........  ...........  ...........
89360               X................  ...................  Collect sweat for test.....         0344       0.6201       $32.34       $17.46        $6.47
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               K................  ...................  Diphtheria antitoxin.......         0356       0.7655       $39.92  ...........        $7.98
90371               E................  ...................  Hep b ig, im...............  ...........  ...........  ...........  ...........  ...........
90375               K................  ...................  Rabies ig, im/sc...........         0356       0.7655       $39.92  ...........        $7.98
90376               K................  ...................  Rabies ig, heat treated....         0356       0.7655       $39.92  ...........        $7.98
90378               E................  ...................  Rsv ig, im, 50mg...........  ...........  ...........  ...........  ...........  ...........
90379               K................  ...................  Rsv ig, iv.................         0356       0.7655       $39.92  ...........        $7.98
90384               E................  ...................  Rh ig, full-dose, im.......  ...........  ...........  ...........  ...........  ...........
90385               N................  ...................  Rh ig, minidose, im........  ...........  ...........  ...........  ...........  ...........
90386               E................  ...................  Rh ig, iv..................  ...........  ...........  ...........  ...........  ...........
90389               N................  ...................  Tetanus ig, im.............  ...........  ...........  ...........  ...........  ...........
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.

[[Page 66936]]

 
90476               N................  ...................  Adenovirus vaccine, type 4.  ...........  ...........  ...........  ...........  ...........
90477               N................  ...................  Adenovirus vaccine, type 7.  ...........  ...........  ...........  ...........  ...........
90581               K................  ...................  Anthrax vaccine, sc........         0356       0.7655       $39.92  ...........        $7.98
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       0.2132       $11.12  ...........        $2.22
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               L................  ...................  Flu vaccine, 6-35 mo, im...  ...........  ...........  ...........  ...........  ...........
90658               L................  ...................  Flu vaccine, 3 yrs, im.....  ...........  ...........  ...........  ...........  ...........
90659               L................  ...................  Flu vaccine, whole, im.....  ...........  ...........  ...........  ...........  ...........
90660               E................  ...................  Flu vaccine, nasal.........  ...........  ...........  ...........  ...........  ...........
90665               N................  ...................  Lyme disease vaccine, im...  ...........  ...........  ...........  ...........  ...........
90669               E................  ...................  Pneumococcal vacc, ped <5..  ...........  ...........  ...........  ...........  ...........
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       0.7655       $39.92  ...........        $7.98
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................  DG.................  Rubella & mumps vaccine, sc         0356       0.7655       $39.92  ...........        $7.98
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       0.7655       $39.92  ...........        $7.98
90725               N................  ...................  Cholera vaccine, injectable  ...........  ...........  ...........  ...........  ...........
90727               N................  ...................  Plague vaccine, im.........  ...........  ...........  ...........  ...........  ...........
90732               L................  ...................  Pneumococcal vaccine.......  ...........  ...........  ...........  ...........  ...........
90733               N................  ...................  Meningococcal vaccine, sc..  ...........  ...........  ...........  ...........  ...........
90735               N................  ...................  Encephalitis vaccine, sc...  ...........  ...........  ...........  ...........  ...........
90740               E................  ...................  Hepb vacc, ill pat 3 dose    ...........  ...........  ...........  ...........  ...........
                                                             im.
90743               E................  ...................  Hep b vacc, adol, 2 dose,    ...........  ...........  ...........  ...........  ...........
                                                             im.
90744               E................  ...................  Hepb vacc ped/adol 3 dose    ...........  ...........  ...........  ...........  ...........
                                                             im.
90746               E................  ...................  Hep b vaccine, adult, im...  ...........  ...........  ...........  ...........  ...........
90747               E................  ...................  Hepb vacc, ill pat 4 dose    ...........  ...........  ...........  ...........  ...........
                                                             im.
90748               E................  ...................  Hep b/hib vaccine, im......  ...........  ...........  ...........  ...........  ...........
90749               N................  ...................  Vaccine toxoid.............  ...........  ...........  ...........  ...........  ...........
90780               E................  ...................  IV infusion therapy, 1 hour  ...........  ...........  ...........  ...........  ...........
90781               E................  ...................  IV infusion, additional      ...........  ...........  ...........  ...........  ...........
                                                             hour.
90782               X................  ...................  Injection, sc/im...........         0353       0.3973       $20.72  ...........        $4.14
90783               X................  ...................  Injection, ia..............         0359       1.1337       $59.12  ...........       $11.82
90784               X................  ...................  Injection, iv..............         0359       1.1337       $59.12  ...........       $11.82
90788               X................  ...................  Injection of antibiotic....         0359       1.1337       $59.12  ...........       $11.82
90799               X................  ...................  Ther/prophylactic/dx inject         0352       0.2229       $11.62  ...........        $2.32

[[Page 66937]]

 
90801               S................  ...................  Psy dx interview...........         0323       1.8410       $96.01       $21.26       $19.20
90802               S................  ...................  Intac psy dx interview.....         0323       1.8410       $96.01       $21.26       $19.20
90804               S................  ...................  Psytx, office, 20-30 min...         0322       1.3275       $69.23       $12.40       $13.85
90805               S................  ...................  Psytx, off, 20-30 min w/e&m         0322       1.3275       $69.23       $12.40       $13.85
90806               S................  ...................  Psytx, off, 45-50 min......         0323       1.8410       $96.01       $21.26       $19.20
90807               S................  ...................  Psytx, off, 45-50 min w/e&m         0323       1.8410       $96.01       $21.26       $19.20
90808               S................  ...................  Psytx, office, 75-80 min...         0323       1.8410       $96.01       $21.26       $19.20
90809               S................  ...................  Psytx, off, 75-80, w/e&m...         0323       1.8410       $96.01       $21.26       $19.20
90810               S................  ...................  Intac psytx, off, 20-30 min         0322       1.3275       $69.23       $12.40       $13.85
90811               S................  ...................  Intac psytx, 20-30, w/e&m..         0322       1.3275       $69.23       $12.40       $13.85
90812               S................  ...................  Intac psytx, off, 45-50 min         0323       1.8410       $96.01       $21.26       $19.20
90813               S................  ...................  Intac psytx, 45-50 min w/           0323       1.8410       $96.01       $21.26       $19.20
                                                             e&m.
90814               S................  ...................  Intac psytx, off, 75-80 min         0323       1.8410       $96.01       $21.26       $19.20
90815               S................  ...................  Intac psytx, 75-80 w/e&m...         0323       1.8410       $96.01       $21.26       $19.20
90816               S................  ...................  Psytx, hosp, 20-30 min.....         0322       1.3275       $69.23       $12.40       $13.85
90817               S................  ...................  Psytx, hosp, 20-30 min w/           0322       1.3275       $69.23       $12.40       $13.85
                                                             e&m.
90818               S................  ...................  Psytx, hosp, 45-50 min.....         0323       1.8410       $96.01       $21.26       $19.20
90819               S................  ...................  Psytx, hosp, 45-50 min w/           0323       1.8410       $96.01       $21.26       $19.20
                                                             e&m.
90821               S................  ...................  Psytx, hosp, 75-80 min.....         0323       1.8410       $96.01       $21.26       $19.20
90822               S................  ...................  Psytx, hosp, 75-80 min w/           0323       1.8410       $96.01       $21.26       $19.20
                                                             e&m.
90823               S................  ...................  Intac psytx, hosp, 20-30            0322       1.3275       $69.23       $12.40       $13.85
                                                             min.
90824               S................  ...................  Intac psytx, hsp 20-30 w/           0322       1.3275       $69.23       $12.40       $13.85
                                                             e&m.
90826               S................  ...................  Intac psytx, hosp, 45-50            0323       1.8410       $96.01       $21.26       $19.20
                                                             min.
90827               S................  ...................  Intac psytx, hsp 45-50 w/           0323       1.8410       $96.01       $21.26       $19.20
                                                             e&m.
90828               S................  ...................  Intac psytx, hosp, 75-80            0323       1.8410       $96.01       $21.26       $19.20
                                                             min.
90829               S................  ...................  Intac psytx, hsp 75-80 w/           0323       1.8410       $96.01       $21.26       $19.20
                                                             e&m.
90845               S................  ...................  Psychoanalysis.............         0323       1.8410       $96.01       $21.26       $19.20
90846               S................  ...................  Family psytx w/o patient...         0324       2.4612      $128.35  ...........       $25.67
90847               S................  ...................  Family psytx w/patient.....         0324       2.4612      $128.35  ...........       $25.67
90849               S................  ...................  Multiple family group psytx         0325       1.4244       $74.28       $18.27       $14.86
90853               S................  ...................  Group psychotherapy........         0325       1.4244       $74.28       $18.27       $14.86
90857               S................  ...................  Intac group psytx..........         0325       1.4244       $74.28       $18.27       $14.86
90862               X................  ...................  Medication management......         0374       1.1434       $59.63        $9.97       $11.93
90865               S................  ...................  Narcosynthesis.............         0323       1.8410       $96.01       $21.26       $19.20
90870               S................  ...................  Electroconvulsive therapy..         0320       4.2635      $222.35       $80.06       $44.47
90871               S................  ...................  Electroconvulsive therapy..         0320       4.2635      $222.35       $80.06       $44.47
90875               E................  ...................  Psychophysiological therapy  ...........  ...........  ...........  ...........  ...........
90876               E................  ...................  Psychophysiological therapy  ...........  ...........  ...........  ...........  ...........
90880               S................  ...................  Hypnotherapy...............         0323       1.8410       $96.01       $21.26       $19.20
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       1.3275       $69.23       $12.40       $13.85
90901               S................  ...................  Biofeedback train, any meth         0321       1.2112       $63.17       $21.78       $12.63
90911               S................  ...................  Biofeedback peri/uro/rectal         0321       1.2112       $63.17       $21.78       $12.63
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       4.8352      $252.16  ...........       $50.43
                                                             evaluation.
90937               E................  ...................  Hemodialysis, repeated eval  ...........  ...........  ...........  ...........  ...........
90939               N................  ...................  Hemodialysis study,          ...........  ...........  ...........  ...........  ...........
                                                             transcut.
90940               N................  ...................  Hemodialysis access study..  ...........  ...........  ...........  ...........  ...........
90945               S................  ...................  Dialysis, one evaluation...         0170       4.8352      $252.16  ...........       $50.43
90947               E................  ...................  Dialysis, repeated eval....  ...........  ...........  ...........  ...........  ...........
90989               E................  ...................  Dialysis training, complete  ...........  ...........  ...........  ...........  ...........
90993               E................  ...................  Dialysis training, incompl.  ...........  ...........  ...........  ...........  ...........
90997               E................  ...................  Hemoperfusion..............  ...........  ...........  ...........  ...........  ...........
90999               E................  ...................  Dialysis procedure.........  ...........  ...........  ...........  ...........  ...........
91000               X................  ...................  Esophageal intubation......         0361       3.3914      $176.86       $83.23       $35.37

[[Page 66938]]

 
91010               X................  ...................  Esophagus motility study...         0361       3.3914      $176.86       $83.23       $35.37
91011               X................  ...................  Esophagus motility study...         0361       3.3914      $176.86       $83.23       $35.37
91012               X................  ...................  Esophagus motility study...         0361       3.3914      $176.86       $83.23       $35.37
91020               X................  ...................  Gastric motility...........         0361       3.3914      $176.86       $83.23       $35.37
91030               X................  ...................  Acid perfusion of esophagus         0361       3.3914      $176.86       $83.23       $35.37
91032               X................  ...................  Esophagus, acid reflux test         0361       3.3914      $176.86       $83.23       $35.37
91033               X................  ...................  Prolonged acid reflux test.         0361       3.3914      $176.86       $83.23       $35.37
91052               X................  ...................  Gastric analysis test......         0361       3.3914      $176.86       $83.23       $35.37
91055               X................  ...................  Gastric intubation for              0360       1.6279       $84.90       $42.45       $16.98
                                                             smear.
91060               X................  ...................  Gastric saline load test...         0360       1.6279       $84.90       $42.45       $16.98
91065               X................  ...................  Breath hydrogen test.......         0360       1.6279       $84.90       $42.45       $16.98
91100               X................  ...................  Pass intestine bleeding             0360       1.6279       $84.90       $42.45       $16.98
                                                             tube.
91105               X................  ...................  Gastric intubation                  0360       1.6279       $84.90       $42.45       $16.98
                                                             treatment.
91122               T................  ...................  Anal pressure record.......         0156       2.9747      $155.13       $46.55       $31.03
91123               N................  ...................  Irrigate fecal impaction...  ...........  ...........  ...........  ...........  ...........
91132               X................  ...................  Electrogastrography........         0360       1.6279       $84.90       $42.45       $16.98
91133               X................  ...................  Electrogastrography w/test.         0360       1.6279       $84.90       $42.45       $16.98
91299               X................  ...................  Gastroenterology procedure.         0360       1.6279       $84.90       $42.45       $16.98
92002               V................  ...................  Eye exam, new patient......         0601       0.9690       $50.53  ...........       $10.11
92004               V................  ...................  Eye exam, new patient......         0602       1.4631       $76.30  ...........       $15.26
92012               V................  ...................  Eye exam established pat...         0600       0.8430       $43.96  ...........        $8.79
92014               V................  ...................  Eye exam & treatment.......         0602       1.4631       $76.30  ...........       $15.26
92015               E................  ...................  Refraction.................  ...........  ...........  ...........  ...........  ...........
92018               T................  ...................  New eye exam & treatment...         0699       3.7596      $196.07       $88.23       $39.21
92019               S................  ...................  Eye exam & treatment.......         0698       0.9205       $48.00       $18.72        $9.60
92020               S................  ...................  Special eye evaluation.....         0230       0.7364       $38.40       $14.97        $7.68
92060               S................  ...................  Special eye evaluation.....         0230       0.7364       $38.40       $14.97        $7.68
92065               S................  ...................  Orthoptic/pleoptic training         0230       0.7364       $38.40       $14.97        $7.68
92070               N................  ...................  Fitting of contact lens....  ...........  ...........  ...........  ...........  ...........
92081               S................  ...................  Visual field examination(s)         0230       0.7364       $38.40       $14.97        $7.68
92082               S................  ...................  Visual field examination(s)         0698       0.9205       $48.00       $18.72        $9.60
92083               S................  ...................  Visual field examination(s)         0698       0.9205       $48.00       $18.72        $9.60
92100               N................  ...................  Serial tonometry exam(s)...  ...........  ...........  ...........  ...........  ...........
92120               S................  ...................  Tonography & eye evaluation         0230       0.7364       $38.40       $14.97        $7.68
92130               S................  ...................  Water provocation                   0698       0.9205       $48.00       $18.72        $9.60
                                                             tonography.
92135               S................  ...................  Opthalmic dx imaging.......         0230       0.7364       $38.40       $14.97        $7.68
92136               S................  ...................  Ophthalmic biometry........         0230       0.7364       $38.40       $14.97        $7.68
92140               S................  ...................  Glaucoma provocative tests.         0698       0.9205       $48.00       $18.72        $9.60
92225               S................  ...................  Special eye exam, initial..         0698       0.9205       $48.00       $18.72        $9.60
92226               S................  ...................  Special eye exam,                   0698       0.9205       $48.00       $18.72        $9.60
                                                             subsequent.
92230               T................  ...................  Eye exam with photos.......         0699       3.7596      $196.07       $88.23       $39.21
92235               T................  ...................  Eye exam with photos.......         0699       3.7596      $196.07       $88.23       $39.21
92240               S................  ...................  Icg angiography............         0231       2.1705      $113.19       $50.94       $22.64
92250               S................  ...................  Eye exam with photos.......         0230       0.7364       $38.40       $14.97        $7.68
92260               S................  ...................  Ophthalmoscopy/dynamometry.         0230       0.7364       $38.40       $14.97        $7.68
92265               S................  ...................  Eye muscle evaluation......         0231       2.1705      $113.19       $50.94       $22.64
92270               S................  ...................  Electro-oculography........         0698       0.9205       $48.00       $18.72        $9.60
92275               S................  ...................  Electroretinography........         0231       2.1705      $113.19       $50.94       $22.64
92283               S................  ...................  Color vision examination...         0230       0.7364       $38.40       $14.97        $7.68
92284               S................  ...................  Dark adaptation eye exam...         0698       0.9205       $48.00       $18.72        $9.60
92285               S................  ...................  Eye photography............         0230       0.7364       $38.40       $14.97        $7.68
92286               S................  ...................  Internal eye photography...         0698       0.9205       $48.00       $18.72        $9.60
92287               S................  ...................  Internal eye photography...         0231       2.1705      $113.19       $50.94       $22.64
92310               E................  ...................  Contact lens fitting.......  ...........  ...........  ...........  ...........  ...........
92311               X................  ...................  Contact lens fitting.......         0362       2.8391      $148.06  ...........       $29.61
92312               X................  ...................  Contact lens fitting.......         0362       2.8391      $148.06  ...........       $29.61
92313               X................  ...................  Contact lens fitting.......         0362       2.8391      $148.06  ...........       $29.61
92314               E................  ...................  Prescription of contact      ...........  ...........  ...........  ...........  ...........
                                                             lens.
92315               X................  ...................  Prescription of contact             0362       2.8391      $148.06  ...........       $29.61
                                                             lens.
92316               X................  ...................  Prescription of contact             0362       2.8391      $148.06  ...........       $29.61
                                                             lens.
92317               X................  ...................  Prescription of contact             0362       2.8391      $148.06  ...........       $29.61
                                                             lens.
92325               X................  ...................  Modification of contact             0362       2.8391      $148.06  ...........       $29.61
                                                             lens.
92326               X................  ...................  Replacement of contact lens         0362       2.8391      $148.06  ...........       $29.61
92330               S................  ...................  Fitting of artificial eye..         0230       0.7364       $38.40       $14.97        $7.68
92335               N................  ...................  Fitting of artificial eye..  ...........  ...........  ...........  ...........  ...........

[[Page 66939]]

 
92340               E................  ...................  Fitting of spectacles......  ...........  ...........  ...........  ...........  ...........
92341               E................  ...................  Fitting of spectacles......  ...........  ...........  ...........  ...........  ...........
92342               E................  ...................  Fitting of spectacles......  ...........  ...........  ...........  ...........  ...........
92352               X................  ...................  Special spectacles fitting.         0362       2.8391      $148.06  ...........       $29.61
92353               X................  ...................  Special spectacles fitting.         0362       2.8391      $148.06  ...........       $29.61
92354               X................  ...................  Special spectacles fitting.         0362       2.8391      $148.06  ...........       $29.61
92355               X................  ...................  Special spectacles fitting.         0362       2.8391      $148.06  ...........       $29.61
92358               X................  ...................  Eye prosthesis service.....         0362       2.8391      $148.06  ...........       $29.61
92370               E................  ...................  Repair & adjust spectacles.  ...........  ...........  ...........  ...........  ...........
92371               X................  ...................  Repair & adjust spectacles.         0362       2.8391      $148.06  ...........       $29.61
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       0.7364       $38.40       $14.97        $7.68
92502               T................  ...................  Ear and throat examination.         0251       1.9089       $99.55  ...........       $19.91
92504               N................  ...................  Ear microscopy examination.  ...........  ...........  ...........  ...........  ...........
92506               A................  ...................  Speech/hearing evaluation..  ...........  ...........  ...........  ...........  ...........
92507               A................  ...................  Speech/hearing therapy.....  ...........  ...........  ...........  ...........  ...........
92508               A................  ...................  Speech/hearing therapy.....  ...........  ...........  ...........  ...........  ...........
92510               A................  ...................  Rehab for ear implant......  ...........  ...........  ...........  ...........  ...........
92511               T................  ...................  Nasopharyngoscopy..........         0071       0.9205       $48.00       $12.89        $9.60
92512               X................  ...................  Nasal function studies.....         0363       1.0852       $56.59       $20.94       $11.32
92516               X................  ...................  Facial nerve function test.         0660       1.5891       $82.87       $30.66       $16.57
92520               X................  ...................  Laryngeal function studies.         0660       1.5891       $82.87       $30.66       $16.57
92525               A................  DG.................  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       1.0852       $56.59       $20.94       $11.32
92542               X................  ...................  Positional nystagmus test..         0363       1.0852       $56.59       $20.94       $11.32
92543               X................  ...................  Caloric vestibular test....         0660       1.5891       $82.87       $30.66       $16.57
92544               X................  ...................  Optokinetic nystagmus test.         0363       1.0852       $56.59       $20.94       $11.32
92545               X................  ...................  Oscillating tracking test..         0363       1.0852       $56.59       $20.94       $11.32
92546               X................  ...................  Sinusoidal rotational test.         0660       1.5891       $82.87       $30.66       $16.57
92547               X................  ...................  Supplemental electrical             0363       1.0852       $56.59       $20.94       $11.32
                                                             test.
92548               X................  ...................  Posturography..............         0660       1.5891       $82.87       $30.66       $16.57
92551               E................  ...................  Pure tone hearing test, air  ...........  ...........  ...........  ...........  ...........
92552               X................  ...................  Pure tone audiometry, air..         0364       0.4457       $23.24        $9.06        $4.65
92553               X................  ...................  Audiometry, air & bone.....         0365       1.2112       $63.17       $18.95       $12.63
92555               X................  ...................  Speech threshold audiometry         0364       0.4457       $23.24        $9.06        $4.65
92556               X................  ...................  Speech audiometry, complete         0364       0.4457       $23.24        $9.06        $4.65
92557               X................  ...................  Comprehensive hearing test.         0365       1.2112       $63.17       $18.95       $12.63
92559               E................  ...................  Group audiometric testing..  ...........  ...........  ...........  ...........  ...........
92560               E................  ...................  Bekesy audiometry, screen..  ...........  ...........  ...........  ...........  ...........
92561               X................  ...................  Bekesy audiometry,                  0365       1.2112       $63.17       $18.95       $12.63
                                                             diagnosis.
92562               X................  ...................  Loudness balance test......         0364       0.4457       $23.24        $9.06        $4.65
92563               X................  ...................  Tone decay hearing test....         0364       0.4457       $23.24        $9.06        $4.65
92564               X................  ...................  Sisi hearing test..........         0364       0.4457       $23.24        $9.06        $4.65
92565               X................  ...................  Stenger test, pure tone....         0364       0.4457       $23.24        $9.06        $4.65
92567               X................  ...................  Tympanometry...............         0364       0.4457       $23.24        $9.06        $4.65
92568               X................  ...................  Acoustic reflex testing....         0364       0.4457       $23.24        $9.06        $4.65
92569               X................  ...................  Acoustic reflex decay test.         0364       0.4457       $23.24        $9.06        $4.65
92571               X................  ...................  Filtered speech hearing             0364       0.4457       $23.24        $9.06        $4.65
                                                             test.
92572               X................  ...................  Staggered spondaic word             0364       0.4457       $23.24        $9.06        $4.65
                                                             test.
92573               X................  ...................  Lombard test...............         0364       0.4457       $23.24        $9.06        $4.65
92575               X................  ...................  Sensorineural acuity test..         0365       1.2112       $63.17       $18.95       $12.63
92576               X................  ...................  Synthetic sentence test....         0364       0.4457       $23.24        $9.06        $4.65
92577               X................  ...................  Stenger test, speech.......         0365       1.2112       $63.17       $18.95       $12.63
92579               X................  ...................  Visual audiometry (vra)....         0365       1.2112       $63.17       $18.95       $12.63
92582               X................  ...................  Conditioning play                   0365       1.2112       $63.17       $18.95       $12.63
                                                             audiometry.

[[Page 66940]]

 
92583               X................  ...................  Select picture audiometry..         0364       0.4457       $23.24        $9.06        $4.65
92584               X................  ...................  Electrocochleography.......         0660       1.5891       $82.87       $30.66       $16.57
92585               S................  ...................  Auditor evoke potent,               0216       2.8972      $151.09       $67.98       $30.22
                                                             compre.
92586               S................  ...................  Auditor evoke potent, limit         0218       1.0077       $52.55  ...........       $10.51
92587               X................  ...................  Evoked auditory test.......         0363       1.0852       $56.59       $20.94       $11.32
92588               X................  ...................  Evoked auditory test.......         0660       1.5891       $82.87       $30.66       $16.57
92589               X................  ...................  Auditory function test(s)..         0364       0.4457       $23.24        $9.06        $4.65
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       1.2112       $63.17       $18.95       $12.63
92597               E................  ...................  Voice Prosthetic Evaluation  ...........  ...........  ...........  ...........  ...........
92598               E................  DG.................  Voice Prosthetic             ...........  ...........  ...........  ...........  ...........
                                                             Modification.
92599               X................  DG.................  ENT procedure/service......         0364       0.4457       $23.24        $9.06        $4.65
92601               A................  NI.................  Cochlear implt f/up exam <   ...........  ...........  ...........  ...........  ...........
                                                             7.
92602               A................  NI.................  Reprogram cochlear implt <   ...........  ...........  ...........  ...........  ...........
                                                             7.
92603               A................  NI.................  Cochlear implt f/up exam 7   ...........  ...........  ...........  ...........  ...........
                                                             .
92604               A................  NI.................  Reprogram cochlear implt 7   ...........  ...........  ...........  ...........  ...........
                                                             .
92605               A................  NI.................  Eval for nonspeech device    ...........  ...........  ...........  ...........  ...........
                                                             rx.
92606               A................  NI.................  Non-speech device service..  ...........  ...........  ...........  ...........  ...........
92607               A................  NI.................  Ex for speech device rx,     ...........  ...........  ...........  ...........  ...........
                                                             1hr.
92608               A................  NI.................  Ex for speech device rx      ...........  ...........  ...........  ...........  ...........
                                                             addl.
92609               A................  NI.................  Use of speech device         ...........  ...........  ...........  ...........  ...........
                                                             service.
92610               A................  NI.................  Evaluate swallowing          ...........  ...........  ...........  ...........  ...........
                                                             function.
92611               A................  NI.................  Motion fluoroscopy/swallow.  ...........  ...........  ...........  ...........  ...........
92612               A................  NI.................  Endoscopy swallow tst        ...........  ...........  ...........  ...........  ...........
                                                             (fees).
92613               E................  NI.................  Endoscopy swallow tst        ...........  ...........  ...........  ...........  ...........
                                                             (fees).
92614               A................  NI.................  Laryngoscopic sensory test.  ...........  ...........  ...........  ...........  ...........
92615               E................  NI.................  Eval laryngoscopy sense tst  ...........  ...........  ...........  ...........  ...........
92616               A................  NI.................  Fees w/laryngeal sense test  ...........  ...........  ...........  ...........  ...........
92617               E................  NI.................  Interprt fees/laryngeal      ...........  ...........  ...........  ...........  ...........
                                                             test.
92700               X................  NI.................  Ent procedure/service......         0364       0.4457       $23.24        $9.06        $4.65
92950               S................  ...................  Heart/lung resuscitation            0094       3.8371      $200.11       $67.63       $40.02
                                                             cpr.
92953               S................  ...................  Temporary external pacing..         0094       3.8371      $200.11       $67.63       $40.02
92960               S................  ...................  Cardioversion electric, ext         0679       5.4069      $281.98       $95.30       $56.40
92961               S................  ...................  Cardioversion, electric,            0679       5.4069      $281.98       $95.30       $56.40
                                                             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       4.1278      $215.27       $58.21       $43.05
92978               S................  ...................  Intravasc us, heart add-on.         0670      30.2416    $1,577.13      $571.17      $315.43
92979               S................  ...................  Intravasc us, heart add-on.         0670      30.2416    $1,577.13      $571.17      $315.43
92980               T................  ...................  Insert intracoronary stent.         0104      76.5486    $3,992.09  ...........      $798.42
92981               T................  ...................  Insert intracoronary stent.         0104      76.5486    $3,992.09  ...........      $798.42
92982               T................  ...................  Coronary artery dilation...         0083      51.9755    $2,710.57  ...........      $542.11
92984               T................  ...................  Coronary artery dilation...         0083      51.9755    $2,710.57  ...........      $542.11
92986               T................  ...................  Revision of aortic valve...         0083      51.9755    $2,710.57  ...........      $542.11
92987               T................  ...................  Revision of mitral valve...         0083      51.9755    $2,710.57  ...........      $542.11
92990               T................  ...................  Revision of pulmonary valve         0083      51.9755    $2,710.57  ...........      $542.11
92992               C................  ...................  Revision of heart chamber..  ...........  ...........  ...........  ...........  ...........
92993               C................  ...................  Revision of heart chamber..  ...........  ...........  ...........  ...........  ...........
92995               T................  ...................  Coronary atherectomy.......         0082      86.4321    $4,507.52    $1,293.59      $901.50
92996               T................  ...................  Coronary atherectomy add-on         0082      86.4321    $4,507.52    $1,293.59      $901.50
92997               T................  ...................  Pul art balloon repr,               0081      43.5067    $2,268.92  ...........      $453.78
                                                             percut.
92998               T................  ...................  Pul art balloon repr,               0081      43.5067    $2,268.92  ...........      $453.78
                                                             percut.
93000               E................  ...................  Electrocardiogram, complete  ...........  ...........  ...........  ...........  ...........
93005               S................  ...................  Electrocardiogram, tracing.         0099       0.3682       $19.20  ...........        $3.84
93010               A................  ...................  Electrocardiogram report...  ...........  ...........  ...........  ...........  ...........
93012               N................  ...................  Transmission of ecg........  ...........  ...........  ...........  ...........  ...........
93014               E................  ...................  Report on transmitted ecg..  ...........  ...........  ...........  ...........  ...........

[[Page 66941]]

 
93015               E................  ...................  Cardiovascular stress test.  ...........  ...........  ...........  ...........  ...........
93016               E................  ...................  Cardiovascular stress test.  ...........  ...........  ...........  ...........  ...........
93017               X................  ...................  Cardiovascular stress test.         0100       1.6085       $83.88       $41.44       $16.78
93018               E................  ...................  Cardiovascular stress test.  ...........  ...........  ...........  ...........  ...........
93024               X................  ...................  Cardiac drug stress test...         0100       1.6085       $83.88       $41.44       $16.78
93025               X................  ...................  Microvolt t-wave assess....         0100       1.6085       $83.88       $41.44       $16.78
93040               E................  ...................  Rhythm ECG with report.....  ...........  ...........  ...........  ...........  ...........
93041               S................  ...................  Rhythm ECG, tracing........         0099       0.3682       $19.20  ...........        $3.84
93042               E................  ...................  Rhythm ECG, report.........  ...........  ...........  ...........  ...........  ...........
93224               E................  ...................  ECG monitor/report, 24 hrs.  ...........  ...........  ...........  ...........  ...........
93225               X................  ...................  ECG monitor/record, 24 hrs.         0097       1.0077       $52.55       $23.80       $10.51
93226               X................  ...................  ECG monitor/report, 24 hrs.         0097       1.0077       $52.55       $23.80       $10.51
93227               E................  ...................  ECG monitor/review, 24 hrs.  ...........  ...........  ...........  ...........  ...........
93230               E................  ...................  ECG monitor/report, 24 hrs.  ...........  ...........  ...........  ...........  ...........
93231               X................  ...................  Ecg monitor/record, 24 hrs.         0097       1.0077       $52.55       $23.80       $10.51
93232               X................  ...................  ECG monitor/report, 24 hrs.         0097       1.0077       $52.55       $23.80       $10.51
93233               E................  ...................  ECG monitor/review, 24 hrs.  ...........  ...........  ...........  ...........  ...........
93235               E................  ...................  ECG monitor/report, 24 hrs.  ...........  ...........  ...........  ...........  ...........
93236               X................  ...................  ECG monitor/report, 24 hrs.         0097       1.0077       $52.55       $23.80       $10.51
93237               E................  ...................  ECG monitor/review, 24 hrs.  ...........  ...........  ...........  ...........  ...........
93268               E................  ...................  ECG record/review..........  ...........  ...........  ...........  ...........  ...........
93270               X................  ...................  ECG recording..............         0097       1.0077       $52.55       $23.80       $10.51
93271               X................  ...................  Ecg/monitoring and analysis         0097       1.0077       $52.55       $23.80       $10.51
93272               E................  ...................  Ecg/review, interpret only.  ...........  ...........  ...........  ...........  ...........
93278               S................  ...................  ECG/signal-averaged........         0099       0.3682       $19.20  ...........        $3.84
93303               S................  ...................  Echo transthoracic.........         0269       3.2170      $167.77       $87.24       $33.55
93304               S................  ...................  Echo transthoracic.........         0697       1.5697       $81.86       $42.57       $16.37
93307               S................  ...................  Echo exam of heart.........         0269       3.2170      $167.77       $87.24       $33.55
93308               S................  ...................  Echo exam of heart.........         0697       1.5697       $81.86       $42.57       $16.37
93312               S................  ...................  Echo transesophageal.......         0270       5.3003      $276.42      $146.79       $55.28
93313               S................  ...................  Echo transesophageal.......         0270       5.3003      $276.42      $146.79       $55.28
93314               N................  ...................  Echo transesophageal.......  ...........  ...........  ...........  ...........  ...........
93315               S................  ...................  Echo transesophageal.......         0270       5.3003      $276.42      $146.79       $55.28
93316               S................  ...................  Echo transesophageal.......         0270       5.3003      $276.42      $146.79       $55.28
93317               N................  ...................  Echo transesophageal.......  ...........  ...........  ...........  ...........  ...........
93318               S................  ...................  Echo transesophageal                0270       5.3003      $276.42      $146.79       $55.28
                                                             intraop.
93320               S................  ...................  Doppler echo exam, heart...         0671       2.3643      $123.30       $64.12       $24.66
93321               S................  ...................  Doppler echo exam, heart...         0697       1.5697       $81.86       $42.57       $16.37
93325               S................  ...................  Doppler color flow add-on..         0697       1.5697       $81.86       $42.57       $16.37
93350               S................  ...................  Echo transthoracic.........         0269       3.2170      $167.77       $87.24       $33.55
93501               T................  ...................  Right heart catheterization         0080      35.2996    $1,840.91      $838.92      $368.18
93503               T................  ...................  Insert/place heart catheter         0103      11.8408      $617.51      $223.63      $123.50
93505               T................  ...................  Biopsy of heart lining.....         0103      11.8408      $617.51      $223.63      $123.50
93508               T................  ...................  Cath placement, angiography         0080      35.2996    $1,840.91      $838.92      $368.18
93510               T................  ...................  Left heart catheterization.         0080      35.2996    $1,840.91      $838.92      $368.18
93511               T................  ...................  Left heart catheterization.         0080      35.2996    $1,840.91      $838.92      $368.18
93514               T................  ...................  Left heart catheterization.         0080      35.2996    $1,840.91      $838.92      $368.18
93524               T................  ...................  Left heart catheterization.         0080      35.2996    $1,840.91      $838.92      $368.18
93526               T................  ...................  Rt & Lt heart catheters....         0080      35.2996    $1,840.91      $838.92      $368.18
93527               T................  ...................  Rt & Lt heart catheters....         0080      35.2996    $1,840.91      $838.92      $368.18
93528               T................  ...................  Rt & Lt heart catheters....         0080      35.2996    $1,840.91      $838.92      $368.18
93529               T................  ...................  Rt, lt heart                        0080      35.2996    $1,840.91      $838.92      $368.18
                                                             catheterization.
93530               T................  ...................  Rt heart cath, congenital..         0080      35.2996    $1,840.91      $838.92      $368.18
93531               T................  ...................  R & l heart cath,                   0080      35.2996    $1,840.91      $838.92      $368.18
                                                             congenital.
93532               T................  ...................  R & l heart cath,                   0080      35.2996    $1,840.91      $838.92      $368.18
                                                             congenital.
93533               T................  ...................  R & l heart cath,                   0080      35.2996    $1,840.91      $838.92      $368.18
                                                             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......  ...........  ...........  ...........  ...........  ...........

