[Federal Register Volume 68, Number 155 (Tuesday, August 12, 2003)]
[Proposed Rules]
[Pages 47966-48248]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-20280]



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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 410 and 419



Medicare Program; Changes to the Hospital Outpatient Prospective 
Payment System and Calendar Year 2004 Payment Rates; Proposed Rule

  Federal Register / Vol. 68, No. 155 / Tuesday, August 12, 2003 / 
Proposed Rules  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 410 and 419

[CMS-1471-P]
RIN 0938-AL19


Medicare Program; Changes to the Hospital Outpatient Prospective 
Payment System and Calendar Year 2004 Payment Rates

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

ACTION: Proposed rule.

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SUMMARY: This proposed rule would revise the Medicare hospital 
outpatient prospective payment system to implement applicable statutory 
requirements and changes arising from our continuing experience with 
this system. In addition, it would describe proposed changes to the 
amounts and factors used to determine the payment rates for Medicare 
hospital outpatient services paid under the prospective payment system. 
These changes would be applicable to services furnished on or after 
January 1, 2004.

DATES: We will consider comments if we receive them at the appropriate 
address, as provided below, no later than 5 p.m. on October 6, 2003.

ADDRESSES: In commenting, please refer to file code CMS-1471-P. Because 
of staff and resource limitations, we cannot accept comments by 
facsimile (FAX) transmission or e-mail.
    Mail written comments (one original and two copies) to the 
following address ONLY:

Centers for Medicare & Medicaid Services, Department of Health and 
Human Services, Attention: CMS-1471-P, P.O. Box 8018, Baltimore, MD 
21244-8018.
    Please allow sufficient time for mailed comments to be timely 
received in the event of delivery delays.
    If you prefer, you may deliver (by hand or courier) your written 
comments (one original and two copies) to one of the following 
addresses:
Room 445-G, Hubert H. Humphrey Building, 200 Independence Avenue, SW., 
Washington, DC 20201, or Room C5-14-03, 7500 Security Boulevard, 
Baltimore, MD 21244-1850.

    (Because access to the interior of the HHH Building is not readily 
available to persons without Federal Government identification, 
commenters are encouraged to leave their comments in the CMS drop slots 
located in the main lobby of the building. A stamp-in clock is 
available for persons wishing to retain a proof of filing by stamping 
in and retaining an extra copy of the comments being filed.)
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and could be considered late.
    We encourage commenters submitting as comments information that 
contains beneficiary specific information (for example, medical 
records, or invoices with beneficiary identification) to remove any 
individually identifiable information, such as information that 
identifies an individual, diagnoses, addresses, telephone numbers, 
attending physician, medical record number, or Medicare or other 
insurance number. Moreover, individually identifiable beneficiary 
medical records, including progress notes, medical orders, test 
results, consultation reports, and photocopies of checks from hospitals 
or other documents that contain bank routing numbers should not be 
submitted to us. Persons or organizations submitting proprietary 
information as public comments must designate in writing if part or all 
of the information contained in such comments should be considered as 
exempt from disclosure under Exemption 4 of the Freedom of Information 
Act (FOIA). Generally, Exemption 4 of the FOIA protects trade secrets 
and commercial or financial information that is privileged or 
confidential, and affords the same protections as the Trade Secrets 
Act, which is also applicable. We will attempt to keep confidential and 
protect from disclosure information that qualifies under Exemption 4. 
However, only data that can be available for public inspection would be 
used for the final rule. For information on viewing public comments, 
see the beginning of the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Dana Burley, (410) 786-4532--
outpatient prospective payment issues; Suzanne Asplen, (410) 786-4558 
or Jana Petze, (410) 786-9374--partial hospitalization and community 
mental health centers issues.

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

Availability of Copies and Electronic Access

    Copies: To order copies of the Federal Register containing this 
document, send your request to: New Orders, Superintendent of 
Documents, P.O. Box 371954, Pittsburgh, PA 15250-7954. Specify the date 
of the issue requested and enclose a check or money order payable to 
the Superintendent of Documents, or enclose your Visa or Master Card 
number and expiration date. Credit card orders can also be placed by 
calling the order desk at (202) 512-1800 (or toll-free at 1-888-293-
6498) or by faxing to (202) 512-2250. The cost for each copy is $10. As 
an alternative, you can view and photocopy the Federal Register 
document at most libraries designated as Federal Depository Libraries 
and at many other public and academic libraries throughout the country 
that receive the Federal Register.
    This Federal Register document is also available from the Federal 
Register online database through GPO Access, a service of the U.S. 
Government Printing Office. The Web site address is: http://www.access.gpo.gov/nara/index.html.
    To assist readers in referencing sections contained in this 
document, we are providing the following table of contents.

Outline of Contents

I. Background
    A. Authority for the Outpatient Prospective Payment System
    B. Summary of Rulemaking for the Outpatient Prospective Payment 
System
II. Proposed Changes to the Ambulatory Payment Classification (APC) 
Groups and Relative Weights
    A. Recommendations of the Advisory Panel on APC Groups
    1. Establishment of the Advisory Panel on APC Groups
    2. The Panel's Meetings
    3. Establishment of an Observation Subcommittee
    4. Recommendations of the Advisory Panel and Our Responses
    B. Other Changes Affecting the APCs
    1. Limit on Variation of Costs of Services Classified Within an 
APC Group
    2. Procedures Moved from New Technology APCs to Clinically 
Appropriate APCs
    3. Revision of Cost Bands and Payment Amounts for New Technology 
APCs
    4. APC Assignment for New Codes Created During Calendar Year 
(CY) 2003
    5. Creation of APCs for Combinations of Device Procedures
    6. New APC for Antepartum Care
III. Recalibration of APC Weights for CY 2004

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    A. Data Issues
    1. Period of Claims Data Used
    2. Treatment of ``Multiple Procedure'' Claims
    3. Adjustment of Median Costs for CY 2003 OPPS
    B. Description of How We Propose To Calculate Weights for CY 
2004
IV. Transitional Pass-Through and Related Payment Issues
    A. Background
    B. Discussion of Pro Rata Reduction
V. Payment for Devices
    A. Pass-Through Devices
    B. Expiration of Transitional Pass-Through Payments in CY 2004
    C. Other Policy Issues Relating to Pass-Through Device 
Categories
VI. Payment for Drugs, Biologicals, Radiopharmaceutical Agents, 
Blood, and Blood Products
    A. Pass-Through Drugs and Biologicals
    B. Drugs, Biologicals, and Radiopharmaceuticals Without Pass-
Through Status
    1. Background
    2. Proposed Criteria for Packaging Payment for Drugs, 
Biologicals, and Radiopharmaceuticals
    3. Payment for Drugs, Biologicals, and Radiopharmaceuticals That 
Are Not Packaged
    4. Proposed Payment Methodology for Drug Administration
    5. Generic Drugs and Radiopharmaceuticals
    6. Orphan Drugs
    7. Vaccines
    8. Blood and Blood Products
    9. Intravenous Immune Globulin
    10. Drug and Device Coding
    11. Payment for Split Unit of Blood
    12. Other Issues
VII. Wage Index Changes for CY 2004
VIII. Copayment for CY 2004
IX. Conversion Factor Update for CY 2004
X. Proposed Outlier Policy and Elimination of Transitional Corridor 
Payments for CY 2004
    A. Proposed Outlier Policy for CY 2004
    B. Elimination of Transitional Corridor Payments for CY 2004
XI. Other Policy Decisions and Proposed Changes
    A. Hospital Coding for Evaluation and Management (E/M) Services
    B. Status Indicators and Issues Related to OCE Editing
    C. Observation Services
    D. Procedures That Will Be Paid Only As Inpatient Procedures
    E. Partial Hospitalization Payment Methodology
    1. Background
    2. PHP APC Update for CY 2004
    3. Outlier Payments to CMHCs
XII. Summary of and Responses to MedPAC Recommendations
XIII. Summary of Proposed Changes for 2004
    A. Changes Required by Statute
    B. Additional Changes
XIV. Collection of Information Requirements
XV. Response to Public Comments
XVI. Regulatory Impact Analysis
    A. General
    B. Changes in This Proposed Rule
    C. Limitations of Our Analysis
    D. Estimated Impacts of This Proposed Rule on Hospitals
    E. Projected Distribution of Outlier Payments
    F. Estimated Impacts of This Proposed Rule 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 E--CPT Codes That Would Be Paid Only as Inpatient 
Procedures
Addendum H--Wage Index for Urban Areas
Addendum I--Wage Index for Rural Areas
Addendum J--Wage Index for Hospitals That Are Reclassified
Addendum L--Packaged Nonchemotherapy Infusion Drugs
Addendum M--Separately Paid Nonchemotherapy Infusion Drugs
Addendum N--Packaged Chemotherapy Drugs Other Than Infusion
Addendum O--Separately Paid Chemotherapy Drugs Other Than Infusion
Addendum P--Packaged Chemotherapy Drugs Infusion Only
Addendum Q--Separately Paid Chemotherapy Drugs Infusion Only

Alphabetical List of Acronyms Appearing in the Proposed Rule

ACEP--American College of Emergency Physicians
AHA--American Hospital Association
AHIMA--American Health Information Management Association
AMA--American Medical Association
APC--Ambulatory payment classification
ASC--Ambulatory surgical center
AWP--Average wholesale price
BBA--Balanced Budget Act of 1997
BIPA--Medicare, Medicaid, and SCHIP Benefits Improvement and 
Protection Act of 2000
BBRA--Medicare, Medicaid, and SCHIP Balanced Budget Refinement Act 
of 1999
CAH--Critical access hospital
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--[Physicians'] Current Procedural Terminology, Fourth Edition, 
2002, copyrighted by the American Medical Association
CY--Calendar year
DMEPOS--Durable medical equipment, prosthetics, orthotics, and 
supplies
DRG--Diagnosis-related group
DSH--Disproportionate Share Hospital
EACH--Essential Access Community Hospital
E/M--Evaluation and management
ESRD--End-stage renal disease
FACA--Federal Advisory Committee Act
FDA--Food and Drug Administration
FI--Fiscal intermediary
FSS--Federal Supply Schedule
FY--Federal fiscal year
HCPCS--Healthcare Common Procedure Coding System
HCRIS--Hospital Cost Report Information System
HHA--Home health agency
HIPAA--Health Insurance Portability and Accountability Act of 1996
ICD-9-CM--International Classification of Diseases, Ninth Edition, 
Clinical Modification
IME--Indirect Medical Education
IPPS--(Hospital) inpatient prospective payment system
IVIG--Intravenous Immune Globulin
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
PHP--Partial hospitalization program
PM--Program memorandum
PPS--Prospective payment system
PPV--Pneumococcal pneumonia (virus)
PRA--Paperwork Reduction Act
RFA--Regulatory Flexibility Act
RRC--Rural Referral Center
SBA--Small Business Administration
SCH--Sole Community Hospital
SDP--Single drug pricer
SI--Status Indicator
TEFRA--Tax Equity and Fiscal Responsibility Act
TOPS--Transitional outpatient payments
USPDI--United States Pharmacopoeia Drug Information

I. Background

A. Authority for the Outpatient Prospective Payment System

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

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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.
    [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 November 2, 2001, we published a final rule (66 FR 
55857) that announced the Medicare OPPS conversion factor for calendar 
year (CY) 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. In 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 November 1, 2002, we published a final rule (67 FR 
66718) that revised the Medicare OPPS to update the payment weights and 
conversion factor for services payable under the 2003 OPPS on the basis 
of data from claims for services furnished from April 1, 2001 through 
March 31, 2002. The rule also removed from pass-through status most 
drugs and devices that had been paid under pass-through provisions in 
2002 as required by the applicable provisions of law governing the 
duration of pass-through payment.

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

    Under the OPPS, we pay for hospital outpatient services on a rate-
per-service basis that varies according to the APC group to which the 
service is assigned. Each APC weight represents the median hospital 
cost of the services included in that APC relative to the median 
hospital cost of the services included in APC 601, Mid-Level Clinic 
Visits. The APC weights are scaled to APC 601 because a mid-level 
clinic visit is one of the most frequently performed services in the 
outpatient setting.
    Section 1833(t)(9)(A) of the Act requires the Secretary to review 
the components of the OPPS not less often than annually and to revise 
the groups, relative payment weights, and other adjustments to take 
into account changes in medical practice, changes in technology, and 
the addition of new services, new cost data, and other relevant 
information and factors. Section 1833(t)(9)(A) of the Act requires the 
Secretary, beginning in 2001, to consult with an outside panel of 
experts to review 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, if elected by the Secretary) for an item 
or service in the group is more than 2 times greater than the lowest 
median cost for an 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

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unusual cases, such as low volume items and services.''
    For purposes of this proposed rule, we analyzed the APC groups 
within this statutory framework.

A. Recommendations of the Advisory Panel on APC Groups

1. Establishment of the Advisory Panel on APC Groups
    Section 1833(t)(9)(A) of the Act requires that we consult with an 
outside panel of experts, the Advisory Panel on APC Groups (the Panel), 
to review the clinical integrity of the groups and weights. The Act 
specifies that the Panel will act in an advisory capacity. This expert 
panel, which is to be composed of representatives of providers subject 
to the OPPS (currently employed full-time, in their respective areas of 
expertise), reviews and advises 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 is technical in nature 
and is governed by the provisions of the Federal Advisory Committee Act 
(FACA) as amended (Pub. L. 92-463).
    On November 1, 2002, the Secretary renewed the charter. The new 
charter indicates that the Panel continues to be technical in nature, 
is governed by the provisions of the FACA, may convene ``up to three 
meetings per year,'' and is chaired by a Federal official.
    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 a 
colleague or themselves. After carefully reviewing the applications, we 
chose 15 highly qualified individuals to serve on the Panel.
    Because of the loss of 6 Panel members in March 2003 due to the 
expiration of terms of office, retirement, and a career change, a 
Federal Register notice was published on February 28, 2003 (68 FR 
9671), requesting nominations of Panel members. From the 40 nominations 
we received, 6 new members have been chosen and will be identified on 
the CMS Web site.
2. The Panel's Meetings
    The first Panel meeting was held on February 27, February 28, and 
March 1, 2001. 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 on January 22, 2002, 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 ([Physicians'] Current Procedural Technology) 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 these Subcommittee recommendations.
    The third Panel meeting was held on January 21 and 22, 2003, to 
discuss the APCs of the newly implemented 2003 OPPS. We published a 
notice in the Federal Register on December 27, 2002 (67 FR 79107), to 
announce the following: The location and time of the third Panel 
meeting; a list of agenda items; and that the meeting was open to the 
public. In that document, we solicited public comment specifically on 
the items included on the agenda for the January 2003 Panel meeting. In 
this section, ``commenter'' refers to entities that provided comments 
in response to that Federal Register notice. We also provided 
additional information about the Panel meeting through a press release 
and on the CMS Web site. Presentations for the 2003 meeting met, at a 
minimum, the adopted guidelines for presentations referred to above.
3. Establishment of an Observation Subcommittee
    At the third annual meeting in January 2003, the Panel suggested 
numerous changes to the APCs (listed below) and that a subcommittee be 
established to review observation issues, such as allowable 
International Classification of Diseases, clinical modification codes, 
and operational issues. Therefore, before the close of the third annual 
meeting, the Observation Subcommittee was established. Other Panel 
members that are not currently participating in this subcommittee are 
welcome to take part in this subcommittee, which is tasked with 
reviewing International Classification of Disease Codes, clinical 
modification codes, and operational issues related to observation. This 
subcommittee will report its findings to the Panel in 1 year.
4. Recommendations of the Advisory Panel and Our Responses
    In this section, we consider the Panel's recommendations affecting 
specific APCs. The Panel based its recommendations on claims data for 
the period April 1, 2002 through September 30, 2002. This data set 
comprises a portion of the data that will be used to set 2004 payment 
rates. APC titles in this discussion are those that existed when the 
APC Panel met in January 2003. In a few cases, APC titles have been 
changed for this proposed rule, and, therefore, some APCs do not have 
the same title in Addendum A as they have in this section.
    The Panel's agenda included APCs that our staff believe violate the 
2 times rule as well as APCs for which comments were submitted. As 
discussed below, the Panel sometimes declined to recommend a change in 
an APC even though the APC appeared to violate the 2 times rule. In 
section II.B of this preamble, we discuss our proposals regarding the 2 
times rule based on the April 1, 2002 through December 31, 2002 data 
that we used to determine the proposed 2004 APC relative weights. 
Section II.B also details the criteria we used when deciding to propose 
exceptions to the 2 times rule.
    a. Debridement and Destruction.
    APC 0012: Level I Debridement & Destruction.
    APC 0013: Level II Debridement & Destruction.
    We expressed concern to the Panel that APCs 0012 and 0013 appear to 
violate the 2 times rule. In order to remedy these violations, we asked 
the Panel to consider the following changes:
    (1) Move the following codes from APC 0013 to APC 0012:

------------------------------------------------------------------------
               HCPCS                             Description
------------------------------------------------------------------------
11001.............................  Debride infected skin add-on.
11302.............................  Shave skin lesion.

[[Page 47970]]

 
15786.............................  Abrasion, lesion, single.
15793.............................  Chemical peel, nonfacial.
15851.............................  Removal of sutures.
16000.............................  Initial treatment of burn(s).
16025.............................  Treatment of burn(s).
------------------------------------------------------------------------

    (2) Move code 11057 (Trim skin lesions, over 4) from APC 0012 to 
APC 0013.
    The Panel agreed with our staff and recommended that we make these 
changes. We propose to accept the Panel's recommendation.
    b. Excision/Biopsy.
    APC 0019: Level I Excision/Biopsy.
    APC 0020: Level II Excision/Biopsy.
    APC 0021: Level III Excision/Biopsy.
    We expressed concern to the Panel that APCs 0019 and 0020 appear to 
violate the 2 times rule. In order to remedy these violations, we asked 
the Panel to consider the following changes:
    (1) Move the following HCPCS codes from APC 0019 to a new APC:

------------------------------------------------------------------------
               HCPCS                             Description
------------------------------------------------------------------------
11755.............................  Biopsy, nail unit.
11976.............................  Removal of contraceptive cap.
24200.............................  Removal of arm foreign body.
28190.............................  Removal of foot foreign body.
56605.............................  Biopsy of vulva/perineum.
56606.............................  Biopsy of vulva/perineum.
69100.............................  Biopsy of external ear.
------------------------------------------------------------------------

    (2) Move the following HCPCS codes from APC 0020 to APC 0021:

------------------------------------------------------------------------
               HCPCS                             Description
------------------------------------------------------------------------
11404.............................  Removal of skin lesion.
11423.............................  Removal of skin lesion.
11604.............................  Removal of skin lesion.
11623.............................  Removal of skin lesion.
------------------------------------------------------------------------

    The Panel recommended that we not change the structure of APCs 
0019, 0020, and 0021 at this time in the interest of preserving 
clinical homogeneity. We propose to accept the Panel's recommendation 
that we make no changes to the structure of these APCs for 2004. We 
plan to place these APCs on the Panel's agenda for the 2005 update.
    c. Thoracentesis/Lavage Procedures and Endoscopies.
    APC 0071: Level I Endoscopy Upper Airway.
    APC 0072: Level II Endoscopy Upper Airway.
    APC 0073: Level III Endoscopy Upper Airway.
    We expressed concern to the Panel that APCs 0071 and 0072 appear to 
violate the 2 times rule. In order to remedy these violations, we asked 
the Panel to consider the following changes:
    Move the following HCPCS codes as described below:

     Table 1.--HCPCS Codes Proposed To Be Redistributed From APCs 0071 and 0072 to APCs 0071, 0072, and 0073
----------------------------------------------------------------------------------------------------------------
                     HCPCS                                 Description               2003 APC        2004 APC
----------------------------------------------------------------------------------------------------------------
31505.........................................  Diagnostic laryngoscopy.........            0072            0071
31575.........................................  Diagnostic laryngoscopy.........            0071            0072
31720.........................................  Clearance of airways............            0072            0073
----------------------------------------------------------------------------------------------------------------

    The Panel recommended that we make the above changes. We propose to 
accept the Panel's recommendation, with the exception of CPT code 
31720. After reviewing an additional quarter of claims data that was 
not available at the time the Panel convened, placement of CPT code 
31720 into APC 0072 better reflects its resource consumption. 
Therefore, we propose to keep CPT code 31720 in APC 0072.
    d. Cardiac and Ambulatory Blood Pressure Monitoring.
    APC 0097: Cardiac and Ambulatory Blood Pressure Monitoring.
    We expressed concern to the Panel that APC 0097 appears to violate 
the 2 times rule. We asked the Panel to recommend options for resolving 
this violation, and suggested splitting APC 0097 into two APCs. The 
Panel recommended that the structure of APC 0097 should not be changed 
at this time based on clinical homogeneity considerations. We propose 
to accept the Panel's recommendation that we make no changes to APC 
0097 for 2004. We plan to place this APC on the Panel's agenda for the 
2005 update.
     e. Electrocardiograms.
    APC 0099: Electrocardiograms.
    APC 0340: Minor Ancillary Procedures.
    We expressed concern to the Panel that APC 0099 appears to violate 
the 2 times rule. We asked the Panel to recommend options for resolving 
this violation, and suggested moving CPT code 93701 (Bioimpedance, 
thoracic) from APC 0099 to APC 0340. The Panel felt, however, that the 
structure of APC 0099 should not be changed at this time based on 
clinical homogeneity considerations. We propose to accept the Panel's 
recommendation that we make no changes to APC 0099 for 2004. We plan to 
place this APC on the Panel's agenda for the 2005 update.
    f. Cardiac Stress Tests.
    APC 0100: Cardiac Stress Tests.
    A presenter to the Panel, who represented a device manufacturer, 
requested that we move CPT code 93025 (Microvolt t-wave assessment) out 
of APC 0100. The presenter believes that the actual cost for this 
procedure is significantly higher than for other procedures in the same 
APC. Since this technology is often billed in conjunction with other 
procedures (for example, stress tests, CPT code 93017), few single-APC 
claims were available to evaluate the presenter's contention.
    The Panel felt the data presented are insufficient to merit moving 
the code and recommends that CPT code 93025 remain in APC 0100 until 
more data are available for review. We propose to accept the Panel's 
recommendation that CPT code 93025 remain in APC 0100 until more claims 
data become available for review.
    g. Revision/Removal of Pacemakers or Automatic Implantable 
Cardioverter Defibrillators.
    APC 0105: Revision/Removal of Pacemakers, AICD, or Vascular.
    We asked the Panel to review the codes within APC 0105 for an 
apparent violation of the 2 times rule, stating that we believe the 
apparent violation is a result of incorrectly coded claims. The Panel 
agreed and recommended no changes to APC 0105 at this time. We propose 
to accept the Panel's recommendation that we make no changes to APC 
0105 until more accurate claims data become available and support the 
need for a change.
    h. Sigmoidoscopy.
    APC 0146: Level I Sigmoidoscopy.
    APC 0147: Level II Sigmoidoscopy.
    We expressed concern to the Panel that relatively simple procedures 
such as anoscopy and rigid sigmoidoscopy have higher median costs than 
more complex procedures such as flexible sigmoidoscopy. Panel members 
suggested the high costs may be due to the need to perform an otherwise 
minor office procedure in a hospital setting (for example, due to the 
clinical condition of the patient). Panel members also suggested that 
claims may be incorrectly coded because coding

[[Page 47971]]

instructions do not clearly state how to code when the procedure 
performed is not as extensive as the procedure planned (for example, 
when a colonoscopy is planned but only a sigmoidoscopy is performed). 
In these cases, coding instructions are unclear as to whether the 
planned procedure should be reported with a modifier for reduced 
services or with the code for the actual procedure performed.
    The Panel recommended that we make no changes to APCs 0146 and 0147 
at this time. We propose to accept the Panel's recommendation that we 
make no changes to APCs 0146 and 0147. We plan to place this APC on the 
Panel's agenda for the 2005 update.
    i. Anal/Rectal Procedures.
    APC 0148: Level I Anal/Rectal Procedure.
    APC 0149: Level III Anal/Rectal Procedure.
    APC 0155: Level II Anal/Rectal Procedure.
    We expressed concern to the Panel that APCs 0148 and 0149 appear to 
violate the 2 times rule. We asked the Panel to recommend options for 
resolving these violations, and suggested rearranging some of the CPT 
codes within APCs 0148, 0149, and 0155. The Panel recommended that we 
move CPT code 46040 (Incision of rectal abscess) from APC 0155 to APC 
0149. We propose to accept the Panel's recommendation.
    j. Insertion of Penile Prosthesis.
    APC 0179: Urinary Incontinence Procedures.
    APC 0182: Insertion of Penile Prosthesis.
    A presenter to the Panel representing manufacturers and providers 
requested that APC 0182 be split into two APCs, based on whether the 
procedure used inflatable or non-inflatable penile prostheses. The 
presenter stated that the complexity of the procedure, the cost of the 
devices, and related resources were all significantly higher with 
inflatable prostheses.
    The Panel recommended that we eliminate APCs 0179 and 0182 and 
create two new APCs, 0385 and 0386 that contain the following CPT 
codes:

------------------------------------------------------------------------
               HCPCS                             Description
------------------------------------------------------------------------
APC 0385:
  52282............................  Cystoscopy, implant stent.
  53440............................  Correct bladder function.
  53444............................  Insert tandem cuff.
  54400............................  Insert semi-rigid prosthesis.
  54416............................  Remv/repl penis contain prosthesis.
APC 0386:
  53445............................  Insert uro/ves nck sphincter.
  53447............................  Remove/replace ur sphincter.
  54401............................  Insert self-contained prosthesis.
  54405............................  Insert multi-comp penis prosthesis.
  54410............................  Remove/replace penis prosthesis.
------------------------------------------------------------------------

    We propose to accept the Panel's recommendation to eliminate APCs 
0179 and 0182 and create two new APCs, 0644 and 0645, containing the 
above CPT code configurations.
    k. Surgical Hysteroscopy.
    APC 0190: Surgical Hysteroscopy.
    A presenter to the Panel, who represented a device manufacturer, 
requested that we move CPT code 58563 (Hysteroscopy, ablation) from APC 
0190 to a higher paying APC. The presenter noted that endometrial 
cryoablation is included in a new technology APC, while a thermal 
ablation system is included with older, less costly techniques. The 
presenter expressed concern that cryoablation may be reimbursed at a 
higher rate than the thermal ablation system, giving its manufacturers 
an unfair competitive advantage.
    Panel members agreed that new, more expensive technologies that 
prove to be more effective merit review for a higher payment rate. 
Without substantial evidence of greater effectiveness, however, the 
Panel was reluctant to create APCs that provide an incentive to use a 
more expensive device. In its discussion of whether or not to recommend 
moving CPT code 58563 to a higher paying APC, the Panel recommended 
that we take into account different methods of endometrial ablation 
associated with hysteroscopy, adequately reflect the resources used for 
the various procedures, avoid creating a competitive advantage or 
disadvantage, and collect data needed to track costs on the type of 
technologies used for this procedure.
    After consulting with experts in the field, we propose to split APC 
0190 (Surgical Hysteroscopy) into 2 APCs that are more clinically 
homogeneous. We propose to change the description for APC 0190 from 
``Surgical Hysteroscopy'' to ``Level I Hysteroscopy'' and keep the 
following HCPCS codes in APC 0190:

------------------------------------------------------------------------
               HCPCS                             Description
------------------------------------------------------------------------
58558.............................  Hysteroscopy, biopsy.
58559.............................  Hysteroscopy, lysis.
58562.............................  Hysteroscopy, remove fb.
58579.............................  Hysteroscope procedure.
------------------------------------------------------------------------

    We also propose to move the following HCPCS codes from APC 0190 to 
newly created APC 0387 titled ``Level II Hysteroscopy'':

------------------------------------------------------------------------
               HCPCS                             Description
------------------------------------------------------------------------
58560.............................  Hysteroscopy, resect septum.
58561.............................  Hysteroscopy, remove myoma.
58563.............................  Hysteroscopy, ablation.
------------------------------------------------------------------------

    In addition, we propose to move the following HCPCS codes as 
described below:

                 Table 2.--HCPCS Codes Proposed To Be Redistributed to APCs 0130, 0195, and 0190
----------------------------------------------------------------------------------------------------------------
                     HCPCS                                 Description               2003 APC        2004 APC
----------------------------------------------------------------------------------------------------------------
58578.........................................  Laparoscopic procedure, uterus..            0190            0130
58353.........................................  Endometrial ablate, thermal.....            0193            0195
58555.........................................  Hysteroscopy, diagnostic, sep.              0194            0190
                                                 procedure.
----------------------------------------------------------------------------------------------------------------

    We believe these proposed changes take into account the different 
technologies used to perform these procedures while maintaining the 
clinical comparability of these APCs as well as improving their 
homogeneity in terms of resource consumption.
    l. Female Reproductive Procedures.
    APC 0195: Level VII Female Reproductive Proc. APC 0202: Level VIII 
Female Reproductive Proc.
    A commenter requested that we place CPT code 57288 (Repair bladder 
defect) in its own APC because it requires the use of a device. Our 
staff suggested that CPT codes 57288 and 57287 remain in APC 0202, 
while the remaining codes in APC 0202 be moved to APC 0195:

------------------------------------------------------------------------
               HCPCS                             Description
------------------------------------------------------------------------
57109.............................  Vaginectomy partial w/nodes.
58920.............................  Partial removal of ovary(s).
58925.............................  Removal of ovarian cyst(s).
------------------------------------------------------------------------

    The Panel agreed with our staff, and we propose to accept the 
Panel's recommendation to move CPT codes

[[Page 47972]]

57109, 58920, and 58925 from APC 0202 to APC 0195.
    m. Nerve Injections.
    APC 0203: Level IV Nerve Injections.
    APC 0204: Level I Nerve Injections.
    APC 0206: Level II Nerve Injections.
    APC 0207: Level III Nerve Injections.
    Several commenters suggested changes in the configuration of APCs 
0203, 0204, 0206, and 0207 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 these APCs. 
Several of these APCs include procedures associated with drugs or 
devices for which pass-through payments are scheduled to expire in 
2003.
    We requested the Panel's input regarding whether or not these APCs 
should be restructured. The Panel stated that the current configuration 
of APCs 0203, 0204, 0206, and 0207 is more clinically cohesive than the 
previous year's configuration and that more data should be collected 
before making any changes. We propose to accept the Panel's 
recommendation that we make no changes to the structure of these APCs 
until more data become available for review.
    n. Laminotomies and Laminectomies; Implantation of Pain Management 
Device.
    APC 0208: Laminotomies and Laminectomies.
    APC 0223: Implantation of Pain Management Device.
    A presenter to the Panel, who represented a device manufacturer, 
requested that we move CPT code 62351 (Implant spinal canal catheter) 
from APC 0208 to APC 0223 to better capture the device cost that may be 
involved with the procedure. The Panel felt the data were insufficient 
to merit moving the code and recommended that CPT code 62351 remain in 
APC 0208 until more data are available for review. We propose to accept 
the Panel's recommendation that CPT code 62351 remain in APC 0208 until 
more claims data become available for review.
    o. Extended EEG Studies and Sleep Studies; Electroencephalogram.
    APC 0209: Extended EEG Studies and Sleep Studies, Level II.
    APC 0213: Extended EEG Studies and Sleep Studies, Level I.
    APC 0214: Electroencephalogram.
    We expressed concern to the Panel that APC 0213 appears to 
minimally violate the 2 times rule. In order to remedy this violation, 
we asked the Panel to consider a commenter's suggestion that we move 
CPT code 95955 (EEG during surgery) from APC 0214 to APC 0213. The 
Panel agreed with the commenter's suggestion. We propose to accept the 
Panel's recommendation to move CPT code 95955 from APC 0214 to APC 
0213.
    p. Nerve and Muscle Tests.
    APC 0215: Level I Nerve and Muscle Tests.
    APC 0216: Level III Nerve and Muscle Tests.
    APC 0218: Level II Nerve and Muscle Tests.
    We expressed concern to the Panel that APC 0218 appears to violate 
the 2 times rule. In order to remedy this violation, one commenter 
requested that we move CPT codes 95921 (Autonomic nerve function test) 
and 95922 (Autonomic nerve function test) from APC 0218 to APC 0216, 
while another commenter requested that we move CPT code 95904 (Sensory 
nerve conduction test) from APC 0215 to APC 0218. Alternatively, our 
staff suggested to the Panel that the following CPT codes be moved from 
APC 0218 to APC 0215.

------------------------------------------------------------------------
               HCPCS                             Description
------------------------------------------------------------------------
95858.............................  Tensilon test & myogram.
95870.............................  Muscle test, nonparaspinal.
95900.............................  Motor nerve conduction test.
95903.............................  Motor nerve conduction test.
------------------------------------------------------------------------

    After considering all of the above proposals, the Panel recommended 
that we move CPT codes 95858, 95870, 95900, and 95903 from APC 0218 to 
APC 0215. We propose to accept the Panel's recommendation.
    q. Implantation of Drug Infusion Device.
    APC 0227: Implantation of Drug Infusion Device.
    APC 0227 contains only two CPT codes: one for implantation of 
programmable spine infusion pumps, 62362, and for implantation of non-
programmable spine infusion pumps, 62361. A commenter requested that we 
split APC 0227 into two APCs to recognize the cost difference between 
CPT code 62361 and CPT code 62362. However, since our cost data do not 
show a significant cost difference between the two devices and APC 227 
does not violate the 2 times rule, the Panel recommended that CPT codes 
62361 and 62362 remain in APC 0227. We propose to accept the Panel's 
recommendation.
    r. Ophthalmologic APCs.
    APC 0230: Level I Eye Tests & Treatments.
    APC 0235: Level I Posterior Segment Eye Procedures.
    APC 0236: Level II Posterior Segment Eye Procedures.
    APC 0698: Level II Eye Tests & Treatments.
    We advised the Panel that APCs 0230 and 0235 violate the 2 times 
rule but that the current configuration of these APCs reflects the 
Panel's previous recommendations. A presenter to the Panel, who 
represented a device manufacturer, expressed concern that the pass-
through device category ``New Technology: Intraocular Lens'' was 
discontinued and these devices are now packaged. The presenter asked 
the Panel to recommend that future new intraocular lens devices be 
considered for a new pass-through category.
    To remedy the violations to the 2 times rule, we asked the Panel to 
consider moving CPT code 67820 (Revise eyelashes) from APC 0230 to APC 
0698 and CPT code 67110 (Repair detached retina) from APC 0235 to APC 
0236. The Panel recommended that we make these changes. We propose to 
accept the Panel's recommendation and monitor the data for APC 0235 for 
possible review next year. The Panel also acknowledged that making 
recommendations concerning pass-through categories is beyond their 
purview.
    s. Skin Tests and Miscellaneous Red Blood Cell Tests; Transfusion 
Laboratory Procedures.
    APC 0341: Skin Tests and Miscellaneous Red Blood Cell Tests.
    APC 0345: Level I Transfusion Laboratory Procedures.
    We advised the Panel that APCs 0341 and 0345 minimally violate the 
2 times rule and suggested moving several CPT codes within these APCs 
into a new APC because a commenter expressed concern over the 
combination of skin tests and miscellaneous red blood cell tests in APC 
0341, asserting that services within this APC cannot be considered 
comparable with respect to resource usage.
    In order to remedy these violations to the 2 times rule, we 
suggested moving CPT code 86901 (Blood typing, Rh (D)) from APC 0345 to 
a new APC along with the following CPT codes from APC 0341:

------------------------------------------------------------------------
               HCPCS                             Description
------------------------------------------------------------------------
86880.............................  Coombs test, direct.
86885.............................  Coombs test, indirect, qualitative.
86886.............................  Coombs test, indirect, titer.
86900.............................  Blood typing, ABO.
------------------------------------------------------------------------

    The Panel recommended that we make the above changes. We propose to 
accept the Panel's recommendation to move HCPCS codes 86880, 86885, 
86886, and 86900 from APC 0341 to new APC 0409 and to move CPT code 
86901 (Blood typing, Rh (D)) from APC 0345 to new APC 0409.

[[Page 47973]]

    t. Otorhinolaryngologic Function Tests.
    APC 0363: Level I Otorhinolaryngologic Function Tests.
    APC 0660: Level II Otorhinolaryngologic Function Tests.
    We expressed concern to the Panel that APC 0660 appears to violate 
the 2 times rule and suggested moving CPT codes 92543 (Caloric 
vestibular test) and 92588 (Evoked auditory test) from APC 0660 to APC 
0363. The Panel recommended that we make these CPT code changes. We 
propose to accept the Panel's recommendation to move CPT codes 92543 
and 92588 from APC 0660 to APC 0363.
    u. Tube Changes and Repositioning.
    APC 0121: Level I Tube changes and Repositioning
    APC 0122: Level II Tube changes and Repositioning
    We expressed concern to the Panel that APC 0121 appears to violate 
the 2 times rule. In order to remedy this violation, we suggested 
moving the following CPT codes from APC 0121 to APC 0122:

------------------------------------------------------------------------
               HCPCS                             Description
------------------------------------------------------------------------
47530.............................  Revise/reinsert bile tube.
50688.............................  Change of ureter tube.
51710.............................  Change of bladder tube.
62225.............................  Replace/irrigate catheter.
------------------------------------------------------------------------

    The Panel recommended that we make these CPT code changes. We 
propose to accept the Panel's recommendation to move CPT codes 47530, 
50688, 51710, and 62225 from APC 0121 to APC 0122.
    v. Myelography.
    APC 0274: Myelography.
    We advised the Panel that APC 0274 minimally violates the 2 times 
rule and suggested moving CPT codes 72285 (X-ray c/t spine disk) and 
72295 (X-ray
c/t spine disk) from APC 0274 to a new APC. A presenter, from an 
organization representing radiologists, agreed with our proposal. The 
Panel recommended that we make these CPT code changes. We propose to 
accept the Panel's recommendation to move CPT codes 72285 and 72295 
from APC 0274 to new APC 0388.
    w. Therapeutic Radiologic Procedures.
    APC 0296: Level I Therapeutic Radiologic Procedures
    APC 0297: Level II Therapeutic Radiologic Procedures
    We advised the Panel that APCs 0296 and 0297 appear to minimally 
violate the 2 times rule as a result of changes recommended by the 
Panel and adopted by CMS last year. The Panel recommended that no 
changes be made to APCs 0296 and 0297 in the interest of preserving the 
clinical homogeneity of these APCs. We propose to accept the Panel's 
recommendation that we make no CPT code changes to APCs 0296 and 0297.
    x. Vascular Procedures; Cannula/Access Device Procedures.
    APC 0103: Miscellaneous Vascular Procedures
    APC 0115: Cannula/Access Device Procedures
    A commenter requested that we move CPT code 36860 (External cannula 
declotting) from APC 0103 to APC 0115, asserting that this procedure is 
more similar to other procedures in APC 0115 and does not fit well in 
its current miscellaneous APC. The Panel found that the claims data 
were insufficient to support moving CPT code 36860 from APC 0103 to the 
higher paying APC 0115 and recommends that CPT code 36860 remain in APC 
0103 until more data are available for review. We propose to accept the 
Panel's recommendation that CPT code 36860 remain in APC 0103 until 
more claims data become available for review.
    y. Angiography and Venography Except Extremity.
    APC 0279: Level II Angiography and Venography except Extremity.
    APC 0280: Level III Angiography and Venography except Extremity.
    APC 0668: Level I Angiography and Venography except Extremity.
    A commenter requested that we move CPT code 75978 (Repair venous 
blockage) from APC 0668 to APC 0280 and that we move CPT code 75774 
(Artery x-ray, each vessel) from APC 0668 to APC 0279. A presenter to 
the Panel testified that CPT code 75978 is commonly used for dialysis 
patients and often requires multiple intraoperative attempts to 
succeed; thus, it should be paid under APC 280. The Panel felt that 
APCs 0279, 0280, and 0668 were clinically homogenous and recommended 
that we only make changes after consulting with experts in the field. 
We propose to accept the Panel's recommendation to make no changes to 
APCs 0279, 0280, and 0668 until consulting with experts in the field. 
We plan to place these APCs on the Panel's agenda for the 2005 update.
    z. Computed Tomography (CT), Magnetic Resonance (MR), and 
Ultrasound Guidance Procedures Currently Packaged.
    APC 0332: Computerized Axial Tomography and Computerized 
Angiography without Contrast Material.
    APC 0335: Magnetic Resonance Imaging, Miscellaneous.
    APC 0268: Ultrasound Guidance Procedures.
    A presenter to the Panel expressed concern that the packaging of 
guidance procedures for tissue ablation does not recognize the 
significant difference in cost and time required to perform each 
procedure (for example, MRI vs. CT). This presenter felt that hospitals 
needed more education on the appropriate application of these codes. 
Another commenter requested that CPT codes 76362, 76394, and 76490 be 
changed from a status indicator of N to a status indicator of S and 
included in an appropriate clinical or new technology APC.
    The Panel agreed with the above comments and stated that the 
packaging of these three procedures made it difficult for hospitals to 
track their use for the purpose of allocating funds. The Panel 
recommended changing the following CPT codes from a packaged status (N 
status indicator) to a separately payable status (S status indicator) 
within the indicated APCs:

  Table 3.--HCPCS Codes Proposed To Be Designated as Separately Payable
------------------------------------------------------------------------
     HCPCS            Description          2003 status       2004 APC
------------------------------------------------------------------------
76362..........  CT scan for tissue     Packaged........            0332
                  ablation.
76394..........  MRI for tissue         Packaged........            0335
                  ablation.
76490..........  US for tissue          Packaged........            0268
                  ablation.
------------------------------------------------------------------------

    We propose to accept the Panel's recommendation to change HCPCS 
codes 76362, 76394, and 76490 from a packaged status to a separately 
payable status as indicated above.
    aa. Magnetic Resonance Imaging and Magnetic Resonance Angiography 
Without Contrast.

[[Page 47974]]

    APC 0336: Magnetic Resonance Imaging and Magnetic Resonance 
Angiography without Contrast
    A commenter requested that we change CPT code 76393 (MR guidance 
for needle placement) from a packaged status to a separately payable 
status within APC 0336. Based on clinical homogeneity considerations, 
the Panel agreed with the commenter and recommended that CPT code 76393 
be changed from a status indicator of N to a status indicator of S and 
placed in APC 0335. We propose to accept the Panel's recommendation.
    bb. Plain Film Except Teeth; Plain Film Except Teeth Including Bone 
Density Measurement.
    APC 0260: Level I Plain Film Except Teeth.
    APC 0261: Level II Plain Film Except Teeth Including Bone Density 
Measurement.
    APC 0272: Level I Fluoroscopy.
    A commenter requested that we move CPT codes 76120 (Cine/video x-
rays) and 76125 (Cine/video x-rays add-on) from APC 0260 to APC 0261. 
However, a presenter to the Panel argued that these CPT codes are 
fluoroscopic procedures that should not be grouped with Level I 
radiography procedures. The Panel recommended that we move CPT code 
76120 from APC 0260 to APC 0272 and that CPT code 76125 remain in APC 
0260. This change makes the APCs more clinically coherent. We propose 
to accept the Panel's recommendation.
    cc. Chemotherapy Administration by Other Technique Except Infusion.
    APC 0116: Chemotherapy Administration by Other Technique Except 
Infusion.
    A presenter to the Panel requested that we split APC 0116 into 
three APCs according to the method of administration: (a) Subcutaneous 
or intramuscular administration (CPT code 96400); (b) ``push'' 
administration (CPT code 96408); and (c) central nervous system 
administration (CPT code 96450). The presenter also requested that 
existing CPT codes should replace the more nonspecific Q codes for 
administration of chemotherapy because the CPT codes would provide more 
detailed data on methods of chemotherapy administration, which could be 
used for future payment policy decisions. Another presenter agreed with 
this request and stated that CPT codes are preferable to Q codes 
because other payers require CPT codes.
    The Panel agreed with the above suggestions to split APC 0116 into 
3 APCs according to the method of administration. The Panel recommended 
that we require hospitals to use the existing CPT codes (for example, 
96400, 96408, and 96450) for administration of chemotherapy and map 
them to APCs 0116, 0117, and 0118, as appropriate. The Panel also 
recommended that payment rates be based on current Q code cost data 
until cost data for the CPT codes are available. These cost data would 
be used to determine whether to change the APC structure for 
chemotherapy administration.
    We propose not to accept the Panel's recommendations to split APC 
0116 into 3 APCs and to use CPT codes for administration of 
chemotherapy. We would consider such a split in the future but would 
like to first address the administration of drugs issue. We believe 
that making a change in APC 116 would be too complicated for hospitals 
given the changes for administration in general that we are considering 
in this proposed rule for implementation in CY 2004. We will consider 
such a split for APC 116 for CY 2005. We also believe the use of CPT 
codes would be burdensome to hospitals, would require extensive 
education, and would result in a significant amount of miscoding. The 
CPT codes for infusion therapy are based on the service furnished per 
hour. We do not believe that all hospitals routinely record the start 
and stop time for infusion therapy and that doing so in order to be 
able to bill the proper number of hours of infusion therapy could be 
very burdensome for them. Moreover, the historic cost data on which we 
base the payment for the service is reported on a per visit basis (much 
easier to cull from the record than the number of hours of service) and 
if we changed to CPT codes for these services, we would be unable to 
convert the charge/cost data now on a per visit basis to a per hour 
basis (as required by the CPT code) for budget neutrality purposes. 
Please see section VI of this proposed rule for further discussion on 
payments for drugs and drug administration.
    dd. Capturing the Costs of Drugs and Biologicals Packaged Into 
APCs.
    APC 0290: Level I Diagnostic Nuclear Medicine Excluding Myocardial 
Scans.
    APC 0291: Level II Diagnostic Nuclear Medicine Excluding Myocardial 
Scans.
    APC 0292: Level III Diagnostic Nuclear Medicine Excluding 
Myocardial Scans.
    APC 0294: Level II Therapeutic Nuclear Medicine.
    APC 0666: Myocardial Add-on Scans.
    We told the Panel that APCs 0290 and 0291 appear to violate the 2 
times rule. Several presenters to the Panel expressed concern that our 
cost data are inadequate because of confusion over coding due to 
changes in codes and coding instructions for these procedures, poor 
hospital reporting of radiopharmaceutical use, and the use of single 
(not multiple) claims in determining costs. One presenter claimed that 
the current cost data used for CPT code 78122 (Whole blood volume 
determination) underestimated real costs because of confusion about 
whether to code radiopharmaceuticals on a ``per dose'' basis or ``per 
millicurie'' basis. This presenter requested that we move CPT code 
78122 from APC 0290 to the higher paying APC 0292.
    Other presenters agreed with these concerns and said they were 
applicable to payments for all drugs, not just radiopharmaceuticals. 
These commenters were also concerned about the loss of drug-specific 
data due to packaging because hospitals would have no incentive to 
code, and thereby, identify, packaged drugs.
    Pass-through payments for 236 drugs, biologicals, and 
radiopharmaceuticals expired as of 2003, and these items are now paid 
either separately or packaged with the procedures with which they are 
associated. Drugs and radiopharmaceuticals with median costs for 
administration of $150 or less were packaged. Beginning in 2003 claims 
data will not provide specific cost information for packaged items. We 
requested input from the Panel for methods to determine drug costs.
    Panel members were concerned that packaging the costs of 
radiopharmaceuticals into procedures would result in underpayments for 
the service because we lack adequate data on the cost of 
radiopharmaceuticals. They were also concerned about creating 
incentives to use radiopharmaceuticals based on cost rather than 
clinical efficacy. The Panel recommended that we consider grouping 
drugs and radiopharmaceuticals into new APCs taking into account both 
their cost and clinical use. The Panel further recommended that, if new 
APCs for radionucliides are created, the descriptors should be as 
simple as possible and use of confusing units of measure should be 
limited.
    Due to the packaging of radiopharmaceuticals into the APC payments 
for nuclear medicine procedures, we, along with commenters have 
expressed concern to the Panel regarding whether the current nuclear 
medicine APC structure is homogeneous in terms of resource consumption. 
We have reviewed information about the use and cost of various

[[Page 47975]]

radiopharmaceuticals and believe that reorganizing the APCs for nuclear 
medicine would result in greater clinical and resource homogeneity. 
Therefore, we propose to eliminate APCs 0286, 0290, 0291, 0292, 0294, 
0666 and create 20 new APCs for nuclear medicine that contain the 
following CPT codes:

------------------------------------------------------------------------
               HCPCS                             Description
------------------------------------------------------------------------
APC 0389:
  78000............................  Thyroid, single uptake.
  78001............................  Thyroid, multiple uptakes.
  78003............................  Thyroid suppress/stimul.
  78020............................  Thyroid met uptake.
  78099............................  Endocrine nuclear procedure.
  78190............................  Platelet survival, kinetics.
  78191............................  Platelet survival.
  78199............................  Blood/lymph nuclear exam.
  78299............................  GI nuclear procedure.
  78399............................  Musculoskeletal nuclear exam.
  78499............................  Cardiovascular nuclear exam.
  78599............................  Respiratory nuclear exam.
  78699............................  Nervous system nuclear exam.
  78725............................  Kidney function study.
  78799............................  Genitourinary nuclear exam.
  78999............................  Nuclear diagnostic exam.
  79999............................  Nuclear medicine therapy.
APC 0390:
  78006............................  Thyroid imaging with uptake.
  78010............................  Thyroid imaging.
  78015............................  Thyroid met imaging.
  78016............................  Thyroid met imaging/studies.
APC 0391:
  78007............................  Thyroid image, mult uptakes.
  78011............................  Thyroid imaging with flow.
  78018............................  Thyroid met imaging, body.
  78070............................  Parathyroid nuclear imaging.
APC 0392:
  78075............................  Adrenal nuclear imaging.
APC 0393:
  78110............................  Plasma volume, single.
  78111............................  Plasma volume, multiple.
  78120............................  Red cell mass, single.
  78121............................  Red cell mass, multiple.
  78122............................  Blood volume.
  78130............................  Red cell survival study.
  78135............................  Red cell survival kinetics.
  78140............................  Red cell sequestration.
  78160............................  Plasma iron turnover.
  78162............................  Radioiron absorption exam.
  78170............................  Red cell iron utilization.
  78172............................  Total body iron estimation.
APC 0400:
  78102............................  Bone marrow imaging, ltd.
  78103............................  Bone marrow imaging, mult.
  78104............................  Bone marrow imaging, body.
  78185............................  Spleen imaging.
  78195............................  Lymph system imaging.
APC 0394:
  78201............................  Liver imaging.
  78202............................  Liver imaging with flow.
  78205............................  Liver imaging (3D).
  78206............................  Liver image (3d) with flow.
  78215............................  Liver and spleen imaging.
  78216............................  Liver & spleen image/flow.
  78220............................  Liver function study.
  78223............................  Hepatobiliary imaging.
APC 0395:
  78230............................  Salivary gland imaging.
  78231............................  Serial salivary imaging.
  78232............................  Salivary gland function exam.
  78258............................  Esophageal motility study.
  78261............................  Gastric mucosa imaging.
  78262............................  Gastroesophageal reflux exam.
  78264............................  Gastric emptying study.
  78278............................  Acute GI blood loss imaging.
  78290............................  Meckel's divert exam.
  78291............................  Leveen/shunt patency exam.
  78270............................  Vit B-12 absorption exam.
  78271............................  Vit b-12 absrp exam, int fac.
  78272............................  Vit B-12 absorp, combined.
  78282............................  GI protein loss exam.
APC 0396:
  78300............................  Bone imaging, limited area.
  78305............................  Bone imaging, multiple areas.
  78306............................  Bone imaging, whole body.
  78315............................  Bone imaging, 3 phase.
  78320............................  Bone imaging (3D).
APC 0397:
  78414............................  Non-imaging heart function.
  78445............................  Venous thrombosis study.
  78455............................  Venous thrombosis study.
  78456............................  Acute venous thrombus image.
  78457............................  Venous thrombosis imaging.
  78458............................  Ven thrombosis images, bilat.
APC 0398:
  78428............................  Cardiac shunt imaging.
  78460............................  Heart muscle blood, single.
  78461............................  Heart muscle blood, multiple.
  78464............................  Heart image (3d), single.
  78465............................  Heart image (3d), multiple.
  78466............................  Heart infarct image.
  78468............................  Heart infarct image (ef).
  78469............................  Heart infarct image (3D).
  78472............................  Gated heart, planar, single.
  78473............................  Gated heart, multiple.
  78481............................  Heart first pass, single.
  78483............................  Heart first pass, multiple.
  78494............................  Heart image, spect.
APC 0399:
  78478............................  Heart wall motion add-on.
  78480............................  Heart function add-on.
  78496............................  Heart first pass add-on.
APC 0401:
  78580............................  Lung perfusion imaging.
  78584............................  Lung V/Q image single breath.
  78585............................  Lung V/Q imaging.
  78586............................  Aerosol lung image, single.
  78587............................  Aerosol lung image, multiple.
  78588............................  Perfusion lung image.
  78591............................  Vent image, 1 breath, 1 proj.
  78593............................  Vent image, 1 proj, gas.
  78594............................  Vent image, mult proj, gas.
  78596............................  Lung differential function.
APC 0402:
  78600............................  Brain imaging, ltd static.
  78601............................  Brain imaging, ltd w/flow.
  78605............................  Brain imaging, complete.
  78606............................  Brain imaging, compl w/flow.
  78607............................  Brain imaging (3D).
  78610............................  Brain flow imaging only.
  78615............................  Cerebral vascular flow image.
APC 0403:
  78630............................  Cerebrospinal fluid scan.
  78635............................  CSF ventriculography.
  78645............................  CSF shunt evaluation.
  78647............................  Cerebrospinal fluid scan.
  78650............................  CSF leakage imaging.
  78660............................  Nuclear exam of tear flow.
APC 0404:
  78700............................  Kidney imaging, static.
  78701............................  Kidney imaging with flow.
  78704............................  Imaging renogram.
  78707............................  Kidney flow/function image.
  78708............................  Kidney flow/function image.
  78709............................  Kidney flow/function image.
  78710............................  Kidney imaging (3D).
  78715............................  Renal vascular flow exam.
APC 0405:
  78730............................  Urinary bladder retention.
  78740............................  Ureteral reflux study.
  78760............................  Testicular imaging.
  78761............................  Testicular imaging/flow.
APC 0406:
  78800............................  Tumor imaging, limited area.
  78801............................  Tumor imaging, mult areas.
  78802............................  Tumor imaging, whole body.
  78803............................  Tumor imaging, whole body.
  78805............................  Abscess imaging, ltd area.
  78806............................  Abscess imaging, whole body.
  78807............................  Nuclear localization/abscess.
  G0273............................  Pretx planning, non-Hodgkins.
APC 0407:
  79000............................  Init hyperthyroid therapy.
  79001............................  Repeat hyperthyroid therapy.
  79020............................  Thyroid ablation.
  79030............................  Thyroid ablation, carcinoma.
  79035............................  Thyroid metastatic therapy.
APC 0408:
  79100............................  Hematopoetic nuclear therapy.
  79200............................  Intracavitary nuclear trmt.
  79300............................  Interstitial nuclear therapy.
  79400............................  Nonhemato nuclear therapy.
  79420............................  Thyroid metastatic therapy.
  79440............................  Nuclear joint therapy.
  G0274............................  Radiopharm tx, non-Hodgkins.
------------------------------------------------------------------------

    We believe that the proposed APC structure, which takes into 
account the organ(s) being examined (or treated) as well as the type 
and complexity of the procedure, is more homogeneous both clinically 
and in terms of resource consumption than the current APC structure.
    Currently, payment for the radiopharmaceutical ``zevalin'' 
(Ibritumomab Tiuxetan) is packaged into the payment for HCPCS codes 
G0273 (Pretx planning, non-Hodgkins) and G0274 (Radiopharm tx, non-
Hodgkins). To ensure consistency with our payment policy for other 
radiopharmaceuticals (that is, making separate payment for 
radiopharmaceuticals whose costs are greater than $150 per episode of 
care), we are proposing to make payment for ``zevalin'' (Ibritumomab 
Tiuxetan) separately from payment for the procedures with which 
``zevalin'' (Ibritumomab Tiuxetan) is used.
    We propose to use HCPCS A9522 (Indium 111 ibritumomab tiuxetan) to 
report the use of In-111 Zevalin (In-111 Ibritumomab Tiuxetan) and 
HCPCS A9523 (Yttrium 90 ibritumomab tiuxetan) to report the use of Y90 
Zevalin (Y90 Ibritumomab Tiuxetan). We would place HCPCS A9522 in APC 
9118 with a payment amount of $2,084.55 and HCPCS A9523 in APC 9117 
with a payment amount of $18,066.09. We note that payment rates for 
radiopharmaceuticals are not subject to wage index adjustments because 
no

[[Page 47976]]

portion of the payment is attributed to labor-related costs.
    Because we propose that payment for G0273 and G0274 no longer 
include payment for ``zevalin,'' we also propose to place G0273 into 
newly created APC 0406 and G0274 into newly created APC 0408. These 
APCs include procedures that are similar clinically and in terms of 
resource consumption to G0274 and G0273, respectively.
    Please see section VI of this proposed rule for further discussion 
on payments for drugs, biologicals, and radiopharmaceuticals.
    ee. Endoscopy Lower Airway.
    APC 0076: Endoscopy Lower Airway.
    A presenter to the Panel expressed concern that APC 0076 apparently 
violates the 2 times rule and requested that we move CPT code 31631 
(bronchoscopy with tracheal stent placement) from APC 0076 and into a 
new APC.
    The Panel suggested that a new APC comprised of the four most 
costly procedures in APC 0076 would result in a more homogenous 
grouping, and recommended that we move the following CPT codes from APC 
0076 and into newly created APC 0415.

------------------------------------------------------------------------
               HCPCS                             Description
------------------------------------------------------------------------
31630.............................  Bronchoscopy dilate/fracture
                                     reduction.
31631.............................  Bronchoscopy, dilate w/stent.
31640.............................  Bronchoscopy w/tumor excise.
31641.............................  Bronchoscopy, treat blockage.
------------------------------------------------------------------------

    We propose to accept the Panel's recommendation that we move CPT 
codes 31630, 31631, 31640, and 31641 from APC 0076 to new APC 0415.
    ff. Gastrointestinal Endoscopic Stenting Procedures.
    APC 0141: Upper GI Procedures.
    APC 0142: Small Intestine Endoscopy.
    APC 0143: Lower GI Endoscopy.
    APC 0147: Level II Sigmoidoscopy.
    A commenter requested that we create a new APC that would be 
comprised of all the gastrointestinal endoscopic stent codes. The Panel 
agreed with the commenter's suggestion because the resource 
requirements for all gastrointestinal endoscopic stents appear to be 
similar.
    The Panel recommended that we move the following CPT codes from 
their 2003 APCs to newly created APC 0384 for 2004:

           Table 4.--HCPCS Codes To Be Moved Into New APC 0646
------------------------------------------------------------------------
        HCPCS                  Description           2003 APC   2004 APC
------------------------------------------------------------------------
43219................  Esophagus endoscopy........       0141       0384
43256................  Upper GI endoscopy w/stent.       0141       0384
44370................  Small bowel endoscopy w/          0142       0384
                        stent.
44379................  Small bowel endoscopy w/          0142       0384
                        stent.
44383................  Small bowel endoscopy......       0142       0384
44397................  Colonoscopy w/stent........       0143       0384
45387................  Colonoscopy w/stent........       0143       0384
45327................  Proctosigmoidoscopy w/stent       0147       0384
45345................  Sigmoidoscopy w/stent......       0147       0384
------------------------------------------------------------------------

    We propose to accept the Panel's recommendation to move the 
following gastrointestinal endoscopic stent CPT codes into newly 
created APC 0384: 43219, 43256 (from APC 0141); 44370, 44379, 44383 
(from APC 0142); 44397, 45387 (from APC 0143); 45327, and 45345 (from 
APC 0147).
    gg. Capturing the Costs of Devices That Are Packaged Into APCs.
    APC 0081: Non-Coronary Angioplasty or Atherectomy.
    APC 0083: Coronary Angioplasty and Percutaneous Valvuloplasty.
    APC 0104: Transcatheter Placement of Intracoronary Stents.
    APC 0222: Implantation of Neurological Device.
    APC 0223: Implantation of Pain Management Device.
    APC 0227: Implantation of Drug Infusion Device.
    APC 0229: Transcatheter Placement of Intravascular Shunts.
    Several commenters requested that the status indicators for the 
above APCs (all of which include high-cost devices) be changed from T 
(multiple-procedure discount applies) to S (multiple-procedure discount 
does not apply). Two presenters to the Panel stated that hospitals do 
not pay less for devices when they are used in the context of a 
multiple-procedure claim and suggested that we apply the multiple-
procedure reduction to the non-device portion of the claim only. 
Alternatively, these presenters recommended that we apply the discount 
policy only when the device cost is below a predetermined proportion of 
the APC cost. Another presenter to the Panel requested that APCs 0222, 
0223, and 0227 be exempt from the multiple procedure discount policy 
because the cost of the devices used in these procedures makes up more 
than 50 percent of the APC cost.
    We sought the Panel's input as to whether there are situations in 
which we should not apply our multiple procedure discount policy. The 
Panel recommended no changes to the status indicators for any of the 
device-related APCs discussed because they were concerned that 
exemptions from the discount policy could result in incentives to use 
more devices than necessary. However, the Panel asked that we analyze 
our data to determine if we may be underpaying for devices when the 
multiple procedure discounting policy is applied and recommended that 
we develop some methodology to track device costs. In section V.C of 
this proposed rule, we discuss the issue of device costs and multiple 
procedure reductions and our progress to date in developing 
``combination APCs'' to address the Panel's concern.
    hh. Discussion of Ways To Increase the Use of Multiple Claims To 
Set APC Payment Rates.
    A presenter to the Panel suggested that we use dates of service on 
multiple procedure claims to increase the number of claims we use to 
set payment rates. Another presenter suggested that we could further 
increase the number of multiple procedure claims that could be used to 
set payment rates by ignoring codes with status indicator K. Other 
suggestions were to exclude from consideration those APCs with small 
dollar values and to create a new code or APC specifically for the 
insertion and removal of devices.
    The Panel recommended that our staff explore ways to increase the 
number of claims used to set payment rates, including the following 
methodologies: sort multiple claims by date of service; exclude codes 
with K status indicator from evaluation; exclude those APCs with 
nominal costs (the definition of ``nominal'' can be determined by

[[Page 47977]]

modeling a variety of possible dollar amounts). In addition, the Panel 
recommended that we create no G codes as part of the effort to use 
multiple procedure claims for developing relative weights. If new codes 
are needed, the Panel suggested that our staff work with the American 
Medical Association's CPT Board to identify possible new codes. Please 
see section V.C of this proposed rule for our discussion of the use of 
multiple procedure claims for developing payment rates for procedures 
that use devices.

B. Other Changes Affecting the APCs

1. Limit on Variation of Costs of Services Classified Within an APC 
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 an APC 
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 APC 
group in unusual cases such as low volume items and services. No 
exception may be made in the case of a drug or biological that has been 
designated as an orphan drug under section 526 of the Federal Food, 
Drug, and Cosmetic Act.
    Taking into account the proposed APC changes discussed in relation 
to the APC Panel recommendations in section II.A.4 of this proposed 
rule and the use of 2002 claims data to calculate the median cost of 
procedures classified to APCs, we reviewed all the APCs to determine 
which of them would not meet the 2 times limit. We use the following 
criteria when deciding whether to make exceptions to the 2 times rule 
for affected APCs:
    [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).
    The following table contains APCs that we propose to exempt from 
the 2 times rule based on the criteria cited above. In cases in which a 
recommendation of the APC Panel appeared to result in or allow a 
violation of the 2 times rule, we generally accepted the Panel 
recommendation 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 5.--Table of APCs Exempted From 2 Times Rule
------------------------------------------------------------------------
             Proposed rule APC                       Description
------------------------------------------------------------------------
0004......................................  Level I Needle Biopsy/
                                             Aspiration Except Bone
                                             Marrow.
0018......................................  Biopsy of Skin/Puncture of
                                             Lesion.
0019......................................  Level I Excision/Biopsy.
0020......................................  Level II Excision/Biopsy.
0032......................................  Insertion of Central Venous/
                                             Arterial Catheter.
0043......................................  Closed Treatment Fracture
                                             Finger/Toe/Trunk.
0046......................................  Open/Percutaneous Treatment
                                             Fracture or Dislocation.
0048......................................  Arthroplasty with
                                             Prosthesis.
0055......................................  Level I Foot Musculoskeletal
                                             Procedures.
0058......................................  Level I Strapping and Cast
                                             Application.
0060......................................  Manipulation Therapy.
0072......................................  Level II Endoscopy Upper
                                             Airway.
0073......................................  Level III Endoscopy Upper
                                             Airway.
0080......................................  Diagnostic Cardiac
                                             Catheterization.
0084......................................  Level I Electrophysiologic
                                             Evaluation.
0097......................................  Cardiac and Ambulatory Blood
                                             Pressure Monitoring.
0099......................................  Electrocardiograms.
0105......................................  Revision/Removal of
                                             Pacemakers, AICD, or
                                             Vascular.
0130......................................  Level I Laparoscopy.
0147......................................  Level II Sigmoidoscopy.
0148......................................  Level I Anal/Rectal
                                             Procedure.
0155......................................  Level II Anal/Rectal
                                             Procedure.
0164......................................  Level I Urinary and Anal
                                             Procedures.
0165......................................  Level III Urinary and Anal
                                             Procedures.
0192......................................  Level IV Female Reproductive
                                             Proc.
0203......................................  Level IV Nerve Injections
0204......................................  Level I Nerve Injections.
0207......................................  Level III Nerve Injections.
0213......................................  Extended EEG Studies and
                                             Sleep Studies, Level I.
0214......................................  Electroencephalogram.
0218......................................  Level II Nerve and Muscle
                                             Tests.
0231......................................  Level III Eye Tests &
                                             Treatments.
0233......................................  Level II Anterior Segment
                                             Eye Procedures.
0235......................................  Level I Posterior Segment
                                             Eye Procedures.
0239......................................  Level II Repair and Plastic
                                             Eye Procedures.
0245......................................  Level I Cataract Procedures
                                             without IOL Insert.
0252......................................  Level II ENT Procedures.
0262......................................  Plain Film of Teeth.
0266......................................  Level II Diagnostic
                                             Ultrasound Except Vascular.
0274......................................  Myelography.
0303......................................  Treatment Device
                                             Construction.
0330......................................  Dental Procedures.
0340......................................  Minor Ancillary Procedures.

[[Page 47978]]

 
0341......................................  Skin Tests.
0344......................................  Level III Pathology.
0363......................................  Level I Otorhinolaryngologic
                                             Function Tests.
0364......................................  Level I Audiometry.
0367......................................  Level I Pulmonary Test.
0368......................................  Level II Pulmonary Tests.
0370......................................  Allergy Tests.
0373......................................  Neuropsychological Testing.
0385......................................  Urinary Incontinence
                                             Procedures.
0397......................................  Vascular Imaging.
0408......................................  Non-thyroid Radionucliide
                                             Treatment.
0409......................................  Red Blood Cell Tests.
0600......................................  Low Level Clinic Visits.
0668......................................  Level I Angiography and
                                             Venography except
                                             Extremity.
0692......................................  Electronic Analysis of
                                             Neurostimulator Pulse
                                             Generators.
0698......................................  Level II Eye Tests &
                                             Treatments.
------------------------------------------------------------------------

2. Procedures Moved From New Technology APCs to Clinically Appropriate 
APCs
    In the November 30, 2001 final rule (66 FR 59903), we made final 
our proposal to change the period of time during which a service may be 
paid under a new technology APC. The April 7, 2000 final rule initially 
established the time frame that new technology APCs would be in effect 
(65 FR 18457). Beginning in 2002, we 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.
    In the context of new technology procedures, we create HCPCS codes 
for services only. We do not create HCPCS codes for equipment that is 
used in the course of providing an item or service (except in the case 
of ``C'' codes for devices that meet the criteria for transitional 
pass-through payments). Equipment that is used to provide an item or 
service is not separately coded because it is a resource required to 
furnish the service. Like other resources that are required to furnish 
a service (for example, cost of a room, cost of staff, cost of 
supplies), the hospital should show charges either as part of its 
charge for the procedure or with a revenue code.
    As described in more detail below, we propose to delete four HCPCS 
codes that are currently paid in new technology APCs. These four HCPCS 
codes do not conform to our current policy to not create HCPCS codes 
for equipment used to provide a service. In addition, there exist, or 
soon will exist, CPT codes to describe the services being furnished, 
including any equipment that is needed to perform them, so we believe 
it is appropriate at this time to delete the HCPCS codes. The HCPCS 
codes we propose to delete effective January 1, 2004 are:
    C1088: Laser Optic Treatment system, Indigo Laseroptic Treatment 
System,
    C9701: Stretta System,
    C9703: Bard Endoscopic Suturing System, and
    C9711: H.E.L.P. Apheresis System.
    These codes were created and assigned to New Technology APCs when 
it was CMS policy to create a C code to describe an item of equipment 
for which there was no other means of making payment for the service in 
which the equipment was used. In the November 30, 2001 final rule, we 
announced that we would not use New Technology APCs to pay for drugs, 
devices, and equipment that are used in the performance of a procedure, 
but which are not in and of themselves a complete service. It is due to 
an oversight on our part that we did not delete these codes at that 
time. We stopped using C codes to describe specific devices in April 
2001 and no longer create C codes to describe items of equipment. 
Moreover, we have found that there are existing CPT codes or, in the 
case of C9701, there will soon be a CPT tracking code, that will 
accurately report the services being furnished, and under which the 
hospital should report the charges for providing the services, 
including charges related to the equipment needed to furnish the 
service. Therefore, payment will be appropriate regardless of whether 
there are separate codes for these items of equipment.
    HCPCS code C1088, the Laser Optic Treatment System, Indigo 
Laseroptic Treatment System, now paid under APC 0980 is no longer 
needed because our review of data shows that the equipment it describes 
is appropriately reported under CPT codes 52647 and 52648. The 
procedures described by these CPT codes may be performed by using 
several types of equipment, one of which is the type described by 
C1088. In fact, most of the claims containing line items for C1088 are 
accompanied by line items for 52647 or 52648. This means that hospitals 
are appropriately reporting these services under the applicable CPT 
codes and that any charges associated with C1088 are likely duplicate 
charges for the service provided. Therefore, we propose to delete C1088 
and to have hospitals continue to report these services under CPT codes 
52647 and 52648, which are in APC 0163.
    HCPCS code C9701, the Stretta System, now paid under APC 0980, is 
used in a procedure that will soon be given a CPT Category Three 
Tracking Code by the American Medical Association's CPT Editorial 
Panel. We propose to use the CPT tracking code to report services using 
the Stretta System and to delete HCPCS code C9701. We propose to assign 
the new CPT tracking code in APC 1557.
    HCPCS code C9703, the Bard Endoscopic Suturing System, now paid 
under APC 0979, is used in a procedure that has been granted a CPT 
Category Three Tracking Code, 0008T, which describes the procedure for 
which this equipment is used. We propose to delete C9703 and to require 
hospitals to use 0008T to report services using this equipment. We 
propose to assign CPT code 0008T to APC 1555 for 2004.
    HCPCS code C9711, the H.E.L.P. Apheresis System, now paid under APC

[[Page 47979]]

0978, is used to provide apheresis, which is appropriately reported 
using CPT codes 36511 through 36516. Therefore, we propose to delete 
C9711 and to require hospitals to report the service in which this 
equipment is used by using CPT codes 36511 through 36516.
3. Revision of Cost Bands and Payment Amounts for New Technology APCs
    In the April 7, 2000 final rule (68 FR 18477), we created 15 new 
technology APCs (APCs 0970 through 0984) to pay for certain new 
technology services under the OPPS. As discussed in both the April 7, 
2000 and November 30, 2001 final rules, new technology APCs are 
intended to pay for new or rarely performed procedures for which we 
lack sufficient cost data to make an assignment to a clinical APC. New 
technology APCs are defined on the basis of costs, not the clinical 
characteristics of a service. The payment rate for each new technology 
APC is based on the midpoint of a range of costs.
    In the November 30, 2001 final rule (66 FR 59856), we revised 
several of the cost bands, added a payment level to the original group 
of new technology APCs, and assigned status indicator ``T'' to APCs 
0970 through 0985. We also created a parallel set of new technology 
APCs (APCs 0706 through 0721), each of which was assigned status 
indicator ``S.'' In addition, we changed the definition of what is 
appropriately paid for under a new technology APC; we refined the 
criteria for determining assignment of a procedure or service to a new 
technology APC; we clarified the information that must be supplied for 
a request for new technology status to be considered; and we removed 
the restrictions on how long a procedure can be assigned to a new 
technology APC. These changes, which are discussed in detail in the 
November 30, 2001 final rule, were implemented effective April 1, 2002.
    In the November 1, 2002 final rule, we established two additional 
new technology APCs, APC 989, and APC 725; as these APCs were not 
discussed in the proposed rule, they were considered interim with 
comment.
    In this proposed rule, we are proposing to implement a 
comprehensive restructuring of all the new technology APCs. First, the 
cost intervals in the current new technology APCs are inconsistent, 
ranging from $50 to $1,500. Secondly, as the number of procedures 
assigned to new technology APCs increases, we believe that narrower 
cost bands are required to avoid significant mispayment for new 
technology services. The increased number of new technology APCs that 
would result from narrowing the cost bands cannot be accommodated 
within the current sequence of available APC numbers. Therefore, we are 
proposing to dedicate two new series of APC numbers to the restructured 
new technology APCs, which would allow us to narrow the cost bands and 
also afford us flexibility in creating additional bands as future needs 
may dictate.
    We propose to establish cost bands from $0 to $100 in increments of 
$50, from $100 through $2,000 in intervals of $100, and from $2,000 
through $6,000 in intervals of $500. We believe that these intervals 
would allow us to price new technology services more appropriately and 
consistently. We also propose to retain two parallel sets of new 
technology APCs, one with status indicator ``S'' and the other with 
status indicator ``T.'' We invite comments on the hierarchy of cost 
levels of the restructured new technology APCs.
    We would reassign current new technology procedures to the level in 
the restructured new technology APCs so that the payment amount for the 
procedure in 2004 closely approximates the current payment amount. As 
we explained in the November 30, 2001 final rule, we generally keep a 
procedure in the new technology APC to which it is initially assigned 
until we have collected data sufficient to enable us to move the 
procedure to a clinically appropriate APC. However, in cases where we 
find that our original new technology APC assignment was based on 
inaccurate or inadequate information, we may, based on more recent 
information (including claims data), reassign the procedure or service 
to a different new technology APC that more appropriately reflects its 
cost.
    The proposed restructured new technology APCs are listed in 
Addendum A.
4. APC Assignment for New Codes Created During Calendar Year (CY) 2003
    During CY 2003, we created several HCPCS codes to describe services 
payable under the hospital OPPS. These codes have already been assigned 
to APCs for CY 2003. In this proposed rule, we solicit comment on the 
APC assignment of these services. In addition, in this proposed rule, 
we propose to create a new HCPCS code with an effective date of July 1, 
2003. Table 6 includes a new procedural HCPCS code created for 
implementation in July 2003.
    Table 6 does not include new codes for drugs and devices for which 
we established or intend to establish pass-through payment eligibility 
effective July or October 2003. Furthermore, neither the new procedural 
HCPCS nor the new pass-through codes proposed for implementation 
beginning October 2003, or later, are included in Addendum B of this 
proposed rule.

                      Table 6--New G Code for 2003
------------------------------------------------------------------------
                                                 Effective
   HCPCS code        Long descriptor       SI       date         APC
------------------------------------------------------------------------
G0296...........  PET imaging, full and     S      07/01/03         0714
                   partial ring PET
                   scanner only, for
                   restaging of
                   previously treated
                   thyroid cancer of
                   follicular cell
                   origin following
                   negative I-131 whole
                   body scan.
------------------------------------------------------------------------

5. Creation of APCs for Combinations of Device Procedures
    In the course of developing the proposed rule for the 2004 OPPS, we 
wanted to ensure that the claims we use to set payment rates for APCs 
into which we package medical devices accurately reflect the costs of 
both the device and non-device portions of the service. As discussed in 
section III of this proposed rule, we have made a number of changes to 
our methodology for the creation of single procedure claims used to set 
relative weights. These changes enabled us to use charge data from more 
claims to set relative weights. However, we have noted that in spite of 
our new methodology, we were unable to significantly increase the 
number of single procedure claims used to set relative weights for 
several APCs that use high cost devices. One reason for this is that 
these APCs are often billed in combination with several other major 
procedures so that we are unable to generate single procedure claims 
for these APCs.
    In the past, commenters have alleged that without using multiple 
procedure claims, we will be unable to capture the

[[Page 47980]]

costs of the more complex cases in which multiple procedures are 
performed and multiple devices are used. These commenters further 
requested that we change the status indicator of certain APCs from 
``T'' to ``S'' in order to appropriately capture the cost of high cost 
devices when multiple procedures, each using devices, were billed. In 
addition to attempting to find a way to use multiple procedure claims, 
we also decided to examine our claims data to investigate whether our 
current payments for multiple procedures performed on the same date, 
each using high cost devices accurately captured the costs of the 
device and non-device portion of each procedure.
    In order to do this, we reviewed claims from APCs that required 
high cost devices and from which we were unable to use the majority of 
claims to set a relative weight for the APC (for example, APCs for 
insertion of pacemakers, defibrillators, and neurostimulators). We 
determined the frequency with which other APCs were billed with the 
high cost device APCs. We then selected those claims where two APCs 
using high cost devices, or one APC using high cost devices and one 
high cost, non-device-requiring APC, were billed together with a 
frequency of more than 100 for the time period April 1, 2002 through 
September 30, 2002. This number was chosen in order to ensure that we 
had enough claims to determine reliable median costs. We included the 
APC combination 0081/0104 unintentionally and performed the analysis 
without realizing until after the data were developed that it had fewer 
than 100 claims and therefore should not have been selected. We 
expected that the data being used to set the 2004 weights would have a 
similar number of each combination to the number we found in the April 
2002 to September 2002 claims. Review of Table 7, Combination APCs Used 
in Analysis, shows that even starting with 100 claims, we frequently 
had to determine median costs with very few claims. Additionally, Table 
7 reveals that only a few combinations of two high cost device-
requiring APCs are billed together 100 or more times. Six of the twelve 
combinations we analyzed (for example, claims for insertion of 
pacemakers and defibrillators) contained APC 0105 (Removal of pacemaker 
defibrillator), which is not a high cost, device-requiring APC. As the 
data show, APC 0105 is frequently found on multiple procedure claims, 
but because it is not a high cost device-requiring APC, when it is 
billed with these APCs, the multiple procedure reductions are applied 
to APC 0105. Therefore, we have determined that the vast majority of 
claims for APCs, such as ``insertion of Cardioverter Defibrillators,'' 
were not usable multiple procedure claims for the purpose of 
determining relative weights under our single claim process because 
they were billed with APC 0105.
    After selecting the combinations to review, we determined the 
hospital costs associated with providing these ``combination'' 
procedures using the following methodology:
    1. We selected claims where the two APCs of interest both appeared 
on the claim with the same date of service, and subjected them to the 
same trimming methodology we use for single procedure claims.
    2. We then required that each APC appear on the claim only once. 
(For example, if two HCPCS codes from APC 0081 appeared on a claim with 
one HCPCS code from APC 0229, we did not use the claim. Many claims 
were discarded because of this requirement.)
    3. From the claims in step two, we selected only those claims that 
included the device category codes for the devices required to perform 
the service. This is similar to our methodology for using single 
procedure claims where the procedure requires the use of a device with 
a category code (for example, for claims involving APCs 0222/0225, we 
used only claims that contained C codes for both a neurostimulator 
pulse generator and neuroelectrodes).
    4. We ignored any line items for separately payable services under 
OPPS or the lab fee schedule and any line items with revenue centers 
containing HCPCS other than those in the APCs of interest.
    5. At this point, we were left with claims where the only 
separately payable services were the line items for the HCPCS in the 
APCs of interest.
    6. We packaged into the payable HCPCS codes all device category 
codes, all packaged HCPCS codes, and all revenue center codes without 
HCPCS.
    7. We then determined the median cost for each APC pair using the 
remaining claims.
    We believe the median cost estimate determined by this methodology 
should, if anything, overestimate the costs of the procedure 
combinations studied since all packaged line items were attributed to 
the APCs of interest unless they were clearly identified as being 
associated with other procedures. For example, if line items for a 
clinic visit and a medical or surgical supply revenue center appeared 
on the claim, we packaged the charges associated with the revenue 
center entirely into the APCs of interest and not into the APC for 
clinic visits.
    We also determined the median costs for these APCs using our usual 
single claims methodology (these medians are contained in Addendum A). 
We then determined a summed median cost of each APC pair using our 
current payment policy, which allows payment at 100 percent for the 
most expensive APC with ``T'' status indicator and 50 percent for each 
additional APC with ``T'' status indicator. That is, we added the 
median cost of the more expensive APC and 50 percent of the median cost 
of the less expensive APC as a proxy for the total median cost (and 
payment) using our current payment policy. We then compared this figure 
with the median cost for the ``combination APC.'' (See Table 7.) We 
believe this comparison is an indicator of whether our current payment 
policy accurately pays for the costs of these APCs when they are billed 
together on the same date of service.
    Our comparison reveals that, of the 12 ``combination APCs'' 
created, 7 had higher median costs than the median costs obtained with 
the multiple procedure methodology (we note that because APC 222 has a 
status indicator of ``S'', we did not apply the multiple procedure 
reduction for the APC 0222/0225 combination).
    For three of these seven combinations, we consider the data 
unreliable because we were able to use very few claims to determine the 
``combination'' median cost. Specifically, for APC combination 0085/
0655, we were able to use only 37 claims; for APC combination 0105/
0089, we were to use only 16 claims; and for APC combination 0105/0655, 
we were able to use only 12 claims. This is in distinction to the 
number of claims we used to determine the median costs for APCs 0655 
and 0089 alone (1,170 and 303 respectively). Further, two of these 
combinations contain only one APC using high cost devices because APC 
0105 does not require the use of high cost devices. This means that the 
multiple procedure reduction was applied to APC 0105. In such cases, we 
believe the reduction is appropriate because when a pacemaker or 
defibrillator is removed and replaced, the patient is only anesthetized 
once, the room only needs to be prepared once, and the time for 
replacement is usually less than the time for insertion due to the 
existence of a subcutaneous pocket.
    Three other APC combinations, 0105/0090, 0105/0107, and 0105/0654, 
also contain only one APC requiring the use of high cost devices and 
therefore

[[Page 47981]]

should not pose the problem of underpayment due to the multiple 
procedure reduction, which was applied to APC 0105. Furthermore, in 
these three cases, the difference in median costs between the 
combination median and the median determined by our multiple procedure 
reduction methodology was, in our view, insignificant (all much less 
than 5 percent).
    For APC combination 0222/0225, the difference in median cost could 
be considered significant at slightly under 5 percent, but only 74 
claims were used to determine the combination median. Because we used 
approximately 600 claims to determine the median costs for APCs 0222 
and APC 0225 individually, we consider the combination median cost 
comparatively unreliable.
    Lastly, we note that for the other five combinations, our current 
payment policy pays more than the ``combination'' payment methodology.
    Based on this comparison we considered several options for payment 
of these APCs when billed together:
    1. Maintain our current payment policy.
    2. Change the status indicators of certain APCs requiring the use 
of high cost devices to ``S.''
    3. Create ``combination APCs'' with relative weights calculated 
using the methodology described above in order to make a single payment 
when the two APCs in the combination are billed together.
    The third option need not result in creation of new HCPCS codes and 
APCs for hospitals to report. Instead, we could make changes in the 
logic of the outpatient code editor (OCE) so that when hospitals bill 
the two APCs in a combination, the OCE would ``map'' the payment to a 
single amount rather than paying the more expensive APC at 100 percent 
and the less expensive at 50 percent. The following is an example of 
how combination APCs might work: If a unit of a code in APC 0081 was 
billed with a unit of a code in APC 0104 on the same date, the multiple 
procedure discount would not be applied, so payment would no longer be 
made at 100 percent of the payment for APC 0104 (the highest paid APC 
in the pair) and 50 percent of the payment for APC 0081. Instead, if we 
were to implement combination APCs for this pair, the combination of 
codes would be mapped to a new ``combination'' APC, and we would make a 
single payment for both services. The payment rate for the new 
``combination'' APC would be based upon a scaled weight calculated from 
the median cost for all claims containing one unit of a code from APC 
0081 and one unit of a code from APC 0104 (using the methodology 
described above). If either of the APCs were billed without the partner 
APC for that established ``combination'' APC, then the APC would map to 
the current APC that contains the code.
    Based on our analysis, we are proposing option one: Maintaining our 
current payment policy. We believe that our analysis shows that our 
current payments for these APCs adequately reflect the costs of the 
procedures, even when billed in combination.
    We note that only a few APCs requiring the use of high cost devices 
are billed in combination. Thus, we do not believe there are compelling 
reasons to establish a new, or special, payment policy in situations 
where two APCs requiring high cost devices are billed together fewer 
than 100 times. Even when APCs are billed together, we have shown that 
frequently the data are unreliable due to the low number of claims we 
can actually use to determine the total median cost of the ``combined'' 
procedure. Furthermore, even where the number of usable claims is large 
enough to give us some assurance that the data are reliable, the median 
costs as determined by the two methodologies do not support any changes 
in our current payment policy. In some instances, adoption of the new 
payment policy would actually reduce payments for these services, and, 
in most other cases, any increase in payments would be negligible.
    One commenter has brought to our attention the fact that, rarely, 
correct coding does not allow hospitals to bill for two APCs requiring 
high cost devices. One example is APC 0082 (Coronary Atherectomy) and 
APC 0104 (Transcoronary Stent Placement) because atherectomy is 
considered to be a component of stent placement when both are performed 
together. In those cases, we would expect hospitals to bill for all the 
devices used to accomplish the atherectomy and the stent placement. To 
the extent that both were performed, the median cost of stent placement 
should reflect the cost of performing an atherectomy. Therefore, we do 
not believe there is a compelling reason to create new payment policy 
for these rare situations. (See also the discussion below on ``case 
rate'' purchasing by hospitals.)
    It could be reasoned that our analysis of the costs of ``combined'' 
procedures is faulty because hospital coding and billing inaccuracies 
may apply to these claims as well as single procedure claims (and may 
even be magnified). However, that reasoning would undercut, and be 
contrary to, the repeated comments that we need to use more multiple 
procedure claims to set relative weights because single procedure 
claims do not capture the true costs of complex procedures or episodes 
of care. Our investigation was performed precisely to address these 
concerns, determine how we might use multiple procedure claims, and 
what effect use of those claims would have on payment rates. Even with 
use of a methodology that overestimated the costs of combination 
procedures, we were unable to show that the median costs (and payments) 
using our current payment policy do not accurately reflect the costs 
for performing these procedures.
    Other possible factors affecting our analysis include charge 
compression and/or inadequate charges for these procedures or the 
devices associated with them. However, it is not possible for us to 
know the magnitude of how charge compression or inadequate charges 
might affect costs or what methodologic or payment adjustment would be 
appropriate to address the problem. Furthermore, we point out that 
charge compression and inadequate charges should affect our cost data 
for these APCs when billed alone and when these APCs are billed in 
combination. It is unknown whether the effects would be similar in each 
instance but we have no reason to believe they would be different. 
Therefore, we do not believe that adjusting for charge compression or 
inadequate charges would change the ``relative'' median costs of the 
APCs when billed alone or in combination. Finally, we believe that the 
median costs of the APCs billed in combination support the concept that 
economies of scale are achieved in those cases. There are at least two 
reasons why this might occur: First, many hospitals purchase devices on 
a case rate or capitated basis, which means that the hospitals' device 
cost ``per case'' is fixed (with quarterly adjustments made based on 
volume and actual device use in the previous quarter(s)). For example, 
inserting a stent or cardioverter defibrillator requires the use of 
multiple devices in addition to the stent or defibrillator. A hospital 
may agree to pay $XXXX ``per case'' for all the devices used to insert 
a stent (for example, guidewires, introducers, catheters, rotablators 
etc.). This ``per case'' payment means that the hospital has the same 
cost irrespective of whether a rotablator, two catheters, or four 
catheters were used for a specific patient. Second, even if hospitals 
purchase devices on a ``per device'' basis, it is possible that no 
extra catheters, guidewires, and/or

[[Page 47982]]

introducers, for example, are used when a second related procedure is 
performed (for example, an electrophysiology study and a defibrillator 
lead placement, or an angioplasty and a stent placement).
    In summary, we have concluded that there is no compelling reason to 
change our current payment policy for APCs requiring the use of high 
cost devices.
    We solicit public comments on our methodology, analysis, and 
payment options for these APCs. We particularly solicit comments on how 
our analysis should affect any use of external data sources in the 
final rule. Specifically, we ask commenters to explain why submitted 
external data should be used in preference to our single or multiple 
claim data for APCs requiring the use of high cost devices.
    We also note that creation of ``combination APCs'' would allow us 
to set relative weights using a number of claims that we otherwise 
would not be able to use. Therefore we solicit comments on this 
approach to using more claims to set relative weights and specifically 
request comments on how to use those claims even if we do not create 
``combination APCs.''

                                   Table 7.--Combination APCs Used in Analysis
----------------------------------------------------------------------------------------------------------------
                                                    Sum of                                             Percent
                                                  single APC   Frequency    Frequency                 difference
                                                   medians         of       of claims   Median cost   median for
                          Descriptions of both     adjusted   combination    used for   of services   both APCs
  Combination of APCs          APCs in the           for       APC billed  median cost    in both     to sum of
                               combination         multiple   on the same  of services      APCs       adjusted
                                                  procedure       date       in both                    single
                                                    policy                     APCs                    medians
----------------------------------------------------------------------------------------------------------------
0081/0104..............  Noncoronary               $5,760.50           55            2    $5,589.14        -2.97
                          Angioplasty/Athectomy
                          & Transcatheter
                          Placement of
                          Intracoronary Stent.
0081/0229..............  Noncoronary                4,507.09         6177          135     4,116.50        -8.67
                          Angioplasty/Athectomy
                          & Transcatheter
                          Placement of
                          Iintravascular Stent.
0085/0108..............  Level II                  29,749.68          502           63    20,438.99       -31.30
                          Electrophysiologic
                          Evaluation &
                          Insertion/Replacement/
                          Convert of
                          Cardioverter
                          Defibrillator.
0085/0655..............  Level II                   9,398.45          268           37    10,832.16        15.25
                          Electrophysiologic
                          Evaluation &
                          Insertion/Replacement/
                          Conversion of
                          Permanent Dual
                          Chamber Pacemaker.
0105/0089..............  Revision/Removal of        7,360.80          221           16    12,268.96        66.68
                          Pacemakers, AICD, or
                          Vascular & Insertion/
                          replacement of
                          Permanent Pacemaker
                          and Electrodes.
0105/0090..............  Revision/Removal of        5,668.72         1426          516     5,751.30         1.46
                          Pacemakers, AICD, or
                          Vascular & Insertion/
                          replacement of
                          Permanent Pacemaker
                          Pulse Generator.
0105/0107..............  Revision/Removal of       17,579.21         1106          235    18,294.85         4.07
                          Pacemakers, AICD, or
                          Vascular & Insertion
                          of Cardioverter-
                          Defibrillator.
0105/0108..............  Revision/Removal of       29,239.29          294            8    26,843.72        -8.19
                          Pacemakers, AICD, or
                          Vascular & Insertion/
                          Replacement/Repair of
                          Cardioverter-
                          Defibrillator Leads.
0105/0654..............  Revision/Removal of        6,639.65         3653         1475     7,014.00         5.64
                          Pacemakers, AICD, or
                          Vascular & Insertion/
                          Replacement of a
                          permanent dual
                          chamber pacemaker.
0105/0655..............  Revision/Removal of        8,888.06          237           12    10,290.88        15.78
                          Pacemakers, AICD, or
                          Vascular & Insertion/
                          Replacement/
                          Conversion of a
                          Permanent Dual
                          Chamber Pacemaker.
0222/0225..............  Implantation of           14,345.41          368           74    15,002.40         4.58
                          Neurological Device &
                          Implantation of
                          Neurostimulator
                          Electrodes.
0223/0227..............  Implantation of Pain      10,350.16          222           65     9,815.08       -5.17
                          Management Device &
                          Implantation of Drug
                          Infusion Device.
----------------------------------------------------------------------------------------------------------------
Table 7 lists the combinations that we investigated, abbreviated titles for the single APCs in the pair, the
  number of times the APCs were billed together, the number of claims used to set the combination APC median, a
  combined median cost for claims in which both the APCs appeared (derived from the methodology discussed
  above), the median cost for the two APCs using the multiple procedure reduction policy, and the difference in
  median costs (expressed in percent).

6. New APC for Antepartum Care
    We propose to split APC 0199, Obstetrical Care Service into two 
APCs. New APC 0700, Antepartum Care Service, would be created and 59412 
(external cephalic version) would be assigned there. The two remaining 
HCPCS code 59409 (vaginal delivery only) and 59612 (vaginal delivery 
only, after previous cesarean delivery) would remain in APC 0199, 
Obstetrical Care Service. We propose to make this change because of the 
great difference in cost between vaginal delivery and the external 
cephalic version procedures. We believe that inclusion of the lower 
cost procedure in the APC with vaginal deliveries may have an affect on 
the median cost for the APC that results in less accurate payment.

III. Recalibration of APC Weights for CY 2004

    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. 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 CY 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, 2004 and before January 1, 2005, we are proposing 
to use the same basic methodology that we

[[Page 47983]]

described in the April 7, 2000 final rule. That is, we would 
recalibrate the weights based on claims and cost report data for 
outpatient services. We propose to use the most recent available data 
to construct the database for calculating APC group weights. For the 
purpose of recalibrating APC relative weights for CY 2004, the most 
recent available claims data are the approximately 115 million final 
action claims for hospital outpatient department services furnished on 
or after January 1, 2002 and before January 1, 2003. We then eliminated 
the following 45.7 million claims because many of these claims were for 
services that are not paid under OPPS: Claims in the first quarter of 
calendar year 2002; claims for bill types other than OPPS bill types; 
claims for services furnished in Maryland, Guam, and the Virgin 
Islands. We matched the 69.3 million claims that were paid under the 
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. Period of Claims Data Used
    We propose to use claims for the period beginning April 1, 2002 
through and including December 31, 2002 as the base for the CY 2004 
OPPS. The statute requires that we take into account new cost data and 
other relevant information and factors in reviewing and revising the 
weights, and we believe that this period will give us the most recent 
costs. We chose not to include the claims for the period beginning on 
January 1, 2002 through March 31, 2002 because they were used to set 
the payment rates for the 2003 OPPS and we believe that the most recent 
9 months of claims data will result in payment rates that are most 
representative of the current relative costs of hospital outpatient 
services.
    The claims base used to calculate the proposed payment weights and 
payment rates in this proposed rule is not the totality of claims on 
which the final weights and rates will be based. The use of this claims 
base is due to (1) a lag in claims submission by providers; (2) a 
statutory limit on the date before which no claim can be paid; and (3) 
the additional processing time it takes for the claims data to be 
included in the national claims history, which is the source of our 
claims data. For these reasons, the claims data used for this proposed 
rule are for the period of services furnished between April 1, 2002 and 
November 1, 2002. However, when the final weights and rates are 
calculated, we will have access to approximately 95 percent of the 
claims data for services furnished from April 1, 2002 through December 
1, 2002.
2. Treatment of ``Multiple Procedure'' Claims
    We have received many requests asking that we ensure that the data 
from claims that contain charges for multiple procedures are included 
in the data from which we calculate the CY 2004 relative payment 
weights. Those making the requests believe that relying solely on 
single-procedure claims to recalibrate APC weights fails to take into 
account data for many frequently performed procedures, particularly 
those commonly performed in combination with other procedures.
    We agree that optimally, it is desirable to use the data from as 
many claims as possible to recalibrate the relative payment weights, 
including those with multiple procedures. We identified certain 
multiple-procedure claims that could be treated as single-procedure 
claims, enabling us to greatly increase the number of services used to 
develop the APC payment weights for CY 2003. However, several inherent 
features of multiple procedure claims prevented us from using all of 
them to recalibrate the payment weights. We discussed these obstacles 
in detail in the August 9, 2002 proposed rule (67 FR 52092, 52108 
through 52111), and the November 1, 2002 final rule (67 FR 66718, 66743 
through 66746).
    For the CY 2004 OPPS, we propose several changes to how we handle 
and use claims data to enable us to use more claims in the creation of 
median costs on which our payment weights and rates are based. 
Specifically, we propose to expand the number of HCPCS codes that we 
ignore for purposes of creating a pseudo single claim from claims that 
contain other separately payable HCPCS codes. We also looked at dates 
of service on packaged HCPCS codes and packaged revenue centers, and 
propose, where possible, to attribute the charges to major, separately 
payable HCPCS codes based on the codes' dates of service. Our complete 
discussion of the use of data to set the weights for CY 2004 OPPS 
follows in section III.B of this proposed rule.
    Expansion of the list of codes to be ignored in creation of single 
claims. For CY 2003 OPPS, we ignored the presence of HCPCS codes 93005, 
71010, and 71020 to create pseudo single claims where there was one 
remaining separately paid, major HCPCS code on the claim. This enabled 
us to attribute the costs of packaged HCPCS codes and packaged revenue 
centers to the remaining separately paid HCPCS codes and, therefore, to 
use the charge data on the claim. We did this based on our belief that 
these three separately payable HCPCS codes would not have charges 
related to them that would be placed in packaged HCPCS codes or 
packaged revenue centers. Instead, we believe that the charges found in 
the packaged HCPCS or packaged revenue centers would be appropriately 
associated with the only other separately payable HCPCS that remained 
on the claim when these codes are ignored.
    For CY 2004 OPPS, we propose to expand the list of HCPCS codes that 
we would ignore for purposes of creating pseudo single claims. On 
claims that contain other separately payable HCPCS, we propose to 
ignore the HCPCS codes in the APCs identified in Table 9. As with HCPCS 
codes 93005, 71010, and 71020, we believe that these codes are highly 
unlikely to have charges that are found in packaged HCPCS or in 
packaged revenue centers. Therefore, we believe that they can be 
ignored for the purpose of creating a pseudo single claim from the 
remaining charges on the claim. We solicit comments on the proposed 
methodology to create pseudo single claims, on the list of codes in 
Table 9 that we propose to ignore, and whether there are other low cost 
services that we could ignore in using this methodology. We also 
request comments on whether we should use the charges for the codes in 
the APCs in Table 9 to create pseudo single claims to be used in 
setting the median costs for these APCs.
    Use of dates of service to create single claims. For CY 2003, we 
did not use dates of service to attribute charges on packaged HCPCS and 
packaged revenue centers to major separately payable HCPCS codes. For 
CY 2004, we propose to use dates of service on HCPCS codes and on 
packaged revenue centers to attribute charges to a major payable HCPCS 
code where the dates of service match. We can only use this approach 
where there are different dates of service for the separately payable 
major HCPCS codes. Where there are multiple major payable HCPCS codes 
on a claim with the same date, we cannot use this approach because 
there is no way to tell to which major payable HCPCS code the charges 
from the packaged HCPCS or packaged revenue center belong. Moreover, 
where the hospital does not provide dates for all packaged revenue 
centers, we cannot attribute charges based on the date of service.
    We believe that this methodology yields more single claims than if 
we did not use dates of service. However,

[[Page 47984]]

because hospitals are not required to put dates of service for line 
items with only a revenue center but no HCPCS code, we will not be able 
to perform this analysis routinely for each claim. Therefore, the 
claims from hospitals that do provide those dates are more likely to be 
used for weight-setting than claims of hospitals that do not provide 
those dates on the claim. We are unable to determine what impact, if 
any, this methodology has on the weights for the services and we 
solicit comments on the approach.
    We invite comments on whether we should require hospitals to enter 
a line item date of service for every OPPS charge. We are interested in 
receiving comments regarding the implications the policy would have for 
hospitals, including potential obstacles and estimates on the amount of 
time that would be required to implement this change.
3. Adjustment of Median Costs for CY 2003 OPPS
    The relative weights of several APCs, especially APCs requiring the 
use of high cost devices, that were developed for the 2003 OPPS fee 
schedule, using claims data from April 1, 2001 to March 31, 2002, 
showed a significant decrease from the relative weights that were 
established for the 2002 OPPS fee schedule. The 2002 OPPS relative 
weights were based on both claims data and packaging of 75 percent of 
the manufacturer submitted costs for devices into the APC cost. Using 
our April 1, 2001, through March 31, 2002 claims data resulted in 
significant decreases in payment for many blood products and separately 
payable drugs. In order to minimize any beneficiary access problems 
related to the reduction in payment for blood products, separately 
payable drugs, and certain device-related APCs, we created a limit for 
any payment reductions as follows:
Device and Procedural APCs
    For APCs requiring the use of one or more devices receiving pass-
through payments, we determined the median cost of the APC using only 
claims that contained device category ``C'' codes. For selected APCs, 
we used only claims containing the device ``C'' code specific to the 
service furnished (for example, we used only claims containing the 
``C'' codes for cardioverter defibrillators to determine the median 
cost for the APC for inserting cardioverter defibrillators).
    We then compared the median costs established for the 2002 OPPS fee 
schedule and the median costs based on our April 1, 2001, through March 
31, 2002 claims data and limited decreases in median costs (from the 
2002 fee schedule) by 15 percent plus half the amount of any reduction 
beyond 15 percent (for example, if the claims data showed the median 
cost of an APC decreased 45 percent, the amount of allowed reduction 
would have been 15 percent + \1/2\ x (45 percent-15 percent) = 30 
percent). For a few APCs where device costs accounted for more than 80 
percent of the total cost of the APC, we also incorporated external 
data into our calculation of the median cost.
Blood and Blood Products
    We limited reductions in median costs to 11 percent as compared to 
the 2002 median costs so that the reduction in payments, after other 
adjustments, for these items would generally not exceed 15 percent.
Separately Payable Drugs
    We noted in the November 1, 2002 final rule that the reason our 
April 1, 2001, through March 31, 2002 claims data resulted in lower 
median costs for many drugs was that the payment rates for 2002 were 
based on 95 percent of average wholesale price (AWP) as required by law 
for pass-through drugs. We believed, and continue to believe, that the 
acquisition cost for many drugs is considerably less than 95 percent of 
AWP. However, we limited reductions in median costs for separately 
payable drugs and for administration of packaged drugs using the same 
methodology as described above for device and procedural APCs.
Procedural and Device Intense APCs for 2004 OPPS
    Comparison of procedural APC medians for 2004 OPPS to adjusted 
medians for 2003 OPPS. Our analysis of the April 1, 2002, through 
December 31, 2002 claims data, which is the basis for the proposed 
median costs for the 2004 OPPS, reveals a distribution of changes in 
median costs that are not unusual. Compared to the adjusted median 
costs used for the 2003 OPPS, most of the median cost increases and 
decreases were for nondevice-related APCs. Very few device-related APCs 
saw their median costs decrease significantly. We also note that, with 
a few exceptions, the median cost increases and decreases were not 
unusually distributed; we believe that the fluctuations should not be 
unexpected in a new payment system. For example, the cost of providing 
items and services changes yearly and, in a new payment system, the 
accuracy of coding services will improve year to year. We also compared 
the actual median costs from the April 1, 2001 through March 31, 2002 
claims data with the actual median costs from the April 1, 2002 through 
December 31, 2002 claims data. Given the level of consistency we see in 
our claims data, we believe that adjustment of median costs last year 
may have resulted in payment amounts for some APCs that were too high.
    The medians we propose to use to set weights for the 2004 OPPS for 
APCs in Table 8 have decreased more than 10 percent in median cost when 
compared to the adjusted median costs for 2003 OPPS. For reference, we 
also provide the actual median cost from the claims data we used to set 
2003 OPPS payment rates. Some changes appear to be the result of normal 
fluctuation in the costs of services. In other cases the actual median 
cost in the April through December 2002 data (the 2004 OPPS medians) is 
consistent with the actual median cost in the April 1, 2001 through 
March 31, 2002 data (used for the 2003 OPPS medians), but decreased 
significantly only in comparison to the adjusted 2001 medians used for 
2003 OPPS. In general, where there is consistency between the 2001 
(2003 OPPS) and 2002 (2004 OPPS) unadjusted medians or where a change 
appears to represent normal fluctuations in costs, and we know of no 
special circumstances that would cause us to believe that there are 
problems in the claims data, we conclude that the claims data 
accurately represent the cost of the service. After reviewing the data, 
we believe that there is no sound basis for making an across-the-board 
adjustment to our April through December 2002 median costs, 
notwithstanding that using the unadjusted 2004 median may result in a 
reduced payment compared to the payment that was based on adjusted 
medians under 2003 OPPS.

[[Page 47985]]



                         Table 8.--APCs With Median Cost Decreases of 10 Percent or More
----------------------------------------------------------------------------------------------------------------
                                                                                                      % diff APC
                                                                                                     median cost
                                                                            Final 2003      2004        (2003
            Final APC                        Description              SI     dampened     proposed     dampened
                                                                           median cost    rule APC     vs. 2004
                                                                                        median cost    proposed
                                                                                                        rule)
----------------------------------------------------------------------------------------------------------------
0312............................  Radioelement Applications.......     S     $3,141.77      $216.18       -93.12
0330............................  Dental Procedures...............     S        284.02        32.87       -88.43
0692............................  Electronic Analysis of               S        371.55        56.40       -84.82
                                   Neurostimulator Pulse
                                   Generators.
0651............................  Complex Interstitial Radiation       S      3,250.63       588.67       -81.89
                                   Source Application.
0225............................  Implantation of Neurostimulator      S      8,277.07     3,283.68       -60.33
                                   Electrodes.
0352............................  Level I Injections..............     X         13.10         6.31       -51.83
0068............................  CPAP Initiation.................     S        123.29        65.83       -46.61
0124............................  Revision of Implanted Infusion       T      2,975.12     1,608.78       -45.93
                                   Pump.
0688............................  Revision/Removal of                  T      4,429.71     2,495.57       -43.66
                                   Neurostimulator Pulse Generator
                                   Receiver.
1719............................  Brachytx seed, Non-HDR Ir-192...     K         31.04        17.89       -42.36
0699............................  Level IV Eye Tests & Treatments.     T        223.07       130.15       -41.65
0199............................  Obstetrical Care Service........     T        232.46       142.74       -38.59
0313............................  Brachytherapy...................     S      1,249.57       769.14       -38.45
0236............................  Level II Posterior Segment Eye       T      1,873.66     1,153.59       -38.43
                                   Procedures.
0123............................  Bone Marrow Harvesting and Bone      S        380.54       234.84       -38.29
                                   Marrow/Stem Cell Transplant.
0223............................  Implantation or Revision of Pain     T      2,437.21     1,525.61       -37.40
                                   Management Catheter.
0385............................  Level I Prosthetic Urological        T      6,199.09     3,895.76       -37.16
                                   Procedures.
0681............................  Knee Arthroplasty...............     T      8,780.47     5,669.25       -35.43
0302............................  Level III Radiation Therapy.....     S        548.35       363.26       -33.75
0301............................  Level II Radiation Therapy......     S        187.53       125.03       -33.33
0094............................  Level I Resuscitation and            S        228.18       154.77       -32.17
                                   Cardioversion.
0671............................  Level II Echocardiogram Except       S        140.57        96.05       -31.67
                                   Transesophageal.
0098............................  Injection of Sclerosing Solution     T         99.06        68.15       -31.20
0346............................  Level II Transfusion Laboratory      X         30.59        22.72       -25.73
                                   Procedures.
0043............................  Closed Treatment Fracture Finger/    T        148.63       112.70       -24.17
                                   Toe/Trunk.
0687............................  Revision/Removal of                  T      1,535.37     1,171.45       -23.70
                                   Neurostimulator Electrodes.
0359............................  Level II Injections.............     X         67.50        51.53       -23.66
0122............................  Level II Tube changes and            T        638.40       494.56       -22.53
                                   Repositioning.
0363............................  Level I Otorhinolaryngologic         X         64.56        50.02       -22.52
                                   Function Tests.
0081............................  Non-Coronary Angioplasty or          T      2,584.47     2,041.29       -21.02
                                   Atherectomy.
0191............................  Level I Female Reproductive Proc     T         12.27         9.84       -19.80
0685............................  Level III Needle Biopsy/             T        355.90       286.61       -19.47
                                   Aspiration Except Bone Marrow.
0371............................  Level I Allergy Injections......     X         29.69        23.93       -19.39
0152............................  Percutaneous Abdominal and           T        595.64       486.01       -18.41
                                   Biliary Procedures.
0222............................  Implantation of Neurological         T     13,528.13    11,061.74       -18.23
                                   Device.
0118............................  Chemotherapy Administration by       S        325.75       267.63       -17.84
                                   Both Infusion and Other
                                   Technique.
0086............................  Ablate Heart Dysrhythm Focus....     T      3,138.30     2,611.43       -16.79
0202............................  Level VIII Female Reproductive       T      2,706.38     2,273.91       -15.98
                                   Proc.
0228............................  Creation of Lumbar Subarachnoid      T      3,541.71     2,996.28       -15.40
                                   Shunt.
0347............................  Level III Transfusion Laboratory     X         66.49        56.52       -14.99
                                   Procedures.
0245............................  Level I Cataract Procedures          T        863.71       736.87       -14.69
                                   without IOL Insert.
0189............................  Level III Female Reproductive        T         90.69        77.39       -14.67
                                   Proc.
0085............................  Level II Electrophysiologic          T      2,478.31     2,128.77       -14.10
                                   Evaluation.
0665............................  Bone Density:                        S         49.02        42.34       -13.63
                                   AppendicularSkeleton.
0670............................  Intravenous and Intracardiac         S      1,796.55     1,555.61       -13.41
                                   Ultrasound.
0368............................  Level II Pulmonary Tests........     X         62.61        54.62       -12.76
0107............................  Insertion of Cardioverter-           T     19,378.60    17,025.21       -12.14
                                   Defibrillator.
0362............................  Level III Otorhinolaryngologic       X        168.41       148.74       -11.68
                                   Function Tests.
0287............................  Complex Venography..............     S        415.06       368.16       -11.30
0120............................  Infusion Therapy Except              T        129.56       115.11       -11.15
                                   Chemotherapy.
0212............................  Nervous System Injections.......     T        196.63       175.73       -10.63
0004............................  Level I Needle Biopsy/               T        103.36        92.43       -10.57
                                   Aspiration Except Bone Marrow.
0676............................  Level II Transcatheter               T        245.24       219.77       -10.39
                                   Thrombolysis.
0268............................  Ultrasound Guidance Procedures..     S         82.47        74.07       -10.19
0106............................  Insertion/Replacement/Repair of      T      3,256.61     2,927.17       -10.12
                                   Pacemaker and/or Electrodes.
----------------------------------------------------------------------------------------------------------------

    We solicit comments on the proposed weights for all APCs and for 
the APC placement of all HCPCS codes. However, because we believe the 
public may be interested in commenting on APCs where the payment rate 
decreases, we discuss several APCs whose payment rates decrease by more 
than 10 percent. We are particularly interested in comments, including 
the submission of external data (as discussed below) regarding these 
APCs.
Discussion of Selected APCs
    APC 312 Radioelement Applications--The proposed median for this APC 
falls 93.12 percent in comparison with the 2003 adjusted median (from 
$3,141.77 to $216.18). The 2003 OPPS median was adjusted against

[[Page 47986]]

the 2002 OPPS median ($7,080.00) into which we packaged the cost of 
brachytherapy seeds. However, for 2003 and 2004, we are making separate 
payment for bracytherapy seeds (with the exception of prostate 
brachytherapy) and, therefore, the costs of those seeds is not packaged 
into the APC payment (except for prostate brachytherapy). The 2003 OPPS 
unadjusted median was $265.53, which is comparable to the proposed 2004 
OPPS median. Hence, we think the 2003 OPPS median reflects the costs of 
brachytherapy, with seeds paid separately.
    APC 692 Electronic Analysis of Neurostimulator Pulse Generators--
The proposed median for this APC falls 84.82 percent in comparison with 
the 2003 OPPS adjusted median (from $371.55 to $56.40). The 2003 OPPS 
median was adjusted against the 2002 OPPS median ($819.00), which 
contained costs for devices that should not have been packaged. 
Moreover, the 2003 OPPS unadjusted median for the service was $46.95, 
and this is comparable to the 2004 OPPS median of $56.40. Hence, we 
believe that the proposed 2004 OPPS median reflects the cost of the 
service.
    APC 651 Complex Interstitial Radiation Source Application--The 
proposed median for this APC falls 81.89 percent in comparison with the 
2003 OPPS adjusted median (from $3,250.63 to $588.67). The 2003 OPPS 
median was adjusted against the 2002 OPPS median ($7,080.00), which 
contained costs for brachytherapy seeds that are currently paid 
separately. Moreover, the 2003 OPPS unadjusted median for the service 
was $483.25, and this is comparable to the proposed 2004 OPPS median of 
$588.67. Hence, we believe that the proposed 2004 OPPS median reflects 
the cost of the service because brachytherapy seeds are paid 
separately.
    APC 225 Implantation of Neurostimulator Electrodes--The proposed 
median for this APC fell 60.33 percent (from $8,277.07 to $3,283.68) as 
compared to the adjusted median used for the 2003 OPPS. The 2003 OPPS 
median was adjusted against the 2002 OPPS median ($15,286.00), which 
reflected the manufacturer(s) price(s) for the devices packaged into 
the APC. However, the proposed 2004 OPPS median ($3,283.68) is very 
close to the unadjusted 2003 OPPS median ($3,561.03), causing us to 
believe that the 2004 proposed median accurately reflects the costs of 
the procedure. Because this APC is commonly performed with implantation 
of a neurostimulator pulse generator (APC 222), we changed the status 
indicator of APC 225 to ``S'' so that it would not be subjected to the 
multiple procedure reduction when it is performed with implantation of 
a neurological device. We do not propose to change the status indicator 
this year, and the multiple procedure reductions would not be applied 
in CY 2004 to APC 0225.
    We determined the proposed 2004 OPPS median for APC 225, using only 
claims that contained the C codes for the neurostimulator leads (either 
C1778 Lead, neurostimulator, or C1897 Lead, neurostimulator test kit) 
in order to ensure that we captured the costs for the leads in the data 
used to calculate the median. We solicit comments concerning the 
accuracy of our data and whether they appropriately reflect the cost of 
neurostimulator electrodes, as well as submission of data on the 
acquisition cost of neurostimulator electrodes (both permanent and test 
electrodes).
    APC 352 Level 1 Injections--The proposed 2004 OPPS median for this 
APC fell 51.83 percent (from $13.10 to $6.31) as compared to the 
adjusted 2003 OPPS median. The 2003 OPPS median was adjusted against 
the 2002 OPPS median ($23.00). However, the 2003 OPPS median ($6.65) is 
very close to the proposed 2004 OPPS median ($6.31), and this leads us 
to believe that the proposed 2004 median reflects the cost of the 
service.
    APC 313 Brachytherapy.--The proposed median for this APC falls 
38.45 percent in comparison with the 2003 OPPS adjusted median (from 
$1,249.57 to $769.14) because the 2003 OPPS median was adjusted against 
the 2002 OPPS median ($2,030.00), which contained costs for 
brachytherapy seeds that should not have been included because the 
radioelement sources used in this APC are not single use seeds. 
Moreover, the 2003 OPPS unadjusted median for the service was $773.63, 
and this is comparable to the proposed 2004 OPPS median of $769.14. 
Hence, we believe that the proposed 2004 OPPS median reflects the cost 
of the service.
    APC 223 Implantation or Revision of Pain Management Catheter.--The 
proposed median for this APC falls 37.40 percent in comparison with the 
2003 OPPS adjusted median (from $2,437.21 to $1,525.61). The single CPT 
code in this APC describes three procedures: revision, repositioning, 
and insertion of a pain management catheter. Therefore, the median cost 
of this APC should reflect the relative frequencies with which these 
three procedures are performed. Furthermore, the descriptor makes it 
inappropriate to use only claims containing ``C'' codes to determine 
the median cost for this APC because a device is not always used when 
this procedure is performed. To require that a ``C'' code be on claims 
for this procedure would result in inaccurate median costs. We believe 
the decrease in median cost is due to the packaging of 75 percent of 
the cost of the catheter into the APC amount for the 2002 OPPS fee 
schedule.
    APC 385 Level 1 Prosthetic Urological Procedures.--The proposed 
median for this APC fell 37.16 percent compared to the adjusted median 
for this APC in 2003 OPPS ($3895.76 compared to $6,199.09). This 
occurred because we removed the more expensive inflatable penile 
prosthesis and prosthetic urinary sphincters from APC 179 and placed 
them in a new APC (APC 386 with proposed 2004 OPPS median of 
$6,298.89). Hence, we believe that the proposed medians for both APCs 
reflect the costs of the services that they now contain.
    APC 687 Revision/Removal of Neurostimulator Electrodes--The 
proposed median costs of this APC decreased 23.7 percent as compared to 
the adjusted median used for the 2003 OPPS fee schedule ($1,171.45 
compared to $1,535.37). (See Table 8.) However, none of the procedures 
in this APC require the use of high cost devices, and we believe the 
change in median cost reflects fluctuation in the costs of providing 
these services.
    APC 359 Level II Injections--See section VI.B.4 of this proposed 
rule for the discussion of administration of drugs.
    APC 81 Non Coronary Angioplasty or Atherectomy--The median for this 
APC fell 21.02 percent in comparison with the actual median cost used 
in the 2003 OPPS fee schedule (from $2,584.47 to $2,041.29). The median 
cost used for OPPS 2003 was significantly higher than the median cost 
used for the 2002 OPPS, which included packaging of 75 percent of the 
devices used in this APC. We believe the decrease this year, which is 
still substantially higher than the median used for 2002, reflects the 
fluctuating costs of providing this service.
    APC 222 Implantation of Neurological Device--The proposed median 
for this APC fell 18.23 percent in comparison with the 2003 OPPS 
adjusted median (from $13,528.13 to $11.528.13). The 2003 OPPS adjusted 
median was adjusted against the 2002 OPPS median, which packaged 75 
percent of the cost (based on manufacturer submitted data) of the 
devices ($17,284.00) into the APC. However, the proposed 2004 OPPS 
median of $11,061.74 compares favorably with the unadjusted 2003 OPPS 
median of $9,146.22. Because we

[[Page 47987]]

developed the proposed 2004 median for APC 222 using only claims that 
contained charges for device code C1767, we believe our current cost 
data better reflect the cost of these devices. We solicit comments on 
the accuracy of our data as well as the submission of data on the 
acquisition cost of these devices.
    APC 118 Chemotherapy Administration by Both Infusion and Other 
Technique--See section VI.B.4 of this proposed rule for the discussion 
of administration of drugs.
    APC 86 Ablate Heart Dysrhythm Focus--The proposed median for this 
APC fell 16.79 percent for 2004 OPPS when compared to the adjusted 
median for 2003 (from $3,138.30 to $2,611.43). The proposed 2004 OPPS 
median is comparable to the unadjusted median for 2003 OPPS of 
$2,745.69. Because this APC requires the use of a device, we required 
that the claims used to set the median for this APC contain a device 
code to qualify. We believe that our cost data accurately reflect the 
cost of providing this service. We note that the high payment rate for 
2003 was adjusted against the 2002 median, which reflected packaging 75 
percent of the device cost (based on manufacturer submitted costs) into 
the APC.
    APC 202 Level VIII Female Reproductive Procedure--We made several 
changes to the structure of this APC and the proposed median for this 
APC fell 15.98 percent for 2004 OPPS when compared to the adjusted 
median for the 2003 (from $2,706.38 to $2,273.91). The proposed 2004 
OPPS median is comparable to the unadjusted median for 2003 OPPS of 
$2,327.25. This APC requires the use of a device and, therefore, we 
required that the claims used to set the median for this APC must 
contain one or more specified device codes to qualify (C1771 Repair 
device, urinary incontinence, with sling graft, C2631 Repair device, 
urinary incontinence, without sling graft). We believe our cost data 
accurately reflect the costs of providing this service.
    APC 670 Intravenous and Intracardiac Ultrasound--The proposed 
median for this APC fell 13.41 percent for the 2004 OPPS when compared 
to the median for 2003 OPPS (from $1,796.55 to $1,555.61). This APC 
requires the use of a device and therefore we required that the claims 
used to set the median for this APC must contain a device code to 
qualify. We believe that our cost data accurately reflect the cost of 
providing this service and that any change in median cost is due to 
fluctuations in hospital costs.
    APC 107 Insertion of Cardioverter-Defibrillator--The proposed 2004 
OPPS median for this APC fell 12.14 percent (from $19,378.60 to 
$17,025.21) as compared to the adjusted median cost for the 2003 OPPS 
fee schedule. The 2003 OPPS median was adjusted against the 2002 OPPS 
median ($21,679.00) which reflected packaging 75 percent of the 
manufacturer submitted prices for the devices used in this APC. The 
proposed 2004 OPPS median is much closer to the adjusted median than it 
is to the unadjusted 2003 OPPS median ($13,572.62).
    We acquired the proposed 2004 OPPS median for APC 107 by using only 
claims that contained the C codes for cardioverter-defibrillators 
(either C1721 Cardioverter-defibrillator dual chamber, C1722 
Cardioverter-defibrillator, single chamber, or C1882 Cardioverter-
defibrillator, other than single or dual chamber) in order to ensure 
that we captured the costs for the device in the data used to calculate 
the median. Although the proposed median cost of this APC is lower than 
the adjusted median used last year, it is considerably higher than the 
actual median from last year, and we have confidence that it reflects 
the cost of the devices used in the procedure. We would also note that 
the proposed median cost for APC 108 also rose dramatically and is 
higher than the adjusted median used for the 2003 OPPS fee schedule. 
Assuming that the proposed median cost for APC 108 accurately reflects 
the cost of inserting a cardioverter-defibrillator with leads, we would 
expect that the proposed median cost of APC 107, which also rose 
significantly as compared to the actual median cost used for OPPS 2003, 
accurately reflects the cost of inserting a cardioverter-defibrillator 
without leads.
    APC 120 Infusion Therapy Except Chemotherapy--See section VI.B.4 of 
this proposed rule for a discussion of infusion therapy other than 
chemotherapy.
    APC 106 Insertion/Replacement/Repair of Pacemaker and/or 
Electrodes--The proposed 2004 OPPS median for this APC fell 10.12 
percent compared to the 2003 OPPS median (from a final 2003 OPPS median 
of $3,256.61 to a proposed 2004 Median of $2,927.17). This APC contains 
both CPT codes for insertion of temporary pacemaker leads (CPT codes 
33210 and 33211) and repair and revision of pacemaker leads (33216, 
33217, 33218, and 33220). This APC contains a mixture of services and, 
therefore, its median cost should reflect the mixture of services 
provided. We solicit comments on whether the proposed median cost for 
this APC reflects the cost of providing these services as well as the 
submission of data on the acquisition costs of the leads used for each 
service in this APC.
    Preferred Characteristics of External Data Submitted in Comments. 
We will consider external data on devices that are provided to the 
extent that they enable us to verify or adjust claims data where we are 
convinced that an adjustment is appropriate. All data we use to create 
payment amounts for the final rule will be available for public 
inspection.
    External data must meet the following criterion:
    [sbull] Be available for public inspection.
    External data that are likely to be of optimal use should meet the 
following criteria:
    [sbull] Represent a diverse group of hospitals both by location 
(for example, rural, urban) and by type (for example, community, 
teaching). We would prefer that commenters identify each hospital 
including location with city and State, nonprofit vs. for profit 
status, teaching vs. nonteaching status, and the percent of Medicare 
vs. non-Medicare patients receiving the service; a pseudo identifier 
could be used for the hospital identification. Data should be submitted 
both ``per hospital'' and in the aggregate.
    [sbull] Identify the number of devices billed to Medicare by each 
hospital as well as any rebates or reductions for bulk purchase or 
similar discounts and identify the characteristics of providers to 
which any such price rebates or reductions apply.
    [sbull] Identify all HCPCS codes with which each item would be 
used.
    [sbull] Identify the source of the data.
    [sbull] Include both the charges and costs for each hospital, by 
quarter for the last 3 quarters of 2002. Cost data for 2003 are not 
compatible with 2002 claims data.
    This information would enable us to compare our claims data to the 
external data and help us determine whether the submitted data are 
representative of hospitals that submit claims under OPPS.
    Please note that information that contains beneficiary-specific 
information (for example, medical records, invoices with beneficiary 
identification on it) should be altered, if necessary, to remove any 
individually identifiable information, such as information that 
identifies an individual, diagnoses, addresses, telephone numbers, 
attending physician, medical record number, Medicare or other insurance 
number, etc. Moreover, individually identifiable beneficiary medical 
records, including progress notes, medical orders, test results, 
consultation reports, etc. should

[[Page 47988]]

not be submitted to us. Similarly, photocopies of checks from hospitals 
or other documents that contain bank routing numbers should not be 
submitted to us.
Blood and Blood Products
    See section VI.B.8 of this proposed rule for our discussion of the 
analysis of data for blood and blood products and our proposal.
Separately Paid Drugs
    See section VI.B.3 of this proposed rule for our discussion of the 
analysis of data for separately paid drugs and our proposal.

B. Description of How We Propose To Calculate Weights for CY 2004

    The methodology we followed to calculate the APC relative payment 
weights proposed for CY 2004 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 end-stage renal disease 
(ESRD)).
    [sbull] We eliminated 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 CY 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 325 hospitals that 
we identified as having reported charges on their cost reports that 
were not actual charges (for example, a uniform charge applied to all 
services). Of these, only 166 hospitals had claims data.
    [sbull] We eliminated from our data claims for critical access 
hospitals that are not paid under OPPS and whose claims are therefore 
not suitable for use in setting weights for services paid under OPPS.
    [sbull] We calculated the geometric mean of the total operating 
CCRs of hospitals remaining in the CCR data. We removed from the CCR 
data 29 hospitals whose total operating CCR deviated from the geometric 
mean by more than three standard deviations.
    [sbull] We excluded from our data approximately 2.1 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 
claims to hospital CCRs.
    [sbull] We separated the 66.345 million claims that we had matched 
with a cost report into the following three distinct groups: (1) 
Single-procedure claims; (2) multiple-procedure claims; and (3) claims 
on which we could not identify at least one OPPS covered service. 
Single-procedure claims are those that include only one HCPCS code 
(other than laboratory and incidentals such as packaged drugs and 
venipuncture) that could be grouped to an APC. Multiple-procedure 
claims include more than one HCPCS code that could be mapped to an APC. 
Thus, dividing the claims yielded approximately 21.92 million single-
procedure claims and 14.8 million multiple-procedure claims. 
Approximately 19.57 million claims without at least one covered OPPS 
service were set aside.
    We converted 8.47 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 preoperative procedures and for those services in the 
APCs identified in Table 9. These are services with payment amounts 
below $50 (under CY 2003 OPPS) for which we believe the charge 
represents the totality of the charges associated with the service 
(that is, that there are no packaged HCPCS or packaged revenue centers 
attributable to the service). If only one procedure (other than HCPCS 
codes in Table 9) 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-procedure claim if billed with single 
units. (4) If the claim had no packaged HCPCS codes but had packaged 
revenue centers for the procedure, we ignored the line item for codes 
in the APCs identified in Table 9. If only one HCPCS code remained, we 
treated the claim as a single-procedure claim.

   Table 9.--APCS That Were Ignored To Create Pseudo Single Procedure
                                 Claims
------------------------------------------------------------------------
 
------------------------------------------------------------------------
0001............................  Level I                   S
                                   Photochemotherapy.
0060............................  Manipulation Therapy....  S
0077............................  Level I Pulmonary         S
                                   Treatment.
0099............................  Electrocardiograms......  S
0215............................  Level I Nerve and Muscle  S
                                   Tests.
0215............................  Level I Nerve and Muscle  S
                                   Tests.
0230............................  Level I Eye Tests &       S
                                   Treatments.
0260............................  Level I Plain Film        X
                                   Except Teeth.
0262............................  Plain Film of Teeth.....  X
0271............................  Mammography.............  S
0341............................  Skin Tests and            X
                                   Miscellaneous Red Blood
                                   Cell Tests.
0342............................  Level I Pathology.......  X
0343............................  Level II Pathology......  X
0344............................  Level III Pathology.....  X
0345............................  Level I Transfusion       X
                                   Laboratory Procedures.
0364............................  Level I Audiometry......  X
0367............................  Level I Pulmonary Test..  X
0669............................  Digital Mammography.....  S
0690............................  Electronic Analysis of    S
                                   Pacemakers and other
                                   Cardiac Devices.
0706............................  New Technology--Level I   S
                                   ($0-$50).
------------------------------------------------------------------------


[[Page 47989]]

    In addition, we assessed the dates of service for HCPCS codes and 
packaged revenue centers on each claim that contained more than one 
major code. Where it was possible to attribute charges for packaged 
HCPCS and packaged revenue centers to HCPCS codes for major procedures 
by matching unique dates of service, we did this and created single 
claims by packaging charges into the charge for the major service on 
the same date. We were only able to do this if the multiple major 
procedures had different dates of service and if there were dates of 
service on all of the packaged revenue centers. Dates of service on 
revenue centers are not required and, therefore, only claims from 
hospitals that submitted dates of service on revenue centers in CY 2002 
could be used in this process for maximizing the number of single-
procedure claims to be used for weight setting. We created an 
additional 23.58 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 except as described otherwise. 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.2 of this proposed rule, we did not use 
multiple-procedure claims that billed more than one separately payable 
HCPCS code with charges for packaged items and services such as 
anesthesia, recovery room, or supplies that could not be reliably 
allocated or apportioned among the primary HCPCS codes on the claim. We 
have not yet developed what we regard as an acceptable method of using 
multiple procedure bills to recalibrate APC weights that minimizes the 
risk of improperly assigning charges to the wrong procedure or visit.
    For APCs in Table 10, we required that there be a C code on the 
claim for the claim to be used. These APCs require the use of a device 
in the provision of the service. Moreover, in 2002, hospitals were 
required to bill the C code in order for the device to receive pass-
through payment for the device. Therefore, if no C code was billed on 
the claim, we presumed that the claim was incorrectly coded, and we did 
not use it. For some of these APCs, we further required that specific 
devices be on the claim.

 Table 10.--APCS for Which a HCPCS for a Device Was Required To Be on a
                      Claim Used for Weight Setting
------------------------------------------------------------------------
               APC                     APC description         Status
------------------------------------------------------------------------
0032............................  Insertion of Central      T
                                   Venous/Arterial
                                   Catheter.
0048............................  Arthroplasty with         T
                                   Prosthesis.
0080............................  Diagnostic Cardiac        T
                                   Catheterization.
0081............................  Non-Coronary Angioplasty  T
                                   or Atherectomy.
0082............................  Coronary Atherectomy....  T
0083............................  Coronary Angioplasty and  T
                                   Percutaneous
                                   Valvuloplasty.
0085............................  Level II                  T
                                   Electrophysiologic
                                   Evaluation.
0086............................  Ablate Heart Dysrhythm    T
                                   Focus.
0087............................  Cardiac                   T
                                   Electrophysiologic
                                   Recording/Mapping.
0089............................  Insertion/Replacement of  T
                                   Permanent Pacemaker and
                                   Electrodes.
0090............................  Insertion/Replacement of  T
                                   Pacemaker Pulse
                                   Generator.
0104............................  Transcatheter Placement   T
                                   of Intracoronary Stents.
0106............................  Insertion/Replacement/    T
                                   Repair of Pacemaker and/
                                   or Electrodes.
0107............................  Insertion of              T
                                   Cardioverter-
                                   Defibrillator.
0108............................  Insertion/Replacement/    T
                                   Repair of Cardioverter-
                                   Defibrillator Leads.
0115............................  Cannula/Access Device     T
                                   Procedures.
0119............................  Implantation of Devices.  T
0122............................  Level II Tube Changes     T
                                   and Repositioning.
0167............................  Level III Urethral        T
                                   Procedures.
0182............................  Insertion of Penile       T
                                   Prosthesis.
0202............................  Level VIII Female         T
                                   Reproductive Proc.
0222............................  Implantation of           T
                                   Neurological Device.
0225............................  Implantation of           S
                                   Neurostimulator
                                   Electrodes.
0226............................  Implantation of Drug      T
                                   Infusion Reservoir.
0227............................  Implantation of Drug      T
                                   Infusion Device.
0229............................  Transcatheter Placement   T
                                   of Intravascular Shunts.
0259............................  Level VI ENT Procedures.  T
0313............................  Brachytherapy...........  S
0384............................  GI Procedures with        T
                                   Stents.
0385............................  Level I Prosthetic        T
                                   Urological Procedures.
0386............................  Level II Prosthetic       T
                                   Urological Procedures.
0648............................  Breast Reconstruction     T
                                   with Prosthesis.
0652............................  Insertion of              T
                                   Intraperitoneal
                                   Catheters.
0653............................  Vascular Reconstruction/  T
                                   Fistula Repair with
                                   Device.
0654............................  Insertion/Replacement of  T
                                   a permanent dual
                                   chamber pacemaker.
0655............................  Insertion/Replacement/    T
                                   Conversion of a
                                   permanent dual chamber
                                   pacemaker.
0670............................  Intravenous and           S
                                   Intracardiac Ultrasound.
0674............................  Prostate Cryoablation...  T
0680............................  Insertion of Patient      S
                                   Activated Event
                                   Recorders.
0681............................  Knee Arthroplasty.......  T
------------------------------------------------------------------------


[[Page 47990]]

    [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 CCR. We used the most recent 
settled or submitted cost reports. Using the most recent ``submitted to 
settled ratio,'' we adjusted CCRs for the submitted cost reports but 
not the settled ones. If an appropriate cost center did not exist for a 
given hospital, we crosswalked the revenue center to a secondary cost 
center when possible, or used the hospital's overall CCR 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 
services. Table 11 contains a list of the revenue centers that we 
packaged into major HCPCS codes when they appeared on the same claim. 
This is a change to the packaging of revenue centers by category of 
service that had been done since the inception of the OPPS in the April 
7, 2000 final rule (65 FR 18457). In all prior years of OPPS, we had 
specific subsets of revenue centers that we packaged into major HCPCS 
codes based on the type of service we assigned to the HCPCS code for 
this purpose. For example, we had a set of revenue centers that could 
be packaged into visit codes and a different, but overlapping, set of 
revenue centers that could be packaged into surgery codes. We propose 
to convert these categories to a single set of revenue codes (see Table 
11) that would be packaged into the major HCPCS code with which it 
appears on a claim. We believe that this will increase the likelihood 
that the total charge for the major HCPCS code will capture all of the 
costs attributed to the services furnished.
    Table 11 lists packaged services by revenue center that we are 
proposing to use to calculate per-service costs for outpatient services 
furnished in CY 2004.

              Table 11.--Packaged Services by Revenue Code
------------------------------------------------------------------------
               Revenue Code                          Description
------------------------------------------------------------------------
250.......................................  PHARMACY
251.......................................  GENERIC
252.......................................  NONGENERIC
254.......................................  PHARMACY INCIDENT TO OTHER
                                             DIAGNOSTIC
255.......................................  PHARMACY INCIDENT TO
                                             RADIOLOGY
257.......................................  NONPRESCRIPTION DRUGS
258.......................................  IV SOLUTIONS
259.......................................  OTHER PHARMACY
260.......................................  IV THERAPY, GENERAL CLASS
262.......................................  IV THERAPY/PHARMACY SERVICES
263.......................................  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
371.......................................  ANESTHESIA INCIDENT TO
                                             RADIOLOGY
372.......................................  ANESTHESIA INCIDENT TO OTHER
                                             DIAGNOSTIC
379.......................................  OTHER ANESTHESIA
390.......................................  BLOOD STORAGE AND PROCESSING
399.......................................  OTHER BLOOD STORAGE AND
                                             PROCESSING
560.......................................  MEDICAL SOCIAL SERVICES
569.......................................  OTHER MEDICAL SOCIAL
                                             SERVICES
621.......................................  SUPPLIES INCIDENT TO
                                             RADIOLOGY
622.......................................  SUPPLIES INCIDENT TO OTHER
                                             DIAGNOSTIC
624.......................................  INVESTIGATIONAL DEVICE (IDE)
630.......................................  DRUGS REQUIRING SPECIFIC
                                             IDENTIFICATION, GENERAL
                                             CLASS
631.......................................  SINGLE SOURCE
632.......................................  MULTIPLE
633.......................................  RESTRICTIVE PRESCRIPTION
637.......................................  SELF-ADMINISTERED DRUG
                                             (INSULIN ADMIN. IN
                                             EMERGENCY DIABETIC COMA)
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
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 proposed FY 2004 hospital inpatient 
prospective payment system (IPPS) wage index published in the Federal 
Register on May 9, 2002 (67 FR 31602). We used 60 percent to represent 
our estimate of that portion of costs attributable, on average, to 
labor. We have used this estimate since the inception of the OPPS and 
continue to believe that it is appropriate. (See 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, to 
the extent possible, the proposed APC changes.
    [sbull] We calculated the median cost for each APC.
    To develop the median cost for observation (APC 339, HCPCS code 
G0244), we selected claims containing HCPCS code G0244 (Observation 
care

[[Page 47991]]

provided by a facility to a patient with CHF, chest pain, or asthma, 
minimum eight hours, maximum forty-eight hours) that also showed one or 
more of the ICD-9 (International Classification of Diseases, Ninth 
Edition) diagnosis codes required for payment of APC 339. We ignored 
other separately payable codes so that the claims with G0244 would not 
be excluded for having multiple major procedures on a single claim. We 
packaged the costs of allowable revenue centers and HCPCS codes with 
status indicator ``N'' into the cost of G0244, and trimmed as was done 
for the calculation of the median costs for other APCs.
    To calculate the weights for APCs 649 (Prostate Brachytherapy with 
Palladium seeds) and 684 (Prostate Brachytherapy with Iodine seeds) 
into which the cost of brachytherapy seeds are packaged, we selected 
claims that contained HCPCS codes 77778 and 55859 where the lines 
containing codes 77778 and 55859 have the same date of service and the 
claim contained either HCPCS code C1720 (Palladium seeds) or C1718 
(Iodine seeds) (which need not be the same date of service as 77778 and 
55859). We ignored line items for services paid on the laboratory fee 
schedule and lines with separately payable HCPCS (even if multiple 
majors). We packaged all remaining costs from allowable revenue centers 
and packaged HCPCS into the claim (regardless of date of service). We 
separated the claims with Palladium seeds from claims with Iodine 
seeds. We then created a median cost for prostate brachytherapy with 
Palladium seeds (APC 0649; G0256) from the claims containing 77778, 
55859, and C1720 (Palladium seeds), and we created a median cost for 
prostate brachytherapy with Iodine seeds (APC 0684; G0261) from claims 
containing 77778, 55859, and C1718 (Iodine seeds).
    [sbull] Using the median APC costs, we calculated the relative 
payment weights for each APC. As in prior years, we scaled all the 
relative payment weights to APC 0601, Mid-level clinic visit, because 
it is one of the most frequently performed services in the hospital 
outpatient setting. 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 2002 
data, the median cost for APC 0601 is $58.78.
    Section 1833(t)(9)(B) of the Act requires that APC revisions, 
relative payment weight revisions, and wage index and other adjustments 
be made in a manner that ensures that estimated aggregate payments 
under the OPPS for 2004 are neither greater than nor less than the 
estimated 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 2003 relative weights to 
aggregate payments using the CY 2004 proposed weights. Based on this 
comparison, we are proposing to make an adjustment of 1.003107132 to 
the weights. The weights that we are proposing for CY 2004, which 
incorporate the recalibration adjustments explained in this section, 
are listed in Addendum A and Addendum B.

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 biological agents. As originally enacted by the 
BBRA, this provision required the Secretary to make additional payments 
to hospitals for current orphan drugs, as designated under section 526 
of the Federal Food, Drug, and Cosmetic Act, Public Law 107-186; 
current drugs, biological agents, and brachytherapy devices used for 
the treatment of cancer; and current drugs and biological products.
    For those drugs, biological agents, 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 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 can 
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 
(PM). On March 22, 2001, we issued two PMs, Transmittals A-01-40 and A-
01-41 that established the initial categories. We posted them on our 
Web site at: http://www.hcfa.gov/pubforms/transmit/A0140.pdf and http://www.hcfa.gov/pubforms/transmit/A0141.pdf, respectively.
    Transmittal A-01-41 includes a list of the initial device 
categories, a crosswalk of all the item-specific codes for individual 
devices that were approved for transitional pass-through payments, and 
the initial category code by which the cross-walked individual device 
was 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 biological agents are identified by status indicator ``G.'' 
Subsequently, we added a number of additional categories, retired 95 
categories effective January 1, 2003, and made clarifications to some 
of the categories' long descriptors found in various program 
transmittals. A list of device category codes in effect as of July 1, 
2003, can be found in Transmittal A-03-051, which was issued on June 
13, 2003. This PM can be accessed on our Web site at  http://www.cms.gov.
    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 were the subject of 
a separate interim final rule with comment period published in the 
Federal Register on November 2, 2001 (66 FR 55850) and made final in 
the November 1, 2002 Federal Register (67 FR 66781) announcing the 2003 
update to the OPPS.
    Transitional pass-through categories are for devices only; they do 
not apply to drugs or biological agents. The regulations at Sec.  
419.64 governing transitional pass-through payments for eligible drugs 
and biological agents are unaffected by the creation of categories.
    The process to apply for transitional pass-through payment for 
eligible drugs and biological agents or for additional device 
categories can be found on respective pages on our Web site at http://www.cms.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) as required under 
the Paperwork Reduction Act (PRA). Notification of new drug, 
biological, or device category application processes is generally 
posted on the OPPS Web site at  http://www.cms.gov.

[[Page 47992]]

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 Medicare and beneficiary 
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. We propose to set 
the percentage at 2.0 percent for the 2004 OPPS.
    If we estimate before the beginning of the calendar year that the 
total amount of pass-through payments in that year would exceed the 
applicable percentage, section 1833(t)(6)(E)(iii) of the Act requires a 
prospective uniform reduction in the amount of each of the transitional 
pass-through payments made in that year to ensure that the limit is not 
exceeded. We make an estimate of pass-through spending to determine not 
only whether payment exceeds the applicable percentage but also to 
determine the appropriate reduction to the conversion factor.
    For devices, making an estimate of pass-through spending in 2004 
entails estimating spending for two groups of items. The first group 
consists of those items for which we have claims data (that is, items 
that were eligible in 2002 and that will continue to be eligible in 
2004). The second group consists of those items for which we have no 
direct claims data (that is, items that became, or will become, 
eligible in 2003 and will retain pass-through status and items that 
will be newly eligible beginning in 2004).
    To estimate 2004 pass-through spending for device categories in the 
first group, we would use volume and hospital cost (derived from 
charges on claims using cost-to-charge ratios) information from 2002 
claims data. This information would be projected forward to 2004 levels 
using appropriate inflation and utilization factors. For existing 
categories with no claims data in 2002 that are, or will be, active in 
2004, we would follow the method described in the November 2, 2001 
final rule (66 FR 55857). We would use price information from 
manufacturers and volume estimates from claims related to procedures 
that use the devices in question. This information would be projected 
forward to 2004 using appropriate inflation and utilization factors to 
estimate 2004 pass-through spending for this group of categories. For 
categories that become eligible in 2004, we would use the same method 
as described for categories that were newly active in 2002. We 
anticipate that any new categories for January 1, 2004 will be 
announced after the publication of this proposed rule but before the 
publication of the final rule. Therefore, the estimate of pass-through 
spending would incorporate pass-through spending for categories made 
effective January 1, 2004.
    To estimate 2004 pass-through spending for drugs and biological 
agents, we would make estimates of utilization, collect data on average 
wholesale price (AWP) and combine these with ratios used to represent 
hospital acquisition costs for these drugs. We would collect drug-
specific information on Medicare use from the pharmaceutical 
manufacturer where possible and rely on other sources (such as peer-
reviewed clinical studies) as needed. In the past, we relied upon the 
AWP published in the Redbook to establish the AWP of pass-through drugs 
payable under the OPPS. As described elsewhere in this preamble, we 
plan to adopt and apply the provisions outlined in the Payment Reform 
for Part B drugs. For the purpose of calculating payments for 
transitional pass-through items, we would determine 95 percent of the 
drug's average wholesale price based on the newly established AWP. We 
would use published ratios on hospital acquisition costs reported in 
our proposed rule of August 9, 2002 (67 FR 52129). For sole source 
drugs the ratio of acquisition cost to AWP equals 0.71; for multi-
source drugs, the ratio is 0.68; and for multi-source drugs with 
generic competitors, the ratio equals 0.46.
    For drugs and biological agents that may receive pass-through 
status effective January 1, 2004, we propose to use the same 
methodology as described for drugs and biological agents that received 
pass-through status in 2003. Any new pass-through drugs and biological 
agents effective beginning in 2004 would be announced after the 
publication of this proposed rule but before the publication of the 
final rule. Therefore, the estimate of pass-through spending would 
incorporate pass-through spending for these drugs and biological agents 
made effective January 1, 2004.
    After using the methodologies described above to determine 
projected 2004 pass-through spending for the groups of devices, drugs, 
and biological agents, we would calculate total projected 2004 pass-
through spending as a percentage of the total projected payments 
(Medicare and beneficiary payments) under OPPS to determine if the pro 
rata reduction will be required.
    Table 12 shows our current estimate of 2004 pass-through spending 
for known pass-through drugs, biologicals, and devices based on 
information available at the time this table was developed. We are 
uncertain whether estimated pass-through spending in 2004 will exceed 
$456 million (2.0 percent of total estimated OPPS spending). We have 
not yet completed the estimate of pass-through spending for a number of 
drugs and devices. In particular, we do not have estimates for those 
drugs still under agency review for additional pass-through payments 
beginning October 2003 or the changes in pass-through spending that 
could result from quarterly rather than annual updates of AWP for pass-
through drugs. Finally, we would incorporate an estimate of pass-
through spending for items for which pass-through payment becomes 
effective later in 2004 (that is, April 1, 2004; July 1, 2004; and 
October 1, 2004) based on estimates of items that become eligible for 
pass-through payment on October 1, 2003 and January 1, 2004. 
Specifically, we would assume a proportionate amount of spending for 
items that become eligible later in the year while making an adjustment 
to account for the fact that items made eligible later in the year will 
not receive pass-through payments for the entire year. We invite 
comments on the methodology as described above and the estimates for 
utilization that appear in the table below.

                        Table 12.--Estimates for 2004 Transitional Pass-Through Spending
----------------------------------------------------------------------------------------------------------------
                                                                    2004 pass-                         2004
                                                                      through     2004 estimated    anticipated
            New HCPC                 APC       Drug biological        payment       utilization    pass-through
                                                                      portion                        payments
----------------------------------------------------------------------------------------------------------------
                                  .........     Existing Pass-
                                                through Drugs/
                                                  Biologicals
C9111...........................       9111  Injection                   $100.50          21,007       2,111,200
                                              Bivalrudin, 250 mg
                                              per vial.
C9112...........................       9112  Perflutren lipid             $37.44          67,000       2,508,480
                                              microsphere, per 2
                                              ml.

[[Page 47993]]

 
C9113...........................       9113  Inj Pantoprazole              $5.76          20,000         115,200
                                              sodium, per vial.
C9116...........................       9116  Ertapenum sodium,            $11.45           7,200          82,440
                                              per 1 gm vial.
Q4053...........................       9119  Pegfilgrastim, per          $118.00         662,062      78,123,329
                                              1 mg single dose
                                              vial.
C9120...........................       9120  Faslodex, per 50 mg          $44.25         137,078       6,065,702
                                              injection.
C9121...........................       9121  Argatroban, per 5             $3.60          50,000         180,000
                                              mg.
C9200...........................       9200  Orcel, per 36 cm2..         $286.80           1,000         286,800
C9203...........................       9203  Perflexane lipid             $36.00          82,400       2,966,400
                                              microspheres, per
                                              single use vial.
J2324...........................       9114  Nesiritide, per 0.5          $36.48          60,000       2,188,800
                                              mg vial.
J3315...........................       9122  Triptorelin                 $104.90         219,600      23,036,040
                                              pamoate, per 3.75
                                              mg.
J3487...........................       9115  Zoledronic acid, 1           $51.38         539,000      27,693,820
                                              mg.
C9204...........................       9204  Ziprasidone                  $10.50         117,143       1,230,000
                                              mesylate, per 20
                                              mg.
C9205...........................       9205  Oxaliplatin, per 5           $23.86         280,756       6,698,845
                                              mg.


----------------------------------------------------------------------------------------------------------------
                                                                                                       2004
              HCPCS                  APC         Description                      2004 estimated    anticipated
                                                                                    utilization       payment
----------------------------------------------------------------------------------------------------------------
                                  .........     Existing Pass-
                                                through Devices
C1783...........................       1783  Ocular implant,      ..............             323         159,756
                                              aqueous drainage
                                              assist device.
C1814...........................       1814  Retinal tamponade    ..............           35106      13,649,018
                                              device, silicone
                                              oil.
C1884...........................       1884  Embolization         ..............           25000      38,601,544
                                              Protective System.
C1888...........................       1888  Catheter, ablation,  ..............             214         129,128
                                              non-cardiac,
                                              endovascular
                                              (implantable).
C1900...........................       1900  Lead, left           ..............            2091       2,814,528
                                              ventricular
                                              coronary venous
                                              system.
C2614...........................       2614  Probe, percutaneous  ..............             899       1,748,555
                                              lumbar discectomy.
C2632...........................       2632  Brachytherapy        ..............             225       1,890,000
                                              solution, iodine-
                                              125, per mCi.
C1818...........................       1818  Integrated           ..............               4          27,800
                                              keratoprosthesis.
----------------------------------------------------------------------------------------------------------------

V. Payment for Devices

A. Pass-Through Devices

    Section 1833(t)(6)(B)(iii) of the Act requires that a category of 
devices be eligible for transitional pass-through payments for at least 
2, but not more than 3, years. This period begins with the first date 
on which a transitional pass-through payment is made for any medical 
device that is described by the category. We propose that two device 
categories currently in effect would expire effective January 1, 2004. 
Our proposed payment methodology for devices that have been paid by 
means of pass-through categories, and for which pass-through status 
would expire effective January 1, 2004, is discussed in the section 
below.
    Although the device category codes became effective April 1, 2001, 
most 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 and 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). We based the expiration dates for 
the category codes listed in Table 13, on when a category was first 
created, or when the item-specific devices that are described by, and 
included in, the initial categories were first paid as pass-through 
devices, before the implementation of device categories. These proposed 
device category expiration dates are listed in Table 13. We propose to 
base the expiration date for a device category on the earliest 
effective date of pass-through payment status of the devices that 
populate that category. There are two categories for devices that will 
have been eligible for pass-through payments for over 2 1/2 years as of 
December 31, 2003, and we propose that they would not be eligible for 
pass-through payments effective January 1, 2004. The two categories we 
propose for expiration are C1765 and C2618, as indicated in Table 13. 
Each category includes devices for which pass-through payment was first 
made under OPPS in 2000 or 2001.
    A comprehensive list of all pass-through device categories 
effective on or before July 2003 is displayed in Table 13. Also 
displayed are the dates the devices described by the category were 
populated and their respective proposed expiration dates.
    The methodology used to base expiration of a device category is the 
same as that used to determine the 95 initial categories that expired 
as of January 1, 2003. A list including those 95 categories that 
expired as of January 1, 2003 (as well as 5 categories that continue to 
be paid in 2003) is found in the November 1, 2002 final rule (67 FR 
66761 through 66763).

            Table 13.--List of Current Pass-Through Device Categories With Proposed Expiration Dates
----------------------------------------------------------------------------------------------------------------
                                                               Category long          Date(s)       Expiration
                                         HCPCS codes             descriptor          populated         date
----------------------------------------------------------------------------------------------------------------
                                    C1765................  Adhesion Barrier.....   10/1/00-3/31/        12/31/03
                                                                                      01; 7/1/01
                                    C2618................  Probe, cryoblation...          4/1/01        12/31/03
                                    C1888................  Catheter, ablation,            7/1/02        12/31/04
                                                            non-cardiac,
                                                            endovascular
                                                            (implantable).
                                    C1900................  Lead, left                     7/1/02        12/31/04
                                                            ventricular coronary
                                                            venous system.
                                    C1783................  Ocular implant,                7/1/02        12/31/04
                                                            aqueous drainage
                                                            assist device.

[[Page 47994]]

 
                                    C1884................  Embolization                   1/1/03        12/31/04
                                                            protective system.
                                    C2614................  Probe, percutaneous            1/1/03        12/31/04
                                                            lumbar discectomy.
                                    C2632................  Brachytherapy                  1/1/03        12/31/04
                                                            solution, iodine-
                                                            125, per mCi.
                                    C1814................  Retinal tamponade              4/1/03        12/31/05
                                                            device, silicone oil.
                                    C1818................  Integrated                     7/1/03        12/31/05
                                                            keratoprosthesis.
----------------------------------------------------------------------------------------------------------------

    The methodology that we propose to use to package pass-through 
device costs is consistent with the packaging methodology that we 
describe in section II.B.5. For the codes in APCs displayed in Table 
10, we propose to use only those claims on which the hospital included 
the ``C'' code and to discard the claims on which no ``C'' code is 
billed.
    We propose to limit our analysis to the claims with ``C'' codes 
because we are not confident that the claims for the relevant APCs 
include the charges for the devices unless the ``C'' codes are 
specifically billed.
    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 costs of devices that we propose would no longer be 
eligible for pass-through payment in 2004 into the HCPCS codes with 
which the devices were billed.

B. Expiration of Transitional Pass-Through Payments in CY 2004

    In the November 1, 2002 final rule, we established a policy for 
payment of devices included in pass-through categories that are due to 
expire (67 FR 66763). We stated that we would package the costs of the 
devices no longer eligible for pass-through payments in 2003 into the 
costs of the procedures with which the devices were billed in 2001. 
There were very few exceptions to the policy (for example, 
brachytherapy seed for other than prostate brachytherapy), and we 
propose to continue this policy. Therefore, we propose that the payment 
for the devices that populate C1765 and C2618, which we propose will 
cease to be eligible for pass-through payment on January 1, 2004, would 
be made as part of the payment for the APCs with which they are billed.

C. Other Policy Issues Relating to Pass-Through Device Categories

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). Beginning with the implementation 
of the 2002 OPPS update (April 1, 2002), we deduct from the pass-
through payments for the identified devices an amount that offsets the 
portion of the APC payment amount that we determine is associated with 
the device, as required by section 1833(t)(6)(D)(ii) of the Act. In the 
November 1, 2002 final rule, we published the applicable offset amounts 
for 2003 (67 FR 66801).
    For the 2002 and 2003 OPPS updates, we estimated 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 from the period used for recalibration of the 
APC rates. Using these claims, we calculated a median cost for every 
APC without packaging the costs of associated ``C'' codes for device 
categories that were billed with the APC. We then calculated a median 
cost for every APC with the costs of associated device category ``C'' 
codes that were billed with the APC packaged into the median. Comparing 
the median APC cost minus device packaging to the median APC cost 
including device packaging enables us to determine the percentage of 
the median APC cost that is attributable to associated pass-through 
devices. By applying these percentages to the median APC costs, we 
determined the applicable offset amount. We included any APC on the 
offset list for which the device cost was at least 1 percent of the 
APC's cost.
    As we discussed in our November 1, 2002 final rule (67 FR 66801), 
the listed offsets are those that may potentially be used because we do 
not know which procedures would be billed with newly created 
categories.
    After publication of the November 1, 2002 final rule, we received a 
comment indicating that in some cases it may be inappropriate to apply 
an offset to a new device category because the device category is not 
replacing any device whose costs have been packaged into the APC. We 
agree with this comment. Therefore, we propose to modify our policy for 
applying offsets. Specifically, we would apply an offset to a new 
device category only when we can determine that an APC contains costs 
associated with the device. At this time, we propose to continue our 
existing methodology for determining the offset amount, described 
above. However, we solicit comments for alternative methodologies for 
determining the offset amounts that potentially could be applied to the 
payment amounts for new device categories.
    We can use this methodology to establish the device offset amounts 
for the 2004 OPPS because we are using 2002 claims on which device 
codes are reported. However, for the 2005 update to OPPS, we would use 
2003 claims that would not include device coding. Thus, for 2005, we 
are considering whether or not to use the charges from lines on the 
claim having no HCPCS code but have charges under revenue codes 272, 
275, 276, 278, 279, 280, 289, and 624 as proxies for the device charges 
that would have been billed with HCPCS codes for these devices in 
previous years. We are also considering the reinstitution of the ``C'' 
codes for expired device categories and requiring hospitals to use one 
or more newly created ``C'' codes for identification of devices and 
costs on claims. See section VI.B of this proposed rule for further 
discussion.
    We propose to review each new device category on a case-by-case 
basis to determine whether device costs associated with the new 
category are packaged into the existing APC structure.
    We reviewed the device categories eligible for continuing pass-
through payment in 2004 to determine whether the costs associated with 
the device

[[Page 47995]]

categories are packaged into the existing APCs. For the categories 
existing as of publication of this proposed rule, we have determined 
that there are no close or identifiable costs associated with the 
devices in our data related to the respective APCs that are normally 
billed with those devices. Therefore, for these categories we are 
proposing to set the offset to $0 for 2004.
    If we create a new device category and determine that our data 
contain identifiable costs associated with the devices in any APC, we 
would apply an offset. We propose, if any offsets apply, for new 
categories, to announce the offsets in the program memorandum that 
announces the information regarding the new category.

VI. Payment for Drugs, Biologicals, Radiopharmaceutical Agents, Blood, 
and Blood Products

A. Pass-Through Drugs and Biologicals

    Section 1833(t)(6)(D)(i) of the Act requires us to make 
transitional pass-through payment for new drugs equal to the amount by 
which 95 percent of the average wholesale price (AWP) of the drug 
exceeds the proposed payment rate. In the past, we have used the AWP 
published in the Red Book to determine payment amounts for pass-through 
drugs as we explain in the correction notice issued on February 10, 
2003 (68 FR 6637). However, we are concerned about the extent to which 
Medicare pays more for drugs than other payers and more than the 
market-based price of drugs. To address this problem of how to pay 
appropriately for drugs that are priced using the AWP, we are 
developing regulations that would revise the current payment 
methodology for part B covered drugs paid under section 1842(o) of the 
Act. When the AWP regulations are made final, we propose to adopt and 
apply the provisions of the final AWP rule to establish the AWP of 
pass-through drugs payable under the OPPS. If implementation of the AWP 
final rule necessitates mid-year changes in the 2004 OPPS payment rates 
for pass-through drugs, we propose to make those changes on a 
prospective payment basis through our regular OPPS PM and PRICER 
quarterly updates. We further propose to issue instructions by program 
memorandum regarding implementation of the provisions of the AWP final 
rule to set payment rates for pass-through drugs under the OPPS.
    An AWP final rule could be published before 2004. However, if the 
AWP final rule is not issued in time to permit us to apply its 
provisions to price pass-through drugs furnished on or after January 1, 
2004, we propose to use 95 percent of the AWP listed in the most recent 
quarterly update of the Single Drug Pricer (SDP). In the past, we have 
relied solely on the Red Book to determine the AWP for a pass-through 
drug, as we explain in the correction notice issued on February 10, 
2003 (68 FR 6637). However, on January 1, 2003, we introduced for the 
first time a single pricing source for approximately 400 drugs and 
biologicals for which the Medicare payment allowance is based on 95 
percent of their AWP. We established the SDP to address apparent 
discrepancies in drug pricing that were the unintended result of 
delegating calculation of AWP to multiple contractors, whose 
application of the pricing methodology established under 42 CFR 405.517 
sometimes varied. The SDP continues to rely on published compilations 
such as the Red Book and First Data Bank to identify wholesale drug 
prices. However, using the SDP enables us to establish a uniform 
Medicare payment allowance for drugs whose payment is based on 95 
percent of their AWP, which results in greater consistency in Medicare 
drug pricing nationally. If a drug with pass-through status is not 
included in the SDP, we propose to forward to the SDP contractor the 
AWP information submitted as part of the pass-through application.
    Because the January SDP would not be available in time, we propose 
to announce the January 1, 2004 prices for pass-through drugs in our 
January 2004 OPPS implementing instructions to fiscal intermediaries 
and in the January 2004 OPPS PRICER rather than in the 2004 final rule, 
which is to be published in the Federal Register by November 1, 2003. 
We further propose to update the AWP for pass-through drugs paid under 
the OPPS on a quarterly basis in accordance with the quarterly updates 
of the SDP. The updated rates for pass-through drugs and biologicals 
would also be issued through our quarterly OPPS program memoranda and 
PRICER updates.
    Additional information regarding the SDP can be found on the CMS 
Web site in Program Memorandum AB-02-174, issued December 3, 2002.

B. Drugs, Biologicals, and Radiopharmaceuticals Without Pass-Through 
Status

1. Background
    Under the OPPS, we currently pay for radiopharmaceuticals, drugs, 
and biologicals including blood, and blood products, which do not have 
pass-through status, in one of three ways: packaged payment, separate 
payment (individual APCs), and reasonable cost. As we explained in the 
April 7, 2000 final rule (65 FR 18450), we generally package the cost 
of drugs and radiopharmaceuticals into the APC payment rate for the 
procedure or treatment with which the products are usually furnished. 
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). As 
we explained in the November 1, 2002 final rule (67 FR 66757), we do 
not classify diagnostic and therapeutic radiopharmaceutical agents as 
drugs or biologicals as described in section 1861(t) of the Act.
    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. In 
general, packaging the costs of items and services into the payment for 
the primary procedure or service with which they are associated 
encourages hospital efficiencies and also enables hospitals to manage 
their resources with maximum flexibility. Notwithstanding our 
commitment to package as many costs as possible, we are aware that 
packaging payments for certain drugs and radiopharmaceuticals, 
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.
    As discussed in the November 1, 2002 final rule (67 FR 66774), we 
packaged payment for drugs and radiopharmaceuticals into the APCs with 
which they were billed if the median cost per line for the drug or 
radiopharmaceutical was less than $150, and we established a separate 
APC payment for drugs and radiopharmaceuticals for which the median 
cost per line exceeded than $150. This supported our general view that 
payment for drugs and radiopharmaceuticals should be made as part of 
the payment for the services in which they are used in order to 
encourage efficient purchase and use of drugs and radiopharmaceuticals 
provided in the hospital outpatient department.

[[Page 47996]]

Payment Rates for 2003

    To limit the dramatic reduction in payment rates for many of the 
separately payable drugs and radiopharmaceuticals from 2002 to 2003, we 
limited the decrease in their median costs from 2002 median costs to 15 
percent plus half of the difference between the total proposed 
reduction and 15 percent reduction. (For example, for a drug whose cost 
decreased by 35 percent from the applicable 2002 median cost, the 
allowed reduction from 2002 to 2003 was 15 percent plus (\1/2\ times 
35-15) percent = 25 percent.) For each blood and blood product, we 
provide separate payment in an individual APC and limited any decrease 
in payment rate from 2002 to 2003 to 15 percent. In 2003, we also 
excluded from OPPS certain vaccines and orphan drugs (that met our 
orphan criteria) and paid for these items at reasonable cost. Our 
intent in implementing these policies was to avoid adversely affecting 
beneficiary access to needed treatment.

Drugs for Which We Propose Pass-Through Status Will Expire in 2004

    Section 1833(t)(6)(C)(i) of the Act specifies that the duration of 
transitional pass-through payments for drugs and biologicals must be no 
less than 2 years nor any longer than 3 years. The drugs that are due 
to expire December 31, 2003 meet that criterion. Table 14 lists the 
drugs and biologicals for which we propose pass-through status will 
expire on December 31, 2003.