[[Page 66942]]

 
93561               N................  ...................  Cardiac output measurement.  ...........  ...........  ...........  ...........  ...........
93562               N................  ...................  Cardiac output measurement.  ...........  ...........  ...........  ...........  ...........
93571               N................  ...................  Heart flow reserve measure.  ...........  ...........  ...........  ...........  ...........
93572               N................  ...................  Heart flow reserve measure.  ...........  ...........  ...........  ...........  ...........
93580               T................  NI.................  Transcath closure of asd...         0981  ...........    $2,250.00  ...........      $450.00
93581               T................  NI.................  Transcath closure of vsd...         0981  ...........    $2,250.00  ...........      $450.00
93600               T................  ...................  Bundle of His recording....         0087      39.3983    $2,054.66  ...........      $410.93
93602               T................  ...................  Intra-atrial recording.....         0087      39.3983    $2,054.66  ...........      $410.93
93603               T................  ...................  Right ventricular recording         0087      39.3983    $2,054.66  ...........      $410.93
93609               T................  ...................  Map tachycardia, add-on....         0087      39.3983    $2,054.66  ...........      $410.93
93610               T................  ...................  Intra-atrial pacing........         0087      39.3983    $2,054.66  ...........      $410.93
93612               T................  ...................  Intraventricular pacing....         0087      39.3983    $2,054.66  ...........      $410.93
93613               T................  ...................  Electrophys map 3d, add-on.         0087      39.3983    $2,054.66  ...........      $410.93
93615               T................  ...................  Esophageal recording.......         0087      39.3983    $2,054.66  ...........      $410.93
93616               T................  ...................  Esophageal recording.......         0087      39.3983    $2,054.66  ...........      $410.93
93618               T................  ...................  Heart rhythm pacing........         0087      39.3983    $2,054.66  ...........      $410.93
93619               T................  ...................  Electrophysiology                   0085      41.7238    $2,175.94      $480.03      $435.19
                                                             evaluation.
93620               T................  ...................  Electrophysiology                   0085      41.7238    $2,175.94      $480.03      $435.19
                                                             evaluation.
93621               T................  ...................  Electrophysiology                   0085      41.7238    $2,175.94      $480.03      $435.19
                                                             evaluation.
93622               T................  ...................  Electrophysiology                   0085      41.7238    $2,175.94      $480.03      $435.19
                                                             evaluation.
93623               T................  ...................  Stimulation, pacing heart..         0087      39.3983    $2,054.66  ...........      $410.93
93624               S................  ...................  Electrophysiologic study...         0084       9.3312      $486.63  ...........       $97.33
93631               T................  ...................  Heart pacing, mapping......         0087      39.3983    $2,054.66  ...........      $410.93
93640               S................  ...................  Evaluation heart device....         0084       9.3312      $486.63  ...........       $97.33
93641               S................  ...................  Electrophysiology                   0084       9.3312      $486.63  ...........       $97.33
                                                             evaluation.
93642               S................  ...................  Electrophysiology                   0084       9.3312      $486.63  ...........       $97.33
                                                             evaluation.
93650               T................  ...................  Ablate heart dysrhythm              0086      52.8282    $2,755.04      $936.35      $551.01
                                                             focus.
93651               T................  ...................  Ablate heart dysrhythm              0086      52.8282    $2,755.04      $936.35      $551.01
                                                             focus.
93652               T................  ...................  Ablate heart dysrhythm              0086      52.8282    $2,755.04      $936.35      $551.01
                                                             focus.
93660               S................  ...................  Tilt table evaluation......         0101       4.2247      $220.32      $105.27       $44.06
93662               S................  ...................  Intracardiac ecg (ice).....         0670      30.2416    $1,577.13      $571.17      $315.43
93668               E................  ...................  Peripheral vascular rehab..  ...........  ...........  ...........  ...........  ...........
93701               S................  ...................  Bioimpedance, thoracic.....         0099       0.3682       $19.20  ...........        $3.84
93720               E................  ...................  Total body plethysmography.  ...........  ...........  ...........  ...........  ...........
93721               X................  ...................  Plethysmography tracing....         0368       1.0562       $55.08       $27.55       $11.02
93722               E................  ...................  Plethysmography report.....  ...........  ...........  ...........  ...........  ...........
93724               S................  ...................  Analyze pacemaker system...         0690       0.4263       $22.23       $10.63        $4.45
93727               S................  ...................  Analyze ilr system.........         0690       0.4263       $22.23       $10.63        $4.45
93731               S................  ...................  Analyze pacemaker system...         0690       0.4263       $22.23       $10.63        $4.45
93732               S................  ...................  Analyze pacemaker system...         0690       0.4263       $22.23       $10.63        $4.45
93733               S................  ...................  Telephone analy, pacemaker.         0690       0.4263       $22.23       $10.63        $4.45
93734               S................  ...................  Analyze pacemaker system...         0690       0.4263       $22.23       $10.63        $4.45
93735               S................  ...................  Analyze pacemaker system...         0690       0.4263       $22.23       $10.63        $4.45
93736               S................  ...................  Telephone analy, pacemaker.         0690       0.4263       $22.23       $10.63        $4.45
93740               X................  ...................  Temperature gradient                0367       0.5814       $30.32       $15.16        $6.06
                                                             studies.
93741               S................  ...................  Analyze ht pace device sngl         0689       0.5814       $30.32  ...........        $6.06
93742               S................  ...................  Analyze ht pace device sngl         0689       0.5814       $30.32  ...........        $6.06
93743               S................  ...................  Analyze ht pace device dual         0689       0.5814       $30.32  ...........        $6.06
93744               S................  ...................  Analyze ht pace device dual         0689       0.5814       $30.32  ...........        $6.06
93760               E................  ...................  Cephalic thermogram........  ...........  ...........  ...........  ...........  ...........
93762               E................  ...................  Peripheral thermogram......  ...........  ...........  ...........  ...........  ...........
93770               N................  ...................  Measure venous pressure....  ...........  ...........  ...........  ...........  ...........
93784               E................  ...................  Ambulatory BP monitoring...  ...........  ...........  ...........  ...........  ...........
93786               X................  ...................  Ambulatory BP recording....         0097       1.0077       $52.55       $23.80       $10.51
93788               E................  ...................  Ambulatory BP analysis.....  ...........  ...........  ...........  ...........  ...........
93790               E................  ...................  Review/report BP recording.  ...........  ...........  ...........  ...........  ...........
93797               S................  ...................  Cardiac rehab..............         0095       0.6105       $31.84       $16.73        $6.37
93798               S................  ...................  Cardiac rehab/monitor......         0095       0.6105       $31.84       $16.73        $6.37
93799               S................  ...................  Cardiovascular procedure...         0096       1.7054       $88.94       $48.15       $17.79
93875               S................  ...................  Extracranial study.........         0096       1.7054       $88.94       $48.15       $17.79
93880               S................  ...................  Extracranial study.........         0267       2.4418      $127.34       $65.52       $25.47
93882               S................  ...................  Extracranial study.........         0267       2.4418      $127.34       $65.52       $25.47
93886               S................  ...................  Intracranial study.........         0267       2.4418      $127.34       $65.52       $25.47
93888               S................  ...................  Intracranial study.........         0266       1.5988       $83.38       $45.86       $16.68
93922               S................  ...................  Extremity study............         0096       1.7054       $88.94       $48.15       $17.79

[[Page 66943]]

 
93923               S................  ...................  Extremity study............         0096       1.7054       $88.94       $48.15       $17.79
93924               S................  ...................  Extremity study............         0096       1.7054       $88.94       $48.15       $17.79
93925               S................  ...................  Lower extremity study......         0267       2.4418      $127.34       $65.52       $25.47
93926               S................  ...................  Lower extremity study......         0267       2.4418      $127.34       $65.52       $25.47
93930               S................  ...................  Upper extremity study......         0267       2.4418      $127.34       $65.52       $25.47
93931               S................  ...................  Upper extremity study......         0266       1.5988       $83.38       $45.86       $16.68
93965               S................  ...................  Extremity study............         0096       1.7054       $88.94       $48.15       $17.79
93970               S................  ...................  Extremity study............         0267       2.4418      $127.34       $65.52       $25.47
93971               S................  ...................  Extremity study............         0267       2.4418      $127.34       $65.52       $25.47
93975               S................  ...................  Vascular study.............         0267       2.4418      $127.34       $65.52       $25.47
93976               S................  ...................  Vascular study.............         0267       2.4418      $127.34       $65.52       $25.47
93978               S................  ...................  Vascular study.............         0267       2.4418      $127.34       $65.52       $25.47
93979               S................  ...................  Vascular study.............         0267       2.4418      $127.34       $65.52       $25.47
93980               S................  ...................  Penile vascular study......         0267       2.4418      $127.34       $65.52       $25.47
93981               S................  ...................  Penile vascular study......         0267       2.4418      $127.34       $65.52       $25.47
93990               S................  ...................  Doppler flow testing.......         0267       2.4418      $127.34       $65.52       $25.47
94010               X................  ...................  Breathing capacity test....         0368       1.0562       $55.08       $27.55       $11.02
94014               X................  ...................  Patient recorded spirometry         0367       0.5814       $30.32       $15.16        $6.06
94015               X................  ...................  Patient recorded spirometry         0367       0.5814       $30.32       $15.16        $6.06
94016               A................  ...................  Review patient spirometry..  ...........  ...........  ...........  ...........  ...........
94060               X................  ...................  Evaluation of wheezing.....         0368       1.0562       $55.08       $27.55       $11.02
94070               X................  ...................  Evaluation of wheezing.....         0369       2.5871      $134.92       $44.18       $26.98
94150               X................  ...................  Vital capacity test........         0367       0.5814       $30.32       $15.16        $6.06
94200               X................  ...................  Lung function test (MBC/            0367       0.5814       $30.32       $15.16        $6.06
                                                             MVV).
94240               X................  ...................  Residual lung capacity.....         0368       1.0562       $55.08       $27.55       $11.02
94250               X................  ...................  Expired gas collection.....         0367       0.5814       $30.32       $15.16        $6.06
94260               X................  ...................  Thoracic gas volume........         0368       1.0562       $55.08       $27.55       $11.02
94350               X................  ...................  Lung nitrogen washout curve         0368       1.0562       $55.08       $27.55       $11.02
94360               X................  ...................  Measure airflow resistance.         0367       0.5814       $30.32       $15.16        $6.06
94370               X................  ...................  Breath airway closing               0367       0.5814       $30.32       $15.16        $6.06
                                                             volume.
94375               X................  ...................  Respiratory flow volume             0367       0.5814       $30.32       $15.16        $6.06
                                                             loop.
94400               X................  ...................  CO2 breathing response              0367       0.5814       $30.32       $15.16        $6.06
                                                             curve.
94450               X................  ...................  Hypoxia response curve.....         0367       0.5814       $30.32       $15.16        $6.06
94620               X................  ...................  Pulmonary stress test/              0368       1.0562       $55.08       $27.55       $11.02
                                                             simple.
94621               X................  ...................  Pulm stress test/complex...         0369       2.5871      $134.92       $44.18       $26.98
94640               S................  ...................  Airway inhalation treatment         0077       0.2907       $15.16        $8.34        $3.03
94642               S................  ...................  Aerosol inhalation                  0078       0.6492       $33.86       $14.55        $6.77
                                                             treatment.
94650               S................  DG.................  Pressure breathing (IPPB)..         0077       0.2907       $15.16        $8.34        $3.03
94651               S................  DG.................  Pressure breathing (IPPB)..         0077       0.2907       $15.16        $8.34        $3.03
94652               C................  DG.................  Pressure breathing (IPPB)..  ...........  ...........  ...........  ...........  ...........
94656               S................  ...................  Initial ventilator mgmt....         0079       1.6376       $85.40  ...........       $17.08
94657               S................  ...................  Continued ventilator mgmt..         0079       1.6376       $85.40  ...........       $17.08
94660               S................  ...................  Pos airway pressure, CPAP..         0068       2.0736      $108.14       $59.48       $21.63
94662               S................  ...................  Neg press ventilation, cnp.         0079       1.6376       $85.40  ...........       $17.08
94664               S................  ...................  Aerosol or vapor                    0077       0.2907       $15.16        $8.34        $3.03
                                                             inhalations.
94665               S................  DG.................  Aerosol or vapor                    0077       0.2907       $15.16        $8.34        $3.03
                                                             inhalations.
94667               S................  ...................  Chest wall manipulation....         0077       0.2907       $15.16        $8.34        $3.03
94668               S................  ...................  Chest wall manipulation....         0077       0.2907       $15.16        $8.34        $3.03
94680               X................  ...................  Exhaled air analysis, o2...         0367       0.5814       $30.32       $15.16        $6.06
94681               X................  ...................  Exhaled air analysis, o2/           0368       1.0562       $55.08       $27.55       $11.02
                                                             co2.
94690               X................  ...................  Exhaled air analysis.......         0367       0.5814       $30.32       $15.16        $6.06
94720               X................  ...................  Monoxide diffusing capacity         0368       1.0562       $55.08       $27.55       $11.02
94725               X................  ...................  Membrane diffusion capacity         0368       1.0562       $55.08       $27.55       $11.02
94750               X................  ...................  Pulmonary compliance study.         0367       0.5814       $30.32       $15.16        $6.06
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       0.5814       $30.32       $15.16        $6.06
94772               X................  ...................  Breath recording, infant...         0369       2.5871      $134.92       $44.18       $26.98
94799               X................  ...................  Pulmonary service/procedure         0367       0.5814       $30.32       $15.16        $6.06
95004               X................  ...................  Percut allergy skin tests..         0370       0.7752       $40.43       $11.58        $8.09
95010               X................  ...................  Percut allergy titrate test         0370       0.7752       $40.43       $11.58        $8.09
95015               X................  ...................  Id allergy titrate-drug/bug         0370       0.7752       $40.43       $11.58        $8.09
95024               X................  ...................  Id allergy test, drug/bug..         0370       0.7752       $40.43       $11.58        $8.09
95027               X................  ...................  Skin end point titration...         0370       0.7752       $40.43       $11.58        $8.09

[[Page 66944]]

 
95028               X................  ...................  Id allergy test-delayed             0370       0.7752       $40.43       $11.58        $8.09
                                                             type.
95044               X................  ...................  Allergy patch tests........         0370       0.7752       $40.43       $11.58        $8.09
95052               X................  ...................  Photo patch test...........         0370       0.7752       $40.43       $11.58        $8.09
95056               X................  ...................  Photosensitivity tests.....         0370       0.7752       $40.43       $11.58        $8.09
95060               X................  ...................  Eye allergy tests..........         0370       0.7752       $40.43       $11.58        $8.09
95065               X................  ...................  Nose allergy test..........         0370       0.7752       $40.43       $11.58        $8.09
95070               X................  ...................  Bronchial allergy tests....         0369       2.5871      $134.92       $44.18       $26.98
95071               X................  ...................  Bronchial allergy tests....         0369       2.5871      $134.92       $44.18       $26.98
95075               X................  ...................  Ingestion challenge test...         0361       3.3914      $176.86       $83.23       $35.37
95078               X................  ...................  Provocative testing........         0370       0.7752       $40.43       $11.58        $8.09
95115               X................  ...................  Immunotherapy, one                  0352       0.2229       $11.62  ...........        $2.32
                                                             injection.
95117               X................  ...................  Immunotherapy injections...         0353       0.3973       $20.72  ...........        $4.14
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       0.5039       $26.28  ...........        $5.26
95145               X................  ...................  Antigen therapy services...         0371       0.5039       $26.28  ...........        $5.26
95146               X................  ...................  Antigen therapy services...         0371       0.5039       $26.28  ...........        $5.26
95147               X................  ...................  Antigen therapy services...         0371       0.5039       $26.28  ...........        $5.26
95148               X................  ...................  Antigen therapy services...         0371       0.5039       $26.28  ...........        $5.26
95149               X................  ...................  Antigen therapy services...         0371       0.5039       $26.28  ...........        $5.26
95165               X................  ...................  Antigen therapy services...         0371       0.5039       $26.28  ...........        $5.26
95170               X................  ...................  Antigen therapy services...         0371       0.5039       $26.28  ...........        $5.26
95180               X................  ...................  Rapid desensitization......         0370       0.7752       $40.43       $11.58        $8.09
95199               X................  ...................  Allergy immunology services         0370       0.7752       $40.43       $11.58        $8.09
95250               T................  ...................  Glucose monitoring, cont...         0972  ...........      $150.00  ...........       $30.00
95805               S................  ...................  Multiple sleep latency test         0209      11.3369      $591.23      $280.58      $118.25
95806               S................  ...................  Sleep study, unattended....         0213       3.2557      $169.79       $70.41       $33.96
95807               S................  ...................  Sleep study, attended......         0209      11.3369      $591.23      $280.58      $118.25
95808               S................  ...................  Polysomnography, 1-3.......         0209      11.3369      $591.23      $280.58      $118.25
95810               S................  ...................  Polysomnography, 4 or more.         0209      11.3369      $591.23      $280.58      $118.25
95811               S................  ...................  Polysomnography w/cpap.....         0209      11.3369      $591.23      $280.58      $118.25
95812               S................  ...................  Electroencephalogram (EEG).         0213       3.2557      $169.79       $70.41       $33.96
95813               S................  ...................  Eeg, over 1 hour...........         0213       3.2557      $169.79       $70.41       $33.96
95816               S................  ...................  Electroencephalogram (EEG).         0214       2.2286      $116.22       $58.12       $23.24
95819               S................  ...................  Electroencephalogram (EEG).         0214       2.2286      $116.22       $58.12       $23.24
95822               S................  ...................  Sleep electroencephalogram.         0214       2.2286      $116.22       $58.12       $23.24
95824               S................  ...................  Eeg, cerebral death only...         0214       2.2286      $116.22       $58.12       $23.24
95827               S................  ...................  Night electroencephalogram.         0209      11.3369      $591.23      $280.58      $118.25
95829               S................  ...................  Surgery electrocorticogram.         0214       2.2286      $116.22       $58.12       $23.24
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       1.0077       $52.55  ...........       $10.51
95858               S................  ...................  Tensilon test & myogram....         0218       1.0077       $52.55  ...........       $10.51
95860               S................  ...................  Muscle test, one limb......         0218       1.0077       $52.55  ...........       $10.51
95861               S................  ...................  Muscle test, 2 limbs.......         0218       1.0077       $52.55  ...........       $10.51
95863               S................  ...................  Muscle test, 3 limbs.......         0218       1.0077       $52.55  ...........       $10.51
95864               S................  ...................  Muscle test, 4 limbs.......         0218       1.0077       $52.55  ...........       $10.51
95867               S................  ...................  Muscle test, head or neck..         0218       1.0077       $52.55  ...........       $10.51
95868               S................  ...................  Muscle test cran nerve              0218       1.0077       $52.55  ...........       $10.51
                                                             bilat.
95869               S................  ...................  Muscle test, thor                   0215       0.5814       $30.32       $15.76        $6.06
                                                             paraspinal.
95870               S................  ...................  Muscle test, nonparaspinal.         0218       1.0077       $52.55  ...........       $10.51
95872               S................  ...................  Muscle test, one fiber.....         0218       1.0077       $52.55  ...........       $10.51
95875               S................  ...................  Limb exercise test.........         0215       0.5814       $30.32       $15.76        $6.06
95900               S................  ...................  Motor nerve conduction test         0218       1.0077       $52.55  ...........       $10.51
95903               S................  ...................  Motor nerve conduction test         0218       1.0077       $52.55  ...........       $10.51

[[Page 66945]]

 
95904               S................  ...................  Sense nerve conduction test         0215       0.5814       $30.32       $15.76        $6.06
95920               S................  ...................  Intraop nerve test add-on..         0216       2.8972      $151.09       $67.98       $30.22
95921               S................  ...................  Autonomic nerv function             0218       1.0077       $52.55  ...........       $10.51
                                                             test.
95922               S................  ...................  Autonomic nerv function             0218       1.0077       $52.55  ...........       $10.51
                                                             test.
95923               S................  ...................  Autonomic nerv function             0215       0.5814       $30.32       $15.76        $6.06
                                                             test.
95925               S................  ...................  Somatosensory testing......         0216       2.8972      $151.09       $67.98       $30.22
95926               S................  ...................  Somatosensory testing......         0216       2.8972      $151.09       $67.98       $30.22
95927               S................  ...................  Somatosensory testing......         0216       2.8972      $151.09       $67.98       $30.22
95930               S................  ...................  Visual evoked potential             0218       1.0077       $52.55  ...........       $10.51
                                                             test.
95933               S................  ...................  Blink reflex test..........         0215       0.5814       $30.32       $15.76        $6.06
95934               S................  ...................  H-reflex test..............         0215       0.5814       $30.32       $15.76        $6.06
95936               S................  ...................  H-reflex test..............         0215       0.5814       $30.32       $15.76        $6.06
95937               S................  ...................  Neuromuscular junction test         0218       1.0077       $52.55  ...........       $10.51
95950               S................  ...................  Ambulatory eeg monitoring..         0213       3.2557      $169.79       $70.41       $33.96
95951               S................  ...................  EEG monitoring/videorecord.         0209      11.3369      $591.23      $280.58      $118.25
95953               S................  ...................  EEG monitoring/computer....         0209      11.3369      $591.23      $280.58      $118.25
95954               S................  ...................  EEG monitoring/giving drugs         0214       2.2286      $116.22       $58.12       $23.24
95955               S................  ...................  EEG during surgery.........         0214       2.2286      $116.22       $58.12       $23.24
95956               S................  ...................  Eeg monitoring, cable/radio         0214       2.2286      $116.22       $58.12       $23.24
95957               S................  ...................  EEG digital analysis.......         0214       2.2286      $116.22       $58.12       $23.24
95958               S................  ...................  EEG monitoring/function             0213       3.2557      $169.79       $70.41       $33.96
                                                             test.
95961               S................  ...................  Electrode stimulation,              0216       2.8972      $151.09       $67.98       $30.22
                                                             brain.
95962               S................  ...................  Electrode stim, brain add-          0216       2.8972      $151.09       $67.98       $30.22
                                                             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       6.2595      $326.44      $179.54       $65.29
95971               S................  ...................  Analyze neurostim, simple..         0692       6.2595      $326.44      $179.54       $65.29
95972               S................  ...................  Analyze neurostim, complex.         0692       6.2595      $326.44      $179.54       $65.29
95973               S................  ...................  Analyze neurostim, complex.         0692       6.2595      $326.44      $179.54       $65.29
95974               S................  ...................  Cranial neurostim, complex.         0692       6.2595      $326.44      $179.54       $65.29
95975               S................  ...................  Cranial neurostim, complex.         0692       6.2595      $326.44      $179.54       $65.29
95990               T................  NI.................  Spin/brain pump refil &             0125       2.0639      $107.63  ...........       $21.53
                                                             main.
95999               S................  ...................  Neurological procedure.....         0215       0.5814       $30.32       $15.76        $6.06
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       2.2577      $117.74  ...........       $23.55
96105               X................  ...................  Assessment of aphasia......         0373       2.2577      $117.74  ...........       $23.55
96110               X................  ...................  Developmental test, lim....         0373       2.2577      $117.74  ...........       $23.55
96111               X................  ...................  Developmental test, extend.         0373       2.2577      $117.74  ...........       $23.55
96115               X................  ...................  Neurobehavior status exam..         0373       2.2577      $117.74  ...........       $23.55
96117               X................  ...................  Neuropsych test battery....         0373       2.2577      $117.74  ...........       $23.55
96150               S................  ...................  Assess lth/behave, init....         0322       1.3275       $69.23       $12.40       $13.85
96151               S................  ...................  Assess hlth/behave, subseq.         0322       1.3275       $69.23       $12.40       $13.85
96152               S................  ...................  Intervene hlth/behave,              0322       1.3275       $69.23       $12.40       $13.85
                                                             indiv.
96153               S................  ...................  Intervene hlth/behave,              0322       1.3275       $69.23       $12.40       $13.85
                                                             group.
96154               S................  ...................  Interv hlth/behav, fam w/pt         0322       1.3275       $69.23       $12.40       $13.85
96155               S................  ...................  Interv hlth/behav fam no pt         0322       1.3275       $69.23       $12.40       $13.85
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.....  ...........  ...........  ...........  ...........  ...........

[[Page 66946]]

 
96520               T................  ...................  Port pump refill & main....         0125       2.0639      $107.63  ...........       $21.53
96530               T................  ...................  Pump refilling, maintenance         0125       2.0639      $107.63  ...........       $21.53
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       0.3779       $19.71        $7.09        $3.94
96902               N................  ...................  Trichogram.................  ...........  ...........  ...........  ...........  ...........
96910               S................  ...................  Photochemotherapy with UV-B         0001       0.3779       $19.71        $7.09        $3.94
96912               S................  ...................  Photochemotherapy with UV-A         0001       0.3779       $19.71        $7.09        $3.94
96913               S................  ...................  Photochemotherapy, UV-A or          0683       1.8992       $99.05       $35.65       $19.81
                                                             B.
96920               T................  NI.................  Laser tx, skin < 250 sq cm.         0012       0.7849       $40.93       $11.18        $8.19
96921               T................  NI.................  Laser tx, skin 250-500 sq           0012       0.7849       $40.93       $11.18        $8.19
                                                             cm.
96922               T................  NI.................  Laser tx, skin           0013       1.0756       $56.09       $14.20       $11.22
                                                             500 sq cm.
96999               T................  ...................  Dermatological procedure...         0010       0.6589       $34.36       $10.08        $6.87
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.
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.

[[Page 66947]]

 
97803               A................  ...................  Med nutrition, indiv,        ...........  ...........  ...........  ...........  ...........
                                                             subseq.
97804               A................  ...................  Medical nutrition, group...  ...........  ...........  ...........  ...........  ...........
98925               S................  ...................  Osteopathic manipulation...         0060       0.3294       $17.18  ...........        $3.44
98926               S................  ...................  Osteopathic manipulation...         0060       0.3294       $17.18  ...........        $3.44
98927               S................  ...................  Osteopathic manipulation...         0060       0.3294       $17.18  ...........        $3.44
98928               S................  ...................  Osteopathic manipulation...         0060       0.3294       $17.18  ...........        $3.44
98929               S................  ...................  Osteopathic manipulation...         0060       0.3294       $17.18  ...........        $3.44
98940               S................  ...................  Chiropractic manipulation..         0060       0.3294       $17.18  ...........        $3.44
98941               S................  ...................  Chiropractic manipulation..         0060       0.3294       $17.18  ...........        $3.44
98942               S................  ...................  Chiropractic manipulation..         0060       0.3294       $17.18  ...........        $3.44
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  ...........  ...........  ...........  ...........  ...........
99026               E................  NI.................  In-hospital on call service  ...........  ...........  ...........  ...........  ...........
99027               E................  NI.................  Out-of-hosp on call service  ...........  ...........  ...........  ...........  ...........
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.....  ...........  ...........  ...........  ...........  ...........
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       0.2035       $10.61        $3.08        $2.12
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       0.5329       $27.79       $10.09        $5.56
99199               E................  ...................  Special service/proc/report  ...........  ...........  ...........  ...........  ...........
99201               V................  ...................  Office/outpatient visit,            0600       0.8430       $43.96  ...........        $8.79
                                                             new.
99202               V................  ...................  Office/outpatient visit,            0600       0.8430       $43.96  ...........        $8.79
                                                             new.
99203               V................  ...................  Office/outpatient visit,            0601       0.9690       $50.53  ...........       $10.11
                                                             new.
99204               V................  ...................  Office/outpatient visit,            0602       1.4631       $76.30  ...........       $15.26
                                                             new.
99205               V................  ...................  Office/outpatient visit,            0602       1.4631       $76.30  ...........       $15.26
                                                             new.
99211               V................  ...................  Office/outpatient visit,            0600       0.8430       $43.96  ...........        $8.79
                                                             est.
99212               V................  ...................  Office/outpatient visit,            0600       0.8430       $43.96  ...........        $8.79
                                                             est.
99213               V................  ...................  Office/outpatient visit,            0601       0.9690       $50.53  ...........       $10.11
                                                             est.
99214               V................  ...................  Office/outpatient visit,            0602       1.4631       $76.30  ...........       $15.26
                                                             est.
99215               V................  ...................  Office/outpatient visit,            0602       1.4631       $76.30  ...........       $15.26
                                                             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......  ...........  ...........  ...........  ...........  ...........

[[Page 66948]]

 
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       0.8430       $43.96  ...........        $8.79
99242               V................  ...................  Office consultation........         0600       0.8430       $43.96  ...........        $8.79
99243               V................  ...................  Office consultation........         0601       0.9690       $50.53  ...........       $10.11
99244               V................  ...................  Office consultation........         0602       1.4631       $76.30  ...........       $15.26
99245               V................  ...................  Office consultation........         0602       1.4631       $76.30  ...........       $15.26
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       0.8430       $43.96  ...........        $8.79
99272               V................  ...................  Confirmatory consultation..         0600       0.8430       $43.96  ...........        $8.79
99273               V................  ...................  Confirmatory consultation..         0601       0.9690       $50.53  ...........       $10.11
99274               V................  ...................  Confirmatory consultation..         0602       1.4631       $76.30  ...........       $15.26
99275               V................  ...................  Confirmatory consultation..         0602       1.4631       $76.30  ...........       $15.26
99281               V................  ...................  Emergency dept visit.......         0610       1.4147       $73.78       $19.57       $14.76
99282               V................  ...................  Emergency dept visit.......         0610       1.4147       $73.78       $19.57       $14.76
99283               V................  ...................  Emergency dept visit.......         0611       2.5290      $131.89       $36.47       $26.38
99284               V................  ...................  Emergency dept visit.......         0612       4.3410      $226.39       $54.14       $45.28
99285               V................  ...................  Emergency dept visit.......         0612       4.3410      $226.39       $54.14       $45.28
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       9.9610      $519.48      $150.55      $103.90
99292               N................  ...................  Critical care, addl 30 min.  ...........  ...........  ...........  ...........  ...........
99293               C................  NI.................  Ped critical care, initial.  ...........  ...........  ...........  ...........  ...........
99294               C................  NI.................  Ped critical care, subseq..  ...........  ...........  ...........  ...........  ...........
99295               C................  ...................  Neonatal critical care.....  ...........  ...........  ...........  ...........  ...........
99296               C................  ...................  Neonatal critical care.....  ...........  ...........  ...........  ...........  ...........
99297               C................  DG.................  Neonatal critical care.....  ...........  ...........  ...........  ...........  ...........
99298               C................  ...................  Neonatal critical care.....  ...........  ...........  ...........  ...........  ...........
99299               C................  NI.................  Ic, lbw infant 1500-2500 gm  ...........  ...........  ...........  ...........  ...........
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....  ...........  ...........  ...........  ...........  ...........

[[Page 66949]]

 
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.
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       0.8430       $43.96  ...........        $8.79
                                                             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       3.8371      $200.11       $67.63       $40.02
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................  DG.................  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................  DG.................  Home visit, nos............  ...........  ...........  ...........  ...........  ...........
99551               E................  ...................  Home infus, pain mgmt, iv/   ...........  ...........  ...........  ...........  ...........
                                                             sc.

[[Page 66950]]

 
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..  ...........  ...........  ...........  ...........  ...........
99600               E................  NI.................  Home visit nos.............  ...........  ...........  ...........  ...........  ...........
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  ...........  ...........  ...........  ...........  ...........
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.

[[Page 66951]]

 
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...................  ...........  ...........  ...........  ...........  ...........
A4266               E................  NI.................  Diaphragm..................  ...........  ...........  ...........  ...........  ...........
A4267               E................  NI.................  Male condom................  ...........  ...........  ...........  ...........  ...........
A4268               E................  NI.................  Female condom..............  ...........  ...........  ...........  ...........  ...........
A4269               E................  NI.................  Spermicide.................  ...........  ...........  ...........  ...........  ...........
A4270               A................  ...................  Disposable endoscope sheath  ...........  ...........  ...........  ...........  ...........
A4280               A................  ...................  Brst prsths adhsv attchmnt.  ...........  ...........  ...........  ...........  ...........
A4281               E................  NI.................  Replacement breastpump tube  ...........  ...........  ...........  ...........  ...........
A4282               E................  NI.................  Replacement breastpump adpt  ...........  ...........  ...........  ...........  ...........
A4283               E................  NI.................  Replacement breastpump cap.  ...........  ...........  ...........  ...........  ...........
A4284               E................  NI.................  Replcmnt breast pump shield  ...........  ...........  ...........  ...........  ...........
A4285               E................  NI.................  Replcmnt breast pump bottle  ...........  ...........  ...........  ...........  ...........
A4286               E................  NI.................  Replcmnt breastpump lok      ...........  ...........  ...........  ...........  ...........
                                                             ring.
A4290               E................  ...................  Sacral nerve stim test lead  ...........  ...........  ...........  ...........  ...........
A4300               N................  ...................  Cath impl vasc access        ...........  ...........  ...........  ...........  ...........
                                                             portal.
A4301               N................  ...................  Implantable access syst      ...........  ...........  ...........  ...........  ...........
                                                             perc.
A4305               A................  ...................  Drug delivery system =50 ML.
A4306               A................  ...................  Drug delivery system <=5 ML  ...........  ...........  ...........  ...........  ...........
A4310               A................  ...................  Insert tray w/o bag/cath...  ...........  ...........  ...........  ...........  ...........
A4311               A................  ...................  Catheter w/o bag 2-way       ...........  ...........  ...........  ...........  ...........
                                                             latex.
A4312               A................  ...................  Cath w/o bag 2-way silicone  ...........  ...........  ...........  ...........  ...........
A4313               A................  ...................  Catheter w/bag 3-way.......  ...........  ...........  ...........  ...........  ...........
A4314               A................  ...................  Cath w/drainage 2-way latex  ...........  ...........  ...........  ...........  ...........
A4315               A................  ...................  Cath w/drainage 2-way        ...........  ...........  ...........  ...........  ...........
                                                             silcne.
A4316               A................  ...................  Cath w/drainage 3-way......  ...........  ...........  ...........  ...........  ...........
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.  ...........  ...........  ...........  ...........  ...........

[[Page 66952]]

 
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................  DG.................  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................  DG.................  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................  DG.................  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................  DG.................  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.
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...........  ...........  ...........  ...........  ...........  ...........
A4405               A................  NI.................  Nonpectin based ostomy       ...........  ...........  ...........  ...........  ...........
                                                             paste.
A4406               A................  NI.................  Pectin based ostomy paste..  ...........  ...........  ...........  ...........  ...........
A4407               A................  NI.................  Ext wear ost skn barr        ...........  ...........  ...........  ...........  ...........
                                                             <=4sq[gE].
A4408               A................  NI.................  Ext wear ost skn barr 4sq[gE].
A4409               A................  NI.................  Ost skn barr w flng <=4      ...........  ...........  ...........  ...........  ...........
                                                             sq[gE].
A4410               A................  NI.................  Ost skn barr w flng 4sq[gE].
A4413               A................  NI.................  2 pc drainable ost pouch...  ...........  ...........  ...........  ...........  ...........

[[Page 66953]]

 
A4414               A................  NI.................  Ostomy sknbarr w flng        ...........  ...........  ...........  ...........  ...........
                                                             <=4sq[gE].
A4415               A................  NI.................  Ostomy skn barr w flng 4sq[gE].
A4421               A................  ...................  Ostomy supply misc.........  ...........  ...........  ...........  ...........  ...........
A4422               A................  NI.................  Ost pouch absorbent          ...........  ...........  ...........  ...........  ...........
                                                             material.
A4450               A................  NI.................  Non-waterproof tape........  ...........  ...........  ...........  ...........  ...........
A4452               A................  NI.................  Waterproof tape............  ...........  ...........  ...........  ...........  ...........
A4454               A................  DG.................  Tape all types all sizes...  ...........  ...........  ...........  ...........  ...........
A4455               A................  ...................  Adhesive remover per ounce.  ...........  ...........  ...........  ...........  ...........
A4458               E................  NI.................  Reusable enema bag.........  ...........  ...........  ...........  ...........  ...........
A4460               A................  DG.................  Elastic compression bandage  ...........  ...........  ...........  ...........  ...........
A4462               A................  ...................  Abdmnl drssng holder/binder  ...........  ...........  ...........  ...........  ...........
A4464               A................  DG.................  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..  ...........  ...........  ...........  ...........  ...........
A4521               E................  NI.................  Adult size diaper sm each..  ...........  ...........  ...........  ...........  ...........
A4522               E................  NI.................  Adult size diaper med each.  ...........  ...........  ...........  ...........  ...........
A4523               E................  NI.................  Adult size diaper lg each..  ...........  ...........  ...........  ...........  ...........
A4524               E................  NI.................  Adult size diaper xl each..  ...........  ...........  ...........  ...........  ...........
A4525               E................  NI.................  Adult size brief sm each...  ...........  ...........  ...........  ...........  ...........
A4526               E................  NI.................  Adult size brief med each..  ...........  ...........  ...........  ...........  ...........
A4527               E................  NI.................  Adult size brief lg each...  ...........  ...........  ...........  ...........  ...........
A4528               E................  NI.................  Adult size brief xl each...  ...........  ...........  ...........  ...........  ...........
A4529               E................  NI.................  Child size diaper sm/med ea  ...........  ...........  ...........  ...........  ...........
A4530               E................  NI.................  Child size diaper lg each..  ...........  ...........  ...........  ...........  ...........
A4531               E................  NI.................  Child size brief sm/med      ...........  ...........  ...........  ...........  ...........
                                                             each.
A4532               E................  NI.................  Child size brief lg each...  ...........  ...........  ...........  ...........  ...........
A4533               E................  NI.................  Youth size diaper each.....  ...........  ...........  ...........  ...........  ...........
A4534               E................  NI.................  Youth size brief each......  ...........  ...........  ...........  ...........  ...........
A4535               E................  NI.................  Disp incont liner/shield ea  ...........  ...........  ...........  ...........  ...........
A4536               E................  NI.................  Prot underwr wshbl any sz    ...........  ...........  ...........  ...........  ...........
                                                             ea.
A4537               E................  NI.................  Under pad reusable any sz    ...........  ...........  ...........  ...........  ...........
                                                             ea.
A4538               E................  NI.................  Diaper sv ea reusable        ...........  ...........  ...........  ...........  ...........
                                                             diaper.
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................  DG.................  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  ...........  ...........  ...........  ...........  ...........
A4606               A................  NI.................  Oxygen probe used w          ...........  ...........  ...........  ...........  ...........
                                                             oximeter.
A4608               A................  ...................  Transtracheal oxygen cath..  ...........  ...........  ...........  ...........  ...........
A4609               A................  NI.................  Trach suction cath clsed     ...........  ...........  ...........  ...........  ...........
                                                             sys.
A4610               A................  NI.................  Trach sctn cath 72h          ...........  ...........  ...........  ...........  ...........
                                                             clsedsys.
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.........  ...........  ...........  ...........  ...........  ...........

[[Page 66954]]

 
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.........  ...........  ...........  ...........  ...........  ...........
A4632               A................  NI.................  Infus pump rplcemnt battery  ...........  ...........  ...........  ...........  ...........
A4633               A................  NI.................  Uvl replacement bulb.......  ...........  ...........  ...........  ...........  ...........
A4634               A................  NI.................  Replacement bulb th          ...........  ...........  ...........  ...........  ...........
                                                             lightbox.
A4635               A................  ...................  Underarm crutch pad........  ...........  ...........  ...........  ...........  ...........
A4636               A................  ...................  Handgrip for cane etc......  ...........  ...........  ...........  ...........  ...........
A4637               A................  ...................  Repl tip cane/crutch/walker  ...........  ...........  ...........  ...........  ...........
A4639               A................  NI.................  Infrared ht sys replcmnt     ...........  ...........  ...........  ...........  ...........
                                                             pad.
A4640               A................  ...................  Alternating pressure pad...  ...........  ...........  ...........  ...........  ...........
A4641               N................  ...................  Diagnostic imaging agent...  ...........  ...........  ...........  ...........  ...........
A4642               N................  ...................  Satumomab pendetide per      ...........  ...........  ...........  ...........  ...........
                                                             dose.
A4643               N................  ...................  High dose contrast MRI.....  ...........  ...........  ...........  ...........  ...........
A4644               N................  ...................  Contrast 100-199 MGs iodine  ...........  ...........  ...........  ...........  ...........
A4645               N................  ...................  Contrast 200-299 MGs iodine  ...........  ...........  ...........  ...........  ...........
A4646               N................  ...................  Contrast 300-399 MGs iodine  ...........  ...........  ...........  ...........  ...........
A4647               N................  ...................  Supp- paramagnetic contr     ...........  ...........  ...........  ...........  ...........
                                                             mat.
A4649               A................  ...................  Surgical supplies..........  ...........  ...........  ...........  ...........  ...........
A4651               A................  ...................  Calibrated microcap tube...  ...........  ...........  ...........  ...........  ...........
A4652               A................  ...................  Microcapillary tube sealant  ...........  ...........  ...........  ...........  ...........
A4653               A................  NI.................  PD catheter anchor belt....  ...........  ...........  ...........  ...........  ...........
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................  ...................  [gE]Y set[gE] 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..  ...........  ...........  ...........  ...........  ...........

[[Page 66955]]

 
A4773               A................  ...................  Occult blood test strips...  ...........  ...........  ...........  ...........  ...........
A4774               A................  ...................  Ammonia test strips........  ...........  ...........  ...........  ...........  ...........
A4801               A................  DG.................  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  ...........  ...........  ...........  ...........  ...........
A4930               A................  NI.................  Sterile, gloves per pair...  ...........  ...........  ...........  ...........  ...........
A4931               A................  NI.................  Reusable oral thermometer..  ...........  ...........  ...........  ...........  ...........
A4932               E................  NI.................  Reusable rectal thermometer  ...........  ...........  ...........  ...........  ...........
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.......  ...........  ...........  ...........  ...........  ...........
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................  DG.................  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               E................  ...................  Wound warming wound cover..  ...........  ...........  ...........  ...........  ...........
A6010               A................  ...................  Collagen based wound filler  ...........  ...........  ...........  ...........  ...........
A6011               A................  NI.................  Collagen gel/paste wound     ...........  ...........  ...........  ...........  ...........
                                                             fil.
A6021               A................  ...................  Collagen dressing <=16 sq    ...........  ...........  ...........  ...........  ...........
                                                             in.
A6022               A................  ...................  Collagen drsg6<=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.

[[Page 66956]]

 
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 gauze16<=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.....  ...........  ...........  ...........  ...........  ...........
A6232               A................  ...................  Hydrogel dsg16<=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................  DG.................  Non-sterile elastic gauze/   ...........  ...........  ...........  ...........  ...........
                                                             yd.
A6264               A................  DG.................  Non-sterile no elastic       ...........  ...........  ...........  ...........  ...........
                                                             gauze.
A6265               A................  DG.................  Tape per 18 sq inches......  ...........  ...........  ...........  ...........  ...........
A6266               A................  ...................  Impreg gauze no h20/sal/     ...........  ...........  ...........  ...........  ...........
                                                             yard.
A6402               A................  ...................  Sterile gauze <= 16 sq in..  ...........  ...........  ...........  ...........  ...........