         Table 14.--Proposed List of Drugs and Biologicals for Which Pass-Through Status Expires CY 2004
----------------------------------------------------------------------------------------------------------------
                                                                                                  Proposed pass-
                                                                                                      through
                HCPCS                    APC         Long descriptor            Trade name          Expiration
                                                                                                       date
----------------------------------------------------------------------------------------------------------------
A9700...............................       9016  Injection,               Optison (single               12-31-03
                                                  Octafluoropropane, per   source).
                                                  3 ml.
J0587...............................       9018  Injection, Botulinum     Myobloc (single               12-31-03
                                                  toxin, type B, per 100   source).
                                                  units.
J0637...............................       9019  Injection, Caspofungin   Cancidas (single              12-31-03
                                                  acetate, 5 mg.           source).
J7517...............................       9015  Mycophenolate mofetil,   CellCept (single              12-31-03
                                                  oral per 250 mg.         source).
J9010...............................       9110  Injection, Alemtuzumab,  Campath (single               12-31-03
                                                  per 10 mg.               source).
J9017...............................       9012  Injection, Arsenic       Trisenox (single              12-31-03
                                                  trioxide, per 1 mg.      source).
J9219...............................       7051  Implant, Leuprolide      Viadur (single source)        12-31-03
                                                  acetate, per 65 mg
                                                  implant.
C9201...............................       9201  Dermagraft, per 37.5     Dermagraft (single            12-31-03
                                                  sq. centimeters.         source).
----------------------------------------------------------------------------------------------------------------

2. Proposed Criteria for Packaging Payment for Drugs, Biologicals, and 
Radiopharmaceuticals
    To the maximum extent possible, our intention is to package into 
the APC payment the costs of any items and supplies that are furnished 
with an outpatient procedure. We considered several options for 
packaging in 2004 and propose the following policy:
    For 2004, we propose to continue with our policy of paying 
separately for drugs and radiopharmaceuticals whose median cost per day 
exceeds $150 and packaging the cost of drugs and radiopharmaceuticals 
with median cost per day of less than $150 into the procedures with 
which they are billed.
    As discussed in the November 1, 2002 final rule, we received 
several comments on our methodology of analyzing single line items on 
drug claims for the 2003 OPPS (67 FR 66772). Commenters stated that our 
methodology was not consistent with how hospitals bill for certain 
drugs, biologicals, and radiopharmaceuticals. They believe that this 
inconsistency affected whether or not a drug, biological, or 
radiopharmaceutical fell below the $150 median cost per line threshold. 
Commenters claimed that we incorrectly assumed ``that a single 
administration of a drug was billed as a single line item on a claim.'' 
These commenters alleged that hospitals often bill for certain drugs 
administered during a single patient encounter using multiple lines on 
a claim. For example, if 10 units of a drug were administered at a cost 
of $100 but the hospital billed 2 line items of 5 units at a cost of 
$50 each, then a methodology that determines median costs on a per line 
basis would incorporate 2 line items at $50 when the real cost was one 
line item at $100. If a significant percentage of administrations for 
this drug was billed in this manner, it would result in median costs 
that underestimate the true cost of the drug. We agree with this 
comment. Therefore, we propose to change our packaging methodology to 
account for such hospital billing practices.
    We calculated the median cost per day using claims data from April 
1, 2002 to December 31, 2002 for all drugs and radiopharmaceuticals 
paid under the OPPS that had a HCPCS code during this time period 
including drugs for which transitional pass-through payment ended on 
January 1, 2003. Although we included orphan drugs in this methodology, 
we discuss them separately below. We excluded from these calculations 
vaccines and blood and blood products that are discussed below. In 
order to calculate the median cost per day for the drugs, biologicals, 
and radiopharmaceuticals, we took the following steps:
    [sbull] After application of the cost-to-charge ratios, we 
aggregated all line items for a single date of service on a single 
claim for each drug or radiopharmaceutical. This resulted in creating a 
single line item with the total number of units and the total cost of a 
drug or radiopharmaceutical given to a patient in a single day.
    [sbull] A separate record was then created for each drug or 
radiopharmaceutical by date of service, regardless of the number of 
lines the drug or radiopharmaceutical was billed in each claim. For 
example, drug X is billed on a claim with two different dates of 
service, and for each date of service, the drug is billed on 2 line 
items with costs of $10 and 5 units in each line item. In this case, 
the computer program would have created two records for this drug, and 
each record would have a total cost of $20 and 10 units.
    [sbull] For each record created for a drug or radiopharmaceutical, 
the cost per unit of the drug was calculated. If drug X's descriptor is 
``per 1 mg'' and one record was created for a total of 10 mg (as 
indicated by the total number of units for the drug on the claim for 
each unique date of service), then the computer program divided the 
total cost for the record by 10 to give a per unit cost. This unit cost 
was then weighted by the total number of units in the record. This was 
done by generating a number of line items equivalent to the number of 
units in that particular claim. Thus, a claim with 100 units and a 
total cost of $200 would be given 100 line items each with a cost of $2 
while a

[[Page 47997]]

claim of 50 units with a cost of $50 would be given 50 line items each 
with a cost of $1.
    [sbull] The unit records with cost per unit greater or less than 3 
standard deviations from the geometric mean were then trimmed.
    [sbull] The remaining unit observations were arrayed and the median 
cost per unit of the drug or radiopharmaceutical was established.
    [sbull] Next, the total number of units billed on all claims for 
the drug or radiopharmaceutical was divided by the total number of 
unique per-day records for the drug or radiopharmaceutical to arrive at 
an average number of units per day.
    [sbull] The average number of units per day for each drug or 
radiopharmaceutical was then multiplied by the median cost per unit to 
arrive at its ``median cost'' per day.
    [sbull] We then arrayed the median cost per day for all drugs and 
radiopharmaceuticals in ascending order and examined the distribution.
    Many commenters have alleged that hospitals do not accurately bill 
the number of units for drugs and radiopharmaceuticals. Because this 
methodology assumes that hospitals bill the number of units accurately, 
we compared the median cost per day obtained by the above methodology 
with the median cost per day derived as follows: We aggregated line 
items as above and created records for each drug and 
radiopharmaceutical based on date of service. However, instead of 
calculating costs on a per-unit basis, we simply reduced total charges 
to total costs for each record and determined the median. This 
methodology assumes that hospitals record charges more accurately than 
units. We believed that calculating median costs using the second 
methodology would address the concerns of commenters and would help us 
determine whether our median cost per unit calculation accurately 
reflected the costs of drugs and radiopharmaceuticals.
    In most cases, the median costs determined by the two methodologies 
were similar. Based on this comparison, we believe that calculating 
median costs per unit accurately reflects the actual cost of the drug 
or radiopharmaceutical. Furthermore, given the wide variability of 
doses used for many drugs, we believe that it is important to pay on a 
``per unit'' basis for separately payable drugs and 
radiopharmaceuticals. For example, many chemotherapy agents are dosed 
based on both body area and frequency of administration. Thus, a 
patient with a body area of 2 m squared could receive 600 mg of a drug 
every 3 weeks, 400 mg every 2 weeks, or 200 mg every week depending on 
the chemotherapy regimen.
    Based on our analyses, we believe that it is reasonable to continue 
our current policy of packaging drugs and radiopharmaceuticals with a 
median cost of less than $150 per day. This means that approximately 52 
percent of the drugs and radiopharmaceuticals will be packaged and 48 
percent of the drugs and radiopharmaceuticals will be paid separately.
    We noticed that several drugs and radiopharmaceuticals with median 
cost per line that were under $150 for the 2003 OPPS have median costs 
per day that are equal to or greater than $150 based on the data used 
for the 2004 OPPS. For some other drugs and radiopharmaceuticals, we 
saw that their median costs per line were equal to or greater than $150 
for 2003 OPPS; however, using the 2002 data, their median costs per day 
fell below $150. These shifts from 2003 to 2004 would affect packaging 
decisions for a number of drugs.
    Given that these variations exist, we propose to provide an 
exception in 2004 to the packaging rule for drugs and 
radiopharmaceuticals whose payment status would change as a result of 
using newer data and a different methodology. As we explain elsewhere 
in this proposed rule, we expect to use additional 2002 claims data for 
the establishment of our final policies for CY 2004. Based on this 
additional data and comments from the public, we intend to re-evaluate 
whether to package or pay separately for drugs for which the per-day 
median cost would cross the threshold from 2003 to 2004. For 2004, we 
propose that:
    [sbull] Currently packaged drugs and radiopharmaceuticals with 
median costs per day that are at or above $150 would receive separate 
payment in 2004.
    [sbull] Currently separately payable drugs and radiopharmaceuticals 
with median costs per day that are under $150 would continue to receive 
separate payment in CY 2004.
    [sbull] Drugs whose pass-through status would expire on December 
31, 2003, and whose median costs per day are under $150 would receive 
separate payment in 2004.
    [sbull] Currently packaged drugs and radiopharmaceuticals with 
median costs per day below $150 would remain packaged in 2004.
    We request comments on the methodology we used to determine the 
median cost per day, on the threshold we propose to use for packaging 
drugs and radiopharmaceuticals, and on the proposal to pay separately 
for drugs and radiopharmaceuticals whose payment status would change 
based on use of recent claims data and our proposed methodology.
    Although in the future we expect to expand packaging the costs of 
drugs and radiopharmaceuticals into the APCs for the services with 
which they are billed, we request comments on alternatives to 
packaging.
3. Payment for Drugs, Biologicals, and Radiopharmaceuticals That Are 
Not Packaged
    For the 2003 OPPS, the APC payment rate for separately payable 
drugs and radiopharmaceuticals with status indicator ``K'' is based on 
a relative weight calculated in the same way that the relative weights 
for procedural APCs are calculated. As with procedural APCs, we 
observed a decrease in the proposed payment rates for many separately 
payable drugs and radiopharmaceuticals; therefore, we dampened the 
payment reduction for APCs whose median costs decreased by more than 15 
percent from 2002 to 2003.
    In order to establish payment rates for separately payable drugs 
and radiopharmaceuticals for the 2004 OPPS, we first determined each 
drug's and radiopharmaceutical's median cost as described above. When 
we compared the median cost per unit used for determining the 2003 
payment rate (for example, the true or dampened median cost) for 
separately payable drugs and radiopharmaceuticals with their 2004 
median cost per unit, we found fluctuations in costs from 2003 to 2004.
    CY 2004 median costs decreased more than 15 percent from the 
corresponding 2003 median cost for many of the separately payable drugs 
and radiopharmaceuticals. Many of these decreases affected low-volume 
drugs and radiopharmaceuticals and may be the result of inaccurate 
coding. Similarly, the 2004 median costs increased by more than 15 
percent from the corresponding 2003 median cost for approximately 12 
(mostly low volume) drugs and radiopharmaceuticals. For many of the 
high-volume, separately payable drugs and radiopharmaceuticals, the 
2004 median costs increased or decreased by less than 15 percent as 
compared to the corresponding 2003 median cost. We solicit comments 
concerning the reasons for the fluctuations in median costs from 2003 
to 2004. We are interested in determining whether these fluctuations 
reflect changes in the market prices of these drugs and 
radiopharmaceuticals or problems in the hospital claims data (for 
example, inaccurate coding, improper

[[Page 47998]]

charges) that we use for setting payment rates.
    We considered several options to address the fluctuations in median 
costs for separately payable drugs and radiopharmaceuticals. One option 
was to base payment on our 2002 claims data without modification. A 
second option was to adopt for 2004 the same methodology that we used 
to moderate payment decreases in 2003.
    A third option was to create drug and radiopharmaceutical cost 
bands for separately payable drugs and radiopharmaceuticals (for 
example, all drugs with median costs per unit of $60.01 to $70 would be 
assigned a proxy median of $70), which would be based on their median 
costs calculated using 2002 claims data. We considered adopting two 
sets of cost bands: one for separately payable drugs and biologicals 
other than radiopharmaceutical agents and one for separately payable 
radiopharmaceutical agents. The cost bands for drugs and 
radiopharmaceuticals would be assigned based solely on cost, with no 
consideration given to the therapeutic use or chemical composition of 
the drug.
    When we applied the dampening methodology used for the 2003 OPPS to 
drugs and radiopharmaceuticals that will be separately payable in 2004, 
we observed that this methodology did not sufficiently limit payment 
reductions for many of the drugs and radiopharmaceuticals with large 
decreases in median cost from 2003 to 2004. Therefore, a fourth option 
that we considered and are proposing for 2004 is a variation of the 
methodology used for the 2003 OPPS. For separately payable drugs and 
radiopharmaceuticals whose 2004 median costs decreased by more than 15 
percent from the applicable 2003 median cost, we propose to limit the 
reduction in median costs to one fourth of the difference between the 
value derived from claims data and a 15 percent reduction (for example, 
for a drug whose cost decreased by 35 percent from the applicable 2003 
median cost, the allowed reduction from 2003 to 2004 would be 15 
percent + (\1/4\ times 35-15) percent = 20 percent). For separately 
payable drugs and radiopharmaceuticals whose median costs decreased by 
less than 15 percent from 2003 to 2004, we propose to establish their 
payment rates using the median costs derived from the 2002 claims data. 
We believe that it is appropriate to determine payment rates based on 
our claims data where those data show the cost of drugs and 
radiopharmaceuticals to be stable over 2 years. In cases where costs 
show significant fluctuation, we believe it is appropriate to mitigate 
the potential for underpayment. We believe our proposal bases payment 
rates on our claims data as required by statute and addresses the 
potential for making underpayments. However, based on more complete 
claims data we expect to have for the final rule and on the comments 
from the public, we will re-evaluate the appropriateness of adjusting 
median costs for drugs for which median costs would decline in 2004.
    We also propose a separate payment policy, which is described 
below, for drugs, biologicals, and radiopharmaceuticals that have 
generic alternatives approved by the Food and Drug Administration (FDA) 
between October 2001 and December 2002.
    We solicit comment on both our proposed methodology and payment 
rates for separately payable drugs and radiopharmaceuticals for 2004. 
Commenters who disagree with the proposed rate for a drug or 
radiopharmaceutical should submit verifiable information that shows our 
payment rate does not reflect the price that is widely available to the 
hospital market. Thus, information should demonstrate actual, market-
based pricing of drugs and radiopharmaceuticals and should be prices at 
which a broadly based, national sample of hospitals are routinely able 
to procure the drug or radiopharmaceutical. We do not consider the 
published average wholesale price (AWP) for a drug to be an indication 
of its market-based price.
4. Proposed Payment Methodology for Drug Administration
    Currently, payment for drug administration is made separately using 
HCPCS codes Q0081, Q0083, Q0084, Q0085, 90782, 90783, 90784, and 90788 
with certain drugs packaged into the median cost for administration. 
The amount packaged should reflect the costs of the packaged drugs in 
relation to the frequency with which they are administered. Each of 
these codes is to be reported once per visit no matter how many drugs 
are administered. When a hospital administers only packaged drug(s), 
the appropriate HCPCS code is reported once and no separate payment is 
made for the drugs. When a hospital administers only separately payable 
drug(s) the appropriate HCPCS code is reported once; in addition, 
separate payment is made for the drugs. Because the payment for 
administration includes payment for packaged drugs, a hospital receives 
inappropriate reimbursement every time it administers a separately 
payable drug.
    In order to facilitate accurate payments for drugs and drug 
administration, we are considering whether to make several changes in 
our current payment policy with regard to payment for Q0081, Q0083, 
Q0084, and Q0085. We are not considering changes to payment policy for 
HCPCS codes 90782, 90783, 90784, and 90788 at this time, although we 
are interested in receiving comments regarding payment for these codes.
    We are proposing to continue our current policy of packaging drugs 
and radiopharmaceuticals that cost less than $150 per episode of care 
into the APC with which they are associated (for example, nuclear 
medicine scans, drug administration).
    We are considering whether and how to make different payments to 
hospitals for administration of packaged drugs and administration of 
unpackaged drugs. We would like to ensure that when a hospital 
administers a separately paid drug, it would receive payment for the 
drug and the drug administration, but not for any drugs packaged into 
the administration. We also would like to ensure that the payments that 
are made for administration of packaged drugs are appropriate for the 
costs of the drugs as well as the cost of the administration.
    In order to achieve the above objectives, we considered several 
coding and payment options and analyzed our claims data for the period 
April 1, 2002 through December 31, 2002.
Summary of Findings and Alternatives
    As explained in greater detail below, we carefully examined data 
for administration of packaged and separately paid drugs billed under 
Q0081, Q0083, Q0084 and Q0085. We found that the data showed that 
paying based on a median cost for the APC for each of the current four 
codes generally results in underpayment when packaged drugs are billed 
on the claim and overpayment when separately paid drugs are billed on 
the claim. In the sections that follow, we discuss our data analysis in 
detail. We also discuss four alternatives to the current codes and APC 
payments in detail. In summary, those alternatives are:
    1. Maintain the current codes and APCs with payments based on the 
median costs of all claims in the APC.
    2. Eliminate the four current codes and create eight new codes to 
enable hospitals to report that they administered a packaged drug or a 
separately paid drug. We would pay a different APC amount for each of 
the

[[Page 47999]]

eight new codes. The new code descriptors would parallel those of the 
current codes. This would retain the concept of using one code rather 
than two when both ``infusion'' and administration of chemotherapy by 
``other than infusion'' occurred (as exists under the current codes). 
Coders would have to look up the drugs administered to know which code 
to bill.
    3. Eliminate the four current codes and create six new codes to 
enable hospitals to report that they administered a packaged drug or 
separately paid drug and pay a different APC amount for each of the six 
new codes. In this option, no code equivalent to Q0085 would exist. 
Therefore, when administering chemotherapy by ``infusion'' or ``other 
than infusion,'' hospitals would report two codes, one for 
administration by ``infusion'' and one for administration by ``other 
than infusion.'' This would eliminate the need to use one code when 
both infusion and another method of administration of chemotherapy 
occurred. Coders would have to look up the drugs administered to know 
which code to bill.
    4. Retain three of the current codes (Q0081, Q0083, and Q0084) but 
delete Q0085 (infusion and other administration of chemotherapy) and 
modify the OCE to use the drugs billed on the claim to assign an APC 
for packaged drugs or an APC for separately paid drugs. No drug 
administration code could be paid without a drug also being reported on 
the claim.
Claims Data Analysis
    Using our methodology for creating single procedure claims, we 
looked at all single claims for HCPCS codes Q0081, Q0083, Q0084, and 
Q0085. We created separate files for each HCPCS code and further 
subdivided those into four subgroups for each code. The subgroups were 
for the HCPCS code billed (1) without any HCPCS for drugs; (2) with 
HCPCS only for packaged drugs; (3) with HCPCS only for separately 
payable drugs; and (4) with HCPCS for both packaged and separately 
packaged drugs.
    We then reviewed the median costs for each of these subgroups and 
determined that we could use these subgroups to create two median costs 
for each existing administration HCPCS code (Q0081, Q0083, Q0084, and 
Q0085). See Table 15 for median cost data for HCPCS subgroups. We used 
claims where packaged drugs appeared (subgroups W and X) to create a 
median cost for administration of packaged drugs. We used claims 
without HCPCS codes for drugs and claims with HCPCS for only separately 
payable drugs (subgroups Y and Z) to create a median cost for the 
administration of separately payable drugs.
    We believe that the resultant median costs accurately reflect the 
costs of packaged drugs and the costs of administration of separately 
payable drugs. It is obvious that there are significant differences in 
median costs of services within the same drug administration code, 
depending on whether a packaged or separately paid drug was 
administered, the type of drug administered (chemotherapy versus non-
chemotherapy) and the route of administration (infusion versus other 
route or both).

                             Table 15.--Median Costs by Types of Drugs on the Claim
----------------------------------------------------------------------------------------------------------------
                                                      Neither      With packaged    No packaged    Both packaged
                                                   packaged nor     drug but no    drug but with     drug and
             HCPCS                 Description    separate  drug   separate drug   separate drug   separate drug
                                                        (W)             (X)             (Y)             (Z)
----------------------------------------------------------------------------------------------------------------
Q0081.........................  Infusion therapy         $104.97         $276.98         $117.89         $231.56
                                 other than
                                 chemo.
Q0083.........................  Chemotherapy               35.16          119.88           42.26          188.98
                                 other than
                                 infusion.
Q0084.........................  Chemotherapy by           127.34          250.97          159.01          265.46
                                 infusion.
Q0085.........................  Chemotherapy by            97.11          154.01          203.43          318.05
                                 both infusion
                                 and other.
----------------------------------------------------------------------------------------------------------------

    We then calculated medians for circumstances in which there were 
neither packaged nor separately paid drugs on the claim, and there were 
no packaged drugs, but there were separately paid drugs on the claim 
(both W and Y). We also calculated medians for circumstances in which 
there were packaged drugs on the claim (both X and Z). The resultant 
medians and the number of claims used to set the medians appear in 
Table 16 below with the HCPCS medians for all claims (packaged and 
separately paid drugs together).

                                Table 16.--Numbers of Claims and Medians by Code
----------------------------------------------------------------------------------------------------------------
                                                                     Number of      Median for
                                     Number of       Median of    claims with no  claims with no   HCPCS Median
           HCPCS code               claims with     claims with       drug or         drug or     for all claims
                                  packaged drugs  packaged drugs    separately      separately       for 2004
                                                                     paid drug       paid drug
----------------------------------------------------------------------------------------------------------------
Q0081...........................          19,116         $274.47         280,939         $107.93         $115.11
Q0083...........................           8,681          125.86          24,710           39.10           48.25
Q0084...........................          34,085          257.57          23,933          142.38          205.70
Q0085...........................          17,749          303.87           3,242          126.55          267.63
----------------------------------------------------------------------------------------------------------------

    Review of the data reveals that the median costs for all claims for 
Q0081 and Q0083 more closely reflect the median cost of claims where no 
drug or only separately payable drugs were on the claim because that 
subset of claims represents the vast majority of claims for Q0081 and 
Q0083. Therefore, if we do not differentiate payment for Q0081 and 
Q0083 based on whether or not a packaged drug was administered, we 
would underpay the cases in which a packaged drug was administered. The 
opposite is true of Q0084 and Q0085 in which more claims reflect 
packaged drugs than separately paid drugs, and, therefore, the claims 
with packaged drugs will determine the median cost for the code, thus 
overpaying cases in which the drug is separately paid.

[[Page 48000]]

    We also examined the mean and median number of drugs billed with 
each of the Q codes when only packaged drugs were billed, only 
separately paid drugs were billed, and both packaged and separately 
payable drugs were billed (see Table 17). With the exception of Q0085, 
we believe the data on the number of drugs billed per claim is 
consistent with the cost data in Table 15. Again, with the exception of 
Q0085, we are confident that the cost of packaged drugs is accurately 
reflected in the median cost of the codes for administration of 
packaged drugs. We are also confident that the median cost for 
administration of separately payable drugs is appropriate.

                             Table 17.--Numbers of Drugs Billed per Specified Codes
----------------------------------------------------------------------------------------------------------------
                                                                                  Mean number of  Median  number
                                                  Mean number of  Median  number       drugs         of drugs
                      HCPCS                            drugs         of drugs       separately      separately
                                                     packaged        packaged          paid            paid
----------------------------------------------------------------------------------------------------------------
Q0081...........................................            1.05               1            1.01               1
Q0083...........................................            1.77               2            1.02               1
Q0084...........................................            1.68               1            1.10               1
Q0085...........................................            2.33               2            1.19               1
----------------------------------------------------------------------------------------------------------------

    We have some concerns about the cost data for Q0085. The cost for 
administration of only separately payable drugs is less than the 
comparable cost for Q0084 ($126 vs. $142). This is counterintuitive as 
Q0085 describes administration of, at minimum, two drugs, while Q0084 
describes administration of one or more drugs. These cost data for 
Q0085 also raise the concern that proper usage of the code is not 
understood by hospitals and, therefore, the data are not being used 
properly.
    We believe our analysis supports the need for creating different 
payment amounts for the administration of packaged drugs and for the 
administration of separately payable drugs (and, in the case of Q0081, 
the administration of no drug).
    While reviewing options for coding and payment for drug 
administration we kept five major considerations in mind:
    1. Ensuring beneficiary access to drugs.
    2. Making accurate payment for both packaged and separately payable 
drugs.
    3. Collecting sufficient data on drugs and drug administration to 
ensure that future policy development in this area will be properly 
informed.
    4. Facilitating proper coding by hospitals.
    5. Avoiding complicated billing rules and hospital burden to the 
extent possible.
    We thought that three basic coding and payment options were 
available:
    1. Continuing the current coding structure and payment policy (for 
example, a single payment for drug administration per day no matter how 
many drugs were administered). (Option 1 below).
    2. Creation of new codes and new payment policy to describe drug 
administration (for example, different sets of codes for administration 
of packaged and separately payable drugs along with allowance for more 
than one payment for drug administration per day). (Options 2 and 3 
below).
    3. Continuation of the current drug administration codes but 
creating new payment policy (for example, allowance for more than one 
payment for drug administration per day).
    After reviewing these three basic options, we developed more fully 
four specific options. Under all of these options, hospitals would be 
required to bill all drugs using the HCPCS code for the drug.
    Moreover, although we have included an expanded option for Q0085 
(Chemotherapy by both infusion and other technique) in option 2, and 
have retained Q0085 in option 1, we have serious concerns about the 
extent to which Q0085 is used correctly and about the extent to which 
the data for this code validly reflect the costs of an identifiable 
service. Hence, we are particularly interested in comments regarding 
whether we should eliminate Q0085. (Option 4 below).
    Option 1--Retain the current codes and continue to pay on a per-
visit basis, based on median costs for each code regardless of whether 
or not packaged or separately paid drugs are administered.
    We would retain the current codes, use all claims for these 
services to set a relative weight, and make a single payment based on 
the median costs for the code regardless of whether or not packaged or 
separately paid drugs are administered. This would result in 
significant underpayment for administration of packaged drugs because 
the largest volume of claims with this code are either for 
administration of no drug (Q0081) or for drugs that are separately paid 
(and have no packaged drug costs). See Table 16 for the median costs 
determined on the basis of all claims for the existing codes. We would 
require hospitals to report HCPCS codes for both packaged and 
separately payable drugs in order to inform future policy decisions in 
this area.
    We do not propose payment amounts for this option because the 
budget neutrality scalar would be different under this proposal than 
under option 2 (which was used in the scalar and impact analysis).
    Option 2--Create eight new drug administration codes to enable 
hospitals to report administration of both packaged and separately 
payable drugs.
    We would create two new sets of HCPCS codes to describe 
administration of packaged and separately payable drugs. Each of the 
eight codes would have its own APC payment. The descriptions and median 
costs for these proposed codes would be as follows:

                           Table 18.--Median Costs of Proposed G Codes Under Option 2
----------------------------------------------------------------------------------------------------------------
               HCPCS                   2004 APC          2004 SI              Description          Median costs
----------------------------------------------------------------------------------------------------------------
GXXX1.............................            0382  S                  Infusion of packaged non-         $274.47
                                                                        cancer chemotherapy
                                                                        drug(s), per day.
GXXX3.............................            0376  S                  Administration of                  125.86
                                                                        packaged cancer
                                                                        chemotherapy drug(s) by
                                                                        other than infusion, per
                                                                        day.

[[Page 48001]]

 
GXXX4.............................            0378  S                  Administration of                  257.57
                                                                        packaged cancer
                                                                        chemotherapy drug(s) by
                                                                        infusion, per day.
GXXX5.............................            0380  S                  Administration of                  303.87
                                                                        packaged cancer
                                                                        chemotherapy drugs by
                                                                        both infusion and other
                                                                        than infusion, per day.
GYYY1.............................            0383  S                  Infusion of separately             107.93
                                                                        payable non-cancer
                                                                        chemotherapy drug(s) or
                                                                        non-drug infusion
                                                                        therapy, per day.
GYYY3.............................            0377  S                  Administration of                   39.10
                                                                        separately payable
                                                                        cancer chemotherapy
                                                                        drug(s) by other than
                                                                        infusion, per day.
GYYY4.............................            0379  S                  Administration of                  142.38
                                                                        separately payable
                                                                        cancer chemotherapy
                                                                        drug(s) by infusion, per
                                                                        day.
GYYY5.............................            0381  S                  Administration of                  126.55
                                                                        separately payable
                                                                        cancer chemotherapy
                                                                        drugs by both infusion
                                                                        and other than infusion,
                                                                        per day.
----------------------------------------------------------------------------------------------------------------

The median costs for administration of packaged drugs would be 
determined from claims that contain at least one packaged drug and the 
median costs for administration of separately payable drugs (or no 
drugs in the case of Q0081) would be determined from claims that 
contained only separately payable (or no) drugs.
    Although payment would not depend on accurate reporting of HCPCS 
codes for drugs, we would require hospitals to use HCPCS codes for both 
packaged and separately payable drugs in order to ensure that we had 
reliable data upon which to base future relative weights for these 
services. As described under option 4, we would create six lists of 
drugs in order to facilitate proper payment in the future.
    Hospitals would report the appropriate code for the type of drug 
administered and the route(s) of administration. In this option, 
hospitals could bill for administration of both chemotherapy agents and 
administration of non-chemotherapy agents (or non-drug infusions). We 
would permit a maximum of one chemotherapy and one non-chemotherapy 
administration per day.
    We are concerned that creation of these codes could require 
complicated billing rules and cause burden to hospitals. We would need 
to specify how to bill different combinations of route and category of 
drug (for example, two infused drugs, one pushed drug, antiemetics, and 
hydration). Because hospital billers would have to review both the type 
of administration and the type of drug administered to determine the 
correct code to bill, we are concerned about the potential for 
miscoding (with resultant mispayment) under this option, and we solicit 
comments on both of these issues. In some cases, this additional coding 
burden might result in less payment for administration (particularly 
Q0081).
    Under this option, all codes would have a status indicator of S, 
and no multiple procedure reductions would apply.
    This option is modeled for purposes of the budget neutrality scalar 
and the impact analysis (see Table 18).
    Option 3--Create six new drug administration codes to enable 
hospitals to report administration of both packaged and separately 
payable drugs.
    This option is similar to option 2 except that we would eliminate 
the codes used to describe administration of chemotherapy by both 
infusion and other techniques. Where a code is billed with a packaged 
drug suitable for the code, we would pay the APC for the packaged drug. 
Where both a packaged drug and a separately paid drug were administered 
via the same route of administration (and therefore only one code was 
billed), we would pay the APC only for the administration of the 
packaged drug and would pay separately for the separately paid drug and 
would not pay the APC for administration of the separately paid drug. 
Under this option, we would allow up to three payments for 
administration of drugs or infusions. We would allow one payment for 
non-chemotherapy drugs/infusions (for example, antiemetics, fluids), 
one payment for chemotherapy administered by infusion, and one payment 
for chemotherapy administered by ``other than infusion.'' As stated 
above, we would not allow payment for administration of packaged 
chemotherapy drugs by infusion and payment for administration of 
separately payable chemotherapy by infusion. This coding scheme would 
allow us to more accurately recognize the true costs of administering 
multiple drugs. For example, there are some economies of scale when 
infusing two or more drugs (for example, only one I. V. line needed), 
but each drug requires its own mixing and nursing care. This option 
would allow up to three payments for administration of drugs or non-
drug infusion, thereby recognizing the unique costs of administering 
each drug while not making duplicate payment. In order to ensure that 
we do not make duplicate payment for patients receiving chemotherapy 
drugs and non-chemotherapy drugs (and/or hydration), we would pay GXXX1 
and GYYY1 at 50 percent of their payment when one of these codes is 
paid in addition to chemotherapy administration (GXXX3, GXXX4, GYYY3, 
and GYYY4). This is because we believe there are economies of scale 
achieved for multiple drug administrations and that the additional 
resources used to provide non-chemotherapy treatment are minimal.
    Following are examples of how payment would be made:
    [sbull] When both packaged and separately payable chemotherapy 
drugs are infused, we would make payment for GXXX4--Administration of 
packaged chemotherapy drugs by infusion and for each separately payable 
chemotherapy drug, but we would not make payment for GYYY4--Infusion of 
separately payable chemotherapy drugs.
    [sbull] When packaged chemotherapy drugs are pushed and infused, 
and separately payable chemotherapy drugs are infused, we would make 
payment for GXXX3 and GXXX4 and for each separately payable 
chemotherapy drug, but we would not make payment for GYYY4.
    [sbull] When packaged chemotherapy drugs are infused and pushed; 
separately payable chemotherapy drugs are infused and packaged; and 
separately payable non-chemotherapy drugs are infused (for example, 
antiemetics), and hydration is given; we would make payment for GXXX3, 
GXXX4, each separately infused chemotherapy drug, GXXX1, and each 
separately payable non-chemotherapy drug. We would not make payment for 
GYYY1 or GYYY3. Note that payment for GXXX1 in this case would be made 
at 50 percent because it was billed with chemotherapy (if it was billed 
without

[[Page 48002]]

chemotherapy, then payment would be made at 100 percent).
    Medians for these codes would be as follows:

                                     Table 19.--Median Costs Under Option 3
----------------------------------------------------------------------------------------------------------------
               HCPCS                   2004 APC          2004 SI              Description          Median costs
----------------------------------------------------------------------------------------------------------------
GXXX1.............................            XXX1  T                  Infusion of packaged non-         $274.47
                                                                        cancer chemotherapy
                                                                        drug(s), per day.
GXXX3.............................            XXX3  S                  Administration of                  125.86
                                                                        packaged cancer
                                                                        chemotherapy drug(s) by
                                                                        other than infusion, per
                                                                        day.
GXXX4.............................            XXX4  S                  Administration of                  257.57
                                                                        packaged cancer
                                                                        chemotherapy drug(s) by
                                                                        infusion, per day.
GYYY1.............................            YYY1  T                  Infusion of separately             107.93
                                                                        payable non-cancer
                                                                        chemotherapy drug(s) or
                                                                        non-drug infusion
                                                                        therapy, per day.
GYYY3.............................            YYY3  S                  Administration of                   39.10
                                                                        separately payable
                                                                        cancer chemotherapy
                                                                        drug(s) by other than
                                                                        infusion, per day.
GYYY4.............................            YYY4  S                  Administration of                  142.38
                                                                        separately payable
                                                                        cancer chemotherapy
                                                                        drug(s) by infusion, per
                                                                        day.
----------------------------------------------------------------------------------------------------------------

    As modeled, these codes would have status indicator S (except as 
described above for GXXX1 and GYYY1).
    Similar to option 2, we would require hospitals to report HCPCS 
codes for packaged and separately payable drugs to ensure that we have 
reliable data upon which to base future relative weights for these 
services. As described under option 4, we would create six lists of 
drugs in order to facilitate proper coding and payment in the future.
    We do not propose payment amounts for this option because the 
budget neutrality scalar would be different under this proposal than 
under option 2 (which was used in the scalar and impact analysis).
    Option 4--Use of codes Q0081, Q0083, and Q0084 and deletion of 
Q0085 with creation of logic in the outpatient code editor (OCE) to 
enable differential payment for administration of packaged and 
separately payable drugs.
    This option is similar to option 3 in terms of payment policy. 
However, instead of creating six new codes, hospitals would continue to 
report codes Q0081, Q0083, Q0084, and the HCPCS codes for all packaged 
and separately payable drugs. We would delete Q0085 in order to 
simplify hospital reporting and to facilitate creation of payment logic 
in the OCE.
    We would create six lists of drugs (see Addenda L, M, N, O, P, Q): 
packaged chemotherapy agents administered by other than infusion, 
separately payable chemotherapy agents administered by other than 
infusion, packaged chemotherapy agents administered by infusion, 
separately payable chemotherapy agents administered by infusion, 
packaged non-chemotherapy agents administered by infusion, and 
separately payable non-chemotherapy agents administered by infusion. 
These lists would be coded into the OCE, and would be updated quarterly 
by program memoranda. We realize that a few drugs may be administered 
by both infusion and other techniques. In these lists, we would assign 
each drug to its predominant form of administration in a hospital 
outpatient setting. If we could not determine whether a drug was 
infused or administered by a technique other than infusion (for 
example, we receive a claim with Q0083 and Q0084 and two drugs that may 
be administered by either infusion or another technique), we would 
associate each drug with its predominant administration code.
    We would create logic in the OCE that would base payment on the 
combination of administration and drug codes on the claim but would 
only allow one unit of each administration type as described in option 
3. The medians for the APCs to which OCE would assign the codes are 
described in Table 20.

                                                       Table 20.--Medians for APCS Under Option 4
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                     Nonchemo drug,
                                   Nonchemo drug,    Chemo drug,    separately paid    Chemo drug,
Drug administration codes on the   packaged list    packaged list      list or no    separately paid      Admin APC       APC median       Applicable
              claim                 (subgroup X)     (subgroup W)     drug billed    list  (subgroup                                         addenda
                                                                      (subgroup Z)          Y)
--------------------------------------------------------------------------------------------------------------------------------------------------------
Q0081...........................               X   ...............  ...............  ...............  A                        $274.47  L
Q0081...........................  ...............  ...............               X   ...............  B                         107.93  M
Q0083...........................  ...............               X   ...............  ...............  C                         125.86  N
Q0083...........................  ...............  ...............  ...............               X   D                          39.10  O
Q0084...........................  ...............               X   ...............  ...............  E                         257.57  P
Q0084...........................  ...............  ...............  ...............               X   F                         149.38  Q
--------------------------------------------------------------------------------------------------------------------------------------------------------

    The payment policy is identical to the policy described in option 3 
including the discount for Q0081 when billed with Q0083 and/or Q0084. 
Although this option would not require hospitals to change coding of 
drug administration it would, unlike options 2 and 3, require accurate 
coding of HCPCS codes for drugs in order to ensure proper payment. 
Additionally, we would revise the definitions of the administration 
codes to ``per day'' instead of ``per visit.''
    Similar to option 3, we would make payment for up to three drug 
administrations per day, if appropriate. Where a code is billed with a 
packaged drug suitable for the code, we would pay the APC for the 
packaged drug. Where both a packaged drug and a

[[Page 48003]]

separately paid drug were administered via the same route of 
administration (and therefore only one code was billed), we would pay 
the APC only for the administration of the packaged drug and would pay 
separately for the separately paid drug and would not pay the APC for 
administration of the separately paid drug. In no case would we pay for 
more than one unit of an administration code.
    Under options 2, 3, and 4, we would return a claim to the provider 
when a chemotherapy administration code was reported without a HCPCS 
code for a chemotherapy drug. Therefore, it is very important that 
commenters advise us as to whether there are any cancer chemotherapy 
drugs that are not included in Addenda L, M, N, O, P, or Q. 
Specifically, we solicit comments as to whether there are any cancer 
chemotherapy drugs that do not have HCPCS codes.
    We do not propose payment amounts for this option because the 
budget neutrality scalar would be different under this proposal than 
under option 2 (which was used in the scalar and impact analysis). We 
solicit comment on each option described above.
General Billing Instructions
    Any previous regulatory or sub-regulatory guidance notwithstanding, 
we propose to implement the following billing rules under any of the 
above payment options:
    (1) Q0081 may not be used to bill separately for the hanging of a 
bag of solution for which the sole purpose is to administer 
chemotherapy drugs; that charge should be billed as part of the charge 
for Q0084 or Q0085.
    (2) Q0081 may not be billed when it is an integral part of another 
procedure. In those cases, the charge for the procedure should reflect 
the costs of the infusion therapy, either as part of the charge for the 
HCPCS code or as a revenue code charge (for example, hydration or drug 
administration during a surgical procedure performed under general 
anesthesia).
    (3) Q0081, Q0083, and Q0084 should not be used to bill for the 
administration of radiopharmaceuticals that are administered as part of 
diagnostic or therapeutic nuclear medicine procedures. In those cases, 
the radionucliide should be billed with the appropriate nuclear 
medicine HCPCS code.
    (4) Q0081, Q0083, and Q0084 may not be used to report the 
transfusion of blood, platelets, or any other blood products. Those 
transfusions should be reported by use of the appropriate HCPCS code(s) 
in APC 0110.
5. Generic Drugs, and Radiopharmaceuticals
    In general, hospital acquisition costs for drugs, biologicals, and 
radiopharmaceutical agents with generic competitors are lower than the 
acquisition costs for sole source or multi-source drugs. In order to 
ensure that Medicare recognizes these lower costs in a timely manner, 
we are proposing a new method of calculating payment amounts for drugs, 
biologicals, and radiopharmaceuticals that are separately paid under 
the OPPS and for which the Food and Drug Administration (FDA) has 
recently approved generic alternatives when we determine our claims 
data do not reflect the costs of the generic alternatives.
    Because many hospitals have long term purchasing arrangements for 
drugs and radiopharmaceuticals, we believe that there is generally a 
12-month lag between the time that generic items are made available and 
when our claims data will accurately reflect the costs associated with 
the availability of the generic alternative. Therefore, during the 
interval between FDA approval of a generic item and the time when we 
would reasonably expect claims data to reflect the cost of generic 
alternatives, we propose to adopt the following methodology to price 
the affected drugs, biologicals, and radiopharmaceuticals under the 
OPPS.
    We would first identify items approved for generic availability by 
the FDA during the 6 months before the first day of the claims period 
we would use as the basis for an annual OPPS update. Where we determine 
that our claims data do not reflect the costs of generic alternatives 
for a separately payable drug, biological, or radiopharmaceutical, we 
propose to base our payment rate on 43 percent of the AWP for the drug, 
biological, or radiopharmaceutical. As described in the 2003 OPPS rule 
(67 FR 66768), the ratio of hospital acquisition cost, on average, to 
AWP for multisource drugs with generic competitors equals 0.43. We 
believe that using this ratio would allow us to appropriately calculate 
the costs that hospitals incur when purchasing generic drugs or 
radiopharmaceuticals. When we determine that our claims data accurately 
reflect the cost of the generic alternative(s), we would use the claims 
data to set payment rates in preference to 43 percent of AWP for the 
drug or radiopharmaceutical.
    We considered another payment option where we would base our 
payment rate on the lower of: (1) The median cost (with dampening if 
applicable) based on claims data; or (2) the Federal Supply Schedule 
price. We are not proposing this policy because we believe we would not 
be able to calculate payment rates that are close to the actual 
hospital acquisition costs of generic alternatives since the Federal 
Supply Schedule represents prices that are lower than the prices paid 
by most hospitals. Also, median costs from the claims data would not 
reflect the actual cost of generics because of the time lag described 
above.
    To apply this payment methodology to the 2004 OPPS update, we 
reviewed FDA approvals for generic drugs, biologicals, and 
radiopharmaceuticals issued between October 2001 and December 2002. We 
found six drugs, which we propose to be separately paid under the 2004 
OPPS that had generic alternatives approved during that time. These 
drugs are: Daunorubicin, Bleomycin, Pamidronate, Paclitaxel, 
Ifosfomide, and Idarubicin. Table 21 shows the dates when the FDA 
approved generic alternatives for these drugs.
    We understand that there is a wide range of utilization for these 
drugs in the OPPS and that price reductions for generic drugs will 
depend on their utilization and the types of illnesses for which they 
are used. However, we would not expect claims data from April 1, 2002 
through December 31, 2002 to reflect fully the availability of the 
generic alternatives.
    Table 21 shows the median cost for these six drugs as determined by 
claims data (with any adjustments for APCs that decreased in median 
cost by more than 15 percent from 2003 to 2004) and their costs at 43 
percent of AWP as determined under the July 2003 update of the Medicare 
Single Drug Pricer.
    We solicit comments on this proposed method of calculating payment 
for drugs, biologicals, and radiopharmaceuticals for which generic 
alternatives have recently been approved. Specifically, we are 
interested in comments concerning our proposed methodology for 
identifying these items, whether we properly identified all the items, 
and whether our proposed payment policy for these generic alternatives 
is appropriate.

[[Page 48004]]



  Table 21.--Proposed List of Separately Payable OPPS Drugs With Generic Alternatives Approved Between October
                                             2001 and December 2002
----------------------------------------------------------------------------------------------------------------
                                                                                                    2004 Median
                                                              Date of Generic                       cost (with
                APC                      Description        Approval by the FDA     43% of AWP     dampening if
                                                                                                    applicable)
----------------------------------------------------------------------------------------------------------------
0832..............................  Idarubicin hcl         May 2002.............         $190.08         $188.25
                                     injection.
0831..............................  Ifosfomide injection.  May 2002.............           68.07          115.46
0863..............................  Paclitaxel injection.  May 2002.............           74.27          116.61
0730..............................  Pamidronate disodium.  May 2002.............          120.34          184.40
0857..............................  Bleomycin sulfate      October 2001.........          130.98          169.28
                                     injection.
0820..............................  Daunorubicin hcl       November 2001........           35.46           89.65
                                     injection.
----------------------------------------------------------------------------------------------------------------

6. Orphan Drugs
    In response to last year's proposed rule, many commenters explained 
that many orphan drugs were life-saving therapies used solely for the 
treatment of rare disorders where no other treatment was available. 
They further stated that many of these drugs would be received by very 
few Medicare beneficiaries and that if we packaged these drugs into 
other procedures, our payment rates would be insufficient to recognize 
their high cost, thus impairing the access of beneficiaries who needed 
the drugs. These commenters also stated that the claims data we used to 
set payment rates for 2003 did not accurately reflect the cost of these 
drugs. We shared these concerns, and in the November 1, 2002 final rule 
(67 FR 66772), we set forth the following payment policy:
    We identified orphan drugs that are used solely for orphan 
conditions by applying the following criteria:
    [sbull] The drug is designated as an orphan drug by the FDA and 
approved by the FDA for treatment of only one or more orphan 
condition(s).
    [sbull] The current United States Pharmacopoeia Drug Information 
(USPDI) shows that the drug has neither an approved use nor an off-
label use for other than the orphan condition(s). Payment for drugs 
that met these criteria was made outside of OPPS under reasonable cost.
    In that same rule, we identified four orphan drugs (J0205 
Injection, alglucerase, per 10 units; J0256 Injection, alpha 1-
proteinase inhibitor, 10 mg; J9300 Gemtuzumab ozogamicin, 5 mg; and 
J1785 Injection, imiglucerase, per unit) as meeting these criteria. 
Therefore, we excluded them from payment under OPPS and paid for them 
at reasonable cost in 2003.
    We received several comments in response to the final rule, stating 
that we had not identified all drugs that qualified for special payment 
as orphans under our criteria. After reviewing these comments, we have 
identified 7 additional drugs that meet our criteria. These drugs are: 
J2355 Injection, oprelvekin, 5 mg; J3240 Injection, thyrotropin alpha, 
0.9 mg; J7513 Daclizumab parenteral, 25 mg; J9015 Aldesleukin, per 
vial; J9160 Denileukin diftitox, 300 mcg; J9216 Interferon, gamma 1-b, 
3 million units; and Q2019 Injection, basiliximab, 20 mg.
    We have now identified a total of 11 drugs that meet our orphan 
drug criteria, and we expect to identify more such drugs in the future. 
Last year's policy was intended to narrowly target a very small number 
of drugs received by very few Medicare beneficiaries in order to ensure 
beneficiary access to life saving therapies. The aggregate number of 
Medicare beneficiaries who will receive the 11 drugs that meet our 
criteria for orphans is significantly higher than the number who 
receive the 4 we identified last year. Furthermore, as we identify more 
drugs that meet our criteria, we expect the number of beneficiaries who 
receive these drugs to grow. As the number of beneficiaries who receive 
these drugs increases, so do total payments for the drugs. Therefore, 
we no longer believe that paying for these drugs at reasonable cost, 
outside of OPPS, is appropriate. Our goal is to pay for as many 
hospital outpatient department (OPD) services as possible under the 
OPPS system. We believe that any payments made outside of OPPS should 
remain relatively small and, as in the case of vaccines, be made 
because it is unlikely our claims data will reflect the cost of the 
item or service (see discussion of vaccines below).
    In the case of orphan drugs, we believe that our claims data for 
April 1, 2002 through December 31, 2002 do reflect the cost of orphan 
drugs, and we are concerned about the potential of making ever 
increasing payments for these drugs outside of the OPPS. Furthermore, 
we believe that many of the concerns expressed by commenters would be 
addressed if we continue to make separate payment for these drugs.
    Therefore, we propose the following payment policy for orphan 
drugs:
    [sbull] We propose to continue using the same criteria to identify 
orphan drugs used solely for an orphan condition under the OPPS.
    [sbull] We propose to discontinue retrospective cost payments and 
to make prospective payments under the OPPS for those identified orphan 
drugs.
    [sbull] We propose to base payments on the same methodology we use 
to pay for other drugs including any limitation on payment reductions 
(as described above).
    [sbull] We propose to make separate payment for orphan drugs and 
place them in APCs.
    We solicit comment on each of these proposals and request that 
commenters submit information meeting the same criteria as comments for 
other drugs (as discussed above).
7. Vaccines
    Outpatient hospital departments administer large amounts of the 
vaccines for influenza (flu) and pneumococcal pneumonia (PPV), 
typically by participating in immunization programs. In recent years, 
the availability and cost of some vaccines (particularly the flu 
vaccine) have fluctuated considerably. As discussed in the November 1, 
2002 final rule (67 FR 66718), we were advised by providers that OPPS 
payment was insufficient to cover the costs of the flu vaccine and that 
access of Medicare beneficiaries to flu vaccines might be limited. They 
cited the timing of updates to OPPS rates as a major concern. They said 
that our update methodology, which uses 2-year-old claims data to 
recalibrate payment rates would never be able to take into account 
yearly fluctuations in the cost of the flu vaccine. We agreed with this 
concern and decided to pay hospitals for influenza and pneumococcal 
pneumonia vaccines based on a reasonable cost methodology. As a result 
of this change, hospitals, home health agencies (HHAs), and hospices,

[[Page 48005]]

which were paid for these vaccines under OPPS in 2002 are being paid at 
reasonable cost for these vaccines in 2003. We are aware that access 
concerns continue to exist for these vaccines; therefore, we propose to 
continue paying for influenza and pneumococcal pneumonia vaccines under 
reasonable cost methodology.
8. Blood and Blood Products
    From the onset of the OPPS, we have made separate payment for blood 
and blood products in APCs 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), 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 we did 
not create any incentives that were inconsistent with the promotion of 
blood safety and access. Therefore, we propose to continue to pay 
separately for blood and blood products.
    As described in the November 1, 2002 final rule (67 FR 66773), we 
applied a special dampening option to blood and blood products that had 
significant reductions in payment rates from 2002 to 2003. For 2003, we 
limited the decrease in payment rates for blood and blood products to 
approximately 15 percent.
    After careful comparison of the 2003 dampened medians with the 2004 
medians from our claims data, we believe that establishing payment 
rates based on the 2004 median costs would, for many blood and blood 
products, result in payments that are significantly lower than hospital 
acquisition costs. In order to mitigate any significant payment 
reductions and to minimize any compromise in access of beneficiaries to 
these products, we propose to limit the decrease in payment rates for 
blood and blood products from 2003 to 2004 by approximately 10 percent.
    This is different than the amount by which we limited payment 
decreases last year because when we applied the dampening methodology 
used for the 2003 OPPS to blood and blood products, we observed that it 
did not sufficiently limit payment reductions for the blood and blood 
products with large decreases in median cost from 2003 to 2004. 
Therefore, we are proposing for 2004 a variation of the methodology 
used for the 2003 OPPS because we believe that a 10 percent limit in 
the decrease in payment rates for blood and blood products would better 
reflect hospital acquisition costs, ensure appropriate reimbursement to 
hospitals, and enable continued beneficiary access to blood and blood 
products.
    The list of APCs containing blood and blood products can be found 
in the November 1, 2002 final rule (67 FR 66750). We note that the APCs 
for these products are intended to make payment for the costs of the 
products. Costs for storage and other administrative expenses are 
packaged into the APCs for the procedures with which the products are 
used.
    We solicit comment on this proposal especially from hospitals. We 
are especially interested in comments that include verifiable 
information about the widely available acquisition cost of commonly 
used blood and blood products.
9. Intravenous Immune Globulin
    Following publication of the proposed rule on August 9, 2002, we 
received comments urging us to reclassify intravenous immune globulin 
(IVIG) as a blood product. After carefully reviewing these comments 
with our medical advisors, we decided to make final our proposal to 
classify immune globulin as a biological, subject to the same payment 
policy we implemented for other drugs and biologicals. Our reasons were 
set forth in the November 1, 2002 final rule (67 FR 66774). Since 
implementation of the 2003 OPPS update, we have received further 
comments on this decision. These commenters continue to assert that we 
should make special payment provisions for IVIG and reclassify IVIG as 
a blood and blood product. They have expressed particular concern about 
the potentially negative impact of our payment policy for IVIG on 
patient access, especially for those individuals who have primary 
immune deficiency diseases.
    We appreciate the concerns regarding our decision to pay for IVIG 
in accordance with the payment methodology we applied to other drugs 
and biologicals in the 2003 update of the OPPS. We have reviewed the 
claims data that are the basis for the payment rates in this proposed 
rule, and our analysis reveals that IVIG would be separately payable in 
2004. The claims data for IVIG are robust, and the most recent claims 
data, when compared with claims data used in earlier updates of the 
OPPS suggest that hospital costs are consistent and that hospitals are 
billing accurately for these products. Therefore, we believe that 
payment for these products is appropriate using the methodology we 
propose to implement for other drugs and biologicals. Therefore, we 
propose to continue to classify IVIG as a biologic. We solicit comments 
on this proposal.
10. Drug and Device Coding
    We propose to require hospitals to report individual codes for all 
drugs and devices used during the episode, including those that are 
packaged.
    Last year (CY 2003), the pass-through status of many drugs and 
devices expired. These drugs and devices were packaged, consistent with 
the fundamental principles of a prospective payment system. By 
packaging the costs of items and services into the payment for the 
primary procedure or service with which they are associated, we 
encourage hospital efficiency and provide hospitals with the ability to 
manage their resources with maximum flexibility. We believed that an 
additional advantage of increased packaging would be that hospitals 
would no longer need to report codes for the individual items and 
services included in the package. While we continue to support 
packaging to the greatest extent possible, the loss of coding 
information on claims creates some obstacles to accurate rate-setting.
    The data for 2002 that we are using for CY 2004 rate-setting still 
have considerable drug and device coding information. However, for the 
CY 2005 OPPS update, for which 2003 data would be used, there will be 
much less information regarding specific drug and device costs. We do 
not expect to have as much Medicare claims information on which to base 
certain decisions such as which drugs to remove from packaged status 
and pay separately.
    This concerns us and has led us to consider the need for drug and 
device coding. Even though payment is not directly related to that 
information, we believe that reporting the codes may be in hospitals' 
best interest because it may result in the most accurate payments. For 
example, in setting the weights of certain device-related APCs, we 
discovered that the median costs of those APCs were higher when we used 
only claims on which the device codes appeared. Similarly, certain drug 
administration APCs have higher median costs when separate HCPCS for 
drugs are reported on the claims.
    If we are to continue to price drugs and devices using up-to-date 
median costs from claims data, we need information on the costs of the 
items, even when packaged. We propose to require the separate coding of 
individual drugs and device categories,

[[Page 48006]]

even where their costs are packaged, to address this need. We would 
like comments on whether or not to require coding of devices. We also 
solicit comments regarding our proposal to report drug codes on claims 
and alternative methods for rate-setting if codes for drugs and/or 
devices are no longer present on the claims. We are particularly 
interested in receiving comments from hospitals on this proposal.
11. Payment for Split Unit of Blood
    Since implementation of the OPPS, we have assigned status indicator 
``E'' to HCPCS code P9011, blood (split unit). Status indicator ``E'' 
designates services for which payment is not allowed under the OPPS or 
services that are not covered by Medicare. P9011 was created to 
identify situations where one unit of red blood cells or whole blood, 
for example, is split and half of the unit is transfused to one patient 
and the other half to another patient. Because use of split units is 
not uncommon, we propose to change the status indicator for P9011 from 
``E'' to ``K'' and assign it to a blood and blood product APC that pays 
approximately 50 percent of the payment for the whole unit of blood. We 
propose to assign P9010 to APC 0957 (Platelet concentrate) with a 
payment rate of $37.30. We invite comments on this proposed change in 
the status indicator and payment amount for P9010.
12. Other Issues
    We propose to continue our payment policy for Procrit and Aranesp 
for calendar year 2004. As explained in detail in the November 1, 2002 
final rule (67 FR 66758), Aranesp and Procrit are in separate APCs, and 
are paid at equivalent rates with the application of a ratio to convert 
the dosage units of Aranesp into units of Procrit. The current 
conversion ratio is based on the best information available at the time 
we developed the final rule for calendar year 2003. In the final rule, 
we explained that we based our conclusion regarding the appropriate 
conversion ratio on the FDA labeling for each product and the body of 
available clinical evidence contained in published and unpublished 
articles and abstracts and in materials provided by the products' 
manufacturers. We indicated that we might refine the conversion ratio 
as soon as feasible based on information not available at the time we 
established the current conversion ratio.
    Consistent with our statements in the final rule, we have continued 
to gather information regarding an appropriate conversion ratio by 
reviewing recent published studies and data from alternative sources. 
We have met with the manufacturers of the products and consulted with 
clinicians. We are continuing to evaluate this additional data and 
information. However, we have not yet determined whether the data would 
support a change to the current policy. We remain open to establishing 
a different conversion ratio in the final rule if we conclude that a 
change is warranted based on public comments and information submitted 
during the public comment period and/or any other information we 
consider in developing the final rule.
    Therefore, we propose to continue with the current policy regarding 
payment for Procrit and Aranesp, including the current conversion 
ratio. We solicit comments on this issue and are especially interested 
in submission of articles in peer-reviewed publications and other 
clinical data concerning the frequency of administration and the dosage 
amounts of these agents. Submission of prospective, randomized, 
controlled trials comparing the dosage amounts, frequency of 
administration, and clinical outcomes of these agents are preferred. 
All data submitted would be available to the public. We would base any 
changes to our current payment policy for these two drugs only on data 
that we could make available to the public.

VII. Wage Index Changes for CY 2004

    Section 1833(t)(2)(D) of the Act requires that we determine a wage 
adjustment factor to adjust for geographic wage differences, in a 
budget neutral manner, that portion of the OPPS payment rate and 
copayment amount that is attributable to labor and labor-related costs.
    We used the proposed Federal fiscal year (FY) 2004 hospital 
inpatient PPS wage index to make wage adjustments in determining the 
proposed payment rates set forth in this proposed rule. The proposed FY 
2004 hospital inpatient wage index published in the May 19, 2003 
Federal Register (68 FR 27154) is reprinted in this proposed rule as 
Addendum H--Wage Index for Urban Areas; Addendum I--Wage Index for 
Rural Areas; and Addendum J--Wage Index for Hospitals That Are 
Reclassified. We propose to use the final FY 2004 hospital inpatient 
wage index to calculate the payment rates and coinsurance amounts that 
we will publish in the final rule implementing the OPPS for CY 2004.

VIII. Copayment for CY 2004

    In the November 30, 2001 final rule (66 FR 59887), we adopted a 
methodology that applied five rules for calculating APC copayment 
amounts when payments for APC groups change because the APCs' relative 
weights are recalibrated or when individual services are reclassified 
from one APC group to another. In calculating the unadjusted copayment 
amounts for 2004, we encountered circumstances that the methodology in 
the November 30, 2001 final rule either did not address or whose 
applicability was ambiguous. For example, rules 2 and 3 refer to 
payment rate changes resulting from the recalibration of relative 
payment weights but do not clearly apply to payment rate changes 
resulting from the reclassification of HCPCS codes from one APC group 
to another APC group. Therefore, we propose to revise and clarify the 
methodology we would follow to calculate unadjusted copayment amounts, 
including situations in which recalibration of the relative payment 
weight of an existing APC results in a change in the APC payment; to 
situations in which reclassification of HCPCS codes from an existing 
APC to another APC results in a change in the APC payment; and to 
payment rates for newly created APCs that are comprised of HCPCS codes 
from existing APCs.
    As a general rule, we would seek to lower the coinsurance rate for 
the services in an APC from the prior year. This principle is 
consistent with section 1833(t)(8)(C)(ii) of the Act, which accelerates 
the reduction in the national unadjusted coinsurance rate so that 
beneficiary liability will eventually equal 20 percent of the OPPS 
payment rate for all OPPS services and with section 1833(t)(3)(B), 
which indicates the congressional goal of achieving 20 percent 
coinsurance when fully phased in and gives the Secretary the authority 
to set rules for determining copayment amounts to new services. 
However, in no event is the proposed 2004 coinsurance rate for an APC 
group lower than 20 percent or greater than 50 percent of the payment 
rate.
    We propose to determine copayment amounts in 2004 and subsequent 
years in accordance with the following rules.
    1. When an APC group consists solely of HCPCS codes that were not 
paid under the OPPS the prior year because they were packaged or 
excluded or are new codes, the unadjusted copayment amount would be 20 
percent of the APC payment rate.
    2. If a new APC that did not exist during the prior year is created 
and

[[Page 48007]]

consists of HCPCS codes previously assigned to other APCs, the 
copayment amount is calculated as the product of the APC payment rate 
and the lowest coinsurance percentage of the codes comprising the new 
APC.
    3. If no codes are added to or removed from an APC and, after 
recalibration of its relative payment weight, the new payment rate is 
equal to or greater than the prior year's rate, the copayment amount 
remains constant (unless the resulting coinsurance rate is less than 20 
percent).
    4. If no codes are added to or removed from an APC and, after 
recalibration of its relative payment weight, the new payment rate is 
less than the prior year's rate, the copayment amount is calculated as 
the product of the new payment rate and the prior year's coinsurance 
percentage.
    5. If HCPCS codes are added to or deleted from an APC, and, after 
recalibrating its relative payment weight, holding its unadjusted 
copayment amount constant results in a decrease in the coinsurance 
percentage for the reconfigured APC, the copayment amount would not 
change (unless retaining the copayment amount would result in a 
coinsurance rate less than 20 percent).
    6. If HCPCS codes are added to an APC, and, after recalibrating its 
relative payment weight, holding its unadjusted copayment amount 
constant results in an increase in the coinsurance percentage for the 
reconfigured APC, the copayment amount would be calculated as the 
product of the payment rate of the reconfigured APC and the lowest 
coinsurance rate of the codes being added to the reconfigured APC.
    This methodology would, in general, reduce the beneficiary 
coinsurance rate and copayment amount for APCs for which the payment 
rate changes as the result of the reconfiguration of APCs and/or the 
recalibration of relative payment weights.

IX. Conversion Factor Update for CY 2004

    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 
2004, 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 forecast of the hospital market basket increase for FY 2004 
published in the inpatient PPS proposed rule on May 19, 2003 is 3.5 
percent. To set the proposed OPPS conversion factor for 2004, we 
increased the 2003 conversion factor of $52.151 (the figure from the 
November 1, 2002 final rule (67 FR 66788) by 3.5 percent.
    In accordance with section 1833(t)(9)(B) of the Act, we further 
adjusted the proposed conversion factor for 2004 to ensure that the 
revisions we are proposing to update by means of the wage index are 
made on a budget-neutral basis. We calculated a budget neutrality 
factor of 1.003 for wage index changes by comparing total payments from 
our simulation model using the proposed FY 2004 hospital inpatient PPS 
wage index values to those payments using the current (FY 2003) wage 
index values. In addition, for CY 2004, allowed pass-through payments 
have decreased to 2 percent of total OPPS payments, down from 2.3 
percent in CY 2003. The 0.3 percent was also used to adjust the 
conversion factor.
    The increase factor of 3.5 percent for 2004, the required wage 
index budget neutrality adjustment of approximately 1.003, and the 0.3 
percent adjustment to the pass-through estimate, result in a proposed 
conversion factor for 2004 of 54.289.

X. Proposed Outlier Policy and Elimination of Transitional Corridor 
Payments for CY 2004

A. Proposed Outlier Policy for CY 2004

    For OPPS services furnished between August 1, 2000 and April 1, 
2002, we calculated outlier payments in the aggregate for all OPPS 
services that appear on a bill in accordance with section 1833(t)(5)(D) 
of the Act. In the November 30, 2001 final rule (66 FR 59856, 59888), 
we specified that beginning with 2002, we will calculate outlier 
payments based on each individual OPPS service. We revised the 
aggregate method that we had used to calculate outlier payments and 
began to determine outliers on a service-by-service basis.
    As explained in the April 7, 2000 final rule (65 FR 18498), we set 
a target for outlier payments at 2.0 percent of total payments. For 
purposes of simulating payments to calculate outlier thresholds, we 
propose to continue to set the target for outlier payments at 2.0 
percent, as we did for CYs 2001, 2002, and 2003. For 2003, the outlier 
threshold is met when costs of furnishing a service or procedure exceed 
2.75 times the APC payment amount, and the current outlier payment 
percentage is 45 percent of the amount of costs in excess of the 
threshold. For the reasons discussed in detail in section XI.E of this 
preamble, we are proposing to establish two separate outlier 
thresholds, one for community mental health centers (CMHCs) and one for 
hospitals. For CY 2004, we propose to continue to set the target for 
outlier payments at 2.0 percent of total OPPS payments (a portion of 
that 2.0 percent, 0.36 percent, would be allocated to CMHCs for PHP 
services). Based on our simulations for 2004, we propose to set the 
hospital threshold for 2004 at 2.75 times the APC payment amount, and 
the proposed 2004 payment percentage applicable to costs over the 
threshold at 50 percent. We propose to set the threshold for CMHCs for 
2004 at 11.75 times the APC payment amount and the 2004 outlier payment 
percentage applicable to costs over the threshold at 50 percent.

B. Elimination of Transitional Corridor Payments for CY 2004

    Since the inception of the OPPS, providers have been eligible to 
receive additional transitional payments if the payments they received 
under the OPPS were less than the payments they would have received for 
the same services under the payment system in effect before the OPPS. 
Under 1833(t)(7) of the Act, most hospitals that realize lower payments 
under the OPPS received transitional corridor payments based on a 
percent of the decrease in payments. However, rural hospitals having 
100 or fewer beds, as well as cancer hospitals and children's hospitals 
described in section 1886(d)(1)(B)(iii) and (v) of the Act, were held 
harmless under this provision and paid the full amount of the decrease 
in payments under the OPPS. Transitional corridor payments were 
intended to be temporary payments to ease providers' transition from 
the prior cost-based payment system to the prospective payment system. 
Beginning January 1, 2004, in accordance with section 1833(t)(7) of the 
Act, transitional corridor payments will no longer be paid to providers 
other than cancer hospitals and children's hospitals. Cancer hospitals 
and children's hospitals are held harmless permanently under the 
transitional corridor provisions of the statute.
    We are concerned that small rural hospitals are not able to achieve 
the same level of operating efficiencies as larger rural hospitals and 
urban hospitals, and we are concerned that the decrease in payments 
these hospitals may experience once they stop receiving transitional 
corridor payments will result in these hospitals having to decrease or 
altogether cease to provide certain outpatient services. A reduction of 
services could have consequences for Medicare beneficiaries and their 
continued access to care in rural areas.

[[Page 48008]]

In light of these concerns, one thing we could do is to provide 
increased APC payments for clinic and emergency room visits furnished 
by rural hospitals having 100 or fewer beds. Any adjustment to payments 
for these hospitals would be made under the authority granted to the 
Secretary under section 1833(t)(2)(E) of the Act, to establish in a 
budget neutral manner adjustments as determined to be necessary to 
ensure equitable payments, such as adjustments for certain classes of 
hospitals. We invite comments on whether we should provide an 
adjustment, such as the one described above, for small rural hospitals.

XI. Other Policy Decisions and Proposed Changes

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

    Facilities code clinic and emergency department visits using the 
same [Physicians'] Current Procedural Terminology (CPT) codes as 
physicians. For both clinic and emergency department visits, there are 
currently five levels of care. Because these codes were defined to 
reflect only the activities of physicians, they are inadequate to 
describe the range and mix of services provided to patients in the 
clinic and emergency department settings (for example, ongoing nursing 
care, preparation for diagnostic tests, and patient education). An 
example to illustrate the services that are billed using E/M codes in 
the hospital outpatient department follows:
    An adult male patient presents to a clinic after a fall while 
working in his yard. As a result, he has scraped off the top layer of 
skin covering his entire back. The physician examines the patient, 
finds a dirty and possibly infected wound, which is the only injury. 
The physician orders the nurse to clean the wound, apply antiseptic 
medication, and dress the wound. In addition, the physician orders an 
intramuscular antibiotic and a tetanus injection.
    The nurse will spend a considerable amount of time cleaning and 
dressing the wound with large amounts of sterile supplies (because of 
the large body surface area) as well as administering medications. The 
nurse also will give the patient discharge instructions regarding the 
care of the wound.
    Although the physician services are captured using existing E/M 
codes, the additional staff and supplies integral to the outpatient 
department services are not. The low level E/M code that describes the 
physician services in the example is not reflective of the services 
provided by the nurse (and any other staff that may have become 
involved) or of the quantity of supplies used in the treatment.
    In the April 7, 2000 final rule (65 FR 18434), we stated that in 
order to ensure proper payment to hospitals, 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. 
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. Commenters recommended that we should keep the 
current E/M coding system until facility specific E/M codes for 
emergency department and clinic visits, along with national coding 
guidelines, were established. Commenters also recommended that we 
convene a panel of experts to develop codes and guidelines that are 
simple to understand, implement, and that are compliant with the Health 
Insurance Portability and Accountability Act (HIPAA) requirements.
APC Panel Recommendations
    During its January 2002 meeting, the APC Panel made the following 
recommendations regarding coding for evaluation and management 
services:
    1. Propose, and make final, facility coding guidelines for E/M 
services for CY 2004.
    2. Create a series of G codes with appropriate descriptors for 
facility E/M services.
    3. Maintain a single set of codes, with five levels of service, for 
emergency department visits.
    4. Develop a single set of codes, with five levels of service, for 
clinic visits. The Panel specifically recommended that we not 
differentiate among visit types (for example, new, established, and 
consultation visits) for the purposes of facility coding of clinic 
visits.
    5. Adopt the American College of Emergency Physicians (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.
    After careful review and consideration of written comments, oral 
testimony, and the APC Panel's recommendations, we proposed the 
following in the August 9, 2002 proposed rule (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 services:
    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.
    In our November 1, 2002 final rule (67 FR 66792), we stated that 
the most appropriate forum for development of new code definitions and 
guidelines would be an independent expert panel that would make 
recommendations to us. We wanted to ensure that definitions and 
guidelines were developed using an open process involving a variety of 
experts in the field. We stated that it is critically important to the 
development, acceptance, and implementation of facility visit code 
definitions and guidelines that the organizations that develop the 
guidelines also maintain and update the guidelines and provide ongoing 
education to providers on use of the codes. In light of the expertise 
of organizations such as the American Hospital Association (AHA) and 
the American Health Information Management Association (AHIMA), we felt 
that these organizations were particularly well equipped to make 
recommendations to us and to provide ongoing education to providers. 
Furthermore, we stated that the process should provide adequate time 
for the education of clinicians and coders and for hospitals to make 
the necessary changes in their systems to accommodate the new codes and 
guidelines.
    On their own initiative, the AHA and the AHIMA convened an 
independent expert panel of individuals from various

[[Page 48009]]

organizations to develop code descriptions and guidelines for hospital 
emergency department and clinic visits and make recommendations to us.
    The panel recommended the following to us.
    1. We should make payment for emergency and clinic visits based on 
four levels of care.
    2. We should create HCPCS codes to describe these levels of care as 
follows:
    GXXX1--Level 1 Emergency Visit.
    GXXX2--Level 2 Emergency Visit.
    GXXX3--Level 3 Emergency Visit.
    GXXX4--Critical Care provided in the emergency department.
    GXXX5--Level 1 Clinic Visit.
    GXXX6--Level 2 Clinic Visit.
    GXXX7--Level 3 Clinic Visit.
    GXXX8--Critical Care provided in the clinic.
    3. We should replace all the HCPCS currently in APCs 600, 601, 602, 
610, 611, 612, and 620 with GXXX1 through GXXX8.
    4. Based on the above recommendations, we would crosswalk payments 
as follows: GXXX1 to APC 610, GXXX2 to APC 611, GXXX3 to APC 612, GXXX4 
to APC 620, GXXX5 to APC 600, GXXX6 to APC 601, GXXX7 to APC 602, and 
GXXX8 to APC 620. These crosswalks and code descriptions are listed in 
Table 22 below.

                        Table 22.--Crosswalks of 2003 HCPCS Codes to the Proposed G Codes
----------------------------------------------------------------------------------------------------------------
                                         2004 G code          2003       2004 Proposed G                Payment
      2003 HCPCS description             description         HCPCS            codes            APC       amount
----------------------------------------------------------------------------------------------------------------
Emergency department visit........  Level 1 Emergency          99281  GXXX1...............       0610     $76.80
                                     Visit.                    99282
Emergency department visit........  Level 2 Emergency          99283  GXXX2...............       0611    $135.08
                                     Visit.
Emergency department visit........  Level 3 Emergency          99284  GXXX3...............       0612    $234.72
                                     Visit.                    99285
Critical care.....................  Level 4 Critical Care      99291  GXXX4...............       0620    $503.03
                                     provided in the           99292
                                     emergency department.
Office/outpatient visit, new......  Level 1 Clinic Visit.      99201  GXXX5...............       0600     $50.90
                                                               99202
Office/outpatient visit, new......  Level 2 Clinic Visit.      99203  GXXX6...............       0601     $54.46
Office/outpatient visit, new......  Level 3 Clinic Visit.      99204  GXXX7...............       0602     $84.71
                                                               99205
Office/outpatient visit,            Level 1 Clinic Visit.      99211  GXXX5...............       0600     $50.90
 established.                                                  99212
Office/outpatient visit,            Level 2 Clinic Visit.      99213  GXXX6...............       0601     $54.46
 established.
Office/outpatient visit,            Level 3 Clinic Visit.      99214  GXXX7...............       0602     $84.71
 established.                                                  99215
Office consultation...............  Level 1 Clinic Visit.      99241  GXXX5...............       0600     $50.90
                                                               99242
Office consultation...............  Level 2 Clinic Visit.      99243  GXXX6...............       0601     $54.46
Office consultation...............  Level 3 Clinic Visit.      99244  GXXX7...............       0602     $84.71
                                                               99245  ....................  .........  .........
Critical care.....................  Level 4 Critical Care      99291  GXXX8...............       0620    $503.03
                                     provided in the           99292
                                     clinic.
----------------------------------------------------------------------------------------------------------------

    The independent panel convened by the AHA and AHIMA recommended 
these levels in anticipation of the development of national coding 
guidelines for emergency and clinic visits that meet the following 
criteria we announced in the August 9, 2002 proposed rule (67 FR 
52131):
    1. Coding guidelines for emergency and clinic visits should be 
based on emergency department or clinic facility resource use, rather 
than physician resource use.
    2. Coding guidelines should be clear, facilitate accurate payment, 
be usable for compliance purposes and audits, and comply with HIPAA.
    3. Coding guidelines should only require documentation that is 
clinically necessary for patient care. Preferably, coding guidelines 
should be based on current hospital documentation requirements.
    4. Coding guidelines should not create incentives for inappropriate 
coding (for example, up-coding).
    We have received recommendations for a set of coding guidelines 
from the independent E/M panel comprised of members of the AHA and 
AHIMA. We propose to implement new evaluation and management codes only 
when we are also ready to implement guidelines for their use, after 
allowing ample opportunity for public comment, systems change, and 
provider education. We also propose to use cost data from the current 
HCPCS codes in these APCs to determine the relative weights of these 
APCs until cost data from GXXX1 through GXXX8 are available to set 
relative weights. We note that this proposal requires discontinuing the 
use of all HCPCS codes in these APCs and would not allow us to collect 
cost data for the five levels of emergency and clinic visits that are 
currently described by CPT codes. We further note that we would no 
longer be able to distinguish among the costs for visits by new 
patients, established patients, consultation patients, or patients 
being seen for more specialized care (for example, pelvic screening 
exams and glaucoma screening exams).
    We would be using claims data from current HCPCS codes and 
crosswalking those data to the new codes in the same APCs; therefore, 
there would be no change in payment for any of these services as a 
result of these coding changes. Once cost data become available from 
the new HCPCS codes, we would use those data to set the relative 
weights, and, therefore, there should be no budgetary impact.
    We are currently considering the set of proposed national coding 
guidelines for emergency and clinic visits recommended by the 
independent panel. We plan to make any proposed guidelines available to 
the public for comment on the OPPS Web site as soon as they are 
complete. We will notify the public through our listserve when these 
proposed guidelines become available. To subscribe to this listserve, 
please go to the following Web site: http://www.cms.hhs.gov/medlearn/listserv.asp and follow the directions to the OPPS

[[Page 48010]]

listserve. With regard to the development of these guidelines, our 
primary concerns are--
    1. To make appropriate payment for medically necessary care;
    2. To minimize the information collection and reporting burden on 
facilities;
    3. To minimize any incentives to provide unnecessary or low quality 
care;
    4. To minimize the extent to which separately billable services are 
counted as E/M services;
    5. To develop coding guidelines that are consistent with facility 
resource use; and
    6. To develop coding guidelines that are clear, facilitate accurate 
payment, are useful for compliance purposes and audits, and comply with 
HIPAA. Before implementation of the codes and coding guidelines, 
adequate time will be provided for the education of clinicians and 
coders and for hospitals to make the necessary changes in their systems 
to accommodate the codes and guidelines. We are requesting comments on 
the amount of time hospitals believe would be adequate to implement 
these new codes and guidelines. We remain committed to working with 
appropriate organizations and stakeholders in our continuing 
development of a standard set of codes and national guidelines for 
facility coding of emergency and clinic visits.

B. Status Indicators and Issues Related to OCE Editing

    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 whether a service represented by a HCPCS code is 
payable under the OPPS or another payment system and also whether 
particular OPPS policies apply to the code. We are providing our 
proposed status indicator (SI) assignments for APCs in Addendum A, 
HCPCS codes in Addendum B, and definitions of the status indicators in 
Addendum D.
    The OPPS is based on HCPCS codes for medical and other health 
services. These codes are used for a wide variety of payment systems 
under Medicare, including, but not limited to, the Medicare fee 
schedule for physician services, the Medicare fee schedule for durable 
medical equipment and prosthetic devices, and the Medicare clinical 
laboratory fee schedule. For purposes of making payment under the OPPS, 
we must be able 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 2004 we propose to use the status indicators in 
the following manner:
    [sbull] We use ``A'' to indicate services that are paid under some 
payment method other than OPPS, such as the durable medical equipment, 
prosthetics, orthotics, and supplies (DMEPOS) fee schedule or the 
physician fee schedule. Some but not all of these other payment systems 
are identified in Addendum D.
    [sbull] We use ``C'' to indicate inpatient services that are not 
payable under the OPPS.
    [sbull] We use ``D'' to indicate a code that was deleted effective 
with the beginning of the calendar year.
    [sbull] We use ``E'' to indicate services for which payment is not 
allowed under the OPPS or that are not covered by Medicare.
    [sbull] We use ``F'' to indicate acquisition of corneal tissue, 
which is paid at reasonable cost. (In 2003, we also use ``F'' to 
indicate those orphan drugs that are paid at reasonable cost.) In 2004, 
we propose to revise the definition of ``F'' solely to indicate 
acquisition of corneal tissue paid at reasonable cost.
    [sbull] We use ``G'' to indicate drugs and biologicals that are 
paid under OPPS transitional pass-through rules.
    [sbull] We use ``H'' to indicate devices that are paid under OPPS 
transitional pass-through rules.
    [sbull] We use ``K'' to indicate drugs, biologicals (including 
blood and blood products), radiopharmaceutical agents, 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] We use ``L'' to indicate flu and pneumococcal immunizations 
which are paid at reasonable cost but to which no coinsurance or 
copayment apply.
    [sbull] We use ``N'' to indicate services that are paid under the 
OPPS but for which payment is packaged into another service or APC 
group.
    [sbull] We use ``P'' to indicate services that are paid under the 
OPPS but only in partial hospitalization programs.
    [sbull] We use ``S'' to indicate significant procedures that are 
paid under OPPS but to which the multiple procedure reduction does not 
apply.
    [sbull] We use ``T'' to indicate significant services that are paid 
under the OPPS and to which the multiple procedure payment discount 
under OPPS applies.
    [sbull] We use ``V'' to indicate medical visits (including clinic 
or emergency department visits) that are paid under the OPPS.
    [sbull] We use ``X'' to indicate ancillary services that are paid 
under the OPPS.
    The software that controls Medicare payment looks to the status 
indicators attached to the HCPCS codes and APCs for direction in the 
processing of the claim. Therefore, the assignment of the status 
indicators has significance for the payment of services.
    We are proposing the status indicators identified for each HCPCS 
code and each APC in Addenda A and B and are requesting comments on the 
appropriateness of the indicators we have assigned.

C. Observation Services

    In the November 1, 2002 update to the OPPS (67 FR 66794), we 
summarized and clarified previously published guidance (Transmittal A-
02-026) regarding payment requirements for HCPCS code G0244, 
Observation care provided by a facility to a patient with congestive 
heart failure, chest pain or asthma, minimum of 8 hours, maximum 48 
hours. We also implemented HCPCS codes G0263 and G0264 to identify 
patients directly admitted to observation. In January 2003, we 
published Transmittal A-02-129, which provides further instructions 
regarding billing for observation services. In this proposed rule, we 
are neither proposing anything new with regard to observation services, 
nor are we seeking public comment on observation issues at this time. 
As we have in the past, we will update by Program Memorandum any 
changes in the list of ICD-9-CM codes required for payment of HCPCS 
code G0244 resulting from October 1 annual update of ICD-9-CM. Any such 
changes will be included in the 2004 final OPPS rule with comment 
period and the public will have an opportunity to comment at that time.

D. Procedures That Will Be Paid Only as Inpatient Procedures

    Before implementation of the OPPS, Medicare paid reasonable costs 
for services provided in the outpatient department. The claims 
submitted were subject to medical review by the fiscal intermediaries 
to determine the appropriateness of providing certain services in the 
outpatient setting. We did not specify in regulations those services 
that were appropriate to provide only in the inpatient setting and

[[Page 48011]]

that, therefore, should be payable only when provided in that setting.
    Section 1833(t)(1)(B)(i) of the Act gives the Secretary broad 
authority to determine the services to be covered and paid for under 
the OPPS. In the April 7, 2000 final rule, we identified procedures 
that are typically provided only in an inpatient setting and, 
therefore, would not be paid by Medicare under the OPPS (65 FR 18455). 
These procedures comprise what is referred to as the ``inpatient 
list.'' The inpatient list specifies those services that are only paid 
when provided in an inpatient setting. These are services that require 
inpatient care because of the nature of the procedure, the need for at 
least 24 hours of postoperative recovery time or monitoring before the 
patient can be safely discharged, or the underlying physical condition 
of the patient. As we discussed in the April 7, 2000 and the November 
30, 2001 final rules, we use the following criteria when reviewing 
procedures to determine whether or not they should be moved from the 
inpatient list and assigned to an APC group for payment under the OPPS:
    [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 that we have already 
removed from the inpatient list.
    In the November 1, 2002 final rule, we added 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 
multiple 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 
ambulatory surgical center (ASC) procedures or proposed by us for 
addition to the ASC list.
    At its January 2003 meeting, the APC Panel did not make 
recommendations regarding procedures on the inpatient list, and we are 
not proposing to make any of the procedures that are currently on the 
inpatient list in Addendum E payable under the OPPS in 2004. We solicit 
comments on whether any procedures in Addendum E should be paid under 
the OPPS. We ask commenters recommending reclassification of a 
procedure to an APC to include evidence (preferably from peer-reviewed 
medical literature) that the procedure is being performed on an 
outpatient basis in a safe and effective manner. We also solicit 
comments on the appropriate APC assignment for the procedure in the 
event that we determine in the final rule, based on comments, that the 
procedure would be payable under the OPPS in 2004.
    Following our review of any comments that we receive about the 
procedures in Addendum E, we propose either to assign a CPT code to an 
APC for payment under the OPPS or, if the comments do not provide 
sufficient information and data to enable us to make a decision, to 
present the comments to the APC Panel at its 2004 meeting.

Proposed New APC To Pay for Services Furnished on Same Date as Service 
with Modifier -CA:

    In the 2003 update of the OPPS, we implemented a new modifier -CA, 
Procedure payable only in the inpatient setting when performed 
emergently on an outpatient who dies before admission. In section VI of 
Transmittal A-02-129, issued on January 3, 2003, we instructed 
hospitals on the use of modifier -CA when submitting a claim on bill 
type 13x for a procedure that is on the inpatient list and that is 
assigned payment status indicator ``C.'' (Transmittal A-02-129 can be 
found on our Web site at cms.hhs.gov.) We also implemented in the 
November 1, 2002 final rule (67 FR 66799) a new payment policy to allow 
payment, under certain conditions, for outpatient services on a claim 
that have the same date of service as the HCPCS code billed with 
modifier -CA. A single payment for outpatient services on the claim, 
other than those coded with status indicator ``C'' and modifier -CA, is 
currently made under APC 977.
    We reviewed this policy and determined that assigning payment for 
these services to APC 977, which is a New Technology APC, is 
problematic because payment under New Technology APCs is a fixed amount 
that does not have a relative payment weight and is, therefore, not 
subject to recalibration based on hospital costs. We propose to 
establish a new APC for which payment would be made under certain 
conditions for otherwise payable outpatient services furnished on the 
same date of service that a procedure with status indicator ``C'' is 
performed emergently on an outpatient who dies before admission to the 
hospital as an inpatient. Beginning in 2004, hospitals would be paid 
under APC 375 instead of APC 977 for services furnished on the same 
date of service that a procedure with status indicator ``C'' and 
modifier -CA is billed. We propose at the outset to set the payment 
rate for APC 375 in the amount of $1,150, which is the payment amount 
for the newly structured New Technology APC that would replace APC 977. 
When the APC weights are recalibrated in 2005, we would use charge data 
from CY 2003 claims for line items that have the same date of service 
as the line with modifier -CA and that show a HCPCS code with status 
indicator ``V,'' ``S,'' ``T,'' ``X,'' ``N,'' or ``K'' to calculate a 
median cost and relative payment weight for APC 375. Once we have 
claims data, we would be able to determine whether it is appropriate to 
calculate a relative payment weight based on median costs from our 
claims data or to continue a fixed payment rate for these special 
cases. We invite comments on these proposed changes.

E. Partial Hospitalization Payment Methodology

1. Background
    As we discussed in the April 7, 2000 OPPS final rule (65 FR 18452), 
partial hospitalization is an intensive outpatient program of 
psychiatric services provided to patients in place of inpatient 
psychiatric care. A partial hospitalization program (PHP) may be 
provided by a hospital to its outpatients or by a Medicare-certified 
community mental health center (CMHC). Payment to providers under the 
OPPS for PHPs represents the provider's overhead costs associated with 
the program. Because a day of care is the unit that defines the 
structure and scheduling of partial hospitalization services, we 
established a per diem payment methodology for the PHP APC, effective 
for services furnished on or after August 1, 2000.
    The PHP per diem amount was based solely on hospital data. Section 
1833(t)(2)(C) of the Act required that we initially establish relative 
payment weights based on median (or mean, at the discretion of the 
Secretary) hospital costs determined by 1996 claims and cost report 
data. We analyzed the service components billed by hospitals over the 
course of a billing period and determined the median hospital cost of 
furnishing a day of partial hospitalization. The analysis of hospital 
partial hospitalization claims resulted in a per diem payment of 
$202.19, effective August 1, 2000. This amount was updated effective 
January 1, 2001 and April 1, 2002 to $206.82 and $212.27, respectively.
    Although we did not use CMHC data in establishing the initial APC 
amount

[[Page 48012]]

for partial hospitalization, in the April 7, 2000 final rule, we 
committed to analyzing future data from hospitals and CMHCs to 
determine whether refinements to the per diem were warranted. As a 
result, for payment rates presented in the proposed and final rules in 
2002, we used data from both hospitals and CMHCs to compute the CY 2003 
per diem rate. A description of the methodology we followed in 
developing the CY 2003 PHP payment rate is presented below.
    We based the CY 2003 per diem amount on hospital and CMHC claims 
data for services furnished from April 1, 2001 through March 31, 2002. 
We used data from all the hospital bills reporting condition code 41, 
which identifies the claim as partial hospitalization, and all bills 
from CMHCs, since CMHCs are Medicare providers only for the purpose of 
providing partial hospitalization services. We used cost-to-charge 
ratios from the most recently available hospital and CMHC cost reports 
to convert each provider's line item charges as reported on bills, to 
estimate the provider's cost for a day of PHP. Unlike hospitals, CMHCs 
do not file cost reports electronically and the cost report information 
is not included in the Hospital Cost Report Information System (HCRIS). 
The CMHC cost reports are held by the Medicare fiscal intermediaries 
(FIs). As a result, we requested that the FIs forward to us the most 
recently available CMHC cost-to-charge ratios so that we could apply 
the ratio to the CMHC's billed charges and approximate the CMHC's per 
diem cost for PHP.
    Per diem costs are computed by summing the line item costs on each 
bill and dividing by the number of days on the bill. Using this method 
of computing costs, preliminary per diem cost estimates for CMHCs were 
much higher than expected, in many cases more than twice the average 
per diem for inpatient psychiatric care. Closer examination of the CMHC 
cost report data summaries showed that costs from CMHC settled cost 
reports were considerably lower than costs from ``as submitted'' CMHC 
cost reports. To account for the difference between settled and as 
submitted cost report data, we computed the ratio of total settled 
costs to total as submitted costs over a 3-year period (CMHC FYs 1998 
through 2000) and calculated an average adjustment factor (0.583), 
which we applied to the costs on each claim. As stated in the 2002 
proposed and final OPPS rules, we thought that an adjustment factor of 
0.583 was adequate to account for the difference between settled and 
``as submitted'' CMHC cost reports and was more reflective of CMHC 
costs for PHP. However, we did not have an opportunity to examine the 
data in depth before publishing the OPPS final rule on November 1, 
2002.
    The adjusted CMHC per diem costs on each claim were summed, then 
divided by the number of days on the claim. We then combined the CMHC 
and hospital PHP data files and determined the median per diem cost for 
PHP. Effective January 1, 2003, the PHP APC amount was $240.03, of 
which $48.17 is the beneficiary's coinsurance.
2. PHP APC Update for CY 2004
    For CY 2004, we analyzed hospital and CMHC PHP claims for services 
furnished between April 1, 2002 and December 31, 2002. We intended to 
propose to use the same methodology for computing median costs per day 
for CY 2004, including the adjustment factor, as we used to compute the 
CY 2003 PHP median cost per day. However, when we applied the 
adjustment factor to the CMHC claims to compute the CY 2004 per diem, 
the CMHC median cost per day was determined to be $605. Without the 
adjustment, the median cost per day for CMHCs to provide partial 
hospitalization services is $1,038. The median cost per day for 
hospital outpatient departments to provide the same benefit is $225. We 
do not believe it is reasonable for CMHCs to incur costs that are more 
than double those incurred by hospital outpatient departments providing 
PHP services. In addition, the median CMHC cost for a day of outpatient 
PHP services exceeds the average per diem cost for inpatient 
psychiatric facilities, which provide a full 24 hours of care, 
medications, and other ancillary services. We do not believe it is 
appropriate for Medicare to pay more for a day of outpatient treatment 
than for a day of inpatient psychiatric care.
    In addition to the vast difference in median costs between CMHCs 
and hospital outpatient departments, we are concerned that this 
difference has grown significantly larger since last year. The median 
per diem cost for hospitals is about the same for 2003 and 2004 ($224 
for CY 2003 compared to $225 for the proposed CY 2004 update), while 
the median per diem cost for CMHCs (after adjustment) has increased by 
58 percent ($384 for CY 2003 compared to $605 for the proposed CY 2004 
update). We believe that the increase in the median CMHC per diem cost 
is primarily due to large increases in CMHC charges, coupled with the 
application of outdated cost-to-charge ratios to determine the per diem 
cost. In a Program Memorandum issued on January 17, 2003 (Transmittal 
A-03-004), we directed FIs to recalculate hospital and CMHC cost-to-
charge ratios using the most recently settled or tentatively settled 
cost reports by April 30, 2003. However, we did not receive the updated 
CMHC cost-to-charge ratios in time to use in our data analysis for this 
proposed rule.
    Therefore, we are proposing a per diem rate for PHP services 
furnished during CY 2004 based solely on hospital PHP data. The 
resulting PHP APC 0033 amount, after scaling, is $208.95, of which 
$41.69 is the beneficiary's coinsurance. We are not inclined to use the 
CMHC data in computing the per diem amount until the data discrepancies 
can be more fully resolved. We anticipate receipt of the revised CMHC 
cost-to-charge ratios this summer and will analyze the updated CMHC 
cost data. To the extent we believe the updated cost-to-charge ratios 
result in a more reasonable median per diem rate, we propose to use the 
CMHC data in developing the final rate for CY 2004.
3. Outlier Payments to CMHCs
    In a related matter, the use of outdated cost-to-charge ratios 
applied to current charges has resulted in an excessive amount of 
outlier payments being made to CMHCs. As a result of more in-depth 
analysis of the 2001 data files that were used to compute the CY 2003 
PHP per diem amount, we discovered a significant difference in the 
amount of outlier payments made to hospitals and CMHCs for PHP. Of the 
approximately 660 hospital programs with claims for PHP in CY 2001, 25 
hospitals received approximately $9,000 in outlier payments. By 
contrast, almost half of the 155 CMHCs in our CY 2001 data file were 
paid outlier payments, totaling approximately $48 million.
    Based on preliminary analysis of the 125 CMHCs with claims in the 
CY 2002 data files, that is, April 1, 2002 through December 31, 2002, 
we have determined that CMHCs received approximately $37 million in 
outlier payments, compared to approximately $13,000 for all hospitals 
in the PHP data file. The $37 million in outlier payments to CMHCs 
almost equals the total amount paid to CMHCs in regular APC payments.
    CMHCs have indicated that they are unable to reduce their costs to 
the per diem payment amount and that outlier payments are needed to 
cover operating expenses. This use of outlier payments is contrary to 
the intent of an outlier policy. Establishing an outlier policy allows 
us to ensure beneficiary access to services by sharing in the loss

[[Page 48013]]

associated with services for specific patients that are extraordinarily 
expensive. Through a comparison of the median per diem costs, we have 
determined that CMHCs dramatically increased their charges between CY 
2001 and CY 2002. During this period, the median per diem cost for 
CMHCs increased by 58 percent. We believe that in most cases, these 
increases in charges were not related to a corresponding increase in 
costs. Since the CMHC cost-to-charge ratios used to calculate outlier 
payments remained constant during this period, we believe that the 58 
percent increase in computed cost is attributable to artificial 
increases in charges designed to enhance outlier payments. 
Approximately two-thirds of outlier payments made to PHP providers were 
paid to 20 of the 125 CMHCs. The charges reported by these providers, 
on average, were over 10 times more than hospital per diem charges.
    Given the difference in PHP charges between hospitals and CMHCs, we 
no longer believe it is appropriate to make outlier payments to CMHCs 
using the outlier percentage target amount and threshold established 
for hospitals. Therefore, we are proposing to designate a portion of 
the estimated 2.0 percent outlier target amount specifically for CMHCs, 
consistent with the percentage of projected payments to CMHCs under the 
OPPS in CY 2004, excluding outlier payments. CMHCs are projected to 
receive 0.36 percent of total OPPS payments in CY 2004, excluding 
outlier payments. Therefore, we are proposing to designate 0.36 percent 
of the estimated 2.0 percent outlier target amount for CMHCs and 
establish a threshold to achieve that level of outlier payments. Based 
on our simulations of CMHC payments in 2004, we are proposing to set 
the threshold for CY 2004 at 11.75 times the PHP APC payment amount. We 
believe that this approach would neutralize the impact of inflated CMHC 
charges on outlier payments. We are proposing to apply the same outlier 
payment percentage that applies to hospitals. Therefore, for CY 2004, 
we are proposing to pay 50 percent of CMHC per diem costs over the 
threshold. To the extent charges remain relatively constant, CMHCs 
would qualify for outlier payments in CY 2004 only for truly high cost 
patients.
    As noted previously, we expect to receive updated cost-to-charge 
ratios from the FIs this summer. Many of the cost-to-charge ratios are 
expected to be considerably lower than those currently used to 
determine a provider's cost for the purpose of outlier and transitional 
pass-through or corridor payments. For example, we are aware of a 
number of situations where the updated cost-to-charge ratios have 
declined by more than 50 percent.
    We specifically request public comments on this proposed outlier 
policy. We intend to monitor the extent to which the current pattern of 
escalating charges continues. CMS and the Office of the Inspector 
General will be further examining the excessive outlier payments to 
CMHCs.

XII. Summary of and Responses to MedPAC Recommendations

    The Medicare Payment Advisory Commission (MedPAC) in its March 2002 
Report to the Congress: ``Medicare Payment Policy,'' makes a number of 
recommendations relating to the OPPS. This section provides responses 
to those recommendations.
    Recommendation: The Congress should increase payment rates for the 
OPPS by the rate of increase in the hospital market basket, less 0.9 
percent, for CY 2004.
    Response: Section 1833(t)(3)(C)(ii) of the Act requires the 
Secretary to update the conversion factor annually. Under section 
1833(t)(3)(C)(iv) of the Act, the update must be equal to the hospital 
market basket percentage increase applicable under the hospital 
inpatient PPS. For years 2000 and 2002 only, the statute required the 
update to be determined by reducing the increase by one percentage 
point, but current law specifies such a reduction only for those 2 
years. For 2004, we propose to increase the conversion factor by the 
rate of increase in the hospital market basket.
    Recommendation: The Secretary should introduce clinical criteria 
for eligibility of drugs and biologicals to receive pass-through 
payments under the outpatient PPS.
    Response: In accordance with section 402 of the Medicare, Medicaid, 
and SCHIP Benefits Improvement and Protection Act (BIPA), pass-through 
payments for medical devices is made on the basis of categories of 
devices. On November 2, 2001, we published in the Federal Register (66 
FR 55850) a rule that specified the criteria for establishment of a new 
category of devices for purposes of pass-through payments. Among these 
is the requirement that the devices to be included in a possible 
category must demonstrate a substantial improvement in medical benefits 
for Medicare beneficiaries compared to benefits obtained by devices in 
previously established categories or other available treatments. We 
elaborated further about this criterion in the final rule updating the 
OPPS for CY 2003, published in the Federal Register on November 1, 
2002. As we stated at that time, ``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.'' (67 FR 66782)
    At present, pass-through payment for drugs and biologicals is not 
made on the basis of categories, and no comparable criterion applies to 
them. Whether we should apply such a requirement to drugs and 
biologicals is an important question. On the one hand, as noted above, 
limiting extra payment to those items that have the potential to make a 
significant difference in treatment of Medicare beneficiaries appears 
useful. On the other hand, developing an appropriate mechanism for 
identifying which drugs or biologicals might qualify is difficult. 
Because the clinical characteristics of particular cases that are 
relevant for drug use may vary substantially, we believe that this 
challenge is more difficult than in the case of devices. Consequently, 
we have not developed a proposal in this area, and we are not prepared 
to advance one at this time.

XIII. Summary of Proposed Changes for 2004

A. Changes Required By Statute

    We are proposing 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 and devices that will have been paid under the transitional 
pass-through methodology for at least 2 years by January 1, 2004.
    [sbull] Cease transitional outpatient payments (TOPS payments) for 
all hospitals paid under OPPS except for cancer hospitals and 
children's hospitals.

[[Page 48014]]

B. Additional Changes

    We are proposing the following additional changes to the OPPS:
    [sbull] Adjust payment to moderate the effects of decreased median 
costs for non-pass-through drugs, biologicals, and 
radiopharmaceuticals.
    [sbull] Implement a new method for paying for drug administration.
    [sbull] Create new evaluation and management service codes for 
outpatient clinic and emergency department encounters.
    [sbull] Change status indicators for HCPCS codes.
    [sbull] List midyear and proposed HCPCS codes that are paid under 
OPPS.
    [sbull] Allocate a portion of the outlier percentage target amount 
to CMHCs and create a separate threshold for outlier payments for 
partial hospitalization services.
    [sbull] Create methodology and payment rates for separately payable 
drugs and radiopharmaceuticals for 2004.
    [sbull] Make several changes in our current payment policy with 
regard to payment for Q0081, Q0083, Q0084, and Q0085 to facilitate 
accurate payments for drugs and drug administration.
    [sbull] Change the status indicator and payment amount for P9010 by 
assigning it to APC 0957 (Platelet concentrate) with a payment rate of 
$37.30.

XIV. Collection of Information Requirements

    Under the Paperwork Reduction Act of 1995, we are required to 
provide 60-day notice in the Federal Register and solicit public 
comment before a collection of information requirement is submitted to 
the Office of Management and Budget (OMB) for review and approval. In 
order to fairly evaluate whether an information collection should be 
approved by OMB, section 3506(c)(2)(A) of the Paperwork Reduction Act 
of 1995 requires that we solicit comment on the following issues:
    [sbull] The need for the information collection and its usefulness 
in carrying out the proper functions of our agency.
    [sbull] The accuracy of our estimate of the information collection 
burden.
    [sbull] The quality, utility, and clarity of the information to be 
collected.
    [sbull] Recommendations to minimize the information collection 
burden on the affected public, including automated collection 
techniques.
    The OPPS provisions set forth in this proposed rule do 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. Response to Public Comments

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

XVI. Regulatory Impact Analysis

A. 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 would be implemented 
by this proposed rule would result in expenditures exceeding $100 
million in any 1 year. We estimate the total increase (from changes in 
the proposed rule as well as enrollment, utilization, and case mix 
changes) in expenditures under the OPPS for CY 2004 compared to CY 2003 
to be approximately $0.457 billion. Therefore, this proposed rule is an 
economically significant rule under Executive Order 12866, and a major 
rule under 5 U.S.C. 804(2).
    The RFA requires agencies to determine whether a rule would 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 would be considered small entities according to 
the Small Business Administration (SBA) size standards. We do not have 
data available to calculate the percentages of entities in the 
pharmaceutical preparation manufacturing, biological products, or 
medical instrument industries 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 603 of the RFA. With 
the exception of hospitals located in certain New England counties, for 
purposes of section 1102(b) of the Act, we define a small rural 
hospital as a hospital that is located outside of a Metropolitan 
Statistical Area (MSA) and has fewer than 100 beds (or New England 
County Metropolitan Area (NECMA)). Section 601(g) of the Social 
Security Amendments of 1983 (Pub. L. 98-21) designated hospitals in 
certain New England counties as belonging to the adjacent NECMA. Thus, 
for purposes of the OPPS, we classify these hospitals as urban 
hospitals. We believe that the changes in this proposed rule would 
affect both a substantial number of rural hospitals as well as other 
classes of hospitals and that the effects on some may be significant. 
Therefore, we conclude that this proposed rule would have a significant 
impact on a substantial number of small entities.
Unfunded Mandates
    Section 202 of the Unfunded Mandates Reform Act of 1995 (Pub. L. 
104-4) also requires that agencies assess anticipated costs and 
benefits before issuing any rule that may result in an expenditure in 
any 1 year by State, local, or tribal governments, in the aggregate, or 
by the private sector, of $110 million. This proposed rule would not 
mandate any requirements for State,

[[Page 48015]]

local, or tribal governments. This proposed rule would not impose 
unfunded mandates on the private sector of more than $110 million 
dollars.
Federalism
    Executive Order 13132 establishes certain requirements that an 
agency must meet when it publishes a proposed rule (and subsequent 
final rule) that imposes substantial direct costs on State and local 
governments, preempts State law, or otherwise has Federalism 
implications.
    We have examined this proposed rule in accordance with Executive 
Order 13132, Federalism, and have determined that it would not have an 
impact on the rights, roles, and responsibilities of State, local or 
tribal governments. The impact analysis (see Table 23) shows that 
payments to governmental hospitals (including State, local, and tribal 
governmental hospitals) would increase by 3.9 percent under the 
proposed rule.

B. Changes in This Proposed Rule

    We are proposing several changes to the OPPS that are required by 
the statute. We are required under section 1833(t)(3)(C)(ii) of the Act 
to update annually the conversion factor used to determine the APC 
payment rates. We are also required under section 1833(t)(9)(A) of the 
Act to revise, not less often than annually, the wage index and other 
adjustments. In addition, we must review the clinical integrity of 
payment groups and weights at least annually. Accordingly, in this 
proposed rule, we are proposing to update the conversion factor and the 
wage index adjustment for hospital outpatient services furnished 
beginning January 1, 2004 as we discuss in sections IX and VII, 
respectively, of this proposed rule. We are also proposing to revise 
the relative APC payment weights based on claims data from April 1, 
2002 through December 31, 2002. Finally, we are proposing to remove two 
devices and eight drugs and biologicals from pass-through payment 
status. Alternatives to the changes we are proposing and why we did not 
accept them are discussed throughout this proposed rule. In particular, 
see section V.B with regard to the expiration of pass-through payment 
for devices; see section VI.B with regard to the expiration of pass-
through payment for drugs and biological agents.
    Under this proposed rule, the change to the conversion factor as 
provided by statute would increase total OPPS payments by 3.8 percent 
in 2004. The changes to the wage index and to the APC weights (which 
incorporate the cessation of pass-through payments for many drugs and 
devices) would not increase OPPS payments because the OPPS is budget 
neutral. However, the wage index and APC weight changes would change 
the distribution of payments within the budget neutral system as shown 
in Table 23 and described in more detail in this section.
Alternatives Considered
    Alternatives to the changes we are proposing and the reasons that 
we are proposing 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 V.B of this 
proposed rule regarding the expiration of pass-through payment for 
devices and section VI.B of this proposed rule regarding the expiration 
of pass-through payment for drugs and biological agents.
Payment for the Administration of Drugs
    As discussed in detail in section VI.B of this proposed rule, we 
considered the following alternatives with regard to payment for 
administration of packaged and separately paid drugs:
    [sbull] Continue to pay under the current drug administration codes 
(Q0081, Q0083, Q0084, and Q0085). This alternative would pay the same 
amount for administration of packaged or separately paid drugs, 
although the data show that the costs are considerably more when 
packaged drugs are administered and considerably less if separately 
paid drugs are administered.
    [sbull] Create eight new HCPCS codes (based on the existing Q codes 
listed above), with one set of codes for packaged drugs and one set for 
separately paid drugs. Establish an APC for each. This alternative 
permits more accurate payment for packaged and separately paid drugs 
than use of the current codes but imposes a significant burden on 
hospitals to bill correctly.
    [sbull] Create six new HCPCS codes (based on the existing Q codes 
with deletion of Q0085). Establish an APC for each. This alternative 
permits more accurate payment for packaged and separately paid drugs 
than use of the current codes and imposes slightly less burden on 
hospital billing than the eight-code alternative.
    [sbull] Delete Q0085 and revise the definitions of the other Q 
codes to once per day. Crosswalk each code billed to one of two APCs 
that would be paid dependent on the drugs billed on the same date of 
service. This alternative permits more accurate payment for packaged 
and separately paid drugs. It also simplifies hospital billing for drug 
administration. Under this option, however, hospitals would be required 
to bill for all drugs they administer, whether packaged or separately 
paid so that the outpatient code editor (OCE) could properly assign the 
APC that applies in the case. The systems changes required for this 
alternative are much more substantial than under any of the other 
alternatives, and we are considering whether we can implement this 
change before January 2005.
    We modeled the second alternative for purposes of budget neutrality 
and impact analysis. We await comments before determining what 
alternative we will undertake for the 2004 OPPS.
Payment for Drugs That Are Not Packaged
    As a result of marked and erratic fluctuations in median costs for 
drugs, biologicals, and radiopharmaceutical agents that are paid 
separately under the OPPS, we explored several options to determine how 
best to provide accurate payment for CY 2004. One option was to pay 
based on our 2002 claims data without any adjustment. We were certain 
that this would not result in accurate payments because of the 
magnitude of some of the fluctuations in median costs seen in the data.
    Another option considered, to create cost bands similar to those 
used for New Technology APCs, was rejected because unless very narrow 
bands were created, this option also would result in inaccurate 
payments.
    Finally, we looked at using the same methodology for moderating 
payment decreases that we used last year, to limit median cost 
decreases of 15 percent or more to 50 percent of the difference between 
the median cost and the amount of decrease greater than 15 percent. 
This option would enable us to moderate the decreased payment amount on 
an individual drug, biological, or radiopharmaceutical agent level, 
which is important in light of the great variations in the data; but 
the 50 percent adjustment level was not adequate for the level of 
moderation we believed was required for CY 2004.
    The adjustment we put forth in this proposed rule is a 75 percent 
moderation of decreases of 15 percent or more. Thus, for separately 
payable drugs, biologicals, and radiopharmaceutical agents for which 
median costs decreased by 15 percent or more, we are proposing to limit 
the reduction in median costs to 15 percent plus 25 percent of the 
difference

[[Page 48016]]

between the value derived from claims data and any decrease of 15 
percent or more.
    Our analyses indicate that application of this method of adjustment 
would result in payment levels that will be fair and accurate. However, 
based on more complete claims data we expect to have for the final rule 
and on the comments from the public, we will re-evaluate the 
appropriateness of adjusting median costs for drugs for which median 
costs would decline in 2004.
Conclusion
    It is clear that the changes in this proposed rule would affect 
both a substantial number of rural hospitals as well as other classes 
of hospitals, and the effects on some may be significant. Therefore, 
the discussion below, in combination with the rest of this proposed 
rule, constitutes a regulatory impact analysis.
    The OPPS rates for CY 2004 would have, overall, a positive effect 
for every category of hospital with the exception of cancer hospitals 
and children's hospitals, which are held harmless under the OPPS. These 
changes in the OPPS for 2004 would result in an overall 3.8 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 relative 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 23.
    The overall projected increase in payments for urban hospitals is 
slightly lower (3.7 percent) than the average increase for all 
hospitals (3.8 percent) while the increase for rural hospitals is 
slightly greater (4.0 percent) than the average increase. The 
introduction of a new wage index combined with changes to the APC 
structure would result in small distributional changes for all 
categories of hospitals. Rural hospitals would gain 0.1 percent from 
the wage index change but show no gains from APC changes. Large urban 
hospitals would lose 0.1 percent from the wage index change, whereas 
``other'' urban hospitals show a decrease of -0.2 percent from the APC 
changes. A discussion of the distribution of outlier payments that we 
project under this proposed rule can be found under section XV.E below. 
Table 24 presents the outlier distribution that we expect to see under 
this proposed rule.

C. Limitations of Our Analysis

    The distributional impacts represent the projected effects of the 
policy changes, as well as statutory changes effective for 2004, 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 are not proposing to make adjustments for future changes 
in variables such as service volume, service mix, or number of 
encounters.

D. Estimated Impacts of This Proposed Rule on Hospitals

    The OPPS is a budget neutral payment system under which the 
increase to the total payments made under OPPS is limited by the 
increase to the conversion factor set under the methodology in the 
statute. The impact tables show the redistribution of hospital payments 
among providers as a result of a new wage index and APC structure. In 
some cases, under this proposed rule, hospitals would receive more 
total payment than in 2003 while in other cases they would receive less 
total payment than they received in 2003. The impact of this proposed 
rule would depend on a number of factors, most significant of which are 
the mix of services furnished by a hospital (for example, how the APCs 
for the hospital's most frequently furnished services would change) and 
the impact of the wage index changes on the hospital.
    Column 4 in Table 23 represents the full impact on each hospital 
group of all the changes for 2004. Columns 2 and 3 in the table reflect 
the independent effects of the proposed change in the wage index and 
the APC reclassification and recalibration changes, respectively. We 
excluded critical access hospitals (CAHs) from the analysis of the 
impact of the proposed 2004 OPPS rates that is summarized in Table 23. 
For that reason, the total number of hospitals included in Table 23 
(4,352) is lower than in previous years. CAHs are excluded from the 
OPPS.
    To a very limited extent, wage index changes favor all hospital 
categories with the exception of large urban hospitals with 500 or more 
beds that show a -0.3 percentage change. Rural hospitals show modest 
increases of 0.1 percent for most bed sizes but show the largest gains 
for categories with 200 or more beds, a 0.3 percent increase. Rural 
hospitals located in Puerto Rico show the largest negative impact (-2.2 
percent) due to changes in the wage index. Hospitals located in the 
Middle Atlantic, South Atlantic, and in the East North Central part of 
the country experience a negative impact due to wage index changes 
regardless of urban or rural designation. 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 with the exception of rural hospitals with 200 or more beds 
that show a negative effect (-1.2 percent). Conversely, urban hospitals 
with 200 to 299 beds (-0.1 percent decrease), and urban hospitals with 
300 to 499 beds (-0.5 percent) show a decrease attributed to APC 
recalibration. Urban hospitals in excess of 500 beds show a 0.1 percent 
increase as a result of APC recalibration. In general, APC changes are 
small and result in very few distributional changes among hospital 
categories.
    In both urban and rural areas, hospitals that provide a lower 
volume of outpatient services are projected to receive a larger 
increase in payments than higher volume hospitals. In rural areas, 
hospitals with volumes of fewer than 5,000 services are projected to 
experience an increase in payments (4.4 percent). Urban hospitals that 
provide low-volume services experience an even larger increase (5.0 
percent) in payments attributable to both wage index and APC changes. 
Conversely, urban and rural hospitals providing more than 21,000 
services are projected to lose as a result of APC recalibration but 
gain from the introduction of the new wage index for a combined effect 
in the range of 3.4 to 3.9 percent.
    Major teaching hospitals are projected to experience a smaller 
increase in payments (3.4 percent) than the aggregate for all hospitals 
(3.8 percent) due to negative impacts of the wage index (-0.4 percent). 
Hospitals with less intensive teaching programs are projected to 
experience an overall increase (3.7 percent) that is smaller than the 
average for all hospitals. There is little difference in impact among 
hospitals that serve low-income patients where increases in payments 
range from 3.4 to 4.2 percent higher than in 2003.

[[Page 48017]]



             Table 23.--Impact of Changes for CY2004 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    New wage index    APC changes     All CY2003
                                                   hospitals (1)        (2)             (3)         changes (4)
----------------------------------------------------------------------------------------------------------------
ALL HOSPITALS...................................           4,352             0.0             0.0             3.8
NON-TEFRA HOSPITALS.............................           3,849             0.0             0.0             3.8
URBAN HOSPS.....................................           2,390             0.0             0.0             3.7
LARGE URBAN (GT 1 MILL.)........................           1,377            -0.1             0.0             3.8
OTHER URBAN (LE 1 MILL.)........................           1,013             0.0            -0.2             3.7
RURAL HOSPS.....................................           1,459             0.1             0.0             4.0
BEDS (URBAN):
    0-99 BEDS...................................             546             0.2             0.4             4.4
    100-199 BEDS................................             875             0.0             0.2             4.1
    200-299 BEDS................................             456             0.0            -0.1             3.7
    300-499 BEDS................................             364             0.1            -0.5             3.4
    500 + BEDS..................................             149            -0.3             0.1             3.6
BEDS (RURAL):
    0-49 BEDS...................................             694             0.1             1.0             4.9
    50-99 BEDS..................................             449             0.1             0.2             4.1
    100-149 BEDS................................             190             0.1             0.0             3.9
    150-199 BEDS................................              65             0.1             0.1             4.0
    200 + BEDS..................................              61             0.3            -1.2             2.9
VOLUME (URBAN):
    LT 5,000....................................             225             0.0             1.1             5.0
    5,000-10,999................................             396             0.0             1.0             4.9
    11,000-20,999...............................             529            -0.2             0.8             4.5
    21,000-42,999...............................             736             0.1            -0.1             3.9
    GT 42,999...................................             504            -0.1            -0.3             3.4
VOLUME (RURAL):
    LT 5,000....................................             419             0.1             0.4             4.4
    5,000-10,999................................             483             0.1             0.9             4.9
    11,000-20,999...............................             318             0.0             0.4             4.3
    21,000-42,999...............................             191             0.2            -0.6             3.5
    GT 42,999...................................              48             0.3            -0.7             3.4
REGION (URBAN):
    NEW ENGLAND.................................             128             0.0            -0.7             3.1
    MIDDLE ATLANTIC.............................             367            -0.6            -0.5             2.7
    SOUTH ATLANTIC..............................             355            -0.1            -0.1             3.7
    EAST NORTH CENT.............................             401            -0.1             0.4             4.1
    EAST SOUTH CENT.............................             152             0.6            -0.2             4.3
    WEST NORTH CENT.............................             166             0.3             0.1             4.2
    WEST SOUTH CENT.............................             293            -0.1             0.1             3.9
    MOUNTAIN....................................             122             0.6             0.0             4.5
    PACIFIC.....................................             366             0.1             0.0             3.9
    PUERTO RICO.................................              40             0.3             2.1             6.3
REGION (RURAL):
    NEW ENGLAND.................................              36             0.8            -0.1             4.6
    MIDDLE ATLANTIC.............................              66            -0.2             0.2             3.8
    SOUTH ATLANTIC..............................             213            -0.2            -0.1             3.5
    EAST NORTH CENT.............................             192            -0.1            -0.5             3.3
    EAST SOUTH CENT.............................             225             0.4             0.2             4.4
    WEST NORTH CENT.............................             244             0.6             0.0             4.4
    WEST SOUTH CENT.............................             267             0.2             0.5             4.6
    MOUNTAIN....................................             123             0.1             0.0             3.9
    PACIFIC.....................................              88             0.3             0.7             4.8
    PUERTO RICO.................................               5            -2.2             1.4             3.0
TEACHING STATUS:
    NON-TEACHING................................           2,803             0.1             0.1             4.0
    MINOR.......................................             758             0.1            -0.2             3.7
    MAJOR.......................................             288            -0.4             0.0             3.4
DSH PATIENT PERCENT:
    0...........................................              11             2.7             3.0             9.8
    GT 0-0.10...................................             862            -0.1            -0.3             3.4
    0.10-0.16...................................             845             0.0            -0.2             3.6
    0.16-0.23...................................             778             0.1             0.4             4.2
    0.23-0.35...................................             757             0.0             0.0             3.8
    GE 0.35.....................................             596             0.0             0.2             4.0
URBAN IME/DSH:
    IME & DSH...................................             963            -0.1            -0.1             3.6
    IME/NO DSH..................................               1             0.0            -1.3             2.4
    NO IME/DSH..................................           1,417             0.0             0.1             3.9
    NO IME/NO DSH...............................               9             2.8             3.0            10.0
RURAL HOSP. TYPES:

[[Page 48018]]

 
    NO SPECIAL STATUS...........................             481            -0.2             0.3             4.0
    RRC.........................................             159             0.3            -0.6             3.5
    SCH/EACH....................................             483             0.2             0.6             4.7
    MDH.........................................             249             0.1             0.7             4.7
    SCH AND RRC.................................              78             0.3            -0.5             3.6
TYPE OF OWNERSHIP:
    VOLUNTARY...................................           2,362             0.0            -0.1             3.6
    PROPRIETARY.................................             696             0.1             0.6             4.6
    GOVERNMENT..................................             791             0.1             0.0             3.9
SPECIALTY HOSPITALS:
    EYE AND EAR.................................              13            -0.4             1.7             5.2
    CANCER......................................              11            -0.3            -4.7            -1.3
TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES):
    REHAB.......................................             159             0.5             0.3             4.6
    PSYCH.......................................             167             0.8             7.2            12.2
    LTC.........................................             135             1.8             4.3            10.3
    CHILDREN....................................              42             0.0            -1.1            2.7
----------------------------------------------------------------------------------------------------------------
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 FY2004
  hospital inpatient wage index after geographic reclassification by the Medicare Geographic Classification
  Review Board. The hospital inpatient proposed rule for FY2004 was published in the Federal Register on May 19,
  2003.
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 2002 hospital claims data.
4. This column shows changes in total payment from CY2003 to CY2004, 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 2004 payment update. The sum of the columns may be different from the percentage changes shown here due
  to rounding.

E. Projected Distribution of Outlier Payments

    As stated elsewhere in this preamble, we have allocated 2 percent 
of the estimated 2004 expenditures to outlier payments. In Table 24 
below, we provide a table that illustrates the percentage of outlier 
payments relative to the total projected payments for the categories of 
hospitals that we show in the impact table.
    We project, based on the mix of services for the hospitals that 
would be paid under the OPPS in 2004, that most hospitals would receive 
outlier payments--approximately 94 percent would receive outlier 
payments. The anticipated outlier payments for urban hospitals can be 
expected to ameliorate the impact of the wage index and APC changes on 
payments to urban hospitals.

         Table 24.--Distribution of Outlier Payments for CY 2004 Hospital Outpatient Prospective Payment
----------------------------------------------------------------------------------------------------------------
                                                                                                Outlier payments
                                          Number of       Percent of total      Number of       as a percent of
                                          hospitals          hospitals        hospitals with     total payments
                                                                                 outliers          (percent)
----------------------------------------------------------------------------------------------------------------
ALL HOSPITALS.......................              4,352               96.4              4,097                2.0
NON-TEFRA HOSPITALS.................              3,849               85.2              3,831                2.0
URBAN HOSPS.........................              2,390               52.8              2,376                2.1
LARGE URBAN (GT 1 MILL.)............              1,377               30.4              1,368                2.3
OTHER URBAN (LE 1 MILL.)............              1,013               22.4              1,008                1.9
RURAL HOSPS.........................              1,459               32.2              1,455                1.7
BEDS (URBAN):
    0-99 BEDS.......................                546               12.0                534                2.6
    100-199 BEDS....................                875               19.4                874                1.8
    200-299 BEDS....................                456               10.0                455                2.0
    300-499 BEDS....................                364                8.0                364                2.0
    500 + BEDS......................                149                3.2                149                2.6
BEDS (RURAL):
    0-49 BEDS.......................                694               15.4                691                2.2
    50-99 BEDS......................                449               10.0                448                1.8
    100-149 BEDS....................                190                4.2                190                1.4
    150-199 BEDS....................                 65                1.4                 65                1.7
    200 + BEDS......................                 61                1.4                 61                1.4
VOLUME (URBAN):
    LT 5,000........................                225                5.0                212                3.0
    5,000-10,999....................                396                8.8                395                3.4
    11,000-20,999...................                529               11.8                529                2.1
    21,000-42,999...................                736               16.2                736                1.9
    GT 42,999.......................                504               11.2                504                2.1

[[Page 48019]]

 
VOLUME (RURAL):
    LT 5,000........................                419                9.2                416                2.7
    5,000-10,999....................                483               10.6                482                2.1
    11,000-20,999...................                318                7.0                318                1.7
    21,000-42,999...................                191                4.2                191                1.4
    GT 42,999.......................                 48                1.0                 48                1.5
REGION (URBAN):
    NEW ENGLAND.....................                128                2.8                127                1.9
    MIDDLE ATLANTIC.................                367                8.2                367                3.2
    SOUTH ATLANTIC..................                355                7.8                355                1.9
    EAST NORTH CENT.................                401                8.8                398                1.7
    EAST SOUTH CENT.................                152                3.4                150                1.4
    WEST NORTH CENT.................                166                3.6                166                1.8
    WEST SOUTH CENT.................                293                6.4                292                2.6
    MOUNTAIN........................                122                2.6                120                1.8
    PACIFIC.........................                366                8.0                363                2.0
    PUERTO RICO.....................                 40                0.8                 38                0.6
REGION (RURAL):
    NEW ENGLAND.....................                 36                0.8                 36                2.4
    MIDDLE ATLANTIC.................                 66                1.4                 66                1.4
    SOUTH ATLANTIC..................                213                4.8                212                1.6
    EAST NORTH CENT.................                192                4.2                192                1.5
    EAST SOUTH CENT.................                225                5.0                225                1.2
    WEST NORTH CENT.................                244                5.4                243                1.8
    WEST SOUTH CENT.................                267                6.0                266                1.7
    MOUNTAIN........................                123                2.8                123                2.8
    PACIFIC.........................                 88                2.0                 87                2.2
    PUERTO RICO.....................                  5                0.2                  5                0.9
TEACHING STATUS:
    NON-TEACHING....................              2,803               62.0              2,786                1.8
    MINOR...........................                758               16.8                757                1.7
    MAJOR...........................                288                6.4                288                3.1
DSH PATIENT PERCENT:
    0...............................                 11                0.2                 10                6.7
    GT 0-0.10.......................                862               19.0                853                1.9
    0.10-0.16.......................                845               18.6                845                1.7
    0.16-0.23.......................                778               17.2                777                1.8
    0.23-0.35.......................                757               16.8                752                2.2
    GE 0.35.........................                596               13.2                594                3.1
URBAN IME/DSH:
    IME & DSH.......................                963               21.4                963                2.3
    IME/NO DSH......................                  1                0.0                  0                0.0
    NO IME/DSH......................              1,417               31.4              1,404                1.9
    NO IME/NO DSH...................                  9                0.2                  9                6.8
RURAL HOSP. TYPES:
    NO SPECIAL STATUS...............                481               10.6                478                1.8
    RRC.............................                159                3.6                159                1.4
    SCH/EACH........................                483               10.6                483                2.1
    MDH.............................                249                5.6                249                1.8
    SCH AND RRC.....................                 78                1.8                 78                1.4
TYPE OF OWNERSHIP:
    VOLUNTARY.......................              2,362               52.2              2,359                1.9
    PROPRIETARY.....................                696               15.4                685                2.4
    GOVERNMENT......................                791               17.6                787                2.5
SPECIALTY HOSPITALS:
    EYE AND EAR.....................                 13                0.2                 13                2.5
    TRAUMA..........................                151                3.4                151                2.6
    CANCER..........................                 11                0.2                 11                5.2
TEFRA HOSPITALS (NOT INCLUDED ON
 OTHER LINES):
    REHAB...........................                159                3.6                 94                5.8
    PSYCH...........................                167                3.6                 46                0.6
    LTC.............................                135                3.0                 88                2.7
    CHILDREN........................                 42                1.0                 38               11.8
----------------------------------------------------------------------------------------------------------------


[[Page 48020]]

F. Estimated Impacts of This Proposed Rule on Beneficiaries

    For services for which the beneficiary pays a coinsurance of 20 
percent of the payment rate, the beneficiary share of payment would 
increase for services for which OPPS payments would rise and would 
decrease for services for which OPPS payments would fall. For example, 
for a mid level office visit (APC 0601), the minimum unadjusted 
copayment in 2003 was $10.11; under this proposed rule, the minimum 
unadjusted copayment for APC 601 would be $10.89 because the OPPS 
payment for the service would increase under this proposed rule. For 
some services (those services for which a national unadjusted copayment 
amount is shown in Addendum B), however, the beneficiary copayment is 
frozen based on historic data and would not change, therefore not 
presenting any potential impact on beneficiaries.
    However, in all cases, the statute limits beneficiary liability for 
copayment for a service to the inpatient hospital deductible for the 
applicable year. This amount was $840 for 2003, but is not yet 
determined for 2004. In general, the impact of this proposed rule on 
beneficiaries would vary based on the service the beneficiary receives 
and whether the copayment for the service is one that is frozen under 
the OPPS.
    In accordance with the provisions of Executive Order 12866, this 
regulation was reviewed by the Office of Management and Budget.

    Dated: July 16, 2003.
(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
    Approved: July 22, 2003.
Tommy G. Thompson,
Secretary.

Addendum A.--List of Ambulatory Payment Classifications (APCs) With Status Indicators, Relative Weights, Payment
                                 Rates, and Copayment Amounts Calendar Year 2004
----------------------------------------------------------------------------------------------------------------
                                                                                          National     Minimum
       APC              Group title        Status  indicator    Relative     Payment     unadjusted   unadjusted
                                                                 weight        rate      copayment    copayment
----------------------------------------------------------------------------------------------------------------
0001.............  Level I                S.................       0.3940       $21.39        $7.09        $4.28
                    Photochemotherapy.
0002.............  Fine needle Biopsy/    T.................       1.0937       $59.38  ...........       $11.88
                    Aspiration.
0003.............  Bone Marrow Biopsy/    T.................       2.2627      $122.84  ...........       $24.57
                    Aspiration.
0004.............  Level I Needle Biopsy/ T.................       1.5774       $85.64       $22.10       $17.13
                    Aspiration Except
                    Bone Marrow.
0005.............  Level II Needle        T.................       3.3675      $182.82       $71.59       $36.56
                    Biopsy /Aspiration
                    Except Bone Marrow.
0006.............  Level I Incision &     T.................       1.7487       $94.94       $24.12       $18.99
                    Drainage.
0007.............  Level II Incision &    T.................      11.4943      $624.01  ...........      $124.80
                    Drainage.
0008.............  Level III Incision     T.................      16.8303      $913.70  ...........      $182.74
                    and Drainage.
0009.............  Nail Procedures......  T.................       0.6597       $35.81        $8.34        $7.16
0010.............  Level I Destruction    T.................       0.6806       $36.95       $10.08        $7.39
                    of Lesion.
0011.............  Level II Destruction   T.................       2.1800      $118.35       $27.88       $23.67
                    of Lesion.
0012.............  Level I Debridement &  T.................       0.8203       $44.53       $11.18        $8.91
                    Destruction.
0013.............  Level II Debridement   T.................       1.1420       $62.00       $14.20       $12.40
                    & Destruction.
0015.............  Level III Debridement  T.................       1.5832       $85.95       $20.35       $17.19
                    & Destruction.
0016.............  Level IV Debridement   T.................       2.7343      $148.44       $57.31       $29.69
                    & Destruction.
0017.............  Level VI Debridement   T.................      16.7332      $908.43      $227.84      $181.69
                    & Destruction.
0018.............  Biopsy of Skin/        T.................       0.9567       $51.94       $16.04       $10.39
                    Puncture of Lesion.
0019.............  Level I Excision/      T.................       3.9807      $216.11       $71.87       $43.22
                    Biopsy.
0020.............  Level II Excision/     T.................       7.3105      $396.88      $113.25       $79.38
                    Biopsy.
0021.............  Level III Excision/    T.................      14.5749      $791.26      $219.48      $158.25
                    Biopsy.
0022.............  Level IV Excision/     T.................      18.6725    $1,013.71      $354.45      $202.74
                    Biopsy.
0023.............  Exploration            T.................       3.1587      $171.48       $40.37       $34.30
                    Penetrating Wound.
0024.............  Level I Skin Repair..  T.................       1.7847       $96.89       $34.75       $19.38
0025.............  Level II Skin Repair.  T.................       6.2703      $340.41      $115.49       $68.08
0027.............  Level IV Skin Repair.  T.................      15.8319      $859.50      $329.72      $171.90
0028.............  Level I Breast         T.................      17.7459      $963.41      $303.74      $192.68
                    Surgery.
0029.............  Level II Breast        T.................      29.2783    $1,589.49      $632.64      $317.90
                    Surgery.
0030.............  Level III Breast       T.................      37.2809    $2,023.94      $763.55      $404.79
                    Surgery.
0032.............  Insertion of Central   T.................      11.5584      $627.49  ...........      $125.50
                    Venous/Arterial
                    Catheter.
0033.............  Partial                P.................       3.8397      $208.45       $41.83       $41.69
                    Hospitalization.
0035.............  Placement of Arterial  T.................       0.2236       $12.14        $3.51        $2.43
                    or Central Venous
                    Catheter.
0041.............  Level I Arthroscopy..  T.................      27.2538    $1,479.58  ...........      $295.92
0042.............  Level II Arthroscopy.  T.................      42.8551    $2,326.56      $804.74      $465.31
0043.............  Closed Treatment       T.................       1.9233      $104.41  ...........       $20.88
                    Fracture Finger/Toe/
                    Trunk.
0045.............  Bone/Joint             T.................      13.5546      $735.87      $268.47      $147.17
                    Manipulation Under
                    Anesthesia.
0046.............  Open/Percutaneous      T.................      31.9719    $1,735.72      $535.76      $347.14
                    Treatment Fracture
                    or Dislocation.
0047.............  Arthroplasty without   T.................      30.3786    $1,649.22      $537.03      $329.84
                    Prosthesis.
0048.............  Arthroplasty with      T.................      47.4707    $2,577.14      $695.60      $515.43
                    Prosthesis.
0049.............  Level I                T.................      19.9376    $1,082.39  ...........      $216.48
                    Musculoskeletal
                    Procedures Except
                    Hand and Foot.
0050.............  Level II               T.................      25.1166    $1,363.56  ...........      $272.71
                    Musculoskeletal
                    Procedures Except
                    Hand and Foot.
0051.............  Level III              T.................      34.9381    $1,896.75  ...........      $379.35
                    Musculoskeletal
                    Procedures Except
                    Hand and Foot.
0052.............  Level IV               T.................      42.6430    $2,315.05  ...........      $463.01
                    Musculoskeletal
                    Procedures Except
                    Hand and Foot.
0053.............  Level I Hand           T.................      14.8188      $804.50      $253.49      $160.90
                    Musculoskeletal
                    Procedures.
0054.............  Level II Hand          T.................      24.2685    $1,317.51  ...........      $263.50
                    Musculoskeletal
                    Procedures.
0055.............  Level I Foot           T.................      18.8851    $1,025.25      $355.34      $205.05
                    Musculoskeletal
                    Procedures.
0056.............  Level II Foot          T.................      25.1591    $1,365.86      $405.81      $273.17
                    Musculoskeletal
                    Procedures.
0057.............  Bunion Procedures....  T.................      25.4248    $1,380.29      $475.91      $276.06
0058.............  Level I Strapping and  S.................       1.0785       $58.55  ...........       $11.71
                    Cast Application.

[[Page 48021]]

 
0060.............  Manipulation Therapy.  S.................       0.3151       $17.11        $3.43        $3.42
0068.............  CPAP Initiation......  S.................       1.1234       $60.99       $30.49       $12.20
0069.............  Thoracoscopy.........  T.................      28.6334    $1,554.48      $591.64      $310.90
0070.............  Thoracentesis/Lavage   T.................       3.1393      $170.43  ...........       $34.09
                    Procedures.
0071.............  Level I Endoscopy      T.................       0.9012       $48.93       $12.89        $9.79
                    Upper Airway.
0072.............  Level II Endoscopy     T.................       1.6987       $92.22       $26.68       $18.44
                    Upper Airway.
0073.............  Level III Endoscopy    T.................       3.4396      $186.73       $73.38       $37.35
                    Upper Airway.
0074.............  Level IV Endoscopy     T.................      14.4952      $786.93      $295.70      $157.39
                    Upper Airway.
0075.............  Level V Endoscopy      T.................      20.4113    $1,108.11      $445.92      $221.62
                    Upper Airway.
0076.............  Level I Endoscopy      T.................       9.3560      $507.93      $189.82      $101.59
                    Lower Airway.
0077.............  Level I Pulmonary      S.................       0.2772       $15.05        $7.52        $3.01
                    Treatment.
0078.............  Level II Pulmonary     S.................       0.7731       $41.97       $14.55        $8.39
                    Treatment.
0079.............  Ventilation            S.................       2.2837      $123.98  ...........       $24.80
                    Initiation and
                    Management.
0080.............  Diagnostic Cardiac     T.................      36.0982    $1,959.74      $838.92      $391.95
                    Catheterization.
0081.............  Non-Coronary           T.................      34.8355    $1,891.18  ...........      $378.24
                    Angioplasty or
                    Atherectomy.
0082.............  Coronary Atherectomy.  T.................     100.3996    $5,450.59    $1,293.59    $1,090.12
0083.............  Coronary Angioplasty   T.................      59.3417    $3,221.60  ...........      $644.32
                    and Percutaneous
                    Valvuloplasty.
0084.............  Level I                S.................      10.3392      $561.30  ...........      $112.26
                    Electrophysiologic
                    Evaluation.
0085.............  Level II               T.................      36.3284    $1,972.23      $435.09      $394.45
                    Electrophysiologic
                    Evaluation.
0086.............  Ablate Heart           T.................      44.5652    $2,419.40      $822.28      $483.88
                    Dysrhythm Focus.
0087.............  Cardiac                T.................      40.4579    $2,196.42  ...........      $439.28
                    Electrophysiologic
                    Recording/Mapping.
0088.............  Thrombectomy.........  T.................      34.6065    $1,878.75      $655.22      $375.75
0089.............  Insertion/Replacement  T.................     116.1611    $6,306.27    $1,722.59    $1,261.25
                    of Permanent
                    Pacemaker and
                    Electrodes.
0090.............  Insertion/Replacement  T.................      87.2850    $4,738.62    $1,705.90      $947.72
                    of Pacemaker Pulse
                    Generator.
0091.............  Level II Vascular      T.................      28.5187    $1,548.25      $348.23      $309.65
                    Ligation.
0092.............  Level I Vascular       T.................      25.1347    $1,364.54      $505.37      $272.91
                    Ligation.
0093.............  Vascular               T.................      20.6662    $1,121.95      $277.34      $224.39
                    Reconstruction/
                    Fistula Repair
                    without Device.
0094.............  Level I Resuscitation  S.................       2.6412      $143.39       $48.46       $28.68
                    and Cardioversion.
0095.............  Cardiac                S.................       0.5984       $32.49       $16.24        $6.50
                    Rehabilitation.
0096.............  Non-Invasive Vascular  S.................       1.7332       $94.09       $47.05       $18.82
                    Studies.
0097.............  Cardiac and            X.................       1.0565       $57.36       $23.80       $11.47
                    Ambulatory Blood
                    Pressure Monitoring.
0098.............  Injection of           T.................       1.1630       $63.14       $15.17       $12.63
                    Sclerosing Solution.
0099.............  Electrocardiograms...  S.................       0.3708       $20.13  ...........        $4.03
0100.............  Cardiac Stress Tests.  X.................       1.6726       $90.80       $41.44       $18.16
0101.............  Tilt Table Evaluation  S.................       4.3675      $237.11      $105.27       $47.42
0103.............  Miscellaneous          T.................      12.1256      $658.29      $223.63      $131.66
                    Vascular Procedures.
0104.............  Transcatheter          T.................      80.8877    $4,391.31  ...........      $878.26
                    Placement of
                    Intracoronary Stents.
0105.............  Revision/Removal of    T.................      18.9084    $1,026.52      $370.40      $205.30
                    Pacemakers, AICD, or
                    Vascular.
0106.............  Insertion/Replacement/ T.................      49.9534    $2,711.92      $542.39      $542.38
                    Repair of Pacemaker
                    and/or Electrodes.
0107.............  Insertion of           T.................     290.5429   $15,773.28    $3,429.62    $3,154.66
                    Cardioverter-
                    Defibrillator.
0108.............  Insertion/Replacement/ T.................     489.5275   $26,575.96  ...........    $5,315.19
                    Repair of
                    Cardioverter-
                    Defibrillator Leads.
0109.............  Removal of Implanted   T.................       7.7075      $418.43      $131.49       $83.69
                    Devices.
0110.............  Transfusion..........  S.................       3.7128      $201.56  ...........       $40.31
0111.............  Blood Product          S.................      14.0169      $760.96      $211.96      $152.19
                    Exchange.
0112.............  Apheresis,             S.................      34.8318    $1,890.98      $609.71      $378.20
                    Photopheresis, and
                    Plasmapheresis.
0113.............  Excision Lymphatic     T.................      19.9529    $1,083.22  ...........      $216.64
                    System.
0114.............  Thyroid/               T.................      37.3583    $2,028.14      $485.91      $405.63
                    Lymphadenectomy
                    Procedures.
0115.............  Cannula/Access Device  T.................      25.6233    $1,391.06      $459.35      $278.21
                    Procedures.
0119.............  Implantation of        T.................     129.8988    $7,052.08  ...........    $1,410.42
                    Infusion Pump.
0121.............  Level I Tube changes   T.................       2.2058      $119.75       $43.80       $23.95
                    and Repositioning.
0122.............  Level II Tube changes  T.................       8.4398      $458.19       $93.97       $91.64
                    and Repositioning.
0123.............  Bone Marrow            S.................       4.0076      $217.57  ...........       $43.51
                    Harvesting and Bone
                    Marrow/Stem Cell
                    Transplant.
0124.............  Revision of Implanted  T.................      27.4545    $1,490.48      $298.10      $298.10
                    Infusion Pump.
0125.............  Refilling of Infusion  T.................       2.5105      $136.29  ...........       $27.26
                    Pump.
0130.............  Level I Laparoscopy..  T.................      32.5959    $1,769.60      $659.53      $353.92
0131.............  Level II Laparoscopy.  T.................      40.8955    $2,220.18    $1,001.89      $444.04
0132.............  Level III Laparoscopy  T.................      56.6318    $3,074.48    $1,239.22      $614.90
0140.............  Esophageal Dilation    T.................       6.3480      $344.63      $107.24       $68.93
                    without Endoscopy.
0141.............  Upper GI Procedures..  T.................       7.8542      $426.40      $143.38       $85.28
0142.............  Small Intestine        T.................       9.0138      $489.35      $152.78       $97.87
                    Endoscopy.
0143.............  Lower GI Endoscopy...  T.................       8.3227      $451.83      $186.06       $90.37
0146.............  Level I Sigmoidoscopy  T.................       3.9986      $217.08       $64.40       $43.42
0147.............  Level II               T.................       7.5876      $411.92  ...........       $82.38
                    Sigmoidoscopy.
0148.............  Level I Anal/Rectal    T.................       4.1171      $223.51       $63.38       $44.70
                    Procedure.
0149.............  Level III Anal/Rectal  T.................      16.8557      $915.08      $293.06      $183.02
                    Procedure.

[[Page 48022]]

 
0150.............  Level IV Anal/Rectal   T.................      22.2565    $1,208.28      $437.12      $241.66
                    Procedure.
0151.............  Endoscopic Retrograde  T.................      18.8763    $1,024.78      $245.46      $204.96
                    Cholangio-
                    Pancreatography
                    (ERCP).
0152.............  Percutaneous           T.................       8.2940      $450.27      $113.02       $90.05
                    Abdominal and
                    Biliary Procedures.
0153.............  Peritoneal and         T.................      21.2745    $1,154.97      $410.87      $230.99
                    Abdominal Procedures.
0154.............  Hernia/Hydrocele       T.................      26.8861    $1,459.62      $464.85      $291.92
                    Procedures.
0155.............  Level II Anal/Rectal   T.................       9.9148      $538.26      $188.89      $107.65
                    Procedure.
0156.............  Level II Urinary and   T.................       3.1438      $170.67       $46.55       $34.13
                    Anal Procedures.
0157.............  Colorectal Cancer      S.................       2.4771      $134.48  ...........       $26.90
                    Screening: Barium
                    Enema.
0158.............  Colorectal Cancer      T.................       7.4187      $402.75      $100.69       $80.55
                    Screening:
                    Colonoscopy.
0159.............  Colorectal Cancer      S.................       2.7168      $147.49       $36.87       $29.50
                    Screening: Flexible
                    Sigmoidoscopy.
0160.............  Level I                T.................       6.8152      $369.99      $105.06       $74.00
                    Cystourethroscopy
                    and other
                    Genitourinary
                    Procedures.
0161.............  Level II               T.................      16.5822      $900.23      $249.36      $180.05
                    Cystourethroscopy
                    and other
                    Genitourinary
                    Procedures.
0162.............  Level III              T.................      21.8578    $1,186.64  ...........      $237.33
                    Cystourethroscopy
                    and other
                    Genitourinary
                    Procedures.
0163.............  Level IV               T.................      33.6435    $1,826.47  ...........      $365.29
                    Cystourethroscopy
                    and other
                    Genitourinary
                    Procedures.
0164.............  Level I Urinary and    T.................       1.2115       $65.77       $17.59       $13.15
                    Anal Procedures.
0165.............  Level III Urinary and  T.................      14.0780      $764.28  ...........      $152.86
                    Anal Procedures.
0166.............  Level I Urethral       T.................      16.8401      $914.23      $218.73      $182.85
                    Procedures.
0167.............  Level III Urethral     T.................      30.1066    $1,634.46      $555.84      $326.89
                    Procedures.
0168.............  Level II Urethral      T.................      30.3485    $1,647.59      $405.60      $329.52
                    Procedures.
0169.............  Lithotripsy..........  T.................      44.5329    $2,417.65    $1,115.69      $483.53
0170.............  Dialysis.............  S.................       5.9427      $322.62  ...........       $64.52
0180.............  Circumcision.........  T.................      18.4967    $1,004.17      $304.87      $200.83
0181.............  Penile Procedures....  T.................      29.0094    $1,574.89      $621.82      $314.98
0183.............  Testes/Epididymis      T.................      21.7612    $1,181.39  ...........      $236.28
                    Procedures.
0184.............  Prostate Biopsy......  T.................       3.8073      $206.69       $96.27       $41.34
0187.............  Miscellaneous          X.................       4.4274      $240.36       $90.71       $48.07
                    Placement/
                    Repositioning.
0188.............  Level II Female        T.................       1.1079       $60.15  ...........       $12.03
                    Reproductive Proc.
0189.............  Level III Female       T.................       1.3207       $71.70       $16.70       $14.34
                    Reproductive Proc.
0190.............  Level I Hysteroscopy.  T.................      19.8088    $1,075.40      $424.28      $215.08
0191.............  Level I Female         T.................       0.1679        $9.12        $2.65        $1.82
                    Reproductive Proc.
0192.............  Level IV Female        T.................       2.6966      $146.40       $39.11       $29.28
                    Reproductive Proc.
0193.............  Level V Female         T.................      15.7365      $854.32      $171.13      $170.86
                    Reproductive Proc.
0194.............  Level VI Female        T.................      18.8194    $1,021.69      $397.84      $204.34
                    Reproductive Proc.
0195.............  Level VII Female       T.................      25.3207    $1,374.64      $483.80      $274.93
                    Reproductive Proc.
0196.............  Dilation and           T.................      16.1823      $878.52      $338.23      $175.70
                    Curettage.
0197.............  Infertility            T.................       5.1958      $282.07  ...........       $56.41
                    Procedures.
0198.............  Pregnancy and          T.................       1.3718       $74.47       $32.19       $14.89
                    Neonatal Care
                    Procedures.
0199.............  Obstetrical Care       T.................      16.8630      $915.48  ...........      $183.10
                    Service.
0200.............  Therapeutic Abortion.  T.................      18.3633      $996.93      $307.83      $199.39
0201.............  Spontaneous Abortion.  T.................      17.2803      $938.13      $329.65      $187.63
0202.............  Level VIII Female      T.................      38.8053    $2,106.70    $1,032.28      $421.34
                    Reproductive Proc.
0203.............  Level IV Nerve         T.................      11.8511      $643.38      $276.76      $128.68
                    Injections.
0204.............  Level I Nerve          T.................       2.2209      $120.57       $40.13       $24.11
                    Injections.
0206.............  Level II Nerve         T.................       5.2584      $285.47       $75.55       $57.09
                    Injections.
0207.............  Level III Nerve        T.................       6.5998      $358.30      $123.69       $71.66
                    Injections.
0208.............  Laminotomies and       T.................      40.6521    $2,206.96  ...........      $441.39
                    Laminectomies.
0209.............  Extended EEG Studies   S.................      11.5352      $626.23      $280.58      $125.25
                    and Sleep Studies,
                    Level II.
0212.............  Nervous System         T.................       2.9989      $162.81       $74.92       $32.56
                    Injections.
0213.............  Extended EEG Studies   S.................       3.2422      $176.02       $70.41       $35.20
                    and Sleep Studies,
                    Level I.
0214.............  Electroencephalogram.  S.................       2.2459      $121.93       $58.12       $24.39
0215.............  Level I Nerve and      S.................       0.6390       $34.69       $15.76        $6.94
                    Muscle Tests.
0216.............  Level III Nerve and    S.................       2.8332      $153.81       $67.98       $30.76
                    Muscle Tests.
0218.............  Level II Nerve and     S.................       1.1296       $61.32  ...........       $12.26
                    Muscle Tests.
0220.............  Level I Nerve          T.................      16.5293      $897.36  ...........      $179.47
                    Procedures.
0221.............  Level II Nerve         T.................      25.8194    $1,401.71      $463.62      $280.34
                    Procedures.
0222.............  Implantation of        T.................     188.7735   $10,248.32  ...........    $2,049.66
                    Neurological Device.
0223.............  Implantation or        T.................      26.0352    $1,413.42  ...........      $282.68
                    Revision of Pain
                    Management Catheter.
0224.............  Implantation of        T.................      34.0161    $1,846.70      $453.41      $369.34
                    Reservoir/Pump/Shunt.
0225.............  Implantation of        S.................      56.0375    $3,042.22  ...........      $608.44
                    Neurostimulator
                    Electrodes.
0226.............  Implantation of Drug   T.................     159.6795    $8,668.84  ...........    $1,733.77
                    Infusion Reservoir.
0227.............  Implantation of Drug   T.................     163.6124    $8,882.35  ...........    $1,776.47
                    Infusion Device.
0228.............  Creation of Lumbar     T.................      51.1329    $2,775.95      $621.80      $555.19
                    Subarachnoid Shunt.
0229.............  Transcatherter         T.................      59.4977    $3,230.07      $771.23      $646.01
                    Placement of
                    Intravascular Shunts.
0230.............  Level I Eye Tests &    S.................       0.7379       $40.06       $14.97        $8.01
                    Treatments.
0231.............  Level III Eye Tests &  S.................       2.0880      $113.36       $50.94       $22.67
                    Treatments.

[[Page 48023]]

 
0232.............  Level I Anterior       T.................       4.9739      $270.03      $103.17       $54.01
                    Segment Eye
                    Procedures.
0233.............  Level II Anterior      T.................      14.5435      $789.55      $266.33      $157.91
                    Segment Eye
                    Procedures.
0234.............  Level III Anterior     T.................      21.5482    $1,169.83      $511.31      $233.97
                    Segment Eye
                    Procedures.
0235.............  Level I Posterior      T.................       4.9900      $270.90       $72.04       $54.18
                    Segment Eye
                    Procedures.
0236.............  Level II Posterior     T.................      19.6866    $1,068.77  ...........      $213.75
                    Segment Eye
                    Procedures.
0237.............  Level III Posterior    T.................      34.0324    $1,847.58      $818.54      $369.52
                    Segment Eye
                    Procedures.
0238.............  Level I Repair and     T.................       3.2016      $173.81       $58.96       $34.76
                    Plastic Eye
                    Procedures.
0239.............  Level II Repair and    T.................       6.2432      $338.94      $110.62       $67.79
                    Plastic Eye
                    Procedures.
0240.............  Level III Repair and   T.................      17.3397      $941.35      $315.31      $188.27
                    Plastic Eye
                    Procedures.
0241.............  Level IV Repair and    T.................      21.9830    $1,193.44      $384.47      $238.69
                    Plastic Eye
                    Procedures.
0242.............  Level V Repair and     T.................      29.2193    $1,586.29      $597.36      $317.26
                    Plastic Eye
                    Procedures.
0243.............  Strabismus/Muscle      T.................      21.1035    $1,145.69      $431.39      $229.14
                    Procedures.
0244.............  Corneal Transplant...  T.................      37.4885    $2,035.21      $803.26      $407.04
0245.............  Level I Cataract       T.................      12.5751      $682.69      $226.11      $136.54
                    Procedures without
                    IOL Insert.
0246.............  Cataract Procedures    T.................      22.8428    $1,240.11      $495.96      $248.02
                    with IOL Insert.
0247.............  Laser Eye Procedures   T.................       5.0192      $272.49      $104.31       $54.50
                    Except Retinal.
0248.............  Laser Retinal          T.................       4.7544      $258.11       $95.08       $51.62
                    Procedures.
0249.............  Level II Cataract      T.................      28.3307    $1,538.05      $524.67      $307.61
                    Procedures without
                    IOL Insert.
0250.............  Nasal Cauterization/   T.................       1.5381       $83.50       $29.23       $16.70
                    Packing.
0251.............  Level I ENT            T.................       1.8643      $101.21  ...........       $20.24
                    Procedures.
0252.............  Level II ENT           T.................       6.5416      $355.14      $113.41       $71.03
                    Procedures.
0253.............  Level III ENT          T.................      15.1698      $823.55      $282.29      $164.71
                    Procedures.
0254.............  Level IV ENT           T.................      21.4368    $1,163.78      $321.35      $232.76
                    Procedures.
0256.............  Level V ENT            T.................      35.0866    $1,904.82  ...........      $380.96
                    Procedures.
0258.............  Tonsil and Adenoid     T.................      21.0273    $1,141.55      $437.25      $228.31
                    Procedures.
0259.............  Level VI ENT           T.................     389.1764   $21,128.00    $9,394.83    $4,225.60
                    Procedures.
0260.............  Level I Plain Film     X.................       0.7845       $42.59       $21.29        $8.52
                    Except Teeth.
0261.............  Level II Plain Film    X.................       1.3238       $71.87  ...........       $14.37
                    Except Teeth
                    Including Bone
                    Density Measurement.
0262.............  Plain Film of Teeth..  X.................       0.7851       $42.62        $9.82        $8.52
0263.............  Level I Miscellaneous  X.................       2.1875      $118.76       $43.58       $23.75
                    Radiology Procedures.
0264.............  Level II               X.................       3.0022      $162.99       $79.41       $32.60
                    Miscellaneous
                    Radiology Procedures.
0265.............  Level I Diagnostic     S.................       1.0245       $55.62       $27.81       $11.12
                    Ultrasound Except
                    Vascular.
0266.............  Level II Diagnostic    S.................       1.6234       $88.13       $44.07       $17.63
                    Ultrasound Except
                    Vascular.
0267.............  Level III Diagnostic   S.................       2.4805      $134.66       $65.52       $26.93
                    Ultrasound Except
                    Vascular.
0268.............  Ultrasound Guidance    S.................       1.2640       $68.62  ...........       $13.72
                    Procedures.
0269.............  Level III              S.................       3.2517      $176.53       $87.24       $35.31
                    Echocardiogram
                    Except
                    Transesophageal.
0270.............  Transesophageal        S.................       5.9057      $320.61      $146.79       $64.12
                    Echocardiogram.
0271.............  Mammography..........  S.................       0.6548       $35.55       $16.80        $7.11
0272.............  Level I Fluoroscopy..  X.................       1.4086       $76.47       $38.24       $15.29
0274.............  Myelography..........  S.................       3.5837      $194.56       $92.92       $38.91
0275.............  Arthrography.........  S.................       3.2967      $178.97       $69.09       $35.79
0276.............  Level I Digestive      S.................       1.6025       $87.00       $41.72       $17.40
                    Radiology.
0277.............  Level II Digestive     S.................       2.4462      $132.80       $60.47       $26.56
                    Radiology.
0278.............  Diagnostic Urography.  S.................       2.7365      $148.56       $66.07       $29.71
0279.............  Level II Angiography   S.................      11.0678      $600.86      $174.57      $120.17
                    and Venography
                    except Extremity.
0280.............  Level III Angiography  S.................      19.0237    $1,032.78      $353.85      $206.56
                    and Venography
                    except Extremity.
0281.............  Venography of          S.................       6.6888      $363.13      $115.16       $72.63
                    Extremity.
0282.............  Miscellaneous          S.................       1.6813       $91.28       $44.51       $18.26
                    Computerized Axial
                    Tomography.
0283.............  Computerized Axial     S.................       4.6121      $250.39      $125.19       $50.08
                    Tomography with
                    Contrast Material.
0284.............  Magnetic Resonance     S.................       7.0207      $381.15      $190.57       $76.23
                    Imaging and Magnetic
                    Resonance
                    Angiography with
                    Contras.
0285.............  Myocardial Positron    S.................      19.5044    $1,058.87      $409.56      $211.77
                    Emission Tomography
                    (PET).
0287.............  Complex Venography...  S.................       6.2829      $341.09      $107.20       $68.22
0288.............  Bone Density:Axial     S.................       1.2854       $69.78  ...........       $13.96
                    Skeleton.
0289.............  Needle Localization    X.................       3.6386      $197.54       $44.80       $39.51
                    for Breast Biopsy.
0296.............  Level I Therapeutic    S.................       3.1381      $170.36       $69.20       $34.07
                    Radiologic
                    Procedures.
0297.............  Level II Therapeutic   S.................       8.1532      $442.63      $172.51       $88.53
                    Radiologic
                    Procedures.
0299.............  Miscellaneous          S.................       5.7427      $311.77       $62.36       $62.35
                    Radiation Treatment.
0300.............  Level I Radiation      S.................       1.5112       $82.04  ...........       $16.41
                    Therapy.
0301.............  Level II Radiation     S.................       2.1337      $115.84       $23.17       $23.17
                    Therapy.
0302.............  Level III Radiation    S.................       6.1992      $336.55      $127.49       $67.31
                    Therapy.
0303.............  Treatment Device       X.................       2.8636      $155.46       $66.95       $31.09
                    Construction.
0304.............  Level I Therapeutic    X.................       1.6599       $90.11       $41.52       $18.02
                    Radiation Treatment
                    Preparation.
0305.............  Level II Therapeutic   X.................       3.6649      $198.96       $91.38       $39.79
                    Radiation Treatment
                    Preparation.
0310.............  Level III Therapeutic  X.................      13.7085      $744.22      $325.27      $148.84
                    Radiation Treatment
                    Preparation.
0312.............  Radioelement           S.................       3.6892      $200.28       $40.06       $40.06
                    Applications.
0313.............  Brachytherapy........  S.................      13.1258      $712.59  ...........      $142.52
0314.............  Hyperthermic           S.................       5.0930      $276.49      $101.77       $55.30
                    Therapies.

[[Page 48024]]

 
0320.............  Electroconvulsive      S.................       5.4480      $295.77       $80.06       $59.15
                    Therapy.
0321.............  Biofeedback and Other  S.................       1.2462       $67.65       $21.78       $13.53
                    Training.
0322.............  Brief Individual       S.................       1.3091       $71.07  ...........       $14.21
                    Psychotherapy.
0323.............  Extended Individual    S.................       1.7955       $97.48       $21.26       $19.50
                    Psychotherapy.
0324.............  Family Psychotherapy.  S.................       2.8219      $153.20  ...........       $30.64
0325.............  Group Psychotherapy..  S.................       1.5820       $85.89       $18.27       $17.18
0330.............  Dental Procedures....  S.................       0.5609       $30.45        $6.09        $6.09
0332.............  Computerized Axial     S.................       3.3916      $184.13       $91.27       $36.83
                    Tomography and
                    Computerized
                    Angiography without
                    Contras.
0333.............  Computerized Axial     S.................       5.4299      $294.78      $146.98       $58.96
                    Tomography and
                    Computerized Angio.
                    w/o Contrast
                    Material.
0335.............  Magnetic Resonance     S.................       6.4453      $349.91      $151.46       $69.98
                    Imaging,
                    Miscellaneous.
0336.............  Magnetic Resonance     S.................       6.4817      $351.89      $175.94       $70.38
                    Imaging and Magnetic
                    Resonance
                    Angiography without
                    Cont.
0337.............  MRI and Magnetic       S.................       9.3215      $506.05      $240.77      $101.21
                    Resonance
                    Angiography without
                    Contrast Material
                    followed.
0339.............  Observation..........  S.................       7.2016      $390.97  ...........       $78.19
0340.............  Minor Ancillary        X.................       0.6232       $33.83  ...........        $6.77
                    Procedures.
0341.............  Skin Tests...........  X.................       0.1468        $7.97        $3.08        $1.59
0342.............  Level I Pathology....  X.................       0.2169       $11.78        $5.88        $2.36
0343.............  Level II Pathology...  X.................       0.4662       $25.31       $12.55        $5.06
0344.............  Level III Pathology..  X.................       0.6278       $34.08       $17.04        $6.82
0345.............  Level I Transfusion    X.................       0.2589       $14.06        $3.10        $2.81
                    Laboratory
                    Procedures.
0346.............  Level II Transfusion   X.................       0.3877       $21.05        $5.31        $4.21
                    Laboratory
                    Procedures.
0347.............  Level III Transfusion  X.................       0.9646       $52.37       $13.19       $10.47
                    Laboratory
                    Procedures.
0348.............  Fertility Laboratory   X.................       1.2207       $66.27  ...........       $13.25
                    Procedures.
0352.............  Level I Injections...  X.................       0.1076        $5.84  ...........        $1.17
0353.............  Level II Allergy       X.................       0.4106       $22.29  ...........        $4.46
                    Injections.
0355.............  Level III              K.................       0.2667       $14.48  ...........        $2.90
                    Immunizations.
0356.............  Level IV               K.................       0.4353       $23.63  ...........        $4.73
                    Immunizations.
0359.............  Level II Injections..  X.................       0.8794       $47.74  ...........        $9.55
0360.............  Level I Alimentary     X.................       1.7088       $92.77       $42.45       $18.55
                    Tests.
0361.............  Level II Alimentary    X.................       3.5574      $193.13       $83.23       $38.63
                    Tests.
0362.............  Level III              X.................       2.5384      $137.81  ...........       $27.56
                    Otorhinolaryngologic
                    Function Tests.
0363.............  Level I                X.................       0.8536       $46.34       $17.15        $9.27
                    Otorhinolaryngologic
                    Function Tests.
0364.............  Level I Audiometry...  X.................       0.4415       $23.97        $9.06        $4.79
0365.............  Level II Audiometry..  X.................       1.1915       $64.69       $18.95       $12.94
0367.............  Level I Pulmonary      X.................       0.5828       $31.64       $15.16        $6.33
                    Test.
0368.............  Level II Pulmonary     X.................       0.9321       $50.60       $25.30       $10.12
                    Tests.
0369.............  Level III Pulmonary    X.................       2.5282      $137.25       $44.18       $27.45
                    Tests.
0370.............  Allergy Tests........  X.................       0.8858       $48.09       $11.58        $9.62
0371.............  Level I Allergy        X.................       0.4084       $22.17        $4.44        $4.43
                    Injections.
0372.............  Therapeutic            X.................       0.5529       $30.02       $10.09        $6.00
                    Phlebotomy.
0373.............  Neuropsychological     X.................       2.1165      $114.90       $22.98       $22.98
                    Testing.
0374.............  Monitoring             X.................       1.1062       $60.05  ...........       $12.01
                    Psychiatric Drugs.
0375.............  Ancillary Outpatient   T.................  ...........    $1,150.00  ...........      $230.00
                    Services when
                    Patient Expires.
0376.............  Pkgd cancer chemo,     S.................       2.1479      $116.61  ...........       $23.32
                    other.
0377.............  Sep cancer chemo,      S.................       0.6673       $36.23  ...........        $7.25
                    other.
0378.............  Infusion of pkgd       S.................       4.3955      $238.63  ...........       $47.73
                    cancer.
0379.............  Infusion, separate     S.................       2.4298      $131.91  ...........       $26.38
                    cancer.
0380.............  Pkgd cancer chemo,     S.................       5.1857      $281.53  ...........       $56.31
                    both.
0381.............  Sep cancer chemo,      S.................       2.1596      $117.24  ...........       $23.45
                    both.
0382.............  Infusion, pkgd         S.................       4.6839      $254.28  ...........       $50.86
                    noncancer.
0383.............  Infusion, separate     S.................       1.8419       $99.99  ...........       $20.00
                    noncancer.
0384.............  GI Procedures with     T.................      36.0040    $1,954.62      $424.53      $390.92
                    Stents.
0385.............  Level I Prosthetic     T.................      66.4829    $3,609.29  ...........      $721.86
                    Urological
                    Procedures.
0386.............  Level II Prosthetic    T.................     118.8122    $6,450.20  ...........    $1,290.04
                    Urological
                    Procedures.
0387.............  Level II Hysteroscopy  T.................      28.5174    $1,548.18      $660.84      $309.64
0388.............  Discography..........  S.................      11.7450      $637.62      $304.54      $127.52
0389.............  Non-imaging Nuclear    S.................       1.6475       $89.44       $44.72       $17.89
                    Medicine.
0390.............  Level I Thyroid        S.................       2.8434      $154.37       $77.18       $30.87
                    Imaging.
0391.............  Level II Thyroid       S.................       3.7174      $201.81      $100.91       $40.36
                    Imaging.
0392.............  Adrenal Imaging......  S.................       6.7081      $364.18      $182.09       $72.84
0393.............  Red Cell/Plasma        S.................       4.0720      $221.06      $110.53       $44.21
                    Studies.
0394.............  Hepatobiliary Imaging  S.................       4.4370      $240.88      $120.44       $48.18
0395.............  GI Tract and B12       S.................       3.9372      $213.75      $106.87       $42.75
                    Studies.
0396.............  Bone Imaging.........  S.................       4.2445      $230.43      $115.21       $46.09
0397.............  Vascular Imaging.....  S.................       2.4737      $134.29       $67.15       $26.86
0398.............  Cardiac Imaging......  S.................       6.6521      $361.14      $180.57       $72.23

[[Page 48025]]

 
0399.............  Cardiac Add-on         S.................       1.6033       $87.04       $43.52       $17.41
                    Imaging.
0400.............  Hematopoietic Imaging  S.................       3.8691      $210.05      $105.02       $42.01
0401.............  Pulmonary Imaging....  S.................       4.9130      $266.72      $133.36       $53.34
0402.............  Brain Imaging........  S.................       5.4818      $297.60      $148.80       $59.52
0403.............  CSF Imaging..........  S.................       3.9265      $213.17      $106.58       $42.63
0404.............  Renal Imaging........  S.................       5.1538      $279.79      $139.90       $55.96
0405.............  Non-renal GU Studies.  S.................       0.7739       $42.01       $21.01        $8.40
0406.............  Tumor/Infection        S.................       4.7542      $258.10  ...........       $51.62
                    Imaging.
0407.............  Thyroid Radionucliide  S.................       4.2797      $232.34      $116.17       $46.47
                    treatment.
0408.............  Non-thyroid            S.................       4.0000      $217.16  ...........       $43.43
                    Radionucliide
                    treatment.
0409.............  Red Blood Cell Tests.  X.................       0.1385        $7.52        $2.31        $1.50
0410.............  Mammogram Add On.....  S.................       0.1473        $8.00  ...........        $1.60
0411.............  Respiratory            S.................       0.4207       $22.84  ...........        $4.57
                    Procedures.
0412.............  IMRT Treatment         S.................       5.2832      $286.82  ...........       $57.36
                    Delivery.
0413.............  IMRT Treatment Plan..  S.................       6.0369      $327.74  ...........       $65.55
0414.............  Reconstruction CT      S.................       4.8012      $260.65  ...........       $52.13
                    Angiography of Aorta.
0415.............  Level II Endoscopy     T.................      20.9920    $1,139.63      $463.30      $227.93
                    Lower Airway.
0600.............  Low Level Clinic       V.................       0.9376       $50.90  ...........       $10.18
                    Visits.
0601.............  Mid Level Clinic       V.................       1.0031       $54.46  ...........       $10.89
                    Visits.
0602.............  High Level Clinic      V.................       1.5603       $84.71  ...........       $16.94
                    Visits.
0610.............  Low Level Emergency    V.................       1.4146       $76.80       $19.57       $15.36
                    Visits.
0611.............  Mid Level Emergency    V.................       2.4881      $135.08       $36.47       $27.02
                    Visits.
0612.............  High Level Emergency   V.................       4.3235      $234.72       $54.14       $46.94
                    Visits.
0620.............  Critical Care........  S.................       9.2657      $503.03      $145.78      $100.61
0648.............  Breast Reconstruction  T.................      55.5345    $3,014.91  ...........      $602.98
                    with Prosthesis.
0649.............  Prostate               T.................     119.0281    $6,461.92  ...........    $1,292.38
                    Brachytherapy
                    Palladium Seeds.
0651.............  Complex Interstitial   S.................      10.0459      $545.38      $109.08      $109.08
                    Radiation Source
                    Application.
0652.............  Insertion of           T.................      28.0692    $1,523.85  ...........      $304.77
                    Intraperitoneal
                    Catheters.
0653.............  Vascular               T.................      32.4880    $1,763.74  ...........      $352.75
                    Reconstruction/
                    Fistula Repair with
                    Device.
0654.............  Insertion/Replacement  T.................     103.8544    $5,638.15  ...........    $1,127.63
                    of a permanent dual
                    chamber pacemaker.
0655.............  Insertion/Replacement/ T.................     142.2244    $7,721.22  ...........    $1,544.24
                    Conversion of a
                    permanent dual
                    chamber pacemaker.
0656.............  Transcatheter          T.................     101.3662    $5,503.07  ...........    $1,100.61
                    Placement of
                    Intracoronary Drug-
                    Eluting Stents.
0657.............  Placement of Tissue    S.................       1.5630       $84.85  ...........       $16.97
                    Clips.
0658.............  Percutaneous Breast    T.................       5.6035      $304.21  ...........       $60.84
                    Biopsies.
0659.............  Hyperbaric Oxygen....  S.................       3.2220      $174.92  ...........       $34.98
0660.............  Level II               X.................       1.7330       $94.08       $30.66       $18.82
                    Otorhinolaryngologic
                    Function Tests.
0661.............  Level IV Pathology...  X.................       3.3215      $180.32       $90.16       $36.06
0662.............  CT Angiography.......  S.................       5.8751      $318.95      $156.47       $63.79
0664.............  Proton Beam Radiation  S.................       9.6828      $525.67  ...........      $105.13
                    Therapy.
0665.............  Bone                   S.................       0.7225       $39.22  ...........        $7.84
                    Density:Appendicular
                    Skeleton.
0668.............  Level I Angiography    S.................      10.4896      $569.47      $237.76      $113.89
                    and Venography
                    except Extremity.
0669.............  Digital Mammography..  S.................       0.9111       $49.46  ...........        $9.89
0670.............  Intravenous and        S.................      26.5472    $1,441.22      $521.95      $288.24
                    Intracardiac
                    Ultrasound.
0671.............  Level II               S.................       1.6392       $88.99       $44.50       $17.80
                    Echocardiogram
                    Except
                    Transesophageal.
0672.............  Level IV Posterior     T.................      39.1363    $2,124.67      $988.43      $424.93
                    Segment Procedures.
0673.............  Level IV Anterior      T.................      26.7626    $1,452.91      $649.56      $290.58
                    Segment Eye
                    Procedures.
0674.............  Prostate Cryoablation  T.................     101.1198    $5,489.69  ...........    $1,097.94
0675.............  Prostatic              T.................      49.3613    $2,679.78  ...........      $535.96
                    Thermotherapy.
0676.............  Level II               T.................       3.7505      $203.61       $55.06       $40.72
                    Transcatheter
                    Thrombolysis.
0677.............  Level I Transcatheter  T.................       3.0769      $167.04  ...........       $33.41
                    Thrombolysis.
0678.............  External               T.................       2.0622      $111.95  ...........       $22.39
                    Counterpulsation.
0679.............  Level II               S.................       5.4862      $297.84       $95.30       $59.57
                    Resuscitation and
                    Cardioversion.
0680.............  Insertion of Patient   S.................      61.4222    $3,334.55  ...........      $666.91
                    Activated Event
                    Recorders.
0681.............  Knee Arthroplasty....  T.................      96.7483    $5,252.37    $2,090.21    $1,050.47
0682.............  Level V Debridement &  T.................       7.6815      $417.02      $174.57       $83.40
                    Destruction.
0683.............  Level II               S.................       1.7915       $97.26       $35.01       $19.45
                    Photochemotherapy.
0684.............  Prostate               T.................     104.7194    $5,685.11  ...........    $1,137.02
                    Brachytherapy Iodine
                    Seeds.
0685.............  Level III Needle       T.................       4.8912      $265.54      $116.83       $53.11
                    Biopsy/Aspiration
                    Except Bone Marrow.
0686.............  Level III Skin Repair  T.................      17.0868      $927.63      $341.70      $185.53
0687.............  Revision/Removal of    T.................      19.9913    $1,085.31      $499.24      $217.06
                    Neurostimulator
                    Electrodes.
0688.............  Revision/Removal of    T.................      42.5880    $2,312.06    $1,132.91      $462.41
                    Neurostimulator
                    Pulse Generator
                    Receiver.
0689.............  Electronic Analysis    S.................       0.5427       $29.46  ...........        $5.89
                    of Cardioverter-
                    defibrillators.
0690.............  Electronic Analysis    S.................       0.3986       $21.64       $10.35        $4.33
                    of Pacemakers and
                    other Cardiac
                    Devices.
0691.............  Electronic Analysis    S.................       2.9894      $162.29       $81.15       $32.46
                    of Programmable
                    Shunts/Pumps.
0692.............  Electronic Analysis    S.................       0.9625       $52.25       $26.13       $10.45
                    of Neurostimulator
                    Pulse Generators.
0693.............  Level II Breast        T.................      38.6469    $2,098.10      $798.17      $419.62
                    Reconstruction.