[[Page 66957]]

 
A6403               A................  ...................  Sterile gauze16   ...........  ...........  ...........  ...........  ...........
                                                             <= 48 sq in.
A6404               A................  ...................  Sterile gauze     ...........  ...........  ...........  ...........  ...........
                                                             48 sq in.
A6405               A................  DG.................  Sterile elastic gauze /yd..  ...........  ...........  ...........  ...........  ...........
A6406               A................  DG.................  Sterile non-elastic gauze/   ...........  ...........  ...........  ...........  ...........
                                                             yd.
A6410               A................  NI.................  Sterile eye pad............  ...........  ...........  ...........  ...........  ...........
A6411               A................  NI.................  Non-sterile eye pad........  ...........  ...........  ...........  ...........  ...........
A6412               E................  NI.................  Occlusive eye patch........  ...........  ...........  ...........  ...........  ...........
A6421               A................  NI.................  Pad bandage =3    ...........  ...........  ...........  ...........  ...........
                                                             <5in w /roll.
A6422               A................  NI.................  Conf bandage ns =3<5[gE]w/roll.
A6424               A................  NI.................  Conf bandage ns =5[gE]w /roll.
A6426               A................  NI.................  Conf bandage s =3<5[gE] w/roll.
A6428               A................  NI.................  Conf bandage s =5[gE] w /roll.
A6430               A................  NI.................  Lt compres bdg =3<5[gE]w /roll.
A6432               A................  NI.................  Lt compres bdg =5[gE]w /roll.
A6434               A................  NI.................  Mo compres bdg =3<5[gE]w /roll.
A6436               A................  NI.................  Hi compres bdg =3<5[gE]w /roll.
A6438               A................  NI.................  Self-adher bdg =3<5[gE]w /roll.
A6440               A................  NI.................  Zinc paste bdg =3<5[gE]w /roll.
A6501               A................  NI.................  Compres burngarment          ...........  ...........  ...........  ...........  ...........
                                                             bodysuit.
A6502               A................  NI.................  Compres burngarment          ...........  ...........  ...........  ...........  ...........
                                                             chinstrp.
A6503               A................  NI.................  Compres burngarment          ...........  ...........  ...........  ...........  ...........
                                                             facehood.
A6504               A................  NI.................  Cmprsburngarment glove-      ...........  ...........  ...........  ...........  ...........
                                                             wrist.
A6505               A................  NI.................  Cmprsburngarment glove-      ...........  ...........  ...........  ...........  ...........
                                                             elbow.
A6506               A................  NI.................  Cmprsburngrmnt glove-axilla  ...........  ...........  ...........  ...........  ...........
A6507               A................  NI.................  Cmprs burngarment foot-knee  ...........  ...........  ...........  ...........  ...........
A6508               A................  NI.................  Cmprs burngarment foot-      ...........  ...........  ...........  ...........  ...........
                                                             thigh.
A6509               A................  NI.................  Compres burn garment jacket  ...........  ...........  ...........  ...........  ...........
A6510               A................  NI.................  Compres burn garment         ...........  ...........  ...........  ...........  ...........
                                                             leotard.
A6511               A................  NI.................  Compres burn garment panty.  ...........  ...........  ...........  ...........  ...........
A6512               A................  NI.................  Compres burn garment, noc..  ...........  ...........  ...........  ...........  ...........
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.
A7025               A................  NI.................  Replace chest compress vest  ...........  ...........  ...........  ...........  ...........
A7026               A................  NI.................  Replace chst cmprss sys      ...........  ...........  ...........  ...........  ...........
                                                             hose.
A7030               A................  NI.................  CPAP full face mask........  ...........  ...........  ...........  ...........  ...........
A7031               A................  NI.................  Replacement facemask         ...........  ...........  ...........  ...........  ...........
                                                             interfa.
A7032               A................  NI.................  Replacement nasal cushion..  ...........  ...........  ...........  ...........  ...........
A7033               A................  NI.................  Replacement nasal pillows..  ...........  ...........  ...........  ...........  ...........
A7034               A................  NI.................  Nasal application device...  ...........  ...........  ...........  ...........  ...........
A7035               A................  NI.................  Pos airway press headgear..  ...........  ...........  ...........  ...........  ...........
A7036               A................  NI.................  Pos airway press chinstrap.  ...........  ...........  ...........  ...........  ...........
A7037               A................  NI.................  Pos airway pressure tubing.  ...........  ...........  ...........  ...........  ...........
A7038               A................  NI.................  Pos airway pressure filter.  ...........  ...........  ...........  ...........  ...........
A7039               A................  NI.................  Filter, non disposable w     ...........  ...........  ...........  ...........  ...........
                                                             pap.
A7042               A................  NI.................  Implanted pleural catheter.  ...........  ...........  ...........  ...........  ...........
A7043               A................  NI.................  Vacuum drainagebottle/       ...........  ...........  ...........  ...........  ...........
                                                             tubing.

[[Page 66958]]

 
A7044               A................  NI.................  PAP oral interface.........  ...........  ...........  ...........  ...........  ...........
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.
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      16.4434      $857.54  ...........      $171.51
                                                             pendetid.
A9508               K................  ...................  Iobenguane sulfate I-131...         1045       1.5697       $81.86  ...........       $16.37
A9510               N................  ...................  Technetium TC99m Disofenin.  ...........  ...........  ...........  ...........  ...........
A9511               K................  ...................  Technetium TC 99m                   1095       5.6006      $292.08  ...........       $58.42
                                                             depreotide.
A9512               N................  NI.................  Technetium tc99m             ...........  ...........  ...........  ...........  ...........
                                                             pertechnetate.
A9513               N................  NI.................  Technetium tc-99m            ...........  ...........  ...........  ...........  ...........
                                                             mebrofenin.
A9514               N................  NI.................  Technetium tc99m             ...........  ...........  ...........  ...........  ...........
                                                             pyrophosphate.
A9515               N................  NI.................  Technetium tc-99m pentetate  ...........  ...........  ...........  ...........  ...........
A9516               N................  NI.................  I-123 sodium iodide capsule  ...........  ...........  ...........  ...........  ...........
A9517               N................  NI.................  I-131 sodium iodide capsule  ...........  ...........  ...........  ...........  ...........
A9518               K................  NI.................  I-131 sodium iodide                 1348       0.9399       $49.02  ...........        $9.80
                                                             solution.
A9519               N................  NI.................  Technetium tc-99m macroag    ...........  ...........  ...........  ...........  ...........
                                                             albu.
A9520               N................  NI.................  Technetium tc-99m sulfur     ...........  ...........  ...........  ...........  ...........
                                                             clld.
A9521               K................  NI.................  Technetium tc-99m                   1096       4.4379      $231.44  ...........       $46.29
                                                             exametazine.
A9522               E................  NI.................  Indium111ibritumomabtiuxeta  ...........  ...........  ...........  ...........  ...........
                                                             n.
A9523               E................  NI.................  Yttrium90ibritumomabtiuxeta  ...........  ...........  ...........  ...........  ...........
                                                             n.
A9524               N................  NI.................  Iodinated I-131              ...........  ...........  ...........  ...........  ...........
                                                             serumalbumin.
A9600               K................  ...................  Strontium-89 chloride......         0701       8.9920      $468.94  ...........       $93.79
A9603               N................  NI.................  I-131sodiumiodidecap per     ...........  ...........  ...........  ...........  ...........
                                                             mci.
A9605               K................  ...................  Samarium sm153 lexidronamm.         0702      14.6218      $762.54  ...........      $152.51
A9699               N................  NI.................  Noc therapeutic radiopharm.  ...........  ...........  ...........  ...........  ...........
A9700               G................  ...................  Echocardiography Contrast..         9016  ...........      $118.75  ...........       $17.75
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.
B4100               E................  NI.................  Food thickener oral........  ...........  ...........  ...........  ...........  ...........
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%..  ...........  ...........  ...........  ...........  ...........

[[Page 66959]]

 
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       2.3352      $121.78  ...........       $24.36
C1011               K................  ...................  Platelets, HLA-m, L/R, unit         1011       9.5831      $499.77  ...........       $99.95
C1012               K................  DG.................  PLATELET CONC, L/R, Irrad..         0954       2.2868      $119.26  ...........       $23.85
C1013               K................  DG.................  PLATELET CONC, L/R, Unit...         1013       0.9496       $49.52  ...........        $9.90
C1014               K................  DG.................  Platelet,Aph/Pher, L/R,             9501       7.8390      $408.81  ...........       $81.76
                                                             unit.
C1015               K................  NI.................  Plt, pher,L/R,CMV, irrad...         1020       9.4959      $495.22  ...........       $99.04
C1016               K................  ...................  BLOOD,L/R,FROZ/DEGLY/Washed         1016       5.7848      $301.68  ...........       $60.34
C1017               K................  ...................  Plt, APH/PHER,L/R,CMV-NEG..         1017       7.5386      $393.15  ...........       $78.63
C1018               K................  ...................  Blood, L/R, IRRADIATED.....         1018       2.5387      $132.40  ...........       $26.48
C1020               K................  NI.................  RBC, frz/deg/wsh, L/R,              1021       6.4436      $336.04  ...........       $67.21
                                                             irrad.
C1021               K................  NI.................  RBC, L/R, CMV neg, irrad...         1022       3.8565      $201.12  ...........       $40.22
C1022               K................  NI.................  Plasma, frz within 24 hour.         0955       1.8217       $95.00  ...........       $19.00
C1058               N................  DG.................  TC 99M oxidronate, per vial  ...........  ...........  ...........  ...........  ...........
C1064               N................  DG.................  I-131 cap, each add mCi....  ...........  ...........  ...........  ...........  ...........
C1065               N................  DG.................  I-131 sol, each add mCi....  ...........  ...........  ...........  ...........  ...........
C1066               N................  DG.................  IN 111 satumomab pendetide.  ...........  ...........  ...........  ...........  ...........
C1079               N................  ...................  CO 57/58 per 0.5 uCi.......  ...........  ...........  ...........  ...........  ...........
C1087               N................  DG.................  I-123 per 100 uCi..........  ...........  ...........  ...........  ...........  ...........
C1088               T................  ...................  LASER OPTIC TR Sys.........         0980  ...........    $1,875.00  ...........      $375.00
C1091               K................  ...................  IN111                               1091       4.7092      $245.59  ...........       $49.12
                                                             oxyquinoline,per0.5mCi.
C1092               K................  ...................  IN 111 pentetate per 0.5            1092       4.4379      $231.44  ...........       $46.29
                                                             mCi.
C1094               N................  DG.................  TC99Malbumin aggr,per        ...........  ...........  ...........  ...........  ...........
                                                             1.0mCi.
C1096               K................  DG.................  TC 99M EXAMETAZIME, PER             1096       4.4379      $231.44  ...........       $46.29
                                                             Dose.
C1097               N................  DG.................  TC 99M MEBROFENIN, PER Vial  ...........  ...........  ...........  ...........  ...........
C1098               N................  DG.................  TC 99M PENTETATE, PER Vial.  ...........  ...........  ...........  ...........  ...........
C1099               N................  DG.................  TC 99M PYROPHOSPHATE,PER     ...........  ...........  ...........  ...........  ...........
                                                             Via.
C1122               K................  ...................  Tc 99M ARCITUMOMAB PER VIAL         1122      11.4726      $598.31  ...........      $119.66
C1166               N................  ...................  CYTARABINE LIPOSOMAL, 10 mg  ...........  ...........  ...........  ...........  ...........
C1167               K................  ...................  EPIRUBICIN HCL, 2 mg.......         1167       0.3294       $17.18  ...........        $3.44
C1178               K................  ...................  BUSULFAN IV, 6 Mg..........         1178       0.4845       $25.27  ...........        $5.05
C1188               N................  DG.................  I-131 cap, per 1-5 mCi.....  ...........  ...........  ...........  ...........  ...........
C1200               N................  ...................  TC 99M Sodium Glucoheptonat  ...........  ...........  ...........  ...........  ...........
C1201               N................  ...................  TC 99M SUCCIMER, PER Vial..  ...........  ...........  ...........  ...........  ...........
C1202               N................  DG.................  TC 99M SULFUR COLLOID, Vial  ...........  ...........  ...........  ...........  ...........
C1207               K................  DG.................  OCTREOTIDE ACETATE DEPOT            1207       1.4244       $74.28  ...........       $14.86
                                                             1mg.
C1300               S................  ...................  HYPERBARIC Oxygen..........         0659       3.2364      $168.78  ...........       $33.76
C1305               K................  ...................  Apligraf...................         1305      13.0520      $680.67  ...........      $136.13
C1348               K................  DG.................  I-131 sol, per 1-6 mCi.....         1348       0.9399       $49.02  ...........        $9.80
C1713               D................  DNG................  Anchor/screw bn/bn,tis/bn..  ...........  ...........  ...........  ...........  ...........
C1714               D................  DNG................  Cath, trans atherectomy,     ...........  ...........  ...........  ...........  ...........
                                                             dir.
C1715               D................  DNG................  Brachytherapy needle.......  ...........  ...........  ...........  ...........  ...........
C1716               K................  ...................  Brachytx seed, Gold 198....         1716       0.4360       $22.74  ...........        $4.55
C1717               D................  DNG................  Brachytx seed, HDR Ir-192..  ...........  ...........  ...........  ...........  ...........
C1718               K................  ...................  Brachytx seed, Iodine 125..         1718       0.6008       $31.33  ...........        $6.27
C1719               K................  ...................  Brachytx seed,Non-HDR Ir-           1719       0.5232       $27.29  ...........        $5.46
                                                             192.
C1720               K................  ...................  Brachytx seed, Palladium            1720       0.8430       $43.96  ...........        $8.79
                                                             103.

[[Page 66960]]

 
C1721               D................  DNG................  AICD, dual chamber.........  ...........  ...........  ...........  ...........  ...........
C1722               D................  DNG................  AICD, single chamber.......  ...........  ...........  ...........  ...........  ...........
C1724               D................  DNG................  Cath, trans                  ...........  ...........  ...........  ...........  ...........
                                                             atherec,rotation.
C1725               D................  DNG................  Cath, translumin non-laser.  ...........  ...........  ...........  ...........  ...........
C1726               D................  DNG................  Cath, bal dil, non-vascular  ...........  ...........  ...........  ...........  ...........
C1727               D................  DNG................  Cath, bal tis dis, non-vas.  ...........  ...........  ...........  ...........  ...........
C1728               D................  DNG................  Cath, brachytx seed adm....  ...........  ...........  ...........  ...........  ...........
C1729               D................  DNG................  Cath, drainage.............  ...........  ...........  ...........  ...........  ...........
C1730               D................  DNG................  Cath, EP, 19 or few elect..  ...........  ...........  ...........  ...........  ...........
C1731               D................  DNG................  Cath, EP, 20 or more elec..  ...........  ...........  ...........  ...........  ...........
C1732               D................  DNG................  Cath, EP, diag/abl, 3D/vect  ...........  ...........  ...........  ...........  ...........
C1733               D................  DNG................  Cath, EP, othr than cool-    ...........  ...........  ...........  ...........  ...........
                                                             tip.
C1750               D................  DNG................  Cath, hemodialysis,long-     ...........  ...........  ...........  ...........  ...........
                                                             term.
C1751               D................  DNG................  Cath, inf, per/cent/midline  ...........  ...........  ...........  ...........  ...........
C1752               D................  DNG................  Cath,hemodialysis,short-     ...........  ...........  ...........  ...........  ...........
                                                             term.
C1753               D................  DNG................  Cath, intravas ultrasound..  ...........  ...........  ...........  ...........  ...........
C1754               D................  DNG................  Catheter, intradiscal......  ...........  ...........  ...........  ...........  ...........
C1755               D................  DNG................  Catheter, intraspinal......  ...........  ...........  ...........  ...........  ...........
C1756               D................  DNG................  Cath, pacing, transesoph...  ...........  ...........  ...........  ...........  ...........
C1757               D................  DNG................  Cath, thrombectomy/embolect  ...........  ...........  ...........  ...........  ...........
C1758               D................  DNG................  Catheter, ureteral.........  ...........  ...........  ...........  ...........  ...........
C1759               D................  DNG................  Cath, intra                  ...........  ...........  ...........  ...........  ...........
                                                             echocardiography.
C1760               D................  DNG................  Closure dev, vasc..........  ...........  ...........  ...........  ...........  ...........
C1762               D................  DNG................  Conn tiss, human(inc         ...........  ...........  ...........  ...........  ...........
                                                             fascia).
C1763               D................  DNG................  Conn tiss, non-human.......  ...........  ...........  ...........  ...........  ...........
C1764               D................  DNG................  Event recorder, cardiac....  ...........  ...........  ...........  ...........  ...........
C1765               H................  ...................  Adhesion barrier...........         1765  ...........  ...........  ...........  ...........
C1766               D................  DNG................  Intro/sheath,strble,non-     ...........  ...........  ...........  ...........  ...........
                                                             peel.
C1767               D................  DNG................  Generator, neurostim, imp..  ...........  ...........  ...........  ...........  ...........
C1768               D................  DNG................  Graft, vascular............  ...........  ...........  ...........  ...........  ...........
C1769               D................  DNG................  Guide wire.................  ...........  ...........  ...........  ...........  ...........
C1770               D................  DNG................  Imaging coil, MR,            ...........  ...........  ...........  ...........  ...........
                                                             insertable.
C1771               D................  DNG................  Rep dev, urinary, w/sling..  ...........  ...........  ...........  ...........  ...........
C1772               D................  DNG................  Infusion pump, programmable  ...........  ...........  ...........  ...........  ...........
C1773               D................  DNG................  Ret dev, insertable........  ...........  ...........  ...........  ...........  ...........
C1774               K................  ...................  Darbepoetin alfa, 1 mcg....         0734       0.0454        $2.37  ...........         $.47
C1775               K................  ...................  FDG, per dose (4-40 mCi/ml)         1775       7.5289      $392.64  ...........       $78.53
C1776               D................  DNG................  Joint device (implantable).  ...........  ...........  ...........  ...........  ...........
C1777               D................  DNG................  Lead, AICD, endo single      ...........  ...........  ...........  ...........  ...........
                                                             coil.
C1778               D................  DNG................  Lead, neurostimulator......  ...........  ...........  ...........  ...........  ...........
C1779               D................  DNG................  Lead, pmkr, transvenous VDD  ...........  ...........  ...........  ...........  ...........
C1780               D................  DNG................  Lens, intraocular (new       ...........  ...........  ...........  ...........  ...........
                                                             tech).
C1781               D................  DNG................  Mesh (implantable).........  ...........  ...........  ...........  ...........  ...........
C1782               D................  DNG................  Morcellator................  ...........  ...........  ...........  ...........  ...........
C1783               H................  ...................  Ocular imp, aqueous drain           1783  ...........  ...........  ...........  ...........
                                                             dev.
C1784               D................  DNG................  Ocular dev, intraop, det     ...........  ...........  ...........  ...........  ...........
                                                             ret.
C1785               D................  DNG................  Pmkr, dual, rate-resp......  ...........  ...........  ...........  ...........  ...........
C1786               D................  DNG................  Pmkr, single, rate-resp....  ...........  ...........  ...........  ...........  ...........
C1787               D................  DNG................  Patient progr, neurostim...  ...........  ...........  ...........  ...........  ...........
C1788               D................  DNG................  Port, indwelling, imp......  ...........  ...........  ...........  ...........  ...........
C1789               D................  DNG................  Prosthesis, breast, imp....  ...........  ...........  ...........  ...........  ...........
C1813               D................  DNG................  Prosthesis, penile,          ...........  ...........  ...........  ...........  ...........
                                                             inflatab.
C1815               D................  DNG................  Pros, urinary sph, imp.....  ...........  ...........  ...........  ...........  ...........
C1816               D................  DNG................  Receiver/transmitter, neuro  ...........  ...........  ...........  ...........  ...........
C1817               D................  DNG................  Septal defect imp sys......  ...........  ...........  ...........  ...........  ...........
C1874               D................  DNG................  Stent, coated/cov w/del sys  ...........  ...........  ...........  ...........  ...........
C1875               D................  DNG................  Stent, coated/cov w/o del    ...........  ...........  ...........  ...........  ...........
                                                             sy.
C1876               D................  DNG................  Stent, non-coa/non-cov w/    ...........  ...........  ...........  ...........  ...........
                                                             del.
C1877               D................  DNG................  Stent, non-coat/cov w/o del  ...........  ...........  ...........  ...........  ...........
C1878               D................  DNG................  Matrl for vocal cord.......  ...........  ...........  ...........  ...........  ...........
C1879               D................  DNG................  Tissue marker, implantable.  ...........  ...........  ...........  ...........  ...........
C1880               D................  DNG................  Vena cava filter...........  ...........  ...........  ...........  ...........  ...........
C1881               D................  DNG................  Dialysis access system.....  ...........  ...........  ...........  ...........  ...........
C1882               D................  DNG................  AICD, other than sing/dual.  ...........  ...........  ...........  ...........  ...........
C1883               D................  DNG................  Adapt/ext, pacing/neuro      ...........  ...........  ...........  ...........  ...........
                                                             lead.

[[Page 66961]]

 
C1885               D................  DNG................  Cath, translumin angio       ...........  ...........  ...........  ...........  ...........
                                                             laser.
C1887               D................  DNG................  Catheter, guiding..........  ...........  ...........  ...........  ...........  ...........
C1888               H................  ...................  Endovas non-cardiac abl             1888  ...........  ...........  ...........  ...........
                                                             cath.
C1891               D................  DNG................  Infusion pump,non-prog,      ...........  ...........  ...........  ...........  ...........
                                                             perm.
C1892               D................  DNG................  Intro/sheath,fixed,peel-     ...........  ...........  ...........  ...........  ...........
                                                             away.
C1893               D................  DNG................  Intro/sheath, fixed,non-     ...........  ...........  ...........  ...........  ...........
                                                             peel.
C1894               D................  DNG................  Intro/sheath, non-laser....  ...........  ...........  ...........  ...........  ...........
C1895               D................  DNG................  Lead, AICD, endo dual coil.  ...........  ...........  ...........  ...........  ...........
C1896               D................  DNG................  Lead, AICD, non sing/dual..  ...........  ...........  ...........  ...........  ...........
C1897               D................  DNG................  Lead, neurostim test kit...  ...........  ...........  ...........  ...........  ...........
C1898               D................  DNG................  Lead, pmkr, other than       ...........  ...........  ...........  ...........  ...........
                                                             trans.
C1899               D................  DNG................  Lead, pmkr/AICD combination  ...........  ...........  ...........  ...........  ...........
C1900               H................  ...................  Lead coronary venous.......         1900  ...........  ...........  ...........  ...........
C2614               H................  NI.................  Probe, perc lumb disc......         2614  ...........  ...........  ...........  ...........
C2615               D................  DNG................  Sealant, pulmonary, liquid.  ...........  ...........  ...........  ...........  ...........
C2616               K................  ...................  Brachytx seed, Yttrium-90..         2616       8.8370      $460.86  ...........       $92.17
C2617               D................  DNG................  Stent, non-cor, tem w/o del  ...........  ...........  ...........  ...........  ...........
C2618               H................  ...................  Probe, cryoablation........         2618  ...........  ...........  ...........  ...........
C2619               D................  DNG................  Pmkr, dual, non rate-resp..  ...........  ...........  ...........  ...........  ...........
C2620               D................  DNG................  Pmkr, single, non rate-resp  ...........  ...........  ...........  ...........  ...........
C2621               D................  DNG................  Pmkr, other than sing/dual.  ...........  ...........  ...........  ...........  ...........
C2622               D................  DNG................  Prosthesis, penile, non-inf  ...........  ...........  ...........  ...........  ...........
C2625               D................  DNG................  Stent, non-cor, tem w/del    ...........  ...........  ...........  ...........  ...........
                                                             sy.
C2626               D................  DNG................  Infusion pump, non-          ...........  ...........  ...........  ...........  ...........
                                                             prog,temp.
C2627               D................  DNG................  Cath, suprapubic/            ...........  ...........  ...........  ...........  ...........
                                                             cystoscopic.
C2628               D................  DNG................  Catheter, occlusion........  ...........  ...........  ...........  ...........  ...........
C2629               D................  DNG................  Intro/sheath, laser........  ...........  ...........  ...........  ...........  ...........
C2630               D................  DNG................  Cath, EP, cool-tip.........  ...........  ...........  ...........  ...........  ...........
C2631               D................  DNG................  Rep dev, urinary, w/o sling  ...........  ...........  ...........  ...........  ...........
C2632               H................  NI.................  Brachytx sol, I-125, per            2632  ...........  ...........  ...........  ...........
                                                             mCi.
C8900               S................  ...................  MRA w/cont, abd............         0284       7.2382      $377.48      $201.02       $75.50
C8901               S................  ...................  MRA w/o cont, abd..........         0336       6.5987      $344.13      $176.94       $68.83
C8902               S................  ...................  MRA w/o fol w/cont, abd....         0337       9.2440      $482.08      $240.77       $96.42
C8903               S................  ...................  MRI w/cont, breast, uni....         0284       7.2382      $377.48      $201.02       $75.50
C8904               S................  ...................  MRI w/o cont, breast, uni..         0336       6.5987      $344.13      $176.94       $68.83
C8905               S................  ...................  MRI w/o fol w/cont, brst,           0337       9.2440      $482.08      $240.77       $96.42
                                                             un.
C8906               S................  ...................  MRI w/cont, breast, bi.....         0284       7.2382      $377.48      $201.02       $75.50
C8907               S................  ...................  MRI w/o cont, breast, bi...         0336       6.5987      $344.13      $176.94       $68.83
C8908               S................  ...................  MRI w/o fol w/cont, breast,         0337       9.2440      $482.08      $240.77       $96.42
C8909               S................  ...................  MRA w/cont, chest..........         0284       7.2382      $377.48      $201.02       $75.50
C8910               S................  ...................  MRA w/o cont, chest........         0336       6.5987      $344.13      $176.94       $68.83
C8911               S................  ...................  MRA w/o fol w/cont, chest..         0337       9.2440      $482.08      $240.77       $96.42
C8912               S................  ...................  MRA w/cont, lwr ext........         0284       7.2382      $377.48      $201.02       $75.50
C8913               S................  ...................  MRA w/o cont, lwr ext......         0336       6.5987      $344.13      $176.94       $68.83
C8914               S................  ...................  MRA w/o fol w/cont, lwr ext         0337       9.2440      $482.08      $240.77       $96.42
C9000               K................  ...................  Na chromateCr51, per                9000       1.8798       $98.03  ...........       $19.61
                                                             0.25mCi.
C9003               K................  ...................  Palivizumab, per 50 mg.....         9003       8.5657      $446.71  ...........       $89.34
C9007               N................  ...................  Baclofen Intrathecal kit-    ...........  ...........  ...........  ...........  ...........
                                                             1am.
C9008               N................  ...................  Baclofen Refill Kit-500mcg.  ...........  ...........  ...........  ...........  ...........
C9009               K................  ...................  Baclofen Refill Kit-2000mcg         9009       0.7267       $37.90  ...........        $7.58
C9010               K................  ...................  Baclofen Refill Kit--               9010       0.9205       $48.00  ...........        $9.60
                                                             4000mcg.
C9013               N................  ...................  Co 57 cobaltous chloride...  ...........  ...........  ...........  ...........  ...........
C9019               G................  DG.................  Caspofungin acetate, 5 mg..         9019  ...........       $34.20  ...........        $5.11
C9020               K................  DG.................  Sirolimussolution, 1 mg....         9020       0.0581        $3.03  ...........         $.61
C9100               N................  DG.................  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       1.5116       $78.83  ...........       $15.77
C9108               K................  DG.................  Thyrotropin alfa, 1.1 mg...         9108       7.5870      $395.67  ...........       $79.13
C9109               K................  ...................  Tirofiban hcl, 6.25 mg.....         9109       2.1996      $114.71  ...........       $22.94
C9110               G................  DG.................  Alemtuzumab, per 10mg/ml...         9110  ...........      $511.22  ...........       $76.41
C9111               G................  ...................  Inj, bivalirudin, 250mg             9111  ...........      $397.81  ...........       $56.46
                                                             vial.
C9112               G................  ...................  Perflutren lipid micro, 2ml         9112  ...........        $4.94  ...........         $.74
C9113               G................  ...................  Inj pantoprazole sodium,            9113  ...........       $22.80  ...........        $3.41
                                                             via.
C9114               G................  DG.................  Nesiritide, per 1.5 mg vial         9114  ...........      $433.20  ...........       $64.75

[[Page 66962]]

 
C9115               G................  DG.................  Inj, zoledronic acid, 2 mg.         9115  ...........      $406.78  ...........       $60.80
C9116               G................  NI.................  Ertapenem sodium, per 1 gm.         9116  ...........       $45.31  ...........        $6.77
C9117               E................  DG.................  Y-90 ibritumomab tiuxetan..  ...........  ...........  ...........  ...........  ...........
C9118               E................  DG.................  IN-111 ibritumomab tiuxetan  ...........  ...........  ...........  ...........  ...........
C9119               G................  NI.................  Injection, pegfilgrastim...         9119  ...........    $2,802.50  ...........      $418.90
C9120               G................  NI.................  Injection, fulvestrant.....         9120  ...........       $87.58  ...........       $13.09
C9121               G................  NI.................  Injection, argatroban......         9121  ...........       $14.25  ...........        $2.13
C9200               G................  ...................  Orcel, per 36 cm2..........         9200  ...........    $1,135.25  ...........      $169.69
C9201               G................  ...................  Dermagraft, per 37.5 sq cm.         9201  ...........      $577.60  ...........       $86.34
C9503               K................  ...................  Fresh frozen plasma, ea             9503       1.3372       $69.74  ...........       $13.95
                                                             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................  DG.................  Preview Tx Planning                 0975  ...........      $625.00  ...........      $125.00
                                                             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       4.7770      $249.13  ...........       $49.83
                                                             evaluation.
D0160               E................  ...................  Extensv oral eval prob       ...........  ...........  ...........  ...........  ...........
                                                             focus.
D0170               E................  ...................  Re-eval,est pt,problem       ...........  ...........  ...........  ...........  ...........
                                                             focus.
D0180               E................  NI.................  Comp periodontal evaluation  ...........  ...........  ...........  ...........  ...........
D0210               E................  ...................  Intraor complete film        ...........  ...........  ...........  ...........  ...........
                                                             series.
D0220               E................  ...................  Intraoral periapical first   ...........  ...........  ...........  ...........  ...........
                                                             f.
D0230               E................  ...................  Intraoral periapical ea add  ...........  ...........  ...........  ...........  ...........
D0240               S................  ...................  Intraoral occlusal film....         0330       4.7770      $249.13  ...........       $49.83
D0250               S................  ...................  Extraoral first film.......         0330       4.7770      $249.13  ...........       $49.83
D0260               S................  ...................  Extraoral ea additional             0330       4.7770      $249.13  ...........       $49.83
                                                             film.
D0270               S................  ...................  Dental bitewing single film         0330       4.7770      $249.13  ...........       $49.83
D0272               S................  ...................  Dental bitewings two films.         0330       4.7770      $249.13  ...........       $49.83
D0274               S................  ...................  Dental bitewings four films         0330       4.7770      $249.13  ...........       $49.83
D0277               S................  ...................  Vert bitewings-sev to eight         0330       4.7770      $249.13  ...........       $49.83
D0290               E................  ...................  Dental film skull/facial     ...........  ...........  ...........  ...........  ...........
                                                             bon.
D0310               E................  ...................  Dental saliography.........  ...........  ...........  ...........  ...........  ...........
D0320               E................  ...................  Dental tmj arthrogram incl   ...........  ...........  ...........  ...........  ...........
                                                             i.
D0321               E................  ...................  Dental other tmj films.....  ...........  ...........  ...........  ...........  ...........
D0322               E................  ...................  Dental tomographic survey..  ...........  ...........  ...........  ...........  ...........
D0330               E................  ...................  Dental panoramic film......  ...........  ...........  ...........  ...........  ...........
D0340               E................  ...................  Dental cephalometric film..  ...........  ...........  ...........  ...........  ...........
D0350               E................  ...................  Oral/facial images.........  ...........  ...........  ...........  ...........  ...........
D0415               E................  ...................  Bacteriologic study........  ...........  ...........  ...........  ...........  ...........
D0425               E................  ...................  Caries susceptibility test.  ...........  ...........  ...........  ...........  ...........
D0460               S................  ...................  Pulp vitality test.........         0330       4.7770      $249.13  ...........       $49.83
D0470               E................  ...................  Diagnostic casts...........  ...........  ...........  ...........  ...........  ...........
D0472               S................  ...................  Gross exam, prep & report..         0330       4.7770      $249.13  ...........       $49.83
D0473               S................  ...................  Micro exam, prep & report..         0330       4.7770      $249.13  ...........       $49.83
D0474               S................  ...................  Micro w exam of surg                0330       4.7770      $249.13  ...........       $49.83
                                                             margins.
D0480               S................  ...................  Cytopath smear prep &               0330       4.7770      $249.13  ...........       $49.83
                                                             report.
D0501               S................  DG.................  Histopathologic                     0330       4.7770      $249.13  ...........       $49.83
                                                             examinations.
D0502               S................  ...................  Other oral pathology                0330       4.7770      $249.13  ...........       $49.83
                                                             procedu.
D0999               S................  ...................  Unspecified diagnostic              0330       4.7770      $249.13  ...........       $49.83
                                                             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       4.7770      $249.13  ...........       $49.83
D1515               S................  ...................  Fixed bilat space                   0330       4.7770      $249.13  ...........       $49.83
                                                             maintainer.
D1520               S................  ...................  Remove unilat space                 0330       4.7770      $249.13  ...........       $49.83
                                                             maintain.
D1525               S................  ...................  Remove bilat space maintain         0330       4.7770      $249.13  ...........       $49.83
D1550               S................  ...................  Recement space maintainer..         0330       4.7770      $249.13  ...........       $49.83
D2110               E................  DG.................  Amalgam one surface primary  ...........  ...........  ...........  ...........  ...........

[[Page 66963]]

 
D2120               E................  DG.................  Amalgam two surfaces         ...........  ...........  ...........  ...........  ...........
                                                             primary.
D2130               E................  DG.................  Amalgam three surfaces       ...........  ...........  ...........  ...........  ...........
                                                             prima.
D2131               E................  DG.................  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................  DG.................  Composite resin crown......  ...........  ...........  ...........  ...........  ...........
D2337               E................  DG.................  Compo resin crown ant-perm.  ...........  ...........  ...........  ...........  ...........
D2380               E................  DG.................  Resin one surf poster        ...........  ...........  ...........  ...........  ...........
                                                             primar.
D2381               E................  DG.................  Resin two surf poster        ...........  ...........  ...........  ...........  ...........
                                                             primar.
D2382               E................  DG.................  Resin three/more surf post   ...........  ...........  ...........  ...........  ...........
                                                             p.
D2385               E................  DG.................  Resin one surf poster        ...........  ...........  ...........  ...........  ...........
                                                             perman.
D2386               E................  DG.................  Resin two surf poster        ...........  ...........  ...........  ...........  ...........
                                                             perman.
D2387               E................  DG.................  Resin three/more surf post   ...........  ...........  ...........  ...........  ...........
                                                             p.
D2388               E................  DG.................  Resin four/more, post perm.  ...........  ...........  ...........  ...........  ...........
D2390               E................  NI.................  Ant resin-based cmpst crown  ...........  ...........  ...........  ...........  ...........
D2391               E................  NI.................  Post 1 srfc resinbased       ...........  ...........  ...........  ...........  ...........
                                                             cmpst.
D2392               E................  NI.................  Post 2 srfc resinbased       ...........  ...........  ...........  ...........  ...........
                                                             cmpst.
D2393               E................  NI.................  Post 3 srfc resinbased       ...........  ...........  ...........  ...........  ...........
                                                             cmpst.
D2394               E................  NI.................  Post =4srfc       ...........  ...........  ...........  ...........  ...........
                                                             resinbase cmpst.
D2410               E................  ...................  Dental gold foil one         ...........  ...........  ...........  ...........  ...........
                                                             surface.
D2420               E................  ...................  Dental gold foil two         ...........  ...........  ...........  ...........  ...........
                                                             surface.
D2430               E................  ...................  Dental gold foil three       ...........  ...........  ...........  ...........  ...........
                                                             surfa.
D2510               E................  ...................  Dental inlay metalic 1 surf  ...........  ...........  ...........  ...........  ...........
D2520               E................  ...................  Dental inlay metallic 2      ...........  ...........  ...........  ...........  ...........
                                                             surf.
D2530               E................  ...................  Dental inlay metl 3/more     ...........  ...........  ...........  ...........  ...........
                                                             sur.
D2542               E................  ...................  Dental onlay metallic 2      ...........  ...........  ...........  ...........  ...........
                                                             surf.
D2543               E................  ...................  Dental onlay metallic 3      ...........  ...........  ...........  ...........  ...........
                                                             surf.
D2544               E................  ...................  Dental onlay metl 4/more     ...........  ...........  ...........  ...........  ...........
                                                             sur.
D2610               E................  ...................  Inlay porcelain/ceramic 1    ...........  ...........  ...........  ...........  ...........
                                                             su.
D2620               E................  ...................  Inlay porcelain/ceramic 2    ...........  ...........  ...........  ...........  ...........
                                                             su.
D2630               E................  ...................  Dental onlay porc 3/more     ...........  ...........  ...........  ...........  ...........
                                                             sur.
D2642               E................  ...................  Dental onlay porcelin 2      ...........  ...........  ...........  ...........  ...........
                                                             surf.
D2643               E................  ...................  Dental onlay porcelin 3      ...........  ...........  ...........  ...........  ...........
                                                             surf.
D2644               E................  ...................  Dental onlay porc 4/more     ...........  ...........  ...........  ...........  ...........
                                                             sur.
D2650               E................  ...................  Inlay composite/resin one    ...........  ...........  ...........  ...........  ...........
                                                             su.
D2651               E................  ...................  Inlay composite/resin two    ...........  ...........  ...........  ...........  ...........
                                                             su.
D2652               E................  ...................  Dental inlay resin 3/mre     ...........  ...........  ...........  ...........  ...........
                                                             sur.
D2662               E................  ...................  Dental onlay resin 2         ...........  ...........  ...........  ...........  ...........
                                                             surface.
D2663               E................  ...................  Dental onlay resin 3         ...........  ...........  ...........  ...........  ...........
                                                             surface.
D2664               E................  ...................  Dental onlay resin 4/mre     ...........  ...........  ...........  ...........  ...........
                                                             sur.
D2710               E................  ...................  Crown resin laboratory.....  ...........  ...........  ...........  ...........  ...........
D2720               E................  ...................  Crown resin w/ high noble    ...........  ...........  ...........  ...........  ...........
                                                             me.
D2721               E................  ...................  Crown resin w/ base metal..  ...........  ...........  ...........  ...........  ...........
D2722               E................  ...................  Crown resin w/ noble metal.  ...........  ...........  ...........  ...........  ...........
D2740               E................  ...................  Crown porcelain/ceramic      ...........  ...........  ...........  ...........  ...........
                                                             subs.
D2750               E................  ...................  Crown porcelain w/ h noble   ...........  ...........  ...........  ...........  ...........
                                                             m.
D2751               E................  ...................  Crown porcelain fused base   ...........  ...........  ...........  ...........  ...........
                                                             m.
D2752               E................  ...................  Crown porcelain w/ noble     ...........  ...........  ...........  ...........  ...........
                                                             met.
D2780               E................  ...................  Crown 3/4 cast hi noble met  ...........  ...........  ...........  ...........  ...........
D2781               E................  ...................  Crown 3/4 cast base metal..  ...........  ...........  ...........  ...........  ...........
D2782               E................  ...................  Crown 3/4 cast noble metal.  ...........  ...........  ...........  ...........  ...........
D2783               E................  ...................  Crown 3/4 porcelain/ceramic  ...........  ...........  ...........  ...........  ...........
D2790               E................  ...................  Crown full cast high noble   ...........  ...........  ...........  ...........  ...........
                                                             m.
D2791               E................  ...................  Crown full cast base metal.  ...........  ...........  ...........  ...........  ...........
D2792               E................  ...................  Crown full cast noble metal  ...........  ...........  ...........  ...........  ...........
D2799               E................  ...................  Provisional crown..........  ...........  ...........  ...........  ...........  ...........
D2910               E................  ...................  Dental recement inlay......  ...........  ...........  ...........  ...........  ...........
D2920               E................  ...................  Dental recement crown......  ...........  ...........  ...........  ...........  ...........
D2930               E................  ...................  Prefab stnlss steel crwn     ...........  ...........  ...........  ...........  ...........
                                                             pri.