[[Page 48026]]

 
0694.............  Mohs Surgery.........  T.................       3.3272      $180.63       $72.25       $36.13
0695.............  Level VII Debridement  T.................      19.1377    $1,038.97      $266.59      $207.79
                    & Destruction.
0697.............  Level I                S.................       1.4621       $79.38       $39.69       $15.88
                    Echocardiogram
                    Except
                    Transesophageal.
0698.............  Level II Eye Tests &   S.................       0.9355       $50.79       $18.72       $10.16
                    Treatments.
0699.............  Level IV Eye Tests &   T.................       2.2211      $120.58       $54.26       $24.12
                    Treatments.
0700.............  Antepartum             T.................       2.4359      $132.24       $37.03       $26.45
                    Manipulation.
0701.............  SR 89 chloride, per    K.................       7.4586      $404.92  ...........       $80.98
                    mCi.
0702.............  SM 153 lexidronam, 50  K.................      16.1415      $876.31  ...........      $175.26
                    mCi.
0704.............  IN 111 Satumomab       K.................       2.9212      $158.59  ...........       $31.72
                    pendetide per dose.
0726.............  Dexrazoxane hcl        K.................       1.9860      $107.82  ...........       $21.56
                    injection, 250 mg.
0728.............  Filgrastim 300 mcg     K.................       2.2544      $122.39  ...........       $24.48
                    injection.
0730.............  Pamidronate disodium   K.................       1.5359       $83.38  ...........       $16.68
                    , 30 mg.
0732.............  Mesna injection 200    K.................       0.4908       $26.65  ...........        $5.33
                    mg.
0733.............  Non esrd epoetin       K.................       0.1782        $9.67  ...........        $1.93
                    alpha inj, 1000 u.
0734.............  Injection,             K.................       0.0463        $2.51  ...........         $.50
                    darbepoetin alfa
                    (for non-ESRD use),
                    pre 1 mcg.
0800.............  Leuprolide acetate,    K.................       3.3020      $179.26  ...........       $35.85
                    3.75 mg.
0802.............  Etoposide oral 50 mg.  K.................       0.4830       $26.22  ...........        $5.24
0807.............  Aldesleukin/single     K.................       7.0936      $385.10  ...........       $77.02
                    use vial.
0810.............  Goserelin acetate      K.................       4.9549      $269.00  ...........       $53.80
                    implant 3.6 mg.
0811.............  Carboplatin injection  K.................       1.5475       $84.01  ...........       $16.80
                    50 mg.
0812.............  Carmustine, 100 mg...  K.................       0.9972       $54.14  ...........       $10.83
0813.............  Cisplatin 10 mg        K.................       0.3594       $19.51  ...........        $3.90
                    injection.
0820.............  Daunorubicin 10 mg...  K.................         0.60       $32.86  ...........        $6.57
0821.............  Daunorubicin citrate   K.................       2.9697      $161.22  ...........       $32.24
                    liposom 10 mg.
0822.............  Diethylstilbestrol     K.................       1.3274       $72.06  ...........       $14.41
                    injection 250 mg.
0823.............  Docetaxel, 20 mg.....  K.................       4.0041      $217.38  ...........       $43.48
0827.............  Floxuridine injection  K.................       2.1836      $118.55  ...........       $23.71
                    500 mg.
0828.............  Gemcitabine HCL 200    K.................       1.4523       $78.84  ...........       $15.77
                    mg.
0830.............  Irinotecan injection   K.................       1.8626      $101.12  ...........       $20.22
                    20 mg.
0831.............  Ifosfomide injection   K.................       1.1616       $63.06  ...........       $12.61
                    1 gm.
0832.............  Idarubicin hcl         K.................       3.2438      $176.10  ...........       $35.22
                    injection 5 mg.
0836.............  Interferon alfa-2b     K.................       0.2000       $10.86  ...........        $2.17
                    inj recombinant, 1
                    million.
0838.............  Interferon gamma 1-b   K.................       2.4742      $134.32  ...........       $26.86
                    inj, 3 million u.
0840.............  Melphalan hydrochl 50  K.................       4.4072      $239.26  ...........       $47.85
                    mg.
0842.............  Fludarabine phosphate  K.................       3.6854      $200.08  ...........       $40.02
                    inj 50 mg.
0843.............  Pegaspargase, singl    K.................       5.7621      $312.82  ...........       $62.56
                    dose vial.
0844.............  Pentostatin            K.................      17.4201      $945.72  ...........      $189.14
                    injection, 10 mg.
0849.............  Rituximab, 100 mg....  K.................       5.5636      $302.04  ...........       $60.41
0850.............  Streptozocin           K.................       1.3942       $75.69  ...........       $15.14
                    injection, 1 gm.
0852.............  Topotecan, 4 mg......  K.................       7.9075      $429.29  ...........       $85.86
0855.............  Vinorelbine tartrate,  K.................       1.1683       $63.43  ...........       $12.69
                    10 mg.
0856.............  Porfimer sodium, 75    K.................      25.3788    $1,377.79  ...........      $275.56
                    mg.
0857.............  Bleomycin sulfate      K.................       2.2352      $121.35  ...........       $24.27
                    injection 15 u.
0858.............  Cladribine, 1mg......  K.................       0.7031       $38.17  ...........        $7.63
0861.............  Leuprolide acetate     K.................       0.8223       $44.64  ...........        $8.93
                    injection 1 mg.
0862.............  Mitomycin 5 mg inj...  K.................       0.9557       $51.88  ...........       $10.38
0863.............  Paclitaxel injection,  K.................       1.2674       $68.81  ...........       $13.76
                    30 mg.
0864.............  Mitoxantrone hcl, 5    K.................       3.1513      $171.08  ...........       $34.22
                    mg.
0865.............  Interferon alfa-n3     K.................       1.5823       $85.90  ...........       $17.18
                    inj, human leukocyte
                    derived, 2.
0884.............  Rho d immune globulin  K.................       0.2312       $12.55  ...........        $2.51
                    inj, 1 dose pkg.
0888.............  Cyclosporine oral 100  K.................       0.0482        $2.62  ...........         $.52
                    mg.
0890.............  Lymphocyte immune      K.................       2.1958      $119.21  ...........       $23.84
                    globulin 250 mg.
0891.............  Tacrolimus oral per 1  K.................       0.0236        $1.28  ...........         $.26
                    mg.
0900.............  Alglucerase            K.................       0.5473       $29.71  ...........        $5.94
                    injection, per 10 u.
0901.............  Alpha 1 proteinase     K.................       0.0214        $1.16  ...........         $.23
                    inhibitor, 10 mg.
0902.............  Botulinum toxin a,     K.................       0.0460        $2.50  ...........         $.50
                    per unit.
0903.............  Cytomegalovirus imm    K.................       5.0754      $275.54  ...........       $55.11
                    IV/vial.
0905.............  Immune globulin, 1g..  K.................       0.8103       $43.99  ...........        $8.80
0906.............  RSV-ivig, 50 mg......  K.................       6.0142      $326.50  ...........       $65.30
0909.............  Interferon beta-1a,    K.................       2.8010      $152.06  ...........       $30.41
                    33 mcg.
0910.............  Interferon beta-1b /   K.................       1.9843      $107.73  ...........       $21.55
                    0.25 mg.
0911.............  Streptokinase per      K.................       1.6055       $87.16  ...........       $17.43
                    250,000 iu.
0916.............  Imiglucerase           K.................       0.0531        $2.88  ...........         $.58
                    injection/unit.
0917.............  Inj, Adenosine, 90 mg  K.................       2.3474      $127.44  ...........       $25.49
0925.............  Factor viii per iu...  K.................       0.0085         $.46  ...........         $.09
0926.............  Factor VIII (porcine)  K.................       0.0253        $1.37  ...........         $.27
                    per iu.
0927.............  Factor viii            K.................       0.0168         $.91  ...........         $.18
                    recombinant per iu.
0928.............  Factor ix complex per  K.................       0.0085         $.46  ...........         $.09
                    iu.
0929.............  Anti-inhibitor per iu  K.................       0.0168         $.91  ...........         $.18

[[Page 48027]]

 
0930.............  Antithrombin iii       K.................       0.0117         $.64  ...........         $.13
                    injection per iu.
0931.............  Factor IX non-         K.................       0.0104         $.56  ...........         $.11
                    recombinant, per iu.
0932.............  Factor IX              K.................       0.0168         $.91  ...........         $.18
                    recombinant, per iu.
0949.............  Plasma, Pooled         K.................       2.0608      $111.88  ...........       $22.38
                    Multiple Donor,
                    Solvent/Detergent T.
0950.............  Blood (Whole) For      K.................       1.4575       $79.13  ...........       $15.83
                    Transfusion.
0952.............  Cryoprecipitate......  K.................       0.4860       $26.38  ...........        $5.28
0954.............  RBC leukocytes         K.................       1.9770      $107.33  ...........       $21.47
                    reduced.
0955.............  Plasma, Fresh Frozen.  K.................       1.5750       $85.51  ...........       $17.10
0956.............  Plasma Protein         K.................       1.5414       $83.68  ...........       $16.74
                    Fraction.
0957.............  Platelet Concentrate.  K.................       0.6870       $37.30  ...........        $7.46
0958.............  Platelet Rich Plasma.  K.................       1.1296       $61.32  ...........       $12.26
0959.............  Red Blood Cells......  K.................       1.4326       $77.77  ...........       $15.55
0960.............  Washed Red Blood       K.................       2.6638      $144.62  ...........       $28.92
                    Cells.
0961.............  Infusion, Albumin      K.................       0.7319       $39.73  ...........        $7.95
                    (Human) 5%, 50 ml.
0963.............  Albumin (human), 5%,   K.................       3.4713      $188.45  ...........       $37.69
                    250 ml.
0964.............  Albumin (human), 25%,  K.................       0.7911       $42.95  ...........        $8.59
                    20 ml.
0965.............  Albumin (human), 25%,  K.................       1.9432      $105.49  ...........       $21.10
                    50ml.
0966.............  Plasmaprotein          K.................       7.7071      $418.41  ...........       $83.68
                    fract,5%,250ml.
1009.............  Cryoprecip reduced     K.................       0.9447       $51.29  ...........       $10.26
                    plasma.
1010.............  Blood, L/R, CMV-neg..  K.................       2.1361      $115.97  ...........       $23.19
1011.............  Platelets, HLA-m, L/   K.................       8.2851      $449.79  ...........       $89.96
                    R, unit.
1013.............  Platelet concentrate,  K.................       0.9101       $49.41  ...........        $9.88
                    L/R, unit.
1016.............  Blood, L/R, froz/      K.................       5.0012      $271.51  ...........       $54.30
                    deglycerol/washed.
1017.............  Platelets, aph/pher,   K.................       6.5175      $353.83  ...........       $70.77
                    L/R, CMV-neg, unit.
1018.............  Blood, L/R,            K.................       2.1950      $119.16  ...........       $23.83
                    irradiated.
1019.............  Platelets, aph/pher,   K.................       6.7353      $365.65  ...........       $73.13
                    L/R, irradiated,
                    unit.
1020.............  Pit, pher,L/           K.................       9.6266      $522.62  ...........      $104.52
                    R,CMV,irrad.
1021.............  RBC, frz/deg/wsh, L/   K.................       6.5287      $354.44  ...........       $70.89
                    R, irrad.
1022.............  RBC, L/R, CMV neg,     K.................       3.9139      $212.48  ...........       $42.50
                    irrad.
1045.............  Iobenguane sulfate I-  K.................       2.9293      $159.03  ...........       $31.81
                    131per 0.5 mCi.
1064.............  I-131 sodium iodide    K.................       0.1007        $5.47  ...........        $1.09
                    capsule.
1065.............  I-131 sodium iodide    K.................       0.0002         $.01  ...........         $.00
                    solution.
1084.............  Denileukin diftitox,   K.................      15.0913      $819.29  ...........      $163.86
                    300 MCG.
1086.............  Temozolomide,oral 5    K.................       0.0643        $3.49  ...........         $.70
                    mg.
1091.............  IN 111 Oxyquinoline,   K.................       4.0535      $220.06  ...........       $44.01
                    per .5 mCi.
1092.............  IN 111 Pentetate, per  K.................       4.0824      $221.63  ...........       $44.33
                    0.5 mCi.
1095.............  Technetium TC 99M      K.................       3.7042      $201.10  ...........       $40.22
                    Depreotide.
1096.............  TC 99M Exametazime,    K.................       3.8103      $206.86  ...........       $41.37
                    per dose.
1122.............  TC 99M arcitumomab,    K.................       9.6556      $524.19  ...........      $104.84
                    per vial.
1167.............  Epirubicin hcl, 2 mg.  K.................       0.3597       $19.53  ...........        $3.91
1178.............  Busulfan IV, 6 mg....  K.................       6.0245      $327.06  ...........       $65.41
1203.............  Verteporfin for        K.................      16.1946      $879.19  ...........      $175.84
                    injection.
1207.............  Octreotide injection,  K.................       1.1849       $64.33  ...........       $12.87
                    depot.
1305.............  Apligraf.............  K.................      11.2075      $608.44  ...........      $121.69
1409.............  Factor viia            K.................      17.9693      $975.54  ...........      $195.11
                    recombinant, per 1.2
                    mg.
1501.............  New Technology -       S.................  ...........       $25.00  ...........        $5.00
                    Level I ($0 - $50).
1502.............  New Technology -       S.................  ...........       $75.00  ...........       $15.00
                    Level II ($50 -
                    $100).
1503.............  New Technology -       S.................  ...........      $150.00  ...........       $30.00
                    Level III ($100 -
                    $200).
1504.............  New Technology -       S.................  ...........      $250.00  ...........       $50.00
                    Level IV ($200 -
                    $300).
1505.............  New Technology -       S.................  ...........      $350.00  ...........       $70.00
                    Level V ($300 -
                    $400).
1506.............  New Technology -       S.................  ...........      $450.00  ...........       $90.00
                    Level VI ($400 -
                    $500).
1507.............  New Technology -       S.................  ...........      $550.00  ...........      $110.00
                    Level VII ($500 -
                    $600).
1508.............  New Technology -       S.................  ...........      $650.00  ...........      $130.00
                    Level VIII ($600 -
                    $700).
1509.............  New Technology -       S.................  ...........      $750.00  ...........      $150.00
                    Level IX ($700 -
                    $800).
1510.............  New Technology -       S.................  ...........      $850.00  ...........      $170.00
                    Level X ($800 -
                    $900).
1511.............  New Technology -       S.................  ...........      $950.00  ...........      $190.00
                    Level XI ($900 -
                    $1000).
1512.............  New Technology -       S.................  ...........    $1,050.00  ...........      $210.00
                    Level XII ($1000 -
                    $1100).
1513.............  New Technology -       S.................  ...........    $1,150.00  ...........      $230.00
                    Level XIII ($1100 -
                    $1200).
1514.............  New Technology -       S.................  ...........    $1,250.00  ...........      $250.00
                    Level XIV ($1200 -
                    $1300).
1515.............  New Technology -       S.................  ...........    $1,350.00  ...........      $270.00
                    Level XV ($1300 -
                    $1400).
1516.............  New Technology -       S.................  ...........    $1,450.00  ...........      $290.00
                    Level XVI ($1400 -
                    $1500).
1517.............  New Technology -       S.................  ...........    $1,550.00  ...........      $310.00
                    Level XX ($1500-
                    $1600).
1518.............  New Technology -       S.................  ...........    $1,650.00  ...........      $330.00
                    Level XX ($1600-
                    $1700).
1519.............  New Technology -       S.................  ...........    $1,750.00  ...........      $350.00
                    Level XX ($1700-
                    $1800).
1520.............  New Technology -       S.................  ...........    $1,850.00  ...........      $370.00
                    Level XX ($1800-
                    $1900).
1521.............  New Technology -       S.................  ...........    $1,950.00  ...........      $390.00
                    Level XX ($1900-
                    $2000).
1522.............  New Technology -       S.................  ...........    $2,250.00  ...........      $450.00
                    Level XX ($2000-
                    $2500).
1523.............  New Technology -       S.................  ...........    $2,750.00  ...........      $550.00
                    Level XX ($2500-
                    $3000).
1524.............  New Technology -       S.................  ...........    $3,250.00  ...........      $650.00
                    Level XX ($3000-
                    $3500).

[[Page 48028]]

 
1525.............  New Technology -       S.................  ...........    $3,750.00  ...........      $750.00
                    Level XX ($3500-
                    $4000).
1526.............  New Technology -       S.................  ...........    $4,250.00  ...........      $850.00
                    Level XX ($4000-
                    $4500).
1527.............  New Technology -       S.................  ...........    $4,750.00  ...........      $950.00
                    Level XX ($4500-
                    $5000).
1528.............  New Technology -       S.................  ...........    $5,250.00  ...........    $1,050.00
                    Level XX ($5000-
                    $5500).
1529.............  New Technology -       S.................  ...........    $5,750.00  ...........    $1,150.00
                    Level XX ($5500-
                    $6000).
1530.............  New Technology -       S.................  ...........    $6,250.00  ...........    $1,250.00
                    Level XX ($6000-
                    $6500).
1531.............  New Technology -       S.................  ...........    $6,750.00  ...........    $1,350.00
                    Level XX ($6500-
                    $7000).
1532.............  New Technology -       S.................  ...........    $7,250.00  ...........    $1,450.00
                    Level XX ($7000-
                    $7500).
1533.............  New Technology -       S.................  ...........    $7,750.00  ...........    $1,550.00
                    Level XX ($7500-
                    $8000).
1534.............  New Technology -       S.................  ...........    $8,250.00  ...........    $1,650.00
                    Level XX ($8000-
                    $8500).
1535.............  New Technology -       S.................  ...........    $8,750.00  ...........    $1,750.00
                    Level XX ($8500-
                    $9000).
1536.............  New Technology -       S.................  ...........    $9,250.00  ...........    $1,850.00
                    Level XX ($9000-
                    $9500).
1537.............  New Technology -       S.................  ...........    $9,750.00  ...........    $1,950.00
                    Level XX ($9500-
                    $10000).
1538.............  New Technology -       T.................  ...........       $25.00  ...........        $5.00
                    Level I ($0 - $50).
1539.............  New Technology -       T.................  ...........       $75.00  ...........       $15.00
                    Level II ($50 -
                    $100).
1540.............  New Technology -       T.................  ...........      $150.00  ...........       $30.00
                    Level III ($100 -
                    $200).
1541.............  New Technology -       T.................  ...........      $250.00  ...........       $50.00
                    Level IV ($200 -
                    $300).
1542.............  New Technology -       T.................  ...........      $350.00  ...........       $70.00
                    Level V ($300 -
                    $400).
1543.............  New Technology -       T.................  ...........      $450.00  ...........       $90.00
                    Level VI ($400 -
                    $500).
1544.............  New Technology -       T.................  ...........      $550.00  ...........      $110.00
                    Level VII ($500 -
                    $600).
1545.............  New Technology -       T.................  ...........      $650.00  ...........      $130.00
                    Level VIII ($600 -
                    $700).
1546.............  New Technology -       T.................  ...........      $750.00  ...........      $150.00
                    Level IX ($700 -
                    $800).
1547.............  New Technology -       T.................  ...........      $850.00  ...........      $170.00
                    Level X ($800 -
                    $900).
1548.............  New Technology -       T.................  ...........      $950.00  ...........      $190.00
                    Level XI ($900 -
                    $1000).
1549.............  New Technology -       T.................  ...........    $1,050.00  ...........      $210.00
                    Level XII ($1000 -
                    $1100).
1550.............  New Technology -       T.................  ...........    $1,150.00  ...........      $230.00
                    Level XIII ($1100 -
                    $1200).
1551.............  New Technology -       T.................  ...........    $1,250.00  ...........      $250.00
                    Level XIV ($1200 -
                    $1300).
1552.............  New Technology -       T.................  ...........    $1,350.00  ...........      $270.00
                    Level XV ($1300 -
                    $1400).
1553.............  New Technology -       T.................  ...........    $1,450.00  ...........      $290.00
                    Level XVI ($1400 -
                    $1500).
1554.............  New Technology -       T.................  ...........    $1,550.00  ...........      $310.00
                    Level XX ($1500-
                    $1600).
1555.............  New Technology -       T.................  ...........    $1,650.00  ...........      $330.00
                    Level XX ($1600-
                    $1700).
1556.............  New Technology -       T.................  ...........    $1,750.00  ...........      $350.00
                    Level XX ($1700-
                    $1800).
1557.............  New Technology -       T.................  ...........    $1,850.00  ...........      $370.00
                    Level XX ($1800-
                    $1900).
1558.............  New Technology -       T.................  ...........    $1,950.00  ...........      $390.00
                    Level XX ($1900-
                    $2000).
1559.............  New Technology -       T.................  ...........    $2,250.00  ...........      $450.00
                    Level XX ($2000-
                    $2500).
1560.............  New Technology -       T.................  ...........    $2,750.00  ...........      $550.00
                    Level XX ($2500-
                    $3000).
1561.............  New Technology -       T.................  ...........    $3,250.00  ...........      $650.00
                    Level XX ($3000-
                    $3500).
1562.............  New Technology -       T.................  ...........    $3,750.00  ...........      $750.00
                    Level XX ($3500-
                    $4000).
1563.............  New Technology -       T.................  ...........    $4,250.00  ...........      $850.00
                    Level XX ($4000-
                    $4500).
1564.............  New Technology -       T.................  ...........    $4,750.00  ...........      $950.00
                    Level XX ($4500-
                    $5000).
1565.............  New Technology -       T.................  ...........    $5,250.00  ...........    $1,050.00
                    Level XX ($5000-
                    $5500).
1566.............  New Technology -       T.................  ...........    $5,750.00  ...........    $1,150.00
                    Level XX ($5500-
                    $6000).
1567.............  New Technology -       T.................  ...........    $6,250.00  ...........    $1,250.00
                    Level XX ($6000-
                    $6500).
1568.............  New Technology -       T.................  ...........    $6,750.00  ...........    $1,350.00
                    Level XX ($6500-
                    $7000).
1569.............  New Technology -       T.................  ...........    $7,250.00  ...........    $1,450.00
                    Level XX ($7000-
                    $7500).
1570.............  New Technology -       T.................  ...........    $7,750.00  ...........    $1,550.00
                    Level XX ($7500-
                    $8000).
1571.............  New Technology -       T.................  ...........    $8,250.00  ...........    $1,650.00
                    Level XX ($8000-
                    $8500).
1572.............  New Technology -       T.................  ...........    $8,750.00  ...........    $1,750.00
                    Level XX ($8500-
                    $9000).
1573.............  New Technology -       T.................  ...........    $9,250.00  ...........    $1,850.00
                    Level XX ($9000-
                    $9500).
1574.............  New Technology -       T.................  ...........    $9,750.00  ...........    $1,950.00
                    Level XX ($9500-
                    $10000).
1604.............  IN 111 capromab        K.................      12.4029      $673.34  ...........      $134.67
                    pendetide, per dose.
1605.............  Abciximab injection,   K.................       5.2806      $286.68  ...........       $57.34
                    10 mg.
1606.............  Anistreplase, 30 u...  K.................      25.3116    $1,374.14  ...........      $274.83
1607.............  Eptifibatide           K.................       0.1426        $7.74  ...........        $1.55
                    injection, 5mg.
1609.............  Rho(D) immune          K.................       0.1863       $10.11  ...........        $2.02
                    globulin h, sd, 100
                    iu.
1611.............  Hylan G-F 20           K.................       2.1566      $117.08  ...........       $23.42
                    injection, 16 mg.
1612.............  Daclizumab,            K.................       3.7304      $202.52  ...........       $40.50
                    parenteral, 25 mg.
1613.............  Trastuzumab, 10 mg...  K.................       0.7384       $40.09  ...........        $8.02
1614.............  Valrubicin, 200 mg...  K.................       9.6183      $522.17  ...........      $104.43
1615.............  Basiliximab, 20 mg...  K.................      11.2007      $608.07  ...........      $121.61
1618.............  Vonwillebrandfactrcmp  K.................       0.0168         $.91  ...........         $.18
                    lx, per iu.
1620.............  Technetium tc99m       K.................       3.3106      $179.73  ...........       $35.95
                    bicisate.
1625.............  Indium 111-in          K.................       6.8170      $370.09  ...........       $74.02
                    pentetreotide.
1628.............  Chromic phosphate p32  K.................       2.0103      $109.14  ...........       $21.83
1716.............  Brachytx source, Gold  K.................       1.3399       $72.74  ...........       $14.55
                    198.
1718.............  Brachytx source,       K.................       0.6695       $36.35  ...........        $7.27
                    Iodine 125.
1719.............  Brachytx source, Non-  K.................       0.3053       $16.57  ...........        $3.31
                    HDR Ir-192.
1720.............  Brachytx source,       K.................       0.8104       $44.00  ...........        $8.80
                    Palladium 103.
1775.............  FDG, per dose (4-40    K.................       5.8606      $318.17  ...........       $63.63
                    mCi/ml).

[[Page 48029]]

 
1783.............  Ocular implant,        H.................  ...........  ...........  ...........  ...........
                    aqueous drain device.
1814.............  Retinal Tamp,          H.................  ...........  ...........  ...........  ...........
                    silicone oil.
1818.............  Integrated             H.................  ...........  ...........  ...........  ...........
                    keratoprosthesis.
1900.............  Lead coronary venous.  H.................  ...........  ...........  ...........  ...........
2614.............  Probe, percutaneous    H.................  ...........  ...........  ...........  ...........
                    lumbar disc.
2616.............  Brachytx source,       K.................     163.4011    $8,870.88  ...........    $1,774.18
                    Yttrium-90.
2632.............  Brachytx sol, I-125,   H.................  ...........  ...........  ...........  ...........
                    per mCi.
7000.............  Amifostine, 500 mg...  K.................       3.9932      $216.79  ...........       $43.36
7011.............  Oprelvekin injection,  K.................       2.7246      $147.92  ...........       $29.58
                    5 mg.
7015.............  Busulfan, oral, 2 mg.  K.................       0.0263        $1.43  ...........         $.29
7024.............  Corticorelin ovine     K.................       3.4880      $189.36  ...........       $37.87
                    triflutat.
7025.............  Digoxin immune FAB     K.................       4.4789      $243.16  ...........       $48.63
                    (ovine).
7027.............  Fomepizole, 15mg.....  K.................       0.2215       $12.03  ...........        $2.41
7030.............  Hemin, per 1 mg......  K.................       0.0119         $.65  ...........         $.13
7031.............  Octreotide acetate     K.................       1.0339       $56.13  ...........       $11.23
                    injection.
7034.............  Somatropin injection.  K.................       0.9206       $49.98  ...........       $10.00
7035.............  Teniposide, 50 mg....  K.................       1.5530       $84.31  ...........       $16.86
7036.............  Urokinase 250,000 iu   K.................       5.1032      $277.05  ...........       $55.41
                    inj.
7037.............  Urofollitropin, 75 iu  K.................       1.1321       $61.46  ...........       $12.29
7038.............  Muromonab-CD3, 5 mg..  K.................       5.8452      $317.33  ...........       $63.47
7041.............  Tirofiban              K.................       4.2976      $233.31  ...........       $46.66
                    hydrochloride 12.5
                    mg.
7042.............  Capecitabine, oral,    K.................       0.0290        $1.57  ...........         $.31
                    150 mg.
7043.............  Infliximab injection   K.................       0.6841       $37.14  ...........        $7.43
                    10 mg.
7045.............  Trimetrexate           K.................       1.2099       $65.68  ...........       $13.14
                    glucoronate.
7046.............  Doxorubicin hcl        K.................       4.6362      $251.69  ...........       $50.34
                    liposome inj 10 mg.
7049.............  Filgrastim 480 mcg     K.................       3.1998      $173.71  ...........       $34.74
                    injection.
7051.............  Leuprolide acetate     K.................      68.9392    $3,742.64  ...........      $748.53
                    implant, 65 mg.
9000.............  Na chromate Cr51, per  K.................       1.2631       $68.57  ...........       $13.71
                    0.25mCi.
9002.............  Tenecteplase, 50mg/    K.................      23.2303    $1,261.15  ...........      $252.23
                    vial.
9003.............  Palivizumab, per 50mg  K.................       6.3850      $346.64  ...........       $69.33
9004.............  Gemtuzumab ozogamicin  K.................      17.5020      $950.17  ...........      $190.03
                    inj,5mg.
9005.............  Reteplase injection..  K.................      10.1332      $550.12  ...........      $110.02
9009.............  Baclofen refill kit -  K.................       0.7478       $40.60  ...........        $8.12
                    per 2000 mcg.
9010.............  Baclofen refill kit -  K.................       0.7340       $39.85  ...........        $7.97
                    per 4000 mcg.
9012.............  Arsenic Trioxide.....  K.................       0.4837       $26.26  ...........        $5.25
9015.............  Mycophenolate mofetil  K.................       0.0373        $2.02  ...........         $.40
                    oral 250 mg.
9018.............  Botulinum toxin B,     K.................       0.1272        $6.91  ...........        $1.38
                    per 100 u.
9019.............  Caspofungin acetate,   K.................       0.5334       $28.96  ...........        $5.79
                    5 mg.
9020.............  Sirolimus tablet,      K.................       0.0520        $2.82  ...........         $.56
                    oral 1 mg.
9021.............  Immune globulin 10 mg  K.................       0.0080         $.43  ...........         $.09
9022.............  IM inj interferon      K.................       0.9417       $51.12  ...........       $10.22
                    beta 1-a.
9023.............  Rho d immune globulin  K.................       0.0523        $2.84  ...........         $.57
                    50 mcg.
9024.............  Amphotericin b lipid   K.................       0.4174       $22.66  ...........        $4.53
                    complex.
9025.............  Rubidium-Rb-82.......  K.................       2.5939      $140.82  ...........       $28.16
9100.............  Iodinated I-           K.................       0.0071         $.39  ...........         $.08
                    131albumin, per 5
                    uci.
9104.............  Anti-thymocycte        K.................       2.9801      $161.79  ...........       $32.36
                    globulin rabbit.
9105.............  Hep B imm glob, per 1  K.................       1.5621       $84.80  ...........       $16.96
                    ml.
9108.............  Thyrotropin alfa, per  K.................       6.6059      $358.63  ...........       $71.73
                    1.1 mg.
9109.............  Tirofiban hcl, per     K.................       2.2328      $121.22  ...........       $24.24
                    6.25 mg.
9110.............  Alemtuzumab, per 10    K.................       7.6422      $414.89  ...........       $82.98
                    mg.
9111.............  Inj, bivalirudin, per  G.................  ...........      $397.81  ...........       $59.46
                    250 mg vial.
9112.............  Perflutren lipid       G.................  ...........      $148.20  ...........       $22.15
                    micro, per 2ml.
9113.............  Inj, pantoprazole      G.................  ...........       $22.80  ...........        $3.41
                    sodium, vial.
9114.............  Nesiritide, per 0.5    G.................  ...........      $144.40  ...........       $21.58
                    mg vial.
9115.............  Inj, zoledronic acid,  G.................  ...........      $203.40  ...........       $30.40
                    per 1 mg.
9116.............  Inj, Ertapenem         G.................  ...........       $45.31  ...........        $6.77
                    sodium, per 1 gm
                    vial.
9117.............  Y-90 ibritumomab       K.................     332.7763   $18,066.09  ...........    $3,613.22
                    tiuxetan.
9118.............  IN-111 ibritumomab     K.................      38.3972    $2,084.55  ...........      $416.91
                    tiuxetan.
9119.............  Pegfilgrastim, per 1   G.................  ...........      $467.09  ...........       $69.82
                    mg.
9120.............  Inj, Fulvestrant, per  G.................  ...........      $175.16  ...........       $26.18
                    50 mg.
9121.............  Inj, Argatroban, per   G.................  ...........       $14.25  ...........        $2.13
                    5 mg.
9122.............  Inj, Triptorelin       G.................  ...........      $415.24  ...........       $62.07
                    pamoate, per 3.75 mg.
9200.............  Orcel, per 36 cm2....  G.................  ...........    $1,135.25  ...........      $169.69
9201.............  Dermagraft, per 37.5   K.................       7.9288      $430.45  ...........       $86.09
                    sq cm.
9202.............  Octafluoropropane....  K.................       2.1253      $115.38  ...........       $23.08
9203.............  Perflexane lipid       G.................  ...........      $142.50  ...........       $21.30
                    micro.
9204.............  Ziprasidone mesylate.  G.................  ...........       $41.56  ...........        $6.21
9205.............  Oxaliplatin..........  G.................  ...........       $94.46  ...........       $14.12
9217.............  Leuprolide acetate     K.................       5.5128      $299.28  ...........       $59.86
                    suspnsion, 7.5 mg.

[[Page 48030]]

 
9500.............  Platelets, irradiated  K.................       1.2398       $67.31  ...........       $13.46
9501.............  Platelets, pheresis..  K.................       6.7772      $367.93  ...........       $73.59
9502.............  Platelet pheresis      K.................       7.3552      $399.31  ...........       $79.86
                    irradiated.
9503.............  Fresh frozen plasma,   K.................       1.1560       $62.76  ...........       $12.55
                    ea unit.
9504.............  RBC deglycerolized...  K.................       3.9764      $215.87  ...........       $43.17
9505.............  RBC irradiated.......  K.................       1.8011       $97.78  ...........       $19.56
9506.............  Granulocytes,          K.................      20.7004    $1,123.80  ...........      $224.76
                    pheresis.
----------------------------------------------------------------------------------------------------------------

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

Copyright American Dental Association. All rights reserved.

[[Page 48030]]



                                  Addendum B.--Payment Status by HCPCS Code and Related Information Calendar Year 2004
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                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..........   1501  .........       $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               1557  .........    $1,850.00  ............       $370.00
                                                                       cryoablation.
00100.................  N....................  .....................  Anesth, salivary gland.  .....  .........  ...........  ............  ............
00102.................  N....................  .....................  Anesth, repair of cleft  .....  .........  ...........  ............  ............
                                                                       lip.
00103.................  N....................  .....................  Anesth, blepharoplasty.  .....  .........  ...........  ............  ............
00104.................  N....................  .....................  Anesth, electroshock...  .....  .........  ...........  ............  ............
0010T.................  A....................  .....................  Tb test, gamma           .....  .........  ...........  ............  ............
                                                                       interferon.
00120.................  N....................  .....................  Anesth, ear surgery....  .....  .........  ...........  ............  ............
00124.................  N....................  .....................  Anesth, ear exam.......  .....  .........  ...........  ............  ............
00126.................  N....................  .....................  Anesth, tympanotomy....  .....  .........  ...........  ............  ............
0012T.................  T....................  .....................  Osteochondral knee        0041    27.2538    $1,479.58  ............       $295.92
                                                                       autograft.
0013T.................  T....................  .....................  Osteochondral knee        0041    27.2538    $1,479.58  ............       $295.92
                                                                       allograft.
00140.................  N....................  .....................  Anesth, procedures on    .....  .........  ...........  ............  ............
                                                                       eye.
00142.................  N....................  .....................  Anesth, lens surgery...  .....  .........  ...........  ............  ............
00144.................  N....................  .....................  Anesth, corneal          .....  .........  ...........  ............  ............
                                                                       transplant.
00145.................  N....................  .....................  Anesth, vitreoretinal    .....  .........  ...........  ............  ............
                                                                       surg.
00147.................  N....................  .....................  Anesth, iridectomy.....  .....  .........  ...........  ............  ............
00148.................  N....................  .....................  Anesth, eye exam.......  .....  .........  ...........  ............  ............
0014T.................  T....................  .....................  Meniscal transplant,      0041    27.2538    $1,479.58  ............       $295.92
                                                                       knee.
00160.................  N....................  .....................  Anesth, nose/sinus       .....  .........  ...........  ............  ............
                                                                       surgery.
00162.................  N....................  .....................  Anesth, nose/sinus       .....  .........  ...........  ............  ............
                                                                       surgery.
00164.................  N....................  .....................  Anesth, biopsy of nose.  .....  .........  ...........  ............  ............
0016T.................  T....................  .....................  Thermotx choroid vasc     0235     4.9900      $270.90        $72.04        $54.18
                                                                       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     0.6390       $34.69        $15.76         $6.94
                                                                       stimul.
00190.................  N....................  .....................  Anesth, face/skull bone  .....  .........  ...........  ............  ............
                                                                       surg.
00192.................  C....................  .....................  Anesth, facial bone      .....  .........  ...........  ............  ............
                                                                       surgery.
0019T.................  E....................  .....................  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.

[[Page 48031]]

 
0025T.................  S....................  .....................  Ultrasonic pachymetry..   0230     0.7379       $40.06        $14.97         $8.01
0026T.................  A....................  .....................  Measure remnant          .....  .........  ...........  ............  ............
                                                                       lipoproteins.
0027T.................  T....................  .....................  Endoscopic epidural       1547  .........      $850.00  ............       $170.00
                                                                       lysis.
0028T.................  N....................  .....................  Dexa body composition    .....  .........  ...........  ............  ............
                                                                       study.
0029T.................  N....................  .....................  Magnetic tx for          .....  .........  ...........  ............  ............
                                                                       incontinence.
00300.................  N....................  .....................  Anesth, head/neck/       .....  .........  ...........  ............  ............
                                                                       ptrunk.
0030T.................  A....................  .....................  Antiprothrombin          .....  .........  ...........  ............  ............
                                                                       antibody.
0031T.................  N....................  .....................  Speculoscopy...........  .....  .........  ...........  ............  ............
00320.................  N....................  .....................  Anesth, neck organ       .....  .........  ...........  ............  ............
                                                                       surgery.
00322.................  N....................  .....................  Anesth, biopsy of        .....  .........  ...........  ............  ............
                                                                       thyroid.
00326.................  N....................  .....................  Anesth, larynx/trach, <  .....  .........  ...........  ............  ............
                                                                       1 yr.
0032T.................  N....................  .....................  Speculoscopy w/direct    .....  .........  ...........  ............  ............
                                                                       sample.
0033T.................  C....................  .....................  Endovasc taa repr incl   .....  .........  ...........  ............  ............
                                                                       subcl.
0034T.................  C....................  .....................  Endovasc taa repr w/o    .....  .........  ...........  ............  ............
                                                                       subcl.
00350.................  N....................  .....................  Anesth, neck vessel      .....  .........  ...........  ............  ............
                                                                       surgery.
00352.................  N....................  .....................  Anesth, neck vessel      .....  .........  ...........  ............  ............
                                                                       surgery.
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.
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....................  .....................  Rad s/i, endovasc taa    .....  .........  ...........  ............  ............
                                                                       prosth.
00410.................  N....................  .....................  Anesth, correct heart    .....  .........  ...........  ............  ............
                                                                       rhythm.
0041T.................  A....................  .....................  Detect ur infect agnt w/ .....  .........  ...........  ............  ............
                                                                       cpas.
0042T.................  N....................  .....................  Ct perfusion w/          .....  .........  ...........  ............  ............
                                                                       contrast, cbf.
0043T.................  A....................  .....................  Co expired gas analysis  .....  .........  ...........  ............  ............
0044T.................  N....................  .....................  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.  .....  .........  ...........  ............  ............
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....................  .....................  Anesth, trach-bronch     .....  .........  ...........  ............  ............
                                                                       reconst.
00540.................  C....................  .....................  Anesth, chest surgery..  .....  .........  ...........  ............  ............
00541.................  N....................  .....................  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.

[[Page 48032]]

 
00635.................  N....................  .....................  Anesth, lumbar puncture  .....  .........  ...........  ............  ............
00640.................  N....................  .....................  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....................  .....................  Anesth, hernia repair<   .....  .........  ...........  ............  ............
                                                                       1 yr.
00836.................  N....................  .....................  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.
00865.................  C....................  .....................  Anesth, removal of       .....  .........  ...........  ............  ............
                                                                       prostate.
00866.................  C....................  .....................  Anesth, removal of       .....  .........  ...........  ............  ............
                                                                       adrenal.
00868.................  C....................  .....................  Anesth, kidney           .....  .........  ...........  ............  ............
                                                                       transplant.
00870.................  N....................  .....................  Anesth, bladder stone    .....  .........  ...........  ............  ............
                                                                       surg.
00872.................  N....................  .....................  Anesth kidney stone      .....  .........  ...........  ............  ............
                                                                       destruct.
00873.................  N....................  .....................  Anesth kidney stone      .....  .........  ...........  ............  ............
                                                                       destruct.
00880.................  N....................  .....................  Anesth, abdomen vessel   .....  .........  ...........  ............  ............
                                                                       surg.
00882.................  C....................  .....................  Anesth, major vein       .....  .........  ...........  ............  ............
                                                                       ligation.
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....................  .....................  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.

[[Page 48033]]

 
00950.................  N....................  .....................  Anesth, vaginal          .....  .........  ...........  ............  ............
                                                                       endoscopy.
00952.................  N....................  .....................  Anesth, hysteroscope/    .....  .........  ...........  ............  ............
                                                                       graph.
01112.................  N....................  .....................  Anesth, bone aspirate/   .....  .........  ...........  ............  ............
                                                                       bx.
01120.................  N....................  .....................  Anesth, pelvis surgery.  .....  .........  ...........  ............  ............
01130.................  N....................  .....................  Anesth, body cast        .....  .........  ...........  ............  ............
                                                                       procedure.
01140.................  C....................  .....................  Anesth, amputation at    .....  .........  ...........  ............  ............
                                                                       pelvis.
01150.................  C....................  .....................  Anesth, pelvic tumor     .....  .........  ...........  ............  ............
                                                                       surgery.
01160.................  N....................  .....................  Anesth, pelvis           .....  .........  ...........  ............  ............
                                                                       procedure.
01170.................  N....................  .....................  Anesth, pelvis surgery.  .....  .........  ...........  ............  ............
01180.................  N....................  .....................  Anesth, pelvis nerve     .....  .........  ...........  ............  ............
                                                                       removal.
01190.................  C....................  .....................  Anesth, pelvis nerve     .....  .........  ...........  ............  ............
                                                                       removal.
01200.................  N....................  .....................  Anesth, hip joint        .....  .........  ...........  ............  ............
                                                                       procedure.
01202.................  N....................  .....................  Anesth, arthroscopy of   .....  .........  ...........  ............  ............
                                                                       hip.
01210.................  N....................  .....................  Anesth, hip joint        .....  .........  ...........  ............  ............
                                                                       surgery.
01212.................  C....................  .....................  Anesth, hip              .....  .........  ...........  ............  ............
                                                                       disarticulation.
01214.................  C....................  .....................  Anesth, hip              .....  .........  ...........  ............  ............
                                                                       arthroplasty.
01215.................  N....................  .....................  Anesth, revise hip       .....  .........  ...........  ............  ............
                                                                       repair.
01220.................  N....................  .....................  Anesth, procedure on     .....  .........  ...........  ............  ............
                                                                       femur.
01230.................  N....................  .....................  Anesth, surgery of       .....  .........  ...........  ............  ............
                                                                       femur.
01232.................  C....................  .....................  Anesth, amputation of    .....  .........  ...........  ............  ............
                                                                       femur.
01234.................  C....................  .....................  Anesth, radical femur    .....  .........  ...........  ............  ............
                                                                       surg.
01250.................  N....................  .....................  Anesth, upper leg        .....  .........  ...........  ............  ............
                                                                       surgery.
01260.................  N....................  .....................  Anesth, upper leg veins  .....  .........  ...........  ............  ............
                                                                       surg.
01270.................  N....................  .....................  Anesth, thigh arteries   .....  .........  ...........  ............  ............
                                                                       surg.
01272.................  C....................  .....................  Anesth, femoral artery   .....  .........  ...........  ............  ............
                                                                       surg.
01274.................  C....................  .....................  Anesth, femoral          .....  .........  ...........  ............  ............
                                                                       embolectomy.
01320.................  N....................  .....................  Anesth, knee area        .....  .........  ...........  ............  ............
                                                                       surgery.
01340.................  N....................  .....................  Anesth, knee area        .....  .........  ...........  ............  ............
                                                                       procedure.
01360.................  N....................  .....................  Anesth, knee area        .....  .........  ...........  ............  ............
                                                                       surgery.
01380.................  N....................  .....................  Anesth, knee joint       .....  .........  ...........  ............  ............
                                                                       procedure.
01382.................  N....................  .....................  Anesth, knee             .....  .........  ...........  ............  ............
                                                                       arthroscopy.
01390.................  N....................  .....................  Anesth, knee area        .....  .........  ...........  ............  ............
                                                                       procedure.
01392.................  N....................  .....................  Anesth, knee area        .....  .........  ...........  ............  ............
                                                                       surgery.
01400.................  N....................  .....................  Anesth, knee joint       .....  .........  ...........  ............  ............
                                                                       surgery.
01402.................  C....................  .....................  Anesth, knee             .....  .........  ...........  ............  ............
                                                                       arthroplasty.
01404.................  C....................  .....................  Anesth, amputation at    .....  .........  ...........  ............  ............
                                                                       knee.
01420.................  N....................  .....................  Anesth, knee joint       .....  .........  ...........  ............  ............
                                                                       casting.
01430.................  N....................  .....................  Anesth, knee veins       .....  .........  ...........  ............  ............
                                                                       surgery.
01432.................  N....................  .....................  Anesth, knee vessel      .....  .........  ...........  ............  ............
                                                                       surg.
01440.................  N....................  .....................  Anesth, knee arteries    .....  .........  ...........  ............  ............
                                                                       surg.
01442.................  C....................  .....................  Anesth, knee artery      .....  .........  ...........  ............  ............
                                                                       surg.
01444.................  C....................  .....................  Anesth, knee artery      .....  .........  ...........  ............  ............
                                                                       repair.
01462.................  N....................  .....................  Anesth, lower leg        .....  .........  ...........  ............  ............
                                                                       procedure.
01464.................  N....................  .....................  Anesth, ankle            .....  .........  ...........  ............  ............
                                                                       arthroscopy.
01470.................  N....................  .....................  Anesth, lower leg        .....  .........  ...........  ............  ............
                                                                       surgery.
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.

[[Page 48034]]

 
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....................  .....................  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.
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....................  .....................  Anesth, nerve block/inj  .....  .........  ...........  ............  ............
01992.................  N....................  .....................  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     1.0937       $59.38  ............        $11.88
10022.................  T....................  .....................  Fna w/image............   0002     1.0937       $59.38  ............        $11.88
10040.................  T....................  .....................  Acne surgery...........   0010     0.6806       $36.95        $10.08         $7.39
10060.................  T....................  .....................  Drainage of skin          0006     1.7487       $94.94        $24.12        $18.99
                                                                       abscess.
10061.................  T....................  .....................  Drainage of skin          0006     1.7487       $94.94        $24.12        $18.99
                                                                       abscess.
10080.................  T....................  .....................  Drainage of pilonidal     0006     1.7487       $94.94        $24.12        $18.99
                                                                       cyst.

[[Page 48035]]

 
10081.................  T....................  .....................  Drainage of pilonidal     0007    11.4943      $624.01  ............       $124.80
                                                                       cyst.
10120.................  T....................  .....................  Remove foreign body....   0006     1.7487       $94.94        $24.12        $18.99
10121.................  T....................  .....................  Remove foreign body....   0021    14.5749      $791.26       $219.48       $158.25
10140.................  T....................  .....................  Drainage of hematoma/     0007    11.4943      $624.01  ............       $124.80
                                                                       fluid.
10160.................  T....................  .....................  Puncture drainage of      0018     0.9567       $51.94        $16.04        $10.39
                                                                       lesion.
10180.................  T....................  .....................  Complex drainage, wound   0007    11.4943      $624.01  ............       $124.80
11000.................  T....................  .....................  Debride infected skin..   0015     1.5832       $85.95        $20.35        $17.19
11001.................  T....................  .....................  Debride infected skin     0012     0.8203       $44.53        $11.18         $8.91
                                                                       add-on.
11010.................  T....................  .....................  Debride skin, fx.......   0022    18.6725    $1,013.71       $354.45       $202.74
11011.................  T....................  .....................  Debride skin/muscle, fx   0022    18.6725    $1,013.71       $354.45       $202.74
11012.................  T....................  .....................  Debride skin/muscle/      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       bone, fx.
11040.................  T....................  .....................  Debride skin, partial..   0015     1.5832       $85.95        $20.35        $17.19
11041.................  T....................  .....................  Debride skin, full.....   0015     1.5832       $85.95        $20.35        $17.19
11042.................  T....................  .....................  Debride skin/tissue....   0016     2.7343      $148.44        $57.31        $29.69
11043.................  T....................  .....................  Debride tissue/muscle..   0016     2.7343      $148.44        $57.31        $29.69
11044.................  T....................  .....................  Debride tissue/muscle/    0682     7.6815      $417.02       $174.57        $83.40
                                                                       bone.
11055.................  T....................  .....................  Trim skin lesion.......   0012     0.8203       $44.53        $11.18         $8.91
11056.................  T....................  .....................  Trim skin lesions, 2 to   0012     0.8203       $44.53        $11.18         $8.91
                                                                       4.
11057.................  T....................  .....................  Trim skin lesions, over   0012     0.8203       $44.53        $11.18         $8.91
                                                                       4.
11100.................  T....................  .....................  Biopsy of skin lesion..   0018     0.9567       $51.94        $16.04        $10.39
11101.................  T....................  .....................  Biopsy, skin add-on....   0018     0.9567       $51.94        $16.04        $10.39
11200.................  T....................  .....................  Removal of skin tags...   0013     1.1420       $62.00        $14.20        $12.40
11201.................  T....................  .....................  Remove skin tags add-on   0015     1.5832       $85.95        $20.35        $17.19
11300.................  T....................  .....................  Shave skin lesion......   0012     0.8203       $44.53        $11.18         $8.91
11301.................  T....................  .....................  Shave skin lesion......   0012     0.8203       $44.53        $11.18         $8.91
11302.................  T....................  .....................  Shave skin lesion......   0012     0.8203       $44.53        $11.18         $8.91
11303.................  T....................  .....................  Shave skin lesion......   0015     1.5832       $85.95        $20.35        $17.19
11305.................  T....................  .....................  Shave skin lesion......   0013     1.1420       $62.00        $14.20        $12.40
11306.................  T....................  .....................  Shave skin lesion......   0013     1.1420       $62.00        $14.20        $12.40
11307.................  T....................  .....................  Shave skin lesion......   0013     1.1420       $62.00        $14.20        $12.40
11308.................  T....................  .....................  Shave skin lesion......   0013     1.1420       $62.00        $14.20        $12.40
11310.................  T....................  .....................  Shave skin lesion......   0013     1.1420       $62.00        $14.20        $12.40
11311.................  T....................  .....................  Shave skin lesion......   0013     1.1420       $62.00        $14.20        $12.40
11312.................  T....................  .....................  Shave skin lesion......   0013     1.1420       $62.00        $14.20        $12.40
11313.................  T....................  .....................  Shave skin lesion......   0016     2.7343      $148.44        $57.31        $29.69
11400.................  T....................  .....................  Removal of skin lesion.   0019     3.9807      $216.11        $71.87        $43.22
11401.................  T....................  .....................  Removal of skin lesion.   0019     3.9807      $216.11        $71.87        $43.22
11402.................  T....................  .....................  Removal of skin lesion.   0019     3.9807      $216.11        $71.87        $43.22
11403.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11404.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11406.................  T....................  .....................  Removal of skin lesion.   0021    14.5749      $791.26       $219.48       $158.25
11420.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11421.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11422.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11423.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11424.................  T....................  .....................  Removal of skin lesion.   0021    14.5749      $791.26       $219.48       $158.25
11426.................  T....................  .....................  Removal of skin lesion.   0022    18.6725    $1,013.71       $354.45       $202.74
11440.................  T....................  .....................  Removal of skin lesion.   0019     3.9807      $216.11        $71.87        $43.22
11441.................  T....................  .....................  Removal of skin lesion.   0019     3.9807      $216.11        $71.87        $43.22
11442.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11443.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11444.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11446.................  T....................  .....................  Removal of skin lesion.   0022    18.6725    $1,013.71       $354.45       $202.74
11450.................  T....................  .....................  Removal, sweat gland      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       lesion.
11451.................  T....................  .....................  Removal, sweat gland      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       lesion.
11462.................  T....................  .....................  Removal, sweat gland      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       lesion.
11463.................  T....................  .....................  Removal, sweat gland      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       lesion.
11470.................  T....................  .....................  Removal, sweat gland      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       lesion.
11471.................  T....................  .....................  Removal, sweat gland      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       lesion.
11600.................  T....................  .....................  Removal of skin lesion.   0019     3.9807      $216.11        $71.87        $43.22
11601.................  T....................  .....................  Removal of skin lesion.   0019     3.9807      $216.11        $71.87        $43.22
11602.................  T....................  .....................  Removal of skin lesion.   0019     3.9807      $216.11        $71.87        $43.22
11603.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11604.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11606.................  T....................  .....................  Removal of skin lesion.   0021    14.5749      $791.26       $219.48       $158.25
11620.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38

[[Page 48036]]

 
11621.................  T....................  .....................  Removal of skin lesion.   0019     3.9807      $216.11        $71.87        $43.22
11622.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11623.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11624.................  T....................  .....................  Removal of skin lesion.   0021    14.5749      $791.26       $219.48       $158.25
11626.................  T....................  .....................  Removal of skin lesion.   0022    18.6725    $1,013.71       $354.45       $202.74
11640.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11641.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11642.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11643.................  T....................  .....................  Removal of skin lesion.   0020     7.3105      $396.88       $113.25        $79.38
11644.................  T....................  .....................  Removal of skin lesion.   0021    14.5749      $791.26       $219.48       $158.25
11646.................  T....................  .....................  Removal of skin lesion.   0022    18.6725    $1,013.71       $354.45       $202.74
11719.................  T....................  .....................  Trim nail(s)...........   0009     0.6597       $35.81         $8.34         $7.16
11720.................  T....................  .....................  Debride nail, 1-5......   0009     0.6597       $35.81         $8.34         $7.16
11721.................  T....................  .....................  Debride nail, 6 or more   0009     0.6597       $35.81         $8.34         $7.16
11730.................  T....................  .....................  Removal of nail plate..   0013     1.1420       $62.00        $14.20        $12.40
11732.................  T....................  .....................  Remove nail plate, add-   0012     0.8203       $44.53        $11.18         $8.91
                                                                       on.
11740.................  T....................  .....................  Drain blood from under    0009     0.6597       $35.81         $8.34         $7.16
                                                                       nail.
11750.................  T....................  .....................  Removal of nail bed....   0019     3.9807      $216.11        $71.87        $43.22
11752.................  T....................  .....................  Remove nail bed/finger    0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       tip.
11755.................  T....................  .....................  Biopsy, nail unit......   0019     3.9807      $216.11        $71.87        $43.22
11760.................  T....................  .....................  Repair of nail bed.....   0024     1.7847       $96.89        $34.75        $19.38
11762.................  T....................  .....................  Reconstruction of nail    0024     1.7847       $96.89        $34.75        $19.38
                                                                       bed.
11765.................  T....................  .....................  Excision of nail fold,    0015     1.5832       $85.95        $20.35        $17.19
                                                                       toe.
11770.................  T....................  .....................  Removal of pilonidal      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       lesion.
11771.................  T....................  .....................  Removal of pilonidal      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       lesion.
11772.................  T....................  .....................  Removal of pilonidal      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       lesion.
11900.................  T....................  .....................  Injection into skin       0012     0.8203       $44.53        $11.18         $8.91
                                                                       lesions.
11901.................  T....................  .....................  Added skin lesions        0012     0.8203       $44.53        $11.18         $8.91
                                                                       injection.
11920.................  T....................  .....................  Correct skin color        0024     1.7847       $96.89        $34.75        $19.38
                                                                       defects.
11921.................  T....................  .....................  Correct skin color        0024     1.7847       $96.89        $34.75        $19.38
                                                                       defects.
11922.................  T....................  .....................  Correct skin color        0024     1.7847       $96.89        $34.75        $19.38
                                                                       defects.
11950.................  T....................  .....................  Therapy for contour       0024     1.7847       $96.89        $34.75        $19.38
                                                                       defects.
11951.................  T....................  .....................  Therapy for contour       0024     1.7847       $96.89        $34.75        $19.38
                                                                       defects.
11952.................  T....................  .....................  Therapy for contour       0024     1.7847       $96.89        $34.75        $19.38
                                                                       defects.
11954.................  T....................  .....................  Therapy for contour       0024     1.7847       $96.89        $34.75        $19.38
                                                                       defects.
11960.................  T....................  .....................  Insert tissue             0027    15.8319      $859.50       $329.72       $171.90
                                                                       expander(s).
11970.................  T....................  .....................  Replace tissue expander   0027    15.8319      $859.50       $329.72       $171.90
11971.................  T....................  .....................  Remove tissue             0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       expander(s).
11975.................  E....................  .....................  Insert contraceptive     .....  .........  ...........  ............  ............
                                                                       cap.
11976.................  T....................  .....................  Removal of                0019     3.9807      $216.11        $71.87        $43.22
                                                                       contraceptive cap.
11977.................  E....................  .....................  Removal/reinsert contra  .....  .........  ...........  ............  ............
                                                                       cap.
11980.................  X....................  .....................  Implant hormone           0340     0.6232       $33.83  ............         $6.77
                                                                       pellet(s).
11981.................  X....................  .....................  Insert drug implant       0340     0.6232       $33.83  ............         $6.77
                                                                       device.
11982.................  X....................  .....................  Remove drug implant       0340     0.6232       $33.83  ............         $6.77
                                                                       device.
11983.................  X....................  .....................  Remove/insert drug        0340     0.6232       $33.83  ............         $6.77
                                                                       implant.
12001.................  T....................  .....................  Repair superficial        0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12002.................  T....................  .....................  Repair superficial        0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12004.................  T....................  .....................  Repair superficial        0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12005.................  T....................  .....................  Repair superficial        0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12006.................  T....................  .....................  Repair superficial        0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12007.................  T....................  .....................  Repair superficial        0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12011.................  T....................  .....................  Repair superficial        0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12013.................  T....................  .....................  Repair superficial        0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12014.................  T....................  .....................  Repair superficial        0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12015.................  T....................  .....................  Repair superficial        0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12016.................  T....................  .....................  Repair superficial        0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12017.................  T....................  .....................  Repair superficial        0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12018.................  T....................  .....................  Repair superficial        0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12020.................  T....................  .....................  Closure of split wound.   0024     1.7847       $96.89        $34.75        $19.38
12021.................  T....................  .....................  Closure of split wound.   0024     1.7847       $96.89        $34.75        $19.38
12031.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12032.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12034.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12035.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12036.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12037.................  T....................  .....................  Layer closure of          0025     6.2703      $340.41       $115.49        $68.08
                                                                       wound(s).

[[Page 48037]]

 
12041.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12042.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12044.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12045.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12046.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12047.................  T....................  .....................  Layer closure of          0025     6.2703      $340.41       $115.49        $68.08
                                                                       wound(s).
12051.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12052.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12053.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12054.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12055.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12056.................  T....................  .....................  Layer closure of          0024     1.7847       $96.89        $34.75        $19.38
                                                                       wound(s).
12057.................  T....................  .....................  Layer closure of          0025     6.2703      $340.41       $115.49        $68.08
                                                                       wound(s).
13100.................  T....................  .....................  Repair of wound or        0025     6.2703      $340.41       $115.49        $68.08
                                                                       lesion.
13101.................  T....................  .....................  Repair of wound or        0025     6.2703      $340.41       $115.49        $68.08
                                                                       lesion.
13102.................  T....................  .....................  Repair wound/lesion add-  0024     1.7847       $96.89        $34.75        $19.38
                                                                       on.
13120.................  T....................  .....................  Repair of wound or        0024     1.7847       $96.89        $34.75        $19.38
                                                                       lesion.
13121.................  T....................  .....................  Repair of wound or        0024     1.7847       $96.89        $34.75        $19.38
                                                                       lesion.
13122.................  T....................  .....................  Repair wound/lesion add-  0024     1.7847       $96.89        $34.75        $19.38
                                                                       on.
13131.................  T....................  .....................  Repair of wound or        0024     1.7847       $96.89        $34.75        $19.38
                                                                       lesion.
13132.................  T....................  .....................  Repair of wound or        0024     1.7847       $96.89        $34.75        $19.38
                                                                       lesion.
13133.................  T....................  .....................  Repair wound/lesion add-  0024     1.7847       $96.89        $34.75        $19.38
                                                                       on.
13150.................  T....................  .....................  Repair of wound or        0025     6.2703      $340.41       $115.49        $68.08
                                                                       lesion.
13151.................  T....................  .....................  Repair of wound or        0024     1.7847       $96.89        $34.75        $19.38
                                                                       lesion.
13152.................  T....................  .....................  Repair of wound or        0025     6.2703      $340.41       $115.49        $68.08
                                                                       lesion.
13153.................  T....................  .....................  Repair wound/lesion add-  0024     1.7847       $96.89        $34.75        $19.38
                                                                       on.
13160.................  T....................  .....................  Late closure of wound..   0027    15.8319      $859.50       $329.72       $171.90
14000.................  T....................  .....................  Skin tissue               0027    15.8319      $859.50       $329.72       $171.90
                                                                       rearrangement.
14001.................  T....................  .....................  Skin tissue               0027    15.8319      $859.50       $329.72       $171.90
                                                                       rearrangement.
14020.................  T....................  .....................  Skin tissue               0027    15.8319      $859.50       $329.72       $171.90
                                                                       rearrangement.
14021.................  T....................  .....................  Skin tissue               0027    15.8319      $859.50       $329.72       $171.90
                                                                       rearrangement.
14040.................  T....................  .....................  Skin tissue               0027    15.8319      $859.50       $329.72       $171.90
                                                                       rearrangement.
14041.................  T....................  .....................  Skin tissue               0027    15.8319      $859.50       $329.72       $171.90
                                                                       rearrangement.
14060.................  T....................  .....................  Skin tissue               0027    15.8319      $859.50       $329.72       $171.90
                                                                       rearrangement.
14061.................  T....................  .....................  Skin tissue               0027    15.8319      $859.50       $329.72       $171.90
                                                                       rearrangement.
14300.................  T....................  .....................  Skin tissue               0027    15.8319      $859.50       $329.72       $171.90
                                                                       rearrangement.
14350.................  T....................  .....................  Skin tissue               0027    15.8319      $859.50       $329.72       $171.90
                                                                       rearrangement.
15000.................  T....................  .....................  Skin graft.............   0025     6.2703      $340.41       $115.49        $68.08
15001.................  T....................  .....................  Skin graft add-on......   0025     6.2703      $340.41       $115.49        $68.08
15050.................  T....................  .....................  Skin pinch graft.......   0025     6.2703      $340.41       $115.49        $68.08
15100.................  T....................  .....................  Skin split graft.......   0027    15.8319      $859.50       $329.72       $171.90
15101.................  T....................  .....................  Skin split graft add-on   0027    15.8319      $859.50       $329.72       $171.90
15120.................  T....................  .....................  Skin split graft.......   0027    15.8319      $859.50       $329.72       $171.90
15121.................  T....................  .....................  Skin split graft add-on   0027    15.8319      $859.50       $329.72       $171.90
15200.................  T....................  .....................  Skin full graft........   0027    15.8319      $859.50       $329.72       $171.90
15201.................  T....................  .....................  Skin full graft add-on.   0025     6.2703      $340.41       $115.49        $68.08
15220.................  T....................  .....................  Skin full graft........   0027    15.8319      $859.50       $329.72       $171.90
15221.................  T....................  .....................  Skin full graft add-on.   0025     6.2703      $340.41       $115.49        $68.08
15240.................  T....................  .....................  Skin full graft........   0027    15.8319      $859.50       $329.72       $171.90
15241.................  T....................  .....................  Skin full graft add-on.   0025     6.2703      $340.41       $115.49        $68.08
15260.................  T....................  .....................  Skin full graft........   0027    15.8319      $859.50       $329.72       $171.90
15261.................  T....................  .....................  Skin full graft add-on.   0025     6.2703      $340.41       $115.49        $68.08
15342.................  T....................  .....................  Cultured skin graft, 25   0024     1.7847       $96.89        $34.75        $19.38
                                                                       cm.
15343.................  T....................  .....................  Culture skn graft addl    0024     1.7847       $96.89        $34.75        $19.38
                                                                       25 cm.
15350.................  T....................  .....................  Skin homograft.........   0686    17.0868      $927.63       $341.70       $185.53
15351.................  T....................  .....................  Skin homograft add-on..   0027    15.8319      $859.50       $329.72       $171.90
15400.................  T....................  .....................  Skin heterograft.......   0025     6.2703      $340.41       $115.49        $68.08
15401.................  T....................  .....................  Skin heterograft add-on   0025     6.2703      $340.41       $115.49        $68.08
15570.................  T....................  .....................  Form skin pedicle flap.   0027    15.8319      $859.50       $329.72       $171.90
15572.................  T....................  .....................  Form skin pedicle flap.   0027    15.8319      $859.50       $329.72       $171.90
15574.................  T....................  .....................  Form skin pedicle flap.   0027    15.8319      $859.50       $329.72       $171.90
15576.................  T....................  .....................  Form skin pedicle flap.   0027    15.8319      $859.50       $329.72       $171.90
15600.................  T....................  .....................  Skin graft.............   0027    15.8319      $859.50       $329.72       $171.90
15610.................  T....................  .....................  Skin graft.............   0027    15.8319      $859.50       $329.72       $171.90
15620.................  T....................  .....................  Skin graft.............   0027    15.8319      $859.50       $329.72       $171.90
15630.................  T....................  .....................  Skin graft.............   0027    15.8319      $859.50       $329.72       $171.90

[[Page 48038]]

 
15650.................  T....................  .....................  Transfer skin pedicle     0027    15.8319      $859.50       $329.72       $171.90
                                                                       flap.
15732.................  T....................  .....................  Muscle-skin graft, head/  0027    15.8319      $859.50       $329.72       $171.90
                                                                       neck.
15734.................  T....................  .....................  Muscle-skin graft,        0027    15.8319      $859.50       $329.72       $171.90
                                                                       trunk.
15736.................  T....................  .....................  Muscle-skin graft, arm.   0027    15.8319      $859.50       $329.72       $171.90
15738.................  T....................  .....................  Muscle-skin graft, leg.   0027    15.8319      $859.50       $329.72       $171.90
15740.................  T....................  .....................  Island pedicle flap       0027    15.8319      $859.50       $329.72       $171.90
                                                                       graft.
15750.................  T....................  .....................  Neurovascular pedicle     0027    15.8319      $859.50       $329.72       $171.90
                                                                       graft.
15756.................  C....................  .....................  Free muscle flap,        .....  .........  ...........  ............  ............
                                                                       microvasc.
15757.................  C....................  .....................  Free skin flap,          .....  .........  ...........  ............  ............
                                                                       microvasc.
15758.................  C....................  .....................  Free fascial flap,       .....  .........  ...........  ............  ............
                                                                       microvasc.
15760.................  T....................  .....................  Composite skin graft...   0027    15.8319      $859.50       $329.72       $171.90
15770.................  T....................  .....................  Derma-fat-fascia graft.   0027    15.8319      $859.50       $329.72       $171.90
15775.................  T....................  .....................  Hair transplant punch     0025     6.2703      $340.41       $115.49        $68.08
                                                                       grafts.
15776.................  T....................  .....................  Hair transplant punch     0025     6.2703      $340.41       $115.49        $68.08
                                                                       grafts.
15780.................  T....................  .....................  Abrasion treatment of     0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       skin.
15781.................  T....................  .....................  Abrasion treatment of     0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       skin.
15782.................  T....................  .....................  Abrasion treatment of     0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       skin.
15783.................  T....................  .....................  Abrasion treatment of     0016     2.7343      $148.44        $57.31        $29.69
                                                                       skin.
15786.................  T....................  .....................  Abrasion, lesion,         0012     0.8203       $44.53        $11.18         $8.91
                                                                       single.
15787.................  T....................  .....................  Abrasion, lesions, add-   0013     1.1420       $62.00        $14.20        $12.40
                                                                       on.
15788.................  T....................  .....................  Chemical peel, face,      0012     0.8203       $44.53        $11.18         $8.91
                                                                       epiderm.
15789.................  T....................  .....................  Chemical peel, face,      0015     1.5832       $85.95        $20.35        $17.19
                                                                       dermal.
15792.................  T....................  .....................  Chemical peel,            0012     0.8203       $44.53        $11.18         $8.91
                                                                       nonfacial.
15793.................  T....................  .....................  Chemical peel,            0012     0.8203       $44.53        $11.18         $8.91
                                                                       nonfacial.
15810.................  T....................  .....................  Salabrasion............   0016     2.7343      $148.44        $57.31        $29.69
15811.................  T....................  .....................  Salabrasion............   0016     2.7343      $148.44        $57.31        $29.69
15819.................  T....................  .....................  Plastic surgery, neck..   0025     6.2703      $340.41       $115.49        $68.08
15820.................  T....................  .....................  Revision of lower         0027    15.8319      $859.50       $329.72       $171.90
                                                                       eyelid.
15821.................  T....................  .....................  Revision of lower         0027    15.8319      $859.50       $329.72       $171.90
                                                                       eyelid.
15822.................  T....................  .....................  Revision of upper         0027    15.8319      $859.50       $329.72       $171.90
                                                                       eyelid.
15823.................  T....................  .....................  Revision of upper         0027    15.8319      $859.50       $329.72       $171.90
                                                                       eyelid.
15824.................  T....................  .....................  Removal of forehead       0027    15.8319      $859.50       $329.72       $171.90
                                                                       wrinkles.
15825.................  T....................  .....................  Removal of neck           0027    15.8319      $859.50       $329.72       $171.90
                                                                       wrinkles.
15826.................  T....................  .....................  Removal of brow           0027    15.8319      $859.50       $329.72       $171.90
                                                                       wrinkles.
15828.................  T....................  .....................  Removal of face           0027    15.8319      $859.50       $329.72       $171.90
                                                                       wrinkles.
15829.................  T....................  .....................  Removal of skin           0027    15.8319      $859.50       $329.72       $171.90
                                                                       wrinkles.
15831.................  T....................  .....................  Excise excessive skin     0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       tissue.
15832.................  T....................  .....................  Excise excessive skin     0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       tissue.
15833.................  T....................  .....................  Excise excessive skin     0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       tissue.
15834.................  T....................  .....................  Excise excessive skin     0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       tissue.
15835.................  T....................  .....................  Excise excessive skin     0025     6.2703      $340.41       $115.49        $68.08
                                                                       tissue.
15836.................  T....................  .....................  Excise excessive skin     0020     7.3105      $396.88       $113.25        $79.38
                                                                       tissue.
15837.................  T....................  .....................  Excise excessive skin     0020     7.3105      $396.88       $113.25        $79.38
                                                                       tissue.
15838.................  T....................  .....................  Excise excessive skin     0020     7.3105      $396.88       $113.25        $79.38
                                                                       tissue.
15839.................  T....................  .....................  Excise excessive skin     0020     7.3105      $396.88       $113.25        $79.38
                                                                       tissue.
15840.................  T....................  .....................  Graft for face nerve      0027    15.8319      $859.50       $329.72       $171.90
                                                                       palsy.
15841.................  T....................  .....................  Graft for face nerve      0027    15.8319      $859.50       $329.72       $171.90
                                                                       palsy.
15842.................  T....................  .....................  Flap for face nerve       0027    15.8319      $859.50       $329.72       $171.90
                                                                       palsy.
15845.................  T....................  .....................  Skin and muscle repair,   0027    15.8319      $859.50       $329.72       $171.90
                                                                       face.
15850.................  T....................  .....................  Removal of sutures.....   0016     2.7343      $148.44        $57.31        $29.69
15851.................  T....................  .....................  Removal of sutures.....   0012     0.8203       $44.53        $11.18         $8.91
15852.................  X....................  .....................  Dressing change,not for   0340     0.6232       $33.83  ............         $6.77
                                                                       burn.
15860.................  S....................  .....................  Test for blood flow in    1501  .........       $25.00  ............         $5.00
                                                                       graft.
15876.................  T....................  .....................  Suction assisted          0027    15.8319      $859.50       $329.72       $171.90
                                                                       lipectomy.
15877.................  T....................  .....................  Suction assisted          0027    15.8319      $859.50       $329.72       $171.90
                                                                       lipectomy.
15878.................  T....................  .....................  Suction assisted          0027    15.8319      $859.50       $329.72       $171.90
                                                                       lipectomy.
15879.................  T....................  .....................  Suction assisted          0027    15.8319      $859.50       $329.72       $171.90
                                                                       lipectomy.
15920.................  T....................  .....................  Removal of tail bone      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       ulcer.
15922.................  T....................  .....................  Removal of tail bone      0027    15.8319      $859.50       $329.72       $171.90
                                                                       ulcer.
15931.................  T....................  .....................  Remove sacrum pressure    0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       sore.
15933.................  T....................  .....................  Remove sacrum pressure    0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       sore.
15934.................  T....................  .....................  Remove sacrum pressure    0027    15.8319      $859.50       $329.72       $171.90
                                                                       sore.
15935.................  T....................  .....................  Remove sacrum pressure    0027    15.8319      $859.50       $329.72       $171.90
                                                                       sore.
15936.................  T....................  .....................  Remove sacrum pressure    0027    15.8319      $859.50       $329.72       $171.90
                                                                       sore.
15937.................  T....................  .....................  Remove sacrum pressure    0027    15.8319      $859.50       $329.72       $171.90
                                                                       sore.
15940.................  T....................  .....................  Remove hip pressure       0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       sore.

[[Page 48039]]

 
15941.................  T....................  .....................  Remove hip pressure       0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       sore.
15944.................  T....................  .....................  Remove hip pressure       0027    15.8319      $859.50       $329.72       $171.90
                                                                       sore.
15945.................  T....................  .....................  Remove hip pressure       0027    15.8319      $859.50       $329.72       $171.90
                                                                       sore.
15946.................  T....................  .....................  Remove hip pressure       0027    15.8319      $859.50       $329.72       $171.90
                                                                       sore.
15950.................  T....................  .....................  Remove thigh pressure     0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       sore.
15951.................  T....................  .....................  Remove thigh pressure     0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       sore.
15952.................  T....................  .....................  Remove thigh pressure     0027    15.8319      $859.50       $329.72       $171.90
                                                                       sore.
15953.................  T....................  .....................  Remove thigh pressure     0027    15.8319      $859.50       $329.72       $171.90
                                                                       sore.
15956.................  T....................  .....................  Remove thigh pressure     0027    15.8319      $859.50       $329.72       $171.90
                                                                       sore.
15958.................  T....................  .....................  Remove thigh pressure     0027    15.8319      $859.50       $329.72       $171.90
                                                                       sore.
15999.................  T....................  .....................  Removal of pressure       0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       sore.
16000.................  T....................  .....................  Initial treatment of      0012     0.8203       $44.53        $11.18         $8.91
                                                                       burn(s).
16010.................  T....................  .....................  Treatment of burn(s)...   0016     2.7343      $148.44        $57.31        $29.69
16015.................  T....................  .....................  Treatment of burn(s)...   0017    16.7332      $908.43       $227.84       $181.69
16020.................  T....................  .....................  Treatment of burn(s)...   0013     1.1420       $62.00        $14.20        $12.40
16025.................  T....................  .....................  Treatment of burn(s)...   0012     0.8203       $44.53        $11.18         $8.91
16030.................  T....................  .....................  Treatment of burn(s)...   0015     1.5832       $85.95        $20.35        $17.19
16035.................  C....................  .....................  Incision of burn scab,   .....  .........  ...........  ............  ............
                                                                       initi.
16036.................  C....................  .....................  Incise burn scab, addl   .....  .........  ...........  ............  ............
                                                                       incis.
17000.................  T....................  .....................  Destroy benign/premlg     0010     0.6806       $36.95        $10.08         $7.39
                                                                       lesion.
17003.................  T....................  .....................  Destroy lesions, 2-14..   0010     0.6806       $36.95        $10.08         $7.39
17004.................  T....................  .....................  Destroy lesions, 15 or    0011     2.1800      $118.35        $27.88        $23.67
                                                                       more.
17106.................  T....................  .....................  Destruction of skin       0011     2.1800      $118.35        $27.88        $23.67
                                                                       lesions.
17107.................  T....................  .....................  Destruction of skin       0011     2.1800      $118.35        $27.88        $23.67
                                                                       lesions.
17108.................  T....................  .....................  Destruction of skin       0011     2.1800      $118.35        $27.88        $23.67
                                                                       lesions.
17110.................  T....................  .....................  Destruct lesion, 1-14..   0010     0.6806       $36.95        $10.08         $7.39
17111.................  T....................  .....................  Destruct lesion, 15 or    0011     2.1800      $118.35        $27.88        $23.67
                                                                       more.
17250.................  T....................  .....................  Chemical cautery,         0013     1.1420       $62.00        $14.20        $12.40
                                                                       tissue.
17260.................  T....................  .....................  Destruction of skin       0015     1.5832       $85.95        $20.35        $17.19
                                                                       lesions.
17261.................  T....................  .....................  Destruction of skin       0015     1.5832       $85.95        $20.35        $17.19
                                                                       lesions.
17262.................  T....................  .....................  Destruction of skin       0015     1.5832       $85.95        $20.35        $17.19
                                                                       lesions.
17263.................  T....................  .....................  Destruction of skin       0015     1.5832       $85.95        $20.35        $17.19
                                                                       lesions.
17264.................  T....................  .....................  Destruction of skin       0015     1.5832       $85.95        $20.35        $17.19
                                                                       lesions.
17266.................  T....................  .....................  Destruction of skin       0016     2.7343      $148.44        $57.31        $29.69
                                                                       lesions.
17270.................  T....................  .....................  Destruction of skin       0015     1.5832       $85.95        $20.35        $17.19
                                                                       lesions.
17271.................  T....................  .....................  Destruction of skin       0013     1.1420       $62.00        $14.20        $12.40
                                                                       lesions.
17272.................  T....................  .....................  Destruction of skin       0015     1.5832       $85.95        $20.35        $17.19
                                                                       lesions.
17273.................  T....................  .....................  Destruction of skin       0015     1.5832       $85.95        $20.35        $17.19
                                                                       lesions.
17274.................  T....................  .....................  Destruction of skin       0016     2.7343      $148.44        $57.31        $29.69
                                                                       lesions.
17276.................  T....................  .....................  Destruction of skin       0016     2.7343      $148.44        $57.31        $29.69
                                                                       lesions.
17280.................  T....................  .....................  Destruction of skin       0015     1.5832       $85.95        $20.35        $17.19
                                                                       lesions.
17281.................  T....................  .....................  Destruction of skin       0015     1.5832       $85.95        $20.35        $17.19
                                                                       lesions.
17282.................  T....................  .....................  Destruction of skin       0015     1.5832       $85.95        $20.35        $17.19
                                                                       lesions.
17283.................  T....................  .....................  Destruction of skin       0015     1.5832       $85.95        $20.35        $17.19
                                                                       lesions.
17284.................  T....................  .....................  Destruction of skin       0016     2.7343      $148.44        $57.31        $29.69
                                                                       lesions.
17286.................  T....................  .....................  Destruction of skin       0015     1.5832       $85.95        $20.35        $17.19
                                                                       lesions.
17304.................  T....................  .....................  Chemosurgery of skin      0694     3.3272      $180.63        $72.25        $36.13
                                                                       lesion.
17305.................  T....................  .....................  2 stage mohs, up to 5     0694     3.3272      $180.63        $72.25        $36.13
                                                                       spec.
17306.................  T....................  .....................  3 stage mohs, up to 5     0694     3.3272      $180.63        $72.25        $36.13
                                                                       spec.
17307.................  T....................  .....................  Mohs addl stage up to 5   0694     3.3272      $180.63        $72.25        $36.13
                                                                       spec.
17310.................  T....................  .....................  Extensive skin            0694     3.3272      $180.63        $72.25        $36.13
                                                                       chemosurgery.
17340.................  T....................  .....................  Cryotherapy of skin....   0012     0.8203       $44.53        $11.18         $8.91
17360.................  T....................  .....................  Skin peel therapy......   0012     0.8203       $44.53        $11.18         $8.91
17380.................  T....................  .....................  Hair removal by           0012     0.8203       $44.53        $11.18         $8.91
                                                                       electrolysis.
17999.................  T....................  .....................  Skin tissue procedure..   0006     1.7487       $94.94        $24.12        $18.99
19000.................  T....................  .....................  Drainage of breast        0004     1.5774       $85.64        $22.10        $17.13
                                                                       lesion.
19001.................  T....................  .....................  Drain breast lesion add-  0004     1.5774       $85.64        $22.10        $17.13
                                                                       on.
19020.................  T....................  .....................  Incision of breast        0008    16.8303      $913.70  ............       $182.74
                                                                       lesion.
19030.................  N....................  .....................  Injection for breast x-  .....  .........  ...........  ............  ............
                                                                       ray.
19100.................  T....................  .....................  Bx breast percut w/o      0005     3.3675      $182.82        $71.59        $36.56
                                                                       image.
19101.................  T....................  .....................  Biopsy of breast, open.   0028    17.7459      $963.41       $303.74       $192.68
19102.................  T....................  .....................  Bx breast percut w/       0005     3.3675      $182.82        $71.59        $36.56
                                                                       image.
19103.................  T....................  .....................  Bx breast percut w/       0658     5.6035      $304.21  ............        $60.84
                                                                       device.
19110.................  T....................  .....................  Nipple exploration.....   0028    17.7459      $963.41       $303.74       $192.68
19112.................  T....................  .....................  Excise breast duct        0028    17.7459      $963.41       $303.74       $192.68
                                                                       fistula.
19120.................  T....................  .....................  Removal of breast         0028    17.7459      $963.41       $303.74       $192.68
                                                                       lesion.

[[Page 48040]]

 
19125.................  T....................  .....................  Excision, breast lesion   0028    17.7459      $963.41       $303.74       $192.68
19126.................  T....................  .....................  Excision, addl breast     0028    17.7459      $963.41       $303.74       $192.68
                                                                       lesion.
19140.................  T....................  .....................  Removal of breast         0028    17.7459      $963.41       $303.74       $192.68
                                                                       tissue.
19160.................  T....................  .....................  Removal of breast         0028    17.7459      $963.41       $303.74       $192.68
                                                                       tissue.
19162.................  T....................  .....................  Remove breast tissue,     0693    38.6469    $2,098.10       $798.17       $419.62
                                                                       nodes.
19180.................  T....................  .....................  Removal of breast......   0029    29.2783    $1,589.49       $632.64       $317.90
19182.................  T....................  .....................  Removal of breast......   0029    29.2783    $1,589.49       $632.64       $317.90
19200.................  C....................  .....................  Removal of breast......  .....  .........  ...........  ............  ............
19220.................  C....................  .....................  Removal of breast......  .....  .........  ...........  ............  ............
19240.................  T....................  .....................  Removal of breast......   0030    37.2809    $2,023.94       $763.55       $404.79
19260.................  T....................  .....................  Removal of chest wall     0021    14.5749      $791.26       $219.48       $158.25
                                                                       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,        0657     1.5630       $84.85  ............        $16.97
                                                                       percut.
19316.................  T....................  .....................  Suspension of breast...   0029    29.2783    $1,589.49       $632.64       $317.90
19318.................  T....................  .....................  Reduction of large        0693    38.6469    $2,098.10       $798.17       $419.62
                                                                       breast.
19324.................  T....................  .....................  Enlarge breast.........   0693    38.6469    $2,098.10       $798.17       $419.62
19325.................  T....................  .....................  Enlarge breast with       0648    55.5345    $3,014.91  ............       $602.98
                                                                       implant.
19328.................  T....................  .....................  Removal of breast         0029    29.2783    $1,589.49       $632.64       $317.90
                                                                       implant.
19330.................  T....................  .....................  Removal of implant        0029    29.2783    $1,589.49       $632.64       $317.90
                                                                       material.
19340.................  T....................  .....................  Immediate breast          0030    37.2809    $2,023.94       $763.55       $404.79
                                                                       prosthesis.
19342.................  T....................  .....................  Delayed breast            0648    55.5345    $3,014.91  ............       $602.98
                                                                       prosthesis.
19350.................  T....................  .....................  Breast reconstruction..   0029    29.2783    $1,589.49       $632.64       $317.90
19355.................  T....................  .....................  Correct inverted          0029    29.2783    $1,589.49       $632.64       $317.90
                                                                       nipple(s).
19357.................  T....................  .....................  Breast reconstruction..   0648    55.5345    $3,014.91  ............       $602.98
19361.................  C....................  .....................  Breast reconstruction..  .....  .........  ...........  ............  ............
19364.................  C....................  .....................  Breast reconstruction..  .....  .........  ...........  ............  ............
19366.................  T....................  .....................  Breast reconstruction..   0029    29.2783    $1,589.49       $632.64       $317.90
19367.................  C....................  .....................  Breast reconstruction..  .....  .........  ...........  ............  ............
19368.................  C....................  .....................  Breast reconstruction..  .....  .........  ...........  ............  ............
19369.................  C....................  .....................  Breast reconstruction..  .....  .........  ...........  ............  ............
19370.................  T....................  .....................  Surgery of breast         0029    29.2783    $1,589.49       $632.64       $317.90
                                                                       capsule.
19371.................  T....................  .....................  Removal of breast         0029    29.2783    $1,589.49       $632.64       $317.90
                                                                       capsule.
19380.................  T....................  .....................  Revise breast             0030    37.2809    $2,023.94       $763.55       $404.79
                                                                       reconstruction.
19396.................  T....................  .....................  Design custom breast      0029    29.2783    $1,589.49       $632.64       $317.90
                                                                       implant.
19499.................  T....................  .....................  Breast surgery            0028    17.7459      $963.41       $303.74       $192.68
                                                                       procedure.
20000.................  T....................  .....................  Incision of abscess....   0006     1.7487       $94.94        $24.12        $18.99
20005.................  T....................  .....................  Incision of deep          0049    19.9376    $1,082.39  ............       $216.48
                                                                       abscess.
20100.................  T....................  .....................  Explore wound, neck....   0023     3.1587      $171.48        $40.37        $34.30
20101.................  T....................  .....................  Explore wound, chest...   0027    15.8319      $859.50       $329.72       $171.90
20102.................  T....................  .....................  Explore wound, abdomen.   0027    15.8319      $859.50       $329.72       $171.90
20103.................  T....................  .....................  Explore wound,            0023     3.1587      $171.48        $40.37        $34.30
                                                                       extremity.
20150.................  T....................  .....................  Excise epiphyseal bar..   0051    34.9381    $1,896.75  ............       $379.35
20200.................  T....................  .....................  Muscle biopsy..........   0021    14.5749      $791.26       $219.48       $158.25
20205.................  T....................  .....................  Deep muscle biopsy.....   0021    14.5749      $791.26       $219.48       $158.25
20206.................  T....................  .....................  Needle biopsy, muscle..   0005     3.3675      $182.82        $71.59        $36.56
20220.................  T....................  .....................  Bone biopsy, trocar/      0019     3.9807      $216.11        $71.87        $43.22
                                                                       needle.
20225.................  T....................  .....................  Bone biopsy, trocar/      0020     7.3105      $396.88       $113.25        $79.38
                                                                       needle.
20240.................  T....................  .....................  Bone biopsy, excisional   0022    18.6725    $1,013.71       $354.45       $202.74
20245.................  T....................  .....................  Bone biopsy, excisional   0022    18.6725    $1,013.71       $354.45       $202.74
20250.................  T....................  .....................  Open bone biopsy.......   0049    19.9376    $1,082.39  ............       $216.48
20251.................  T....................  .....................  Open bone biopsy.......   0049    19.9376    $1,082.39  ............       $216.48
20500.................  T....................  .....................  Injection of sinus        0251     1.8643      $101.21  ............        $20.24
                                                                       tract.
20501.................  N....................  .....................  Inject sinus tract for   .....  .........  ...........  ............  ............
                                                                       x-ray.
20520.................  T....................  .....................  Removal of foreign body   0019     3.9807      $216.11        $71.87        $43.22
20525.................  T....................  .....................  Removal of foreign body   0022    18.6725    $1,013.71       $354.45       $202.74
20526.................  T....................  .....................  Ther injection, carp      0204     2.2209      $120.57        $40.13        $24.11
                                                                       tunnel.
20550.................  T....................  .....................  Inject tendon/ligament/   0204     2.2209      $120.57        $40.13        $24.11
                                                                       cyst.
20551.................  T....................  .....................  Inject tendon origin/     0204     2.2209      $120.57        $40.13        $24.11
                                                                       insert.
20552.................  T....................  .....................  Inject trigger point, 1   0204     2.2209      $120.57        $40.13        $24.11
                                                                       or 2.
20553.................  T....................  .....................  Inject trigger points,    0204     2.2209      $120.57        $40.13        $24.11
                                                                        3.
20600.................  T....................  .....................  Drain/inject, joint/      0204     2.2209      $120.57        $40.13        $24.11
                                                                       bursa.
20605.................  T....................  .....................  Drain/inject, joint/      0204     2.2209      $120.57        $40.13        $24.11
                                                                       bursa.
20610.................  T....................  .....................  Drain/inject, joint/      0204     2.2209      $120.57        $40.13        $24.11
                                                                       bursa.

[[Page 48041]]

 
20612.................  T....................  .....................  Aspirate/inj ganglion     0204     2.2209      $120.57        $40.13        $24.11
                                                                       cyst.
20615.................  T....................  .....................  Treatment of bone cyst.   0004     1.5774       $85.64        $22.10        $17.13
20650.................  T....................  .....................  Insert and remove bone    0049    19.9376    $1,082.39  ............       $216.48
                                                                       pin.
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       0340     0.6232       $33.83  ............         $6.77
                                                                       device.
20670.................  T....................  .....................  Removal of support        0021    14.5749      $791.26       $219.48       $158.25
                                                                       implant.
20680.................  T....................  .....................  Removal of support        0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       implant.
20690.................  T....................  .....................  Apply bone fixation       0050    25.1166    $1,363.56  ............       $272.71
                                                                       device.
20692.................  T....................  .....................  Apply bone fixation       0050    25.1166    $1,363.56  ............       $272.71
                                                                       device.
20693.................  T....................  .....................  Adjust bone fixation      0049    19.9376    $1,082.39  ............       $216.48
                                                                       device.
20694.................  T....................  .....................  Remove bone fixation      0049    19.9376    $1,082.39  ............       $216.48
                                                                       device.
20802.................  C....................  .....................  Replantation, arm,       .....  .........  ...........  ............  ............
                                                                       complete.
20805.................  C....................  .....................  Replant forearm,         .....  .........  ...........  ............  ............
                                                                       complete.
20808.................  C....................  .....................  Replantation hand,       .....  .........  ...........  ............  ............
                                                                       complete.
20816.................  C....................  .....................  Replantation digit,      .....  .........  ...........  ............  ............
                                                                       complete.
20822.................  C....................  .....................  Replantation digit,      .....  .........  ...........  ............  ............
                                                                       complete.
20824.................  C....................  .....................  Replantation thumb,      .....  .........  ...........  ............  ............
                                                                       complete.
20827.................  C....................  .....................  Replantation thumb,      .....  .........  ...........  ............  ............
                                                                       complete.
20838.................  C....................  .....................  Replantation foot,       .....  .........  ...........  ............  ............
                                                                       complete.
20900.................  T....................  .....................  Removal of bone for       0050    25.1166    $1,363.56  ............       $272.71
                                                                       graft.
20902.................  T....................  .....................  Removal of bone for       0050    25.1166    $1,363.56  ............       $272.71
                                                                       graft.
20910.................  T....................  .....................  Remove cartilage for      0027    15.8319      $859.50       $329.72       $171.90
                                                                       graft.
20912.................  T....................  .....................  Remove cartilage for      0027    15.8319      $859.50       $329.72       $171.90
                                                                       graft.
20920.................  T....................  .....................  Removal of fascia for     0027    15.8319      $859.50       $329.72       $171.90
                                                                       graft.
20922.................  T....................  .....................  Removal of fascia for     0027    15.8319      $859.50       $329.72       $171.90
                                                                       graft.
20924.................  T....................  .....................  Removal of tendon for     0050    25.1166    $1,363.56  ............       $272.71
                                                                       graft.
20926.................  T....................  .....................  Removal of tissue for     0027    15.8319      $859.50       $329.72       $171.90
                                                                       graft.
20930.................  C....................  .....................  Spinal bone allograft..  .....  .........  ...........  ............  ............
20931.................  C....................  .....................  Spinal bone allograft..  .....  .........  ...........  ............  ............
20936.................  C....................  .....................  Spinal bone autograft..  .....  .........  ...........  ............  ............
20937.................  C....................  .....................  Spinal bone autograft..  .....  .........  ...........  ............  ............
20938.................  C....................  .....................  Spinal bone autograft..  .....  .........  ...........  ............  ............
20950.................  T....................  .....................  Fluid pressure, muscle.   0006     1.7487       $94.94        $24.12        $18.99
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           0049    19.9376    $1,082.39  ............       $216.48
                                                                       stimulation.
20979.................  A....................  .....................  Us bone stimulation....  .....  .........  ...........  ............  ............
20999.................  T....................  .....................  Musculoskeletal surgery   0049    19.9376    $1,082.39  ............       $216.48
21010.................  T....................  .....................  Incision of jaw joint..   0254    21.4368    $1,163.78       $321.35       $232.76
21015.................  T....................  .....................  Resection of facial       0253    15.1698      $823.55       $282.29       $164.71
                                                                       tumor.
21025.................  T....................  .....................  Excision of bone, lower   0256    35.0866    $1,904.82  ............       $380.96
                                                                       jaw.
21026.................  T....................  .....................  Excision of facial        0256    35.0866    $1,904.82  ............       $380.96
                                                                       bone(s).
21029.................  T....................  .....................  Contour of face bone      0256    35.0866    $1,904.82  ............       $380.96
                                                                       lesion.
21030.................  T....................  .....................  Removal of face bone      0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       lesion.
21031.................  T....................  .....................  Remove exostosis,         0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       mandible.
21032.................  T....................  .....................  Remove exostosis,         0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       maxilla.
21034.................  T....................  .....................  Removal of face bone      0256    35.0866    $1,904.82  ............       $380.96
                                                                       lesion.
21040.................  T....................  .....................  Removal of jaw bone       0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       lesion.
21044.................  T....................  .....................  Removal of jaw bone       0256    35.0866    $1,904.82  ............       $380.96
                                                                       lesion.
21045.................  C....................  .....................  Extensive jaw surgery..  .....  .........  ...........  ............  ............
21046.................  T....................  .....................  Remove mandible cyst      0256    35.0866    $1,904.82  ............       $380.96
                                                                       complex.
21047.................  T....................  .....................  Excise lwr jaw cyst w/    0256    35.0866    $1,904.82  ............       $380.96
                                                                       repair.
21048.................  T....................  .....................  Remove maxilla cyst       0256    35.0866    $1,904.82  ............       $380.96
                                                                       complex.
21049.................  T....................  .....................  Excis uppr jaw cyst w/    0256    35.0866    $1,904.82  ............       $380.96
                                                                       repair.
21050.................  T....................  .....................  Removal of jaw joint...   0256    35.0866    $1,904.82  ............       $380.96

[[Page 48042]]

 
21060.................  T....................  .....................  Remove jaw joint          0256    35.0866    $1,904.82  ............       $380.96
                                                                       cartilage.
21070.................  T....................  .....................  Remove coronoid process   0256    35.0866    $1,904.82  ............       $380.96
21076.................  T....................  .....................  Prepare face/oral         0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       prosthesis.
21077.................  T....................  .....................  Prepare face/oral         0256    35.0866    $1,904.82  ............       $380.96
                                                                       prosthesis.
21079.................  T....................  .....................  Prepare face/oral         0256    35.0866    $1,904.82  ............       $380.96
                                                                       prosthesis.
21080.................  T....................  .....................  Prepare face/oral         0256    35.0866    $1,904.82  ............       $380.96
                                                                       prosthesis.
21081.................  T....................  .....................  Prepare face/oral         0256    35.0866    $1,904.82  ............       $380.96
                                                                       prosthesis.
21082.................  T....................  .....................  Prepare face/oral         0256    35.0866    $1,904.82  ............       $380.96
                                                                       prosthesis.
21083.................  T....................  .....................  Prepare face/oral         0256    35.0866    $1,904.82  ............       $380.96
                                                                       prosthesis.
21084.................  T....................  .....................  Prepare face/oral         0256    35.0866    $1,904.82  ............       $380.96
                                                                       prosthesis.
21085.................  T....................  .....................  Prepare face/oral         0253    15.1698      $823.55       $282.29       $164.71
                                                                       prosthesis.
21086.................  T....................  .....................  Prepare face/oral         0256    35.0866    $1,904.82  ............       $380.96
                                                                       prosthesis.
21087.................  T....................  .....................  Prepare face/oral         0256    35.0866    $1,904.82  ............       $380.96
                                                                       prosthesis.
21088.................  T....................  .....................  Prepare face/oral         0256    35.0866    $1,904.82  ............       $380.96
                                                                       prosthesis.
21089.................  T....................  .....................  Prepare face/oral         0253    15.1698      $823.55       $282.29       $164.71
                                                                       prosthesis.
21100.................  T....................  .....................  Maxillofacial fixation.   0256    35.0866    $1,904.82  ............       $380.96
21110.................  T....................  .....................  Interdental fixation...   0252     6.5416      $355.14       $113.41        $71.03
21116.................  N....................  .....................  Injection, jaw joint x-  .....  .........  ...........  ............  ............
                                                                       ray.
21120.................  T....................  .....................  Reconstruction of chin.   0254    21.4368    $1,163.78       $321.35       $232.76
21121.................  T....................  .....................  Reconstruction of chin.   0254    21.4368    $1,163.78       $321.35       $232.76
21122.................  T....................  .....................  Reconstruction of chin.   0254    21.4368    $1,163.78       $321.35       $232.76
21123.................  T....................  .....................  Reconstruction of chin.   0254    21.4368    $1,163.78       $321.35       $232.76
21125.................  T....................  .....................  Augmentation, lower jaw   0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       bone.
21127.................  T....................  .....................  Augmentation, lower jaw   0256    35.0866    $1,904.82  ............       $380.96
                                                                       bone.
21137.................  T....................  .....................  Reduction of forehead..   0254    21.4368    $1,163.78       $321.35       $232.76
21138.................  T....................  .....................  Reduction of forehead..   0256    35.0866    $1,904.82  ............       $380.96
21139.................  T....................  .....................  Reduction of forehead..   0256    35.0866    $1,904.82  ............       $380.96
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      0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       lesion.
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          0256    35.0866    $1,904.82  ............       $380.96
                                                                       segment.
21199.................  T....................  .....................  Reconstr lwr jaw w/       0256    35.0866    $1,904.82  ............       $380.96
                                                                       advance.
21206.................  T....................  .....................  Reconstruct upper jaw     0256    35.0866    $1,904.82  ............       $380.96
                                                                       bone.
21208.................  T....................  .....................  Augmentation of facial    0256    35.0866    $1,904.82  ............       $380.96
                                                                       bones.
21209.................  T....................  .....................  Reduction of facial       0256    35.0866    $1,904.82  ............       $380.96
                                                                       bones.
21210.................  T....................  .....................  Face bone graft........   0256    35.0866    $1,904.82  ............       $380.96
21215.................  T....................  .....................  Lower jaw bone graft...   0256    35.0866    $1,904.82  ............       $380.96
21230.................  T....................  .....................  Rib cartilage graft....   0256    35.0866    $1,904.82  ............       $380.96
21235.................  T....................  .....................  Ear cartilage graft....   0254    21.4368    $1,163.78       $321.35       $232.76
21240.................  T....................  .....................  Reconstruction of jaw     0256    35.0866    $1,904.82  ............       $380.96
                                                                       joint.
21242.................  T....................  .....................  Reconstruction of jaw     0256    35.0866    $1,904.82  ............       $380.96
                                                                       joint.
21243.................  T....................  .....................  Reconstruction of jaw     0256    35.0866    $1,904.82  ............       $380.96
                                                                       joint.
21244.................  T....................  .....................  Reconstruction of lower   0256    35.0866    $1,904.82  ............       $380.96
                                                                       jaw.
21245.................  T....................  .....................  Reconstruction of jaw..   0256    35.0866    $1,904.82  ............       $380.96

[[Page 48043]]

 
21246.................  T....................  .....................  Reconstruction of jaw..   0256    35.0866    $1,904.82  ............       $380.96
21247.................  C....................  .....................  Reconstruct lower jaw    .....  .........  ...........  ............  ............
                                                                       bone.
21248.................  T....................  .....................  Reconstruction of jaw..   0256    35.0866    $1,904.82  ............       $380.96
21249.................  T....................  .....................  Reconstruction of jaw..   0256    35.0866    $1,904.82  ............       $380.96
21255.................  C....................  .....................  Reconstruct lower jaw    .....  .........  ...........  ............  ............
                                                                       bone.
21256.................  C....................  .....................  Reconstruction of orbit  .....  .........  ...........  ............  ............
21260.................  T....................  .....................  Revise eye sockets.....   0256    35.0866    $1,904.82  ............       $380.96
21261.................  T....................  .....................  Revise eye sockets.....   0256    35.0866    $1,904.82  ............       $380.96
21263.................  T....................  .....................  Revise eye sockets.....   0256    35.0866    $1,904.82  ............       $380.96
21267.................  T....................  .....................  Revise eye sockets.....   0256    35.0866    $1,904.82  ............       $380.96
21268.................  C....................  .....................  Revise eye sockets.....  .....  .........  ...........  ............  ............
21270.................  T....................  .....................  Augmentation, cheek       0256    35.0866    $1,904.82  ............       $380.96
                                                                       bone.
21275.................  T....................  .....................  Revision, orbitofacial    0256    35.0866    $1,904.82  ............       $380.96
                                                                       bones.
21280.................  T....................  .....................  Revision of eyelid.....   0256    35.0866    $1,904.82  ............       $380.96
21282.................  T....................  .....................  Revision of eyelid.....   0253    15.1698      $823.55       $282.29       $164.71
21295.................  T....................  .....................  Revision of jaw muscle/   0252     6.5416      $355.14       $113.41        $71.03
                                                                       bone.
21296.................  T....................  .....................  Revision of jaw muscle/   0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       bone.
21299.................  T....................  .....................  Cranio/maxillofacial      0253    15.1698      $823.55       $282.29       $164.71
                                                                       surgery.
21300.................  T....................  .....................  Treatment of skull        0253    15.1698      $823.55       $282.29       $164.71
                                                                       fracture.
21310.................  X....................  .....................  Treatment of nose         0340     0.6232       $33.83  ............         $6.77
                                                                       fracture.
21315.................  X....................  .....................  Treatment of nose         0340     0.6232       $33.83  ............         $6.77
                                                                       fracture.
21320.................  X....................  .....................  Treatment of nose         0340     0.6232       $33.83  ............         $6.77
                                                                       fracture.
21325.................  T....................  .....................  Treatment of nose         0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       fracture.
21330.................  T....................  .....................  Treatment of nose         0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       fracture.
21335.................  T....................  .....................  Treatment of nose         0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       fracture.
21336.................  T....................  .....................  Treat nasal septal        0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
21337.................  T....................  .....................  Treat nasal septal        0253    15.1698      $823.55       $282.29       $164.71
                                                                       fracture.
21338.................  T....................  .....................  Treat nasoethmoid         0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       fracture.
21339.................  T....................  .....................  Treat nasoethmoid         0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       fracture.
21340.................  T....................  .....................  Treatment of nose         0256    35.0866    $1,904.82  ............       $380.96
                                                                       fracture.
21343.................  C....................  .....................  Treatment of sinus       .....  .........  ...........  ............  ............
                                                                       fracture.
21344.................  C....................  .....................  Treatment of sinus       .....  .........  ...........  ............  ............
                                                                       fracture.
21345.................  T....................  .....................  Treat nose/jaw fracture   0254    21.4368    $1,163.78       $321.35       $232.76
21346.................  C....................  .....................  Treat nose/jaw fracture  .....  .........  ...........  ............  ............
21347.................  C....................  .....................  Treat nose/jaw fracture  .....  .........  ...........  ............  ............
21348.................  C....................  .....................  Treat nose/jaw fracture  .....  .........  ...........  ............  ............
21355.................  T....................  .....................  Treat cheek bone          0256    35.0866    $1,904.82  ............       $380.96
                                                                       fracture.
21356.................  C....................  .....................  Treat cheek bone         .....  .........  ...........  ............  ............
                                                                       fracture.
21360.................  C....................  .....................  Treat cheek bone         .....  .........  ...........  ............  ............
                                                                       fracture.
21365.................  C....................  .....................  Treat cheek bone         .....  .........  ...........  ............  ............
                                                                       fracture.
21366.................  C....................  .....................  Treat cheek bone         .....  .........  ...........  ............  ............
                                                                       fracture.
21385.................  C....................  .....................  Treat eye socket         .....  .........  ...........  ............  ............
                                                                       fracture.
21386.................  C....................  .....................  Treat eye socket         .....  .........  ...........  ............  ............
                                                                       fracture.
21387.................  C....................  .....................  Treat eye socket         .....  .........  ...........  ............  ............
                                                                       fracture.
21390.................  T....................  .....................  Treat eye socket          0256    35.0866    $1,904.82  ............       $380.96
                                                                       fracture.
21395.................  C....................  .....................  Treat eye socket         .....  .........  ...........  ............  ............
                                                                       fracture.
21400.................  T....................  .....................  Treat eye socket          0252     6.5416      $355.14       $113.41        $71.03
                                                                       fracture.
21401.................  T....................  .....................  Treat eye socket          0253    15.1698      $823.55       $282.29       $164.71
                                                                       fracture.
21406.................  T....................  .....................  Treat eye socket          0256    35.0866    $1,904.82  ............       $380.96
                                                                       fracture.
21407.................  T....................  .....................  Treat eye socket          0256    35.0866    $1,904.82  ............       $380.96
                                                                       fracture.
21408.................  C....................  .....................  Treat eye socket         .....  .........  ...........  ............  ............
                                                                       fracture.
21421.................  T....................  .....................  Treat mouth roof          0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       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.
21440.................  T....................  .....................  Treat dental ridge        0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       fracture.
21445.................  T....................  .....................  Treat dental ridge        0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       fracture.
21450.................  T....................  .....................  Treat lower jaw           0251     1.8643      $101.21  ............        $20.24
                                                                       fracture.
21451.................  T....................  .....................  Treat lower jaw           0252     6.5416      $355.14       $113.41        $71.03
                                                                       fracture.
21452.................  T....................  .....................  Treat lower jaw           0253    15.1698      $823.55       $282.29       $164.71
                                                                       fracture.
21453.................  T....................  .....................  Treat lower jaw           0256    35.0866    $1,904.82  ............       $380.96
                                                                       fracture.
21454.................  T....................  .....................  Treat lower jaw           0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       fracture.

[[Page 48044]]

 
21461.................  T....................  .....................  Treat lower jaw           0256    35.0866    $1,904.82  ............       $380.96
                                                                       fracture.
21462.................  T....................  .....................  Treat lower jaw           0256    35.0866    $1,904.82  ............       $380.96
                                                                       fracture.
21465.................  T....................  .....................  Treat lower jaw           0256    35.0866    $1,904.82  ............       $380.96
                                                                       fracture.
21470.................  T....................  .....................  Treat lower jaw           0256    35.0866    $1,904.82  ............       $380.96
                                                                       fracture.
21480.................  T....................  .....................  Reset dislocated jaw...   0251     1.8643      $101.21  ............        $20.24
21485.................  T....................  .....................  Reset dislocated jaw...   0253    15.1698      $823.55       $282.29       $164.71
21490.................  T....................  .....................  Repair dislocated jaw..   0256    35.0866    $1,904.82  ............       $380.96
21493.................  T....................  .....................  Treat hyoid bone          0252     6.5416      $355.14       $113.41        $71.03
                                                                       fracture.
21494.................  T....................  .....................  Treat hyoid bone          0252     6.5416      $355.14       $113.41        $71.03
                                                                       fracture.
21495.................  C....................  .....................  Treat hyoid bone         .....  .........  ...........  ............  ............
                                                                       fracture.
21497.................  T....................  .....................  Interdental wiring.....   0253    15.1698      $823.55       $282.29       $164.71
21499.................  T....................  .....................  Head surgery procedure.   0253    15.1698      $823.55       $282.29       $164.71
21501.................  T....................  .....................  Drain neck/chest lesion   0008    16.8303      $913.70  ............       $182.74
21502.................  T....................  .....................  Drain chest lesion.....   0049    19.9376    $1,082.39  ............       $216.48
21510.................  C....................  .....................  Drainage of bone lesion  .....  .........  ...........  ............  ............
21550.................  T....................  .....................  Biopsy of neck/chest...   0021    14.5749      $791.26       $219.48       $158.25
21555.................  T....................  .....................  Remove lesion, neck/      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       chest.
21556.................  T....................  .....................  Remove lesion, neck/      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       chest.
21557.................  C....................  .....................  Remove tumor, neck/      .....  .........  ...........  ............  ............
                                                                       chest.
21600.................  T....................  .....................  Partial removal of rib.   0050    25.1166    $1,363.56  ............       $272.71
21610.................  T....................  .....................  Partial removal of rib.   0050    25.1166    $1,363.56  ............       $272.71
21615.................  C....................  .....................  Removal of rib.........  .....  .........  ...........  ............  ............
21616.................  C....................  .....................  Removal of rib and       .....  .........  ...........  ............  ............
                                                                       nerves.
21620.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       sternum.
21627.................  C....................  .....................  Sternal debridement....  .....  .........  ...........  ............  ............
21630.................  C....................  .....................  Extensive sternum        .....  .........  ...........  ............  ............
                                                                       surgery.
21632.................  C....................  .....................  Extensive sternum        .....  .........  ...........  ............  ............
                                                                       surgery.
21700.................  T....................  .....................  Revision of neck muscle   0049    19.9376    $1,082.39  ............       $216.48
21705.................  C....................  .....................  Revision of neck muscle/ .....  .........  ...........  ............  ............
                                                                       rib.
21720.................  T....................  .....................  Revision of neck muscle   0049    19.9376    $1,082.39  ............       $216.48
21725.................  T....................  .....................  Revision of neck muscle   0006     1.7487       $94.94        $24.12        $18.99
21740.................  C....................  .....................  Reconstruction of        .....  .........  ...........  ............  ............
                                                                       sternum.
21742.................  T....................  .....................  Repair stern/nuss w/o     0051    34.9381    $1,896.75  ............       $379.35
                                                                       scope.
21743.................  T....................  .....................  Repair sternum/nuss w/    0051    34.9381    $1,896.75  ............       $379.35
                                                                       scope.
21750.................  C....................  .....................  Repair of sternum        .....  .........  ...........  ............  ............
                                                                       separation.
21800.................  T....................  .....................  Treatment of rib          0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
21805.................  T....................  .....................  Treatment of rib          0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
21810.................  C....................  .....................  Treatment of rib         .....  .........  ...........  ............  ............
                                                                       fracture(s).
21820.................  T....................  .....................  Treat sternum fracture.   0043     1.9233      $104.41  ............        $20.88
21825.................  C....................  .....................  Treat sternum fracture.  .....  .........  ...........  ............  ............
21899.................  T....................  .....................  Neck/chest surgery        0252     6.5416      $355.14       $113.41        $71.03
                                                                       procedure.
21920.................  T....................  .....................  Biopsy soft tissue of     0020     7.3105      $396.88       $113.25        $79.38
                                                                       back.
21925.................  T....................  .....................  Biopsy soft tissue of     0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       back.
21930.................  T....................  .....................  Remove lesion, back or    0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       flank.
21935.................  T....................  .....................  Remove tumor, back.....   0022    18.6725    $1,013.71       $354.45       $202.74
22100.................  T....................  .....................  Remove part of neck       0208    40.6521    $2,206.96  ............       $441.39
                                                                       vertebra.
22101.................  T....................  .....................  Remove part, thorax       0208    40.6521    $2,206.96  ............       $441.39
                                                                       vertebra.
22102.................  T....................  .....................  Remove part, lumbar       0208    40.6521    $2,206.96  ............       $441.39
                                                                       vertebra.
22103.................  T....................  .....................  Remove extra spine        0208    40.6521    $2,206.96  ............       $441.39
                                                                       segment.
22110.................  C....................  .....................  Remove part of neck      .....  .........  ...........  ............  ............
                                                                       vertebra.
22112.................  C....................  .....................  Remove part, thorax      .....  .........  ...........  ............  ............
                                                                       vertebra.
22114.................  C....................  .....................  Remove part, lumbar      .....  .........  ...........  ............  ............
                                                                       vertebra.
22116.................  C....................  .....................  Remove extra spine       .....  .........  ...........  ............  ............
                                                                       segment.
22210.................  C....................  .....................  Revision of neck spine.  .....  .........  ...........  ............  ............
22212.................  C....................  .....................  Revision of thorax       .....  .........  ...........  ............  ............
                                                                       spine.
22214.................  C....................  .....................  Revision of lumbar       .....  .........  ...........  ............  ............
                                                                       spine.
22216.................  C....................  .....................  Revise, extra spine      .....  .........  ...........  ............  ............
                                                                       segment.
22220.................  C....................  .....................  Revision of neck spine.  .....  .........  ...........  ............  ............
22222.................  C....................  .....................  Revision of thorax       .....  .........  ...........  ............  ............
                                                                       spine.
22224.................  C....................  .....................  Revision of lumbar       .....  .........  ...........  ............  ............
                                                                       spine.
22226.................  C....................  .....................  Revise, extra spine      .....  .........  ...........  ............  ............
                                                                       segment.
22305.................  T....................  .....................  Treat spine process       0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
22310.................  T....................  .....................  Treat spine fracture...   0043     1.9233      $104.41  ............        $20.88
22315.................  T....................  .....................  Treat spine fracture...   0043     1.9233      $104.41  ............        $20.88
22318.................  C....................  .....................  Treat odontoid fx w/o    .....  .........  ...........  ............  ............
                                                                       graft.
22319.................  C....................  .....................  Treat odontoid fx w/     .....  .........  ...........  ............  ............
                                                                       graft.

[[Page 48045]]

 
22325.................  C....................  .....................  Treat spine fracture...  .....  .........  ...........  ............  ............
22326.................  C....................  .....................  Treat neck spine         .....  .........  ...........  ............  ............
                                                                       fracture.
22327.................  C....................  .....................  Treat thorax spine       .....  .........  ...........  ............  ............
                                                                       fracture.
22328.................  C....................  .....................  Treat each add spine fx  .....  .........  ...........  ............  ............
22505.................  T....................  .....................  Manipulation of spine..   0045    13.5546      $735.87       $268.47       $147.17
22520.................  T....................  .....................  Percut vertebroplasty     0050    25.1166    $1,363.56  ............       $272.71
                                                                       thor.
22521.................  T....................  .....................  Percut vertebroplasty     0050    25.1166    $1,363.56  ............       $272.71
                                                                       lumb.
22522.................  T....................  .....................  Percut vertebroplasty     0050    25.1166    $1,363.56  ............       $272.71
                                                                       addl.
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    40.6521    $2,206.96  ............       $441.39
22614.................  T....................  .....................  Spine fusion, extra       0208    40.6521    $2,206.96  ............       $441.39
                                                                       segment.
22630.................  C....................  .....................  Lumbar spine fusion....  .....  .........  ...........  ............  ............
22632.................  C....................  .....................  Spine fusion, extra      .....  .........  ...........  ............  ............
                                                                       segment.
22800.................  C....................  .....................  Fusion of spine........  .....  .........  ...........  ............  ............
22802.................  C....................  .....................  Fusion of spine........  .....  .........  ...........  ............  ............
22804.................  C....................  .....................  Fusion of spine........  .....  .........  ...........  ............  ............
22808.................  C....................  .....................  Fusion of spine........  .....  .........  ...........  ............  ............
22810.................  C....................  .....................  Fusion of spine........  .....  .........  ...........  ............  ............
22812.................  C....................  .....................  Fusion of spine........  .....  .........  ...........  ............  ............
22818.................  C....................  .....................  Kyphectomy, 1-2          .....  .........  ...........  ............  ............
                                                                       segments.
22819.................  C....................  .....................  Kyphectomy, 3 or more..  .....  .........  ...........  ............  ............
22830.................  C....................  .....................  Exploration of spinal    .....  .........  ...........  ............  ............
                                                                       fusion.
22840.................  C....................  .....................  Insert spine fixation    .....  .........  ...........  ............  ............
                                                                       device.
22841.................  C....................  .....................  Insert spine fixation    .....  .........  ...........  ............  ............
                                                                       device.
22842.................  C....................  .....................  Insert spine fixation    .....  .........  ...........  ............  ............
                                                                       device.
22843.................  C....................  .....................  Insert spine fixation    .....  .........  ...........  ............  ............
                                                                       device.
22844.................  C....................  .....................  Insert spine fixation    .....  .........  ...........  ............  ............
                                                                       device.
22845.................  C....................  .....................  Insert spine fixation    .....  .........  ...........  ............  ............
                                                                       device.
22846.................  C....................  .....................  Insert spine fixation    .....  .........  ...........  ............  ............
                                                                       device.
22847.................  C....................  .....................  Insert spine fixation    .....  .........  ...........  ............  ............
                                                                       device.
22848.................  C....................  .....................  Insert pelv fixation     .....  .........  ...........  ............  ............
                                                                       device.
22849.................  C....................  .....................  Reinsert spinal          .....  .........  ...........  ............  ............
                                                                       fixation.
22850.................  C....................  .....................  Remove spine fixation    .....  .........  ...........  ............  ............
                                                                       device.
22851.................  C....................  .....................  Apply spine prosth       .....  .........  ...........  ............  ............
                                                                       device.
22852.................  C....................  .....................  Remove spine fixation    .....  .........  ...........  ............  ............
                                                                       device.
22855.................  C....................  .....................  Remove spine fixation    .....  .........  ...........  ............  ............
                                                                       device.
22899.................  T....................  .....................  Spine surgery procedure   0043     1.9233      $104.41  ............        $20.88
22900.................  T....................  .....................  Remove abdominal wall     0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       lesion.
22999.................  T....................  .....................  Abdomen surgery           0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       procedure.
23000.................  T....................  .....................  Removal of calcium        0021    14.5749      $791.26       $219.48       $158.25
                                                                       deposits.
23020.................  T....................  .....................  Release shoulder joint.   0051    34.9381    $1,896.75  ............       $379.35
23030.................  T....................  .....................  Drain shoulder lesion..   0008    16.8303      $913.70  ............       $182.74
23031.................  T....................  .....................  Drain shoulder bursa...   0008    16.8303      $913.70  ............       $182.74
23035.................  T....................  .....................  Drain shoulder bone       0049    19.9376    $1,082.39  ............       $216.48
                                                                       lesion.
23040.................  T....................  .....................  Exploratory shoulder      0050    25.1166    $1,363.56  ............       $272.71
                                                                       surgery.
23044.................  T....................  .....................  Exploratory shoulder      0050    25.1166    $1,363.56  ............       $272.71
                                                                       surgery.
23065.................  T....................  .....................  Biopsy shoulder tissues   0021    14.5749      $791.26       $219.48       $158.25
23066.................  T....................  .....................  Biopsy shoulder tissues   0022    18.6725    $1,013.71       $354.45       $202.74
23075.................  T....................  .....................  Removal of shoulder       0021    14.5749      $791.26       $219.48       $158.25
                                                                       lesion.
23076.................  T....................  .....................  Removal of shoulder       0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       lesion.
23077.................  T....................  .....................  Remove tumor of           0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       shoulder.
23100.................  T....................  .....................  Biopsy of shoulder        0049    19.9376    $1,082.39  ............       $216.48
                                                                       joint.
23101.................  T....................  .....................  Shoulder joint surgery.   0050    25.1166    $1,363.56  ............       $272.71
23105.................  T....................  .....................  Remove shoulder joint     0050    25.1166    $1,363.56  ............       $272.71
                                                                       lining.
23106.................  T....................  .....................  Incision of collarbone    0050    25.1166    $1,363.56  ............       $272.71
                                                                       joint.
23107.................  T....................  .....................  Explore treat shoulder    0050    25.1166    $1,363.56  ............       $272.71
                                                                       joint.
23120.................  T....................  .....................  Partial removal, collar   0051    34.9381    $1,896.75  ............       $379.35
                                                                       bone.
23125.................  T....................  .....................  Removal of collar bone.   0051    34.9381    $1,896.75  ............       $379.35

[[Page 48046]]

 
23130.................  T....................  .....................  Remove shoulder bone,     0051    34.9381    $1,896.75  ............       $379.35
                                                                       part.
23140.................  T....................  .....................  Removal of bone lesion.   0049    19.9376    $1,082.39  ............       $216.48
23145.................  T....................  .....................  Removal of bone lesion.   0050    25.1166    $1,363.56  ............       $272.71
23146.................  T....................  .....................  Removal of bone lesion.   0050    25.1166    $1,363.56  ............       $272.71
23150.................  T....................  .....................  Removal of humerus        0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
23155.................  T....................  .....................  Removal of humerus        0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
23156.................  T....................  .....................  Removal of humerus        0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
23170.................  T....................  .....................  Remove collar bone        0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
23172.................  T....................  .....................  Remove shoulder blade     0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
23174.................  T....................  .....................  Remove humerus lesion..   0050    25.1166    $1,363.56  ............       $272.71
23180.................  T....................  .....................  Remove collar bone        0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
23182.................  T....................  .....................  Remove shoulder blade     0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
23184.................  T....................  .....................  Remove humerus lesion..   0050    25.1166    $1,363.56  ............       $272.71
23190.................  T....................  .....................  Partial removal of        0050    25.1166    $1,363.56  ............       $272.71
                                                                       scapula.
23195.................  T....................  .....................  Removal of head of        0050    25.1166    $1,363.56  ............       $272.71
                                                                       humerus.
23200.................  C....................  .....................  Removal of collar bone.  .....  .........  ...........  ............  ............
23210.................  C....................  .....................  Removal of shoulder      .....  .........  ...........  ............  ............
                                                                       blade.
23220.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       humerus.
23221.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       humerus.
23222.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       humerus.
23330.................  T....................  .....................  Remove shoulder foreign   0020     7.3105      $396.88       $113.25        $79.38
                                                                       body.
23331.................  T....................  .....................  Remove shoulder foreign   0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       body.
23332.................  C....................  .....................  Remove shoulder foreign  .....  .........  ...........  ............  ............
                                                                       body.
23350.................  N....................  .....................  Injection for shoulder   .....  .........  ...........  ............  ............
                                                                       x-ray.
23395.................  T....................  .....................  Muscle                    0051    34.9381    $1,896.75  ............       $379.35
                                                                       transfer,shoulder/arm.
23397.................  T....................  .....................  Muscle transfers.......   0052    42.6430    $2,315.05  ............       $463.01
23400.................  T....................  .....................  Fixation of shoulder      0050    25.1166    $1,363.56  ............       $272.71
                                                                       blade.
23405.................  T....................  .....................  Incision of tendon &      0050    25.1166    $1,363.56  ............       $272.71
                                                                       muscle.
23406.................  T....................  .....................  Incise tendon(s) &        0050    25.1166    $1,363.56  ............       $272.71
                                                                       muscle(s).
23410.................  T....................  .....................  Repair of tendon(s)....   0052    42.6430    $2,315.05  ............       $463.01
23412.................  T....................  .....................  Repair rotator cuff,      0052    42.6430    $2,315.05  ............       $463.01
                                                                       chronic.
23415.................  T....................  .....................  Release of shoulder       0051    34.9381    $1,896.75  ............       $379.35
                                                                       ligament.
23420.................  T....................  .....................  Repair of shoulder.....   0052    42.6430    $2,315.05  ............       $463.01
23430.................  T....................  .....................  Repair biceps tendon...   0052    42.6430    $2,315.05  ............       $463.01
23440.................  T....................  .....................  Remove/transplant         0052    42.6430    $2,315.05  ............       $463.01
                                                                       tendon.
23450.................  T....................  .....................  Repair shoulder capsule   0052    42.6430    $2,315.05  ............       $463.01
23455.................  T....................  .....................  Repair shoulder capsule   0052    42.6430    $2,315.05  ............       $463.01
23460.................  T....................  .....................  Repair shoulder capsule   0052    42.6430    $2,315.05  ............       $463.01
23462.................  T....................  .....................  Repair shoulder capsule   0052    42.6430    $2,315.05  ............       $463.01
23465.................  T....................  .....................  Repair shoulder capsule   0052    42.6430    $2,315.05  ............       $463.01
23466.................  T....................  .....................  Repair shoulder capsule   0052    42.6430    $2,315.05  ............       $463.01
23470.................  T....................  .....................  Reconstruct shoulder      0048    47.4707    $2,577.14       $695.60       $515.43
                                                                       joint.
23472.................  C....................  .....................  Reconstruct shoulder     .....  .........  ...........  ............  ............
                                                                       joint.
23480.................  T....................  .....................  Revision of collar bone   0051    34.9381    $1,896.75  ............       $379.35
23485.................  T....................  .....................  Revision of collar bone   0051    34.9381    $1,896.75  ............       $379.35
23490.................  T....................  .....................  Reinforce clavicle.....   0051    34.9381    $1,896.75  ............       $379.35
23491.................  T....................  .....................  Reinforce shoulder        0051    34.9381    $1,896.75  ............       $379.35
                                                                       bones.
23500.................  T....................  .....................  Treat clavicle fracture   0043     1.9233      $104.41  ............        $20.88
23505.................  T....................  .....................  Treat clavicle fracture   0043     1.9233      $104.41  ............        $20.88
23515.................  T....................  .....................  Treat clavicle fracture   0046    31.9719    $1,735.72       $535.76       $347.14
23520.................  T....................  .....................  Treat clavicle            0043     1.9233      $104.41  ............        $20.88
                                                                       dislocation.
23525.................  T....................  .....................  Treat clavicle            0043     1.9233      $104.41  ............        $20.88
                                                                       dislocation.
23530.................  T....................  .....................  Treat clavicle            0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       dislocation.
23532.................  T....................  .....................  Treat clavicle            0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       dislocation.
23540.................  T....................  .....................  Treat clavicle            0043     1.9233      $104.41  ............        $20.88
                                                                       dislocation.
23545.................  T....................  .....................  Treat clavicle            0043     1.9233      $104.41  ............        $20.88
                                                                       dislocation.
23550.................  T....................  .....................  Treat clavicle            0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       dislocation.
23552.................  T....................  .....................  Treat clavicle            0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       dislocation.
23570.................  T....................  .....................  Treat shoulder blade fx   0043     1.9233      $104.41  ............        $20.88
23575.................  T....................  .....................  Treat shoulder blade fx   0043     1.9233      $104.41  ............        $20.88
23585.................  T....................  .....................  Treat scapula fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
23600.................  T....................  .....................  Treat humerus fracture.   0043     1.9233      $104.41  ............        $20.88
23605.................  T....................  .....................  Treat humerus fracture.   0043     1.9233      $104.41  ............        $20.88
23615.................  T....................  .....................  Treat humerus fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
23616.................  T....................  .....................  Treat humerus fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
23620.................  T....................  .....................  Treat humerus fracture.   0043     1.9233      $104.41  ............        $20.88

[[Page 48047]]

 
23625.................  T....................  .....................  Treat humerus fracture.   0043     1.9233      $104.41  ............        $20.88
23630.................  T....................  .....................  Treat humerus fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
23650.................  T....................  .....................  Treat shoulder            0043     1.9233      $104.41  ............        $20.88
                                                                       dislocation.
23655.................  T....................  .....................  Treat shoulder            0045    13.5546      $735.87       $268.47       $147.17
                                                                       dislocation.
23660.................  T....................  .....................  Treat shoulder            0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       dislocation.
23665.................  T....................  .....................  Treat dislocation/        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
23670.................  T....................  .....................  Treat dislocation/        0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
23675.................  T....................  .....................  Treat dislocation/        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
23680.................  T....................  .....................  Treat dislocation/        0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
23700.................  T....................  .....................  Fixation of shoulder...   0045    13.5546      $735.87       $268.47       $147.17
23800.................  T....................  .....................  Fusion of shoulder        0051    34.9381    $1,896.75  ............       $379.35
                                                                       joint.
23802.................  T....................  .....................  Fusion of shoulder        0051    34.9381    $1,896.75  ............       $379.35
                                                                       joint.
23900.................  C....................  .....................  Amputation of arm &      .....  .........  ...........  ............  ............
                                                                       girdle.
23920.................  C....................  .....................  Amputation at shoulder   .....  .........  ...........  ............  ............
                                                                       joint.
23921.................  T....................  .....................  Amputation follow-up      0025     6.2703      $340.41       $115.49        $68.08
                                                                       surgery.
23929.................  T....................  .....................  Shoulder surgery          0043     1.9233      $104.41  ............        $20.88
                                                                       procedure.
23930.................  T....................  .....................  Drainage of arm lesion.   0008    16.8303      $913.70  ............       $182.74
23931.................  T....................  .....................  Drainage of arm bursa..   0006     1.7487       $94.94        $24.12        $18.99
23935.................  T....................  .....................  Drain arm/elbow bone      0049    19.9376    $1,082.39  ............       $216.48
                                                                       lesion.
24000.................  T....................  .....................  Exploratory elbow         0050    25.1166    $1,363.56  ............       $272.71
                                                                       surgery.
24006.................  T....................  .....................  Release elbow joint....   0050    25.1166    $1,363.56  ............       $272.71
24065.................  T....................  .....................  Biopsy arm/elbow soft     0021    14.5749      $791.26       $219.48       $158.25
                                                                       tissue.
24066.................  T....................  .....................  Biopsy arm/elbow soft     0021    14.5749      $791.26       $219.48       $158.25
                                                                       tissue.
24075.................  T....................  .....................  Remove arm/elbow lesion   0021    14.5749      $791.26       $219.48       $158.25
24076.................  T....................  .....................  Remove arm/elbow lesion   0022    18.6725    $1,013.71       $354.45       $202.74
24077.................  T....................  .....................  Remove tumor of arm/      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       elbow.
24100.................  T....................  .....................  Biopsy elbow joint        0049    19.9376    $1,082.39  ............       $216.48
                                                                       lining.
24101.................  T....................  .....................  Explore/treat elbow       0050    25.1166    $1,363.56  ............       $272.71
                                                                       joint.
24102.................  T....................  .....................  Remove elbow joint        0050    25.1166    $1,363.56  ............       $272.71
                                                                       lining.
24105.................  T....................  .....................  Removal of elbow bursa.   0049    19.9376    $1,082.39  ............       $216.48
24110.................  T....................  .....................  Remove humerus lesion..   0049    19.9376    $1,082.39  ............       $216.48
24115.................  T....................  .....................  Remove/graft bone         0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
24116.................  T....................  .....................  Remove/graft bone         0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
24120.................  T....................  .....................  Remove elbow lesion....   0049    19.9376    $1,082.39  ............       $216.48
24125.................  T....................  .....................  Remove/graft bone         0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
24126.................  T....................  .....................  Remove/graft bone         0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
24130.................  T....................  .....................  Removal of head of        0050    25.1166    $1,363.56  ............       $272.71
                                                                       radius.
24134.................  T....................  .....................  Removal of arm bone       0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
24136.................  T....................  .....................  Remove radius bone        0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
24138.................  T....................  .....................  Remove elbow bone         0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
24140.................  T....................  .....................  Partial removal of arm    0050    25.1166    $1,363.56  ............       $272.71
                                                                       bone.
24145.................  T....................  .....................  Partial removal of        0050    25.1166    $1,363.56  ............       $272.71
                                                                       radius.
24147.................  T....................  .....................  Partial removal of        0050    25.1166    $1,363.56  ............       $272.71
                                                                       elbow.
24149.................  C....................  .....................  Radical resection of     .....  .........  ...........  ............  ............
                                                                       elbow.
24150.................  T....................  .....................  Extensive humerus         0052    42.6430    $2,315.05  ............       $463.01
                                                                       surgery.
24151.................  T....................  .....................  Extensive humerus         0052    42.6430    $2,315.05  ............       $463.01
                                                                       surgery.
24152.................  T....................  .....................  Extensive radius          0052    42.6430    $2,315.05  ............       $463.01
                                                                       surgery.
24153.................  T....................  .....................  Extensive radius          0052    42.6430    $2,315.05  ............       $463.01
                                                                       surgery.
24155.................  T....................  .....................  Removal of elbow joint.   0051    34.9381    $1,896.75  ............       $379.35
24160.................  T....................  .....................  Remove elbow joint        0050    25.1166    $1,363.56  ............       $272.71
                                                                       implant.
24164.................  T....................  .....................  Remove radius head        0050    25.1166    $1,363.56  ............       $272.71
                                                                       implant.
24200.................  T....................  .....................  Removal of arm foreign    0019     3.9807      $216.11        $71.87        $43.22
                                                                       body.
24201.................  T....................  .....................  Removal of arm foreign    0021    14.5749      $791.26       $219.48       $158.25
                                                                       body.
24220.................  N....................  .....................  Injection for elbow x-   .....  .........  ...........  ............  ............
                                                                       ray.
24300.................  T....................  .....................  Manipulate elbow w/       0045    13.5546      $735.87       $268.47       $147.17
                                                                       anesth.
24301.................  T....................  .....................  Muscle/tendon transfer.   0050    25.1166    $1,363.56  ............       $272.71
24305.................  T....................  .....................  Arm tendon lengthening.   0050    25.1166    $1,363.56  ............       $272.71
24310.................  T....................  .....................  Revision of arm tendon.   0049    19.9376    $1,082.39  ............       $216.48
24320.................  T....................  .....................  Repair of arm tendon...   0051    34.9381    $1,896.75  ............       $379.35
24330.................  T....................  .....................  Revision of arm muscles   0051    34.9381    $1,896.75  ............       $379.35
24331.................  T....................  .....................  Revision of arm muscles   0051    34.9381    $1,896.75  ............       $379.35
24332.................  T....................  .....................  Tenolysis, triceps.....   0049    19.9376    $1,082.39  ............       $216.48
24340.................  T....................  .....................  Repair of biceps tendon   0051    34.9381    $1,896.75  ............       $379.35
24341.................  T....................  .....................  Repair arm tendon/        0051    34.9381    $1,896.75  ............       $379.35
                                                                       muscle.
24342.................  T....................  .....................  Repair of ruptured        0051    34.9381    $1,896.75  ............       $379.35
                                                                       tendon.
24343.................  T....................  .....................  Repr elbow lat ligmnt w/  0050    25.1166    $1,363.56  ............       $272.71
                                                                       tiss.

[[Page 48048]]

 
24344.................  T....................  .....................  Reconstruct elbow lat     0051    34.9381    $1,896.75  ............       $379.35
                                                                       ligmnt.
24345.................  T....................  .....................  Repr elbw med ligmnt w/   0050    25.1166    $1,363.56  ............       $272.71
                                                                       tissu.
24346.................  T....................  .....................  Reconstruct elbow med     0051    34.9381    $1,896.75  ............       $379.35
                                                                       ligmnt.
24350.................  T....................  .....................  Repair of tennis elbow.   0050    25.1166    $1,363.56  ............       $272.71
24351.................  T....................  .....................  Repair of tennis elbow.   0050    25.1166    $1,363.56  ............       $272.71
24352.................  T....................  .....................  Repair of tennis elbow.   0050    25.1166    $1,363.56  ............       $272.71
24354.................  T....................  .....................  Repair of tennis elbow.   0050    25.1166    $1,363.56  ............       $272.71
24356.................  T....................  .....................  Revision of tennis        0050    25.1166    $1,363.56  ............       $272.71
                                                                       elbow.
24360.................  T....................  .....................  Reconstruct elbow joint   0047    30.3786    $1,649.22       $537.03       $329.84
24361.................  T....................  .....................  Reconstruct elbow joint   0048    47.4707    $2,577.14       $695.60       $515.43
24362.................  T....................  .....................  Reconstruct elbow joint   0048    47.4707    $2,577.14       $695.60       $515.43
24363.................  T....................  .....................  Replace elbow joint....   0048    47.4707    $2,577.14       $695.60       $515.43
24365.................  T....................  .....................  Reconstruct head of       0047    30.3786    $1,649.22       $537.03       $329.84
                                                                       radius.
24366.................  T....................  .....................  Reconstruct head of       0048    47.4707    $2,577.14       $695.60       $515.43
                                                                       radius.
24400.................  T....................  .....................  Revision of humerus....   0050    25.1166    $1,363.56  ............       $272.71
24410.................  T....................  .....................  Revision of humerus....   0050    25.1166    $1,363.56  ............       $272.71
24420.................  T....................  .....................  Revision of humerus....   0051    34.9381    $1,896.75  ............       $379.35
24430.................  T....................  .....................  Repair of humerus......   0051    34.9381    $1,896.75  ............       $379.35
24435.................  T....................  .....................  Repair humerus with       0051    34.9381    $1,896.75  ............       $379.35
                                                                       graft.
24470.................  T....................  .....................  Revision of elbow joint   0051    34.9381    $1,896.75  ............       $379.35
24495.................  T....................  .....................  Decompression of          0050    25.1166    $1,363.56  ............       $272.71
                                                                       forearm.
24498.................  T....................  .....................  Reinforce humerus......   0051    34.9381    $1,896.75  ............       $379.35
24500.................  T....................  .....................  Treat humerus fracture.   0043     1.9233      $104.41  ............        $20.88
24505.................  T....................  .....................  Treat humerus fracture.   0043     1.9233      $104.41  ............        $20.88
24515.................  T....................  .....................  Treat humerus fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
24516.................  T....................  .....................  Treat humerus fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
24530.................  T....................  .....................  Treat humerus fracture.   0043     1.9233      $104.41  ............        $20.88
24535.................  T....................  .....................  Treat humerus fracture.   0043     1.9233      $104.41  ............        $20.88
24538.................  T....................  .....................  Treat humerus fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
24545.................  T....................  .....................  Treat humerus fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
24546.................  T....................  .....................  Treat humerus fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
24560.................  T....................  .....................  Treat humerus fracture.   0043     1.9233      $104.41  ............        $20.88
24565.................  T....................  .....................  Treat humerus fracture.   0043     1.9233      $104.41  ............        $20.88
24566.................  T....................  .....................  Treat humerus fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
24575.................  T....................  .....................  Treat humerus fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
24576.................  T....................  .....................  Treat humerus fracture.   0043     1.9233      $104.41  ............        $20.88
24577.................  T....................  .....................  Treat humerus fracture.   0043     1.9233      $104.41  ............        $20.88
24579.................  T....................  .....................  Treat humerus fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
24582.................  T....................  .....................  Treat humerus fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
24586.................  T....................  .....................  Treat elbow fracture...   0046    31.9719    $1,735.72       $535.76       $347.14
24587.................  T....................  .....................  Treat elbow fracture...   0046    31.9719    $1,735.72       $535.76       $347.14
24600.................  T....................  .....................  Treat elbow dislocation   0043     1.9233      $104.41  ............        $20.88
24605.................  T....................  .....................  Treat elbow dislocation   0045    13.5546      $735.87       $268.47       $147.17
24615.................  T....................  .....................  Treat elbow dislocation   0046    31.9719    $1,735.72       $535.76       $347.14
24620.................  T....................  .....................  Treat elbow fracture...   0043     1.9233      $104.41  ............        $20.88
24635.................  T....................  .....................  Treat elbow fracture...   0046    31.9719    $1,735.72       $535.76       $347.14
24640.................  T....................  .....................  Treat elbow dislocation   0043     1.9233      $104.41  ............        $20.88
24650.................  T....................  .....................  Treat radius fracture..   0043     1.9233      $104.41  ............        $20.88
24655.................  T....................  .....................  Treat radius fracture..   0043     1.9233      $104.41  ............        $20.88
24665.................  T....................  .....................  Treat radius fracture..   0046    31.9719    $1,735.72       $535.76       $347.14
24666.................  T....................  .....................  Treat radius fracture..   0046    31.9719    $1,735.72       $535.76       $347.14
24670.................  T....................  .....................  Treat ulnar fracture...   0043     1.9233      $104.41  ............        $20.88
24675.................  T....................  .....................  Treat ulnar fracture...   0043     1.9233      $104.41  ............        $20.88
24685.................  T....................  .....................  Treat ulnar fracture...   0046    31.9719    $1,735.72       $535.76       $347.14
24800.................  T....................  .....................  Fusion of elbow joint..   0051    34.9381    $1,896.75  ............       $379.35
24802.................  T....................  .....................  Fusion/graft of elbow     0051    34.9381    $1,896.75  ............       $379.35
                                                                       joint.
24900.................  C....................  .....................  Amputation of upper arm  .....  .........  ...........  ............  ............
24920.................  C....................  .....................  Amputation of upper arm  .....  .........  ...........  ............  ............
24925.................  T....................  .....................  Amputation follow-up      0049    19.9376    $1,082.39  ............       $216.48
                                                                       surgery.
24930.................  C....................  .....................  Amputation follow-up     .....  .........  ...........  ............  ............
                                                                       surgery.
24931.................  C....................  .....................  Amputate upper arm &     .....  .........  ...........  ............  ............
                                                                       implant.
24935.................  T....................  .....................  Revision of amputation.   0052    42.6430    $2,315.05  ............       $463.01
24940.................  C....................  .....................  Revision of upper arm..  .....  .........  ...........  ............  ............
24999.................  T....................  .....................  Upper arm/elbow surgery   0043     1.9233      $104.41  ............        $20.88
25000.................  T....................  .....................  Incision of tendon        0049    19.9376    $1,082.39  ............       $216.48
                                                                       sheath.
25001.................  T....................  .....................  Incise flexor carpi       0049    19.9376    $1,082.39  ............       $216.48
                                                                       radialis.

[[Page 48049]]

 
25020.................  T....................  .....................  Decompress forearm 1      0049    19.9376    $1,082.39  ............       $216.48
                                                                       space.
25023.................  T....................  .....................  Decompress forearm 1      0050    25.1166    $1,363.56  ............       $272.71
                                                                       space.
25024.................  T....................  .....................  Decompress forearm 2      0050    25.1166    $1,363.56  ............       $272.71
                                                                       spaces.
25025.................  T....................  .....................  Decompress forarm 2       0050    25.1166    $1,363.56  ............       $272.71
                                                                       spaces.
25028.................  T....................  .....................  Drainage of forearm       0049    19.9376    $1,082.39  ............       $216.48
                                                                       lesion.
25031.................  T....................  .....................  Drainage of forearm       0049    19.9376    $1,082.39  ............       $216.48
                                                                       bursa.
25035.................  T....................  .....................  Treat forearm bone        0049    19.9376    $1,082.39  ............       $216.48
                                                                       lesion.
25040.................  T....................  .....................  Explore/treat wrist       0050    25.1166    $1,363.56  ............       $272.71
                                                                       joint.
25065.................  T....................  .....................  Biopsy forearm soft       0021    14.5749      $791.26       $219.48       $158.25
                                                                       tissues.
25066.................  T....................  .....................  Biopsy forearm soft       0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       tissues.
25075.................  T....................  .....................  Removel forearm lesion    0021    14.5749      $791.26       $219.48       $158.25
                                                                       subcu.
25076.................  T....................  .....................  Removel forearm lesion    0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       deep.
25077.................  T....................  .....................  Remove tumor, forearm/    0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       wrist.
25085.................  T....................  .....................  Incision of wrist         0049    19.9376    $1,082.39  ............       $216.48
                                                                       capsule.
25100.................  T....................  .....................  Biopsy of wrist joint..   0049    19.9376    $1,082.39  ............       $216.48
25101.................  T....................  .....................  Explore/treat wrist       0050    25.1166    $1,363.56  ............       $272.71
                                                                       joint.
25105.................  T....................  .....................  Remove wrist joint        0050    25.1166    $1,363.56  ............       $272.71
                                                                       lining.
25107.................  T....................  .....................  Remove wrist joint        0050    25.1166    $1,363.56  ............       $272.71
                                                                       cartilage.
25110.................  T....................  .....................  Remove wrist tendon       0049    19.9376    $1,082.39  ............       $216.48
                                                                       lesion.
25111.................  T....................  .....................  Remove wrist tendon       0053    14.8188      $804.50       $253.49       $160.90
                                                                       lesion.
25112.................  T....................  .....................  Reremove wrist tendon     0053    14.8188      $804.50       $253.49       $160.90
                                                                       lesion.
25115.................  T....................  .....................  Remove wrist/forearm      0049    19.9376    $1,082.39  ............       $216.48
                                                                       lesion.
25116.................  T....................  .....................  Remove wrist/forearm      0049    19.9376    $1,082.39  ............       $216.48
                                                                       lesion.
25118.................  T....................  .....................  Excise wrist tendon       0050    25.1166    $1,363.56  ............       $272.71
                                                                       sheath.
25119.................  T....................  .....................  Partial removal of ulna   0050    25.1166    $1,363.56  ............       $272.71
25120.................  T....................  .....................  Removal of forearm        0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
25125.................  T....................  .....................  Remove/graft forearm      0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
25126.................  T....................  .....................  Remove/graft forearm      0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
25130.................  T....................  .....................  Removal of wrist lesion   0050    25.1166    $1,363.56  ............       $272.71
25135.................  T....................  .....................  Remove & graft wrist      0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
25136.................  T....................  .....................  Remove & graft wrist      0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
25145.................  T....................  .....................  Remove forearm bone       0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
25150.................  T....................  .....................  Partial removal of ulna   0050    25.1166    $1,363.56  ............       $272.71
25151.................  T....................  .....................  Partial removal of        0050    25.1166    $1,363.56  ............       $272.71
                                                                       radius.
25170.................  T....................  .....................  Extensive forearm         0052    42.6430    $2,315.05  ............       $463.01
                                                                       surgery.
25210.................  T....................  .....................  Removal of wrist bone..   0054    24.2685    $1,317.51  ............       $263.50
25215.................  T....................  .....................  Removal of wrist bones.   0054    24.2685    $1,317.51  ............       $263.50
25230.................  T....................  .....................  Partial removal of        0050    25.1166    $1,363.56  ............       $272.71
                                                                       radius.
25240.................  T....................  .....................  Partial removal of ulna   0050    25.1166    $1,363.56  ............       $272.71
25246.................  N....................  .....................  Injection for wrist x-   .....  .........  ...........  ............  ............
                                                                       ray.
25248.................  T....................  .....................  Remove forearm foreign    0049    19.9376    $1,082.39  ............       $216.48
                                                                       body.
25250.................  T....................  .....................  Removal of wrist          0050    25.1166    $1,363.56  ............       $272.71
                                                                       prosthesis.
25251.................  T....................  .....................  Removal of wrist          0050    25.1166    $1,363.56  ............       $272.71
                                                                       prosthesis.
25259.................  T....................  .....................  Manipulate wrist w/       0043     1.9233      $104.41  ............        $20.88
                                                                       anesthes.
25260.................  T....................  .....................  Repair forearm tendon/    0050    25.1166    $1,363.56  ............       $272.71
                                                                       muscle.
25263.................  T....................  .....................  Repair forearm tendon/    0050    25.1166    $1,363.56  ............       $272.71
                                                                       muscle.
25265.................  T....................  .....................  Repair forearm tendon/    0050    25.1166    $1,363.56  ............       $272.71
                                                                       muscle.
25270.................  T....................  .....................  Repair forearm tendon/    0050    25.1166    $1,363.56  ............       $272.71
                                                                       muscle.
25272.................  T....................  .....................  Repair forearm tendon/    0050    25.1166    $1,363.56  ............       $272.71
                                                                       muscle.
25274.................  T....................  .....................  Repair forearm tendon/    0050    25.1166    $1,363.56  ............       $272.71
                                                                       muscle.
25275.................  T....................  .....................  Repair forearm tendon     0050    25.1166    $1,363.56  ............       $272.71
                                                                       sheath.
25280.................  T....................  .....................  Revise wrist/forearm      0050    25.1166    $1,363.56  ............       $272.71
                                                                       tendon.
25290.................  T....................  .....................  Incise wrist/forearm      0050    25.1166    $1,363.56  ............       $272.71
                                                                       tendon.
25295.................  T....................  .....................  Release wrist/forearm     0049    19.9376    $1,082.39  ............       $216.48
                                                                       tendon.
25300.................  T....................  .....................  Fusion of tendons at      0050    25.1166    $1,363.56  ............       $272.71
                                                                       wrist.
25301.................  T....................  .....................  Fusion of tendons at      0050    25.1166    $1,363.56  ............       $272.71
                                                                       wrist.
25310.................  T....................  .....................  Transplant forearm        0051    34.9381    $1,896.75  ............       $379.35
                                                                       tendon.
25312.................  T....................  .....................  Transplant forearm        0051    34.9381    $1,896.75  ............       $379.35
                                                                       tendon.
25315.................  T....................  .....................  Revise palsy hand         0051    34.9381    $1,896.75  ............       $379.35
                                                                       tendon(s).
25316.................  T....................  .....................  Revise palsy hand         0051    34.9381    $1,896.75  ............       $379.35
                                                                       tendon(s).
25320.................  T....................  .....................  Repair/revise wrist       0051    34.9381    $1,896.75  ............       $379.35
                                                                       joint.
25332.................  T....................  .....................  Revise wrist joint.....   0047    30.3786    $1,649.22       $537.03       $329.84
25335.................  T....................  .....................  Realignment of hand....   0051    34.9381    $1,896.75  ............       $379.35
25337.................  T....................  .....................  Reconstruct ulna/         0051    34.9381    $1,896.75  ............       $379.35
                                                                       radioulnar.
25350.................  T....................  .....................  Revision of radius.....   0051    34.9381    $1,896.75  ............       $379.35
25355.................  T....................  .....................  Revision of radius.....   0051    34.9381    $1,896.75  ............       $379.35

[[Page 48050]]

 
25360.................  T....................  .....................  Revision of ulna.......   0050    25.1166    $1,363.56  ............       $272.71
25365.................  T....................  .....................  Revise radius & ulna...   0050    25.1166    $1,363.56  ............       $272.71
25370.................  T....................  .....................  Revise radius or ulna..   0051    34.9381    $1,896.75  ............       $379.35
25375.................  T....................  .....................  Revise radius & ulna...   0051    34.9381    $1,896.75  ............       $379.35
25390.................  T....................  .....................  Shorten radius or ulna.   0050    25.1166    $1,363.56  ............       $272.71
25391.................  T....................  .....................  Lengthen radius or ulna   0051    34.9381    $1,896.75  ............       $379.35
25392.................  T....................  .....................  Shorten radius & ulna..   0050    25.1166    $1,363.56  ............       $272.71
25393.................  T....................  .....................  Lengthen radius & ulna.   0051    34.9381    $1,896.75  ............       $379.35
25394.................  T....................  .....................  Repair carpal bone,       0053    14.8188      $804.50       $253.49       $160.90
                                                                       shorten.
25400.................  T....................  .....................  Repair radius or ulna..   0050    25.1166    $1,363.56  ............       $272.71
25405.................  T....................  .....................  Repair/graft radius or    0050    25.1166    $1,363.56  ............       $272.71
                                                                       ulna.
25415.................  T....................  .....................  Repair radius & ulna...   0050    25.1166    $1,363.56  ............       $272.71
25420.................  T....................  .....................  Repair/graft radius &     0051    34.9381    $1,896.75  ............       $379.35
                                                                       ulna.
25425.................  T....................  .....................  Repair/graft radius or    0051    34.9381    $1,896.75  ............       $379.35
                                                                       ulna.
25426.................  T....................  .....................  Repair/graft radius &     0051    34.9381    $1,896.75  ............       $379.35
                                                                       ulna.
25430.................  T....................  .....................  Vasc graft into carpal    0054    24.2685    $1,317.51  ............       $263.50
                                                                       bone.
25431.................  T....................  .....................  Repair nonunion carpal    0054    24.2685    $1,317.51  ............       $263.50
                                                                       bone.
25440.................  T....................  .....................  Repair/graft wrist bone   0051    34.9381    $1,896.75  ............       $379.35
25441.................  T....................  .....................  Reconstruct wrist joint   0048    47.4707    $2,577.14       $695.60       $515.43
25442.................  T....................  .....................  Reconstruct wrist joint   0048    47.4707    $2,577.14       $695.60       $515.43
25443.................  T....................  .....................  Reconstruct wrist joint   0048    47.4707    $2,577.14       $695.60       $515.43
25444.................  T....................  .....................  Reconstruct wrist joint   0048    47.4707    $2,577.14       $695.60       $515.43
25445.................  T....................  .....................  Reconstruct wrist joint   0048    47.4707    $2,577.14       $695.60       $515.43
25446.................  T....................  .....................  Wrist replacement......   0048    47.4707    $2,577.14       $695.60       $515.43
25447.................  T....................  .....................  Repair wrist joint(s)..   0047    30.3786    $1,649.22       $537.03       $329.84
25449.................  T....................  .....................  Remove wrist joint        0047    30.3786    $1,649.22       $537.03       $329.84
                                                                       implant.
25450.................  T....................  .....................  Revision of wrist joint   0051    34.9381    $1,896.75  ............       $379.35
25455.................  T....................  .....................  Revision of wrist joint   0051    34.9381    $1,896.75  ............       $379.35
25490.................  T....................  .....................  Reinforce radius.......   0051    34.9381    $1,896.75  ............       $379.35
25491.................  T....................  .....................  Reinforce ulna.........   0051    34.9381    $1,896.75  ............       $379.35
25492.................  T....................  .....................  Reinforce radius and      0051    34.9381    $1,896.75  ............       $379.35
                                                                       ulna.
25500.................  T....................  .....................  Treat fracture of         0043     1.9233      $104.41  ............        $20.88
                                                                       radius.
25505.................  T....................  .....................  Treat fracture of         0043     1.9233      $104.41  ............        $20.88
                                                                       radius.
25515.................  T....................  .....................  Treat fracture of         0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       radius.
25520.................  T....................  .....................  Treat fracture of         0043     1.9233      $104.41  ............        $20.88
                                                                       radius.
25525.................  T....................  .....................  Treat fracture of         0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       radius.
25526.................  T....................  .....................  Treat fracture of         0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       radius.
25530.................  T....................  .....................  Treat fracture of ulna.   0043     1.9233      $104.41  ............        $20.88
25535.................  T....................  .....................  Treat fracture of ulna.   0043     1.9233      $104.41  ............        $20.88
25545.................  T....................  .....................  Treat fracture of ulna.   0046    31.9719    $1,735.72       $535.76       $347.14
25560.................  T....................  .....................  Treat fracture radius &   0043     1.9233      $104.41  ............        $20.88
                                                                       ulna.
25565.................  T....................  .....................  Treat fracture radius &   0043     1.9233      $104.41  ............        $20.88
                                                                       ulna.
25574.................  T....................  .....................  Treat fracture radius &   0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       ulna.
25575.................  T....................  .....................  Treat fracture radius/    0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       ulna.
25600.................  T....................  .....................  Treat fracture radius/    0043     1.9233      $104.41  ............        $20.88
                                                                       ulna.
25605.................  T....................  .....................  Treat fracture radius/    0043     1.9233      $104.41  ............        $20.88
                                                                       ulna.
25611.................  T....................  .....................  Treat fracture radius/    0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       ulna.
25620.................  T....................  .....................  Treat fracture radius/    0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       ulna.
25622.................  T....................  .....................  Treat wrist bone          0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
25624.................  T....................  .....................  Treat wrist bone          0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
25628.................  T....................  .....................  Treat wrist bone          0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
25630.................  T....................  .....................  Treat wrist bone          0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
25635.................  T....................  .....................  Treat wrist bone          0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
25645.................  T....................  .....................  Treat wrist bone          0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
25650.................  T....................  .....................  Treat wrist bone          0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
25651.................  T....................  .....................  Pin ulnar styloid         0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
25652.................  T....................  .....................  Treat fracture ulnar      0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       styloid.
25660.................  T....................  .....................  Treat wrist dislocation   0043     1.9233      $104.41  ............        $20.88
25670.................  T....................  .....................  Treat wrist dislocation   0046    31.9719    $1,735.72       $535.76       $347.14
25671.................  T....................  .....................  Pin radioulnar            0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       dislocation.
25675.................  T....................  .....................  Treat wrist dislocation   0043     1.9233      $104.41  ............        $20.88
25676.................  T....................  .....................  Treat wrist dislocation   0046    31.9719    $1,735.72       $535.76       $347.14
25680.................  T....................  .....................  Treat wrist fracture...   0043     1.9233      $104.41  ............        $20.88
25685.................  T....................  .....................  Treat wrist fracture...   0046    31.9719    $1,735.72       $535.76       $347.14
25690.................  T....................  .....................  Treat wrist dislocation   0043     1.9233      $104.41  ............        $20.88
25695.................  T....................  .....................  Treat wrist dislocation   0046    31.9719    $1,735.72       $535.76       $347.14

[[Page 48051]]

 
25800.................  T....................  .....................  Fusion of wrist joint..   0051    34.9381    $1,896.75  ............       $379.35
25805.................  T....................  .....................  Fusion/graft of wrist     0051    34.9381    $1,896.75  ............       $379.35
                                                                       joint.
25810.................  T....................  .....................  Fusion/graft of wrist     0051    34.9381    $1,896.75  ............       $379.35
                                                                       joint.
25820.................  T....................  .....................  Fusion of hand bones...   0053    14.8188      $804.50       $253.49       $160.90
25825.................  T....................  .....................  Fuse hand bones with      0054    24.2685    $1,317.51  ............       $263.50
                                                                       graft.
25830.................  T....................  .....................  Fusion, radioulnar jnt/   0051    34.9381    $1,896.75  ............       $379.35
                                                                       ulna.
25900.................  C....................  .....................  Amputation of forearm..  .....  .........  ...........  ............  ............
25905.................  C....................  .....................  Amputation of forearm..  .....  .........  ...........  ............  ............
25907.................  T....................  .....................  Amputation follow-up      0049    19.9376    $1,082.39  ............       $216.48
                                                                       surgery.
25909.................  C....................  .....................  Amputation follow-up     .....  .........  ...........  ............  ............
                                                                       surgery.
25915.................  C....................  .....................  Amputation of forearm..  .....  .........  ...........  ............  ............
25920.................  C....................  .....................  Amputate hand at wrist.  .....  .........  ...........  ............  ............
25922.................  T....................  .....................  Amputate hand at wrist.   0049    19.9376    $1,082.39  ............       $216.48
25924.................  C....................  .....................  Amputation follow-up     .....  .........  ...........  ............  ............
                                                                       surgery.
25927.................  C....................  .....................  Amputation of hand.....  .....  .........  ...........  ............  ............
25929.................  T....................  .....................  Amputation follow-up      0027    15.8319      $859.50       $329.72       $171.90
                                                                       surgery.
25931.................  C....................  .....................  Amputation follow-up     .....  .........  ...........  ............  ............
                                                                       surgery.
25999.................  T....................  .....................  Forearm or wrist          0043     1.9233      $104.41  ............        $20.88
                                                                       surgery.
26010.................  T....................  .....................  Drainage of finger        0006     1.7487       $94.94        $24.12        $18.99
                                                                       abscess.
26011.................  T....................  .....................  Drainage of finger        0007    11.4943      $624.01  ............       $124.80
                                                                       abscess.
26020.................  T....................  .....................  Drain hand tendon         0053    14.8188      $804.50       $253.49       $160.90
                                                                       sheath.
26025.................  T....................  .....................  Drainage of palm bursa.   0053    14.8188      $804.50       $253.49       $160.90
26030.................  T....................  .....................  Drainage of palm          0053    14.8188      $804.50       $253.49       $160.90
                                                                       bursa(s).
26034.................  T....................  .....................  Treat hand bone lesion.   0053    14.8188      $804.50       $253.49       $160.90
26035.................  T....................  .....................  Decompress fingers/hand   0053    14.8188      $804.50       $253.49       $160.90
26037.................  T....................  .....................  Decompress fingers/hand   0053    14.8188      $804.50       $253.49       $160.90
26040.................  T....................  .....................  Release palm              0054    24.2685    $1,317.51  ............       $263.50
                                                                       contracture.
26045.................  T....................  .....................  Release palm              0054    24.2685    $1,317.51  ............       $263.50
                                                                       contracture.
26055.................  T....................  .....................  Incise finger tendon      0053    14.8188      $804.50       $253.49       $160.90
                                                                       sheath.
26060.................  T....................  .....................  Incision of finger        0053    14.8188      $804.50       $253.49       $160.90
                                                                       tendon.
26070.................  T....................  .....................  Explore/treat hand        0053    14.8188      $804.50       $253.49       $160.90
                                                                       joint.
26075.................  T....................  .....................  Explore/treat finger      0053    14.8188      $804.50       $253.49       $160.90
                                                                       joint.
26080.................  T....................  .....................  Explore/treat finger      0053    14.8188      $804.50       $253.49       $160.90
                                                                       joint.
26100.................  T....................  .....................  Biopsy hand joint         0053    14.8188      $804.50       $253.49       $160.90
                                                                       lining.
26105.................  T....................  .....................  Biopsy finger joint       0053    14.8188      $804.50       $253.49       $160.90
                                                                       lining.
26110.................  T....................  .....................  Biopsy finger joint       0053    14.8188      $804.50       $253.49       $160.90
                                                                       lining.
26115.................  T....................  .....................  Removel hand lesion       0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       subcut.
26116.................  T....................  .....................  Removel hand lesion,      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       deep.
26117.................  T....................  .....................  Remove tumor, hand/       0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       finger.
26121.................  T....................  .....................  Release palm              0054    24.2685    $1,317.51  ............       $263.50
                                                                       contracture.
26123.................  T....................  .....................  Release palm              0054    24.2685    $1,317.51  ............       $263.50
                                                                       contracture.
26125.................  T....................  .....................  Release palm              0054    24.2685    $1,317.51  ............       $263.50
                                                                       contracture.
26130.................  T....................  .....................  Remove wrist joint        0053    14.8188      $804.50       $253.49       $160.90
                                                                       lining.
26135.................  T....................  .....................  Revise finger joint,      0054    24.2685    $1,317.51  ............       $263.50
                                                                       each.
26140.................  T....................  .....................  Revise finger joint,      0053    14.8188      $804.50       $253.49       $160.90
                                                                       each.
26145.................  T....................  .....................  Tendon excision, palm/    0053    14.8188      $804.50       $253.49       $160.90
                                                                       finger.
26160.................  T....................  .....................  Remove tendon sheath      0053    14.8188      $804.50       $253.49       $160.90
                                                                       lesion.
26170.................  T....................  .....................  Removal of palm tendon,   0053    14.8188      $804.50       $253.49       $160.90
                                                                       each.
26180.................  T....................  .....................  Removal of finger         0053    14.8188      $804.50       $253.49       $160.90
                                                                       tendon.
26185.................  T....................  .....................  Remove finger bone.....   0053    14.8188      $804.50       $253.49       $160.90
26200.................  T....................  .....................  Remove hand bone lesion   0053    14.8188      $804.50       $253.49       $160.90
26205.................  T....................  .....................  Remove/graft bone         0054    24.2685    $1,317.51  ............       $263.50
                                                                       lesion.
26210.................  T....................  .....................  Removal of finger         0053    14.8188      $804.50       $253.49       $160.90
                                                                       lesion.
26215.................  T....................  .....................  Remove/graft finger       0053    14.8188      $804.50       $253.49       $160.90
                                                                       lesion.
26230.................  T....................  .....................  Partial removal of hand   0053    14.8188      $804.50       $253.49       $160.90
                                                                       bone.
26235.................  T....................  .....................  Partial removal, finger   0053    14.8188      $804.50       $253.49       $160.90
                                                                       bone.
26236.................  T....................  .....................  Partial removal, finger   0053    14.8188      $804.50       $253.49       $160.90
                                                                       bone.
26250.................  T....................  .....................  Extensive hand surgery.   0053    14.8188      $804.50       $253.49       $160.90
26255.................  T....................  .....................  Extensive hand surgery.   0054    24.2685    $1,317.51  ............       $263.50
26260.................  T....................  .....................  Extensive finger          0053    14.8188      $804.50       $253.49       $160.90
                                                                       surgery.
26261.................  T....................  .....................  Extensive finger          0053    14.8188      $804.50       $253.49       $160.90
                                                                       surgery.
26262.................  T....................  .....................  Partial removal of        0053    14.8188      $804.50       $253.49       $160.90
                                                                       finger.
26320.................  T....................  .....................  Removal of implant from   0021    14.5749      $791.26       $219.48       $158.25
                                                                       hand.
26340.................  T....................  .....................  Manipulate finger w/      0043     1.9233      $104.41  ............        $20.88
                                                                       anesth.
26350.................  T....................  .....................  Repair finger/hand        0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26352.................  T....................  .....................  Repair/graft hand         0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.

[[Page 48052]]

 
26356.................  T....................  .....................  Repair finger/hand        0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26357.................  T....................  .....................  Repair finger/hand        0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26358.................  T....................  .....................  Repair/graft hand         0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26370.................  T....................  .....................  Repair finger/hand        0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26372.................  T....................  .....................  Repair/graft hand         0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26373.................  T....................  .....................  Repair finger/hand        0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26390.................  T....................  .....................  Revise hand/finger        0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26392.................  T....................  .....................  Repair/graft hand         0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26410.................  T....................  .....................  Repair hand tendon.....   0053    14.8188      $804.50       $253.49       $160.90
26412.................  T....................  .....................  Repair/graft hand         0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26415.................  T....................  .....................  Excision, hand/finger     0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26416.................  T....................  .....................  Graft hand or finger      0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26418.................  T....................  .....................  Repair finger tendon...   0053    14.8188      $804.50       $253.49       $160.90
26420.................  T....................  .....................  Repair/graft finger       0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26426.................  T....................  .....................  Repair finger/hand        0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26428.................  T....................  .....................  Repair/graft finger       0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26432.................  T....................  .....................  Repair finger tendon...   0053    14.8188      $804.50       $253.49       $160.90
26433.................  T....................  .....................  Repair finger tendon...   0053    14.8188      $804.50       $253.49       $160.90
26434.................  T....................  .....................  Repair/graft finger       0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26437.................  T....................  .....................  Realignment of tendons.   0053    14.8188      $804.50       $253.49       $160.90
26440.................  T....................  .....................  Release palm/finger       0053    14.8188      $804.50       $253.49       $160.90
                                                                       tendon.
26442.................  T....................  .....................  Release palm & finger     0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26445.................  T....................  .....................  Release hand/finger       0053    14.8188      $804.50       $253.49       $160.90
                                                                       tendon.
26449.................  T....................  .....................  Release forearm/hand      0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26450.................  T....................  .....................  Incision of palm tendon   0053    14.8188      $804.50       $253.49       $160.90
26455.................  T....................  .....................  Incision of finger        0053    14.8188      $804.50       $253.49       $160.90
                                                                       tendon.
26460.................  T....................  .....................  Incise hand/finger        0053    14.8188      $804.50       $253.49       $160.90
                                                                       tendon.
26471.................  T....................  .....................  Fusion of finger          0053    14.8188      $804.50       $253.49       $160.90
                                                                       tendons.
26474.................  T....................  .....................  Fusion of finger          0053    14.8188      $804.50       $253.49       $160.90
                                                                       tendons.
26476.................  T....................  .....................  Tendon lengthening.....   0053    14.8188      $804.50       $253.49       $160.90
26477.................  T....................  .....................  Tendon shortening......   0053    14.8188      $804.50       $253.49       $160.90
26478.................  T....................  .....................  Lengthening of hand       0053    14.8188      $804.50       $253.49       $160.90
                                                                       tendon.
26479.................  T....................  .....................  Shortening of hand        0053    14.8188      $804.50       $253.49       $160.90
                                                                       tendon.
26480.................  T....................  .....................  Transplant hand tendon.   0054    24.2685    $1,317.51  ............       $263.50
26483.................  T....................  .....................  Transplant/graft hand     0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26485.................  T....................  .....................  Transplant palm tendon.   0054    24.2685    $1,317.51  ............       $263.50
26489.................  T....................  .....................  Transplant/graft palm     0054    24.2685    $1,317.51  ............       $263.50
                                                                       tendon.
26490.................  T....................  .....................  Revise thumb tendon....   0054    24.2685    $1,317.51  ............       $263.50
26492.................  T....................  .....................  Tendon transfer with      0054    24.2685    $1,317.51  ............       $263.50
                                                                       graft.
26494.................  T....................  .....................  Hand tendon/muscle        0054    24.2685    $1,317.51  ............       $263.50
                                                                       transfer.
26496.................  T....................  .....................  Revise thumb tendon....   0054    24.2685    $1,317.51  ............       $263.50
26497.................  T....................  .....................  Finger tendon transfer.   0054    24.2685    $1,317.51  ............       $263.50
26498.................  T....................  .....................  Finger tendon transfer.   0054    24.2685    $1,317.51  ............       $263.50
26499.................  T....................  .....................  Revision of finger.....   0054    24.2685    $1,317.51  ............       $263.50
26500.................  T....................  .....................  Hand tendon               0053    14.8188      $804.50       $253.49       $160.90
                                                                       reconstruction.
26502.................  T....................  .....................  Hand tendon               0054    24.2685    $1,317.51  ............       $263.50
                                                                       reconstruction.
26504.................  T....................  .....................  Hand tendon               0054    24.2685    $1,317.51  ............       $263.50
                                                                       reconstruction.
26508.................  T....................  .....................  Release thumb             0053    14.8188      $804.50       $253.49       $160.90
                                                                       contracture.
26510.................  T....................  .....................  Thumb tendon transfer..   0054    24.2685    $1,317.51  ............       $263.50
26516.................  T....................  .....................  Fusion of knuckle joint   0054    24.2685    $1,317.51  ............       $263.50
26517.................  T....................  .....................  Fusion of knuckle         0054    24.2685    $1,317.51  ............       $263.50
                                                                       joints.
26518.................  T....................  .....................  Fusion of knuckle         0054    24.2685    $1,317.51  ............       $263.50
                                                                       joints.
26520.................  T....................  .....................  Release knuckle           0053    14.8188      $804.50       $253.49       $160.90
                                                                       contracture.
26525.................  T....................  .....................  Release finger            0053    14.8188      $804.50       $253.49       $160.90
                                                                       contracture.
26530.................  T....................  .....................  Revise knuckle joint...   0047    30.3786    $1,649.22       $537.03       $329.84
26531.................  T....................  .....................  Revise knuckle with       0048    47.4707    $2,577.14       $695.60       $515.43
                                                                       implant.
26535.................  T....................  .....................  Revise finger joint....   0047    30.3786    $1,649.22       $537.03       $329.84
26536.................  T....................  .....................  Revise/implant finger     0048    47.4707    $2,577.14       $695.60       $515.43
                                                                       joint.
26540.................  T....................  .....................  Repair hand joint......   0053    14.8188      $804.50       $253.49       $160.90
26541.................  T....................  .....................  Repair hand joint with    0054    24.2685    $1,317.51  ............       $263.50
                                                                       graft.
26542.................  T....................  .....................  Repair hand joint with    0053    14.8188      $804.50       $253.49       $160.90
                                                                       graft.
26545.................  T....................  .....................  Reconstruct finger        0054    24.2685    $1,317.51  ............       $263.50
                                                                       joint.
26546.................  T....................  .....................  Repair nonunion hand...   0054    24.2685    $1,317.51  ............       $263.50
26548.................  T....................  .....................  Reconstruct finger        0054    24.2685    $1,317.51  ............       $263.50
                                                                       joint.
26550.................  T....................  .....................  Construct thumb           0054    24.2685    $1,317.51  ............       $263.50
                                                                       replacement.
26551.................  C....................  .....................  Great toe-hand transfer  .....  .........  ...........  ............  ............