[[Page 66964]]

 
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       4.7770      $249.13  ...........       $49.83
D2980               E................  ...................  Crown repair...............  ...........  ...........  ...........  ...........  ...........
D2999               S................  ...................  Dental unspec restorative           0330       4.7770      $249.13  ...........       $49.83
                                                             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.
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       4.7770      $249.13  ...........       $49.83
                                                             implan.
D3470               E................  ...................  Intentional replantation...  ...........  ...........  ...........  ...........  ...........
D3910               E................  ...................  Isolation- tooth w rubb dam  ...........  ...........  ...........  ...........  ...........
D3920               E................  ...................  Tooth splitting............  ...........  ...........  ...........  ...........  ...........
D3950               E................  ...................  Canal prep/fitting of dowel  ...........  ...........  ...........  ...........  ...........
D3999               S................  ...................  Endodontic procedure.......         0330       4.7770      $249.13  ...........       $49.83
D4210               E................  ...................  Gingivectomy/plasty per      ...........  ...........  ...........  ...........  ...........
                                                             quad.
D4211               E................  ...................  Gingivectomy/plasty per      ...........  ...........  ...........  ...........  ...........
                                                             toot.
D4220               E................  DG.................  Gingival curettage per       ...........  ...........  ...........  ...........  ...........
                                                             quadr.
D4240               E................  ...................  Gingival flap proc w/        ...........  ...........  ...........  ...........  ...........
                                                             planin.
D4241               E................  NI.................  Gngvl flap w rootplan 1-3    ...........  ...........  ...........  ...........  ...........
                                                             th.
D4245               E................  ...................  Apically positioned flap...  ...........  ...........  ...........  ...........  ...........
D4249               E................  ...................  Crown lengthen hard tissue.  ...........  ...........  ...........  ...........  ...........
D4260               S................  ...................  Osseous surgery per                 0330       4.7770      $249.13  ...........       $49.83
                                                             quadrant.
D4261               E................  NI.................  Osseous surgl-3teethperquad  ...........  ...........  ...........  ...........  ...........
D4263               S................  ...................  Bone replce graft first             0330       4.7770      $249.13  ...........       $49.83
                                                             site.
D4264               S................  ...................  Bone replce graft each add.         0330       4.7770      $249.13  ...........       $49.83
D4265               E................  NI.................  Bio mtrls to aid soft/os     ...........  ...........  ...........  ...........  ...........
                                                             reg.
D4266               E................  ...................  Guided tiss regen resorble.  ...........  ...........  ...........  ...........  ...........
D4267               E................  ...................  Guided tiss regen nonresorb  ...........  ...........  ...........  ...........  ...........
D4268               S................  ...................  Surgical revision procedure         0330       4.7770      $249.13  ...........       $49.83
D4270               S................  ...................  Pedicle soft tissue graft           0330       4.7770      $249.13  ...........       $49.83
                                                             pr.
D4271               S................  ...................  Free soft tissue graft proc         0330       4.7770      $249.13  ...........       $49.83
D4273               S................  ...................  Subepithelial tissue graft.         0330       4.7770      $249.13  ...........       $49.83

[[Page 66965]]

 
D4274               E................  ...................  Distal/proximal wedge proc.  ...........  ...........  ...........  ...........  ...........
D4275               E................  NI.................  Soft tissue allograft......  ...........  ...........  ...........  ...........  ...........
D4276               E................  NI.................  Con tissue w dble ped graft  ...........  ...........  ...........  ...........  ...........
D4320               E................  ...................  Provision splnt              ...........  ...........  ...........  ...........  ...........
                                                             intracoronal.
D4321               E................  ...................  Provisional splint           ...........  ...........  ...........  ...........  ...........
                                                             extracoro.
D4341               E................  ...................  Periodontal scaling & root.  ...........  ...........  ...........  ...........  ...........
D4342               E................  NI.................  Periodontal scaling 1-       ...........  ...........  ...........  ...........  ...........
                                                             3teeth.
D4355               S................  ...................  Full mouth debridement.....         0330       4.7770      $249.13  ...........       $49.83
D4381               S................  ...................  Localized chemo delivery...         0330       4.7770      $249.13  ...........       $49.83
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.
D5670               E................  NI.................  Replc tth&acrlc on mtl       ...........  ...........  ...........  ...........  ...........
                                                             frmwk.
D5671               E................  NI.................  Replc tth&acrlc mandibular.  ...........  ...........  ...........  ...........  ...........
D5710               E................  ...................  Dentures rebase cmplt maxil  ...........  ...........  ...........  ...........  ...........
D5711               E................  ...................  Dentures rebase cmplt mand.  ...........  ...........  ...........  ...........  ...........
D5720               E................  ...................  Dentures rebase part maxill  ...........  ...........  ...........  ...........  ...........
D5721               E................  ...................  Dentures rebase part mandbl  ...........  ...........  ...........  ...........  ...........
D5730               E................  ...................  Denture reln cmplt maxil ch  ...........  ...........  ...........  ...........  ...........
D5731               E................  ...................  Denture reln cmplt mand chr  ...........  ...........  ...........  ...........  ...........
D5740               E................  ...................  Denture reln part maxil chr  ...........  ...........  ...........  ...........  ...........
D5741               E................  ...................  Denture reln part mand chr.  ...........  ...........  ...........  ...........  ...........
D5750               E................  ...................  Denture reln cmplt max lab.  ...........  ...........  ...........  ...........  ...........
D5751               E................  ...................  Denture reln cmplt mand lab  ...........  ...........  ...........  ...........  ...........
D5760               E................  ...................  Denture reln part maxil lab  ...........  ...........  ...........  ...........  ...........
D5761               E................  ...................  Denture reln part mand lab.  ...........  ...........  ...........  ...........  ...........
D5810               E................  ...................  Denture interm cmplt maxill  ...........  ...........  ...........  ...........  ...........
D5811               E................  ...................  Denture interm cmplt mandbl  ...........  ...........  ...........  ...........  ...........
D5820               E................  ...................  Denture interm part maxill.  ...........  ...........  ...........  ...........  ...........
D5821               E................  ...................  Denture interm part mandbl.  ...........  ...........  ...........  ...........  ...........
D5850               E................  ...................  Denture tiss conditn maxill  ...........  ...........  ...........  ...........  ...........
D5851               E................  ...................  Denture tiss condtin mandbl  ...........  ...........  ...........  ...........  ...........
D5860               E................  ...................  Overdenture complete.......  ...........  ...........  ...........  ...........  ...........
D5861               E................  ...................  Overdenture partial........  ...........  ...........  ...........  ...........  ...........
D5862               E................  ...................  Precision attachment.......  ...........  ...........  ...........  ...........  ...........
D5867               E................  ...................  Replacement of precision     ...........  ...........  ...........  ...........  ...........
                                                             att.
D5875               E................  ...................  Prosthesis modification....  ...........  ...........  ...........  ...........  ...........
D5899               E................  ...................  Removable prosthodontic      ...........  ...........  ...........  ...........  ...........
                                                             proc.
D5911               S................  ...................  Facial moulage sectional...         0330       4.7770      $249.13  ...........       $49.83
D5912               S................  ...................  Facial moulage complete....         0330       4.7770      $249.13  ...........       $49.83
D5913               E................  ...................  Nasal prosthesis...........  ...........  ...........  ...........  ...........  ...........
D5914               E................  ...................  Auricular prosthesis.......  ...........  ...........  ...........  ...........  ...........
D5915               E................  ...................  Orbital prosthesis.........  ...........  ...........  ...........  ...........  ...........
D5916               E................  ...................  Ocular prosthesis..........  ...........  ...........  ...........  ...........  ...........

[[Page 66966]]

 
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       4.7770      $249.13  ...........       $49.83
D5984               S................  ...................  Radiation shield...........         0330       4.7770      $249.13  ...........       $49.83
D5985               S................  ...................  Radiation cone locator.....         0330       4.7770      $249.13  ...........       $49.83
D5986               E................  ...................  Fluoride applicator........  ...........  ...........  ...........  ...........  ...........
D5987               S................  ...................  Commissure splint..........         0330       4.7770      $249.13  ...........       $49.83
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  ...........  ...........  ...........  ...........  ...........
D6053               E................  NI.................  Implnt/abtmnt spprt remv     ...........  ...........  ...........  ...........  ...........
                                                             dnt.
D6054               E................  NI.................  Implnt/abtmnt spprt          ...........  ...........  ...........  ...........  ...........
                                                             remvprtl.
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  ...........  ...........  ...........  ...........  ...........
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.............  ...........  ...........  ...........  ...........  ...........

[[Page 66967]]

 
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.  ...........  ...........  ...........  ...........  ...........
D6253               E................  NI.................  Provisional pontic.........  ...........  ...........  ...........  ...........  ...........
D6519               E................  DG.................  Inlay/onlay porce/ceramic..  ...........  ...........  ...........  ...........  ...........
D6520               E................  DG.................  Dental retainer two          ...........  ...........  ...........  ...........  ...........
                                                             surfaces.
D6530               E................  DG.................  Retainer metallic 3+         ...........  ...........  ...........  ...........  ...........
                                                             surface.
D6543               E................  DG.................  Dental retainr onlay 3 surf  ...........  ...........  ...........  ...........  ...........
D6544               E................  DG.................  Dental retainr onlay 4/more  ...........  ...........  ...........  ...........  ...........
D6545               E................  ...................  Dental retainr cast metl...  ...........  ...........  ...........  ...........  ...........
D6548               E................  ...................  Porcelain/ceramic retainer.  ...........  ...........  ...........  ...........  ...........
D6600               E................  NI.................  Porcelain/ceramic inlay      ...........  ...........  ...........  ...........  ...........
                                                             2srf.
D6601               E................  NI.................  Porc/ceram inlay = 3 surfac.
D6602               E................  NI.................  Cst hgh nble mtl inlay 2     ...........  ...........  ...........  ...........  ...........
                                                             srf.
D6603               E................  NI.................  Cst hgh nble mtl inlay =3sr.
D6604               E................  NI.................  Cst bse mtl inlay 2          ...........  ...........  ...........  ...........  ...........
                                                             surfaces.
D6605               E................  NI.................  Cst bse mtl inlay = 3 surfa.
D6606               E................  NI.................  Cast noble metal inlay 2     ...........  ...........  ...........  ...........  ...........
                                                             sur.
D6607               E................  NI.................  Cst noble mtl inlay =3 surf.
D6608               E................  NI.................  Onlay porc/crmc 2 surfaces.  ...........  ...........  ...........  ...........  ...........
D6609               E................  NI.................  Onlay porc/crmc =3 surfaces.
D6610               E................  NI.................  Onlay cst hgh nbl mtl 2      ...........  ...........  ...........  ...........  ...........
                                                             srfc.
D6611               E................  NI.................  Onlay cst hgh nbl mtl =3srf.
D6612               E................  NI.................  Onlay cst base mtl 2         ...........  ...........  ...........  ...........  ...........
                                                             surface.
D6613               E................  NI.................  Onlay cst base mtl =3 surfa.
D6614               E................  NI.................  Onlay cst nbl mtl 2          ...........  ...........  ...........  ...........  ...........
                                                             surfaces.
D6615               E................  NI.................  Onlay cst nbl mtl =3 surfac.
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  ...........  ...........  ...........  ...........  ...........
D6793               E................  NI.................  Provisional retainer crown.  ...........  ...........  ...........  ...........  ...........
D6920               S................  ...................  Dental connector bar.......         0330       4.7770      $249.13  ...........       $49.83
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..............  ...........  ...........  ...........  ...........  ...........
D6985               E................  NI.................  Pediatric partial denture    ...........  ...........  ...........  ...........  ...........
                                                             fx.

[[Page 66968]]

 
D6999               E................  ...................  Fixed prosthodontic proc...  ...........  ...........  ...........  ...........  ...........
D7110               S................  DG.................  Oral surgery single tooth..         0330       4.7770      $249.13  ...........       $49.83
D7111               S................  NI.................  Coronal remnants deciduous          0330       4.7770      $249.13  ...........       $49.83
                                                             t.
D7120               S................  DG.................  Each add tooth extraction..         0330       4.7770      $249.13  ...........       $49.83
D7130               S................  DG.................  Tooth root removal.........         0330       4.7770      $249.13  ...........       $49.83
D7140               S................  NI.................  Extraction erupted tooth/           0330       4.7770      $249.13  ...........       $49.83
                                                             exr.
D7210               S................  ...................  Rem imp tooth w mucoper flp         0330       4.7770      $249.13  ...........       $49.83
D7220               S................  ...................  Impact tooth remov soft             0330       4.7770      $249.13  ...........       $49.83
                                                             tiss.
D7230               S................  ...................  Impact tooth remov part             0330       4.7770      $249.13  ...........       $49.83
                                                             bony.
D7240               S................  ...................  Impact tooth remov comp             0330       4.7770      $249.13  ...........       $49.83
                                                             bony.
D7241               S................  ...................  Impact tooth rem bony w/            0330       4.7770      $249.13  ...........       $49.83
                                                             comp.
D7250               S................  ...................  Tooth root removal.........         0330       4.7770      $249.13  ...........       $49.83
D7260               S................  ...................  Oral antral fistula closure         0330       4.7770      $249.13  ...........       $49.83
D7261               S................  NI.................  Primary closure sinus perf.         0330       4.7770      $249.13  ...........       $49.83
D7270               E................  ...................  Tooth reimplantation.......  ...........  ...........  ...........  ...........  ...........
D7272               E................  ...................  Tooth transplantation......  ...........  ...........  ...........  ...........  ...........
D7280               E................  ...................  Exposure impact tooth        ...........  ...........  ...........  ...........  ...........
                                                             orthod.
D7281               E................  ...................  Exposure tooth aid eruption  ...........  ...........  ...........  ...........  ...........
D7282               E................  NI.................  Mobilize erupted/malpos      ...........  ...........  ...........  ...........  ...........
                                                             toot.
D7285               E................  ...................  Biopsy of oral tissue hard.  ...........  ...........  ...........  ...........  ...........
D7286               E................  ...................  Biopsy of oral tissue soft.  ...........  ...........  ...........  ...........  ...........
D7287               E................  NI.................  Cytology sample collection.  ...........  ...........  ...........  ...........  ...........
D7290               E................  ...................  Repositioning of teeth.....  ...........  ...........  ...........  ...........  ...........
D7291               S................  ...................  Transseptal fiberotomy.....         0330       4.7770      $249.13  ...........       $49.83
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.
D7411               E................  NI.................  Excision benign lesion1.25c.
D7412               E................  NI.................  Excision benign lesion       ...........  ...........  ...........  ...........  ...........
                                                             compl.
D7413               E................  NI.................  Excision malig               ...........  ...........  ...........  ...........  ...........
                                                             lesion<=1.25c.
D7414               E................  NI.................  Excision malig lesion1.25cm.
D7415               E................  NI.................  Excision malig les           ...........  ...........  ...........  ...........  ...........
                                                             complicat.
D7420               E................  DG.................  Lesion  1.25 cm.  ...........  ...........  ...........  ...........  ...........
D7430               E................  DG.................  Exc benign tumor to 1.25 cm  ...........  ...........  ...........  ...........  ...........
D7431               E................  DG.................  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.....  ...........  ...........  ...........  ...........  ...........
D7472               E................  NI.................  Removal of torus palatinus.  ...........  ...........  ...........  ...........  ...........
D7473               E................  NI.................  Remove torus mandibularis..  ...........  ...........  ...........  ...........  ...........
D7480               E................  DG.................  Partial ostectomy..........  ...........  ...........  ...........  ...........  ...........
D7485               E................  NI.................  Surg reduct                  ...........  ...........  ...........  ...........  ...........
                                                             osseoustuberosit.
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.
D7671               E................  NI.................  Alveolus open reduction....  ...........  ...........  ...........  ...........  ...........
D7680               E................  ...................  Reduct simple facial bone    ...........  ...........  ...........  ...........  ...........
                                                             fx.

[[Page 66969]]

 
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.
D7771               E................  NI.................  Alveolus clsd reduc stblz    ...........  ...........  ...........  ...........  ...........
                                                             te.
D7780               E................  ...................  Reduct compnd facial bone    ...........  ...........  ...........  ...........  ...........
                                                             fx.
D7810               E................  ...................  Tmj open reduct-dislocation  ...........  ...........  ...........  ...........  ...........
D7820               E................  ...................  Closed tmp manipulation....  ...........  ...........  ...........  ...........  ...........
D7830               E................  ...................  Tmj manipulation under       ...........  ...........  ...........  ...........  ...........
                                                             anest.
D7840               E................  ...................  Removal of tmj condyle.....  ...........  ...........  ...........  ...........  ...........
D7850               E................  ...................  Tmj meniscectomy...........  ...........  ...........  ...........  ...........  ...........
D7852               E................  ...................  Tmj repair of joint disc...  ...........  ...........  ...........  ...........  ...........
D7854               E................  ...................  Tmj excisn of joint          ...........  ...........  ...........  ...........  ...........
                                                             membrane.
D7856               E................  ...................  Tmj cutting of a muscle....  ...........  ...........  ...........  ...........  ...........
D7858               E................  ...................  Tmj reconstruction.........  ...........  ...........  ...........  ...........  ...........
D7860               E................  ...................  Tmj cutting into joint.....  ...........  ...........  ...........  ...........  ...........
D7865               E................  ...................  Tmj reshaping components...  ...........  ...........  ...........  ...........  ...........
D7870               E................  ...................  Tmj aspiration joint fluid.  ...........  ...........  ...........  ...........  ...........
D7871               E................  ...................  Lysis + lavage w catheters.  ...........  ...........  ...........  ...........  ...........
D7872               E................  ...................  Tmj diagnostic arthroscopy.  ...........  ...........  ...........  ...........  ...........
D7873               E................  ...................  Tmj arthroscopy lysis        ...........  ...........  ...........  ...........  ...........
                                                             adhesn.
D7874               E................  ...................  Tmj arthroscopy disc         ...........  ...........  ...........  ...........  ...........
                                                             reposit.
D7875               E................  ...................  Tmj arthroscopy synovectomy  ...........  ...........  ...........  ...........  ...........
D7876               E................  ...................  Tmj arthroscopy discectomy.  ...........  ...........  ...........  ...........  ...........
D7877               E................  ...................  Tmj arthroscopy debridement  ...........  ...........  ...........  ...........  ...........
D7880               E................  ...................  Occlusal orthotic appliance  ...........  ...........  ...........  ...........  ...........
D7899               E................  ...................  Tmj unspecified therapy....  ...........  ...........  ...........  ...........  ...........
D7910               E................  ...................  Dent sutur recent wnd to     ...........  ...........  ...........  ...........  ...........
                                                             5cm.
D7911               E................  ...................  Dental suture wound to 5 cm  ...........  ...........  ...........  ...........  ...........
D7912               E................  ...................  Suture complicate wnd  5 cm.
D7920               E................  ...................  Dental skin graft..........  ...........  ...........  ...........  ...........  ...........
D7940               S................  ...................  Reshaping bone orthognathic         0330       4.7770      $249.13  ...........       $49.83
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.
D7972               E................  NI.................  Surg redct fibrous           ...........  ...........  ...........  ...........  ...........
                                                             tuberosit.
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  ...........  ...........  ...........  ...........  ...........

[[Page 66970]]

 
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...  ...........  ...........  ...........  ...........  ...........
D9450               E................  NI.................  Case presentation tx plan..  ...........  ...........  ...........  ...........  ...........
D9610               E................  ...................  Dent therapeutic drug        ...........  ...........  ...........  ...........  ...........
                                                             inject.
D9630               S................  ...................  Other drugs/medicaments....         0330       4.7770      $249.13  ...........       $49.83
D9910               E................  ...................  Dent appl desensitizing med  ...........  ...........  ...........  ...........  ...........
D9911               E................  ...................  Appl desensitizing resin...  ...........  ...........  ...........  ...........  ...........
D9920               E................  ...................  Behavior management........  ...........  ...........  ...........  ...........  ...........
D9930               S................  ...................  Treatment of complications.         0330       4.7770      $249.13  ...........       $49.83
D9940               S................  ...................  Dental occlusal guard......         0330       4.7770      $249.13  ...........       $49.83
D9941               E................  ...................  Fabrication athletic guard.  ...........  ...........  ...........  ...........  ...........
D9950               S................  ...................  Occlusion analysis.........         0330       4.7770      $249.13  ...........       $49.83
D9951               S................  ...................  Limited occlusal adjustment         0330       4.7770      $249.13  ...........       $49.83
D9952               S................  ...................  Complete occlusal                   0330       4.7770      $249.13  ...........       $49.83
                                                             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.
E0117               A................  NI.................  Underarm springassist        ...........  ...........  ...........  ...........  ...........
                                                             crutch.
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.  ...........  ...........  ...........  ...........  ...........

[[Page 66971]]

 
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.
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.
E0203               A................  NI.................  Therapeutic lightbox         ...........  ...........  ...........  ...........  ...........
                                                             tabletp.
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               E................  ...................  Wound warming device.......  ...........  ...........  ...........  ...........  ...........
E0232               E................  ...................  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.

[[Page 66972]]

 
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.
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.
E0445               A................  NI.................  Oximeter non-invasive......  ...........  ...........  ...........  ...........  ...........
E0450               A................  ...................  Volume vent stationary/      ...........  ...........  ...........  ...........  ...........
                                                             porta.
E0454               A................  NI.................  Pressure ventilator........  ...........  ...........  ...........  ...........  ...........
E0455               A................  ...................  Oxygen tent excl croup/ped   ...........  ...........  ...........  ...........  ...........
                                                             t.
E0457               A................  ...................  Chest shell................  ...........  ...........  ...........  ...........  ...........
E0459               A................  ...................  Chest wrap.................  ...........  ...........  ...........  ...........  ...........
E0460               A................  ...................  Neg press vent portabl/      ...........  ...........  ...........  ...........  ...........
                                                             statn.
E0461               A................  NI.................  Vol vent noninvasive         ...........  ...........  ...........  ...........  ...........
                                                             interfa.
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...  ...........  ...........  ...........  ...........  ...........
E0483               A................  NI.................  Chest compression gen        ...........  ...........  ...........  ...........  ...........
                                                             system.
E0484               A................  NI.................  Non-elec oscillatory pep     ...........  ...........  ...........  ...........  ...........
                                                             dvc.
E0500               A................  ...................  Ippb all types.............  ...........  ...........  ...........  ...........  ...........
E0550               A................  ...................  Humidif extens supple w      ...........  ...........  ...........  ...........  ...........
                                                             ippb.

[[Page 66973]]

 
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................  DG.................  Apnea monitor..............  ...........  ...........  ...........  ...........  ...........
E0610               A................  ...................  Pacemaker monitr audible/    ...........  ...........  ...........  ...........  ...........
                                                             vis.
E0615               A................  ...................  Pacemaker monitr digital/    ...........  ...........  ...........  ...........  ...........
                                                             vis.
E0616               N................  ...................  Cardiac event recorder.....  ...........  ...........  ...........  ...........  ...........
E0617               A................  ...................  Automatic ext defibrillator  ...........  ...........  ...........  ...........  ...........
E0618               A................  NI.................  Apnea monitor..............  ...........  ...........  ...........  ...........  ...........
E0619               A................  NI.................  Apnea monitor w recorder...  ...........  ...........  ...........  ...........  ...........
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......  ...........  ...........  ...........  ...........  ...........
E0636               A................  NI.................  PT support & positioning     ...........  ...........  ...........  ...........  ...........
                                                             sys.
E0650               A................  ...................  Pneuma compresor non-        ...........  ...........  ...........  ...........  ...........
                                                             segment.
E0651               A................  ...................  Pneum compressor segmental.  ...........  ...........  ...........  ...........  ...........
E0652               A................  ...................  Pneum compres w/cal          ...........  ...........  ...........  ...........  ...........
                                                             pressure.
E0655               A................  ...................  Pneumatic appliance half     ...........  ...........  ...........  ...........  ...........
                                                             arm.
E0660               A................  ...................  Pneumatic appliance full     ...........  ...........  ...........  ...........  ...........
                                                             leg.
E0665               A................  ...................  Pneumatic appliance full     ...........  ...........  ...........  ...........  ...........
                                                             arm.
E0666               A................  ...................  Pneumatic appliance half     ...........  ...........  ...........  ...........  ...........
                                                             leg.
E0667               A................  ...................  Seg pneumatic appl full leg  ...........  ...........  ...........  ...........  ...........
E0668               A................  ...................  Seg pneumatic appl full arm  ...........  ...........  ...........  ...........  ...........
E0669               A................  ...................  Seg pneumatic appli half     ...........  ...........  ...........  ...........  ...........
                                                             leg.
E0671               A................  ...................  Pressure pneum appl full     ...........  ...........  ...........  ...........  ...........
                                                             leg.
E0672               A................  ...................  Pressure pneum appl full     ...........  ...........  ...........  ...........  ...........
                                                             arm.
E0673               A................  ...................  Pressure pneum appl half     ...........  ...........  ...........  ...........  ...........
                                                             leg.
E0690               A................  DG.................  Ultraviolet cabinet........  ...........  ...........  ...........  ...........  ...........
E0691               A................  NI.................  Uvl pnl 2 sq ft or less....  ...........  ...........  ...........  ...........  ...........
E0692               A................  NI.................  Uvl sys panel 4 ft.........  ...........  ...........  ...........  ...........  ...........
E0693               A................  NI.................  Uvl sys panel 6 ft.........  ...........  ...........  ...........  ...........  ...........
E0694               A................  NI.................  Uvl md cabinet sys 6 ft....  ...........  ...........  ...........  ...........  ...........
E0700               E................  ...................  Safety equipment...........  ...........  ...........  ...........  ...........  ...........
E0701               A................  NI.................  Helmet w face guard prefab.  ...........  ...........  ...........  ...........  ...........
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..  ...........  ...........  ...........  ...........  ...........

[[Page 66974]]

 
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.
E0761               E................  NI.................  Nontherm electromgntc        ...........  ...........  ...........  ...........  ...........
                                                             device.
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..  ...........  ...........  ...........  ...........  ...........
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.

[[Page 66975]]

 
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...........  ...........  ...........  ...........  ...........  ...........
E1011               A................  NI.................  Ped wc modify width adjustm  ...........  ...........  ...........  ...........  ...........
E1012               A................  NI.................  Int seat sys planar ped w/c  ...........  ...........  ...........  ...........  ...........
E1013               A................  NI.................  Int seat sys contour ped w/  ...........  ...........  ...........  ...........  ...........
                                                             c.
E1014               A................  NI.................  Reclining back add ped w/c.  ...........  ...........  ...........  ...........  ...........
E1015               A................  NI.................  Shock absorber for man w/c.  ...........  ...........  ...........  ...........  ...........
E1016               A................  NI.................  Shock absorber for power w/  ...........  ...........  ...........  ...........  ...........
                                                             c.
E1017               A................  NI.................  HD shck absrbr for hd man    ...........  ...........  ...........  ...........  ...........
                                                             wc.
E1018               A................  NI.................  HD shck absrber for hd       ...........  ...........  ...........  ...........  ...........
                                                             powwc.
E1020               A................  NI.................  Residual limb support        ...........  ...........  ...........  ...........  ...........
                                                             system.
E1025               A................  NI.................  Pedwc lat/thor sup           ...........  ...........  ...........  ...........  ...........
                                                             nocontour.
E1026               A................  NI.................  Pedwc contoured lat/thor     ...........  ...........  ...........  ...........  ...........
                                                             sup.
E1027               A................  NI.................  Ped wc lat/ant support.....  ...........  ...........  ...........  ...........  ...........
E1031               A................  ...................  Rollabout chair with         ...........  ...........  ...........  ...........  ...........
                                                             casters.
E1035               E................  ...................  Patient transfer system....  ...........  ...........  ...........  ...........  ...........
E1037               A................  NI.................  Transport chair, ped size..  ...........  ...........  ...........  ...........  ...........
E1038               A................  NI.................  Transport chair, adult size  ...........  ...........  ...........  ...........  ...........
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......  ...........  ...........  ...........  ...........  ...........
E1161               A................  NI.................  Manual adult wc w            ...........  ...........  ...........  ...........  ...........
                                                             tiltinspac.
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.

[[Page 66976]]

 
E1211               A................  ...................  Wheelchair motorized w/ det  ...........  ...........  ...........  ...........  ...........
E1212               A................  ...................  Wheelchair motorized w full  ...........  ...........  ...........  ...........  ...........
E1213               A................  ...................  Wheelchair motorized w/ det  ...........  ...........  ...........  ...........  ...........
E1220               A................  ...................  Whlchr special size/constrc  ...........  ...........  ...........  ...........  ...........
E1221               A................  ...................  Wheelchair spec size w foot  ...........  ...........  ...........  ...........  ...........
E1222               A................  ...................  Wheelchair spec size w/ leg  ...........  ...........  ...........  ...........  ...........
E1223               A................  ...................  Wheelchair spec size w foot  ...........  ...........  ...........  ...........  ...........
E1224               A................  ...................  Wheelchair spec size w/ leg  ...........  ...........  ...........  ...........  ...........
E1225               A................  ...................  Wheelchair spec sz semi-     ...........  ...........  ...........  ...........  ...........
                                                             recl.
E1226               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.....  ...........  ...........  ...........  ...........  ...........
E1231               A................  NI.................  Rigid ped w/c tilt-in-space  ...........  ...........  ...........  ...........  ...........
E1232               A................  NI.................  Folding ped wc tilt-in-      ...........  ...........  ...........  ...........  ...........
                                                             space.
E1233               A................  NI.................  Rig ped wc tltnspc w/o seat  ...........  ...........  ...........  ...........  ...........
E1234               A................  NI.................  Fld ped wc tltnspc w/o seat  ...........  ...........  ...........  ...........  ...........
E1235               A................  NI.................  Rigid ped wc adjustable....  ...........  ...........  ...........  ...........  ...........
E1236               A................  NI.................  Folding ped wc adjustable..  ...........  ...........  ...........  ...........  ...........
E1237               A................  NI.................  Rgd ped wc adjstabl w/o      ...........  ...........  ...........  ...........  ...........
                                                             seat.
E1238               A................  NI.................  Fld ped wc adjstabl w/o      ...........  ...........  ...........  ...........  ...........
                                                             seat.
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.

[[Page 66977]]

 
E1638               A................  DG.................  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...........  ...........  ...........  ...........  ...........  ...........
E1802               A................  NI.................  Adjst forearm pro/sup        ...........  ...........  ...........  ...........  ...........
                                                             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............  ...........  ...........  ...........  ...........  ...........
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................  DG.................  Temporary urinary catheter.         0340       0.6492       $33.86  ...........        $6.77
G0004               E................  DG.................  ECG transm phys review &     ...........  ...........  ...........  ...........  ...........
                                                             int.
G0005               X................  DG.................  ECG 24 hour recording......         0097       1.0077       $52.55       $23.80       $10.51
G0006               X................  DG.................  ECG transmission & analysis         0097       1.0077       $52.55       $23.80       $10.51
G0007               N................  DG.................  ECG phy review & interpret.  ...........  ...........  ...........  ...........  ...........
G0008               L................  ...................  Admin influenza virus vac..  ...........  ...........  ...........  ...........  ...........
G0009               L................  ...................  Admin pneumococcal vaccine.  ...........  ...........  ...........  ...........  ...........
G0010               K................  ...................  Admin hepatitis b vaccine..         0355       0.2132       $11.12  ...........        $2.22
G0015               X................  DG.................  Post symptom ECG tracing...         0097       1.0077       $52.55       $23.80       $10.51
G0025               N................  ...................  Collagen skin test kit.....  ...........  ...........  ...........  ...........  ...........
G0026               A................  DG.................  Fecal leukocyte examination  ...........  ...........  ...........  ...........  ...........
G0027               A................  DG.................  Semen analysis.............  ...........  ...........  ...........  ...........  ...........
G0030               S................  ...................  PET imaging prev PET single         0285      18.1294      $945.47      $409.56      $189.09
G0031               S................  ...................  PET imaging prev PET                0285      18.1294      $945.47      $409.56      $189.09
                                                             multple.
G0032               S................  ...................  PET follow SPECT 78464              0285      18.1294      $945.47      $409.56      $189.09
                                                             singl.
G0033               S................  ...................  PET follow SPECT 78464 mult         0285      18.1294      $945.47      $409.56      $189.09
G0034               S................  ...................  PET follow SPECT 76865              0285      18.1294      $945.47      $409.56      $189.09
                                                             singl.
G0035               S................  ...................  PET follow SPECT 78465 mult         0285      18.1294      $945.47      $409.56      $189.09
G0036               S................  ...................  PET follow cornry angio             0285      18.1294      $945.47      $409.56      $189.09
                                                             sing.
G0037               S................  ...................  PET follow cornry angio             0285      18.1294      $945.47      $409.56      $189.09
                                                             mult.
G0038               S................  ...................  PET follow myocard perf             0285      18.1294      $945.47      $409.56      $189.09
                                                             sing.
G0039               S................  ...................  PET follow myocard perf             0285      18.1294      $945.47      $409.56      $189.09
                                                             mult.
G0040               S................  ...................  PET follow stress echo              0285      18.1294      $945.47      $409.56      $189.09
                                                             singl.
G0041               S................  ...................  PET follow stress echo mult         0285      18.1294      $945.47      $409.56      $189.09
G0042               S................  ...................  PET follow ventriculogm             0285      18.1294      $945.47      $409.56      $189.09
                                                             sing.
G0043               S................  ...................  PET follow ventriculogm             0285      18.1294      $945.47      $409.56      $189.09
                                                             mult.
G0044               S................  ...................  PET following rest ECG              0285      18.1294      $945.47      $409.56      $189.09
                                                             singl.
G0045               S................  ...................  PET following rest ECG mult         0285      18.1294      $945.47      $409.56      $189.09
G0046               S................  ...................  PET follow stress ECG singl         0285      18.1294      $945.47      $409.56      $189.09
G0047               S................  ...................  PET follow stress ECG mult.         0285      18.1294      $945.47      $409.56      $189.09
G0050               S................  DG.................  Residual urine by                   0265       0.9787       $51.04       $28.07       $10.21
                                                             ultrasound.
G0101               V................  ...................  CA screen;pelvic/breast             0600       0.8430       $43.96  ...........        $8.79
                                                             exam.
G0102               N................  ...................  Prostate ca screening; dre.  ...........  ...........  ...........  ...........  ...........
G0103               A................  ...................  Psa, total screening.......  ...........  ...........  ...........  ...........  ...........
G0104               S................  ...................  CA screen;flexi                     0159       2.3255      $121.28  ...........       $30.32
                                                             sigmoidscope.
G0105               T................  ...................  Colorectal scrn; hi risk            0158       7.0638      $368.38  ...........       $92.10
                                                             ind.
G0106               S................  ...................  Colon CA screen;barium              0157       2.5387      $132.40  ...........       $26.48
                                                             enema.
G0107               A................  ...................  CA screen; fecal blood test  ...........  ...........  ...........  ...........  ...........
G0108               A................  ...................  Diab manage trn per indiv..  ...........  ...........  ...........  ...........  ...........

[[Page 66978]]

 
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       0.7364       $38.40       $14.97        $7.68
                                                             direc.
G0118               S................  ...................  Glaucoma scrn hgh risk              0230       0.7364       $38.40       $14.97        $7.68
                                                             direc.
G0120               S................  ...................  Colon ca scrn; barium enema         0157       2.5387      $132.40  ...........       $26.48
G0121               T................  ...................  Colon ca scrn not hi rsk            0158       7.0638      $368.38  ...........       $92.10
                                                             ind.
G0122               E................  ...................  Colon ca scrn; barium enema  ...........  ...........  ...........  ...........  ...........
G0123               A................  ...................  Screen cerv/vag thin layer.  ...........  ...........  ...........  ...........  ...........
G0124               A................  ...................  Screen c/v thin layer by MD  ...........  ...........  ...........  ...........  ...........
G0125               S................  ...................  PET img WhBD sgl pulm ring.         0714  ...........    $1,375.00  ...........      $275.00
G0127               T................  ...................  Trim nail(s)...............         0009       0.6298       $32.84        $8.34        $6.57
G0128               E................  ...................  CORF skilled nursing         ...........  ...........  ...........  ...........  ...........
                                                             service.
G0129               P................  ...................  Partial hosp prog service..         0033       4.6026      $240.03       $48.17       $48.01
G0130               X................  ...................  Single energy x-ray study..         0260       0.7655       $39.92       $21.95        $7.98
G0131               S................  DG.................  CT scan, bone density study         0288       1.2984       $67.71  ...........       $13.54
G0132               S................  DG.................  CT scan, bone density study         0665       0.8236       $42.95  ...........        $8.59
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       2.2189      $115.72  ...........       $23.14
G0167               E................  ...................  Hyperbaric oz tx;no md       ...........  ...........  ...........  ...........  ...........
                                                             reqrd.
G0168               X................  ...................  Wound closure by adhesive..         0340       0.6492       $33.86  ...........        $6.77
G0173               S................  ...................  Stereo                              0721  ...........    $5,500.00  ...........    $1,100.00
                                                             radoisurgery,complete.
G0175               V................  ...................  OPPS Service,sched team             0602       1.4631       $76.30  ...........       $15.26
                                                             conf.
G0176               P................  ...................  OPPS/PHP;activity therapy..         0033       4.6026      $240.03       $48.17       $48.01
G0177               P................  ...................  OPPS/PHP; train & educ serv         0033       4.6026      $240.03       $48.17       $48.01
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................  DG.................  Transpuppillary thermotx...         0235       5.0871      $265.30       $73.44       $53.06
G0186               T................  ...................  Dstry eye lesn,fdr vssl             0235       5.0871      $265.30       $73.44       $53.06
                                                             tech.
G0187               T................  DG.................  Dstry mclr drusen,photocoag         0235       5.0871      $265.30       $73.44       $53.06
G0192               N................  DG.................  Immunization oral/           ...........  ...........  ...........  ...........  ...........
                                                             intranasal.
G0193               A................  DG.................  Endoscopicstudyswallowfunct  ...........  ...........  ...........  ...........  ...........
                                                             n.
G0194               A................  DG.................  Sensorytestingendoscopicstu  ...........  ...........  ...........  ...........  ...........
                                                             d.
G0195               A................  DG.................  Clinicalevalswallowingfunct  ...........  ...........  ...........  ...........  ...........
G0196               A................  DG.................  Evalofswallowingwithradioop  ...........  ...........  ...........  ...........  ...........
                                                             a.
G0197               A................  DG.................  Evalofptforprescipspeechdev  ...........  ...........  ...........  ...........  ...........
                                                             i.
G0198               A................  DG.................  Patientadapation&trainforsp  ...........  ...........  ...........  ...........  ...........
                                                             e.
G0199               A................  DG.................  Reevaluationofpatientusespe  ...........  ...........  ...........  ...........  ...........
                                                             c.
G0200               A................  DG.................  Evalofpatientprescipofvoice  ...........  ...........  ...........  ...........  ...........
                                                             p.
G0201               A................  DG.................  Modifortraininginusevoicepr  ...........  ...........  ...........  ...........  ...........
                                                             o.
G0202               A................  ...................  Screeningmammographydigital  ...........  ...........  ...........  ...........  ...........
G0204               S................  ...................  Diagnosticmammographydigita         0669       0.8915       $46.49  ...........        $9.30
                                                             l.
G0206               S................  ...................  Diagnosticmammographydigita         0669       0.8915       $46.49  ...........        $9.30
                                                             l.
G0210               S................  ...................  PET img whbd ring dxlung ca         0714  ...........    $1,375.00  ...........      $275.00
G0211               S................  ...................  PET img whbd ring init lung         0714  ...........    $1,375.00  ...........      $275.00
G0212               S................  ...................  PET img whbd ring restag            0714  ...........    $1,375.00  ...........      $275.00
                                                             lun.
G0213               S................  ...................  PET img whbd ring dx                0714  ...........    $1,375.00  ...........      $275.00
                                                             colorec.