[[Page 48053]]

 
26553.................  C....................  .....................  Single transfer, toe-    .....  .........  ...........  ............  ............
                                                                       hand.
26554.................  C....................  .....................  Double transfer, toe-    .....  .........  ...........  ............  ............
                                                                       hand.
26555.................  T....................  .....................  Positional change of      0054    24.2685    $1,317.51  ............       $263.50
                                                                       finger.
26556.................  C....................  .....................  Toe joint transfer.....  .....  .........  ...........  ............  ............
26560.................  T....................  .....................  Repair of web finger...   0053    14.8188      $804.50       $253.49       $160.90
26561.................  T....................  .....................  Repair of web finger...   0054    24.2685    $1,317.51  ............       $263.50
26562.................  T....................  .....................  Repair of web finger...   0054    24.2685    $1,317.51  ............       $263.50
26565.................  T....................  .....................  Correct metacarpal flaw   0054    24.2685    $1,317.51  ............       $263.50
26567.................  T....................  .....................  Correct finger            0054    24.2685    $1,317.51  ............       $263.50
                                                                       deformity.
26568.................  T....................  .....................  Lengthen metacarpal/      0054    24.2685    $1,317.51  ............       $263.50
                                                                       finger.
26580.................  T....................  .....................  Repair hand deformity..   0054    24.2685    $1,317.51  ............       $263.50
26587.................  T....................  .....................  Reconstruct extra         0053    14.8188      $804.50       $253.49       $160.90
                                                                       finger.
26590.................  T....................  .....................  Repair finger deformity   0054    24.2685    $1,317.51  ............       $263.50
26591.................  T....................  .....................  Repair muscles of hand.   0054    24.2685    $1,317.51  ............       $263.50
26593.................  T....................  .....................  Release muscles of hand   0053    14.8188      $804.50       $253.49       $160.90
26596.................  T....................  .....................  Excision constricting     0054    24.2685    $1,317.51  ............       $263.50
                                                                       tissue.
26600.................  T....................  .....................  Treat metacarpal          0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
26605.................  T....................  .....................  Treat metacarpal          0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
26607.................  T....................  .....................  Treat metacarpal          0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
26608.................  T....................  .....................  Treat metacarpal          0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
26615.................  T....................  .....................  Treat metacarpal          0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
26641.................  T....................  .....................  Treat thumb dislocation   0043     1.9233      $104.41  ............        $20.88
26645.................  T....................  .....................  Treat thumb fracture...   0043     1.9233      $104.41  ............        $20.88
26650.................  T....................  .....................  Treat thumb fracture...   0046    31.9719    $1,735.72       $535.76       $347.14
26665.................  T....................  .....................  Treat thumb fracture...   0046    31.9719    $1,735.72       $535.76       $347.14
26670.................  T....................  .....................  Treat hand dislocation.   0043     1.9233      $104.41  ............        $20.88
26675.................  T....................  .....................  Treat hand dislocation.   0043     1.9233      $104.41  ............        $20.88
26676.................  T....................  .....................  Pin hand dislocation...   0046    31.9719    $1,735.72       $535.76       $347.14
26685.................  T....................  .....................  Treat hand dislocation.   0046    31.9719    $1,735.72       $535.76       $347.14
26686.................  T....................  .....................  Treat hand dislocation.   0046    31.9719    $1,735.72       $535.76       $347.14
26700.................  T....................  .....................  Treat knuckle             0043     1.9233      $104.41  ............        $20.88
                                                                       dislocation.
26705.................  T....................  .....................  Treat knuckle             0043     1.9233      $104.41  ............        $20.88
                                                                       dislocation.
26706.................  T....................  .....................  Pin knuckle dislocation   0043     1.9233      $104.41  ............        $20.88
26715.................  T....................  .....................  Treat knuckle             0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       dislocation.
26720.................  T....................  .....................  Treat finger fracture,    0043     1.9233      $104.41  ............        $20.88
                                                                       each.
26725.................  T....................  .....................  Treat finger fracture,    0043     1.9233      $104.41  ............        $20.88
                                                                       each.
26727.................  T....................  .....................  Treat finger fracture,    0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       each.
26735.................  T....................  .....................  Treat finger fracture,    0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       each.
26740.................  T....................  .....................  Treat finger fracture,    0043     1.9233      $104.41  ............        $20.88
                                                                       each.
26742.................  T....................  .....................  Treat finger fracture,    0043     1.9233      $104.41  ............        $20.88
                                                                       each.
26746.................  T....................  .....................  Treat finger fracture,    0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       each.
26750.................  T....................  .....................  Treat finger fracture,    0043     1.9233      $104.41  ............        $20.88
                                                                       each.
26755.................  T....................  .....................  Treat finger fracture,    0043     1.9233      $104.41  ............        $20.88
                                                                       each.
26756.................  T....................  .....................  Pin finger fracture,      0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       each.
26765.................  T....................  .....................  Treat finger fracture,    0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       each.
26770.................  T....................  .....................  Treat finger              0043     1.9233      $104.41  ............        $20.88
                                                                       dislocation.
26775.................  T....................  .....................  Treat finger              0045    13.5546      $735.87       $268.47       $147.17
                                                                       dislocation.
26776.................  T....................  .....................  Pin finger dislocation.   0046    31.9719    $1,735.72       $535.76       $347.14
26785.................  T....................  .....................  Treat finger              0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       dislocation.
26820.................  T....................  .....................  Thumb fusion with graft   0054    24.2685    $1,317.51  ............       $263.50
26841.................  T....................  .....................  Fusion of thumb........   0054    24.2685    $1,317.51  ............       $263.50
26842.................  T....................  .....................  Thumb fusion with graft   0054    24.2685    $1,317.51  ............       $263.50
26843.................  T....................  .....................  Fusion of hand joint...   0054    24.2685    $1,317.51  ............       $263.50
26844.................  T....................  .....................  Fusion/graft of hand      0054    24.2685    $1,317.51  ............       $263.50
                                                                       joint.
26850.................  T....................  .....................  Fusion of knuckle......   0054    24.2685    $1,317.51  ............       $263.50
26852.................  T....................  .....................  Fusion of knuckle with    0054    24.2685    $1,317.51  ............       $263.50
                                                                       graft.
26860.................  T....................  .....................  Fusion of finger joint.   0054    24.2685    $1,317.51  ............       $263.50
26861.................  T....................  .....................  Fusion of finger jnt,     0054    24.2685    $1,317.51  ............       $263.50
                                                                       add-on.
26862.................  T....................  .....................  Fusion/graft of finger    0054    24.2685    $1,317.51  ............       $263.50
                                                                       joint.
26863.................  T....................  .....................  Fuse/graft added joint.   0054    24.2685    $1,317.51  ............       $263.50
26910.................  T....................  .....................  Amputate metacarpal       0054    24.2685    $1,317.51  ............       $263.50
                                                                       bone.
26951.................  T....................  .....................  Amputation of finger/     0053    14.8188      $804.50       $253.49       $160.90
                                                                       thumb.
26952.................  T....................  .....................  Amputation of finger/     0053    14.8188      $804.50       $253.49       $160.90
                                                                       thumb.
26989.................  T....................  .....................  Hand/finger surgery....   0043     1.9233      $104.41  ............        $20.88
26990.................  T....................  .....................  Drainage of pelvis        0049    19.9376    $1,082.39  ............       $216.48
                                                                       lesion.
26991.................  T....................  .....................  Drainage of pelvis        0049    19.9376    $1,082.39  ............       $216.48
                                                                       bursa.

[[Page 48054]]

 
26992.................  C....................  .....................  Drainage of bone lesion  .....  .........  ...........  ............  ............
27000.................  T....................  .....................  Incision of hip tendon.   0049    19.9376    $1,082.39  ............       $216.48
27001.................  T....................  .....................  Incision of hip tendon.   0050    25.1166    $1,363.56  ............       $272.71
27003.................  T....................  .....................  Incision of hip tendon.   0050    25.1166    $1,363.56  ............       $272.71
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        0051    34.9381    $1,896.75  ............       $379.35
                                                                       joint.
27035.................  T....................  .....................  Denervation of hip        0052    42.6430    $2,315.05  ............       $463.01
                                                                       joint.
27036.................  C....................  .....................  Excision of hip joint/   .....  .........  ...........  ............  ............
                                                                       muscle.
27040.................  T....................  .....................  Biopsy of soft tissues.   0021    14.5749      $791.26       $219.48       $158.25
27041.................  T....................  .....................  Biopsy of soft tissues.   0022    18.6725    $1,013.71       $354.45       $202.74
27047.................  T....................  .....................  Remove hip/pelvis         0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       lesion.
27048.................  T....................  .....................  Remove hip/pelvis         0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       lesion.
27049.................  T....................  .....................  Remove tumor, hip/        0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       pelvis.
27050.................  T....................  .....................  Biopsy of sacroiliac      0049    19.9376    $1,082.39  ............       $216.48
                                                                       joint.
27052.................  T....................  .....................  Biopsy of hip joint....   0049    19.9376    $1,082.39  ............       $216.48
27054.................  C....................  .....................  Removal of hip joint     .....  .........  ...........  ............  ............
                                                                       lining.
27060.................  T....................  .....................  Removal of ischial        0049    19.9376    $1,082.39  ............       $216.48
                                                                       bursa.
27062.................  T....................  .....................  Remove femur lesion/      0049    19.9376    $1,082.39  ............       $216.48
                                                                       bursa.
27065.................  T....................  .....................  Removal of hip bone       0049    19.9376    $1,082.39  ............       $216.48
                                                                       lesion.
27066.................  T....................  .....................  Removal of hip bone       0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
27067.................  T....................  .....................  Remove/graft hip bone     0050    25.1166    $1,363.56  ............       $272.71
                                                                       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    25.1166    $1,363.56  ............       $272.71
27086.................  T....................  .....................  Remove hip foreign body   0020     7.3105      $396.88       $113.25        $79.38
27087.................  T....................  .....................  Remove hip foreign body   0049    19.9376    $1,082.39  ............       $216.48
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.................  E....................  .....................  Inject sacroiliac joint  .....  .........  ...........  ............  ............
27097.................  T....................  .....................  Revision of hip tendon.   0050    25.1166    $1,363.56  ............       $272.71
27098.................  T....................  .....................  Transfer tendon to        0050    25.1166    $1,363.56  ............       $272.71
                                                                       pelvis.
27100.................  T....................  .....................  Transfer of abdominal     0051    34.9381    $1,896.75  ............       $379.35
                                                                       muscle.
27105.................  T....................  .....................  Transfer of spinal        0051    34.9381    $1,896.75  ............       $379.35
                                                                       muscle.
27110.................  T....................  .....................  Transfer of iliopsoas     0051    34.9381    $1,896.75  ............       $379.35
                                                                       muscle.
27111.................  T....................  .....................  Transfer of iliopsoas     0051    34.9381    $1,896.75  ............       $379.35
                                                                       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  .....  .........  ...........  ............  ............

[[Page 48055]]

 
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         0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27194.................  T....................  .....................  Treat pelvic ring         0045    13.5546      $735.87       $268.47       $147.17
                                                                       fracture.
27200.................  T....................  .....................  Treat tail bone           0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27202.................  T....................  .....................  Treat tail bone           0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
27215.................  C....................  .....................  Treat pelvic             .....  .........  ...........  ............  ............
                                                                       fracture(s).
27216.................  T....................  .....................  Treat pelvic ring         0050    25.1166    $1,363.56  ............       $272.71
                                                                       fracture.
27217.................  C....................  .....................  Treat pelvic ring        .....  .........  ...........  ............  ............
                                                                       fracture.
27218.................  C....................  .....................  Treat pelvic ring        .....  .........  ...........  ............  ............
                                                                       fracture.
27220.................  T....................  .....................  Treat hip socket          0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27222.................  C....................  .....................  Treat hip socket         .....  .........  ...........  ............  ............
                                                                       fracture.
27226.................  C....................  .....................  Treat hip wall fracture  .....  .........  ...........  ............  ............
27227.................  C....................  .....................  Treat hip fracture(s)..  .....  .........  ...........  ............  ............
27228.................  C....................  .....................  Treat hip fracture(s)..  .....  .........  ...........  ............  ............
27230.................  T....................  .....................  Treat thigh fracture...   0043     1.9233      $104.41  ............        $20.88
27232.................  C....................  .....................  Treat thigh fracture...  .....  .........  ...........  ............  ............
27235.................  T....................  .....................  Treat thigh fracture...   0050    25.1166    $1,363.56  ............       $272.71
27236.................  C....................  .....................  Treat thigh fracture...  .....  .........  ...........  ............  ............
27238.................  T....................  .....................  Treat thigh fracture...   0043     1.9233      $104.41  ............        $20.88
27240.................  C....................  .....................  Treat thigh fracture...  .....  .........  ...........  ............  ............
27244.................  C....................  .....................  Treat thigh fracture...  .....  .........  ...........  ............  ............
27245.................  C....................  .....................  Treat thigh fracture...  .....  .........  ...........  ............  ............
27246.................  T....................  .....................  Treat thigh fracture...   0043     1.9233      $104.41  ............        $20.88
27248.................  C....................  .....................  Treat thigh fracture...  .....  .........  ...........  ............  ............
27250.................  T....................  .....................  Treat hip dislocation..   0043     1.9233      $104.41  ............        $20.88
27252.................  T....................  .....................  Treat hip dislocation..   0045    13.5546      $735.87       $268.47       $147.17
27253.................  C....................  .....................  Treat hip dislocation..  .....  .........  ...........  ............  ............
27254.................  C....................  .....................  Treat hip dislocation..  .....  .........  ...........  ............  ............
27256.................  T....................  .....................  Treat hip dislocation..   0043     1.9233      $104.41  ............        $20.88
27257.................  T....................  .....................  Treat hip dislocation..   0045    13.5546      $735.87       $268.47       $147.17
27258.................  C....................  .....................  Treat hip dislocation..  .....  .........  ...........  ............  ............
27259.................  C....................  .....................  Treat hip dislocation..  .....  .........  ...........  ............  ............
27265.................  T....................  .....................  Treat hip dislocation..   0043     1.9233      $104.41  ............        $20.88
27266.................  T....................  .....................  Treat hip dislocation..   0045    13.5546      $735.87       $268.47       $147.17
27275.................  T....................  .....................  Manipulation of hip       0045    13.5546      $735.87       $268.47       $147.17
                                                                       joint.
27280.................  C....................  .....................  Fusion of sacroiliac     .....  .........  ...........  ............  ............
                                                                       joint.
27282.................  C....................  .....................  Fusion of pubic bones..  .....  .........  ...........  ............  ............
27284.................  C....................  .....................  Fusion of hip joint....  .....  .........  ...........  ............  ............
27286.................  C....................  .....................  Fusion of hip joint....  .....  .........  ...........  ............  ............
27290.................  C....................  .....................  Amputation of leg at     .....  .........  ...........  ............  ............
                                                                       hip.
27295.................  C....................  .....................  Amputation of leg at     .....  .........  ...........  ............  ............
                                                                       hip.
27299.................  T....................  .....................  Pelvis/hip joint          0043     1.9233      $104.41  ............        $20.88
                                                                       surgery.
27301.................  T....................  .....................  Drain thigh/knee lesion   0008    16.8303      $913.70  ............       $182.74
27303.................  C....................  .....................  Drainage of bone lesion  .....  .........  ...........  ............  ............
27305.................  T....................  .....................  Incise thigh tendon &     0049    19.9376    $1,082.39  ............       $216.48
                                                                       fascia.
27306.................  T....................  .....................  Incision of thigh         0049    19.9376    $1,082.39  ............       $216.48
                                                                       tendon.
27307.................  T....................  .....................  Incision of thigh         0049    19.9376    $1,082.39  ............       $216.48
                                                                       tendons.
27310.................  T....................  .....................  Exploration of knee       0050    25.1166    $1,363.56  ............       $272.71
                                                                       joint.
27315.................  T....................  .....................  Partial removal, thigh    0220    16.5293      $897.36  ............       $179.47
                                                                       nerve.
27320.................  T....................  .....................  Partial removal, thigh    0220    16.5293      $897.36  ............       $179.47
                                                                       nerve.
27323.................  T....................  .....................  Biopsy, thigh soft        0021    14.5749      $791.26       $219.48       $158.25
                                                                       tissues.
27324.................  T....................  .....................  Biopsy, thigh soft        0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       tissues.
27327.................  T....................  .....................  Removal of thigh lesion   0022    18.6725    $1,013.71       $354.45       $202.74
27328.................  T....................  .....................  Removal of thigh lesion   0022    18.6725    $1,013.71       $354.45       $202.74
27329.................  T....................  .....................  Remove tumor, thigh/      0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       knee.
27330.................  T....................  .....................  Biopsy, knee joint        0050    25.1166    $1,363.56  ............       $272.71
                                                                       lining.
27331.................  T....................  .....................  Explore/treat knee        0050    25.1166    $1,363.56  ............       $272.71
                                                                       joint.
27332.................  T....................  .....................  Removal of knee           0050    25.1166    $1,363.56  ............       $272.71
                                                                       cartilage.
27333.................  T....................  .....................  Removal of knee           0050    25.1166    $1,363.56  ............       $272.71
                                                                       cartilage.
27334.................  T....................  .....................  Remove knee joint         0050    25.1166    $1,363.56  ............       $272.71
                                                                       lining.
27335.................  T....................  .....................  Remove knee joint         0050    25.1166    $1,363.56  ............       $272.71
                                                                       lining.
27340.................  T....................  .....................  Removal of kneecap        0049    19.9376    $1,082.39  ............       $216.48
                                                                       bursa.
27345.................  T....................  .....................  Removal of knee cyst...   0049    19.9376    $1,082.39  ............       $216.48

[[Page 48056]]

 
27347.................  T....................  .....................  Remove knee cyst.......   0049    19.9376    $1,082.39  ............       $216.48
27350.................  T....................  .....................  Removal of kneecap.....   0050    25.1166    $1,363.56  ............       $272.71
27355.................  T....................  .....................  Remove femur lesion....   0050    25.1166    $1,363.56  ............       $272.71
27356.................  T....................  .....................  Remove femur lesion/      0050    25.1166    $1,363.56  ............       $272.71
                                                                       graft.
27357.................  T....................  .....................  Remove femur lesion/      0050    25.1166    $1,363.56  ............       $272.71
                                                                       graft.
27358.................  T....................  .....................  Remove femur lesion/      0050    25.1166    $1,363.56  ............       $272.71
                                                                       fixation.
27360.................  T....................  .....................  Partial removal, leg      0050    25.1166    $1,363.56  ............       $272.71
                                                                       bone(s).
27365.................  C....................  .....................  Extensive leg surgery..  .....  .........  ...........  ............  ............
27370.................  N....................  .....................  Injection for knee x-    .....  .........  ...........  ............  ............
                                                                       ray.
27372.................  T....................  .....................  Removal of foreign body   0022    18.6725    $1,013.71       $354.45       $202.74
27380.................  T....................  .....................  Repair of kneecap         0049    19.9376    $1,082.39  ............       $216.48
                                                                       tendon.
27381.................  T....................  .....................  Repair/graft kneecap      0049    19.9376    $1,082.39  ............       $216.48
                                                                       tendon.
27385.................  T....................  .....................  Repair of thigh muscle.   0049    19.9376    $1,082.39  ............       $216.48
27386.................  T....................  .....................  Repair/graft of thigh     0049    19.9376    $1,082.39  ............       $216.48
                                                                       muscle.
27390.................  T....................  .....................  Incision of thigh         0049    19.9376    $1,082.39  ............       $216.48
                                                                       tendon.
27391.................  T....................  .....................  Incision of thigh         0049    19.9376    $1,082.39  ............       $216.48
                                                                       tendons.
27392.................  T....................  .....................  Incision of thigh         0049    19.9376    $1,082.39  ............       $216.48
                                                                       tendons.
27393.................  T....................  .....................  Lengthening of thigh      0050    25.1166    $1,363.56  ............       $272.71
                                                                       tendon.
27394.................  T....................  .....................  Lengthening of thigh      0050    25.1166    $1,363.56  ............       $272.71
                                                                       tendons.
27395.................  T....................  .....................  Lengthening of thigh      0051    34.9381    $1,896.75  ............       $379.35
                                                                       tendons.
27396.................  T....................  .....................  Transplant of thigh       0050    25.1166    $1,363.56  ............       $272.71
                                                                       tendon.
27397.................  T....................  .....................  Transplants of thigh      0051    34.9381    $1,896.75  ............       $379.35
                                                                       tendons.
27400.................  T....................  .....................  Revise thigh muscles/     0051    34.9381    $1,896.75  ............       $379.35
                                                                       tendons.
27403.................  T....................  .....................  Repair of knee            0050    25.1166    $1,363.56  ............       $272.71
                                                                       cartilage.
27405.................  T....................  .....................  Repair of knee ligament   0051    34.9381    $1,896.75  ............       $379.35
27407.................  T....................  .....................  Repair of knee ligament   0051    34.9381    $1,896.75  ............       $379.35
27409.................  T....................  .....................  Repair of knee            0051    34.9381    $1,896.75  ............       $379.35
                                                                       ligaments.
27418.................  T....................  .....................  Repair degenerated        0051    34.9381    $1,896.75  ............       $379.35
                                                                       kneecap.
27420.................  T....................  .....................  Revision of unstable      0051    34.9381    $1,896.75  ............       $379.35
                                                                       kneecap.
27422.................  T....................  .....................  Revision of unstable      0051    34.9381    $1,896.75  ............       $379.35
                                                                       kneecap.
27424.................  T....................  .....................  Revision/removal of       0051    34.9381    $1,896.75  ............       $379.35
                                                                       kneecap.
27425.................  T....................  .....................  Lateral retinacular       0050    25.1166    $1,363.56  ............       $272.71
                                                                       release.
27427.................  T....................  .....................  Reconstruction, knee...   0052    42.6430    $2,315.05  ............       $463.01
27428.................  T....................  .....................  Reconstruction, knee...   0052    42.6430    $2,315.05  ............       $463.01
27429.................  T....................  .....................  Reconstruction, knee...   0052    42.6430    $2,315.05  ............       $463.01
27430.................  T....................  .....................  Revision of thigh         0051    34.9381    $1,896.75  ............       $379.35
                                                                       muscles.
27435.................  T....................  .....................  Incision of knee joint.   0051    34.9381    $1,896.75  ............       $379.35
27437.................  T....................  .....................  Revise kneecap.........   0047    30.3786    $1,649.22       $537.03       $329.84
27438.................  T....................  .....................  Revise kneecap with       0048    47.4707    $2,577.14       $695.60       $515.43
                                                                       implant.
27440.................  T....................  .....................  Revision of knee joint.   0047    30.3786    $1,649.22       $537.03       $329.84
27441.................  T....................  .....................  Revision of knee joint.   0047    30.3786    $1,649.22       $537.03       $329.84
27442.................  T....................  .....................  Revision of knee joint.   0047    30.3786    $1,649.22       $537.03       $329.84
27443.................  T....................  .....................  Revision of knee joint.   0047    30.3786    $1,649.22       $537.03       $329.84
27445.................  C....................  .....................  Revision of knee joint.  .....  .........  ...........  ............  ............
27446.................  T....................  .....................  Revision of knee joint.   0681    96.7483    $5,252.37     $2,090.21     $1,050.47
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/   0049    19.9376    $1,082.39  ............       $216.48
                                                                       knee.
27497.................  T....................  .....................  Decompression of thigh/   0049    19.9376    $1,082.39  ............       $216.48
                                                                       knee.

[[Page 48057]]

 
27498.................  T....................  .....................  Decompression of thigh/   0049    19.9376    $1,082.39  ............       $216.48
                                                                       knee.
27499.................  T....................  .....................  Decompression of thigh/   0049    19.9376    $1,082.39  ............       $216.48
                                                                       knee.
27500.................  T....................  .....................  Treatment of thigh        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27501.................  T....................  .....................  Treatment of thigh        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27502.................  T....................  .....................  Treatment of thigh        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27503.................  T....................  .....................  Treatment of thigh        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27506.................  C....................  .....................  Treatment of thigh       .....  .........  ...........  ............  ............
                                                                       fracture.
27507.................  C....................  .....................  Treatment of thigh       .....  .........  ...........  ............  ............
                                                                       fracture.
27508.................  T....................  .....................  Treatment of thigh        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27509.................  T....................  .....................  Treatment of thigh        0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
27510.................  T....................  .....................  Treatment of thigh        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27511.................  C....................  .....................  Treatment of thigh       .....  .........  ...........  ............  ............
                                                                       fracture.
27513.................  C....................  .....................  Treatment of thigh       .....  .........  ...........  ............  ............
                                                                       fracture.
27514.................  C....................  .....................  Treatment of thigh       .....  .........  ...........  ............  ............
                                                                       fracture.
27516.................  T....................  .....................  Treat thigh fx growth     0043     1.9233      $104.41  ............        $20.88
                                                                       plate.
27517.................  T....................  .....................  Treat thigh fx growth     0043     1.9233      $104.41  ............        $20.88
                                                                       plate.
27519.................  C....................  .....................  Treat thigh fx growth    .....  .........  ...........  ............  ............
                                                                       plate.
27520.................  T....................  .....................  Treat kneecap fracture.   0043     1.9233      $104.41  ............        $20.88
27524.................  T....................  .....................  Treat kneecap fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
27530.................  T....................  .....................  Treat knee fracture....   0043     1.9233      $104.41  ............        $20.88
27532.................  T....................  .....................  Treat knee fracture....   0043     1.9233      $104.41  ............        $20.88
27535.................  C....................  .....................  Treat knee fracture....  .....  .........  ...........  ............  ............
27536.................  C....................  .....................  Treat knee fracture....  .....  .........  ...........  ............  ............
27538.................  T....................  .....................  Treat knee fracture(s).   0043     1.9233      $104.41  ............        $20.88
27540.................  C....................  .....................  Treat knee fracture....  .....  .........  ...........  ............  ............
27550.................  T....................  .....................  Treat knee dislocation.   0043     1.9233      $104.41  ............        $20.88
27552.................  T....................  .....................  Treat knee dislocation.   0045    13.5546      $735.87       $268.47       $147.17
27556.................  C....................  .....................  Treat knee dislocation.  .....  .........  ...........  ............  ............
27557.................  C....................  .....................  Treat knee dislocation.  .....  .........  ...........  ............  ............
27558.................  C....................  .....................  Treat knee dislocation.  .....  .........  ...........  ............  ............
27560.................  T....................  .....................  Treat kneecap             0043     1.9233      $104.41  ............        $20.88
                                                                       dislocation.
27562.................  T....................  .....................  Treat kneecap             0045    13.5546      $735.87       $268.47       $147.17
                                                                       dislocation.
27566.................  T....................  .....................  Treat kneecap             0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       dislocation.
27570.................  T....................  .....................  Fixation of knee joint.   0045    13.5546      $735.87       $268.47       $147.17
27580.................  C....................  .....................  Fusion of knee.........  .....  .........  ...........  ............  ............
27590.................  C....................  .....................  Amputate leg at thigh..  .....  .........  ...........  ............  ............
27591.................  C....................  .....................  Amputate leg at thigh..  .....  .........  ...........  ............  ............
27592.................  C....................  .....................  Amputate leg at thigh..  .....  .........  ...........  ............  ............
27594.................  T....................  .....................  Amputation follow-up      0049    19.9376    $1,082.39  ............       $216.48
                                                                       surgery.
27596.................  C....................  .....................  Amputation follow-up     .....  .........  ...........  ............  ............
                                                                       surgery.
27598.................  C....................  .....................  Amputate lower leg at    .....  .........  ...........  ............  ............
                                                                       knee.
27599.................  T....................  .....................  Leg surgery procedure..   0043     1.9233      $104.41  ............        $20.88
27600.................  T....................  .....................  Decompression of lower    0049    19.9376    $1,082.39  ............       $216.48
                                                                       leg.
27601.................  T....................  .....................  Decompression of lower    0049    19.9376    $1,082.39  ............       $216.48
                                                                       leg.
27602.................  T....................  .....................  Decompression of lower    0049    19.9376    $1,082.39  ............       $216.48
                                                                       leg.
27603.................  T....................  .....................  Drain lower leg lesion.   0008    16.8303      $913.70  ............       $182.74
27604.................  T....................  .....................  Drain lower leg bursa..   0049    19.9376    $1,082.39  ............       $216.48
27605.................  T....................  .....................  Incision of achilles      0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       tendon.
27606.................  T....................  .....................  Incision of achilles      0049    19.9376    $1,082.39  ............       $216.48
                                                                       tendon.
27607.................  T....................  .....................  Treat lower leg bone      0049    19.9376    $1,082.39  ............       $216.48
                                                                       lesion.
27610.................  T....................  .....................  Explore/treat ankle       0050    25.1166    $1,363.56  ............       $272.71
                                                                       joint.
27612.................  T....................  .....................  Exploration of ankle      0050    25.1166    $1,363.56  ............       $272.71
                                                                       joint.
27613.................  T....................  .....................  Biopsy lower leg soft     0020     7.3105      $396.88       $113.25        $79.38
                                                                       tissue.
27614.................  T....................  .....................  Biopsy lower leg soft     0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       tissue.
27615.................  T....................  .....................  Remove tumor, lower leg   0046    31.9719    $1,735.72       $535.76       $347.14
27618.................  T....................  .....................  Remove lower leg lesion   0021    14.5749      $791.26       $219.48       $158.25
27619.................  T....................  .....................  Remove lower leg lesion   0022    18.6725    $1,013.71       $354.45       $202.74
27620.................  T....................  .....................  Explore/treat ankle       0050    25.1166    $1,363.56  ............       $272.71
                                                                       joint.
27625.................  T....................  .....................  Remove ankle joint        0050    25.1166    $1,363.56  ............       $272.71
                                                                       lining.
27626.................  T....................  .....................  Remove ankle joint        0050    25.1166    $1,363.56  ............       $272.71
                                                                       lining.
27630.................  T....................  .....................  Removal of tendon         0049    19.9376    $1,082.39  ............       $216.48
                                                                       lesion.
27635.................  T....................  .....................  Remove lower leg bone     0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
27637.................  T....................  .....................  Remove/graft leg bone     0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
27638.................  T....................  .....................  Remove/graft leg bone     0050    25.1166    $1,363.56  ............       $272.71
                                                                       lesion.
27640.................  T....................  .....................  Partial removal of        0051    34.9381    $1,896.75  ............       $379.35
                                                                       tibia.
27641.................  T....................  .....................  Partial removal of        0050    25.1166    $1,363.56  ............       $272.71
                                                                       fibula.

[[Page 48058]]

 
27645.................  C....................  .....................  Extensive lower leg      .....  .........  ...........  ............  ............
                                                                       surgery.
27646.................  C....................  .....................  Extensive lower leg      .....  .........  ...........  ............  ............
                                                                       surgery.
27647.................  T....................  .....................  Extensive ankle/heel      0051    34.9381    $1,896.75  ............       $379.35
                                                                       surgery.
27648.................  N....................  .....................  Injection for ankle x-   .....  .........  ...........  ............  ............
                                                                       ray.
27650.................  T....................  .....................  Repair achilles tendon.   0051    34.9381    $1,896.75  ............       $379.35
27652.................  T....................  .....................  Repair/graft achilles     0051    34.9381    $1,896.75  ............       $379.35
                                                                       tendon.
27654.................  T....................  .....................  Repair of achilles        0051    34.9381    $1,896.75  ............       $379.35
                                                                       tendon.
27656.................  T....................  .....................  Repair leg fascia         0049    19.9376    $1,082.39  ............       $216.48
                                                                       defect.
27658.................  T....................  .....................  Repair of leg tendon,     0049    19.9376    $1,082.39  ............       $216.48
                                                                       each.
27659.................  T....................  .....................  Repair of leg tendon,     0049    19.9376    $1,082.39  ............       $216.48
                                                                       each.
27664.................  T....................  .....................  Repair of leg tendon,     0049    19.9376    $1,082.39  ............       $216.48
                                                                       each.
27665.................  T....................  .....................  Repair of leg tendon,     0050    25.1166    $1,363.56  ............       $272.71
                                                                       each.
27675.................  T....................  .....................  Repair lower leg          0049    19.9376    $1,082.39  ............       $216.48
                                                                       tendons.
27676.................  T....................  .....................  Repair lower leg          0050    25.1166    $1,363.56  ............       $272.71
                                                                       tendons.
27680.................  T....................  .....................  Release of lower leg      0050    25.1166    $1,363.56  ............       $272.71
                                                                       tendon.
27681.................  T....................  .....................  Release of lower leg      0050    25.1166    $1,363.56  ............       $272.71
                                                                       tendons.
27685.................  T....................  .....................  Revision of lower leg     0050    25.1166    $1,363.56  ............       $272.71
                                                                       tendon.
27686.................  T....................  .....................  Revise lower leg          0050    25.1166    $1,363.56  ............       $272.71
                                                                       tendons.
27687.................  T....................  .....................  Revision of calf tendon   0050    25.1166    $1,363.56  ............       $272.71
27690.................  T....................  .....................  Revise lower leg tendon   0051    34.9381    $1,896.75  ............       $379.35
27691.................  T....................  .....................  Revise lower leg tendon   0051    34.9381    $1,896.75  ............       $379.35
27692.................  T....................  .....................  Revise additional leg     0051    34.9381    $1,896.75  ............       $379.35
                                                                       tendon.
27695.................  T....................  .....................  Repair of ankle           0050    25.1166    $1,363.56  ............       $272.71
                                                                       ligament.
27696.................  T....................  .....................  Repair of ankle           0050    25.1166    $1,363.56  ............       $272.71
                                                                       ligaments.
27698.................  T....................  .....................  Repair of ankle           0050    25.1166    $1,363.56  ............       $272.71
                                                                       ligament.
27700.................  T....................  .....................  Revision of ankle joint   0047    30.3786    $1,649.22       $537.03       $329.84
27702.................  C....................  .....................  Reconstruct ankle joint  .....  .........  ...........  ............  ............
27703.................  C....................  .....................  Reconstruction, ankle    .....  .........  ...........  ............  ............
                                                                       joint.
27704.................  T....................  .....................  Removal of ankle          0049    19.9376    $1,082.39  ............       $216.48
                                                                       implant.
27705.................  T....................  .....................  Incision of tibia......   0051    34.9381    $1,896.75  ............       $379.35
27707.................  T....................  .....................  Incision of fibula.....   0049    19.9376    $1,082.39  ............       $216.48
27709.................  T....................  .....................  Incision of tibia &       0050    25.1166    $1,363.56  ............       $272.71
                                                                       fibula.
27712.................  C....................  .....................  Realignment of lower     .....  .........  ...........  ............  ............
                                                                       leg.
27715.................  C....................  .....................  Revision of lower leg..  .....  .........  ...........  ............  ............
27720.................  C....................  .....................  Repair of tibia........  .....  .........  ...........  ............  ............
27722.................  C....................  .....................  Repair/graft of tibia..  .....  .........  ...........  ............  ............
27724.................  C....................  .....................  Repair/graft of tibia..  .....  .........  ...........  ............  ............
27725.................  C....................  .....................  Repair of lower leg....  .....  .........  ...........  ............  ............
27727.................  C....................  .....................  Repair of lower leg....  .....  .........  ...........  ............  ............
27730.................  T....................  .....................  Repair of tibia           0050    25.1166    $1,363.56  ............       $272.71
                                                                       epiphysis.
27732.................  T....................  .....................  Repair of fibula          0050    25.1166    $1,363.56  ............       $272.71
                                                                       epiphysis.
27734.................  T....................  .....................  Repair lower leg          0050    25.1166    $1,363.56  ............       $272.71
                                                                       epiphyses.
27740.................  T....................  .....................  Repair of leg epiphyses   0050    25.1166    $1,363.56  ............       $272.71
27742.................  T....................  .....................  Repair of leg epiphyses   0051    34.9381    $1,896.75  ............       $379.35
27745.................  T....................  .....................  Reinforce tibia........   0051    34.9381    $1,896.75  ............       $379.35
27750.................  T....................  .....................  Treatment of tibia        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27752.................  T....................  .....................  Treatment of tibia        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27756.................  T....................  .....................  Treatment of tibia        0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
27758.................  T....................  .....................  Treatment of tibia        0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
27759.................  T....................  .....................  Treatment of tibia        0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
27760.................  T....................  .....................  Treatment of ankle        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27762.................  T....................  .....................  Treatment of ankle        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27766.................  T....................  .....................  Treatment of ankle        0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
27780.................  T....................  .....................  Treatment of fibula       0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27781.................  T....................  .....................  Treatment of fibula       0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27784.................  T....................  .....................  Treatment of fibula       0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
27786.................  T....................  .....................  Treatment of ankle        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27788.................  T....................  .....................  Treatment of ankle        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27792.................  T....................  .....................  Treatment of ankle        0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
27808.................  T....................  .....................  Treatment of ankle        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27810.................  T....................  .....................  Treatment of ankle        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27814.................  T....................  .....................  Treatment of ankle        0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
27816.................  T....................  .....................  Treatment of ankle        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27818.................  T....................  .....................  Treatment of ankle        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27822.................  T....................  .....................  Treatment of ankle        0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
27823.................  T....................  .....................  Treatment of ankle        0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.

[[Page 48059]]

 
27824.................  T....................  .....................  Treat lower leg           0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27825.................  T....................  .....................  Treat lower leg           0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
27826.................  T....................  .....................  Treat lower leg           0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
27827.................  T....................  .....................  Treat lower leg           0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
27828.................  T....................  .....................  Treat lower leg           0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
27829.................  T....................  .....................  Treat lower leg joint..   0046    31.9719    $1,735.72       $535.76       $347.14
27830.................  T....................  .....................  Treat lower leg           0043     1.9233      $104.41  ............        $20.88
                                                                       dislocation.
27831.................  T....................  .....................  Treat lower leg           0043     1.9233      $104.41  ............        $20.88
                                                                       dislocation.
27832.................  T....................  .....................  Treat lower leg           0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       dislocation.
27840.................  T....................  .....................  Treat ankle dislocation   0043     1.9233      $104.41  ............        $20.88
27842.................  T....................  .....................  Treat ankle dislocation   0045    13.5546      $735.87       $268.47       $147.17
27846.................  T....................  .....................  Treat ankle dislocation   0046    31.9719    $1,735.72       $535.76       $347.14
27848.................  T....................  .....................  Treat ankle dislocation   0046    31.9719    $1,735.72       $535.76       $347.14
27860.................  T....................  .....................  Fixation of ankle joint   0045    13.5546      $735.87       $268.47       $147.17
27870.................  T....................  .....................  Fusion of ankle joint..   0051    34.9381    $1,896.75  ............       $379.35
27871.................  T....................  .....................  Fusion of tibiofibular    0051    34.9381    $1,896.75  ............       $379.35
                                                                       joint.
27880.................  C....................  .....................  Amputation of lower leg  .....  .........  ...........  ............  ............
27881.................  C....................  .....................  Amputation of lower leg  .....  .........  ...........  ............  ............
27882.................  C....................  .....................  Amputation of lower leg  .....  .........  ...........  ............  ............
27884.................  T....................  .....................  Amputation follow-up      0049    19.9376    $1,082.39  ............       $216.48
                                                                       surgery.
27886.................  C....................  .....................  Amputation follow-up     .....  .........  ...........  ............  ............
                                                                       surgery.
27888.................  C....................  .....................  Amputation of foot at    .....  .........  ...........  ............  ............
                                                                       ankle.
27889.................  T....................  .....................  Amputation of foot at     0050    25.1166    $1,363.56  ............       $272.71
                                                                       ankle.
27892.................  T....................  .....................  Decompression of leg...   0049    19.9376    $1,082.39  ............       $216.48
27893.................  T....................  .....................  Decompression of leg...   0049    19.9376    $1,082.39  ............       $216.48
27894.................  T....................  .....................  Decompression of leg...   0049    19.9376    $1,082.39  ............       $216.48
27899.................  T....................  .....................  Leg/ankle surgery         0043     1.9233      $104.41  ............        $20.88
                                                                       procedure.
28001.................  T....................  .....................  Drainage of bursa of      0008    16.8303      $913.70  ............       $182.74
                                                                       foot.
28002.................  T....................  .....................  Treatment of foot         0049    19.9376    $1,082.39  ............       $216.48
                                                                       infection.
28003.................  T....................  .....................  Treatment of foot         0049    19.9376    $1,082.39  ............       $216.48
                                                                       infection.
28005.................  T....................  .....................  Treat foot bone lesion.   0055    18.8851    $1,025.25       $355.34       $205.05
28008.................  T....................  .....................  Incision of foot fascia   0055    18.8851    $1,025.25       $355.34       $205.05
28010.................  T....................  .....................  Incision of toe tendon.   0055    18.8851    $1,025.25       $355.34       $205.05
28011.................  T....................  .....................  Incision of toe tendons   0055    18.8851    $1,025.25       $355.34       $205.05
28020.................  T....................  .....................  Exploration of foot       0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       joint.
28022.................  T....................  .....................  Exploration of foot       0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       joint.
28024.................  T....................  .....................  Exploration of toe        0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       joint.
28030.................  T....................  .....................  Removal of foot nerve..   0220    16.5293      $897.36  ............       $179.47
28035.................  T....................  .....................  Decompression of tibia    0220    16.5293      $897.36  ............       $179.47
                                                                       nerve.
28043.................  T....................  .....................  Excision of foot lesion   0021    14.5749      $791.26       $219.48       $158.25
28045.................  T....................  .....................  Excision of foot lesion   0055    18.8851    $1,025.25       $355.34       $205.05
28046.................  T....................  .....................  Resection of tumor,       0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       foot.
28050.................  T....................  .....................  Biopsy of foot joint      0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       lining.
28052.................  T....................  .....................  Biopsy of foot joint      0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       lining.
28054.................  T....................  .....................  Biopsy of toe joint       0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       lining.
28060.................  T....................  .....................  Partial removal, foot     0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       fascia.
28062.................  T....................  .....................  Removal of foot fascia.   0056    25.1591    $1,365.86       $405.81       $273.17
28070.................  T....................  .....................  Removal of foot joint     0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       lining.
28072.................  T....................  .....................  Removal of foot joint     0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       lining.
28080.................  T....................  .....................  Removal of foot lesion.   0055    18.8851    $1,025.25       $355.34       $205.05
28086.................  T....................  .....................  Excise foot tendon        0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       sheath.
28088.................  T....................  .....................  Excise foot tendon        0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       sheath.
28090.................  T....................  .....................  Removal of foot lesion.   0055    18.8851    $1,025.25       $355.34       $205.05
28092.................  T....................  .....................  Removal of toe lesions.   0055    18.8851    $1,025.25       $355.34       $205.05
28100.................  T....................  .....................  Removal of ankle/heel     0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       lesion.
28102.................  T....................  .....................  Remove/graft foot         0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       lesion.
28103.................  T....................  .....................  Remove/graft foot         0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       lesion.
28104.................  T....................  .....................  Removal of foot lesion.   0055    18.8851    $1,025.25       $355.34       $205.05
28106.................  T....................  .....................  Remove/graft foot         0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       lesion.
28107.................  T....................  .....................  Remove/graft foot         0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       lesion.
28108.................  T....................  .....................  Removal of toe lesions.   0055    18.8851    $1,025.25       $355.34       $205.05
28110.................  T....................  .....................  Part removal of           0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       metatarsal.
28111.................  T....................  .....................  Part removal of           0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       metatarsal.
28112.................  T....................  .....................  Part removal of           0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       metatarsal.
28113.................  T....................  .....................  Part removal of           0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       metatarsal.
28114.................  T....................  .....................  Removal of metatarsal     0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       heads.

[[Page 48060]]

 
28116.................  T....................  .....................  Revision of foot.......   0055    18.8851    $1,025.25       $355.34       $205.05
28118.................  T....................  .....................  Removal of heel bone...   0055    18.8851    $1,025.25       $355.34       $205.05
28119.................  T....................  .....................  Removal of heel spur...   0055    18.8851    $1,025.25       $355.34       $205.05
28120.................  T....................  .....................  Part removal of ankle/    0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       heel.
28122.................  T....................  .....................  Partial removal of foot   0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       bone.
28124.................  T....................  .....................  Partial removal of toe.   0055    18.8851    $1,025.25       $355.34       $205.05
28126.................  T....................  .....................  Partial removal of toe.   0055    18.8851    $1,025.25       $355.34       $205.05
28130.................  T....................  .....................  Removal of ankle bone..   0055    18.8851    $1,025.25       $355.34       $205.05
28140.................  T....................  .....................  Removal of metatarsal..   0055    18.8851    $1,025.25       $355.34       $205.05
28150.................  T....................  .....................  Removal of toe.........   0055    18.8851    $1,025.25       $355.34       $205.05
28153.................  T....................  .....................  Partial removal of toe.   0055    18.8851    $1,025.25       $355.34       $205.05
28160.................  T....................  .....................  Partial removal of toe.   0055    18.8851    $1,025.25       $355.34       $205.05
28171.................  T....................  .....................  Extensive foot surgery.   0055    18.8851    $1,025.25       $355.34       $205.05
28173.................  T....................  .....................  Extensive foot surgery.   0055    18.8851    $1,025.25       $355.34       $205.05
28175.................  T....................  .....................  Extensive foot surgery.   0055    18.8851    $1,025.25       $355.34       $205.05
28190.................  T....................  .....................  Removal of foot foreign   0019     3.9807      $216.11        $71.87        $43.22
                                                                       body.
28192.................  T....................  .....................  Removal of foot foreign   0021    14.5749      $791.26       $219.48       $158.25
                                                                       body.
28193.................  T....................  .....................  Removal of foot foreign   0021    14.5749      $791.26       $219.48       $158.25
                                                                       body.
28200.................  T....................  .....................  Repair of foot tendon..   0055    18.8851    $1,025.25       $355.34       $205.05
28202.................  T....................  .....................  Repair/graft of foot      0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       tendon.
28208.................  T....................  .....................  Repair of foot tendon..   0055    18.8851    $1,025.25       $355.34       $205.05
28210.................  T....................  .....................  Repair/graft of foot      0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       tendon.
28220.................  T....................  .....................  Release of foot tendon.   0055    18.8851    $1,025.25       $355.34       $205.05
28222.................  T....................  .....................  Release of foot tendons   0055    18.8851    $1,025.25       $355.34       $205.05
28225.................  T....................  .....................  Release of foot tendon.   0055    18.8851    $1,025.25       $355.34       $205.05
28226.................  T....................  .....................  Release of foot tendons   0055    18.8851    $1,025.25       $355.34       $205.05
28230.................  T....................  .....................  Incision of foot          0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       tendon(s).
28232.................  T....................  .....................  Incision of toe tendon.   0055    18.8851    $1,025.25       $355.34       $205.05
28234.................  T....................  .....................  Incision of foot tendon   0055    18.8851    $1,025.25       $355.34       $205.05
28238.................  T....................  .....................  Revision of foot tendon   0056    25.1591    $1,365.86       $405.81       $273.17
28240.................  T....................  .....................  Release of big toe.....   0055    18.8851    $1,025.25       $355.34       $205.05
28250.................  T....................  .....................  Revision of foot fascia   0056    25.1591    $1,365.86       $405.81       $273.17
28260.................  T....................  .....................  Release of midfoot        0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       joint.
28261.................  T....................  .....................  Revision of foot tendon   0056    25.1591    $1,365.86       $405.81       $273.17
28262.................  T....................  .....................  Revision of foot and      0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       ankle.
28264.................  T....................  .....................  Release of midfoot        0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       joint.
28270.................  T....................  .....................  Release of foot           0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       contracture.
28272.................  T....................  .....................  Release of toe joint,     0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       each.
28280.................  T....................  .....................  Fusion of toes.........   0055    18.8851    $1,025.25       $355.34       $205.05
28285.................  T....................  .....................  Repair of hammertoe....   0055    18.8851    $1,025.25       $355.34       $205.05
28286.................  T....................  .....................  Repair of hammertoe....   0055    18.8851    $1,025.25       $355.34       $205.05
28288.................  T....................  .....................  Partial removal of foot   0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       bone.
28289.................  T....................  .....................  Repair hallux rigidus..   0056    25.1591    $1,365.86       $405.81       $273.17
28290.................  T....................  .....................  Correction of bunion...   0056    25.1591    $1,365.86       $405.81       $273.17
28292.................  T....................  .....................  Correction of bunion...   0057    25.4248    $1,380.29       $475.91       $276.06
28293.................  T....................  .....................  Correction of bunion...   0057    25.4248    $1,380.29       $475.91       $276.06
28294.................  T....................  .....................  Correction of bunion...   0056    25.1591    $1,365.86       $405.81       $273.17
28296.................  T....................  .....................  Correction of bunion...   0056    25.1591    $1,365.86       $405.81       $273.17
28297.................  T....................  .....................  Correction of bunion...   0057    25.4248    $1,380.29       $475.91       $276.06
28298.................  T....................  .....................  Correction of bunion...   0056    25.1591    $1,365.86       $405.81       $273.17
28299.................  T....................  .....................  Correction of bunion...   0057    25.4248    $1,380.29       $475.91       $276.06
28300.................  T....................  .....................  Incision of heel bone..   0056    25.1591    $1,365.86       $405.81       $273.17
28302.................  T....................  .....................  Incision of ankle bone.   0056    25.1591    $1,365.86       $405.81       $273.17
28304.................  T....................  .....................  Incision of midfoot       0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       bones.
28305.................  T....................  .....................  Incise/graft midfoot      0056    25.1591    $1,365.86       $405.81       $273.17
                                                                       bones.
28306.................  T....................  .....................  Incision of metatarsal.   0056    25.1591    $1,365.86       $405.81       $273.17
28307.................  T....................  .....................  Incision of metatarsal.   0056    25.1591    $1,365.86       $405.81       $273.17
28308.................  T....................  .....................  Incision of metatarsal.   0056    25.1591    $1,365.86       $405.81       $273.17
28309.................  T....................  .....................  Incision of metatarsals   0056    25.1591    $1,365.86       $405.81       $273.17
28310.................  T....................  .....................  Revision of big toe....   0055    18.8851    $1,025.25       $355.34       $205.05
28312.................  T....................  .....................  Revision of toe........   0055    18.8851    $1,025.25       $355.34       $205.05
28313.................  T....................  .....................  Repair deformity of toe   0055    18.8851    $1,025.25       $355.34       $205.05
28315.................  T....................  .....................  Removal of sesamoid       0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       bone.
28320.................  T....................  .....................  Repair of foot bones...   0056    25.1591    $1,365.86       $405.81       $273.17
28322.................  T....................  .....................  Repair of metatarsals..   0056    25.1591    $1,365.86       $405.81       $273.17
28340.................  T....................  .....................  Resect enlarged toe       0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       tissue.

[[Page 48061]]

 
28341.................  T....................  .....................  Resect enlarged toe....   0055    18.8851    $1,025.25       $355.34       $205.05
28344.................  T....................  .....................  Repair extra toe(s)....   0056    25.1591    $1,365.86       $405.81       $273.17
28345.................  T....................  .....................  Repair webbed toe(s)...   0056    25.1591    $1,365.86       $405.81       $273.17
28360.................  T....................  .....................  Reconstruct cleft foot.   0056    25.1591    $1,365.86       $405.81       $273.17
28400.................  T....................  .....................  Treatment of heel         0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
28405.................  T....................  .....................  Treatment of heel         0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
28406.................  T....................  .....................  Treatment of heel         0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
28415.................  T....................  .....................  Treat heel fracture....   0046    31.9719    $1,735.72       $535.76       $347.14
28420.................  T....................  .....................  Treat/graft heel          0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
28430.................  T....................  .....................  Treatment of ankle        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
28435.................  T....................  .....................  Treatment of ankle        0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
28436.................  T....................  .....................  Treatment of ankle        0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
28445.................  T....................  .....................  Treat ankle fracture...   0046    31.9719    $1,735.72       $535.76       $347.14
28450.................  T....................  .....................  Treat midfoot fracture,   0043     1.9233      $104.41  ............        $20.88
                                                                       each.
28455.................  T....................  .....................  Treat midfoot fracture,   0043     1.9233      $104.41  ............        $20.88
                                                                       each.
28456.................  T....................  .....................  Treat midfoot fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
28465.................  T....................  .....................  Treat midfoot fracture,   0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       each.
28470.................  T....................  .....................  Treat metatarsal          0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
28475.................  T....................  .....................  Treat metatarsal          0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
28476.................  T....................  .....................  Treat metatarsal          0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
28485.................  T....................  .....................  Treat metatarsal          0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
28490.................  T....................  .....................  Treat big toe fracture.   0043     1.9233      $104.41  ............        $20.88
28495.................  T....................  .....................  Treat big toe fracture.   0043     1.9233      $104.41  ............        $20.88
28496.................  T....................  .....................  Treat big toe fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
28505.................  T....................  .....................  Treat big toe fracture.   0046    31.9719    $1,735.72       $535.76       $347.14
28510.................  T....................  .....................  Treatment of toe          0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
28515.................  T....................  .....................  Treatment of toe          0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
28525.................  T....................  .....................  Treat toe fracture.....   0046    31.9719    $1,735.72       $535.76       $347.14
28530.................  T....................  .....................  Treat sesamoid bone       0043     1.9233      $104.41  ............        $20.88
                                                                       fracture.
28531.................  T....................  .....................  Treat sesamoid bone       0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       fracture.
28540.................  T....................  .....................  Treat foot dislocation.   0043     1.9233      $104.41  ............        $20.88
28545.................  T....................  .....................  Treat foot dislocation.   0045    13.5546      $735.87       $268.47       $147.17
28546.................  T....................  .....................  Treat foot dislocation.   0046    31.9719    $1,735.72       $535.76       $347.14
28555.................  T....................  .....................  Repair foot dislocation   0046    31.9719    $1,735.72       $535.76       $347.14
28570.................  T....................  .....................  Treat foot dislocation.   0043     1.9233      $104.41  ............        $20.88
28575.................  T....................  .....................  Treat foot dislocation.   0043     1.9233      $104.41  ............        $20.88
28576.................  T....................  .....................  Treat foot dislocation.   0046    31.9719    $1,735.72       $535.76       $347.14
28585.................  T....................  .....................  Repair foot dislocation   0046    31.9719    $1,735.72       $535.76       $347.14
28600.................  T....................  .....................  Treat foot dislocation.   0043     1.9233      $104.41  ............        $20.88
28605.................  T....................  .....................  Treat foot dislocation.   0043     1.9233      $104.41  ............        $20.88
28606.................  T....................  .....................  Treat foot dislocation.   0046    31.9719    $1,735.72       $535.76       $347.14
28615.................  T....................  .....................  Repair foot dislocation   0046    31.9719    $1,735.72       $535.76       $347.14
28630.................  T....................  .....................  Treat toe dislocation..   0043     1.9233      $104.41  ............        $20.88
28635.................  T....................  .....................  Treat toe dislocation..   0045    13.5546      $735.87       $268.47       $147.17
28636.................  T....................  .....................  Treat toe dislocation..   0046    31.9719    $1,735.72       $535.76       $347.14
28645.................  T....................  .....................  Repair toe dislocation.   0046    31.9719    $1,735.72       $535.76       $347.14
28660.................  T....................  .....................  Treat toe dislocation..   0043     1.9233      $104.41  ............        $20.88
28665.................  T....................  .....................  Treat toe dislocation..   0045    13.5546      $735.87       $268.47       $147.17
28666.................  T....................  .....................  Treat toe dislocation..   0046    31.9719    $1,735.72       $535.76       $347.14
28675.................  T....................  .....................  Repair of toe             0046    31.9719    $1,735.72       $535.76       $347.14
                                                                       dislocation.
28705.................  T....................  .....................  Fusion of foot bones...   0056    25.1591    $1,365.86       $405.81       $273.17
28715.................  T....................  .....................  Fusion of foot bones...   0056    25.1591    $1,365.86       $405.81       $273.17
28725.................  T....................  .....................  Fusion of foot bones...   0056    25.1591    $1,365.86       $405.81       $273.17
28730.................  T....................  .....................  Fusion of foot bones...   0056    25.1591    $1,365.86       $405.81       $273.17
28735.................  T....................  .....................  Fusion of foot bones...   0056    25.1591    $1,365.86       $405.81       $273.17
28737.................  T....................  .....................  Revision of foot bones.   0055    18.8851    $1,025.25       $355.34       $205.05
28740.................  T....................  .....................  Fusion of foot bones...   0056    25.1591    $1,365.86       $405.81       $273.17
28750.................  T....................  .....................  Fusion of big toe joint   0055    18.8851    $1,025.25       $355.34       $205.05
28755.................  T....................  .....................  Fusion of big toe joint   0055    18.8851    $1,025.25       $355.34       $205.05
28760.................  T....................  .....................  Fusion of big toe joint   0056    25.1591    $1,365.86       $405.81       $273.17
28800.................  C....................  .....................  Amputation of midfoot..  .....  .........  ...........  ............  ............
28805.................  C....................  .....................  Amputation thru          .....  .........  ...........  ............  ............
                                                                       metatarsal.
28810.................  T....................  .....................  Amputation toe &          0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       metatarsal.
28820.................  T....................  .....................  Amputation of toe......   0055    18.8851    $1,025.25       $355.34       $205.05
28825.................  T....................  .....................  Partial amputation of     0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       toe.
28899.................  T....................  .....................  Foot/toes surgery         0043     1.9233      $104.41  ............        $20.88
                                                                       procedure.

[[Page 48062]]

 
29000.................  S....................  .....................  Application of body       0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29010.................  S....................  .....................  Application of body       0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29015.................  S....................  .....................  Application of body       0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29020.................  S....................  .....................  Application of body       0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29025.................  S....................  .....................  Application of body       0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29035.................  S....................  .....................  Application of body       0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29040.................  S....................  .....................  Application of body       0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29044.................  S....................  .....................  Application of body       0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29046.................  S....................  .....................  Application of body       0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29049.................  S....................  .....................  Application of figure     0058     1.0785       $58.55  ............        $11.71
                                                                       eight.
29055.................  S....................  .....................  Application of shoulder   0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29058.................  S....................  .....................  Application of shoulder   0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29065.................  S....................  .....................  Application of long arm   0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29075.................  S....................  .....................  Application of forearm    0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29085.................  S....................  .....................  Apply hand/wrist cast..   0058     1.0785       $58.55  ............        $11.71
29086.................  S....................  .....................  Apply finger cast......   0058     1.0785       $58.55  ............        $11.71
29105.................  S....................  .....................  Apply long arm splint..   0058     1.0785       $58.55  ............        $11.71
29125.................  S....................  .....................  Apply forearm splint...   0058     1.0785       $58.55  ............        $11.71
29126.................  S....................  .....................  Apply forearm splint...   0058     1.0785       $58.55  ............        $11.71
29130.................  S....................  .....................  Application of finger     0058     1.0785       $58.55  ............        $11.71
                                                                       splint.
29131.................  S....................  .....................  Application of finger     0058     1.0785       $58.55  ............        $11.71
                                                                       splint.
29200.................  S....................  .....................  Strapping of chest.....   0058     1.0785       $58.55  ............        $11.71
29220.................  S....................  .....................  Strapping of low back..   0058     1.0785       $58.55  ............        $11.71
29240.................  S....................  .....................  Strapping of shoulder..   0058     1.0785       $58.55  ............        $11.71
29260.................  S....................  .....................  Strapping of elbow or     0058     1.0785       $58.55  ............        $11.71
                                                                       wrist.
29280.................  S....................  .....................  Strapping of hand or      0058     1.0785       $58.55  ............        $11.71
                                                                       finger.
29305.................  S....................  .....................  Application of hip cast   0058     1.0785       $58.55  ............        $11.71
29325.................  S....................  .....................  Application of hip        0058     1.0785       $58.55  ............        $11.71
                                                                       casts.
29345.................  S....................  .....................  Application of long leg   0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29355.................  S....................  .....................  Application of long leg   0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29358.................  S....................  .....................  Apply long leg cast       0058     1.0785       $58.55  ............        $11.71
                                                                       brace.
29365.................  S....................  .....................  Application of long leg   0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29405.................  S....................  .....................  Apply short leg cast...   0058     1.0785       $58.55  ............        $11.71
29425.................  S....................  .....................  Apply short leg cast...   0058     1.0785       $58.55  ............        $11.71
29435.................  S....................  .....................  Apply short leg cast...   0058     1.0785       $58.55  ............        $11.71
29440.................  S....................  .....................  Addition of walker to     0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29445.................  S....................  .....................  Apply rigid leg cast...   0058     1.0785       $58.55  ............        $11.71
29450.................  S....................  .....................  Application of leg cast   0058     1.0785       $58.55  ............        $11.71
29505.................  S....................  .....................  Application, long leg     0058     1.0785       $58.55  ............        $11.71
                                                                       splint.
29515.................  S....................  .....................  Application lower leg     0058     1.0785       $58.55  ............        $11.71
                                                                       splint.
29520.................  S....................  .....................  Strapping of hip.......   0058     1.0785       $58.55  ............        $11.71
29530.................  S....................  .....................  Strapping of knee......   0058     1.0785       $58.55  ............        $11.71
29540.................  S....................  .....................  Strapping of ankle.....   0058     1.0785       $58.55  ............        $11.71
29550.................  S....................  .....................  Strapping of toes......   0058     1.0785       $58.55  ............        $11.71
29580.................  S....................  .....................  Application of paste      0058     1.0785       $58.55  ............        $11.71
                                                                       boot.
29590.................  S....................  .....................  Application of foot       0058     1.0785       $58.55  ............        $11.71
                                                                       splint.
29700.................  S....................  .....................  Removal/revision of       0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29705.................  S....................  .....................  Removal/revision of       0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29710.................  S....................  .....................  Removal/revision of       0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29715.................  S....................  .....................  Removal/revision of       0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29720.................  S....................  .....................  Repair of body cast....   0058     1.0785       $58.55  ............        $11.71
29730.................  S....................  .....................  Windowing of cast......   0058     1.0785       $58.55  ............        $11.71
29740.................  S....................  .....................  Wedging of cast........   0058     1.0785       $58.55  ............        $11.71
29750.................  S....................  .....................  Wedging of clubfoot       0058     1.0785       $58.55  ............        $11.71
                                                                       cast.
29799.................  S....................  .....................  Casting/strapping         0058     1.0785       $58.55  ............        $11.71
                                                                       procedure.
29800.................  T....................  .....................  Jaw arthroscopy/surgery   0041    27.2538    $1,479.58  ............       $295.92
29804.................  T....................  .....................  Jaw arthroscopy/surgery   0041    27.2538    $1,479.58  ............       $295.92
29805.................  T....................  .....................  Shoulder arthroscopy,     0041    27.2538    $1,479.58  ............       $295.92
                                                                       dx.
29806.................  T....................  .....................  Shoulder arthroscopy/     0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29807.................  T....................  .....................  Shoulder arthroscopy/     0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29819.................  T....................  .....................  Shoulder arthroscopy/     0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29820.................  T....................  .....................  Shoulder arthroscopy/     0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29821.................  T....................  .....................  Shoulder arthroscopy/     0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29822.................  T....................  .....................  Shoulder arthroscopy/     0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29823.................  T....................  .....................  Shoulder arthroscopy/     0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29824.................  T....................  .....................  Shoulder arthroscopy/     0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.

[[Page 48063]]

 
29825.................  T....................  .....................  Shoulder arthroscopy/     0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29826.................  T....................  .....................  Shoulder arthroscopy/     0042    42.8551    $2,326.56       $804.74       $465.31
                                                                       surgery.
29827.................  T....................  .....................  Arthroscop rotator cuff   0041    27.2538    $1,479.58  ............       $295.92
                                                                       repr.
29830.................  T....................  .....................  Elbow arthroscopy......   0041    27.2538    $1,479.58  ............       $295.92
29834.................  T....................  .....................  Elbow arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29835.................  T....................  .....................  Elbow arthroscopy/        0042    42.8551    $2,326.56       $804.74       $465.31
                                                                       surgery.
29836.................  T....................  .....................  Elbow arthroscopy/        0042    42.8551    $2,326.56       $804.74       $465.31
                                                                       surgery.
29837.................  T....................  .....................  Elbow arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29838.................  T....................  .....................  Elbow arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29840.................  T....................  .....................  Wrist arthroscopy......   0041    27.2538    $1,479.58  ............       $295.92
29843.................  T....................  .....................  Wrist arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29844.................  T....................  .....................  Wrist arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29845.................  T....................  .....................  Wrist arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29846.................  T....................  .....................  Wrist arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29847.................  T....................  .....................  Wrist arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29848.................  T....................  .....................  Wrist endoscopy/surgery   0041    27.2538    $1,479.58  ............       $295.92
29850.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29851.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29855.................  T....................  .....................  Tibial arthroscopy/       0042    42.8551    $2,326.56       $804.74       $465.31
                                                                       surgery.
29856.................  T....................  .....................  Tibial arthroscopy/       0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29860.................  T....................  .....................  Hip arthroscopy, dx....   0041    27.2538    $1,479.58  ............       $295.92
29861.................  T....................  .....................  Hip arthroscopy/surgery   0041    27.2538    $1,479.58  ............       $295.92
29862.................  T....................  .....................  Hip arthroscopy/surgery   0042    42.8551    $2,326.56       $804.74       $465.31
29863.................  T....................  .....................  Hip arthroscopy/surgery   0042    42.8551    $2,326.56       $804.74       $465.31
29870.................  T....................  .....................  Knee arthroscopy, dx...   0041    27.2538    $1,479.58  ............       $295.92
29871.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       drainage.
29873.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29874.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29875.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29876.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29877.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29879.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29880.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29881.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29882.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29883.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29884.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29885.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29886.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29887.................  T....................  .....................  Knee arthroscopy/         0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29888.................  T....................  .....................  Knee arthroscopy/         0042    42.8551    $2,326.56       $804.74       $465.31
                                                                       surgery.
29889.................  T....................  .....................  Knee arthroscopy/         0042    42.8551    $2,326.56       $804.74       $465.31
                                                                       surgery.
29891.................  T....................  .....................  Ankle arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29892.................  T....................  .....................  Ankle arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29893.................  T....................  .....................  Scope, plantar            0055    18.8851    $1,025.25       $355.34       $205.05
                                                                       fasciotomy.
29894.................  T....................  .....................  Ankle arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29895.................  T....................  .....................  Ankle arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29897.................  T....................  .....................  Ankle arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29898.................  T....................  .....................  Ankle arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29899.................  T....................  .....................  Ankle arthroscopy/        0041    27.2538    $1,479.58  ............       $295.92
                                                                       surgery.
29900.................  T....................  .....................  Mcp joint arthroscopy,    0053    14.8188      $804.50       $253.49       $160.90
                                                                       dx.
29901.................  T....................  .....................  Mcp joint arthroscopy,    0053    14.8188      $804.50       $253.49       $160.90
                                                                       surg.
29902.................  T....................  .....................  Mcp joint arthroscopy,    0053    14.8188      $804.50       $253.49       $160.90
                                                                       surg.
29999.................  T....................  .....................  Arthroscopy of joint...   0041    27.2538    $1,479.58  ............       $295.92
30000.................  T....................  .....................  Drainage of nose lesion   0251     1.8643      $101.21  ............        $20.24
30020.................  T....................  .....................  Drainage of nose lesion   0251     1.8643      $101.21  ............        $20.24
30100.................  T....................  .....................  Intranasal biopsy......   0252     6.5416      $355.14       $113.41        $71.03
30110.................  T....................  .....................  Removal of nose           0253    15.1698      $823.55       $282.29       $164.71
                                                                       polyp(s).
30115.................  T....................  .....................  Removal of nose           0253    15.1698      $823.55       $282.29       $164.71
                                                                       polyp(s).
30117.................  T....................  .....................  Removal of intranasal     0253    15.1698      $823.55       $282.29       $164.71
                                                                       lesion.
30118.................  T....................  .....................  Removal of intranasal     0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       lesion.
30120.................  T....................  .....................  Revision of nose.......   0253    15.1698      $823.55       $282.29       $164.71
30124.................  T....................  .....................  Removal of nose lesion.   0252     6.5416      $355.14       $113.41        $71.03
30125.................  T....................  .....................  Removal of nose lesion.   0256    35.0866    $1,904.82  ............       $380.96
30130.................  T....................  .....................  Removal of turbinate      0253    15.1698      $823.55       $282.29       $164.71
                                                                       bones.
30140.................  T....................  .....................  Removal of turbinate      0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       bones.

[[Page 48064]]

 
30150.................  T....................  .....................  Partial removal of nose   0256    35.0866    $1,904.82  ............       $380.96
30160.................  T....................  .....................  Removal of nose........   0256    35.0866    $1,904.82  ............       $380.96
30200.................  T....................  .....................  Injection treatment of    0253    15.1698      $823.55       $282.29       $164.71
                                                                       nose.
30210.................  T....................  .....................  Nasal sinus therapy....   0252     6.5416      $355.14       $113.41        $71.03
30220.................  T....................  .....................  Insert nasal septal       0252     6.5416      $355.14       $113.41        $71.03
                                                                       button.
30300.................  X....................  .....................  Remove nasal foreign      0340     0.6232       $33.83  ............         $6.77
                                                                       body.
30310.................  T....................  .....................  Remove nasal foreign      0253    15.1698      $823.55       $282.29       $164.71
                                                                       body.
30320.................  T....................  .....................  Remove nasal foreign      0253    15.1698      $823.55       $282.29       $164.71
                                                                       body.
30400.................  T....................  .....................  Reconstruction of nose.   0256    35.0866    $1,904.82  ............       $380.96
30410.................  T....................  .....................  Reconstruction of nose.   0256    35.0866    $1,904.82  ............       $380.96
30420.................  T....................  .....................  Reconstruction of nose.   0256    35.0866    $1,904.82  ............       $380.96
30430.................  T....................  .....................  Revision of nose.......   0254    21.4368    $1,163.78       $321.35       $232.76
30435.................  T....................  .....................  Revision of nose.......   0256    35.0866    $1,904.82  ............       $380.96
30450.................  T....................  .....................  Revision of nose.......   0256    35.0866    $1,904.82  ............       $380.96
30460.................  T....................  .....................  Revision of nose.......   0256    35.0866    $1,904.82  ............       $380.96
30462.................  T....................  .....................  Revision of nose.......   0256    35.0866    $1,904.82  ............       $380.96
30465.................  T....................  .....................  Repair nasal stenosis..   0256    35.0866    $1,904.82  ............       $380.96
30520.................  T....................  .....................  Repair of nasal septum.   0254    21.4368    $1,163.78       $321.35       $232.76
30540.................  T....................  .....................  Repair nasal defect....   0256    35.0866    $1,904.82  ............       $380.96
30545.................  T....................  .....................  Repair nasal defect....   0256    35.0866    $1,904.82  ............       $380.96
30560.................  T....................  .....................  Release of nasal          0251     1.8643      $101.21  ............        $20.24
                                                                       adhesions.
30580.................  T....................  .....................  Repair upper jaw          0256    35.0866    $1,904.82  ............       $380.96
                                                                       fistula.
30600.................  T....................  .....................  Repair mouth/nose         0256    35.0866    $1,904.82  ............       $380.96
                                                                       fistula.
30620.................  T....................  .....................  Intranasal                0256    35.0866    $1,904.82  ............       $380.96
                                                                       reconstruction.
30630.................  T....................  .....................  Repair nasal septum       0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       defect.
30801.................  T....................  .....................  Cauterization, inner      0252     6.5416      $355.14       $113.41        $71.03
                                                                       nose.
30802.................  T....................  .....................  Cauterization, inner      0253    15.1698      $823.55       $282.29       $164.71
                                                                       nose.
30901.................  T....................  .....................  Control of nosebleed...   0250     1.5381       $83.50        $29.23        $16.70
30903.................  T....................  .....................  Control of nosebleed...   0250     1.5381       $83.50        $29.23        $16.70
30905.................  T....................  .....................  Control of nosebleed...   0250     1.5381       $83.50        $29.23        $16.70
30906.................  T....................  .....................  Repeat control of         0250     1.5381       $83.50        $29.23        $16.70
                                                                       nosebleed.
30915.................  T....................  .....................  Ligation, nasal sinus     0091    28.5187    $1,548.25       $348.23       $309.65
                                                                       artery.
30920.................  T....................  .....................  Ligation, upper jaw       0092    25.1347    $1,364.54       $505.37       $272.91
                                                                       artery.
30930.................  T....................  .....................  Therapy, fracture of      0253    15.1698      $823.55       $282.29       $164.71
                                                                       nose.
30999.................  T....................  .....................  Nasal surgery procedure   0251     1.8643      $101.21  ............        $20.24
31000.................  T....................  .....................  Irrigation, maxillary     0251     1.8643      $101.21  ............        $20.24
                                                                       sinus.
31002.................  T....................  .....................  Irrigation, sphenoid      0252     6.5416      $355.14       $113.41        $71.03
                                                                       sinus.
31020.................  T....................  .....................  Exploration, maxillary    0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       sinus.
31030.................  T....................  .....................  Exploration, maxillary    0256    35.0866    $1,904.82  ............       $380.96
                                                                       sinus.
31032.................  T....................  .....................  Explore sinus, remove     0256    35.0866    $1,904.82  ............       $380.96
                                                                       polyps.
31040.................  T....................  .....................  Exploration behind        0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       upper jaw.
31050.................  T....................  .....................  Exploration, sphenoid     0256    35.0866    $1,904.82  ............       $380.96
                                                                       sinus.
31051.................  T....................  .....................  Sphenoid sinus surgery.   0256    35.0866    $1,904.82  ............       $380.96
31070.................  T....................  .....................  Exploration of frontal    0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       sinus.
31075.................  T....................  .....................  Exploration of frontal    0256    35.0866    $1,904.82  ............       $380.96
                                                                       sinus.
31080.................  T....................  .....................  Removal of frontal        0256    35.0866    $1,904.82  ............       $380.96
                                                                       sinus.
31081.................  T....................  .....................  Removal of frontal        0256    35.0866    $1,904.82  ............       $380.96
                                                                       sinus.
31084.................  T....................  .....................  Removal of frontal        0256    35.0866    $1,904.82  ............       $380.96
                                                                       sinus.
31085.................  T....................  .....................  Removal of frontal        0256    35.0866    $1,904.82  ............       $380.96
                                                                       sinus.
31086.................  T....................  .....................  Removal of frontal        0256    35.0866    $1,904.82  ............       $380.96
                                                                       sinus.
31087.................  T....................  .....................  Removal of frontal        0256    35.0866    $1,904.82  ............       $380.96
                                                                       sinus.
31090.................  T....................  .....................  Exploration of sinuses.   0256    35.0866    $1,904.82  ............       $380.96
31200.................  T....................  .....................  Removal of ethmoid        0256    35.0866    $1,904.82  ............       $380.96
                                                                       sinus.
31201.................  T....................  .....................  Removal of ethmoid        0256    35.0866    $1,904.82  ............       $380.96
                                                                       sinus.
31205.................  T....................  .....................  Removal of ethmoid        0256    35.0866    $1,904.82  ............       $380.96
                                                                       sinus.
31225.................  C....................  .....................  Removal of upper jaw...  .....  .........  ...........  ............  ............
31230.................  C....................  .....................  Removal of upper jaw...  .....  .........  ...........  ............  ............
31231.................  T....................  .....................  Nasal endoscopy, dx....   0071     0.9012       $48.93        $12.89         $9.79
31233.................  T....................  .....................  Nasal/sinus endoscopy,    0073     3.4396      $186.73        $73.38        $37.35
                                                                       dx.
31235.................  T....................  .....................  Nasal/sinus endoscopy,    0074    14.4952      $786.93       $295.70       $157.39
                                                                       dx.
31237.................  T....................  .....................  Nasal/sinus endoscopy,    0075    20.4113    $1,108.11       $445.92       $221.62
                                                                       surg.
31238.................  T....................  .....................  Nasal/sinus endoscopy,    0074    14.4952      $786.93       $295.70       $157.39
                                                                       surg.
31239.................  T....................  .....................  Nasal/sinus endoscopy,    0075    20.4113    $1,108.11       $445.92       $221.62
                                                                       surg.
31240.................  T....................  .....................  Nasal/sinus endoscopy,    0074    14.4952      $786.93       $295.70       $157.39
                                                                       surg.
31254.................  T....................  .....................  Revision of ethmoid       0075    20.4113    $1,108.11       $445.92       $221.62
                                                                       sinus.
31255.................  T....................  .....................  Removal of ethmoid        0075    20.4113    $1,108.11       $445.92       $221.62
                                                                       sinus.