[[Page 66979]]

 
G0214               S................  ...................  PET img whbd ring init              0714  ...........    $1,375.00  ...........      $275.00
                                                             colre.
G0215               S................  ...................  PET img whbd restag col....         0714  ...........    $1,375.00  ...........      $275.00
G0216               S................  ...................  PET img whbd ring dx                0714  ...........    $1,375.00  ...........      $275.00
                                                             melanom.
G0217               S................  ...................  PET img whbd ring init              0714  ...........    $1,375.00  ...........      $275.00
                                                             melan.
G0218               S................  ...................  PET img whbd ring restag            0714  ...........    $1,375.00  ...........      $275.00
                                                             mel.
G0219               E................  ...................  PET img whbd ring noncov     ...........  ...........  ...........  ...........  ...........
                                                             ind.
G0220               S................  ...................  PET img whbd ring dx                0714  ...........    $1,375.00  ...........      $275.00
                                                             lymphom.
G0221               S................  ...................  PET img whbd ring init              0714  ...........    $1,375.00  ...........      $275.00
                                                             lymph.
G0222               S................  ...................  PET img whbd ring resta             0714  ...........    $1,375.00  ...........      $275.00
                                                             lymp.
G0223               S................  ...................  PET img whbd reg ring dx            0714  ...........    $1,375.00  ...........      $275.00
                                                             hea.
G0224               S................  ...................  PETimg whbd reg ring ini            0714  ...........    $1,375.00  ...........      $275.00
                                                             hea.
G0225               S................  ...................  PET img whbd ring restag            0714  ...........    $1,375.00  ...........      $275.00
                                                             hea.
G0226               S................  ...................  PET img whbd dx esophag....         0714  ...........    $1,375.00  ...........      $275.00
G0227               S................  ...................  PET img whbd ring ini               0714  ...........    $1,375.00  ...........      $275.00
                                                             esopha.
G0228               S................  ...................  PET img whbd ring restg             0714  ...........    $1,375.00  ...........      $275.00
                                                             esop.
G0229               S................  ...................  PET img metabolic brain             0714  ...........    $1,375.00  ...........      $275.00
                                                             ring.
G0230               S................  ...................  PET myocard viability ring.         0714  ...........    $1,375.00  ...........      $275.00
G0231               S................  ...................  PET WhBD colorec; gamma cam         0714  ...........    $1,375.00  ...........      $275.00
G0232               S................  ...................  PET whbd lymphoma; gamma            0714  ...........    $1,375.00  ...........      $275.00
                                                             cam.
G0233               S................  ...................  PET whbd melanoma; gamma            0714  ...........    $1,375.00  ...........      $275.00
                                                             cam.
G0234               S................  ...................  PET WhBD pulm nod; gamma            0714  ...........    $1,375.00  ...........      $275.00
                                                             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................  DG.................  Critic care by MD transport  ...........  ...........  ...........  ...........  ...........
G0241               A................  DG.................  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       7.2188      $376.47  ...........       $75.29
                                                             topt.
G0245               V................  ...................  Initial Foot Exam PTLOPS...         0600       0.8430       $43.96  ...........        $8.79
G0246               V................  ...................  Follow-up Eval of Foot              0600       0.8430       $43.96  ...........        $8.79
                                                             PTLOPS.
G0247               T................  ...................  Routine footcare w LOPS....         0009       0.6298       $32.84        $8.34        $6.57
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  ...........  ...........  ...........  ...........  ...........
G0251               S................  NI.................  Linear acc based stero              0713  ...........    $1,125.00  ...........      $225.00
                                                             radio.
G0252               S................  NI.................  PET imaging initial dx.....         0714  ...........    $1,375.00  ...........      $275.00
G0253               S................  NI.................  PET image brst dection              0714  ...........    $1,375.00  ...........      $275.00
                                                             recur.
G0254               S................  NI.................  PET image brst eval to tx..         0714  ...........    $1,375.00  ...........      $275.00
G0255               E................  NI.................  Current percep threshold     ...........  ...........  ...........  ...........  ...........
                                                             tst.
G0256               T................  NF.................  Prostate brachy w palladium         0649     115.0167    $5,998.24  ...........    $1,199.65
G0257               S................  NF.................  Unsched dialysis ESRD pt            0170       4.8352      $252.16  ...........       $50.43
                                                             hos.
G0258               X................  DG.................  IV infusion during obs stay         0340       0.6492       $33.86  ...........        $6.77
G0259               N................  NF.................  Inject for sacroiliac joint  ...........  ...........  ...........  ...........  ...........
G0260               T................  NF.................  Inj for sacroiliac jt               0204       2.0251      $105.61       $40.13       $21.12
                                                             anesth.
G0261               T................  NF.................  Prostate brachy w iodine            0684      98.8349    $5,154.34  ...........    $1,030.87
                                                             see.
G0262               S................  NI.................  Sm intestinal image capsule         0711  ...........      $625.00  ...........      $125.00
G0263               N................  NF.................  Adm with CHF, CP, asthma...  ...........  ...........  ...........  ...........  ...........
G0264               V................  NF.................  Assmt otr CHF, CP, asthma..         0600       0.8430       $43.96  ...........        $8.79
G0265               A................  NI.................  Cryopresevation              ...........  ...........  ...........  ...........  ...........
                                                             Freeze+stora.
G0266               A................  NI.................  Thawing + expansion froz     ...........  ...........  ...........  ...........  ...........
                                                             cel.
G0267               A................  NI.................  Bone marrow or psc harvest.  ...........  ...........  ...........  ...........  ...........
G0268               X................  NI.................  Removal of impacted wax md.         0340       0.6492       $33.86  ...........        $6.77
G0269               N................  NI.................  Occlusive device in vein     ...........  ...........  ...........  ...........  ...........
                                                             art.
G0270               A................  NI.................  MNT subs tx for change dx..  ...........  ...........  ...........  ...........  ...........
G0271               A................  NI.................  Group MNT 2 or more 30 mins  ...........  ...........  ...........  ...........  ...........
G0272               X................  NI.................  Naso/oro gastric tube pl MD         0272       1.3372       $69.74       $38.36       $13.95
G0273               S................  NI.................  Pretx planning, non-                0718  ...........    $2,750.00  ...........      $550.00
                                                             Hodgkins.
G0274               S................  NI.................  Radiopharm tx, non-Hodgkins         0725  ...........   $20,000.00  ...........    $4,000.00
G0275               N................  NI.................  Renal angio, cardiac cath..  ...........  ...........  ...........  ...........  ...........
G0278               N................  NI.................  Iliac art angio,cardiac      ...........  ...........  ...........  ...........  ...........
                                                             cath.
G0279               A................  NI.................  Excorp shock tx, elbow epi.  ...........  ...........  ...........  ...........  ...........
G0280               A................  NI.................  Excorp shock tx other than.  ...........  ...........  ...........  ...........  ...........
G0281               A................  NI.................  Elec stim unattend for       ...........  ...........  ...........  ...........  ...........
                                                             press.

[[Page 66980]]

 
G0282               A................  NI.................  Elect stim wound care not    ...........  ...........  ...........  ...........  ...........
                                                             pd.
G0283               A................  NI.................  Elec stim other than wound.  ...........  ...........  ...........  ...........  ...........
G0288               T................  NI.................  Recon, CTA for surg plan...         0975  ...........      $625.00  ...........      $125.00
G0289               N................  NI.................  Arthro, loose body +         ...........  ...........  ...........  ...........  ...........
                                                             chondro.
G0290               E................  NF.................  Drug-eluting stents, single  ...........  ...........  ...........  ...........  ...........
G0291               E................  NF.................  Drug-eluting stents,each     ...........  ...........  ...........  ...........  ...........
                                                             add.
G0292               S................  NI.................  Adm exp drugs,clinical              0708  ...........      $150.00  ...........       $30.00
                                                             trial.
G0293               S................  NI.................  Non-cov surg proc,clin              0710  ...........      $400.00  ...........       $80.00
                                                             trial.
G0294               S................  NI.................  Non-cov proc, clinical              0707  ...........       $75.00  ...........       $15.00
                                                             trial.
G0295               E................  NI.................  Electromagnetic therapy onc  ...........  ...........  ...........  ...........  ...........
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  ...........  ...........  ...........  ...........  ...........
H0031               E................  NI.................  MH health assess by non-md.  ...........  ...........  ...........  ...........  ...........
H0032               E................  NI.................  MH svc plan dev by non-md..  ...........  ...........  ...........  ...........  ...........
H0033               E................  NI.................  Oral med adm direct observe  ...........  ...........  ...........  ...........  ...........
H0034               E................  NI.................  Med trng & support per       ...........  ...........  ...........  ...........  ...........
                                                             15min.
H0035               E................  NI.................  MH partial hosp tx under     ...........  ...........  ...........  ...........  ...........
                                                             24h.
H0036               E................  NI.................  Comm psy face-face per       ...........  ...........  ...........  ...........  ...........
                                                             15min.
H0037               E................  NI.................  Comm psy sup tx pgm per      ...........  ...........  ...........  ...........  ...........
                                                             diem.
H0038               E................  NI.................  Self-help/peer svc per       ...........  ...........  ...........  ...........  ...........
                                                             15min.
H0039               E................  NI.................  Asser com tx face-face/      ...........  ...........  ...........  ...........  ...........
                                                             15min.
H0040               E................  NI.................  Assert comm tx pgm per diem  ...........  ...........  ...........  ...........  ...........
H0041               E................  NI.................  Fos c chld non-ther per      ...........  ...........  ...........  ...........  ...........
                                                             diem.
H0042               E................  NI.................  Fos c chld non-ther per mon  ...........  ...........  ...........  ...........  ...........

[[Page 66981]]

 
H0043               E................  NI.................  Supported housing, per diem  ...........  ...........  ...........  ...........  ...........
H0044               E................  NI.................  Supported housing, per       ...........  ...........  ...........  ...........  ...........
                                                             month.
H0045               E................  NI.................  Respite not-in-home per      ...........  ...........  ...........  ...........  ...........
                                                             diem.
H0046               E................  NI.................  Mental health service, nos.  ...........  ...........  ...........  ...........  ...........
H0047               E................  NI.................  Alcohol/drug abuse svc nos.  ...........  ...........  ...........  ...........  ...........
H0048               E................  NI.................  Spec coll non-blood:a/d      ...........  ...........  ...........  ...........  ...........
                                                             test.
H1000               A................  ...................  Prenatal care atrisk         ...........  ...........  ...........  ...........  ...........
                                                             assessm.
H1001               A................  ...................  Antepartum management......  ...........  ...........  ...........  ...........  ...........
H1002               A................  ...................  Carecoordination prenatal..  ...........  ...........  ...........  ...........  ...........
H1003               A................  ...................  Prenatal at risk education.  ...........  ...........  ...........  ...........  ...........
H1004               A................  ...................  Follow up home visit/        ...........  ...........  ...........  ...........  ...........
                                                             prental.
H1005               A................  ...................  Prenatalcare enhanced srv    ...........  ...........  ...........  ...........  ...........
                                                             pk.
H1010               E................  NI.................  Nonmed family planning ed..  ...........  ...........  ...........  ...........  ...........
H1011               E................  NI.................  Family assessment..........  ...........  ...........  ...........  ...........  ...........
H2000               E................  NI.................  Comp multidisipln            ...........  ...........  ...........  ...........  ...........
                                                             evaluation.
H2001               E................  NI.................  Rehabilitation program 1/2   ...........  ...........  ...........  ...........  ...........
                                                             d.
J0120               N................  ...................  Tetracyclin injection......  ...........  ...........  ...........  ...........  ...........
J0130               K................  ...................  Abciximab injection........         1605       5.8526      $305.22  ...........       $61.04
J0150               N................  ...................  Injection adenosine 6 MG...  ...........  ...........  ...........  ...........  ...........
J0151               K................  ...................  Adenosine injection........         0917       3.1986      $166.81  ...........       $33.36
J0170               N................  ...................  Adrenalin epinephrin inject  ...........  ...........  ...........  ...........  ...........
J0190               N................  ...................  Inj biperiden lactate/5 mg.  ...........  ...........  ...........  ...........  ...........
J0200               N................  ...................  Alatrofloxacin mesylate....  ...........  ...........  ...........  ...........  ...........
J0205               F................  ...................  Alglucerase injection......  ...........  ...........  ...........  ...........  ...........
J0207               K................  ...................  Amifostine.................         7000       4.5057      $234.98  ...........       $47.00
J0210               N................  ...................  Methyldopate hcl injection.  ...........  ...........  ...........  ...........  ...........
J0256               F................  ...................  Alpha 1 proteinase           ...........  ...........  ...........  ...........  ...........
                                                             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................  DG.................  Amphotericin B lipid                7001       2.3449      $122.29  ...........       $24.46
                                                             complex.
J0287               K................  NI.................  Amphotericin b lipid                9024       0.4167       $21.73  ...........        $4.35
                                                             complex.
J0288               N................  NI.................  Ampho b cholesteryl sulfate  ...........  ...........  ...........  ...........  ...........
J0289               N................  NI.................  Amphotericin b liposome inj  ...........  ...........  ...........  ...........  ...........
J0290               N................  ...................  Ampicillin 500 MG inj......  ...........  ...........  ...........  ...........  ...........
J0295               N................  ...................  Ampicillin sodium per 1.5    ...........  ...........  ...........  ...........  ...........
                                                             gm.
J0300               N................  ...................  Amobarbital 125 MG inj.....  ...........  ...........  ...........  ...........  ...........
J0330               N................  ...................  Succinycholine chloride inj  ...........  ...........  ...........  ...........  ...........
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       0.0484        $2.52  ...........         $.50
J0587               G................  ...................  Botulinum toxin type B.....         9018  ...........        $8.79  ...........        $1.31
J0592               N................  NI.................  Buprenorphine hydrochloride  ...........  ...........  ...........  ...........  ...........
J0600               N................  ...................  Edetate calcium disodium     ...........  ...........  ...........  ...........  ...........
                                                             inj.
J0610               N................  ...................  Calcium gluconate injection  ...........  ...........  ...........  ...........  ...........
J0620               N................  ...................  Calcium glycer & lact/10 ML  ...........  ...........  ...........  ...........  ...........

[[Page 66982]]

 
J0630               N................  ...................  Calcitonin salmon injection  ...........  ...........  ...........  ...........  ...........
J0635               N................  DG.................  Calcitriol injection.......  ...........  ...........  ...........  ...........  ...........
J0636               N................  NI.................  Inj calcitriol per 0.1 mcg.  ...........  ...........  ...........  ...........  ...........
J0637               G................  NI.................  Caspofungin acetate........         9019  ...........       $34.20  ...........        $5.11
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.
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       4.7383      $247.11  ...........       $49.42
                                                             vial.
J0880               E................  NI.................  Darbepoetin alfa injection.  ...........  ...........  ...........  ...........  ...........
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................  DG.................  Medroxyprogesterone inj....  ...........  ...........  ...........  ...........  ...........
J1051               N................  NI.................  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.
J1094               N................  NI.................  Inj dexamethasone acetate..  ...........  ...........  ...........  ...........  ...........
J1095               N................  DG.................  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       2.2577      $117.74  ...........       $23.55
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........  ...........  ...........  ...........  ...........  ...........

[[Page 66983]]

 
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       2.1027      $109.66  ...........       $21.93
                                                             injection.
J1441               K................  ...................  Filgrastim 480 mcg                  7049       3.2267      $168.28  ...........       $33.66
                                                             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....  ...........  ...........  ...........  ...........  ...........
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................  DG.................  Immune globulin 500 mg.....         0905       0.8333       $43.46  ...........        $8.69
J1563               E................  ...................  IV immune globulin.........  ...........  ...........  ...........  ...........  ...........
J1564               K................  NI.................  Immune globulin 10 mg......         9021       0.0097         $.51  ...........         $.10
J1565               K................  ...................  RSV-ivig...................         0906       0.5911       $30.83  ...........        $6.17
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               N................  ...................  Inj enoxaparin sodium......  ...........  ...........  ...........  ...........  ...........
J1652               N................  NI.................  Fondaparinux 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       0.7364       $38.40  ...........        $7.68
J1750               N................  ...................  Iron dextran...............  ...........  ...........  ...........  ...........  ...........
J1755               N................  DG.................  Iron sucrose injection.....  ...........  ...........  ...........  ...........  ...........
J1756               N................  NI.................  Iron sucrose injection.....  ...........  ...........  ...........  ...........  ...........
J1785               K................  ...................  Injection imiglucerase /            0916       0.0484        $2.52  ...........         $.50
                                                             unit.
J1790               N................  ...................  Droperidol injection.......  ...........  ...........  ...........  ...........  ...........
J1800               N................  ...................  Propranolol injection......  ...........  ...........  ...........  ...........  ...........
J1810               E................  ...................  Droperidol/fentanyl inj....  ...........  ...........  ...........  ...........  ...........
J1815               N................  NI.................  Insulin injection..........  ...........  ...........  ...........  ...........  ...........
J1817               N................  NI.................  Insulin for insulin pump     ...........  ...........  ...........  ...........  ...........
                                                             use.
J1820               N................  DG.................  Insulin injection..........  ...........  ...........  ...........  ...........  ...........
J1825               K................  ...................  Interferon beta-1a.........         0909       2.7906      $145.53  ...........       $29.11

[[Page 66984]]

 
J1830               K................  ...................  Interferon beta-1b / .25 MG         0910       1.9864      $103.59  ...........       $20.72
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       3.7984      $198.09  ...........       $39.62
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.  ...........  ...........  ...........  ...........  ...........
J2320               N................  ...................  Nandrolone decanoate 50 MG.  ...........  ...........  ...........  ...........  ...........
J2321               N................  ...................  Nandrolone decanoate 100 MG  ...........  ...........  ...........  ...........  ...........
J2322               N................  ...................  Nandrolone decanoate 200 MG  ...........  ...........  ...........  ...........  ...........
J2324               G................  NI.................  Nesiritide.................         9114  ...........      $433.20  ...........       $64.75
J2352               K................  ...................  Octreotide acetate                  7031       1.2694       $66.20  ...........       $13.24
                                                             injection.
J2355               K................  ...................  Oprelvekin injection.......         7011       2.7325      $142.50  ...........       $28.50
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       3.2654      $170.29  ...........       $34.06
J2440               N................  ...................  Papaverin hcl injection....  ...........  ...........  ...........  ...........  ...........
J2460               N................  ...................  Oxytetracycline injection..  ...........  ...........  ...........  ...........  ...........
J2500               N................  DG.................  Paricalcitol...............  ...........  ...........  ...........  ...........  ...........
J2501               N................  NI.................  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...  ...........  ...........  ...........  ...........  ...........
J2675               N................  ...................  Inj progesterone per 50 MG.  ...........  ...........  ...........  ...........  ...........
J2680               N................  ...................  Fluphenazine decanoate 25    ...........  ...........  ...........  ...........  ...........
                                                             MG.
J2690               N................  ...................  Procainamide hcl injection.  ...........  ...........  ...........  ...........  ...........
J2700               N................  ...................  Oxacillin sodium injeciton.  ...........  ...........  ...........  ...........  ...........
J2710               N................  ...................  Neostigmine methylslfte inj  ...........  ...........  ...........  ...........  ...........
J2720               N................  ...................  Inj protamine sulfate/10 MG  ...........  ...........  ...........  ...........  ...........
J2725               N................  ...................  Inj protirelin per 250 mcg.  ...........  ...........  ...........  ...........  ...........
J2730               N................  ...................  Pralidoxime chloride inj...  ...........  ...........  ...........  ...........  ...........
J2760               N................  ...................  Phentolaine mesylate inj...  ...........  ...........  ...........  ...........  ...........

[[Page 66985]]

 
J2765               N................  ...................  Metoclopramide hcl           ...........  ...........  ...........  ...........  ...........
                                                             injection.
J2770               N................  ...................  Quinupristin/dalfopristin..  ...........  ...........  ...........  ...........  ...........
J2780               N................  ...................  Ranitidine hydrochloride     ...........  ...........  ...........  ...........  ...........
                                                             inj.
J2788               K................  NI.................  Rho d immune globulin 50            9023       0.0484        $2.52  ...........         $.50
                                                             mcg.
J2790               N................  ...................  Rho d immune globulin inj..  ...........  ...........  ...........  ...........  ...........
J2792               K................  ...................  Rho(D) immune globulin h,           1609       0.2229       $11.62  ...........        $2.32
                                                             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................  DG.................  NA Ferric Gluconate Complex  ...........  ...........  ...........  ...........  ...........
J2916               N................  NI.................  Na ferric gluconate complex  ...........  ...........  ...........  ...........  ...........
J2920               N................  ...................  Methylprednisolone           ...........  ...........  ...........  ...........  ...........
                                                             injection.
J2930               N................  ...................  Methylprednisolone           ...........  ...........  ...........  ...........  ...........
                                                             injection.
J2940               N................  ...................  Somatrem injection.........  ...........  ...........  ...........  ...........  ...........
J2941               K................  ...................  Somatropin injection.......         7034       0.7170       $37.39  ...........        $7.48
J2950               N................  ...................  Promazine hcl injection....  ...........  ...........  ...........  ...........  ...........
J2993               K................  ...................  Reteplase injection........         9005      12.6547      $659.96  ...........      $131.99
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      27.5963    $1,439.17  ...........      $287.83
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               K................  ...................  Thyrotropin injection......         9108       7.5870      $395.67  ...........       $79.13
J3245               K................  ...................  Tirofiban hydrochloride....         7041       4.9417      $257.71  ...........       $51.54
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       1.3081       $68.22  ...........       $13.64
                                                             glucoronate.
J3310               N................  ...................  Perphenazine injeciton.....  ...........  ...........  ...........  ...........  ...........
J3315               E................  NI.................  Triptorelin pamoate........  ...........  ...........  ...........  ...........  ...........
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      16.5209      $861.58  ...........      $172.32
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.................  ...........  ...........  ...........  ...........  ...........
J3487               G................  NI.................  Zoledronic acid............         9115  ...........      $406.78  ...........       $60.80
J3490               N................  ...................  Drugs unclassified           ...........  ...........  ...........  ...........  ...........
                                                             injection.
J3520               .................  ...................  Edetate disodium per 150 mg  ...........  ...........  ...........  ...........  ...........
J3530               N................  ...................  Nasal vaccine inhalation...  ...........  ...........  ...........  ...........  ...........
J3535               E................  ...................  Metered dose inhaler drug..  ...........  ...........  ...........  ...........  ...........

[[Page 66986]]

 
J3570               E................  ...................  Laetrile amygdalin vit B17.  ...........  ...........  ...........  ...........  ...........
J3590               N................  NI.................  Unclassified biologics.....  ...........  ...........  ...........  ...........  ...........
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       0.0097         $.51  ...........         $.10
J7191               K................  ...................  Factor VIII (porcine)......         0926       0.0291        $1.52  ...........         $.30
J7192               K................  ...................  Factor viii recombinant....         0927       0.0194        $1.01  ...........         $.20
J7193               K................  ...................  Factor IX non-recombinant..         0931       0.0097         $.51  ...........         $.10
J7194               K................  ...................  Factor ix complex..........         0928       0.0097         $.51  ...........         $.10
J7195               K................  ...................  Factor IX recombinant......         0932       0.0194        $1.01  ...........         $.20
J7197               K................  ...................  Antithrombin iii injection.         0930       0.0194        $1.01  ...........         $.20
J7198               K................  ...................  Anti-inhibitor.............         0929       0.0194        $1.01  ...........         $.20
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................  DG.................  Sodium hyaluronate           ...........  ...........  ...........  ...........  ...........
                                                             injection.
J7317               N................  NI.................  Sodium hyaluronate           ...........  ...........  ...........  ...........  ...........
                                                             injection.
J7320               K................  ...................  Hylan G-F 20 injection.....         1611       2.3643      $123.30  ...........       $24.66
J7330               K................  ...................  Cultured chondrocytes               1059     114.2706    $5,959.33  ...........    $1,191.87
                                                             implnt.
J7340               E................  ...................  Metabolic active D/E tissue  ...........  ...........  ...........  ...........  ...........
J7342               N................  NI.................  Metabolically active tissue  ...........  ...........  ...........  ...........  ...........
J7350               N................  NI.................  Injectable human tissue....  ...........  ...........  ...........  ...........  ...........
J7500               N................  ...................  Azathioprine oral 50mg.....  ...........  ...........  ...........  ...........  ...........
J7501               N................  ...................  Azathioprine parenteral....  ...........  ...........  ...........  ...........  ...........
J7502               K................  ...................  Cyclosporine oral 100 mg...         0888       0.0484        $2.52  ...........         $.50
J7504               K................  ...................  Lymphocyte immune globulin.         0890       3.3429      $174.34  ...........       $34.87
J7505               K................  ...................  Monoclonal antibodies......         7038       6.9572      $362.82  ...........       $72.56
J7506               N................  ...................  Prednisone oral............  ...........  ...........  ...........  ...........  ...........
J7507               K................  ...................  Tacrolimus oral per 1 MG...         0891       0.0291        $1.52  ...........         $.30
J7508               E................  ...................  Tacrolimus oral per 5 MG...  ...........  ...........  ...........  ...........  ...........
J7509               N................  ...................  Methylprednisolone oral....  ...........  ...........  ...........  ...........  ...........
J7510               N................  ...................  Prednisolone oral per 5 mg.  ...........  ...........  ...........  ...........  ...........
J7511               K................  ...................  Antithymocyte globuln               9104       2.6356      $137.45  ...........       $27.49
                                                             rabbit.
J7513               K................  ...................  Daclizumab, parenteral.....         1612       4.3991      $229.42  ...........       $45.88
J7515               N................  ...................  Cyclosporine oral 25 mg....  ...........  ...........  ...........  ...........  ...........
J7516               N................  ...................  Cyclosporin parenteral       ...........  ...........  ...........  ...........  ...........
                                                             250mg.
J7517               K................  ...................  Mycophenolate mofetil oral.         9015       0.0291        $1.52  ...........         $.30
J7520               K................  ...................  Sirolimus, oral............         9020       0.0581        $3.03  ...........         $.61
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  ...........  ...........  ...........  ...........  ...........
J7633               N................  NI.................  Budesonide concentrated sol  ...........  ...........  ...........  ...........  ...........
J7635               A................  ...................  Atropine inhal sol con.....  ...........  ...........  ...........  ...........  ...........
J7636               A................  ...................  Atropine inhal sol unit      ...........  ...........  ...........  ...........  ...........
                                                             dose.
J7637               A................  ...................  Dexamethasone inhal sol con  ...........  ...........  ...........  ...........  ...........
J7638               A................  ...................  Dexamethasone inhal sol u d  ...........  ...........  ...........  ...........  ...........

[[Page 66987]]

 
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       0.0291        $1.52  ...........         $.30
J8521               E................  ...................  Capecitabine, oral, 500 mg.  ...........  ...........  ...........  ...........  ...........
J8530               N................  ...................  Cyclophosphamide oral 25 MG  ...........  ...........  ...........  ...........  ...........
J8560               K................  ...................  Etoposide oral 50 MG.......         0802       0.5523       $28.80  ...........        $5.76
J8600               N................  ...................  Melphalan oral 2 MG........  ...........  ...........  ...........  ...........  ...........
J8610               N................  ...................  Methotrexate oral 2.5 MG...  ...........  ...........  ...........  ...........  ...........
J8700               K................  ...................  Temozolmide................         1086       0.0581        $3.03  ...........         $.61
J8999               E................  ...................  Oral prescription drug       ...........  ...........  ...........  ...........  ...........
                                                             chemo.
J9000               N................  ...................  Doxorubic hcl 10 MG vl       ...........  ...........  ...........  ...........  ...........
                                                             chemo.
J9001               K................  ...................  Doxorubicin hcl liposome            7046       4.3894      $228.91  ...........       $45.78
                                                             inj.
J9010               G................  NI.................  Alemtuzumab injection......         9110  ...........      $511.22  ...........       $76.41
J9015               K................  ...................  Aldesleukin/single use vial         0807       7.2867      $380.01  ...........       $76.00
J9017               G................  ...................  Arsenic trioxide...........         9012  ...........       $31.35  ...........        $4.69
J9020               N................  ...................  Asparaginase injection.....  ...........  ...........  ...........  ...........  ...........
J9031               N................  ...................  Bcg live intravesical vac..  ...........  ...........  ...........  ...........  ...........
J9040               K................  ...................  Bleomycin sulfate injection         0857       3.1879      $166.25  ...........       $33.25
J9045               K................  ...................  Carboplatin injection......         0811       1.4922       $77.82  ...........       $15.56
J9050               K................  ...................  Carmus bischl nitro inj....         0812       1.5310       $79.84  ...........       $15.97
J9060               K................  ...................  Cisplatin 10 MG injection..         0813       0.4263       $22.23  ...........        $4.45
J9062               E................  ...................  Cisplatin 50 MG injection..  ...........  ...........  ...........  ...........  ...........
J9065               K................  ...................  Inj cladribine per 1 MG....         0858       0.7946       $41.44  ...........        $8.29
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.
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       1.9379      $101.06  ...........       $20.21
J9151               K................  ...................  Daunorubicin citrate                0821       2.9069      $151.60  ...........       $30.32
                                                             liposom.
J9160               K................  ...................  Denileukin diftitox, 300            1084      12.1315      $632.67  ...........      $126.53
                                                             mcg.
J9165               K................  ...................  Diethylstilbestrol                  0822       2.0251      $105.61  ...........       $21.12
                                                             injection.
J9170               K................  ...................  Docetaxel..................         0823       3.8953      $203.14  ...........       $40.63
J9180               E................  ...................  Epirubicin HCl injection...  ...........  ...........  ...........  ...........  ...........
J9181               N................  ...................  Etoposide 10 MG inj........  ...........  ...........  ...........  ...........  ...........
J9182               E................  ...................  Etoposide 100 MG inj.......  ...........  ...........  ...........  ...........  ...........
J9185               K................  ...................  Fludarabine phosphate inj..         0842       3.2848      $171.31  ...........       $34.26

[[Page 66988]]

 
J9190               N................  ...................  Fluorouracil injection.....  ...........  ...........  ...........  ...........  ...........
J9200               K................  ...................  Floxuridine injection......         0827       2.2189      $115.72  ...........       $23.14
J9201               K................  ...................  Gemcitabine HCl............         0828       1.2984       $67.71  ...........       $13.54
J9202               K................  ...................  Goserelin acetate implant..         0810       5.5619      $290.06  ...........       $58.01
J9206               K................  ...................  Irinotecan injection.......         0830       1.7538       $91.46  ...........       $18.29
J9208               K................  ...................  Ifosfomide injection.......         0831       1.9186      $100.06  ...........       $20.01
J9209               K................  ...................  Mesna injection............         0732       0.5039       $26.28  ...........        $5.26
J9211               K................  ...................  Idarubicin hcl injection...         0832       4.8642      $253.67  ...........       $50.73
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       3.0426      $158.67  ...........       $31.73
J9217               K................  ...................  Leuprolide acetate                  9217       6.5696      $342.61  ...........       $68.52
                                                             suspnsion.
J9218               K................  ...................  Leuprolide acetate                  0861       0.7752       $40.43  ...........        $8.09
                                                             injeciton.
J9219               G................  ...................  Leuprolide acetate implant.         7051  ...........    $5,399.80  ...........      $807.13
J9230               N................  ...................  Mechlorethamine hcl inj....  ...........  ...........  ...........  ...........  ...........
J9245               K................  ...................  Inj melphalan hydrochl 50           0840       4.5348      $236.49  ...........       $47.30
                                                             MG.
J9250               N................  ...................  Methotrexate sodium inj....  ...........  ...........  ...........  ...........  ...........
J9260               E................  ...................  Methotrexate sodium inj....  ...........  ...........  ...........  ...........  ...........
J9265               K................  ...................  Paclitaxel injection.......         0863       2.3158      $120.77  ...........       $24.15
J9266               K................  ...................  Pegaspargase/singl dose             0843       8.8079      $459.34  ...........       $91.87
                                                             vial.
J9268               K................  ...................  Pentostatin injection......         0844      19.8833    $1,036.93  ...........      $207.39
J9270               N................  ...................  Plicamycin (mithramycin)     ...........  ...........  ...........  ...........  ...........
                                                             inj.
J9280               K................  ...................  Mitomycin 5 MG inj.........         0862       1.1337       $59.12  ...........       $11.82
J9290               E................  ...................  Mitomycin 20 MG inj........  ...........  ...........  ...........  ...........  ...........
J9291               E................  ...................  Mitomycin 40 MG inj........  ...........  ...........  ...........  ...........  ...........
J9293               K................  ...................  Mitoxantrone hydrochl / 5           0864       2.9263      $152.61  ...........       $30.52
                                                             MG.
J9300               F................  ...................  Gemtuzumab ozogamicin......  ...........  ...........  ...........  ...........  ...........
J9310               K................  ...................  Rituximab cancer treatment.         0849       5.4941      $286.52  ...........       $57.30
J9320               N................  ...................  Streptozocin injection.....  ...........  ...........  ...........  ...........  ...........
J9340               N................  ...................  Thiotepa injection.........  ...........  ...........  ...........  ...........  ...........
J9350               K................  ...................  Topotecan..................         0852       7.7130      $402.24  ...........       $80.45
J9355               K................  ...................  Trastuzumab................         1613       0.6298       $32.84  ...........        $6.57
J9357               K................  ...................  Valrubicin, 200 mg.........         1614       3.5658      $185.96  ...........       $37.19
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       1.0756       $56.09  ...........       $11.22
J9600               K................  ...................  Porfimer sodium............         0856      29.6117    $1,544.28  ...........      $308.86
J9999               E................  ...................  Chemotherapy drug..........  ...........  ...........  ...........  ...........  ...........
K0001               A................  ...................  Standard wheelchair........  ...........  ...........  ...........  ...........  ...........
K0002               A................  ...................  Stnd hemi (low seat) whlchr  ...........  ...........  ...........  ...........  ...........
K0003               A................  ...................  Lightweight wheelchair.....  ...........  ...........  ...........  ...........  ...........
K0004               A................  ...................  High strength ltwt whlchr..  ...........  ...........  ...........  ...........  ...........
K0005               A................  ...................  Ultralightweight wheelchair  ...........  ...........  ...........  ...........  ...........
K0006               A................  ...................  Heavy duty wheelchair......  ...........  ...........  ...........  ...........  ...........
K0007               A................  ...................  Extra heavy duty wheelchair  ...........  ...........  ...........  ...........  ...........
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................  DG.................  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.  ...........  ...........  ...........  ...........  ...........

[[Page 66989]]

 
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................  DG.................  Heel loop each.............  ...........  ...........  ...........  ...........  ...........
K0035               A................  ...................  Heel loop with ankle strap.  ...........  ...........  ...........  ...........  ...........
K0036               A................  ...................  Toe loop each..............  ...........  ...........  ...........  ...........  ...........
K0037               A................  ...................  High mount flip-up footrest  ...........  ...........  ...........  ...........  ...........
K0038               A................  ...................  Leg strap each.............  ...........  ...........  ...........  ...........  ...........
K0039               A................  ...................  Leg strap h style each.....  ...........  ...........  ...........  ...........  ...........
K0040               A................  ...................  Adjustable angle footplate.  ...........  ...........  ...........  ...........  ...........
K0041               A................  ...................  Large size footplate each..  ...........  ...........  ...........  ...........  ...........
K0042               A................  ...................  Standard size footplate      ...........  ...........  ...........  ...........  ...........
                                                             each.
K0043               A................  ...................  Ftrst lower extension tube.  ...........  ...........  ...........  ...........  ...........
K0044               A................  ...................  Ftrst upper hanger bracket.  ...........  ...........  ...........  ...........  ...........
K0045               A................  ...................  Footrest complete assembly.  ...........  ...........  ...........  ...........  ...........
K0046               A................  ...................  Elevat legrst low extension  ...........  ...........  ...........  ...........  ...........
K0047               A................  ...................  Elevat legrst up hangr       ...........  ...........  ...........  ...........  ...........
                                                             brack.
K0048               A................  ...................  Elevate legrest complete...  ...........  ...........  ...........  ...........  ...........
K0049               A................  ...................  Calf pad each..............  ...........  ...........  ...........  ...........  ...........
K0050               A................  ...................  Ratchet assembly...........  ...........  ...........  ...........  ...........  ...........
K0051               A................  ...................  Cam relese assem ftrst/      ...........  ...........  ...........  ...........  ...........
                                                             lgrst.
K0052               A................  ...................  Swingaway detach footrest..  ...........  ...........  ...........  ...........  ...........
K0053               A................  ...................  Elevate footrest articulate  ...........  ...........  ...........  ...........  ...........
K0054               A................  ...................  Seat wdth 10-12/15/17/20 wc  ...........  ...........  ...........  ...........  ...........
K0055               A................  ...................  Seat dpth 15/17/18 ltwt wc.  ...........  ...........  ...........  ...........  ...........
K0056               A................  ...................  Seat ht <17 or =21 ltwt wc.
K0057               A................  ...................  Seat wdth 19/20 hvy dty wc.  ...........  ...........  ...........  ...........  ...........
K0058               A................  ...................  Seat dpth 17/18 power wc...  ...........  ...........  ...........  ...........  ...........
K0059               A................  ...................  Plastic coated handrim each  ...........  ...........  ...........  ...........  ...........
K0060               A................  ...................  Steel handrim each.........  ...........  ...........  ...........  ...........  ...........
K0061               A................  ...................  Aluminum handrim each......  ...........  ...........  ...........  ...........  ...........
K0062               A................  ...................  Handrim 8-10 vert/obliq      ...........  ...........  ...........  ...........  ...........
                                                             proj.
K0063               A................  ...................  Hndrm 12-16 vert/obliq proj  ...........  ...........  ...........  ...........  ...........
K0064               A................  ...................  Zero pressure tube flat      ...........  ...........  ...........  ...........  ...........
                                                             free.
K0065               A................  ...................  Spoke protectors...........  ...........  ...........  ...........  ...........  ...........
K0066               A................  ...................  Solid tire any size each...  ...........  ...........  ...........  ...........  ...........
K0067               A................  ...................  Pneumatic tire any size      ...........  ...........  ...........  ...........  ...........
                                                             each.
K0068               A................  ...................  Pneumatic tire tube each...  ...........  ...........  ...........  ...........  ...........
K0069               A................  ...................  Rear whl complete solid      ...........  ...........  ...........  ...........  ...........
                                                             tire.
K0070               A................  ...................  Rear whl compl pneum tire..  ...........  ...........  ...........  ...........  ...........
K0071               A................  ...................  Front castr compl pneum      ...........  ...........  ...........  ...........  ...........
                                                             tire.
K0072               A................  ...................  Frnt cstr cmpl sem-pneum     ...........  ...........  ...........  ...........  ...........
                                                             tir.
K0073               A................  ...................  Caster pin lock each.......  ...........  ...........  ...........  ...........  ...........
K0074               A................  ...................  Pneumatic caster tire each.  ...........  ...........  ...........  ...........  ...........
K0075               A................  ...................  Semi-pneumatic caster tire.  ...........  ...........  ...........  ...........  ...........
K0076               A................  ...................  Solid caster tire each.....  ...........  ...........  ...........  ...........  ...........
K0077               A................  ...................  Front caster assem complete  ...........  ...........  ...........  ...........  ...........
K0078               A................  ...................  Pneumatic caster tire tube.  ...........  ...........  ...........  ...........  ...........
K0079               A................  ...................  Wheel lock extension pair..  ...........  ...........  ...........  ...........  ...........
K0080               A................  ...................  Anti-rollback device pair..  ...........  ...........  ...........  ...........  ...........
K0081               A................  ...................  Wheel lock assembly          ...........  ...........  ...........  ...........  ...........
                                                             complete.
K0082               A................  ...................  22 nf deep cycl acid         ...........  ...........  ...........  ...........  ...........
                                                             battery.
K0083               A................  ...................  22 nf gel cell battery each  ...........  ...........  ...........  ...........  ...........
K0084               A................  ...................  Grp 24 deep cycl acid        ...........  ...........  ...........  ...........  ...........
                                                             battry.
K0085               A................  ...................  Group 24 gel cell battery..  ...........  ...........  ...........  ...........  ...........
K0086               A................  ...................  U-1 lead acid battery each.  ...........  ...........  ...........  ...........  ...........
K0087               A................  ...................  U-1 gel cell battery each..  ...........  ...........  ...........  ...........  ...........
K0088               A................  ...................  Battry chrgr acid/gel cell.  ...........  ...........  ...........  ...........  ...........
K0089               A................  ...................  Battery charger dual mode..  ...........  ...........  ...........  ...........  ...........
K0090               A................  ...................  Rear tire power wheelchair.  ...........  ...........  ...........  ...........  ...........

[[Page 66990]]

 
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................  DG.................  One-arm drive attachment...  ...........  ...........  ...........  ...........  ...........
K0102               A................  ...................  Crutch and cane holder.....  ...........  ...........  ...........  ...........  ...........
K0103               A................  ...................  Transfer board < 25[gE]....  ...........  ...........  ...........  ...........  ...........
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................  DG.................  Nasal application device...  ...........  ...........  ...........  ...........  ...........
K0184               A................  DG.................  Nasal pillow or face seal..  ...........  ...........  ...........  ...........  ...........
K0185               A................  DG.................  Pos airway pressure          ...........  ...........  ...........  ...........  ...........
                                                             headgear.
K0186               A................  DG.................  Pos airway prssure           ...........  ...........  ...........  ...........  ...........
                                                             chinstrap.
K0187               A................  DG.................  Pos airway pressure tubing.  ...........  ...........  ...........  ...........  ...........
K0188               A................  DG.................  Pos airway pressure filter.  ...........  ...........  ...........  ...........  ...........
K0189               A................  DG.................  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.
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................  DG.................  Residual limb support        ...........  ...........  ...........  ...........  ...........
                                                             system.
K0556               A................  NI.................  Socket insert w lock mech..  ...........  ...........  ...........  ...........  ...........
K0557               A................  NI.................  Socket insert w/o lock mech  ...........  ...........  ...........  ...........  ...........
K0558               A................  NI.................  Intl custm cong/atyp insert  ...........  ...........  ...........  ...........  ...........
K0559               A................  NI.................  Initial custom socket        ...........  ...........  ...........  ...........  ...........
                                                             insert.
K0581               A................  NI.................  Ost pch clsd w barrier/      ...........  ...........  ...........  ...........  ...........
                                                             filtr.
K0582               A................  NI.................  Ost pch w bar/bltinconv/     ...........  ...........  ...........  ...........  ...........
                                                             fltr.
K0583               A................  NI.................  Ost pch clsd w/o bar w       ...........  ...........  ...........  ...........  ...........
                                                             filtr.
K0584               A................  NI.................  Ost pch for bar w flange/    ...........  ...........  ...........  ...........  ...........
                                                             flt.

[[Page 66991]]

 
K0585               A................  NI.................  Ost pch clsd for bar w lk    ...........  ...........  ...........  ...........  ...........
                                                             fl.
K0586               A................  NI.................  Ost pch for bar w lk fl/     ...........  ...........  ...........  ...........  ...........
                                                             fltr.
K0587               A................  NI.................  Ost pch drain w bar &        ...........  ...........  ...........  ...........  ...........
                                                             filter.
K0588               A................  NI.................  Ost pch drain for barrier    ...........  ...........  ...........  ...........  ...........
                                                             fl.
K0589               A................  NI.................  Ost pch drain 2 piece        ...........  ...........  ...........  ...........  ...........
                                                             system.
K0590               A................  NI.................  Ost pch drain/barr lk flng/  ...........  ...........  ...........  ...........  ...........
                                                             f.
K0591               A................  NI.................  Urine ost pouch w faucet/    ...........  ...........  ...........  ...........  ...........
                                                             tap.
K0592               A................  NI.................  Urine ost pouch w bltinconv  ...........  ...........  ...........  ...........  ...........
K0593               A................  NI.................  Ost urine pch w b/bltin      ...........  ...........  ...........  ...........  ...........
                                                             conv.
K0594               A................  NI.................  Ost pch urine w barrier/     ...........  ...........  ...........  ...........  ...........
                                                             tapv.
K0595               A................  NI.................  Os pch urine w bar/fange/    ...........  ...........  ...........  ...........  ...........
                                                             tap.
K0596               A................  NI.................  Urine ost pch bar w lock     ...........  ...........  ...........  ...........  ...........
                                                             fln.
K0597               A................  NI.................  Ost pch urine w lock flng/   ...........  ...........  ...........  ...........  ...........
                                                             ft.
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................  DG.................  TLSO flex surgical support.  ...........  ...........  ...........  ...........  ...........
L0310               A................  DG.................  Tlso flexible custom         ...........  ...........  ...........  ...........  ...........
                                                             fabrica.
L0315               A................  DG.................  Tlso flex elas rigid post    ...........  ...........  ...........  ...........  ...........
                                                             pa.
L0317               A................  DG.................  Tlso flex hypext elas post   ...........  ...........  ...........  ...........  ...........
                                                             p.
L0320               A................  DG.................  Tlso a-p contrl w apron      ...........  ...........  ...........  ...........  ...........
                                                             frnt.
L0321               A................  DG.................  Tlso anti-post-cntrl prefab  ...........  ...........  ...........  ...........  ...........
L0330               A................  DG.................  Tlso ant-pos-lateral         ...........  ...........  ...........  ...........  ...........
                                                             control.
L0331               A................  DG.................  Tlso ant-post-lat cntrl      ...........  ...........  ...........  ...........  ...........
                                                             prfb.
L0340               A................  DG.................  Tlso a-p-l-rotary with       ...........  ...........  ...........  ...........  ...........
                                                             apron.
L0350               A................  DG.................  Tlso flex compress jacket    ...........  ...........  ...........  ...........  ...........
                                                             cu.
L0360               A................  DG.................  Tlso flex compress jacket    ...........  ...........  ...........  ...........  ...........
                                                             mo.
L0370               A................  DG.................  Tlso a-p-l-rotary            ...........  ...........  ...........  ...........  ...........
                                                             hyperexten.
L0380               A................  DG.................  Tlso a-p-l-rot w/ pos        ...........  ...........  ...........  ...........  ...........
                                                             extens.
L0390               A................  DG.................  Tlso a-p-l control molded..  ...........  ...........  ...........  ...........  ...........
L0391               A................  DG.................  Tlso ant-post-lat-rot cntrl  ...........  ...........  ...........  ...........  ...........
L0400               A................  DG.................  Tlso a-p-l w interface       ...........  ...........  ...........  ...........  ...........
                                                             mater.
L0410               A................  DG.................  Tlso a-p-l two piece constr  ...........  ...........  ...........  ...........  ...........
L0420               A................  DG.................  Tlso a-p-l 2 piece w         ...........  ...........  ...........  ...........  ...........
                                                             interfa.
L0430               A................  DG.................  Tlso a-p-l w interface       ...........  ...........  ...........  ...........  ...........
                                                             custm.
L0440               A................  DG.................  Tlso a-p-l overlap frnt      ...........  ...........  ...........  ...........  ...........
                                                             cust.
L0450               A................  NI.................  TLSO flex prefab thoracic..  ...........  ...........  ...........  ...........  ...........
L0452               A................  NI.................  tlso flex custom fab         ...........  ...........  ...........  ...........  ...........
                                                             thoraci.
L0454               A................  NI.................  TLSO flex prefab sacrococ-   ...........  ...........  ...........  ...........  ...........
                                                             T9.
L0456               A................  NI.................  TLSO flex prefab...........  ...........  ...........  ...........  ...........  ...........
L0458               A................  NI.................  TLSO 2Mod symphis-xipho pre  ...........  ...........  ...........  ...........  ...........
L0460               A................  NI.................  TLSO2Mod symphysis-stern     ...........  ...........  ...........  ...........  ...........
                                                             pre.
L0462               A................  NI.................  TLSO 3Mod sacro-scap pre...  ...........  ...........  ...........  ...........  ...........
L0464               A................  NI.................  TLSO 4Mod sacro-scap pre...  ...........  ...........  ...........  ...........  ...........
L0466               A................  NI.................  TLSO rigid frame pre soft    ...........  ...........  ...........  ...........  ...........
                                                             ap.
L0468               A................  NI.................  TLSO rigid frame prefab      ...........  ...........  ...........  ...........  ...........
                                                             pelv.
L0470               A................  NI.................  TLSO rigid frame pre         ...........  ...........  ...........  ...........  ...........
                                                             subclav.
L0472               A................  NI.................  TLSO rigid frame hyperex     ...........  ...........  ...........  ...........  ...........
                                                             pre.
L0474               A................  NI.................  TLSO rigid frame pre pelvic  ...........  ...........  ...........  ...........  ...........
L0476               A................  NI.................  TLSO flexion compres jac     ...........  ...........  ...........  ...........  ...........
                                                             pre.
L0478               A................  NI.................  TLSO flexion compres jac     ...........  ...........  ...........  ...........  ...........
                                                             cus.
L0480               A................  NI.................  TLSO rigid plastic custom    ...........  ...........  ...........  ...........  ...........
                                                             fa.
L0482               A................  NI.................  TLSO rigid lined custom fab  ...........  ...........  ...........  ...........  ...........

[[Page 66992]]

 
L0484               A................  NI.................  TLSO rigid plastic cust fab  ...........  ...........  ...........  ...........  ...........
L0486               A................  NI.................  TLSO rigidlined cust fab     ...........  ...........  ...........  ...........  ...........
                                                             two.
L0488               A................  NI.................  TLSO rigid lined pre one     ...........  ...........  ...........  ...........  ...........
                                                             pie.
L0490               A................  NI.................  TLSO rigid plastic pre one.  ...........  ...........  ...........  ...........  ...........
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................  DG.................  Torso/ptosis support.......  ...........  ...........  ...........  ...........  ...........
L0910               A................  DG.................  Torso & ptosis supp custm    ...........  ...........  ...........  ...........  ...........
                                                             fa.
L0920               A................  DG.................  Torso/pendulous abd support  ...........  ...........  ...........  ...........  ...........
L0930               A................  DG.................  Pendulous abdomen supp       ...........  ...........  ...........  ...........  ...........
                                                             custm.
L0940               A................  DG.................  Torso/postsurgical support.  ...........  ...........  ...........  ...........  ...........
L0950               A................  DG.................  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................  DG.................  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..  ...........  ...........  ...........  ...........  ...........

[[Page 66993]]

 
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  ...........  ...........  ...........  ...........  ...........
L1652               A................  NI.................  HO bi thighcuffs w sprdr     ...........  ...........  ...........  ...........  ...........
                                                             bar.
L1660               A................  ...................  HO abduction static plastic  ...........  ...........  ...........  ...........  ...........
L1680               A................  ...................  Pelvic & hip control thigh   ...........  ...........  ...........  ...........  ...........
                                                             c.
L1685               A................  ...................  Post-op hip abduct custom    ...........  ...........  ...........  ...........  ...........
                                                             fa.
L1686               A................  ...................  HO post-op hip abduction...  ...........  ...........  ...........  ...........  ...........
L1690               A................  ...................  Combination bilateral HO...  ...........  ...........  ...........  ...........  ...........
L1700               A................  ...................  Leg perthes orth toronto     ...........  ...........  ...........  ...........  ...........
                                                             typ.
L1710               A................  ...................  Legg perthes orth newington  ...........  ...........  ...........  ...........  ...........
L1720               A................  ...................  Legg perthes orthosis        ...........  ...........  ...........  ...........  ...........
                                                             trilat.
L1730               A................  ...................  Legg perthes orth scottish   ...........  ...........  ...........  ...........  ...........
                                                             r.
L1750               A................  ...................  Legg perthes sling.........  ...........  ...........  ...........  ...........  ...........
L1755               A................  ...................  Legg perthes patten bottom   ...........  ...........  ...........  ...........  ...........
                                                             t.
L1800               A................  ...................  Knee orthoses elas w stays.  ...........  ...........  ...........  ...........  ...........
L1810               A................  ...................  Ko elastic with joints.....  ...........  ...........  ...........  ...........  ...........
L1815               A................  ...................  Elastic with condylar pads.  ...........  ...........  ...........  ...........  ...........
L1820               A................  ...................  Ko elas w/ condyle pads &    ...........  ...........  ...........  ...........  ...........
                                                             jo.
L1825               A................  ...................  Ko elastic knee cap........  ...........  ...........  ...........  ...........  ...........
L1830               A................  ...................  Ko immobilizer canvas        ...........  ...........  ...........  ...........  ...........
                                                             longit.
L1832               A................  ...................  KO adj jnt pos rigid         ...........  ...........  ...........  ...........  ...........
                                                             support.
L1834               A................  ...................  Ko w/0 joint rigid molded    ...........  ...........  ...........  ...........  ...........
                                                             to.
L1836               A................  NI.................  Rigid KO wo joints.........  ...........  ...........  ...........  ...........  ...........
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.
L1901               A................  NI.................  Prefab ankle orthosis......  ...........  ...........  ...........  ...........  ...........
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/ ...........  ...........  ...........  ...........  ...........
                                                             .

[[Page 66994]]

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

[[Page 66995]]

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

[[Page 66996]]

 
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................  DG.................  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................  DG.................  Mens surgical boot each....  ...........  ...........  ...........  ...........  ...........
L3224               A................  ...................  Woman's shoe oxford brace..  ...........  ...........  ...........  ...........  ...........
L3225               A................  ...................  Man's shoe oxford brace....  ...........  ...........  ...........  ...........  ...........
L3230               .................  ...................  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.
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.

[[Page 66997]]

 
L3650               A................  ...................  Shlder fig 8 abduct          ...........  ...........  ...........  ...........  ...........
                                                             restrain.
L3651               A................  NI.................  Prefab shoulder orthosis...  ...........  ...........  ...........  ...........  ...........
L3652               A................  NI.................  Prefab dbl shoulder          ...........  ...........  ...........  ...........  ...........
                                                             orthosis.
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  ...........  ...........  ...........  ...........  ...........
L3701               A................  NI.................  Prefab elbow orthosis......  ...........  ...........  ...........  ...........  ...........
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  ...........  ...........  ...........  ...........  ...........
L3762               A................  NI.................  Rigid EO wo joints.........  ...........  ...........  ...........  ...........  ...........
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...  ...........  ...........  ...........  ...........  ...........
L3909               A................  NI.................  Prefab wrist orthosis......  ...........  ...........  ...........  ...........  ...........
L3910               A................  ...................  Whfo swanson design........  ...........  ...........  ...........  ...........  ...........
L3911               A................  NI.................  Prefab hand finger orthosis  ...........  ...........  ...........  ...........  ...........
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.

[[Page 66998]]

 
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......  ...........  ...........  ...........  ...........  ...........
L4386               A................  NI.................  Non-pneumatic walking        ...........  ...........  ...........  ...........  ...........
                                                             splint.
L4392               A................  ...................  Replace AFO soft interface.  ...........  ...........  ...........  ...........  ...........
L4394               A................  ...................  Replace foot drop spint....  ...........  ...........  ...........  ...........  ...........
L4396               A................  ...................  Static AFO.................  ...........  ...........  ...........  ...........  ...........
L4398               A................  ...................  Foot drop splint recumbent.  ...........  ...........  ...........  ...........  ...........
L5000               A................  ...................  Sho insert w arch toe        ...........  ...........  ...........  ...........  ...........
                                                             filler.
L5010               A................  ...................  Mold socket ank hgt w/ toe   ...........  ...........  ...........  ...........  ...........
                                                             f.
L5020               A................  ...................  Tibial tubercle hgt w/ toe   ...........  ...........  ...........  ...........  ...........
                                                             f.
L5050               A................  ...................  Ank symes mold sckt sach ft  ...........  ...........  ...........  ...........  ...........
L5060               A................  ...................  Symes met fr leath socket    ...........  ...........  ...........  ...........  ...........
                                                             ar.
L5100               A................  ...................  Molded socket shin sach      ...........  ...........  ...........  ...........  ...........
                                                             foot.
L5105               A................  ...................  Plast socket jts/thgh lacer  ...........  ...........  ...........  ...........  ...........
L5150               A................  ...................  Mold sckt ext knee shin      ...........  ...........  ...........  ...........  ...........
                                                             sach.
L5160               A................  ...................  Mold socket bent knee shin   ...........  ...........  ...........  ...........  ...........
                                                             s.
L5200               A................  ...................  Kne sing axis fric shin      ...........  ...........  ...........  ...........  ...........
                                                             sach.
L5210               A................  ...................  No knee/ankle joints w/ ft   ...........  ...........  ...........  ...........  ...........
                                                             b.
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.

[[Page 66999]]

 
L5410               A................  ...................  Postop dsg bk ea add cast    ...........  ...........  ...........  ...........  ...........
                                                             ch.
L5420               A................  ...................  Postop dsg & 1 cast chg ak/  ...........  ...........  ...........  ...........  ...........
                                                             d.
L5430               A................  ...................  Postop dsg ak ea add cast    ...........  ...........  ...........  ...........  ...........
                                                             ch.
L5450               A................  ...................  Postop app non-wgt bear dsg  ...........  ...........  ...........  ...........  ...........
L5460               A................  ...................  Postop app non-wgt bear dsg  ...........  ...........  ...........  ...........  ...........
L5500               A................  ...................  Init bk ptb plaster direct.  ...........  ...........  ...........  ...........  ...........
L5505               A................  ...................  Init ak ischal plstr direct  ...........  ...........  ...........  ...........  ...........
L5510               A................  ...................  Prep BK ptb plaster molded.  ...........  ...........  ...........  ...........  ...........
L5520               A................  ...................  Perp BK ptb thermopls        ...........  ...........  ...........  ...........  ...........
                                                             direct.
L5530               A................  ...................  Prep BK ptb thermopls        ...........  ...........  ...........  ...........  ...........
                                                             molded.
L5535               A................  ...................  Prep BK ptb open end socket  ...........  ...........  ...........  ...........  ...........
L5540               A................  ...................  Prep BK ptb laminated        ...........  ...........  ...........  ...........  ...........
                                                             socket.
L5560               A................  ...................  Prep AK ischial plast        ...........  ...........  ...........  ...........  ...........
                                                             molded.
L5570               A................  ...................  Prep AK ischial direct form  ...........  ...........  ...........  ...........  ...........
L5580               A................  ...................  Prep AK ischial thermo mold  ...........  ...........  ...........  ...........  ...........
L5585               A................  ...................  Prep AK ischial open end...  ...........  ...........  ...........  ...........  ...........
L5590               A................  ...................  Prep AK ischial laminated..  ...........  ...........  ...........  ...........  ...........
L5595               A................  ...................  Hip disartic sach thermopls  ...........  ...........  ...........  ...........  ...........
L5600               A................  ...................  Hip disart sach laminat      ...........  ...........  ...........  ...........  ...........
                                                             mold.
L5610               A................  ...................  Above knee hydracadence....  ...........  ...........  ...........  ...........  ...........
L5611               A................  ...................  Ak 4 bar link w/fric swing.  ...........  ...........  ...........  ...........  ...........
L5613               A................  ...................  Ak 4 bar ling w/hydraul      ...........  ...........  ...........  ...........  ...........
                                                             swig.
L5614               A................  ...................  4-bar link above knee w/     ...........  ...........  ...........  ...........  ...........
                                                             swng.
L5616               A................  ...................  Ak univ multiplex sys frict  ...........  ...........  ...........  ...........  ...........
L5617               A................  ...................  AK/BK self-aligning unit ea  ...........  ...........  ...........  ...........  ...........
L5618               A................  ...................  Test socket symes..........  ...........  ...........  ...........  ...........  ...........
L5620               A................  ...................  Test socket below knee.....  ...........  ...........  ...........  ...........  ...........
L5622               A................  ...................  Test socket knee             ...........  ...........  ...........  ...........  ...........
                                                             disarticula.
L5624               A................  ...................  Test socket above knee.....  ...........  ...........  ...........  ...........  ...........
L5626               A................  ...................  Test socket hip              ...........  ...........  ...........  ...........  ...........
                                                             disarticulat.
L5628               A................  ...................  Test socket hemipelvectomy.  ...........  ...........  ...........  ...........  ...........
L5629               A................  ...................  Below knee acrylic socket..  ...........  ...........  ...........  ...........  ...........
L5630               A................  ...................  Syme typ expandabl wall      ...........  ...........  ...........  ...........  ...........
                                                             sckt.
L5631               A................  ...................  Ak/knee disartic acrylic     ...........  ...........  ...........  ...........  ...........
                                                             soc.
L5632               A................  ...................  Symes type ptb brim design   ...........  ...........  ...........  ...........  ...........
                                                             s.
L5634               A................  ...................  Symes type poster opening    ...........  ...........  ...........  ...........  ...........
                                                             so.
L5636               A................  ...................  Symes type medial opening    ...........  ...........  ...........  ...........  ...........
                                                             so.
L5637               A................  ...................  Below knee total contact...  ...........  ...........  ...........  ...........  ...........
L5638               A................  ...................  Below knee leather socket..  ...........  ...........  ...........  ...........  ...........
L5639               A................  ...................  Below knee wood socket.....  ...........  ...........  ...........  ...........  ...........
L5640               A................  ...................  Knee disarticulat leather    ...........  ...........  ...........  ...........  ...........
                                                             so.
L5642               A................  ...................  Above knee leather socket..  ...........  ...........  ...........  ...........  ...........
L5643               A................  ...................  Hip flex inner socket ext    ...........  ...........  ...........  ...........  ...........
                                                             fr.
L5644               A................  ...................  Above knee wood socket.....  ...........  ...........  ...........  ...........  ...........
L5645               A................  ...................  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................  DG.................  Sock insrt syme silicone     ...........  ...........  ...........  ...........  ...........
                                                             gel.
L5661               A................  ...................  Multi-durometer symes......  ...........  ...........  ...........  ...........  ...........
L5662               A................  DG.................  Socket insert bk silicone    ...........  ...........  ...........  ...........  ...........
                                                             ge.
L5663               A................  DG.................  Sock knee disartic silicone  ...........  ...........  ...........  ...........  ...........
L5664               A................  DG.................  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.

[[Page 67000]]

 
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  ...........  ...........  ...........  ...........  ...........
L5781               A................  NI.................  Lower limb pros vacuum pump  ...........  ...........  ...........  ...........  ...........
L5782               A................  NI.................  HD low limb pros vacuum      ...........  ...........  ...........  ...........  ...........
                                                             pump.
L5785               A................  ...................  Exoskeletal bk ultralt       ...........  ...........  ...........  ...........  ...........
                                                             mater.
L5790               A................  ...................  Exoskeletal ak ultra-light   ...........  ...........  ...........  ...........  ...........
                                                             m.
L5795               A................  ...................  Exoskel hip ultra-light      ...........  ...........  ...........  ...........  ...........
                                                             mate.
L5810               A................  ...................  Endoskel knee-shin mnl lock  ...........  ...........  ...........  ...........  ...........
L5811               A................  ...................  Endo knee-shin mnl lck       ...........  ...........  ...........  ...........  ...........
                                                             ultra.
L5812               A................  ...................  Endo knee-shin frct swg &    ...........  ...........  ...........  ...........  ...........
                                                             st.
L5814               A................  ...................  Endo knee-shin hydral swg    ...........  ...........  ...........  ...........  ...........
                                                             ph.
L5816               A................  ...................  Endo knee-shin polyc mch     ...........  ...........  ...........  ...........  ...........
                                                             sta.
L5818               A................  ...................  Endo knee-shin frct swg &    ...........  ...........  ...........  ...........  ...........
                                                             st.
L5822               A................  ...................  Endo knee-shin pneum swg     ...........  ...........  ...........  ...........  ...........
                                                             frc.
L5824               A................  ...................  Endo knee-shin fluid swing   ...........  ...........  ...........  ...........  ...........
                                                             p.
L5826               A................  ...................  Miniature knee joint.......  ...........  ...........  ...........  ...........  ...........
L5828               A................  ...................  Endo knee-shin fluid swg/    ...........  ...........  ...........  ...........  ...........
                                                             sta.
L5830               A................  ...................  Endo knee-shin pneum/swg     ...........  ...........  ...........  ...........  ...........
                                                             pha.
L5840               A................  ...................  Multi-axial knee/shin        ...........  ...........  ...........  ...........  ...........
                                                             system.
L5845               A................  ...................  Knee-shin sys stance         ...........  ...........  ...........  ...........  ...........
                                                             flexion.
L5846               A................  ...................  Knee-shin sys                ...........  ...........  ...........  ...........  ...........
                                                             microprocessor.
L5847               A................  ...................  Microprocessor cntrl         ...........  ...........  ...........  ...........  ...........
                                                             feature.
L5848               A................  NI.................  Knee-shin sys hydraul        ...........  ...........  ...........  ...........  ...........
                                                             stance.
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.....  ...........  ...........  ...........  ...........  ...........

[[Page 67001]]

 
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  ...........  ...........  ...........  ...........  ...........
L5995               A................  NI.................  Lower ext pros heavyduty     ...........  ...........  ...........  ...........  ...........
                                                             fea.
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.
L6025               A................  NI.................  Part hand disart             ...........  ...........  ...........  ...........  ...........
                                                             myoelectric.
L6050               A................  ...................  Wrst MLd sck flx hng tri     ...........  ...........  ...........  ...........  ...........
                                                             pad.
L6055               A................  ...................  Wrst mold sock w/exp         ...........  ...........  ...........  ...........  ...........
                                                             interfa.
L6100               A................  ...................  Elb mold sock flex hinge     ...........  ...........  ...........  ...........  ...........
                                                             pad.
L6110               A................  ...................  Elbow mold sock suspension   ...........  ...........  ...........  ...........  ...........
                                                             t.
L6120               A................  ...................  Elbow mold doub splt soc     ...........  ...........  ...........  ...........  ...........
                                                             ste.
L6130               A................  ...................  Elbow stump activated lock   ...........  ...........  ...........  ...........  ...........
                                                             h.
L6200               A................  ...................  Elbow mold outsid lock       ...........  ...........  ...........  ...........  ...........
                                                             hinge.
L6205               A................  ...................  Elbow molded w/ expand       ...........  ...........  ...........  ...........  ...........
                                                             inter.
L6250               A................  ...................  Elbow inter loc elbow        ...........  ...........  ...........  ...........  ...........
                                                             forarm.
L6300               A................  ...................  Shlder disart int lock       ...........  ...........  ...........  ...........  ...........
                                                             elbow.
L6310               A................  ...................  Shoulder passive restor      ...........  ...........  ...........  ...........  ...........
                                                             comp.
L6320               A................  ...................  Shoulder passive restor cap  ...........  ...........  ...........  ...........  ...........
L6350               A................  ...................  Thoracic intern lock elbow.  ...........  ...........  ...........  ...........  ...........
L6360               A................  ...................  Thoracic passive restor      ...........  ...........  ...........  ...........  ...........
                                                             comp.
L6370               A................  ...................  Thoracic passive restor cap  ...........  ...........  ...........  ...........  ...........
L6380               A................  ...................  Postop dsg cast chg wrst/    ...........  ...........  ...........  ...........  ...........
                                                             elb.
L6382               A................  ...................  Postop dsg cast chg elb dis/ ...........  ...........  ...........  ...........  ...........
                                                             .
L6384               A................  ...................  Postop dsg cast chg shlder/  ...........  ...........  ...........  ...........  ...........
                                                             t.
L6386               A................  ...................  Postop ea cast chg &         ...........  ...........  ...........  ...........  ...........
                                                             realign.
L6388               A................  ...................  Postop applicat rigid dsg    ...........  ...........  ...........  ...........  ...........
                                                             on.
L6400               A................  ...................  Below elbow prosth tiss      ...........  ...........  ...........  ...........  ...........
                                                             shap.
L6450               A................  ...................  Elb disart prosth tiss shap  ...........  ...........  ...........  ...........  ...........
L6500               A................  ...................  Above elbow prosth tiss      ...........  ...........  ...........  ...........  ...........
                                                             shap.
L6550               A................  ...................  Shldr disar prosth tiss      ...........  ...........  ...........  ...........  ...........
                                                             shap.
L6570               A................  ...................  Scap thorac prosth tiss      ...........  ...........  ...........  ...........  ...........
                                                             shap.
L6580               A................  ...................  Wrist/elbow bowden cable     ...........  ...........  ...........  ...........  ...........
                                                             mol.
L6582               A................  ...................  Wrist/elbow bowden cbl dir   ...........  ...........  ...........  ...........  ...........
                                                             f.
L6584               A................  ...................  Elbow fair lead cable        ...........  ...........  ...........  ...........  ...........
                                                             molded.
L6586               A................  ...................  Elbow fair lead cable dir    ...........  ...........  ...........  ...........  ...........
                                                             fo.
L6588               A................  ...................  Shdr fair lead cable molded  ...........  ...........  ...........  ...........  ...........
L6590               A................  ...................  Shdr fair lead cable direct  ...........  ...........  ...........  ...........  ...........
L6600               A................  ...................  Polycentric hinge pair.....  ...........  ...........  ...........  ...........  ...........
L6605               A................  ...................  Single pivot hinge pair....  ...........  ...........  ...........  ...........  ...........
L6610               A................  ...................  Flexible metal hinge pair..  ...........  ...........  ...........  ...........  ...........

[[Page 67002]]

 
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...  ...........  ...........  ...........  ...........  ...........
L6638               A................  NI.................  Elec lock on manual pw       ...........  ...........  ...........  ...........  ...........
                                                             elbow.
L6640               A................  ...................  Shoulder abduction joint     ...........  ...........  ...........  ...........  ...........
                                                             pai.
L6641               A................  ...................  Excursion amplifier pulley   ...........  ...........  ...........  ...........  ...........
                                                             t.
L6642               A................  ...................  Excursion amplifier lever    ...........  ...........  ...........  ...........  ...........
                                                             ty.
L6645               A................  ...................  Shoulder flexion-abduction   ...........  ...........  ...........  ...........  ...........
                                                             j.
L6646               A................  NI.................  Multipo locking shoulder     ...........  ...........  ...........  ...........  ...........
                                                             jnt.
L6647               A................  NI.................  Shoulder lock actuator.....  ...........  ...........  ...........  ...........  ...........
L6648               A................  NI.................  Ext pwrd shlder lock/unlock  ...........  ...........  ...........  ...........  ...........
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 model555.
L6780               A................  ...................  Terminal device model        ...........  ...........  ...........  ...........  ...........
                                                             ss555.
L6790               A................  ...................  Hooks-accu hook or equal...  ...........  ...........  ...........  ...........  ...........
L6795               A................  ...................  Hooks-2 load or equal......  ...........  ...........  ...........  ...........  ...........
L6800               A................  ...................  Hooks-aprl vc or equal.....  ...........  ...........  ...........  ...........  ...........
L6805               A................  ...................  Modifier wrist flexion unit  ...........  ...........  ...........  ...........  ...........
L6806               A................  ...................  Trs grip vc or equal.......  ...........  ...........  ...........  ...........  ...........
L6807               A................  ...................  Term device 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...............  ...........  ...........  ...........  ...........  ...........

[[Page 67003]]

 
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.
L7366               A................  ...................  Battery chrgr 12 volt utah/  ...........  ...........  ...........  ...........  ...........
                                                             e.
L7367               A................  NI.................  Replacemnt lithium           ...........  ...........  ...........  ...........  ...........
                                                             ionbatter.
L7368               A................  NI.................  Lithium ion battery charger  ...........  ...........  ...........  ...........  ...........
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.............  ...........  ...........  ...........  ...........  ...........

[[Page 67004]]

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

[[Page 67005]]

 
L8614               E................  ...................  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       1.1434       $59.63        $9.97       $11.93
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       1.6860       $87.93  ...........       $17.59
P9011               E................  ...................  Blood split unit...........  ...........  ...........  ...........  ...........  ...........
P9012               K................  ...................  Cryoprecipitate each unit..         0952       0.5620       $29.31  ...........        $5.86
P9016               K................  ...................  RBC leukocytes reduced.....         0954       2.2868      $119.26  ...........       $23.85
P9017               K................  ...................  One donor fresh frozn               0955       1.8217       $95.00  ...........       $19.00
                                                             plasma.
P9019               K................  ...................  Platelets, each unit.......         0957       0.7946       $41.44  ...........        $8.29
P9020               K................  ...................  Plaelet rich plasma unit...         0958       1.0271       $53.56  ...........       $10.71
P9021               K................  ...................  Red blood cells unit.......         0959       1.6569       $86.41  ...........       $17.28
P9022               K................  ...................  Washed red blood cells unit         0960       3.0813      $160.69  ...........       $32.14
P9023               K................  ...................  Frozen plasma, pooled, sd..         0949       2.3837      $124.31  ...........       $24.86
P9031               K................  ...................  Platelets leukocytes                1013       0.9496       $49.52  ...........        $9.90
                                                             reduced.
P9032               K................  ...................  Platelets, irradiated......         9500       1.4341       $74.79  ...........       $14.96
P9033               K................  ...................  Platelets leukoreduced              0954       2.2868      $119.26  ...........       $23.85
                                                             irrad.
P9034               K................  ...................  Platelets, pheresis........         9501       7.8390      $408.81  ...........       $81.76
P9035               K................  ...................  Platelet pheres                     9501       7.8390      $408.81  ...........       $81.76
                                                             leukoreduced.
P9036               K................  ...................  Platelet pheresis                   9502       8.5076      $443.68  ...........       $88.74
                                                             irradiated.
P9037               K................  ...................  Plate pheres leukoredu              1019       7.7905      $406.28  ...........       $81.26
                                                             irrad.
P9038               K................  ...................  RBC irradiated.............         9505       2.0833      $108.65  ...........       $21.73
P9039               K................  ...................  RBC deglycerolized.........         9504       3.5174      $183.44  ...........       $36.69
P9040               K................  ...................  RBC leukoreduced irradiated         9504       3.5174      $183.44  ...........       $36.69
P9041               K................  ...................  Albumin (human),5%, 50ml...         0961       0.9980       $52.05  ...........       $10.41
P9043               K................  ...................  Plasma protein                      0956       1.7829       $92.98  ...........       $18.60
                                                             fract,5%,50ml.
P9044               K................  ...................  Cryoprecipitatereducedplasm         1009       0.7170       $37.39  ...........        $7.48
                                                             a.
P9045               K................  ...................  Albumin (human), 5%, 250 ml         0963       4.9708      $259.23  ...........       $51.85
P9046               K................  ...................  Albumin (human), 25%, 20 ml         0964       1.0756       $56.09  ...........       $11.22
P9047               K................  ...................  Albumin (human), 25%, 50ml.         0965       2.6840      $139.97  ...........       $27.99
P9048               K................  ...................  Plasmaprotein                       0966       8.9145      $464.90  ...........       $92.98
                                                             fract,5%,250ml.
P9050               K................  ...................  Granulocytes, pheresis unit         9506      23.9432    $1,248.66  ...........      $249.73
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       1.6085       $83.88       $41.44       $16.78
Q0081               T................  ...................  Infusion ther other than            0120       2.1802      $113.70       $30.75       $22.74
                                                             che.
Q0083               S................  ...................  Chemo by other than                 0116       0.7752       $40.43  ...........        $8.09
                                                             infusion.
Q0084               S................  ...................  Chemotherapy by infusion...         0117       3.6046      $187.98       $48.28       $37.60
Q0085               S................  ...................  Chemo by both infusion and          0118       5.4844      $286.02       $72.03       $57.20
                                                             o.
Q0086               A................  ...................  Physical therapy evaluation/ ...........  ...........  ...........  ...........  ...........
                                                             .
Q0091               T................  ...................  Obtaining screen pap smear.         0191       0.2035       $10.61        $3.08        $2.12
Q0092               N................  ...................  Set up port xray equipment.  ...........  ...........  ...........  ...........  ...........
Q0111               A................  ...................  Wet mounts/ w preparations.  ...........  ...........  ...........  ...........  ...........
Q0112               A................  ...................  Potassium hydroxide preps..  ...........  ...........  ...........  ...........  ...........

[[Page 67006]]

 
Q0113               A................  ...................  Pinworm examinations.......  ...........  ...........  ...........  ...........  ...........
Q0114               A................  ...................  Fern test..................  ...........  ...........  ...........  ...........  ...........
Q0115               A................  ...................  Post-coital mucous exam....  ...........  ...........  ...........  ...........  ...........
Q0136               K................  ...................  Non esrd epoetin alpha inj.         0733       0.1744        $9.10  ...........        $1.82
Q0144               E................  ...................  Azithromycin dihydrate,      ...........  ...........  ...........  ...........  ...........
                                                             oral.
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      20.7844    $1,083.93  ...........      $216.79
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       2.2965      $119.76  ...........       $23.95
                                                             triflutat.
Q2006               K................  ...................  Digoxin immune fab (ovine).         7025       4.9805      $259.74  ...........       $51.95
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       0.0097         $.51  ...........         $.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       1.9573      $102.08  ...........       $20.42
Q2018               N................  ...................  Urofollitropin, 75 iu......  ...........  ...........  ...........  ...........  ...........
Q2019               K................  ...................  Basiliximab................         1615      13.3621      $696.85  ...........      $139.37
Q2020               E................  ...................  Histrelin acetate..........  ...........  ...........  ...........  ...........  ...........
Q2021               N................  ...................  Lepirudin..................  ...........  ...........  ...........  ...........  ...........
Q2022               K................  ...................  VonWillebrandFactrCmplxperI         1618       0.0194        $1.01  ...........         $.20
                                                             U.
Q3001               N................  ...................  Brachytherapy Radioelements  ...........  ...........  ...........  ...........  ...........
Q3002               N................  ...................  Gallium ga 67..............  ...........  ...........  ...........  ...........  ...........
Q3003               K................  ...................  Technetium tc99m bicisate..         1620       3.8759      $202.13  ...........       $40.43
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       8.2169      $428.52  ...........       $85.70
Q3009               N................  ...................  Technetium tc99m oxidronate  ...........  ...........  ...........  ...........  ...........
Q3010               N................  ...................  Technetium tc99mlabeledrbcs  ...........  ...........  ...........  ...........  ...........
Q3011               K................  ...................  Chromic phosphate p32......         1628       1.5891       $82.87  ...........       $16.57
Q3012               N................  ...................  Cyanocobalamin cobalt co57.  ...........  ...........  ...........  ...........  ...........
Q3014               A................  ...................  Telehealth facility fee....  ...........  ...........  ...........  ...........  ...........

[[Page 67007]]

 
Q3017               E................  DG.................  ALS assessment.............  ...........  ...........  ...........  ...........  ...........
Q3019               A................  ...................  ALS emer trans no ALS serv.  ...........  ...........  ...........  ...........  ...........
Q3020               A................  ...................  ALS nonemer trans no ALS se  ...........  ...........  ...........  ...........  ...........
Q3021               K................  NI.................  Ped hepatitis b vaccine inj         0355       0.2132       $11.12  ...........        $2.22
Q3022               K................  NI.................  Hepatitis b vaccine adult           0356       0.7655       $39.92  ...........        $7.98
                                                             ds.
Q3023               K................  NI.................  Injection hepatitis                 0356       0.7655       $39.92  ...........        $7.98
                                                             Bvaccine.
Q3025               K................  NI.................  IM inj interferon beta 1-a.         9022       0.9302       $48.51  ...........        $9.70
Q3026               N................  NI.................  Subc inj interferon beta-1a  ...........  ...........  ...........  ...........  ...........
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......  ...........  ...........  ...........  ...........  ...........

[[Page 67008]]

 
Q9926               A................  ...................  Epoetin with hct = 26......  ...........  ...........  ...........  ...........  ...........
Q9927               A................  ...................  Epoetin with hct = 27......  ...........  ...........  ...........  ...........  ...........
Q9928               A................  ...................  Epoetin with hct = 28......  ...........  ...........  ...........  ...........  ...........
Q9929               A................  ...................  Epoetin with hct = 29......  ...........  ...........  ...........  ...........  ...........
Q9930               A................  ...................  Epoetin with hct = 30......  ...........  ...........  ...........  ...........  ...........
Q9931               A................  ...................  Epoetin with hct = 31......  ...........  ...........  ...........  ...........  ...........
Q9932               A................  ...................  Epoetin with hct = 32......  ...........  ...........  ...........  ...........  ...........
Q9933               A................  ...................  Epoetin with hct = 33......  ...........  ...........  ...........  ...........  ...........
Q9934               A................  ...................  Epoetin with hct = 34......  ...........  ...........  ...........  ...........  ...........
Q9935               A................  ...................  Epoetin with hct = 35......  ...........  ...........  ...........  ...........  ...........
Q9936               A................  ...................  Epoetin with hct = 36......  ...........  ...........  ...........  ...........  ...........
Q9937               A................  ...................  Epoetin with hct = 37......  ...........  ...........  ...........  ...........  ...........
Q9938               A................  ...................  Epoetin with hct = 38......  ...........  ...........  ...........  ...........  ...........
Q9939               A................  ...................  Epoetin with hct = 39......  ...........  ...........  ...........  ...........  ...........
Q9940               A................  ...................  Epoetin with hct = 40.
R0070               N................  ...................  Transport portable x-ray...  ...........  ...........  ...........  ...........  ...........
R0075               N................  ...................  Transport port x-ray         ...........  ...........  ...........  ...........  ...........
                                                             multipl.
R0076               N................  ...................  Transport portable EKG.....  ...........  ...........  ...........  ...........  ...........
T1015               E................  ...................  Clinic service.............  ...........  ...........  ...........  ...........  ...........
T1016               E................  NI.................  Case management............  ...........  ...........  ...........  ...........  ...........
T1017               E................  NI.................  Targeted case management...  ...........  ...........  ...........  ...........  ...........
T1018               E................  NI.................  School-based IEP ser         ...........  ...........  ...........  ...........  ...........
                                                             bundled.
T1019               E................  NI.................  Personal care ser per 15     ...........  ...........  ...........  ...........  ...........
                                                             min.
T1020               E................  NI.................  Personal care ser per diem.  ...........  ...........  ...........  ...........  ...........
T1021               E................  NI.................  HH Aide or cn aide per       ...........  ...........  ...........  ...........  ...........
                                                             visit.
T1022               E................  NI.................  Contracted services per day  ...........  ...........  ...........  ...........  ...........
T1023               E................  NI.................  Program intake assessment..  ...........  ...........  ...........  ...........  ...........
T1024               E................  NI.................  Team evaluation &            ...........  ...........  ...........  ...........  ...........
                                                             management.
T1025               E................  NI.................  Ped compr care pkg, per      ...........  ...........  ...........  ...........  ...........
                                                             diem.
T1026               E................  NI.................  Ped compr care pkg, per      ...........  ...........  ...........  ...........  ...........
                                                             hour.
T1027               E................  NI.................  Family training &            ...........  ...........  ...........  ...........  ...........
                                                             counseling.
T1028               E................  NI.................  Home environment assessment  ...........  ...........  ...........  ...........  ...........
T1029               E................  NI.................  Dwelling lead investigation  ...........  ...........  ...........  ...........  ...........
T1030               E................  NI.................  RN home care per diem......  ...........  ...........  ...........  ...........  ...........
T1031               E................  NI.................  LPN home care per diem.....  ...........  ...........  ...........  ...........  ...........
T1500               E................  NI.................  Reusable diaper/pant.......  ...........  ...........  ...........  ...........  ...........
T1502               E................  NI.................  Medication admin visit.....  ...........  ...........  ...........  ...........  ...........
T1999               E................  NI.................  NOC retail items             ...........  ...........  ...........  ...........  ...........
                                                             andsupplies.
T2001               E................  NI.................  N-et; patient attend/escort  ...........  ...........  ...........  ...........  ...........
T2002               E................  NI.................  N-et; per diem.............  ...........  ...........  ...........  ...........  ...........
T2003               E................  NI.................  N-et; encounter/trip.......  ...........  ...........  ...........  ...........  ...........
T2004               E................  NI.................  N-et; commerc carrier pass.  ...........  ...........  ...........  ...........  ...........
T2005               E................  NI.................  N-et; stretcher van........  ...........  ...........  ...........  ...........  ...........
T2006               E................  NI.................  Amb response & trt, no       ...........  ...........  ...........  ...........  ...........
                                                             trans.
T2007               E................  NI.................  Non-emer transport wait      ...........  ...........  ...........  ...........  ...........
                                                             time.
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......  ...........  ...........  ...........  ...........  ...........

[[Page 67009]]

 
V2118               A................  ...................  Lens aniseikonic single....  ...........  ...........  ...........  ...........  ...........
V2199               A................  ...................  Lens single vision not oth   ...........  ...........  ...........  ...........  ...........
                                                             c.
V2200               A................  ...................  Lens spher bifoc plano       ...........  ...........  ...........  ...........  ...........
                                                             4.00d.
V2201               A................  ...................  Lens sphere bifocal 4.12-    ...........  ...........  ...........  ...........  ...........
                                                             7.0.
V2202               A................  ...................  Lens sphere bifocal 7.12-    ...........  ...........  ...........  ...........  ...........
                                                             20..
V2203               A................  ...................  Lens sphcyl bifocal 4.00d/   ...........  ...........  ...........  ...........  ...........
                                                             .1.
V2204               A................  ...................  Lens sphcy bifocal 4.00d/    ...........  ...........  ...........  ...........  ...........
                                                             2.1.
V2205               A................  ...................  Lens sphcy bifocal 4.00d/    ...........  ...........  ...........  ...........  ...........
                                                             4.2.
V2206               A................  ...................  Lens sphcy bifocal 4.00d/    ...........  ...........  ...........  ...........  ...........
                                                             ove.
V2207               A................  ...................  Lens sphcy bifocal 4.25-7d/  ...........  ...........  ...........  ...........  ...........
                                                             ..
V2208               A................  ...................  Lens sphcy bifocal 4.25-7/   ...........  ...........  ...........  ...........  ...........
                                                             2..
V2209               A................  ...................  Lens sphcy bifocal 4.25-7/   ...........  ...........  ...........  ...........  ...........
                                                             4..
V2210               A................  ...................  Lens sphcy bifocal 4.25-7/   ...........  ...........  ...........  ...........  ...........
                                                             ov.
V2211               A................  ...................  Lens sphcy bifo 7.25-12/.25- ...........  ...........  ...........  ...........  ...........
                                                             .
V2212               A................  ...................  Lens sphcyl bifo 7.25-12/    ...........  ...........  ...........  ...........  ...........
                                                             2.2.
V2213               A................  ...................  Lens sphcyl bifo 7.25-12/    ...........  ...........  ...........  ...........  ...........
                                                             4.2.
V2214               A................  ...................  Lens sphcyl bifocal over     ...........  ...........  ...........  ...........  ...........
                                                             12..
V2215               A................  ...................  Lens lenticular bifocal....  ...........  ...........  ...........  ...........  ...........
V2216               A................  ...................  Lens lenticular nonaspheric  ...........  ...........  ...........  ...........  ...........
V2217               A................  ...................  Lens lenticular aspheric     ...........  ...........  ...........  ...........  ...........
                                                             bif.
V2218               A................  ...................  Lens aniseikonic bifocal...  ...........  ...........  ...........  ...........  ...........
V2219               A................  ...................  Lens bifocal seg width over  ...........  ...........  ...........  ...........  ...........
V2220               A................  ...................  Lens bifocal add over 3.25d  ...........  ...........  ...........  ...........  ...........
V2299               A................  ...................  Lens bifocal speciality....  ...........  ...........  ...........  ...........  ...........
V2300               A................  ...................  Lens sphere trifocal 4.00d.  ...........  ...........  ...........  ...........  ...........
V2301               A................  ...................  Lens sphere trifocal 4.12-   ...........  ...........  ...........  ...........  ...........
                                                             7..
V2302               A................  ...................  Lens sphere trifocal 7.12-   ...........  ...........  ...........  ...........  ...........
                                                             20.
V2303               A................  ...................  Lens sphcy trifocal 4.0/.12- ...........  ...........  ...........  ...........  ...........
                                                             .
V2304               A................  ...................  Lens sphcy trifocal 4.0/     ...........  ...........  ...........  ...........  ...........
                                                             2.25.
V2305               A................  ...................  Lens sphcy trifocal 4.0/     ...........  ...........  ...........  ...........  ...........
                                                             4.25.
V2306               A................  ...................  Lens sphcyl trifocal 4.00/   ...........  ...........  ...........  ...........  ...........
                                                             6.
V2307               A................  ...................  Lens sphcy trifocal 4.25-7/  ...........  ...........  ...........  ...........  ...........
                                                             ..
V2308               A................  ...................  Lens sphc trifocal 4.25-7/   ...........  ...........  ...........  ...........  ...........
                                                             2..
V2309               A................  ...................  Lens sphc trifocal 4.25-7/   ...........  ...........  ...........  ...........  ...........
                                                             4..
V2310               A................  ...................  Lens sphc trifocal 4.25-7/   ...........  ...........  ...........  ...........  ...........
                                                             6.
V2311               A................  ...................  Lens sphc trifo 7.25-12/.25- ...........  ...........  ...........  ...........  ...........
                                                             .
V2312               A................  ...................  Lens sphc trifo 7.25-12/     ...........  ...........  ...........  ...........  ...........
                                                             2.25.
V2313               A................  ...................  Lens sphc trifo 7.25-12/     ...........  ...........  ...........  ...........  ...........
                                                             4.25.
V2314               A................  ...................  Lens sphcyl trifocal over    ...........  ...........  ...........  ...........  ...........
                                                             12.
V2315               A................  ...................  Lens lenticular trifocal...  ...........  ...........  ...........  ...........  ...........
V2316               A................  ...................  Lens lenticular nonaspheric  ...........  ...........  ...........  ...........  ...........
V2317               A................  ...................  Lens lenticular aspheric     ...........  ...........  ...........  ...........  ...........
                                                             tri.
V2318               A................  ...................  Lens aniseikonic trifocal..  ...........  ...........  ...........  ...........  ...........
V2319               A................  ...................  Lens trifocal seg width  28.
V2320               A................  ...................  Lens trifocal add over       ...........  ...........  ...........  ...........  ...........
                                                             3.25d.
V2399               A................  ...................  Lens trifocal speciality...  ...........  ...........  ...........  ...........  ...........
V2410               A................  ...................  Lens variab asphericity      ...........  ...........  ...........  ...........  ...........
                                                             sing.
V2430               A................  ...................  Lens variable asphericity    ...........  ...........  ...........  ...........  ...........
                                                             bi.
V2499               A................  ...................  Variable asphericity lens..  ...........  ...........  ...........  ...........  ...........
V2500               A................  ...................  Contact lens pmma spherical  ...........  ...........  ...........  ...........  ...........
V2501               A................  ...................  Cntct lens pmma-toric/prism  ...........  ...........  ...........  ...........  ...........
V2502               A................  ...................  Contact lens pmma bifocal..  ...........  ...........  ...........  ...........  ...........
V2503               A................  ...................  Cntct lens pmma color        ...........  ...........  ...........  ...........  ...........
                                                             vision.
V2510               A................  ...................  Cntct gas permeable          ...........  ...........  ...........  ...........  ...........
                                                             sphericl.
V2511               A................  ...................  Cntct toric prism ballast..  ...........  ...........  ...........  ...........  ...........
V2512               A................  ...................  Cntct lens gas permbl        ...........  ...........  ...........  ...........  ...........
                                                             bifocl.
V2513               A................  ...................  Contact lens extended wear.  ...........  ...........  ...........  ...........  ...........
V2520               A................  ...................  Contact lens hydrophilic...  ...........  ...........  ...........  ...........  ...........
V2521               A................  ...................  Cntct lens hydrophilic       ...........  ...........  ...........  ...........  ...........
                                                             toric.
V2522               A................  ...................  Cntct lens hydrophil bifocl  ...........  ...........  ...........  ...........  ...........
V2523               A................  ...................  Cntct lens hydrophil extend  ...........  ...........  ...........  ...........  ...........
V2530               A................  ...................  Contact lens gas             ...........  ...........  ...........  ...........  ...........
                                                             impermeable.
V2531               A................  ...................  Contact lens gas permeable.  ...........  ...........  ...........  ...........  ...........
V2599               A................  ...................  Contact lens/es other type.  ...........  ...........  ...........  ...........  ...........
V2600               A................  ...................  Hand held low vision aids..  ...........  ...........  ...........  ...........  ...........

[[Page 67010]]

 
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.
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.  ...........  ...........  ...........  ...........  ...........
V5095               E................  NI.................  Implant mid ear hearing      ...........  ...........  ...........  ...........  ...........
                                                             pros.
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  ...........  ...........  ...........  ...........  ...........

[[Page 67011]]

 
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.............  ...........  ...........  ...........  ...........  ...........
V5298               E................  NI.................  Hearing aid noc............  ...........  ...........  ...........  ...........  ...........
V5299               E................  ...................  Hearing service............  ...........  ...........  ...........  ...........  ...........
V5336               E................  ...................  Repair communication device  ...........  ...........  ...........  ...........  ...........
V5362               A................  ...................  Speech screening...........  ...........  ...........  ...........  ...........  ...........
V5363               A................  ...................  Language screening.........  ...........  ...........  ...........  ...........  ...........
V5364               A................  ...................  Dysphagia screening........  ...........  ...........  ...........  ...........  ...........
--------------------------------------------------------------------------------------------------------------------------------------------------------
CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
Copyright American Dental Association. All rights reserved.
*Code is new in 2002.








  Federal Register / Vol. 67, No. 212 / Friday, November 1, 2002 / 
Rules and Regulations  

[[Page 67011]]




   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,              Physician Fee
                             Occupational and       Schedule.
                             Speech Therapy.
A.........................  Physician Services     Physician Fee
                             for ESRD Patients.     Schedule.
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
                             Services, Codes not    Medicare or When
                             Reportable in          Performed in a
                             Hospital Outpatient    Hospital Outpatient
                             Settings.              Setting.
F.........................  Corneal tissue         Paid at Reasonable
                             acquisition; orphan    Cost.
                             drugs.
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,            Separate APC.
                             Radiopharmaceutical
                             Agents, Certain
                             Brachytherapy seeds.
L.........................  Influenza Vaccine;     Paid reasonable cost;
                             Pneumococcal           not subject to
                             Pneumonia Vaccine.     deductible or
                                                    coinsurance.
N.........................  Items and Services     Paid under OPPS;
                             Packaged into APC      Payment Is Packaged
                             Rate.                  Into Payment for
                                                    Other Services.

[[Page 67012]]

 
P.........................  Partial                Paid under OPPS; Per
                             Hospitalization.       Diem APC.
S.........................  Significant            Paid Under OPPS;
                             Procedure, Not         Separate APC.
                             Discounted When
                             Multiple.
T.........................  Significant            Paid Under OPPS;
                             Procedure, Multiple    Separate APC.
                             Procedure Reduction
                             Applies.
V.........................  Visit to Clinic or     Paid Under OPPS;
                             Emergency Department.  Separate APC .
X.........................  Ancillary Service....  Paid Under OPPS;
                                                    Separate APC.
------------------------------------------------------------------------


                      Addendum D1.--Code Conditions
------------------------------------------------------------------------
          Code condition                         Descriptor
------------------------------------------------------------------------
DG................................  Deleted code with a grace period;
                                     payment will be made under the
                                     deleted code in accord with the
                                     status indicator during the
                                     standard grace period.
DNG...............................  Deleted code with no grace period;
                                     payment will not be made under the
                                     deleted code after January 1, 2003.
NF................................  New code final APC assignment;
                                     comments were accepted on a
                                     proposed APC assignment in the
                                     NPRM; APC assignment is no longer
                                     open to comment.
NI................................  New code interim APC assignment;
                                     comments will be accepted on the
                                     interim APC assignment for the new
                                     code.
------------------------------------------------------------------------

    --------------------
All Rights Reserved. Applicable FARS/DFARS Apply.

Copyright American Dental Association. All rights reserved.

[[Page 67012]]



                     Addendum E.--CPT Codes Which Would Be Paid Only As Inpatient Procedures
                                              [Calendar Year 2003]
----------------------------------------------------------------------------------------------------------------
               CPT/HCPCS                      Status indicator                        Description
----------------------------------------------------------------------------------------------------------------
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

[[Page 67013]]

 
15757.................................  C...........................  Free skin flap, microvasc
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

[[Page 67014]]

 
21255.................................  C...........................  Reconstruct lower jaw bone
21256.................................  C...........................  Reconstruction of orbit
21268.................................  C...........................  Revise eye sockets
21343.................................  C...........................  Treatment of sinus fracture
21344.................................  C...........................  Treatment of sinus fracture
21346.................................  C...........................  Treat nose/jaw fracture
21347.................................  C...........................  Treat nose/jaw fracture
21348.................................  C...........................  Treat nose/jaw fracture
21356.................................  C...........................  Treat cheek bone fracture
21360.................................  C...........................  Treat cheek bone fracture
21365.................................  C...........................  Treat cheek bone fracture
21366.................................  C...........................  Treat cheek bone fracture
21385.................................  C...........................  Treat eye socket fracture
21386.................................  C...........................  Treat eye socket fracture
21387.................................  C...........................  Treat eye socket fracture
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

[[Page 67015]]

 
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
27078.................................  C...........................  Extensive hip surgery

[[Page 67016]]

 
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
27472.................................  C...........................  Repair/graft of thigh

[[Page 67017]]

 
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
31760.................................  C...........................  Repair of windpipe

[[Page 67018]]

 
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
32852.................................  C...........................  Lung transplant with bypass

[[Page 67019]]

 
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
33470.................................  C...........................  Revision of pulmonary valve

[[Page 67020]]

 
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
33736.................................  C...........................  Revision of heart chamber

[[Page 67021]]

 
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
33980.................................  C...........................  Remove intracorporeal device

[[Page 67022]]

 
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
34833.................................  C...........................  Xpose for endoprosth, iliac
34834.................................  C...........................  Xpose, endoprosth, brachial
34900.................................  C...........................  Endovasc iliac repr w/graft
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

[[Page 67023]]

 
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
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

[[Page 67024]]

 
35666.................................  C...........................  Artery bypass graft
35671.................................  C...........................  Artery bypass graft
35681.................................  C...........................  Composite bypass graft
35682.................................  C...........................  Composite bypass graft
35683.................................  C...........................  Composite bypass graft
35691.................................  C...........................  Arterial transposition
35693.................................  C...........................  Arterial transposition
35694.................................  C...........................  Arterial transposition
35695.................................  C...........................  Arterial transposition
35700.................................  C...........................  Reoperation, bypass graft
35701.................................  C...........................  Exploration, carotid artery
35721.................................  C...........................  Exploration, femoral artery
35741.................................  C...........................  Exploration popliteal artery
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
37182.................................  C...........................  Insert hepatic shunt (tips)
37183.................................  C...........................  Remove hepatic shunt (tips)
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

[[Page 67025]]

 
39545.................................  C...........................  Revision of diaphragm
39560.................................  C...........................  Resect diaphragm, simple
39561.................................  C...........................  Resect diaphragm, complex
39599.................................  C...........................  Diaphragm surgery procedure
41130.................................  C...........................  Partial removal of tongue
41135.................................  C...........................  Tongue and neck surgery
41140.................................  C...........................  Removal of tongue
41145.................................  C...........................  Tongue removal, neck surgery
41150.................................  C...........................  Tongue, mouth, jaw surgery
41153.................................  C...........................  Tongue, mouth, neck surgery
41155.................................  C...........................  Tongue, jaw, & neck surgery
42426.................................  C...........................  Excise parotid gland/lesion
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

[[Page 67026]]

 
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
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

[[Page 67027]]

 
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
44204.................................  C...........................  Laparo partial colectomy
44205.................................  C...........................  Lap colectomy part w/ileum
44210.................................  C...........................  Laparo total proctocolectomy
44211.................................  C...........................  Laparo total proctocolectomy
44212.................................  C...........................  Laparo total proctocolectomy
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

[[Page 67028]]

 
46716.................................  C...........................  Repair of anovaginal fistula
46730.................................  C...........................  Construction of absent anus
46735.................................  C...........................  Construction of absent anus
46740.................................  C...........................  Construction of absent anus
46742.................................  C...........................  Repair of imperforated anus
46744.................................  C...........................  Repair of cloacal anomaly
46746.................................  C...........................  Repair of cloacal anomaly
46748.................................  C...........................  Repair of cloacal anomaly
46751.................................  C...........................  Repair of anal sphincter
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

[[Page 67029]]

 
48146.................................  C...........................  Pancreatectomy
48148.................................  C...........................  Removal of pancreatic duct
48150.................................  C...........................  Partial removal of pancreas
48152.................................  C...........................  Pancreatectomy
48153.................................  C...........................  Pancreatectomy
48154.................................  C...........................  Pancreatectomy
48155.................................  C...........................  Removal of pancreas
48180.................................  C...........................  Fuse pancreas and bowel
48400.................................  C...........................  Injection, intraop add-on
48500.................................  C...........................  Surgery of 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
49904.................................  C...........................  Omental flap, extra-abdom
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

[[Page 67030]]

 
50360.................................  C...........................  Transplantation of kidney
50365.................................  C...........................  Transplantation of kidney
50370.................................  C...........................  Remove transplanted kidney
50380.................................  C...........................  Reimplantation of kidney
50400.................................  C...........................  Revision of kidney/ureter
50405.................................  C...........................  Revision of kidney/ureter
50500.................................  C...........................  Repair of kidney wound
50520.................................  C...........................  Close kidney-skin fistula
50525.................................  C...........................  Repair renal-abdomen fistula
50526.................................  C...........................  Repair renal-abdomen fistula
50540.................................  C...........................  Revision of horseshoe kidney
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

[[Page 67031]]

 
51580.................................  C...........................  Remove bladder/revise tract
51585.................................  C...........................  Removal of bladder & nodes
51590.................................  C...........................  Remove bladder/revise tract
51595.................................  C...........................  Remove bladder/revise tract
51596.................................  C...........................  Remove bladder/create pouch
51597.................................  C...........................  Removal of pelvic structures
51800.................................  C...........................  Revision of bladder/urethra
51820.................................  C...........................  Revision of urinary tract
51840.................................  C...........................  Attach bladder/urethra
51841.................................  C...........................  Attach bladder/urethra
51845.................................  C...........................  Repair bladder neck
51860.................................  C...........................  Repair of bladder wound
51865.................................  C...........................  Repair of bladder wound
51900.................................  C...........................  Repair bladder/vagina lesion
51920.................................  C...........................  Close bladder-uterus fistula
51925.................................  C...........................  Hysterectomy/bladder repair
51940.................................  C...........................  Correction of bladder defect
51960.................................  C...........................  Revision of bladder & bowel
51980.................................  C...........................  Construct bladder opening
53085.................................  C...........................  Drainage of urinary leakage
53415.................................  C...........................  Reconstruction of urethra
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
55866.................................  C...........................  Laparo radical prostatectomy
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

[[Page 67032]]

 
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
58146.................................  C...........................  Myomectomy abdom complex
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
58290.................................  C...........................  Vag hyst complex
58291.................................  C...........................  Vag hyst incl t/o, complex
58292.................................  C...........................  Vag hyst t/o & repair, compl
58293.................................  C...........................  Vag hyst w/uro repair, compl
58294.................................  C...........................  Vag hyst w/enterocele, compl
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

[[Page 67033]]

 
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
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
61322.................................  C...........................  Decompressive craniotomy
61323.................................  C...........................  Decompressive lobectomy
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

[[Page 67034]]

 
61526.................................  C...........................  Removal of brain lesion
61530.................................  C...........................  Removal of brain lesion
61531.................................  C...........................  Implant brain electrodes
61533.................................  C...........................  Implant brain electrodes
61534.................................  C...........................  Removal of brain lesion
61535.................................  C...........................  Remove brain electrodes
61536.................................  C...........................  Removal of brain lesion
61538.................................  C...........................  Removal of brain tissue
61539.................................  C...........................  Removal of brain tissue
61541.................................  C...........................  Incision of brain tissue
61542.................................  C...........................  Removal of brain tissue
61543.................................  C...........................  Removal of brain tissue
61544.................................  C...........................  Remove & treat brain lesion
61545.................................  C...........................  Excision of brain tumor
61546.................................  C...........................  Removal of pituitary gland
61548.................................  C...........................  Removal of pituitary gland
61550.................................  C...........................  Release of skull seams
61552.................................  C...........................  Release of skull seams
61556.................................  C...........................  Incise skull/sutures
61557.................................  C...........................  Incise skull/sutures
61558.................................  C...........................  Excision of skull/sutures
61559.................................  C...........................  Excision of skull/sutures
61563.................................  C...........................  Excision of skull tumor
61564.................................  C...........................  Excision of skull tumor
61570.................................  C...........................  Remove foreign body, brain
61571.................................  C...........................  Incise skull for brain wound
61575.................................  C...........................  Skull base/brainstem surgery
61576.................................  C...........................  Skull base/brainstem surgery
61580.................................  C...........................  Craniofacial approach, skull
61581.................................  C...........................  Craniofacial approach, skull
61582.................................  C...........................  Craniofacial approach, skull
61583.................................  C...........................  Craniofacial approach, skull
61584.................................  C...........................  Orbitocranial approach/skull
61585.................................  C...........................  Orbitocranial approach/skull
61586.................................  C...........................  Resect nasopharynx, skull
61590.................................  C...........................  Infratemporal approach/skull
61591.................................  C...........................  Infratemporal approach/skull
61592.................................  C...........................  Orbitocranial approach/skull
61595.................................  C...........................  Transtemporal approach/skull
61596.................................  C...........................  Transcochlear approach/skull
61597.................................  C...........................  Transcondylar approach/skull
61598.................................  C...........................  Transpetrosal approach/skull
61600.................................  C...........................  Resect/excise cranial lesion
61601.................................  C...........................  Resect/excise cranial lesion
61605.................................  C...........................  Resect/excise cranial lesion
61606.................................  C...........................  Resect/excise cranial lesion
61607.................................  C...........................  Resect/excise cranial lesion
61608.................................  C...........................  Resect/excise cranial lesion
61609.................................  C...........................  Transect artery, sinus
61610.................................  C...........................  Transect artery, sinus
61611.................................  C...........................  Transect artery, sinus
61612.................................  C...........................  Transect artery, sinus
61613.................................  C...........................  Remove aneurysm, sinus
61615.................................  C...........................  Resect/excise lesion, skull
61616.................................  C...........................  Resect/excise lesion, skull
61618.................................  C...........................  Repair dura
61619.................................  C...........................  Repair dura
61624.................................  C...........................  Occlusion/embolization cath
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

[[Page 67035]]

 
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
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
62161.................................  C...........................  Dissect brain w/scope
62162.................................  C...........................  Remove colloid cyst w/scope
62163.................................  C...........................  Neuroendoscopy w/fb removal
62164.................................  C...........................  Remove brain tumor w/scope
62165.................................  C...........................  Remove pituit tumor w/scope
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

[[Page 67036]]

 
63173.................................  C...........................  Drainage of spinal cyst
63180.................................  C...........................  Revise spinal cord ligaments
63182.................................  C...........................  Revise spinal cord ligaments
63185.................................  C...........................  Incise spinal column/nerves
63190.................................  C...........................  Incise spinal column/nerves
63191.................................  C...........................  Incise spinal column/nerves
63194.................................  C...........................  Incise spinal column & cord
63195.................................  C...........................  Incise spinal column & cord
63196.................................  C...........................  Incise spinal column & cord
63197.................................  C...........................  Incise spinal column & cord
63198.................................  C...........................  Incise spinal column & cord
63199.................................  C...........................  Incise spinal column & cord
63200.................................  C...........................  Release of spinal cord
63250.................................  C...........................  Revise spinal cord vessels
63251.................................  C...........................  Revise spinal cord vessels
63252.................................  C...........................  Revise spinal cord vessels
63265.................................  C...........................  Excise intraspinal lesion
63266.................................  C...........................  Excise intraspinal lesion
63267.................................  C...........................  Excise intraspinal lesion
63268.................................  C...........................  Excise intraspinal lesion
63270.................................  C...........................  Excise intraspinal lesion
63271.................................  C...........................  Excise intraspinal lesion
63272.................................  C...........................  Excise intraspinal lesion
63273.................................  C...........................  Excise intraspinal lesion
63275.................................  C...........................  Biopsy/excise spinal tumor
63276.................................  C...........................  Biopsy/excise spinal tumor
63277.................................  C...........................  Biopsy/excise spinal tumor
63278.................................  C...........................  Biopsy/excise spinal tumor
63280.................................  C...........................  Biopsy/excise spinal tumor
63281.................................  C...........................  Biopsy/excise spinal tumor
63282.................................  C...........................  Biopsy/excise spinal tumor
63283.................................  C...........................  Biopsy/excise spinal tumor
63285.................................  C...........................  Biopsy/excise spinal tumor
63286.................................  C...........................  Biopsy/excise spinal tumor
63287.................................  C...........................  Biopsy/excise spinal tumor
63290.................................  C...........................  Biopsy/excise spinal tumor
63300.................................  C...........................  Removal of vertebral body
63301.................................  C...........................  Removal of vertebral body
63302.................................  C...........................  Removal of vertebral body
63303.................................  C...........................  Removal of vertebral body
63304.................................  C...........................  Removal of vertebral body
63305.................................  C...........................  Removal of vertebral body
63306.................................  C...........................  Removal of vertebral body
63307.................................  C...........................  Removal of vertebral body
63308.................................  C...........................  Remove vertebral body add-on
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

[[Page 67037]]

 
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
75954.................................  C...........................  Iliac 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
99262.................................  C...........................  Follow-up inpatient consult
99263.................................  C...........................  Follow-up inpatient consult
99293.................................  C...........................  Ped critical care, initial
99294.................................  C...........................  Ped critical care, subseq
99295.................................  C...........................  Neonatal critical care
99296.................................  C...........................  Neonatal critical care
99297.................................  C...........................  Neonatal critical care
99298.................................  C...........................  Neonatal critical care
99299.................................  C...........................  Ic, lbw infant 1500-2500 gm
99356.................................  C...........................  Prolonged service, inpatient
99357.................................  C...........................  Prolonged service, inpatient
99433.................................  C...........................  Normal newborn care/hospital
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
00215.................................  C...........................  Anesth, skull repair/fract
0021T.................................  C...........................  Fetal oximetry, trnsvag/cerv
0024T.................................  C...........................  Transcath cardiac reduction
0033T.................................  C...........................  Endovasc taa repr incl subcl
0034T.................................  C...........................  Endovasc taa repr w/o subcl
0035T.................................  C...........................  Insert endovasc prosth, taa
0036T.................................  C...........................  Endovasc prosth, taa, add-on
0037T.................................  C...........................  Artery transpose/endovas taa
0038T.................................  C...........................  Rad endovasc taa rpr w/cover
0039T.................................  C...........................  Rad s/i, endovasc taa repair
00404.................................  C...........................  Anesth, surgery of breast
00406.................................  C...........................  Anesth, surgery of breast
0040T.................................  C...........................  Rad s/i, endovasc taa prosth
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

[[Page 67038]]

 
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
----------------------------------------------------------------------------------------------------------------
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. 212 / Friday, November 1, 2002 / 
Rules and Regulations  

[[Page 67038]]




                 Addendum H.--Wage Index for Urban Areas
------------------------------------------------------------------------
                                                                  Wage
               Urban area (constituent counties)                  index
------------------------------------------------------------------------
0040 Abilene, TX \2\..........................................    0.7827
  Taylor, TX
0060 Aguadilla, PR............................................    0.4587
  Aguada, PR
  Aguadilla, PR
  Moca, PR
0080 Akron, OH................................................    0.9600
  Portage, OH
  Summit, OH
0120 Albany, GA...............................................    1.0594
  Dougherty, GA
  Lee, GA
0160 Albany-Schenectady-Troy, NY \2\..........................    0.8542
  Albany, NY
  Montgomery, NY
  Rensselaer, NY
  Saratoga, NY
  Schenectady, NY
  Schoharie, NY
0200 Albuquerque, NM..........................................    0.9390
  Bernalillo, NM
  Sandoval, NM
  Valencia, NM
0220 Alexandria, LA...........................................    0.7883
  Rapides, LA
0240 Allentown-Bethlehem-Easton, PA...........................    0.9735
  Carbon, PA
  Lehigh, PA
  Northampton, PA
0280 Altoona, PA..............................................    0.9225
  Blair, PA
0320 Amarillo, TX.............................................    0.9034
  Potter, TX
  Randall, TX
0380 Anchorage, AK............................................    1.2490
  Anchorage, AK
0440 Ann Arbor, MI............................................    1.1103
  Lenawee, MI
  Livingston, MI
  Washtenaw, MI
0450 Anniston, AL.............................................    0.8044
  Calhoun, AL
0460 Appleton-Oshkosh-Neenah, WI \2\..........................    0.9162
  Calumet, WI
  Outagamie, WI
  Winnebago, WI
0470 Arecibo, PR \2\..........................................    0.4356
  Arecibo, PR
  Camuy, PR
  Hatillo, PR
0480 Asheville, NC............................................    0.9876
  Buncombe, NC
  Madison, NC
0500 Athens, GA...............................................    1.0211
  Clarke, GA
  Madison, GA
  Oconee, GA
0520 Atlanta, GA \1\..........................................    0.9991
  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....................................    1.1017
  Atlantic, NJ
  Cape May, NJ
0580 Auburn-Opelika, AL.......................................    0.8325
  Lee, AL
0600 Augusta-Aiken, GA-SC.....................................    1.0264
  Columbia, GA
  McDuffie, GA
  Richmond, GA
  Aiken, SC
  Edgefield, SC
0640 Austin-San Marcos, TX \1\................................    0.9637
  Bastrop, TX
  Caldwell, TX
  Hays, TX
  Travis, TX
  Williamson, TX
0680 Bakersfield, CA..........................................    0.9899
  Kern, CA
0720 Baltimore, MD \1\........................................    0.9929
  Anne Arundel, MD
  Baltimore, MD
  Baltimore City, MD
  Carroll, MD
  Harford, MD
  Howard, MD
  Queen Anne's, MD
0733 Bangor, ME...............................................    0.9664
  Penobscot, ME
0743 Barnstable-Yarmouth, MA..................................    1.3202
  Barnstable, MA
0760 Baton Rouge, LA..........................................    0.8294
  Ascension, LA
  East Baton Rouge, LA
  Livingston, LA
  West Baton Rouge, LA
0840 Beaumont-Port Arthur, TX.................................    0.8324
  Hardin, TX
  Jefferson, TX
  Orange, TX
0860 Bellingham, WA...........................................    1.2282
  Whatcom, WA
0870 Benton Harbor, MI........................................    0.9106
  Berrien, MI
0875 Bergen-Passaic, NJ \1\...................................    1.2207
  Bergen, NJ
  Passaic, NJ
0880 Billings, MT.............................................    0.9022
  Yellowstone, MT
0920 Biloxi-Gulfport-Pascagoula, MS...........................    0.8757
  Hancock, MS
  Harrison, MS
  Jackson, MS
0960 Binghamton, NY \2\.......................................    0.8542
  Broome, NY
  Tioga, NY
1000 Birmingham, AL...........................................    0.9222
  Blount, AL
  Jefferson, AL
  St. Clair, AL

[[Page 67039]]

 
  Shelby, AL
1010 Bismarck, ND.............................................    0.7972
  Burleigh, ND
  Morton, ND
1020 Bloomington, IN..........................................    0.8907
  Monroe, IN
1040 Bloomington-Normal, IL...................................    0.9109
  McLean, IL
1080 Boise City, ID...........................................    0.9310
  Ada, ID
  Canyon, ID
1123 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH (MA         1.1288
 Hospitals) \1\ \2\...........................................
  Bristol, MA
  Essex, MA
  Middlesex, MA
  Norfolk, MA
  Plymouth, MA
  Suffolk, MA
  Worcester, MA
  Hillsborough, NH
  Merrimack, NH
  Rockingham, NH
  Strafford, NH
1123 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH (NH         1.1235
 Hospitals) \1\...............................................
  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.....................................    0.9689
  Boulder, CO
1145 Brazoria, TX.............................................    0.8535
  Brazoria, TX
1150 Bremerton, WA............................................    1.0944
  Kitsap, WA
1240 Brownsville-Harlingen-San Benito, TX.....................    0.8880
  Cameron, TX
1260 Bryan-College Station, TX................................    0.8821
  Brazos, TX
1280 Buffalo-Niagara Falls, NY \1\............................    0.9365
  Erie, NY
  Niagara, NY
1303 Burlington, VT...........................................    1.0052
  Chittenden, VT
  Franklin, VT
  Grand Isle, VT
1310 Caguas, PR...............................................    0.4408
  Caguas, PR
  Cayey, PR
  Cidra, PR
  Gurabo, PR
  San Lorenzo, PR
1320 Canton-Massillon, OH.....................................    0.8932
  Carroll, OH
  Stark, OH
1350 Casper, WY...............................................    0.9690
  Natrona, WY
1360 Cedar Rapids, IA.........................................    0.9056
  Linn, IA
1400 Champaign-Urbana, IL.....................................    1.0635
  Champaign, IL
1440 Charleston-North Charleston, SC..........................    0.9235
  Berkeley, SC
  Charleston, SC
  Dorchester, SC
1480 Charleston, WV...........................................    0.8898
  Kanawha, WV
  Putnam, WV
1520 Charlotte-Gastonia-Rock Hill, NC-SC \1\..................    0.9850
  Cabarrus, NC
  Gaston, NC
  Lincoln, NC
  Mecklenburg, NC
  Rowan, NC
  Stanly, NC
  Union, NC
  York, SC
1540 Charlottesville, VA......................................    1.0438
  Albemarle, VA
  Charlottesville City, VA
  Fluvanna, VA
  Greene, VA
1560 Chattanooga, TN-GA.......................................    0.8976
  Catoosa, GA
  Dade, GA
  Walker, GA
  Hamilton, TN
  Marion, TN
1580 Cheyenne, WY \2\.........................................    0.9007
  Laramie, WY
1600 Chicago, IL \1\..........................................    1.1044
  Cook, IL
  DeKalb, IL
  DuPage, IL
  Grundy, IL
  Kane, IL
  Kendall, IL
  Lake, IL
  McHenry, IL
  Will, IL
1620 Chico-Paradise, CA \2\...................................    0.9840
  Butte, CA
1640 Cincinnati, OH-KY-IN \1\.................................    0.9389
  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..........................    0.8419
  Christian, KY
  Montgomery, TN
1680 Cleveland-Lorain-Elyria, OH \1\..........................    0.9670
  Ashtabula, OH
  Cuyahoga, OH
  Geauga, OH
  Lake, OH
  Lorain, OH
  Medina, OH
1720 Colorado Springs, CO.....................................    0.9916
  El Paso, CO
1740 Columbia, MO.............................................    0.8515
  Boone, MO
1760 Columbia, SC.............................................    0.9307
  Lexington, SC
  Richland, SC
1800 Columbus, GA-AL..........................................    0.8374
  Russell, AL
  Chattahoochee, GA
  Harris, GA
  Muscogee, GA
1840 Columbus, OH \1\.........................................    0.9751
  Delaware, OH
  Fairfield, OH
  Franklin, OH
  Licking, OH
  Madison, OH
  Pickaway, OH
1880 Corpus Christi, TX.......................................    0.8729
  Nueces, TX
  San Patricio, TX
1890 Corvallis, OR............................................    1.1453
  Benton, OR
1900 Cumberland, MD-WV (MD Hospitals) \2\.....................    0.8946
  Allegany, MD
  Mineral, WV
1900 Cumberland, MD-WV (WV Hospitals) \2\.....................    0.7975
  Allegany, MD
  Mineral, WV
1920 Dallas, TX \1\...........................................    0.9998
  Collin, TX
  Dallas, TX
  Denton, TX
  Ellis, TX
  Henderson, TX
  Hunt, TX
  Kaufman, TX
  Rockwall, TX
1950 Danville, VA.............................................    0.8859
  Danville City, VA
  Pittsylvania, VA
1960 Davenport-Moline-Rock Island, IA-IL......................    0.8835
  Scott, IA
  Henry, IL
  Rock Island, IL
2000 Dayton-Springfield, OH...................................    0.9282
  Clark, OH
  Greene, OH
  Miami, OH
  Montgomery, OH
2020 Daytona Beach, FL........................................    0.9062
  Flagler, FL
  Volusia, FL
2030 Decatur, AL..............................................    0.8973
  Lawrence, AL
  Morgan, AL
2040 Decatur, IL \2\..........................................    0.8204
  Macon, IL
2080 Denver, CO \1\...........................................    1.0601
  Adams, CO
  Arapahoe, CO
  Broomfield, CO
  Denver, CO
  Douglas, CO
  Jefferson, CO
2120 Des Moines, IA...........................................    0.8827

[[Page 67040]]

 
  Dallas, IA
  Polk, IA
  Warren, IA
2160 Detroit, MI \1\..........................................    1.0448
  Lapeer, MI
  Macomb, MI
  Monroe, MI
  Oakland, MI
  St. Clair, MI
  Wayne, MI
2180 Dothan, AL...............................................    0.8158
  Dale, AL
  Houston, AL
2190 Dover, DE................................................    0.9356
  Kent, DE
2200 Dubuque, IA..............................................    0.8795
  Dubuque, IA
2240 Duluth-Superior, MN-WI...................................    1.0368
  St. Louis, MN
  Douglas, WI
2281 Dutchess County, NY......................................    1.0684
  Dutchess, NY
2290 Eau Claire, WI \2\.......................................    0.9162
  Chippewa, WI
  Eau Claire, WI
2320 El Paso, TX..............................................    0.9265
  El Paso, TX
2330 Elkhart-Goshen, IN.......................................    0.9722
  Elkhart, IN
2335 Elmira, NY \2\...........................................    0.8542
  Chemung, NY
2340 Enid, OK.................................................    0.8376
  Garfield, OK
2360 Erie, PA.................................................    0.8925
  Erie, PA
2400 Eugene-Springfield, OR...................................    1.0944
  Lane, OR
2440 Evansville-Henderson, IN-KY (IN Hospitals) \2\...........    0.8755
  Posey, IN
  Vanderburgh, IN
  Warrick, IN
  Henderson, KY
2440 Evansville-Henderson, IN-KY (KY Hospitals)...............    0.8177
  Posey, IN
  Vanderburgh, IN
  Warrick, IN
  Henderson, KY
2520 Fargo-Moorhead, ND-MN....................................    0.9684
  Clay, MN
  Cass, ND
2560 Fayetteville, NC.........................................    0.8992
  Cumberland, NC
2580 Fayetteville-Springdale-Rogers, AR.......................    0.8100
  Benton, AR
  Washington, AR
2620 Flagstaff, AZ-UT.........................................    1.0682
  Coconino, AZ
  Kane, UT
2640 Flint, MI................................................    1.1135
  Genesee, MI
2650 Florence, AL.............................................    0.7819
  Colbert, AL
  Lauderdale, AL
2655 Florence, SC.............................................    0.8780
  Florence, SC
2670 Fort Collins-Loveland, CO................................    1.0066
  Larimer, CO
2680 Ft. Lauderdale, FL \1\...................................    1.0704
  Broward, FL
2700 Fort Myers-Cape Coral, FL................................    0.9680
  Lee, FL
2710 Fort Pierce-Port St. Lucie, FL...........................    0.9931
  Martin, FL
  St. Lucie, FL
2720 Fort Smith, AR-OK........................................    0.7895
  Crawford, AR
  Sebastian, AR
  Sequoyah, OK
2750 Fort Walton Beach, FL....................................    0.9693
  Okaloosa, FL
2760 Fort Wayne, IN...........................................    0.9457
  Adams, IN
  Allen, IN
  De Kalb, IN
  Huntington, IN
  Wells, IN
  Whitley, IN
2800 Forth Worth-Arlington, TX \1\............................    0.9446
  Hood, TX
  Johnson, TX
  Parker, TX
  Tarrant, TX
2840 Fresno, CA...............................................    1.0216
  Fresno, CA
  Madera, CA
2880 Gadsden, AL..............................................    0.8599
  Etowah, AL
2900 Gainesville, FL..........................................    0.9871
  Alachua, FL
2920 Galveston-Texas City, TX.................................    0.9465
  Galveston, TX
2960 Gary, IN.................................................    0.9584
  Lake, IN
  Porter, IN
2975 Glens Falls, NY \2\......................................    0.8542
  Warren, NY
  Washington, NY
2980 Goldsboro, NC Wayne, NC..................................    0.8892
2985 Grand Forks, ND-MN.......................................    0.9243
  Polk, MN
  Grand Forks, ND
2995 Grand Junction, CO.......................................    0.9679
  Mesa, CO
3000 Grand Rapids-Muskegon-Holland, MI \1\....................    0.9548
  Allegan, MI
  Kent, MI
  Muskegon, MI
  Ottawa, MI
3040 Great Falls, MT..........................................    0.8966
  Cascade, MT
3060 Greeley, CO..............................................    0.9336
  Weld, CO
3080 Green Bay, WI............................................    0.9668
  Brown, WI
3120 Greensboro-Winston-Salem-High Point, NC \1\..............    0.9282
  Alamance, NC
  Davidson, NC
  Davie, NC
  Forsyth, NC
  Guilford, NC
  Randolph, NC
  Stokes, NC
  Yadkin, NC
3150 Greenville, NC...........................................    0.9174
  Pitt, NC
3160 Greenville-Spartanburg-Anderson, SC......................    0.9122
  Anderson, SC
  Cherokee, SC
  Greenville, SC
  Pickens, SC
  Spartanburg, SC
3180 Hagerstown, MD...........................................    0.9268
  Washington, MD
3200 Hamilton-Middletown, OH..................................    0.9418
  Butler, OH
3240 Harrisburg-Lebanon-Carlisle, PA..........................    0.9223
  Cumberland, PA
  Dauphin, PA
  Lebanon, PA
  Perry, PA
3283 Hartford, CT \1\ \2\.....................................    1.2394
  Hartford, CT
  Litchfield, CT
  Middlesex, CT
  Tolland, CT
3285 Hattiesburg, MS \2\......................................    0.7680
  Forrest, MS
  Lamar, MS
3290 Hickory-Morganton-Lenoir, NC.............................    0.9028
  Alexander, NC
  Burke, NC
  Caldwell, NC
  Catawba, NC
3320 Honolulu, HI.............................................    1.1457
  Honolulu, HI
3350 Houma, LA................................................    0.8385
  Lafourche, LA
  Terrebonne, LA
3360 Houston, TX \1\..........................................    0.9892
  Chambers, TX
  Fort Bend, TX
  Harris, TX
  Liberty, TX
  Montgomery, TX
  Waller, TX
3400 Huntington-Ashland, WV-KY-OH.............................    0.9636
  Boyd, KY
  Carter, KY
  Greenup, KY
  Lawrence, OH
  Cabell, WV
  Wayne, WV
3440 Huntsville, AL...........................................    0.8903
  Limestone, AL
  Madison, AL
3480 Indianapolis, IN \1\.....................................    0.9717
  Boone, IN
  Hamilton, IN
  Hancock, IN
  Hendricks, IN
  Johnson, IN
  Madison, IN
  Marion, IN
  Morgan, IN
  Shelby, IN
3500 Iowa City, IA............................................    0.9587
  Johnson, IA
3520 Jackson, MI..............................................    0.9532
  Jackson, MI
3560 Jackson, MS..............................................    0.8607

[[Page 67041]]

 
  Hinds, MS
  Madison, MS
  Rankin, MS
3580 Jackson, TN..............................................    0.9275
  Madison, TN
  Chester, TN
3600 Jacksonville, FL \1\.....................................    0.9381
  Clay, FL
  Duval, FL
  Nassau, FL
  St. Johns, FL
3605 Jacksonville, NC \2\.....................................    0.8666
  Onslow, NC
3610 Jamestown, NY \2\........................................    0.8542
  Chautauqua, NY
3620 Janesville-Beloit, WI....................................    0.9849
  Rock, WI
3640 Jersey City, NJ..........................................    1.1190
  Hudson, NJ
3660 Johnson City-Kingsport-Bristol, TN-VA (TN Hospitals).....    0.8337
  Carter, TN
  Hawkins, TN
  Sullivan, TN
  Unicoi, TN
  Washington, TN
  Bristol City, VA
  Scott, VA
  Washington, VA
3660 Johnson City-Kingsport-Bristol, TN-VA (VA Hospitals) \2\.    0.8504
  Carter, TN
  Hawkins, TN
  Sullivan, TN
  Unicoi, TN
  Washington, TN
  Bristol City, VA
  Scott, VA
  Washington, VA
3680 Johnstown, PA \2\........................................    0.8462
  Cambria, PA
  Somerset, PA
3700 Jonesboro, AR............................................    0.7843
  Craighead, AR
3710 Joplin, MO...............................................    0.8613
  Jasper, MO
  Newton, MO
3720 Kalamazoo-Battlecreek, MI................................    1.0595
  Calhoun, MI
  Kalamazoo, MI
  Van Buren, MI
3740 Kankakee, IL \2\.........................................    0.8204
  Kankakee, IL
3760 Kansas City, KS-MO \1\...................................    0.9736
  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..............................................    0.9686
  Kenosha, WI
3810 Killeen-Temple, TX.......................................    0.9570
  Bell, TX
  Coryell, TX
3840 Knoxville, TN............................................    0.8970
  Anderson, TN
  Blount, TN
  Knox, TN
  Loudon, TN
  Sevier, TN
  Union, TN
3850 Kokomo, IN...............................................    0.9038
  Howard, IN
  Tipton, IN
3870 La Crosse, WI-MN.........................................    0.9400
  Houston, MN
  La Crosse, WI
3880 Lafayette, LA............................................    0.8475
  Acadia, LA
  Lafayette, LA
  St. Landry, LA
  St. Martin, LA
3920 Lafayette, IN............................................    0.9278
  Clinton, IN
  Tippecanoe, IN
3960 Lake Charles, LA.........................................    0.7965
  Calcasieu, LA
3980 Lakeland-Winter Haven, FL................................    0.9357
  Polk, FL
4000 Lancaster, PA............................................    0.9078
  Lancaster, PA
4040 Lansing-East Lansing, MI.................................    0.9726
  Clinton, MI
  Eaton, MI
  Ingham, MI
4080 Laredo, TX...............................................    0.8472
  Webb, TX
4100 Las Cruces, NM \2\.......................................    0.8872
  Dona Ana, NM
4120 Las Vegas, NV-AZ \1\.....................................    1.1521
  Mohave, AZ
  Clark, NV
  Nye, NV
4150 Lawrence, KS.............................................    0.7923
  Douglas, KS
4200 Lawton, OK...............................................    0.8315
  Comanche, OK
4243 Lewiston-Auburn, ME......................................    0.9179
  Androscoggin, ME
4280 Lexington, KY............................................    0.8581
  Bourbon, KY
  Clark, KY
  Fayette, KY
  Jessamine, KY
  Madison, KY
  Scott, KY
  Woodford, KY
4320 Lima, OH.................................................    0.9483
  Allen, OH
  Auglaize, OH
4360 Lincoln, NE..............................................    0.9892
  Lancaster, NE
4400 Little Rock-North Little Rock, AR........................    0.9097
  Faulkner, AR
  Lonoke, AR
  Pulaski, AR
  Saline, AR
4420 Longview-Marshall, TX....................................    0.8629
  Gregg, TX
  Harrison, TX
  Upshur, TX
4480 Los Angeles-Long Beach, CA \1\...........................    1.2011
  Los Angeles, CA
4520 Louisville, KY-IN \1\....................................    0.9276
  Clark, IN
  Floyd, IN
  Harrison, IN
  Scott, IN
  Bullitt, KY
  Jefferson, KY
  Oldham, KY
4600 Lubbock, TX..............................................    0.9646
  Lubbock, TX
4640 Lynchburg, VA............................................    0.9219
  Amherst, VA
  Bedford, VA
  Bedford City, VA
  Campbell, VA
  Lynchburg City, VA
4680 Macon, GA................................................    0.9250
  Bibb, GA
  Houston, GA
  Jones, GA
  Peach, GA
  Twiggs, GA
4720 Madison, WI..............................................    1.0467
  Dane, WI
4800 Mansfield, OH............................................    0.8900
  Crawford, OH
  Richland, OH
4840 Mayaguez, PR.............................................    0.4914
  Anasco, PR
  Cabo Rojo, PR
  Hormigueros, PR
  Mayaguez, PR
  Sabana Grande, PR
  San German, PR
4880 McAllen-Edinburg-Mission, TX.............................    0.8428
  Hidalgo, TX
4890 Medford-Ashland, OR......................................    1.0498
  Jackson, OR
4900 Melbourne-Titusville-Palm Bay, FL........................    1.0253
  Brevard, Fl
4920 Memphis, TN-AR-MS \1\....................................    0.8920
  Crittenden, AR
  DeSoto, MS
  Fayette, TN
  Shelby, TN
  Tipton, TN
4940 Merced, CA \2\...........................................    0.9840
  Merced, CA
5000 Miami, FL \1\............................................    0.9815
  Dade, FL
5015 Middlesex-Somerset-Hunterdon, NJ \1\.....................    1.1213
  Hunterdon, NJ
  Middlesex, NJ
  Somerset, NJ
5080 Milwaukee-Waukesha, WI \1\...............................    0.9893
  Milwaukee, WI
  Ozaukee, WI
  Washington, WI
  Waukesha, WI
5120 Minneapolis-St. Paul, MN-WI \1\..........................    1.0903
  Anoka, MN
  Carver, MN
  Chisago, MN
  Dakota, MN
  Hennepin, MN

[[Page 67042]]

 
  Isanti, MN
  Ramsey, MN
  Scott, MN
  Sherburne, MN
  Washington, MN
  Wright, MN
  Pierce, WI
  St. Croix, WI
5140 Missoula, MT.............................................    0.9157
  Missoula, MT
5160 Mobile, AL...............................................    0.8110
  Baldwin, AL
  Mobile, AL
5170 Modesto, CA..............................................    1.0498
  Stanislaus, CA
5190 Monmouth-Ocean, NJ \1\...................................    1.0814
  Monmouth, NJ
  Ocean, NJ
5200 Monroe, LA...............................................    0.8137
  Ouachita, LA
5240 Montgomery, AL...........................................    0.7734
  Autauga, AL
  Elmore, AL
  Montgomery, AL
5280 Muncie, IN...............................................    0.9284
  Delaware, IN
5330 Myrtle Beach, SC.........................................    0.8976
  Horry, SC
5345 Naples, FL...............................................    0.9754
  Collier, FL
5360 Nashville, TN \1\........................................    0.9578
  Cheatham, TN
  Davidson, TN
  Dickson, TN
  Robertson, TN
  Rutherford TN
  Sumner, TN
  Williamson, TN
  Wilson, TN
5380 Nassau-Suffolk, NY \1\...................................    1.3357
  Nassau, NY
  Suffolk, NY
5483 New Haven-Bridgeport-Stamford-Waterbury- Danbury, CT \1\.    1.2459
  Fairfield, CT
  New Haven, CT
5523 New London-Norwich, CT \2\...............................    1.2394
  New London, CT
5560 New Orleans, LA \1\......................................    0.9046
  Jefferson, LA
  Orleans, LA
  Plaquemines, LA
  St. Bernard, LA
  St. Charles, LA
  St. James, LA
  St. John The Baptist, LA
  St. Tammany, LA
5600 New York, NY \1\.........................................    1.4414
  Bronx, NY
  Kings, NY
  New York, NY
  Putnam, NY
  Queens, NY
  Richmond, NY
  Rockland, NY
  Westchester, NY
5640 Newark, NJ \1\...........................................    1.1406
  Essex, NJ
  Morris, NJ
  Sussex, NJ
  Union, NJ
  Warren, NJ
5660 Newburgh, NY-PA..........................................    1.1387
  Orange, NY
  Pike, PA
5720 Norfolk-Virginia Beach-Newport News, VA-NC \1\...........    0.8574
  Currituck, NC
  Chesapeake City, VA
  Gloucester, VA
  Hampton City, VA
  Isle of Wight, VA
  James City, VA
  Mathews, VA
  Newport News City, VA
  Norfolk City, VA
  Poquoson City, VA
  Portsmouth City, VA
  Suffolk City, VA
  Virginia Beach City VA
  Williamsburg City, VA
  York, VA
5775 Oakland, CA \1\..........................................    1.5185
  Alameda, CA
  Contra Costa, CA
5790 Ocala, FL................................................    0.9402
  Marion, FL
5800 Odessa-Midland, TX.......................................    0.9397
  Ector, TX
  Midland, TX
5880 Oklahoma City, OK \1\....................................    0.8900
  Canadian, OK
  Cleveland, OK
  Logan, OK
  McClain, OK
  Oklahoma, OK
  Pottawatomie, OK
5910 Olympia, WA..............................................    1.0960
  Thurston, WA
5920 Omaha, NE-IA.............................................    0.9978
  Pottawattamie, IA
  Cass, NE
  Douglas, NE
  Sarpy, NE
  Washington, NE
5945 Orange County, CA \1\....................................    1.1594
  Orange, CA
5960 Orlando, FL \1\..........................................    0.9640
  Lake, FL
  Orange, FL
  Osceola, FL
  Seminole, FL
5990 Owensboro, KY............................................    0.8344
  Daviess, KY
6015 Panama City, FL..........................................    0.8865
  Bay, FL
6020 Parkersburg-Marietta, WV-OH (WV Hospitals)...............    0.8127
  Washington, OH
  Wood, WV
6020 Parkersburg-Marietta, WV-OH (OH Hospitals) \2\...........    0.8613
  Washington, OH
  Wood, WV
6080 Pensacola, FL \2\........................................    0.8814
  Escambia, FL
  Santa Rosa, FL
6120 Peoria-Pekin, IL.........................................    0.8739
  Peoria, IL
  Tazewell, IL
  Woodford, IL
6160 Philadelphia, PA-NJ \1\..................................    1.0713
  Burlington, NJ
  Camden, NJ
  Gloucester, NJ
  Salem, NJ
  Bucks, PA
  Chester, PA
  Delaware, PA
  Montgomery, PA
  Philadelphia, PA
6200 Phoenix-Mesa, AZ \1\.....................................    0.9820
  Maricopa, AZ
  Pinal, AZ
6240 Pine Bluff, AR...........................................    0.7962
  Jefferson, AR
6280 Pittsburgh, PA \1\.......................................    0.9365
  Allegheny, PA
  Beaver, PA
  Butler, PA
  Fayette, PA
  Washington, PA
  Westmoreland, PA
6323 Pittsfield, MA \2\.......................................    1.1288
  Berkshire, MA
6340 Pocatello, ID............................................    0.9674
  Bannock, ID
6360 Ponce, PR................................................    0.5169
  Guayanilla, PR
  Juana Diaz, PR
  Penuelas, PR
  Ponce, PR
  Villalba, PR
  Yauco, PR
6403 Portland, ME.............................................    0.9794
  Cumberland, ME
  Sagadahoc, ME
  York, ME
6440 Portland-Vancouver, OR-WA \1\............................    1.0684
  Clackamas, OR
  Columbia, OR
  Multnomah, OR
  Washington, OR
  Yamhill, OR
  Clark, WA
6483 Providence-Warwick-Pawtucket, RI \1\.....................    1.0854
  Bristol, RI
  Kent, RI
  Newport, RI
  Providence, RI
  Washington, RI
6520 Provo-Orem, UT...........................................    0.9984
  Utah, UT
6560 Pueblo, CO \2\...........................................    0.9015
  Pueblo, CO
6580 Punta Gorda, FL..........................................    0.9218
  Charlotte, FL
6600 Racine, WI...............................................    0.9334
  Racine, WI
6640 Raleigh-Durham-Chapel Hill, NC \1\.......................    0.9990
  Chatham, NC
  Durham, NC
  Franklin, NC
  Johnston, NC
  Orange, NC
  Wake, NC

[[Page 67043]]

 
6660 Rapid City, SD...........................................    0.8846
  Pennington, SD
6680 Reading, PA..............................................    0.9295
  Berks, PA
6690 Redding, CA..............................................    1.1135
  Shasta, CA
6720 Reno, NV.................................................    1.0648
  Washoe, NV
6740 Richland-Kennewick-Pasco, WA.............................    1.1491
  Benton, WA
  Franklin, WA
6760 Richmond-Petersburg, VA..................................    0.9477
  Charles City County, VA
  Chesterfield, VA
  Colonial Heights City, VA
  Dinwiddie, VA
  Goochland, VA
  Hanover, VA
  Henrico, VA
  Hopewell City, VA
  New Kent, VA
  Petersburg City, VA
  Powhatan, VA
  Prince George, VA
  Richmond City, VA
6780 Riverside-San Bernardino, CA \1\.........................    1.1365
  Riverside, CA
  San Bernardino, CA
6800 Roanoke, VA..............................................    0.8614
  Botetourt, VA
  Roanoke, VA
  Roanoke City, VA
  Salem City, VA
6820 Rochester, MN............................................    1.2139
  Olmsted, MN
6840 Rochester, NY \1\........................................    0.9194
  Genesee, NY
  Livingston, NY
  Monroe, NY
  Ontario, NY
  Orleans, NY
  Wayne, NY
6880 Rockford, IL.............................................    0.9625
  Boone, IL
  Ogle, IL
  Winnebago, IL
6895 Rocky Mount, NC..........................................    0.9228
  Edgecombe, NC
  Nash, NC
6920 Sacramento, CA \1\.......................................    1.1513
  El Dorado, CA
  Placer, CA
  Sacramento, CA
6960 Saginaw-Bay City-Midland, MI.............................    0.9650
  Bay, MI
  Midland, MI
  Saginaw, MI
6980 St. Cloud, MN............................................    0.9785
  Benton, MN
  Stearns, MN
7000 St. Joseph, MO \2\.......................................    0.8026
  Andrew, MO
  Buchanan, MO
7040 St. Louis, MO-IL \1\.....................................    0.8855
  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................................................    1.0367
  Marion, OR
  Polk, OR
7120 Salinas, CA..............................................    1.4623
  Monterey, CA
7160 Salt Lake City-Ogden, UT \1\.............................    0.9945
  Davis, UT
  Salt Lake, UT
  Weber, UT
7200 San Angelo, TX...........................................    0.8374
  Tom Green, TX
7240 San Antonio, TX \1\......................................    0.8753
  Bexar, TX
  Comal, TX
  Guadalupe, TX
  Wilson, TX
7320 San Diego, CA \1\........................................    1.1135
  San Diego, CA
7360 San Francisco, CA \1\....................................    1.4142
  Marin, CA
  San Francisco, CA
  San Mateo, CA
7400 San Jose, CA \1\.........................................    1.4145
  Santa Clara, CA
7440 San Juan-Bayamon, PR \1\.................................    0.4741
  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...............    1.1271
  San Luis Obispo, CA
7480 Santa Barbara-Santa Maria-Lompoc, CA.....................    1.0481
  Santa Barbara, CA
7485 Santa Cruz-Watsonville, CA...............................    1.3646
  Santa Cruz, CA
7490 Santa Fe, NM.............................................    1.0712
  Los Alamos, NM
  Santa Fe, NM
7500 Santa Rosa, CA...........................................    1.3046
  Sonoma, CA
7510 Sarasota-Bradenton, FL...................................    0.9449
  Manatee, FL
  Sarasota, FL
7520 Savannah, GA.............................................    0.9376
  Bryan, GA
  Chatham, GA
  Effingham, GA
7560 Scranton--Wilkes-Barre--Hazleton, PA.....................    0.8599
  Columbia, PA
  Lackawanna, PA
  Luzerne, PA
  Wyoming, PA
7600 Seattle-Bellevue-Everett, WA \1\.........................    1.1474
  Island, WA
  King, WA
  Snohomish, WA
7610 Sharon, PA \2\...........................................    0.8462
  Mercer, PA
7620 Sheboygan, WI \2\........................................    0.9162
  Sheboygan, WI
7640 Sherman-Denison, TX......................................    0.9255
  Grayson, TX
7680 Shreveport-Bossier City, LA..............................    0.8987
  Bossier, LA
  Caddo, LA
  Webster, LA
7720 Sioux City, IA-NE........................................    0.9046
  Woodbury, IA
  Dakota, NE
7760 Sioux Falls, SD..........................................    0.9257
  Lincoln, SD
  Minnehaha, SD
7800 South Bend, IN...........................................    0.9802
  St. Joseph, IN
7840 Spokane, WA..............................................    1.0852
  Spokane, WA
7880 Springfield, IL..........................................    0.8659
  Menard, IL
  Sangamon, IL
7920 Springfield, MO..........................................    0.8424
  Christian, MO
  Greene, MO
  Webster, MO
8003 Springfield, MA \2\......................................    1.1288
  Hampden, MA
  Hampshire, MA
8050 State College, PA........................................    0.8941
  Centre, PA
8080 Steubenville-Weirton, OH-WV..............................    0.8804
  Jefferson, OH
  Brooke, WV
  Hancock, WV
8120 Stockton-Lodi, CA........................................    1.0650
  San Joaquin, CA
8140 Sumter, SC \2\...........................................    0.8607
  Sumter, SC
8160 Syracuse, NY.............................................    0.9714
  Cayuga, NY
  Madison, NY
  Onondaga, NY

[[Page 67044]]

 
  Oswego, NY
8200 Tacoma, WA...............................................    1.0940
  Pierce, WA
8240 Tallahassee, FL \2\......................................    0.8814
  Gadsden, FL
  Leon, FL
8280 Tampa-St. Petersburg-Clearwater, FL \1\..................    0.9171
  Hernando, FL
  Hillsborough, FL
  Pasco, FL
  Pinellas, FL
8320 Terre Haute, IN \2\......................................    0.8755
  Clay, IN
  Vermillion, IN
  Vigo, IN
8360 Texarkana,AR-Texarkana, TX...............................    0.8126
  Miller, AR
  Bowie, TX
8400 Toledo, OH...............................................    0.9810
  Fulton, OH
  Lucas, OH
  Wood, OH
8440 Topeka, KS...............................................    0.9199
  Shawnee, KS
8480 Trenton, NJ..............................................    1.0432
  Mercer, NJ
8520 Tucson, AZ...............................................    0.8911
  Pima, AZ
8560 Tulsa, OK................................................    0.8332
  Creek, OK
  Osage, OK
  Rogers, OK
  Tulsa, OK
  Wagoner, OK
8600 Tuscaloosa, AL...........................................    0.8203
  Tuscaloosa, AL
8640 Tyler, TX................................................    0.9521
  Smith, TX
8680 Utica-Rome, NY \2\.......................................    0.8542
  Herkimer, NY
  Oneida, NY
8720 Vallejo-Fairfield-Napa, CA...............................    1.3421
  Napa, CA
  Solano, CA
8735 Ventura, CA..............................................    1.1096
  Ventura, CA
8750 Victoria, TX.............................................    0.8756
  Victoria, TX
8760 Vineland-Millville-Bridgeton, NJ.........................    1.0031
  Cumberland, NJ
8780 Visalia-Tulare-Porterville, CA \2\.......................    0.9840
  Tulare, CA
8800 Waco, TX.................................................    0.8088
  McLennan, TX
8840 Washington, DC-MD-VA-WV \1\..............................    1.0851
  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.................................    0.8902
  Black Hawk, IA
8940 Wausau, WI...............................................    0.9782
  Marathon, WI
8960 West Palm Beach-Boca Raton, FL \1\.......................    0.9939
  Palm Beach, FL
9000 Wheeling, WV-OH (WV Hospitals) \2\.......................    0.7975
  Belmont, OH
  Marshall, WV
  Ohio, WV
9000 Wheeling, WV-OH (OH Hospitals) \2\.......................    0.8613
  Belmont, OH
  Marshall, WV
  Ohio, WV
9040 Wichita, KS..............................................    0.9520
  Butler, KS
  Harvey, KS
  Sedgwick, KS
9080 Wichita Falls, TX........................................    0.8498
  Archer, TX
  Wichita, TX
9140 Williamsport, PA.........................................    0.8544
  Lycoming, PA
9160 Wilmington-Newark, DE-MD.................................    1.1173
  New Castle, DE
  Cecil, MD
9200 Wilmington, NC...........................................    0.9640
  New Hanover, NC
  Brunswick, NC
9260 Yakima, WA...............................................    1.0569
  Yakima, WA
9270 Yolo, CA \2\.............................................    0.9840
  Yolo, CA
9280 York, PA.................................................    0.9026
  York, PA
9320 Youngstown-Warren, OH....................................    0.9358
  Columbiana, OH
  Mahoning, OH
  Trumbull, OH
9340 Yuba City, CA............................................    1.0276
  Sutter, CA
  Yuba, CA
9360 Yuma, AZ.................................................    0.8589
  Yuma, AZ
------------------------------------------------------------------------
 \1\Large Urban Area.
 \2\Hospitals geographically located in the area are assigned the
  statewide rural wage index for FY 2003.


                 Addendum I.--Wage Index for Rural Areas
------------------------------------------------------------------------
                                                                  Wage
                         Nonurban area                            index
------------------------------------------------------------------------
Alabama.......................................................    0.7727
Alaska........................................................    1.2293
Arizona.......................................................    0.8493
Arkansas......................................................    0.7666
California....................................................    0.9840
Colorado......................................................    0.9015
Connecticut...................................................    1.2394
Delaware......................................................    0.9128
Florida.......................................................    0.8814
Georgia.......................................................    0.8230
Hawaii........................................................    1.0255
Idaho.........................................................    0.8747
Illinois......................................................    0.8204
Indiana.......................................................    0.8755
Iowa..........................................................    0.8315
Kansas........................................................    0.7923
Kentucky......................................................    0.8079
Louisiana.....................................................    0.7647
Maine.........................................................    0.8874
Maryland......................................................    0.8946
Massachusetts.................................................    1.1288
Michigan......................................................    0.9013
Minnesota.....................................................    0.9151
Mississippi...................................................    0.7680
Missouri......................................................    0.8026
Montana.......................................................    0.8481
Nebraska......................................................    0.8204
Nevada........................................................    0.9577
New Hampshire.................................................    0.9796
New Jersey \1\................................................  ........
New Mexico....................................................    0.8872
New York......................................................    0.8542
North Carolina................................................    0.8666
North Dakota..................................................    0.7788
Ohio..........................................................    0.8613
Oklahoma......................................................    0.7590
Oregon........................................................    1.0303
Pennsylvania..................................................    0.8462
Puerto Rico...................................................    0.4356
Rhode Island \1\..............................................  ........
South Carolina................................................    0.8607
South Dakota..................................................    0.7815
Tennessee.....................................................    0.7877
Texas.........................................................    0.7827
Utah..........................................................    0.9312
Vermont.......................................................    0.9345
Virginia......................................................    0.8504
Washington....................................................    1.0179
West Virginia.................................................    0.7975
Wisconsin.....................................................    0.9162
Wyoming.......................................................   0.9007
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban.


[[Page 67045]]


       Addendum J.--Wage Index for Hospitals That Are Reclassified
------------------------------------------------------------------------
                                                                  Wage
                             Area                                 index
------------------------------------------------------------------------
Abilene, TX...................................................    0.7827
Akron, OH.....................................................    0.9600
Albany, GA....................................................    1.0427
Albuquerque, NM...............................................    0.9390
Alexandria, LA................................................    0.7883
Allentown-Bethlehem-Easton, PA................................    0.9735
Altoona, PA...................................................    0.9225
Amarillo, TX..................................................    0.8884
Anchorage, AK.................................................    1.2490
Ann Arbor, MI.................................................    1.1103
Anniston, AL..................................................    0.7910
Asheville, NC.................................................    0.9575
Athens, GA....................................................    1.0066
Atlanta, GA...................................................    0.9889
Augusta-Aiken, GA-SC..........................................    0.9887
Austin-San Marcos, TX.........................................    0.9637
Barnstable-Yarmouth, MA.......................................    1.2943
Baton Rouge, LA...............................................    0.8190
Bellingham, WA................................................    1.1642
Benton Harbor, MI.............................................    0.9106
Bergen-Passaic, NJ............................................    1.2207
Billings, MT..................................................    0.9022
Biloxi-Gulfport-Pascagoula, MS................................    0.8368
Binghamton, NY................................................    0.8462
Birmingham, AL................................................    0.9222
Bismarck, ND..................................................    0.7972
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH..............    1.1235
Burlington, VT................................................    0.9572
Caguas, PR....................................................    0.4408
Casper, WY....................................................    0.9586
Champaign-Urbana, IL..........................................    0.9772
Charleston-North Charleston, SC...............................    0.9235
Charleston, WV................................................    0.8649
Charlotte-Gastonia-Rock Hill, NC-SC...........................    0.9743
Charlottesville, VA...........................................    1.0120
Chattanooga, TN-GA............................................    0.8843
Chicago, IL...................................................    1.0905
Cincinnati, OH-KY-IN..........................................    0.9389
Clarksville-Hopkinsville, TN-KY...............................    0.8419
Cleveland-Lorain-Elyria, OH...................................    0.9670
Columbia, MO..................................................    0.8515
Columbia, SC..................................................    0.9194
Columbus, GA-AL (GA Hospitals)................................    0.8230
Columbus, GA-AL (AL Hospitals)................................    0.7985
Columbus, OH..................................................    0.9549
Corpus Christi, TX............................................    0.8729
Dallas, TX....................................................    0.9998
Davenport-Moline-Rock Island, IA-IL...........................    0.8835
Dayton-Springfield, OH........................................    0.9282
Denver, CO....................................................    1.0484
Des Moines, IA................................................    0.8827
Detroit, MI...................................................    1.0448
Dothan, AL....................................................    0.8158
Dover, DE.....................................................    0.9254
Duluth-Superior, MN-WI........................................    1.0368
Eau Claire, WI................................................    0.9162
Elkhart-Goshen, IN............................................    0.9516
Erie, PA......................................................    0.8761
Eugene-Springfield, OR........................................    1.0944
Fargo-Moorhead, ND-MN.........................................    0.9468
Fayetteville, NC..............................................    0.8992
Flagstaff, AZ-UT..............................................    1.0131
Flint, MI.....................................................    1.0963
Florence, AL..................................................    0.7819
Florence, SC..................................................    0.8780
Fort Collins-Loveland, CO.....................................    1.0066
Ft. Lauderdale, FL............................................    1.0704
Fort Pierce-Port St. Lucie, FL................................    0.9931
Fort Smith, AR-OK.............................................    0.7738
Fort Walton Beach, FL.........................................    0.9430
Forth Worth-Arlington, TX.....................................    0.9446
Gadsden, AL...................................................    0.8599
Gainesville, FL...............................................    0.9871
Grand Forks, ND-MN............................................    0.9243
Grand Junction, CO............................................    0.9679
Grand Rapids-Muskegon-Holland, MI.............................    0.9548
Great Falls, MT...............................................    0.8966
Greeley, CO...................................................    0.9336
Green Bay, WI.................................................    0.9668
Greensboro-Winston-Salem-High Point, NC.......................    0.9129
Greenville, NC................................................    0.9174
Harrisburg-Lebanon-Carlisle, PA...............................    0.9223
Hartford, CT..................................................    1.1549
Hattiesburg, MS...............................................    0.7680
Hickory-Morganton-Lenoir, NC..................................    0.8926
Houston, TX...................................................    0.9792
Huntington-Ashland, WV-KY-OH..................................    0.9167
Huntsville, AL................................................    0.8771
Indianapolis, IN..............................................    0.9717
Iowa City, IA.................................................    0.9442
Jackson, MS...................................................    0.8607
Jackson, TN...................................................    0.9002
Jacksonville, FL..............................................    0.9237
Johnson City-Kingsport-Bristol, TN-VA (VA Hospitals)..........    0.8504
Johnson City-Kingsport-Bristol, TN-VA (KY Hospitals)..........    0.8337
Jonesboro, AR (AR Hospitals)..................................    0.7843
Jonesboro, AR (MO Hospitals)..................................    0.8026
Joplin, MO....................................................    0.8613
Kalamazoo-Battlecreek, MI.....................................    1.0400
Kansas City, KS-MO............................................    0.9736
Knoxville, TN.................................................    0.8970
Kokomo, IN....................................................    0.9038
Lafayette, LA.................................................    0.8316
Lakeland-Winter Haven, FL.....................................    0.9357
Las Vegas, NV-AZ..............................................    1.1521
Lawton, OK....................................................    0.8077
Lexington, KY.................................................    0.8581
Lima, OH......................................................    0.9483
Lincoln, NE...................................................    0.9711
Little Rock-North Little Rock, AR.............................    0.8951
Longview-Marshall, TX.........................................    0.8629
Los Angeles-Long Beach, CA....................................    1.2011
Louisville, KY-IN.............................................    0.9163
Lubbock, TX...................................................    0.9646
Lynchburg, VA.................................................    0.8909
Macon, GA.....................................................    0.9250
Madison, WI...................................................    1.0467
Medford-Ashland, OR...........................................    1.0303
Memphis, TN-AR-MS.............................................    0.8712
Miami, FL.....................................................    0.9815
Milwaukee-Waukesha, WI........................................    0.9893
Minneapolis-St. Paul, MN-WI...................................    1.0903
Missoula, MT..................................................    0.9047
Mobile, AL....................................................    0.8110
Modesto, CA...................................................    1.0498
Monmouth-Ocean, NJ............................................    1.0814
Monroe, LA....................................................    0.8137
Montgomery, AL................................................    0.7734
Nashville, TN.................................................    0.9375
New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT...........    1.2459
New London-Norwich, CT........................................    1.1626
New Orleans, LA...............................................    0.9046
New York, NY..................................................    1.4220
Newark, NJ....................................................    1.1406
Newburgh, NY-PA...............................................    1.0747
Norfolk-Virginia Beach-Newport News, VA-NC....................    0.8666
Oakland, CA...................................................    1.5185
Odessa-Midland, TX............................................    0.9180
Oklahoma City, OK.............................................    0.8900
Omaha, NE-IA..................................................    0.9978
Orange County, CA.............................................    1.1594
Orlando, FL...................................................    0.9640
Peoria-Pekin, IL..............................................    0.8739
Philadelphia, PA-NJ...........................................    1.0713
Phoenix-Mesa, AZ..............................................    0.9820
Pine Bluff, AR................................................    0.7798
Pittsburgh, PA................................................    0.9224
Pittsfield, MA................................................    0.9863
Pocatello, ID.................................................    0.9674
Portland, ME..................................................    0.9620
Portland-Vancouver, OR-WA.....................................    1.0684
Provo-Orem, UT................................................    0.9984
Raleigh-Durham-Chapel Hill, NC................................    0.9990
Rapid City, SD................................................    0.8846
Reading, PA...................................................    0.9108
Redding, CA...................................................    1.1135
Reno, NV......................................................    1.0466
Richland-Kennewick-Pasco, WA..................................    1.0800
Richmond-Petersburg, VA.......................................    0.9477
Roanoke, VA...................................................    0.8614
Rochester, MN.................................................    1.2139
Rockford, IL..................................................    0.9399
Sacramento, CA................................................    1.1513
Saginaw-Bay City-Midland, MI..................................    0.9543
St. Cloud, MN.................................................    0.9785
St. Joseph, MO................................................    0.8240
St. Louis, MO-IL..............................................    0.8855
Salinas, CA...................................................    1.4623
Salt Lake City-Ogden, UT......................................    0.9945
San Antonio, TX...............................................    0.8753
San Diego, CA.................................................    1.1135
Santa Fe, NM..................................................    0.9891
Santa Rosa, CA................................................    1.2761
Sarasota-Bradenton, FL........................................    0.9449
Savannah, GA..................................................    0.9376
Seattle-Bellevue-Everett, WA..................................    1.1474
Sherman-Denison, TX...........................................    0.9008
Shreveport-Bossier City, LA...................................    0.8987
Sioux City, IA-NE.............................................    0.8647
Sioux Falls, SD...............................................    0.9059
South Bend, IN................................................    0.9802
Spokane, WA...................................................    1.0663
Springfield, IL...............................................    0.8659
Springfield, MO...............................................    0.8153
Stockton-Lodi, CA.............................................    1.0650
Syracuse, NY..................................................    0.9612
Tampa-St. Petersburg-Clearwater, FL...........................    0.9171
Texarkana,AR-Texarkana, TX....................................    0.8126
Toledo, OH....................................................    0.9810
Topeka, KS....................................................    0.9031
Tucson, AZ....................................................    0.8911
Tulsa, OK.....................................................    0.8332
Tuscaloosa, AL................................................    0.8203
Tyler, TX.....................................................    0.9195
Vallejo-Fairfield-Napa, CA....................................    1.3421
Victoria, TX..................................................    0.8756
Waco, TX......................................................    0.8088
Washington, DC-MD-VA-WV.......................................    1.0851

[[Page 67046]]

 
Waterloo-Cedar Falls, IA......................................    0.8902
Wausau, WI....................................................    0.9782
West Palm Beach-Boca Raton, FL................................    0.9939
Wichita, KS...................................................    0.9179
Wichita Falls, TX.............................................    0.8498
Wilmington-Newark, DE-MD......................................    1.0862
Wilmington, NC................................................    0.9425
York, PA......................................................    0.9026
Youngstown-Warren, OH.........................................    0.9358
Rural Alabama.................................................    0.7727
Rural Florida.................................................    0.8814
Rural Illinois (IA Hospitals).................................    0.8315
Rural Illinois (MO Hospitals).................................    0.8204
Rural Kentucky................................................    0.8079
Rural Louisiana...............................................    0.7647
Rural Michigan................................................    0.9013
Rural Minnesota...............................................    0.9151
Rural Missouri................................................    0.8026
Rural Montana.................................................    0.8481
Rural Nebraska................................................    0.8204
Rural Nevada..................................................    0.9117
Rural Texas...................................................    0.7827
Rural Washington..............................................    1.0179
Rural Wyoming.................................................    0.9007
------------------------------------------------------------------------

[FR Doc. 02-27548 Filed 10-31-02; 8:45 am]
BILLING CODE 4120-01-P