[[Page 48065]]

 
31256.................  T....................  .....................  Exploration maxillary     0075    20.4113    $1,108.11       $445.92       $221.62
                                                                       sinus.
31267.................  T....................  .....................  Endoscopy, maxillary      0075    20.4113    $1,108.11       $445.92       $221.62
                                                                       sinus.
31276.................  T....................  .....................  Sinus endoscopy,          0075    20.4113    $1,108.11       $445.92       $221.62
                                                                       surgical.
31287.................  T....................  .....................  Nasal/sinus endoscopy,    0075    20.4113    $1,108.11       $445.92       $221.62
                                                                       surg.
31288.................  T....................  .....................  Nasal/sinus endoscopy,    0075    20.4113    $1,108.11       $445.92       $221.62
                                                                       surg.
31290.................  C....................  .....................  Nasal/sinus endoscopy,   .....  .........  ...........  ............  ............
                                                                       surg.
31291.................  C....................  .....................  Nasal/sinus endoscopy,   .....  .........  ...........  ............  ............
                                                                       surg.
31292.................  C....................  .....................  Nasal/sinus endoscopy,   .....  .........  ...........  ............  ............
                                                                       surg.
31293.................  C....................  .....................  Nasal/sinus endoscopy,   .....  .........  ...........  ............  ............
                                                                       surg.
31294.................  C....................  .....................  Nasal/sinus endoscopy,   .....  .........  ...........  ............  ............
                                                                       surg.
31299.................  T....................  .....................  Sinus surgery procedure   0252     6.5416      $355.14       $113.41        $71.03
31300.................  T....................  .....................  Removal of larynx         0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       lesion.
31320.................  T....................  .....................  Diagnostic incision,      0256    35.0866    $1,904.82  ............       $380.96
                                                                       larynx.
31360.................  C....................  .....................  Removal of larynx......  .....  .........  ...........  ............  ............
31365.................  C....................  .....................  Removal of larynx......  .....  .........  ...........  ............  ............
31367.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       larynx.
31368.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       larynx.
31370.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       larynx.
31375.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       larynx.
31380.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       larynx.
31382.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       larynx.
31390.................  C....................  .....................  Removal of larynx &      .....  .........  ...........  ............  ............
                                                                       pharynx.
31395.................  C....................  .....................  Reconstruct larynx &     .....  .........  ...........  ............  ............
                                                                       pharynx.
31400.................  T....................  .....................  Revision of larynx.....   0256    35.0866    $1,904.82  ............       $380.96
31420.................  T....................  .....................  Removal of epiglottis..   0256    35.0866    $1,904.82  ............       $380.96
31500.................  S....................  .....................  Insert emergency airway   0094     2.6412      $143.39        $48.46        $28.68
31502.................  T....................  .....................  Change of windpipe        0121     2.2058      $119.75        $43.80        $23.95
                                                                       airway.
31505.................  T....................  .....................  Diagnostic laryngoscopy   0071     0.9012       $48.93        $12.89         $9.79
31510.................  T....................  .....................  Laryngoscopy with         0074    14.4952      $786.93       $295.70       $157.39
                                                                       biopsy.
31511.................  T....................  .....................  Remove foreign body,      0072     1.6987       $92.22        $26.68        $18.44
                                                                       larynx.
31512.................  T....................  .....................  Removal of larynx         0074    14.4952      $786.93       $295.70       $157.39
                                                                       lesion.
31513.................  T....................  .....................  Injection into vocal      0072     1.6987       $92.22        $26.68        $18.44
                                                                       cord.
31515.................  T....................  .....................  Laryngoscopy for          0074    14.4952      $786.93       $295.70       $157.39
                                                                       aspiration.
31520.................  T....................  .....................  Diagnostic laryngoscopy   0072     1.6987       $92.22        $26.68        $18.44
31525.................  T....................  .....................  Diagnostic laryngoscopy   0074    14.4952      $786.93       $295.70       $157.39
31526.................  T....................  .....................  Diagnostic laryngoscopy   0075    20.4113    $1,108.11       $445.92       $221.62
31527.................  T....................  .....................  Laryngoscopy for          0075    20.4113    $1,108.11       $445.92       $221.62
                                                                       treatment.
31528.................  T....................  .....................  Laryngoscopy and          0074    14.4952      $786.93       $295.70       $157.39
                                                                       dilation.
31529.................  T....................  .....................  Laryngoscopy and          0074    14.4952      $786.93       $295.70       $157.39
                                                                       dilation.
31530.................  T....................  .....................  Operative laryngoscopy.   0075    20.4113    $1,108.11       $445.92       $221.62
31531.................  T....................  .....................  Operative laryngoscopy.   0075    20.4113    $1,108.11       $445.92       $221.62
31535.................  T....................  .....................  Operative laryngoscopy.   0075    20.4113    $1,108.11       $445.92       $221.62
31536.................  T....................  .....................  Operative laryngoscopy.   0075    20.4113    $1,108.11       $445.92       $221.62
31540.................  T....................  .....................  Operative laryngoscopy.   0075    20.4113    $1,108.11       $445.92       $221.62
31541.................  T....................  .....................  Operative laryngoscopy.   0075    20.4113    $1,108.11       $445.92       $221.62
31560.................  T....................  .....................  Operative laryngoscopy.   0075    20.4113    $1,108.11       $445.92       $221.62
31561.................  T....................  .....................  Operative laryngoscopy.   0075    20.4113    $1,108.11       $445.92       $221.62
31570.................  T....................  .....................  Laryngoscopy with         0074    14.4952      $786.93       $295.70       $157.39
                                                                       injection.
31571.................  T....................  .....................  Laryngoscopy with         0075    20.4113    $1,108.11       $445.92       $221.62
                                                                       injection.
31575.................  T....................  .....................  Diagnostic laryngoscopy   0072     1.6987       $92.22        $26.68        $18.44
31576.................  T....................  .....................  Laryngoscopy with         0075    20.4113    $1,108.11       $445.92       $221.62
                                                                       biopsy.
31577.................  T....................  .....................  Remove foreign body,      0073     3.4396      $186.73        $73.38        $37.35
                                                                       larynx.
31578.................  T....................  .....................  Removal of larynx         0075    20.4113    $1,108.11       $445.92       $221.62
                                                                       lesion.
31579.................  T....................  .....................  Diagnostic laryngoscopy   0073     3.4396      $186.73        $73.38        $37.35
31580.................  T....................  .....................  Revision of larynx.....   0256    35.0866    $1,904.82  ............       $380.96
31582.................  T....................  .....................  Revision of larynx.....   0256    35.0866    $1,904.82  ............       $380.96
31584.................  C....................  .....................  Treat larynx fracture..  .....  .........  ...........  ............  ............
31585.................  T....................  .....................  Treat larynx fracture..   0253    15.1698      $823.55       $282.29       $164.71
31586.................  T....................  .....................  Treat larynx fracture..   0256    35.0866    $1,904.82  ............       $380.96
31587.................  C....................  .....................  Revision of larynx.....  .....  .........  ...........  ............  ............
31588.................  T....................  .....................  Revision of larynx.....   0256    35.0866    $1,904.82  ............       $380.96
31590.................  T....................  .....................  Reinnervate larynx.....   0256    35.0866    $1,904.82  ............       $380.96
31595.................  T....................  .....................  Larynx nerve surgery...   0256    35.0866    $1,904.82  ............       $380.96
31599.................  T....................  .....................  Larynx surgery            0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       procedure.
31600.................  T....................  .....................  Incision of windpipe...   0254    21.4368    $1,163.78       $321.35       $232.76
31601.................  T....................  .....................  Incision of windpipe...   0254    21.4368    $1,163.78       $321.35       $232.76

[[Page 48066]]

 
31603.................  T....................  .....................  Incision of windpipe...   0252     6.5416      $355.14       $113.41        $71.03
31605.................  T....................  .....................  Incision of windpipe...   0253    15.1698      $823.55       $282.29       $164.71
31610.................  T....................  .....................  Incision of windpipe...   0254    21.4368    $1,163.78       $321.35       $232.76
31611.................  T....................  .....................  Surgery/speech            0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       prosthesis.
31612.................  T....................  .....................  Puncture/clear windpipe   0254    21.4368    $1,163.78       $321.35       $232.76
31613.................  T....................  .....................  Repair windpipe opening   0254    21.4368    $1,163.78       $321.35       $232.76
31614.................  T....................  .....................  Repair windpipe opening   0256    35.0866    $1,904.82  ............       $380.96
31615.................  T....................  .....................  Visualization of          0076     9.3560      $507.93       $189.82       $101.59
                                                                       windpipe.
31622.................  T....................  .....................  Dx bronchoscope/wash...   0076     9.3560      $507.93       $189.82       $101.59
31623.................  T....................  .....................  Dx bronchoscope/brush..   0076     9.3560      $507.93       $189.82       $101.59
31624.................  T....................  .....................  Dx bronchoscope/lavage.   0076     9.3560      $507.93       $189.82       $101.59
31625.................  T....................  .....................  Bronchoscopy w/           0076     9.3560      $507.93       $189.82       $101.59
                                                                       biopsy(s).
31628.................  T....................  .....................  Bronchoscopy/lung bx,     0076     9.3560      $507.93       $189.82       $101.59
                                                                       each.
31629.................  T....................  .....................  Bronchoscopy/needle bx,   0076     9.3560      $507.93       $189.82       $101.59
                                                                       each.
31630.................  T....................  .....................  Bronchoscopy dilate/fx    0415    20.9920    $1,139.63       $463.30       $227.93
                                                                       repr.
31631.................  T....................  .....................  Bronchoscopy, dilate w/   0415    20.9920    $1,139.63       $463.30       $227.93
                                                                       stent.
31635.................  T....................  .....................  Bronchoscopy w/fb         0076     9.3560      $507.93       $189.82       $101.59
                                                                       removal.
31640.................  T....................  .....................  Bronchoscopy w/tumor      0415    20.9920    $1,139.63       $463.30       $227.93
                                                                       excise.
31641.................  T....................  .....................  Bronchoscopy, treat       0415    20.9920    $1,139.63       $463.30       $227.93
                                                                       blockage.
31643.................  T....................  .....................  Diag bronchoscope/        0076     9.3560      $507.93       $189.82       $101.59
                                                                       catheter.
31645.................  T....................  .....................  Bronchoscopy, clear       0076     9.3560      $507.93       $189.82       $101.59
                                                                       airways.
31646.................  T....................  .....................  Bronchoscopy, reclear     0076     9.3560      $507.93       $189.82       $101.59
                                                                       airway.
31656.................  T....................  .....................  Bronchoscopy, inj for x-  0076     9.3560      $507.93       $189.82       $101.59
                                                                       ray.
31700.................  T....................  .....................  Insertion of airway       0072     1.6987       $92.22        $26.68        $18.44
                                                                       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     3.4396      $186.73        $73.38        $37.35
31720.................  T....................  .....................  Clearance of airways...   0072     1.6987       $92.22        $26.68        $18.44
31725.................  C....................  .....................  Clearance of airways...  .....  .........  ...........  ............  ............
31730.................  T....................  .....................  Intro, windpipe wire/     0073     3.4396      $186.73        $73.38        $37.35
                                                                       tube.
31750.................  T....................  .....................  Repair of windpipe.....   0256    35.0866    $1,904.82  ............       $380.96
31755.................  T....................  .....................  Repair of windpipe.....   0256    35.0866    $1,904.82  ............       $380.96
31760.................  C....................  .....................  Repair of windpipe.....  .....  .........  ...........  ............  ............
31766.................  C....................  .....................  Reconstruction of        .....  .........  ...........  ............  ............
                                                                       windpipe.
31770.................  C....................  .....................  Repair/graft of          .....  .........  ...........  ............  ............
                                                                       bronchus.
31775.................  C....................  .....................  Reconstruct bronchus...  .....  .........  ...........  ............  ............
31780.................  C....................  .....................  Reconstruct windpipe...  .....  .........  ...........  ............  ............
31781.................  C....................  .....................  Reconstruct windpipe...  .....  .........  ...........  ............  ............
31785.................  T....................  .....................  Remove windpipe lesion.   0254    21.4368    $1,163.78       $321.35       $232.76
31786.................  C....................  .....................  Remove windpipe lesion.  .....  .........  ...........  ............  ............
31800.................  C....................  .....................  Repair of windpipe       .....  .........  ...........  ............  ............
                                                                       injury.
31805.................  C....................  .....................  Repair of windpipe       .....  .........  ...........  ............  ............
                                                                       injury.
31820.................  T....................  .....................  Closure of windpipe       0253    15.1698      $823.55       $282.29       $164.71
                                                                       lesion.
31825.................  T....................  .....................  Repair of windpipe        0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       defect.
31830.................  T....................  .....................  Revise windpipe scar...   0254    21.4368    $1,163.78       $321.35       $232.76
31899.................  T....................  .....................  Airways surgical          0076     9.3560      $507.93       $189.82       $101.59
                                                                       procedure.
32000.................  T....................  .....................  Drainage of chest......   0070     3.1393      $170.43  ............        $34.09
32002.................  T....................  .....................  Treatment of collapsed    0070     3.1393      $170.43  ............        $34.09
                                                                       lung.
32005.................  T....................  .....................  Treat lung lining         0070     3.1393      $170.43  ............        $34.09
                                                                       chemically.
32020.................  T....................  .....................  Insertion of chest tube   0070     3.1393      $170.43  ............        $34.09
32035.................  C....................  .....................  Exploration of chest...  .....  .........  ...........  ............  ............
32036.................  C....................  .....................  Exploration of chest...  .....  .........  ...........  ............  ............
32095.................  C....................  .....................  Biopsy through chest     .....  .........  ...........  ............  ............
                                                                       wall.
32100.................  C....................  .....................  Exploration/biopsy of    .....  .........  ...........  ............  ............
                                                                       chest.
32110.................  C....................  .....................  Explore/repair chest...  .....  .........  ...........  ............  ............
32120.................  C....................  .....................  Re-exploration of chest  .....  .........  ...........  ............  ............
32124.................  C....................  .....................  Explore chest free       .....  .........  ...........  ............  ............
                                                                       adhesions.
32140.................  C....................  .....................  Removal of lung          .....  .........  ...........  ............  ............
                                                                       lesion(s).
32141.................  C....................  .....................  Remove/treat lung        .....  .........  ...........  ............  ............
                                                                       lesions.
32150.................  C....................  .....................  Removal of lung          .....  .........  ...........  ............  ............
                                                                       lesion(s).
32151.................  C....................  .....................  Remove lung foreign      .....  .........  ...........  ............  ............
                                                                       body.
32160.................  C....................  .....................  Open chest heart         .....  .........  ...........  ............  ............
                                                                       massage.
32200.................  C....................  .....................  Drain, open, lung        .....  .........  ...........  ............  ............
                                                                       lesion.
32201.................  T....................  .....................  Drain, percut, lung       0070     3.1393      $170.43  ............        $34.09
                                                                       lesion.
32215.................  C....................  .....................  Treat chest lining.....  .....  .........  ...........  ............  ............

[[Page 48067]]

 
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       0005     3.3675      $182.82        $71.59        $36.56
                                                                       lining.
32402.................  C....................  .....................  Open biopsy chest        .....  .........  ...........  ............  ............
                                                                       lining.
32405.................  T....................  .....................  Biopsy, lung or           0685     4.8912      $265.54       $116.83        $53.11
                                                                       mediastinum.
32420.................  T....................  .....................  Puncture/clear lung....   0070     3.1393      $170.43  ............        $34.09
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,             0069    28.6334    $1,554.48       $591.64       $310.90
                                                                       diagnostic.
32602.................  T....................  .....................  Thoracoscopy,             0069    28.6334    $1,554.48       $591.64       $310.90
                                                                       diagnostic.
32603.................  T....................  .....................  Thoracoscopy,             0069    28.6334    $1,554.48       $591.64       $310.90
                                                                       diagnostic.
32604.................  T....................  .....................  Thoracoscopy,             0069    28.6334    $1,554.48       $591.64       $310.90
                                                                       diagnostic.
32605.................  T....................  .....................  Thoracoscopy,             0069    28.6334    $1,554.48       $591.64       $310.90
                                                                       diagnostic.
32606.................  T....................  .....................  Thoracoscopy,             0069    28.6334    $1,554.48       $591.64       $310.90
                                                                       diagnostic.
32650.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32651.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32652.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32653.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32654.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32655.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32656.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32657.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32658.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32659.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32660.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32661.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32662.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32663.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32664.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32665.................  C....................  .....................  Thoracoscopy, surgical.  .....  .........  ...........  ............  ............
32800.................  C....................  .....................  Repair lung hernia.....  .....  .........  ...........  ............  ............
32810.................  C....................  .....................  Close chest after        .....  .........  ...........  ............  ............
                                                                       drainage.
32815.................  C....................  .....................  Close bronchial fistula  .....  .........  ...........  ............  ............
32820.................  C....................  .....................  Reconstruct injured      .....  .........  ...........  ............  ............
                                                                       chest.
32850.................  C....................  .....................  Donor pneumonectomy....  .....  .........  ...........  ............  ............
32851.................  C....................  .....................  Lung transplant, single  .....  .........  ...........  ............  ............
32852.................  C....................  .....................  Lung transplant 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               0070     3.1393      $170.43  ............        $34.09
                                                                       pneumothorax.
32997.................  C....................  .....................  Total lung lavage......  .....  .........  ...........  ............  ............
32999.................  T....................  .....................  Chest surgery procedure   0070     3.1393      $170.43  ............        $34.09
33010.................  T....................  .....................  Drainage of heart sac..   0070     3.1393      $170.43  ............        $34.09
33011.................  T....................  .....................  Repeat drainage of        0070     3.1393      $170.43  ............        $34.09
                                                                       heart sac.
33015.................  C....................  .....................  Incision of heart sac..  .....  .........  ...........  ............  ............
33020.................  C....................  .....................  Incision of heart sac..  .....  .........  ...........  ............  ............
33025.................  C....................  .....................  Incision of heart sac..  .....  .........  ...........  ............  ............

[[Page 48068]]

 
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   116.1611    $6,306.27     $1,722.59     $1,261.25
                                                                       pacemaker.
33207.................  T....................  .....................  Insertion of heart        0089   116.1611    $6,306.27     $1,722.59     $1,261.25
                                                                       pacemaker.
33208.................  T....................  .....................  Insertion of heart        0655   142.2244    $7,721.22  ............     $1,544.24
                                                                       pacemaker.
33210.................  T....................  .....................  Insertion of heart        0106    49.9534    $2,711.92       $542.39       $542.38
                                                                       electrode.
33211.................  T....................  .....................  Insertion of heart        0106    49.9534    $2,711.92       $542.39       $542.38
                                                                       electrode.
33212.................  T....................  .....................  Insertion of pulse        0090    87.2850    $4,738.62     $1,705.90       $947.72
                                                                       generator.
33213.................  T....................  .....................  Insertion of pulse        0654   103.8544    $5,638.15  ............     $1,127.63
                                                                       generator.
33214.................  T....................  .....................  Upgrade of pacemaker      0655   142.2244    $7,721.22  ............     $1,544.24
                                                                       system.
33215.................  T....................  .....................  Reposition pacing-defib   0105    18.9084    $1,026.52       $370.40       $205.30
                                                                       lead.
33216.................  T....................  .....................  Revise eltrd pacing-      0106    49.9534    $2,711.92       $542.39       $542.38
                                                                       defib.
33217.................  T....................  .....................  Insert lead pace-defib,   0106    49.9534    $2,711.92       $542.39       $542.38
                                                                       dual.
33218.................  T....................  .....................  Repair lead pace-defib,   0106    49.9534    $2,711.92       $542.39       $542.38
                                                                       one.
33220.................  T....................  .....................  Repair lead pace-defib,   0106    49.9534    $2,711.92       $542.39       $542.38
                                                                       dual.
33222.................  T....................  .....................  Revise pocket,            0027    15.8319      $859.50       $329.72       $171.90
                                                                       pacemaker.
33223.................  T....................  .....................  Revise pocket, pacing-    0027    15.8319      $859.50       $329.72       $171.90
                                                                       defib.
33224.................  T....................  .....................  Insert pacing lead &      1547  .........      $850.00  ............       $170.00
                                                                       connect.
33225.................  T....................  .....................  L ventric pacing lead     1550  .........    $1,150.00  ............       $230.00
                                                                       add-on.
33226.................  T....................  .....................  Reposition l ventric      0105    18.9084    $1,026.52       $370.40       $205.30
                                                                       lead.
33233.................  T....................  .....................  Removal of pacemaker      0105    18.9084    $1,026.52       $370.40       $205.30
                                                                       system.
33234.................  T....................  .....................  Removal of pacemaker      0105    18.9084    $1,026.52       $370.40       $205.30
                                                                       system.
33235.................  T....................  .....................  Removal pacemaker         0105    18.9084    $1,026.52       $370.40       $205.30
                                                                       electrode.
33236.................  C....................  .....................  Remove electrode/        .....  .........  ...........  ............  ............
                                                                       thoracotomy.
33237.................  C....................  .....................  Remove electrode/        .....  .........  ...........  ............  ............
                                                                       thoracotomy.
33238.................  C....................  .....................  Remove electrode/        .....  .........  ...........  ............  ............
                                                                       thoracotomy.
33240.................  T....................  .....................  Insert pulse generator.   0107   290.5429   $15,773.28     $3,429.62     $3,154.66
33241.................  T....................  .....................  Remove pulse generator.   0105    18.9084    $1,026.52       $370.40       $205.30
33243.................  C....................  .....................  Remove eltrd/            .....  .........  ...........  ............  ............
                                                                       thoracotomy.
33244.................  T....................  .....................  Remove eltrd, transven.   0105    18.9084    $1,026.52       $370.40       $205.30
33245.................  C....................  .....................  Insert epic eltrd pace-  .....  .........  ...........  ............  ............
                                                                       defib.
33246.................  C....................  .....................  Insert epic eltrd/       .....  .........  ...........  ............  ............
                                                                       generator.
33249.................  T....................  .....................  Eltrd/insert pace-defib   0108   489.5275   $26,575.96  ............     $5,315.19
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    61.4222    $3,334.55  ............       $666.91
                                                                       record.
33284.................  T....................  .....................  Remove pat-active ht      0109     7.7075      $418.43       $131.49        $83.69
                                                                       record.
33300.................  C....................  .....................  Repair of heart wound..  .....  .........  ...........  ............  ............
33305.................  C....................  .....................  Repair of heart wound..  .....  .........  ...........  ............  ............
33310.................  C....................  .....................  Exploratory heart        .....  .........  ...........  ............  ............
                                                                       surgery.
33315.................  C....................  .....................  Exploratory heart        .....  .........  ...........  ............  ............
                                                                       surgery.
33320.................  C....................  .....................  Repair major blood       .....  .........  ...........  ............  ............
                                                                       vessel(s).
33321.................  C....................  .....................  Repair major vessel....  .....  .........  ...........  ............  ............
33322.................  C....................  .....................  Repair major blood       .....  .........  ...........  ............  ............
                                                                       vessel(s).
33330.................  C....................  .....................  Insert major vessel      .....  .........  ...........  ............  ............
                                                                       graft.
33332.................  C....................  .....................  Insert major vessel      .....  .........  ...........  ............  ............
                                                                       graft.
33335.................  C....................  .....................  Insert major vessel      .....  .........  ...........  ............  ............
                                                                       graft.
33400.................  C....................  .....................  Repair of aortic valve.  .....  .........  ...........  ............  ............
33401.................  C....................  .....................  Valvuloplasty, open....  .....  .........  ...........  ............  ............
33403.................  C....................  .....................  Valvuloplasty, w/cp      .....  .........  ...........  ............  ............
                                                                       bypass.
33404.................  C....................  .....................  Prepare heart-aorta      .....  .........  ...........  ............  ............
                                                                       conduit.
33405.................  C....................  .....................  Replacement of aortic    .....  .........  ...........  ............  ............
                                                                       valve.
33406.................  C....................  .....................  Replacement of aortic    .....  .........  ...........  ............  ............
                                                                       valve.
33410.................  C....................  .....................  Replacement of aortic    .....  .........  ...........  ............  ............
                                                                       valve.
33411.................  C....................  .....................  Replacement of aortic    .....  .........  ...........  ............  ............
                                                                       valve.
33412.................  C....................  .....................  Replacement of aortic    .....  .........  ...........  ............  ............
                                                                       valve.
33413.................  C....................  .....................  Replacement of aortic    .....  .........  ...........  ............  ............
                                                                       valve.

[[Page 48069]]

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

[[Page 48070]]

 
33670.................  C....................  .....................  Repair of heart          .....  .........  ...........  ............  ............
                                                                       chambers.
33681.................  C....................  .....................  Repair heart septum      .....  .........  ...........  ............  ............
                                                                       defect.
33684.................  C....................  .....................  Repair heart septum      .....  .........  ...........  ............  ............
                                                                       defect.
33688.................  C....................  .....................  Repair heart septum      .....  .........  ...........  ............  ............
                                                                       defect.
33690.................  C....................  .....................  Reinforce pulmonary      .....  .........  ...........  ............  ............
                                                                       artery.
33692.................  C....................  .....................  Repair of heart defects  .....  .........  ...........  ............  ............
33694.................  C....................  .....................  Repair of heart defects  .....  .........  ...........  ............  ............
33697.................  C....................  .....................  Repair of heart defects  .....  .........  ...........  ............  ............
33702.................  C....................  .....................  Repair of heart defects  .....  .........  ...........  ............  ............
33710.................  C....................  .....................  Repair of heart defects  .....  .........  ...........  ............  ............
33720.................  C....................  .....................  Repair of heart defect.  .....  .........  ...........  ............  ............
33722.................  C....................  .....................  Repair of heart defect.  .....  .........  ...........  ............  ............
33730.................  C....................  .....................  Repair heart-vein        .....  .........  ...........  ............  ............
                                                                       defect(s).
33732.................  C....................  .....................  Repair heart-vein        .....  .........  ...........  ............  ............
                                                                       defect.
33735.................  C....................  .....................  Revision of heart        .....  .........  ...........  ............  ............
                                                                       chamber.
33736.................  C....................  .....................  Revision of heart        .....  .........  ...........  ............  ............
                                                                       chamber.
33737.................  C....................  .....................  Revision of heart        .....  .........  ...........  ............  ............
                                                                       chamber.
33750.................  C....................  .....................  Major vessel shunt.....  .....  .........  ...........  ............  ............
33755.................  C....................  .....................  Major vessel shunt.....  .....  .........  ...........  ............  ............
33762.................  C....................  .....................  Major vessel shunt.....  .....  .........  ...........  ............  ............
33764.................  C....................  .....................  Major vessel shunt &     .....  .........  ...........  ............  ............
                                                                       graft.
33766.................  C....................  .....................  Major vessel shunt.....  .....  .........  ...........  ............  ............
33767.................  C....................  .....................  Major vessel shunt.....  .....  .........  ...........  ............  ............
33770.................  C....................  .....................  Repair great vessels     .....  .........  ...........  ............  ............
                                                                       defect.
33771.................  C....................  .....................  Repair great vessels     .....  .........  ...........  ............  ............
                                                                       defect.
33774.................  C....................  .....................  Repair great vessels     .....  .........  ...........  ............  ............
                                                                       defect.
33775.................  C....................  .....................  Repair great vessels     .....  .........  ...........  ............  ............
                                                                       defect.
33776.................  C....................  .....................  Repair great vessels     .....  .........  ...........  ............  ............
                                                                       defect.
33777.................  C....................  .....................  Repair great vessels     .....  .........  ...........  ............  ............
                                                                       defect.
33778.................  C....................  .....................  Repair great vessels     .....  .........  ...........  ............  ............
                                                                       defect.
33779.................  C....................  .....................  Repair great vessels     .....  .........  ...........  ............  ............
                                                                       defect.
33780.................  C....................  .....................  Repair great vessels     .....  .........  ...........  ............  ............
                                                                       defect.
33781.................  C....................  .....................  Repair great vessels     .....  .........  ...........  ............  ............
                                                                       defect.
33786.................  C....................  .....................  Repair arterial trunk..  .....  .........  ...........  ............  ............
33788.................  C....................  .....................  Revision of pulmonary    .....  .........  ...........  ............  ............
                                                                       artery.
33800.................  C....................  .....................  Aortic suspension......  .....  .........  ...........  ............  ............
33802.................  C....................  .....................  Repair vessel defect...  .....  .........  ...........  ............  ............
33803.................  C....................  .....................  Repair vessel defect...  .....  .........  ...........  ............  ............
33813.................  C....................  .....................  Repair septal defect...  .....  .........  ...........  ............  ............
33814.................  C....................  .....................  Repair septal defect...  .....  .........  ...........  ............  ............
33820.................  C....................  .....................  Revise major vessel....  .....  .........  ...........  ............  ............
33822.................  C....................  .....................  Revise major vessel....  .....  .........  ...........  ............  ............
33824.................  C....................  .....................  Revise major vessel....  .....  .........  ...........  ............  ............
33840.................  C....................  .....................  Remove aorta             .....  .........  ...........  ............  ............
                                                                       constriction.
33845.................  C....................  .....................  Remove aorta             .....  .........  ...........  ............  ............
                                                                       constriction.
33851.................  C....................  .....................  Remove aorta             .....  .........  ...........  ............  ............
                                                                       constriction.
33852.................  C....................  .....................  Repair septal defect...  .....  .........  ...........  ............  ............
33853.................  C....................  .....................  Repair septal defect...  .....  .........  ...........  ............  ............
33860.................  C....................  .....................  Ascending aortic graft.  .....  .........  ...........  ............  ............
33861.................  C....................  .....................  Ascending aortic graft.  .....  .........  ...........  ............  ............
33863.................  C....................  .....................  Ascending aortic graft.  .....  .........  ...........  ............  ............
33870.................  C....................  .....................  Transverse aortic arch   .....  .........  ...........  ............  ............
                                                                       graft.
33875.................  C....................  .....................  Thoracic aortic graft..  .....  .........  ...........  ............  ............
33877.................  C....................  .....................  Thoracoabdominal graft.  .....  .........  ...........  ............  ............
33910.................  C....................  .....................  Remove lung artery       .....  .........  ...........  ............  ............
                                                                       emboli.
33915.................  C....................  .....................  Remove lung artery       .....  .........  ...........  ............  ............
                                                                       emboli.
33916.................  C....................  .....................  Surgery of great vessel  .....  .........  ...........  ............  ............
33917.................  C....................  .....................  Repair pulmonary artery  .....  .........  ...........  ............  ............
33918.................  C....................  .....................  Repair pulmonary         .....  .........  ...........  ............  ............
                                                                       atresia.
33919.................  C....................  .....................  Repair pulmonary         .....  .........  ...........  ............  ............
                                                                       atresia.
33920.................  C....................  .....................  Repair pulmonary         .....  .........  ...........  ............  ............
                                                                       atresia.
33922.................  C....................  .....................  Transect pulmonary       .....  .........  ...........  ............  ............
                                                                       artery.
33924.................  C....................  .....................  Remove pulmonary shunt.  .....  .........  ...........  ............  ............
33930.................  C....................  .....................  Removal of donor heart/  .....  .........  ...........  ............  ............
                                                                       lung.
33935.................  C....................  .....................  Transplantation, heart/  .....  .........  ...........  ............  ............
                                                                       lung.
33940.................  C....................  .....................  Removal of donor heart.  .....  .........  ...........  ............  ............

[[Page 48071]]

 
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           0070     3.1393      $170.43  ............        $34.09
                                                                       procedure.
34001.................  C....................  .....................  Removal of artery clot.  .....  .........  ...........  ............  ............
34051.................  C....................  .....................  Removal of artery clot.  .....  .........  ...........  ............  ............
34101.................  T....................  .....................  Removal of artery clot.   0088    34.6065    $1,878.75       $655.22       $375.75
34111.................  T....................  .....................  Removal of arm artery     0088    34.6065    $1,878.75       $655.22       $375.75
                                                                       clot.
34151.................  C....................  .....................  Removal of artery clot.  .....  .........  ...........  ............  ............
34201.................  T....................  .....................  Removal of artery clot.   0088    34.6065    $1,878.75       $655.22       $375.75
34203.................  T....................  .....................  Removal of leg artery     0088    34.6065    $1,878.75       $655.22       $375.75
                                                                       clot.
34401.................  C....................  .....................  Removal of vein clot...  .....  .........  ...........  ............  ............
34421.................  T....................  .....................  Removal of vein clot...   0088    34.6065    $1,878.75       $655.22       $375.75
34451.................  C....................  .....................  Removal of vein clot...  .....  .........  ...........  ............  ............
34471.................  T....................  .....................  Removal of vein clot...   0088    34.6065    $1,878.75       $655.22       $375.75
34490.................  T....................  .....................  Removal of vein clot...   0088    34.6065    $1,878.75       $655.22       $375.75
34501.................  T....................  .....................  Repair valve, femoral     0088    34.6065    $1,878.75       $655.22       $375.75
                                                                       vein.
34502.................  C....................  .....................  Reconstruct vena cava..  .....  .........  ...........  ............  ............
34510.................  T....................  .....................  Transposition of vein     0088    34.6065    $1,878.75       $655.22       $375.75
                                                                       valve.
34520.................  T....................  .....................  Cross-over vein graft..   0088    34.6065    $1,878.75       $655.22       $375.75
34530.................  T....................  .....................  Leg vein fusion........   0088    34.6065    $1,878.75       $655.22       $375.75
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....................  .....................  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  .....  .........  ...........  ............  ............
35011.................  T....................  .....................  Repair defect of artery   0653    32.4880    $1,763.74  ............       $352.75
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.

[[Page 48072]]

 
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       0093    20.6662    $1,121.95       $277.34       $224.39
                                                                       lesion.
35182.................  C....................  .....................  Repair blood vessel      .....  .........  ...........  ............  ............
                                                                       lesion.
35184.................  T....................  .....................  Repair blood vessel       0093    20.6662    $1,121.95       $277.34       $224.39
                                                                       lesion.
35188.................  T....................  .....................  Repair blood vessel       0088    34.6065    $1,878.75       $655.22       $375.75
                                                                       lesion.
35189.................  C....................  .....................  Repair blood vessel      .....  .........  ...........  ............  ............
                                                                       lesion.
35190.................  T....................  .....................  Repair blood vessel       0093    20.6662    $1,121.95       $277.34       $224.39
                                                                       lesion.
35201.................  T....................  .....................  Repair blood vessel       0093    20.6662    $1,121.95       $277.34       $224.39
                                                                       lesion.
35206.................  T....................  .....................  Repair blood vessel       0093    20.6662    $1,121.95       $277.34       $224.39
                                                                       lesion.
35207.................  T....................  .....................  Repair blood vessel       0088    34.6065    $1,878.75       $655.22       $375.75
                                                                       lesion.
35211.................  C....................  .....................  Repair blood vessel      .....  .........  ...........  ............  ............
                                                                       lesion.
35216.................  C....................  .....................  Repair blood vessel      .....  .........  ...........  ............  ............
                                                                       lesion.
35221.................  C....................  .....................  Repair blood vessel      .....  .........  ...........  ............  ............
                                                                       lesion.
35226.................  T....................  .....................  Repair blood vessel       0093    20.6662    $1,121.95       $277.34       $224.39
                                                                       lesion.
35231.................  T....................  .....................  Repair blood vessel       0093    20.6662    $1,121.95       $277.34       $224.39
                                                                       lesion.
35236.................  T....................  .....................  Repair blood vessel       0093    20.6662    $1,121.95       $277.34       $224.39
                                                                       lesion.
35241.................  C....................  .....................  Repair blood vessel      .....  .........  ...........  ............  ............
                                                                       lesion.
35246.................  C....................  .....................  Repair blood vessel      .....  .........  ...........  ............  ............
                                                                       lesion.
35251.................  C....................  .....................  Repair blood vessel      .....  .........  ...........  ............  ............
                                                                       lesion.
35256.................  T....................  .....................  Repair blood vessel       0093    20.6662    $1,121.95       $277.34       $224.39
                                                                       lesion.
35261.................  T....................  .....................  Repair blood vessel       0653    32.4880    $1,763.74  ............       $352.75
                                                                       lesion.
35266.................  T....................  .....................  Repair blood vessel       0653    32.4880    $1,763.74  ............       $352.75
                                                                       lesion.
35271.................  C....................  .....................  Repair blood vessel      .....  .........  ...........  ............  ............
                                                                       lesion.
35276.................  C....................  .....................  Repair blood vessel      .....  .........  ...........  ............  ............
                                                                       lesion.
35281.................  C....................  .....................  Repair blood vessel      .....  .........  ...........  ............  ............
                                                                       lesion.
35286.................  T....................  .....................  Repair blood vessel       0653    32.4880    $1,763.74  ............       $352.75
                                                                       lesion.
35301.................  C....................  .....................  Rechanneling of artery.  .....  .........  ...........  ............  ............
35311.................  C....................  .....................  Rechanneling of artery.  .....  .........  ...........  ............  ............
35321.................  T....................  .....................  Rechanneling of artery.   0093    20.6662    $1,121.95       $277.34       $224.39
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           0081    34.8355    $1,891.18  ............       $378.24
                                                                       blockage.
35459.................  T....................  .....................  Repair arterial           0081    34.8355    $1,891.18  ............       $378.24
                                                                       blockage.
35460.................  T....................  .....................  Repair venous blockage.   0081    34.8355    $1,891.18  ............       $378.24
35470.................  T....................  .....................  Repair arterial           0081    34.8355    $1,891.18  ............       $378.24
                                                                       blockage.
35471.................  T....................  .....................  Repair arterial           0081    34.8355    $1,891.18  ............       $378.24
                                                                       blockage.
35472.................  T....................  .....................  Repair arterial           0081    34.8355    $1,891.18  ............       $378.24
                                                                       blockage.
35473.................  T....................  .....................  Repair arterial           0081    34.8355    $1,891.18  ............       $378.24
                                                                       blockage.
35474.................  T....................  .....................  Repair arterial           0081    34.8355    $1,891.18  ............       $378.24
                                                                       blockage.
35475.................  T....................  .....................  Repair arterial           0081    34.8355    $1,891.18  ............       $378.24
                                                                       blockage.
35476.................  T....................  .....................  Repair venous blockage.   0081    34.8355    $1,891.18  ............       $378.24
35480.................  C....................  .....................  Atherectomy, open......  .....  .........  ...........  ............  ............
35481.................  C....................  .....................  Atherectomy, open......  .....  .........  ...........  ............  ............
35482.................  C....................  .....................  Atherectomy, open......  .....  .........  ...........  ............  ............
35483.................  C....................  .....................  Atherectomy, open......  .....  .........  ...........  ............  ............
35484.................  T....................  .....................  Atherectomy, open......   0081    34.8355    $1,891.18  ............       $378.24

[[Page 48073]]

 
35485.................  T....................  .....................  Atherectomy, open......   0081    34.8355    $1,891.18  ............       $378.24
35490.................  T....................  .....................  Atherectomy,              0081    34.8355    $1,891.18  ............       $378.24
                                                                       percutaneous.
35491.................  T....................  .....................  Atherectomy,              0081    34.8355    $1,891.18  ............       $378.24
                                                                       percutaneous.
35492.................  T....................  .....................  Atherectomy,              0081    34.8355    $1,891.18  ............       $378.24
                                                                       percutaneous.
35493.................  T....................  .....................  Atherectomy,              0081    34.8355    $1,891.18  ............       $378.24
                                                                       percutaneous.
35494.................  T....................  .....................  Atherectomy,              0081    34.8355    $1,891.18  ............       $378.24
                                                                       percutaneous.
35495.................  T....................  .....................  Atherectomy,              0081    34.8355    $1,891.18  ............       $378.24
                                                                       percutaneous.
35500.................  T....................  .....................  Harvest vein for bypass   0081    34.8355    $1,891.18  ............       $378.24
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....................  .....................  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....  .....  .........  ...........  ............  ............
35654.................  C....................  .....................  Artery bypass graft....  .....  .........  ...........  ............  ............
35656.................  C....................  .....................  Artery bypass graft....  .....  .........  ...........  ............  ............
35661.................  C....................  .....................  Artery bypass graft....  .....  .........  ...........  ............  ............
35663.................  C....................  .....................  Artery bypass graft....  .....  .........  ...........  ............  ............
35665.................  C....................  .....................  Artery bypass graft....  .....  .........  ...........  ............  ............
35666.................  C....................  .....................  Artery bypass graft....  .....  .........  ...........  ............  ............
35671.................  C....................  .....................  Artery bypass graft....  .....  .........  ...........  ............  ............
35681.................  C....................  .....................  Composite bypass graft.  .....  .........  ...........  ............  ............
35682.................  C....................  .....................  Composite bypass graft.  .....  .........  ...........  ............  ............
35683.................  C....................  .....................  Composite bypass graft.  .....  .........  ...........  ............  ............

[[Page 48074]]

 
35685.................  T....................  .....................  Bypass graft patency/     0093    20.6662    $1,121.95       $277.34       $224.39
                                                                       patch.
35686.................  T....................  .....................  Bypass graft/av fist      0093    20.6662    $1,121.95       $277.34       $224.39
                                                                       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/    0115    25.6233    $1,391.06       $459.35       $278.21
                                                                       vein.
35800.................  C....................  .....................  Explore neck vessels...  .....  .........  ...........  ............  ............
35820.................  C....................  .....................  Explore chest vessels..  .....  .........  ...........  ............  ............
35840.................  C....................  .....................  Explore abdominal        .....  .........  ...........  ............  ............
                                                                       vessels.
35860.................  T....................  .....................  Explore limb vessels...   0093    20.6662    $1,121.95       $277.34       $224.39
35870.................  C....................  .....................  Repair vessel graft      .....  .........  ...........  ............  ............
                                                                       defect.
35875.................  T....................  .....................  Removal of clot in        0088    34.6065    $1,878.75       $655.22       $375.75
                                                                       graft.
35876.................  T....................  .....................  Removal of clot in        0088    34.6065    $1,878.75       $655.22       $375.75
                                                                       graft.
35879.................  T....................  .....................  Revise graft w/vein....   0088    34.6065    $1,878.75       $655.22       $375.75
35881.................  T....................  .....................  Revise graft w/vein....   0088    34.6065    $1,878.75       $655.22       $375.75
35901.................  C....................  .....................  Excision, graft, neck..  .....  .........  ...........  ............  ............
35903.................  T....................  .....................  Excision, graft,          0115    25.6233    $1,391.06       $459.35       $278.21
                                                                       extremity.
35905.................  C....................  .....................  Excision, graft, thorax  .....  .........  ...........  ............  ............
35907.................  C....................  .....................  Excision, graft,         .....  .........  ...........  ............  ............
                                                                       abdomen.
36000.................  N....................  .....................  Place needle in vein...  .....  .........  ...........  ............  ............
36002.................  S....................  .....................  Pseudoaneurysm            0267     2.4805      $134.66        $65.52        $26.93
                                                                       injection 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     0119   129.8988    $7,052.08  ............     $1,410.42
                                                                       pump.
36261.................  T....................  .....................  Revision of infusion      0124    27.4545    $1,490.48       $298.10       $298.10
                                                                       pump.
36262.................  T....................  .....................  Removal of infusion       0109     7.7075      $418.43       $131.49        $83.69
                                                                       pump.
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.
36415.................  E....................  .....................  Drawing blood..........  .....  .........  ...........  ............  ............
36416.................  E....................  .....................  Capillary blood draw...  .....  .........  ...........  ............  ............
36420.................  T....................  .....................  Vein access cutdown < 1   0035     0.2236       $12.14         $3.51         $2.43
                                                                       yr.
36425.................  T....................  .....................  Vein access cutdown  1 yr.
36430.................  S....................  .....................  Blood transfusion         0110     3.7128      $201.56  ............        $40.31
                                                                       service.
36440.................  S....................  .....................  Bl push transfuse, 2 yr   0110     3.7128      $201.56  ............        $40.31
                                                                       or <.
36450.................  S....................  .....................  Bl exchange/transfuse,    0110     3.7128      $201.56  ............        $40.31
                                                                       nb.
36455.................  S....................  .....................  Bl exchange/transfuse     0110     3.7128      $201.56  ............        $40.31
                                                                       non-nb.
36460.................  S....................  .....................  Transfusion service,      0110     3.7128      $201.56  ............        $40.31
                                                                       fetal.
36468.................  T....................  .....................  Injection(s), spider      0098     1.1630       $63.14        $15.17        $12.63
                                                                       veins.
36469.................  T....................  .....................  Injection(s), spider      0098     1.1630       $63.14        $15.17        $12.63
                                                                       veins.

[[Page 48075]]

 
36470.................  T....................  .....................  Injection therapy of      0098     1.1630       $63.14        $15.17        $12.63
                                                                       vein.
36471.................  T....................  .....................  Injection therapy of      0098     1.1630       $63.14        $15.17        $12.63
                                                                       veins.
36481.................  N....................  .....................  Insertion of catheter,   .....  .........  ...........  ............  ............
                                                                       vein.
36488.................  T....................  .....................  Insertion of catheter,    0032    11.5584      $627.49  ............       $125.50
                                                                       vein.
36489.................  T....................  .....................  Insertion of catheter,    0032    11.5584      $627.49  ............       $125.50
                                                                       vein.
36490.................  T....................  .....................  Insertion of catheter,    0032    11.5584      $627.49  ............       $125.50
                                                                       vein.
36491.................  T....................  .....................  Insertion of catheter,    0032    11.5584      $627.49  ............       $125.50
                                                                       vein.
36493.................  X....................  .....................  Repositioning of cvc...   0187     4.4274      $240.36        $90.71        $48.07
36500.................  N....................  .....................  Insertion of catheter,   .....  .........  ...........  ............  ............
                                                                       vein.
36510.................  C....................  .....................  Insertion of catheter,   .....  .........  ...........  ............  ............
                                                                       vein.
36511.................  S....................  .....................  Apheresis wbc..........   0111    14.0169      $760.96       $211.96       $152.19
36512.................  S....................  .....................  Apheresis rbc..........   0111    14.0169      $760.96       $211.96       $152.19
36513.................  S....................  .....................  Apheresis platelets....   0111    14.0169      $760.96       $211.96       $152.19
36514.................  S....................  .....................  Apheresis plasma.......   0111    14.0169      $760.96       $211.96       $152.19
36515.................  S....................  .....................  Apheresis, adsorp/        0112    34.8318    $1,890.98       $609.71       $378.20
                                                                       reinfuse.
36516.................  S....................  .....................  Apheresis, selective...   0112    34.8318    $1,890.98       $609.71       $378.20
36522.................  S....................  .....................  Photopheresis..........   0112    34.8318    $1,890.98       $609.71       $378.20
36530.................  T....................  .....................  Insertion of infusion     0119   129.8988    $7,052.08  ............     $1,410.42
                                                                       pump.
36531.................  T....................  .....................  Revision of infusion      0124    27.4545    $1,490.48       $298.10       $298.10
                                                                       pump.
36532.................  T....................  .....................  Removal of infusion       0109     7.7075      $418.43       $131.49        $83.69
                                                                       pump.
36533.................  T....................  .....................  Insertion of access       0115    25.6233    $1,391.06       $459.35       $278.21
                                                                       device.
36534.................  T....................  .....................  Revision of access        0109     7.7075      $418.43       $131.49        $83.69
                                                                       device.
36535.................  T....................  .....................  Removal of access         0109     7.7075      $418.43       $131.49        $83.69
                                                                       device.
36536.................  T....................  .....................  Remove cva device         1541  .........      $250.00  ............        $50.00
                                                                       obstruct.
36537.................  T....................  .....................  Remove cva lumen          1541  .........      $250.00  ............        $50.00
                                                                       obstruct.
36540.................  N....................  .....................  Collect blood venous     .....  .........  ...........  ............  ............
                                                                       device.
36550.................  T....................  .....................  Declot vascular device.   0677     3.0769      $167.04  ............        $33.41
36600.................  N....................  .....................  Withdrawal of arterial   .....  .........  ...........  ............  ............
                                                                       blood.
36620.................  N....................  .....................  Insertion catheter,      .....  .........  ...........  ............  ............
                                                                       artery.
36625.................  N....................  .....................  Insertion catheter,      .....  .........  ...........  ............  ............
                                                                       artery.
36640.................  T....................  .....................  Insertion catheter,       0032    11.5584      $627.49  ............       $125.50
                                                                       artery.
36660.................  C....................  .....................  Insertion catheter,      .....  .........  ...........  ............  ............
                                                                       artery.
36680.................  X....................  .....................  Insert needle, bone       0340     0.6232       $33.83  ............         $6.77
                                                                       cavity.
36800.................  T....................  .....................  Insertion of cannula...   0115    25.6233    $1,391.06       $459.35       $278.21
36810.................  T....................  .....................  Insertion of cannula...   0115    25.6233    $1,391.06       $459.35       $278.21
36815.................  T....................  .....................  Insertion of cannula...   0115    25.6233    $1,391.06       $459.35       $278.21
36819.................  T....................  .....................  Av fusion/uppr arm vein   0088    34.6065    $1,878.75       $655.22       $375.75
36820.................  T....................  .....................  Av fusion/forearm vein.   0088    34.6065    $1,878.75       $655.22       $375.75
36821.................  T....................  .....................  Av fusion direct any      0088    34.6065    $1,878.75       $655.22       $375.75
                                                                       site.
36822.................  C....................  .....................  Insertion of cannula(s)  .....  .........  ...........  ............  ............
36823.................  C....................  .....................  Insertion of cannula(s)  .....  .........  ...........  ............  ............
36825.................  T....................  .....................  Artery-vein autograft..   0088    34.6065    $1,878.75       $655.22       $375.75
36830.................  T....................  .....................  Artery-vein graft......   0088    34.6065    $1,878.75       $655.22       $375.75
36831.................  T....................  .....................  Open thrombect av         0088    34.6065    $1,878.75       $655.22       $375.75
                                                                       fistula.
36832.................  T....................  .....................  Av fistula revision,      0088    34.6065    $1,878.75       $655.22       $375.75
                                                                       open.
36833.................  T....................  .....................  Av fistula revision....   0088    34.6065    $1,878.75       $655.22       $375.75
36834.................  T....................  .....................  Repair A-V aneurysm....   0088    34.6065    $1,878.75       $655.22       $375.75
36835.................  T....................  .....................  Artery to vein shunt...   0115    25.6233    $1,391.06       $459.35       $278.21
36860.................  T....................  .....................  External cannula          0103    12.1256      $658.29       $223.63       $131.66
                                                                       declotting.
36861.................  T....................  .....................  Cannula declotting.....   0115    25.6233    $1,391.06       $459.35       $278.21
36870.................  T....................  .....................  Percut thrombect av       0653    32.4880    $1,763.74  ............       $352.75
                                                                       fistula.
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.
37200.................  T....................  .....................  Transcatheter biopsy...   0685     4.8912      $265.54       $116.83        $53.11
37201.................  T....................  .....................  Transcatheter therapy     0676     3.7505      $203.61        $55.06        $40.72
                                                                       infuse.
37202.................  T....................  .....................  Transcatheter therapy     0677     3.0769      $167.04  ............        $33.41
                                                                       infuse.
37203.................  T....................  .....................  Transcatheter retrieval   0103    12.1256      $658.29       $223.63       $131.66
37204.................  T....................  .....................  Transcatheter occlusion   0115    25.6233    $1,391.06       $459.35       $278.21
37205.................  T....................  .....................  Transcatheter stent....   0229    59.4977    $3,230.07       $771.23       $646.01
37206.................  T....................  .....................  Transcatheter stent add-  0229    59.4977    $3,230.07       $771.23       $646.01
                                                                       on.

[[Page 48076]]

 
37207.................  T....................  .....................  Transcatheter stent....   0229    59.4977    $3,230.07       $771.23       $646.01
37208.................  T....................  .....................  Transcatheter stent add-  0229    59.4977    $3,230.07       $771.23       $646.01
                                                                       on.
37209.................  T....................  .....................  Exchange arterial         0103    12.1256      $658.29       $223.63       $131.66
                                                                       catheter.
37250.................  S....................  .....................  Iv us first vessel add-   0670    26.5472    $1,441.22       $521.95       $288.24
                                                                       on.
37251.................  S....................  .....................  Iv us each add vessel     0670    26.5472    $1,441.22       $521.95       $288.24
                                                                       add-on.
37500.................  T....................  .....................  Endoscopy ligate perf     0092    25.1347    $1,364.54       $505.37       $272.91
                                                                       veins.
37501.................  T....................  .....................  Vascular endoscopy        0092    25.1347    $1,364.54       $505.37       $272.91
                                                                       procedure.
37565.................  T....................  .....................  Ligation of neck vein..   0093    20.6662    $1,121.95       $277.34       $224.39
37600.................  T....................  .....................  Ligation of neck artery   0093    20.6662    $1,121.95       $277.34       $224.39
37605.................  T....................  .....................  Ligation of neck artery   0091    28.5187    $1,548.25       $348.23       $309.65
37606.................  T....................  .....................  Ligation of neck artery   0091    28.5187    $1,548.25       $348.23       $309.65
37607.................  T....................  .....................  Ligation of a-v fistula   0092    25.1347    $1,364.54       $505.37       $272.91
37609.................  T....................  .....................  Temporal artery           0021    14.5749      $791.26       $219.48       $158.25
                                                                       procedure.
37615.................  T....................  .....................  Ligation of neck artery   0091    28.5187    $1,548.25       $348.23       $309.65
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    28.5187    $1,548.25       $348.23       $309.65
37650.................  T....................  .....................  Revision of major vein.   0091    28.5187    $1,548.25       $348.23       $309.65
37660.................  C....................  .....................  Revision of major vein.  .....  .........  ...........  ............  ............
37700.................  T....................  .....................  Revise leg vein........   0091    28.5187    $1,548.25       $348.23       $309.65
37720.................  T....................  .....................  Removal of leg vein....   0092    25.1347    $1,364.54       $505.37       $272.91
37730.................  T....................  .....................  Removal of leg veins...   0092    25.1347    $1,364.54       $505.37       $272.91
37735.................  T....................  .....................  Removal of leg veins/     0092    25.1347    $1,364.54       $505.37       $272.91
                                                                       lesion.
37760.................  T....................  .....................  Revision of leg veins..   0091    28.5187    $1,548.25       $348.23       $309.65
37780.................  T....................  .....................  Revision of leg vein...   0091    28.5187    $1,548.25       $348.23       $309.65
37785.................  T....................  .....................  Revise secondary          0091    28.5187    $1,548.25       $348.23       $309.65
                                                                       varicosity.
37788.................  C....................  .....................  Revascularization,       .....  .........  ...........  ............  ............
                                                                       penis.
37790.................  T....................  .....................  Penile venous occlusion   0181    29.0094    $1,574.89       $621.82       $314.98
37799.................  T....................  .....................  Vascular surgery          0035     0.2236       $12.14         $3.51         $2.43
                                                                       procedure.
38100.................  C....................  .....................  Removal of spleen,       .....  .........  ...........  ............  ............
                                                                       total.
38101.................  C....................  .....................  Removal of spleen,       .....  .........  ...........  ............  ............
                                                                       partial.
38102.................  C....................  .....................  Removal of spleen,       .....  .........  ...........  ............  ............
                                                                       total.
38115.................  C....................  .....................  Repair of ruptured       .....  .........  ...........  ............  ............
                                                                       spleen.
38120.................  T....................  .....................  Laparoscopy,              0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       splenectomy.
38129.................  T....................  .....................  Laparoscope proc,         0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       spleen.
38200.................  N....................  .....................  Injection for spleen x-  .....  .........  ...........  ............  ............
                                                                       ray.
38204.................  E....................  .....................  Bl donor search          .....  .........  ...........  ............  ............
                                                                       management.
38205.................  S....................  .....................  Harvest allogenic stem    0111    14.0169      $760.96       $211.96       $152.19
                                                                       cells.
38206.................  S....................  .....................  Harvest auto stem cells   0111    14.0169      $760.96       $211.96       $152.19
38207.................  E....................  .....................  Cryopreserve stem cells  .....  .........  ...........  ............  ............
38208.................  E....................  .....................  Thaw preserved stem      .....  .........  ...........  ............  ............
                                                                       cells.
38209.................  E....................  .....................  Wash harvest stem cells  .....  .........  ...........  ............  ............
38210.................  E....................  .....................  T-cell depletion of      .....  .........  ...........  ............  ............
                                                                       harvest.
38211.................  E....................  .....................  Tumor cell deplete of    .....  .........  ...........  ............  ............
                                                                       harvst.
38212.................  E....................  .....................  Rbc depletion of         .....  .........  ...........  ............  ............
                                                                       harvest.
38213.................  E....................  .....................  Platelet deplete of      .....  .........  ...........  ............  ............
                                                                       harvest.
38214.................  E....................  .....................  Volume deplete of        .....  .........  ...........  ............  ............
                                                                       harvest.
38215.................  E....................  .....................  Harvest stem cell        .....  .........  ...........  ............  ............
                                                                       concentrte.
38220.................  T....................  .....................  Bone marrow aspiration.   0003     2.2627      $122.84  ............        $24.57
38221.................  T....................  .....................  Bone marrow biopsy.....   0003     2.2627      $122.84  ............        $24.57
38230.................  S....................  .....................  Bone marrow collection.   0123     4.0076      $217.57  ............        $43.51
38240.................  S....................  .....................  Bone marrow/stem          0123     4.0076      $217.57  ............        $43.51
                                                                       transplant.
38241.................  S....................  .....................  Bone marrow/stem          0123     4.0076      $217.57  ............        $43.51
                                                                       transplant.
38242.................  S....................  .....................  Lymphocyte infuse         0111    14.0169      $760.96       $211.96       $152.19
                                                                       transplant.
38300.................  T....................  .....................  Drainage, lymph node      0008    16.8303      $913.70  ............       $182.74
                                                                       lesion.
38305.................  T....................  .....................  Drainage, lymph node      0008    16.8303      $913.70  ............       $182.74
                                                                       lesion.
38308.................  T....................  .....................  Incision of lymph         0113    19.9529    $1,083.22  ............       $216.64
                                                                       channels.
38380.................  C....................  .....................  Thoracic duct procedure  .....  .........  ...........  ............  ............
38381.................  C....................  .....................  Thoracic duct procedure  .....  .........  ...........  ............  ............
38382.................  C....................  .....................  Thoracic duct procedure  .....  .........  ...........  ............  ............
38500.................  T....................  .....................  Biopsy/removal, lymph     0113    19.9529    $1,083.22  ............       $216.64
                                                                       nodes.
38505.................  T....................  .....................  Needle biopsy, lymph      0005     3.3675      $182.82        $71.59        $36.56
                                                                       nodes.
38510.................  T....................  .....................  Biopsy/removal, lymph     0113    19.9529    $1,083.22  ............       $216.64
                                                                       nodes.
38520.................  T....................  .....................  Biopsy/removal, lymph     0113    19.9529    $1,083.22  ............       $216.64
                                                                       nodes.
38525.................  T....................  .....................  Biopsy/removal, lymph     0113    19.9529    $1,083.22  ............       $216.64
                                                                       nodes.

[[Page 48077]]

 
38530.................  T....................  .....................  Biopsy/removal, lymph     0113    19.9529    $1,083.22  ............       $216.64
                                                                       nodes.
38542.................  T....................  .....................  Explore deep node(s),     0114    37.3583    $2,028.14       $485.91       $405.63
                                                                       neck.
38550.................  T....................  .....................  Removal, neck/armpit      0113    19.9529    $1,083.22  ............       $216.64
                                                                       lesion.
38555.................  T....................  .....................  Removal, neck/armpit      0113    19.9529    $1,083.22  ............       $216.64
                                                                       lesion.
38562.................  C....................  .....................  Removal, pelvic lymph    .....  .........  ...........  ............  ............
                                                                       nodes.
38564.................  C....................  .....................  Removal, abdomen lymph   .....  .........  ...........  ............  ............
                                                                       nodes.
38570.................  T....................  .....................  Laparoscopy, lymph node   0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       biop.
38571.................  T....................  .....................  Laparoscopy,              0132    56.6318    $3,074.48     $1,239.22       $614.90
                                                                       lymphadenectomy.
38572.................  T....................  .....................  Laparoscopy,              0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       lymphadenectomy.
38589.................  T....................  .....................  Laparoscope proc,         0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       lymphatic.
38700.................  T....................  .....................  Removal of lymph nodes,   0113    19.9529    $1,083.22  ............       $216.64
                                                                       neck.
38720.................  T....................  .....................  Removal of lymph nodes,   0113    19.9529    $1,083.22  ............       $216.64
                                                                       neck.
38724.................  C....................  .....................  Removal of lymph nodes,  .....  .........  ...........  ............  ............
                                                                       neck.
38740.................  T....................  .....................  Remove armpit lymph       0114    37.3583    $2,028.14       $485.91       $405.63
                                                                       nodes.
38745.................  T....................  .....................  Remove armpit lymph       0114    37.3583    $2,028.14       $485.91       $405.63
                                                                       nodes.
38746.................  C....................  .....................  Remove thoracic lymph    .....  .........  ...........  ............  ............
                                                                       nodes.
38747.................  C....................  .....................  Remove abdominal lymph   .....  .........  ...........  ............  ............
                                                                       nodes.
38760.................  T....................  .....................  Remove groin lymph        0113    19.9529    $1,083.22  ............       $216.64
                                                                       nodes.
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     3.7128      $201.56  ............        $40.31
                                                                       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    28.6334    $1,554.48       $591.64       $310.90
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     1.8643      $101.21  ............        $20.24
40500.................  T....................  .....................  Partial excision of lip   0253    15.1698      $823.55       $282.29       $164.71
40510.................  T....................  .....................  Partial excision of lip   0254    21.4368    $1,163.78       $321.35       $232.76
40520.................  T....................  .....................  Partial excision of lip   0253    15.1698      $823.55       $282.29       $164.71
40525.................  T....................  .....................  Reconstruct lip with      0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       flap.
40527.................  T....................  .....................  Reconstruct lip with      0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       flap.
40530.................  T....................  .....................  Partial removal of lip.   0254    21.4368    $1,163.78       $321.35       $232.76
40650.................  T....................  .....................  Repair lip.............   0252     6.5416      $355.14       $113.41        $71.03
40652.................  T....................  .....................  Repair lip.............   0252     6.5416      $355.14       $113.41        $71.03
40654.................  T....................  .....................  Repair lip.............   0252     6.5416      $355.14       $113.41        $71.03
40700.................  T....................  .....................  Repair cleft lip/nasal.   0256    35.0866    $1,904.82  ............       $380.96
40701.................  T....................  .....................  Repair cleft lip/nasal.   0256    35.0866    $1,904.82  ............       $380.96
40702.................  T....................  .....................  Repair cleft lip/nasal.   0256    35.0866    $1,904.82  ............       $380.96
40720.................  T....................  .....................  Repair cleft lip/nasal.   0256    35.0866    $1,904.82  ............       $380.96
40761.................  T....................  .....................  Repair cleft lip/nasal.   0256    35.0866    $1,904.82  ............       $380.96
40799.................  T....................  .....................  Lip surgery procedure..   0253    15.1698      $823.55       $282.29       $164.71
40800.................  T....................  .....................  Drainage of mouth         0251     1.8643      $101.21  ............        $20.24
                                                                       lesion.
40801.................  T....................  .....................  Drainage of mouth         0252     6.5416      $355.14       $113.41        $71.03
                                                                       lesion.
40804.................  X....................  .....................  Removal, foreign body,    0340     0.6232       $33.83  ............         $6.77
                                                                       mouth.
40805.................  T....................  .....................  Removal, foreign body,    0252     6.5416      $355.14       $113.41        $71.03
                                                                       mouth.
40806.................  T....................  .....................  Incision of lip fold...   0251     1.8643      $101.21  ............        $20.24
40808.................  T....................  .....................  Biopsy of mouth lesion.   0251     1.8643      $101.21  ............        $20.24
40810.................  T....................  .....................  Excision of mouth         0253    15.1698      $823.55       $282.29       $164.71
                                                                       lesion.

[[Page 48078]]

 
40812.................  T....................  .....................  Excise/repair mouth       0253    15.1698      $823.55       $282.29       $164.71
                                                                       lesion.
40814.................  T....................  .....................  Excise/repair mouth       0253    15.1698      $823.55       $282.29       $164.71
                                                                       lesion.
40816.................  T....................  .....................  Excision of mouth         0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       lesion.
40818.................  T....................  .....................  Excise oral mucosa for    0251     1.8643      $101.21  ............        $20.24
                                                                       graft.
40819.................  T....................  .....................  Excise lip or cheek       0252     6.5416      $355.14       $113.41        $71.03
                                                                       fold.
40820.................  T....................  .....................  Treatment of mouth        0253    15.1698      $823.55       $282.29       $164.71
                                                                       lesion.
40830.................  T....................  .....................  Repair mouth laceration   0251     1.8643      $101.21  ............        $20.24
40831.................  T....................  .....................  Repair mouth laceration   0252     6.5416      $355.14       $113.41        $71.03
40840.................  T....................  .....................  Reconstruction of mouth   0254    21.4368    $1,163.78       $321.35       $232.76
40842.................  T....................  .....................  Reconstruction of mouth   0254    21.4368    $1,163.78       $321.35       $232.76
40843.................  T....................  .....................  Reconstruction of mouth   0254    21.4368    $1,163.78       $321.35       $232.76
40844.................  T....................  .....................  Reconstruction of mouth   0256    35.0866    $1,904.82  ............       $380.96
40845.................  T....................  .....................  Reconstruction of mouth   0256    35.0866    $1,904.82  ............       $380.96
40899.................  T....................  .....................  Mouth surgery procedure   0252     6.5416      $355.14       $113.41        $71.03
41000.................  T....................  .....................  Drainage of mouth         0253    15.1698      $823.55       $282.29       $164.71
                                                                       lesion.
41005.................  T....................  .....................  Drainage of mouth         0251     1.8643      $101.21  ............        $20.24
                                                                       lesion.
41006.................  T....................  .....................  Drainage of mouth         0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       lesion.
41007.................  T....................  .....................  Drainage of mouth         0253    15.1698      $823.55       $282.29       $164.71
                                                                       lesion.
41008.................  T....................  .....................  Drainage of mouth         0253    15.1698      $823.55       $282.29       $164.71
                                                                       lesion.
41009.................  T....................  .....................  Drainage of mouth         0251     1.8643      $101.21  ............        $20.24
                                                                       lesion.
41010.................  T....................  .....................  Incision of tongue fold   0253    15.1698      $823.55       $282.29       $164.71
41015.................  T....................  .....................  Drainage of mouth         0251     1.8643      $101.21  ............        $20.24
                                                                       lesion.
41016.................  T....................  .....................  Drainage of mouth         0252     6.5416      $355.14       $113.41        $71.03
                                                                       lesion.
41017.................  T....................  .....................  Drainage of mouth         0252     6.5416      $355.14       $113.41        $71.03
                                                                       lesion.
41018.................  T....................  .....................  Drainage of mouth         0252     6.5416      $355.14       $113.41        $71.03
                                                                       lesion.
41100.................  T....................  .....................  Biopsy of tongue.......   0252     6.5416      $355.14       $113.41        $71.03
41105.................  T....................  .....................  Biopsy of tongue.......   0253    15.1698      $823.55       $282.29       $164.71
41108.................  T....................  .....................  Biopsy of floor of        0252     6.5416      $355.14       $113.41        $71.03
                                                                       mouth.
41110.................  T....................  .....................  Excision of tongue        0253    15.1698      $823.55       $282.29       $164.71
                                                                       lesion.
41112.................  T....................  .....................  Excision of tongue        0253    15.1698      $823.55       $282.29       $164.71
                                                                       lesion.
41113.................  T....................  .....................  Excision of tongue        0253    15.1698      $823.55       $282.29       $164.71
                                                                       lesion.
41114.................  T....................  .....................  Excision of tongue        0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       lesion.
41115.................  T....................  .....................  Excision of tongue fold   0252     6.5416      $355.14       $113.41        $71.03
41116.................  T....................  .....................  Excision of mouth         0253    15.1698      $823.55       $282.29       $164.71
                                                                       lesion.
41120.................  T....................  .....................  Partial removal of        0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       tongue.
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             0251     1.8643      $101.21  ............        $20.24
                                                                       laceration.
41251.................  T....................  .....................  Repair tongue             0252     6.5416      $355.14       $113.41        $71.03
                                                                       laceration.
41252.................  T....................  .....................  Repair tongue             0252     6.5416      $355.14       $113.41        $71.03
                                                                       laceration.
41500.................  T....................  .....................  Fixation of tongue.....   0254    21.4368    $1,163.78       $321.35       $232.76
41510.................  T....................  .....................  Tongue to lip surgery..   0253    15.1698      $823.55       $282.29       $164.71
41520.................  T....................  .....................  Reconstruction, tongue    0252     6.5416      $355.14       $113.41        $71.03
                                                                       fold.
41599.................  T....................  .....................  Tongue and mouth          0251     1.8643      $101.21  ............        $20.24
                                                                       surgery.
41800.................  T....................  .....................  Drainage of gum lesion.   0251     1.8643      $101.21  ............        $20.24
41805.................  T....................  .....................  Removal foreign body,     0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       gum.
41806.................  T....................  .....................  Removal foreign           0253    15.1698      $823.55       $282.29       $164.71
                                                                       body,jawbone.
41820.................  T....................  .....................  Excision, gum, each       0252     6.5416      $355.14       $113.41        $71.03
                                                                       quadrant.
41821.................  T....................  .....................  Excision of gum flap...   0252     6.5416      $355.14       $113.41        $71.03
41822.................  T....................  .....................  Excision of gum lesion.   0253    15.1698      $823.55       $282.29       $164.71
41823.................  T....................  .....................  Excision of gum lesion.   0254    21.4368    $1,163.78       $321.35       $232.76
41825.................  T....................  .....................  Excision of gum lesion.   0253    15.1698      $823.55       $282.29       $164.71
41826.................  T....................  .....................  Excision of gum lesion.   0253    15.1698      $823.55       $282.29       $164.71
41827.................  T....................  .....................  Excision of gum lesion.   0254    21.4368    $1,163.78       $321.35       $232.76
41828.................  T....................  .....................  Excision of gum lesion.   0253    15.1698      $823.55       $282.29       $164.71
41830.................  T....................  .....................  Removal of gum tissue..   0253    15.1698      $823.55       $282.29       $164.71
41850.................  T....................  .....................  Treatment of gum lesion   0253    15.1698      $823.55       $282.29       $164.71
41870.................  T....................  .....................  Gum graft..............   0254    21.4368    $1,163.78       $321.35       $232.76
41872.................  T....................  .....................  Repair gum.............   0253    15.1698      $823.55       $282.29       $164.71
41874.................  T....................  .....................  Repair tooth socket....   0254    21.4368    $1,163.78       $321.35       $232.76
41899.................  T....................  .....................  Dental surgery            0253    15.1698      $823.55       $282.29       $164.71
                                                                       procedure.

[[Page 48079]]

 
42000.................  T....................  .....................  Drainage mouth roof       0251     1.8643      $101.21  ............        $20.24
                                                                       lesion.
42100.................  T....................  .....................  Biopsy roof of mouth...   0252     6.5416      $355.14       $113.41        $71.03
42104.................  T....................  .....................  Excision lesion, mouth    0253    15.1698      $823.55       $282.29       $164.71
                                                                       roof.
42106.................  T....................  .....................  Excision lesion, mouth    0253    15.1698      $823.55       $282.29       $164.71
                                                                       roof.
42107.................  T....................  .....................  Excision lesion, mouth    0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       roof.
42120.................  T....................  .....................  Remove palate/lesion...   0256    35.0866    $1,904.82  ............       $380.96
42140.................  T....................  .....................  Excision of uvula......   0252     6.5416      $355.14       $113.41        $71.03
42145.................  T....................  .....................  Repair palate, pharynx/   0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       uvula.
42160.................  T....................  .....................  Treatment mouth roof      0253    15.1698      $823.55       $282.29       $164.71
                                                                       lesion.
42180.................  T....................  .....................  Repair palate..........   0251     1.8643      $101.21  ............        $20.24
42182.................  T....................  .....................  Repair palate..........   0256    35.0866    $1,904.82  ............       $380.96
42200.................  T....................  .....................  Reconstruct cleft         0256    35.0866    $1,904.82  ............       $380.96
                                                                       palate.
42205.................  T....................  .....................  Reconstruct cleft         0256    35.0866    $1,904.82  ............       $380.96
                                                                       palate.
42210.................  T....................  .....................  Reconstruct cleft         0256    35.0866    $1,904.82  ............       $380.96
                                                                       palate.
42215.................  T....................  .....................  Reconstruct cleft         0256    35.0866    $1,904.82  ............       $380.96
                                                                       palate.
42220.................  T....................  .....................  Reconstruct cleft         0256    35.0866    $1,904.82  ............       $380.96
                                                                       palate.
42225.................  T....................  .....................  Reconstruct cleft         0256    35.0866    $1,904.82  ............       $380.96
                                                                       palate.
42226.................  T....................  .....................  Lengthening of palate..   0256    35.0866    $1,904.82  ............       $380.96
42227.................  T....................  .....................  Lengthening of palate..   0256    35.0866    $1,904.82  ............       $380.96
42235.................  T....................  .....................  Repair palate..........   0253    15.1698      $823.55       $282.29       $164.71
42260.................  T....................  .....................  Repair nose to lip        0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       fistula.
42280.................  T....................  .....................  Preparation, palate       0251     1.8643      $101.21  ............        $20.24
                                                                       mold.
42281.................  T....................  .....................  Insertion, palate         0253    15.1698      $823.55       $282.29       $164.71
                                                                       prosthesis.
42299.................  T....................  .....................  Palate/uvula surgery...   0251     1.8643      $101.21  ............        $20.24
42300.................  T....................  .....................  Drainage of salivary      0253    15.1698      $823.55       $282.29       $164.71
                                                                       gland.
42305.................  T....................  .....................  Drainage of salivary      0253    15.1698      $823.55       $282.29       $164.71
                                                                       gland.
42310.................  T....................  .....................  Drainage of salivary      0251     1.8643      $101.21  ............        $20.24
                                                                       gland.
42320.................  T....................  .....................  Drainage of salivary      0251     1.8643      $101.21  ............        $20.24
                                                                       gland.
42325.................  T....................  .....................  Create salivary cyst      0251     1.8643      $101.21  ............        $20.24
                                                                       drain.
42326.................  T....................  .....................  Create salivary cyst      0252     6.5416      $355.14       $113.41        $71.03
                                                                       drain.
42330.................  T....................  .....................  Removal of salivary       0253    15.1698      $823.55       $282.29       $164.71
                                                                       stone.
42335.................  T....................  .....................  Removal of salivary       0253    15.1698      $823.55       $282.29       $164.71
                                                                       stone.
42340.................  T....................  .....................  Removal of salivary       0253    15.1698      $823.55       $282.29       $164.71
                                                                       stone.
42400.................  T....................  .....................  Biopsy of salivary        0005     3.3675      $182.82        $71.59        $36.56
                                                                       gland.
42405.................  T....................  .....................  Biopsy of salivary        0253    15.1698      $823.55       $282.29       $164.71
                                                                       gland.
42408.................  T....................  .....................  Excision of salivary      0253    15.1698      $823.55       $282.29       $164.71
                                                                       cyst.
42409.................  T....................  .....................  Drainage of salivary      0253    15.1698      $823.55       $282.29       $164.71
                                                                       cyst.
42410.................  T....................  .....................  Excise parotid gland/     0256    35.0866    $1,904.82  ............       $380.96
                                                                       lesion.
42415.................  T....................  .....................  Excise parotid gland/     0256    35.0866    $1,904.82  ............       $380.96
                                                                       lesion.
42420.................  T....................  .....................  Excise parotid gland/     0256    35.0866    $1,904.82  ............       $380.96
                                                                       lesion.
42425.................  T....................  .....................  Excise parotid gland/     0256    35.0866    $1,904.82  ............       $380.96
                                                                       lesion.
42426.................  C....................  .....................  Excise parotid gland/    .....  .........  ...........  ............  ............
                                                                       lesion.
42440.................  T....................  .....................  Excise submaxillary       0256    35.0866    $1,904.82  ............       $380.96
                                                                       gland.
42450.................  T....................  .....................  Excise sublingual gland   0254    21.4368    $1,163.78       $321.35       $232.76
42500.................  T....................  .....................  Repair salivary duct...   0254    21.4368    $1,163.78       $321.35       $232.76
42505.................  T....................  .....................  Repair salivary duct...   0256    35.0866    $1,904.82  ............       $380.96
42507.................  T....................  .....................  Parotid duct diversion.   0256    35.0866    $1,904.82  ............       $380.96
42508.................  T....................  .....................  Parotid duct diversion.   0256    35.0866    $1,904.82  ............       $380.96
42509.................  T....................  .....................  Parotid duct diversion.   0256    35.0866    $1,904.82  ............       $380.96
42510.................  T....................  .....................  Parotid duct diversion.   0256    35.0866    $1,904.82  ............       $380.96
42550.................  N....................  .....................  Injection for salivary   .....  .........  ...........  ............  ............
                                                                       x-ray.
42600.................  T....................  .....................  Closure of salivary       0253    15.1698      $823.55       $282.29       $164.71
                                                                       fistula.
42650.................  T....................  .....................  Dilation of salivary      0252     6.5416      $355.14       $113.41        $71.03
                                                                       duct.
42660.................  T....................  .....................  Dilation of salivary      0252     6.5416      $355.14       $113.41        $71.03
                                                                       duct.
42665.................  T....................  .....................  Ligation of salivary      0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       duct.
42699.................  T....................  .....................  Salivary surgery          0253    15.1698      $823.55       $282.29       $164.71
                                                                       procedure.
42700.................  T....................  .....................  Drainage of tonsil        0251     1.8643      $101.21  ............        $20.24
                                                                       abscess.
42720.................  T....................  .....................  Drainage of throat        0253    15.1698      $823.55       $282.29       $164.71
                                                                       abscess.
42725.................  T....................  .....................  Drainage of throat        0256    35.0866    $1,904.82  ............       $380.96
                                                                       abscess.
42800.................  T....................  .....................  Biopsy of throat.......   0253    15.1698      $823.55       $282.29       $164.71
42802.................  T....................  .....................  Biopsy of throat.......   0253    15.1698      $823.55       $282.29       $164.71
42804.................  T....................  .....................  Biopsy of upper nose/     0253    15.1698      $823.55       $282.29       $164.71
                                                                       throat.
42806.................  T....................  .....................  Biopsy of upper nose/     0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       throat.
42808.................  T....................  .....................  Excise pharynx lesion..   0253    15.1698      $823.55       $282.29       $164.71
42809.................  X....................  .....................  Remove pharynx foreign    0340     0.6232       $33.83  ............         $6.77
                                                                       body.
42810.................  T....................  .....................  Excision of neck cyst..   0254    21.4368    $1,163.78       $321.35       $232.76

[[Page 48080]]

 
42815.................  T....................  .....................  Excision of neck cyst..   0256    35.0866    $1,904.82  ............       $380.96
42820.................  T....................  .....................  Remove tonsils and        0258    21.0273    $1,141.55       $437.25       $228.31
                                                                       adenoids.
42821.................  T....................  .....................  Remove tonsils and        0258    21.0273    $1,141.55       $437.25       $228.31
                                                                       adenoids.
42825.................  T....................  .....................  Removal of tonsils.....   0258    21.0273    $1,141.55       $437.25       $228.31
42826.................  T....................  .....................  Removal of tonsils.....   0258    21.0273    $1,141.55       $437.25       $228.31
42830.................  T....................  .....................  Removal of adenoids....   0258    21.0273    $1,141.55       $437.25       $228.31
42831.................  T....................  .....................  Removal of adenoids....   0258    21.0273    $1,141.55       $437.25       $228.31
42835.................  T....................  .....................  Removal of adenoids....   0258    21.0273    $1,141.55       $437.25       $228.31
42836.................  T....................  .....................  Removal of adenoids....   0258    21.0273    $1,141.55       $437.25       $228.31
42842.................  T....................  .....................  Extensive surgery of      0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       throat.
42844.................  T....................  .....................  Extensive surgery of      0256    35.0866    $1,904.82  ............       $380.96
                                                                       throat.
42845.................  C....................  .....................  Extensive surgery of     .....  .........  ...........  ............  ............
                                                                       throat.
42860.................  T....................  .....................  Excision of tonsil tags   0258    21.0273    $1,141.55       $437.25       $228.31
42870.................  T....................  .....................  Excision of lingual       0258    21.0273    $1,141.55       $437.25       $228.31
                                                                       tonsil.
42890.................  T....................  .....................  Partial removal of        0256    35.0866    $1,904.82  ............       $380.96
                                                                       pharynx.
42892.................  T....................  .....................  Revision of pharyngeal    0256    35.0866    $1,904.82  ............       $380.96
                                                                       walls.
42894.................  C....................  .....................  Revision of pharyngeal   .....  .........  ...........  ............  ............
                                                                       walls.
42900.................  T....................  .....................  Repair throat wound....   0252     6.5416      $355.14       $113.41        $71.03
42950.................  T....................  .....................  Reconstruction of         0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       throat.
42953.................  C....................  .....................  Repair throat,           .....  .........  ...........  ............  ............
                                                                       esophagus.
42955.................  T....................  .....................  Surgical opening of       0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       throat.
42960.................  T....................  .....................  Control throat bleeding   0250     1.5381       $83.50        $29.23        $16.70
42961.................  C....................  .....................  Control throat bleeding  .....  .........  ...........  ............  ............
42962.................  T....................  .....................  Control throat bleeding   0256    35.0866    $1,904.82  ............       $380.96
42970.................  T....................  .....................  Control nose/throat       0250     1.5381       $83.50        $29.23        $16.70
                                                                       bleeding.
42971.................  C....................  .....................  Control nose/throat      .....  .........  ...........  ............  ............
                                                                       bleeding.
42972.................  T....................  .....................  Control nose/throat       0253    15.1698      $823.55       $282.29       $164.71
                                                                       bleeding.
42999.................  T....................  .....................  Throat surgery            0252     6.5416      $355.14       $113.41        $71.03
                                                                       procedure.
43020.................  T....................  .....................  Incision of esophagus..   0252     6.5416      $355.14       $113.41        $71.03
43030.................  T....................  .....................  Throat muscle surgery..   0253    15.1698      $823.55       $282.29       $164.71
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      0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       pouch.
43135.................  C....................  .....................  Removal of esophagus     .....  .........  ...........  ............  ............
                                                                       pouch.
43200.................  T....................  .....................  Esophagus endoscopy....   0141     7.8542      $426.40       $143.38        $85.28
43201.................  T....................  .....................  Esoph scope w/submucous   0141     7.8542      $426.40       $143.38        $85.28
                                                                       inj.
43202.................  T....................  .....................  Esophagus endoscopy,      0141     7.8542      $426.40       $143.38        $85.28
                                                                       biopsy.
43204.................  T....................  .....................  Esoph scope w/sclerosis   0141     7.8542      $426.40       $143.38        $85.28
                                                                       inj.
43205.................  T....................  .....................  Esophagus endoscopy/      0141     7.8542      $426.40       $143.38        $85.28
                                                                       ligation.
43215.................  T....................  .....................  Esophagus endoscopy....   0141     7.8542      $426.40       $143.38        $85.28
43216.................  T....................  .....................  Esophagus endoscopy/      0141     7.8542      $426.40       $143.38        $85.28
                                                                       lesion.
43217.................  T....................  .....................  Esophagus endoscopy....   0141     7.8542      $426.40       $143.38        $85.28
43219.................  T....................  .....................  Esophagus endoscopy....   0384    36.0040    $1,954.62       $424.53       $390.92
43220.................  T....................  .....................  Esoph endoscopy,          0141     7.8542      $426.40       $143.38        $85.28
                                                                       dilation.
43226.................  T....................  .....................  Esoph endoscopy,          0141     7.8542      $426.40       $143.38        $85.28
                                                                       dilation.
43227.................  T....................  .....................  Esoph endoscopy, repair   0141     7.8542      $426.40       $143.38        $85.28
43228.................  T....................  .....................  Esoph endoscopy,          0141     7.8542      $426.40       $143.38        $85.28
                                                                       ablation.
43231.................  T....................  .....................  Esoph endoscopy w/us      0141     7.8542      $426.40       $143.38        $85.28
                                                                       exam.
43232.................  T....................  .....................  Esoph endoscopy w/us fn   0141     7.8542      $426.40       $143.38        $85.28
                                                                       bx.
43234.................  T....................  .....................  Upper GI endoscopy,       0141     7.8542      $426.40       $143.38        $85.28
                                                                       exam.
43235.................  T....................  .....................  Uppr gi endoscopy,        0141     7.8542      $426.40       $143.38        $85.28
                                                                       diagnosis.
43236.................  T....................  .....................  Uppr gi scope w/submuc    0141     7.8542      $426.40       $143.38        $85.28
                                                                       inj.
43239.................  T....................  .....................  Upper GI endoscopy,       0141     7.8542      $426.40       $143.38        $85.28
                                                                       biopsy.
43240.................  T....................  .....................  Esoph endoscope w/drain   0141     7.8542      $426.40       $143.38        $85.28
                                                                       cyst.

[[Page 48081]]

 
43241.................  T....................  .....................  Upper GI endoscopy with   0141     7.8542      $426.40       $143.38        $85.28
                                                                       tube.
43242.................  T....................  .....................  Uppr gi endoscopy w/us    0141     7.8542      $426.40       $143.38        $85.28
                                                                       fn bx.
43243.................  T....................  .....................  Upper gi endoscopy &      0141     7.8542      $426.40       $143.38        $85.28
                                                                       inject.
43244.................  T....................  .....................  Upper GI endoscopy/       0141     7.8542      $426.40       $143.38        $85.28
                                                                       ligation.
43245.................  T....................  .....................  Uppr gi scope dilate      0141     7.8542      $426.40       $143.38        $85.28
                                                                       strictr.
43246.................  T....................  .....................  Place gastrostomy tube.   0141     7.8542      $426.40       $143.38        $85.28
43247.................  T....................  .....................  Operative upper GI        0141     7.8542      $426.40       $143.38        $85.28
                                                                       endoscopy.
43248.................  T....................  .....................  Uppr gi endoscopy/guide   0141     7.8542      $426.40       $143.38        $85.28
                                                                       wire.
43249.................  T....................  .....................  Esoph endoscopy,          0141     7.8542      $426.40       $143.38        $85.28
                                                                       dilation.
43250.................  T....................  .....................  Upper GI endoscopy/       0141     7.8542      $426.40       $143.38        $85.28
                                                                       tumor.
43251.................  T....................  .....................  Operative upper GI        0141     7.8542      $426.40       $143.38        $85.28
                                                                       endoscopy.
43255.................  T....................  .....................  Operative upper GI        0141     7.8542      $426.40       $143.38        $85.28
                                                                       endoscopy.
43256.................  T....................  .....................  Uppr gi endoscopy w       0384    36.0040    $1,954.62       $424.53       $390.92
                                                                       stent.
43258.................  T....................  .....................  Operative upper GI        0141     7.8542      $426.40       $143.38        $85.28
                                                                       endoscopy.
43259.................  T....................  .....................  Endoscopic ultrasound     0141     7.8542      $426.40       $143.38        $85.28
                                                                       exam.
43260.................  T....................  .....................  Endo                      0151    18.8763    $1,024.78       $245.46       $204.96
                                                                       cholangiopancreatograp
                                                                       h.
43261.................  T....................  .....................  Endo                      0151    18.8763    $1,024.78       $245.46       $204.96
                                                                       cholangiopancreatograp
                                                                       h.
43262.................  T....................  .....................  Endo                      0151    18.8763    $1,024.78       $245.46       $204.96
                                                                       cholangiopancreatograp
                                                                       h.
43263.................  T....................  .....................  Endo                      0151    18.8763    $1,024.78       $245.46       $204.96
                                                                       cholangiopancreatograp
                                                                       h.
43264.................  T....................  .....................  Endo                      0151    18.8763    $1,024.78       $245.46       $204.96
                                                                       cholangiopancreatograp
                                                                       h.
43265.................  T....................  .....................  Endo                      0151    18.8763    $1,024.78       $245.46       $204.96
                                                                       cholangiopancreatograp
                                                                       h.
43267.................  T....................  .....................  Endo                      0151    18.8763    $1,024.78       $245.46       $204.96
                                                                       cholangiopancreatograp
                                                                       h.
43268.................  T....................  .....................  Endo                      0151    18.8763    $1,024.78       $245.46       $204.96
                                                                       cholangiopancreatograp
                                                                       h.
43269.................  T....................  .....................  Endo                      0151    18.8763    $1,024.78       $245.46       $204.96
                                                                       cholangiopancreatograp
                                                                       h.
43271.................  T....................  .....................  Endo                      0151    18.8763    $1,024.78       $245.46       $204.96
                                                                       cholangiopancreatograp
                                                                       h.
43272.................  T....................  .....................  Endo                      0151    18.8763    $1,024.78       $245.46       $204.96
                                                                       cholangiopancreatograp
                                                                       h.
43280.................  T....................  .....................  Laparoscopy,              0132    56.6318    $3,074.48     $1,239.22       $614.90
                                                                       fundoplasty.
43289.................  T....................  .....................  Laparoscope proc, esoph   0130    32.5959    $1,769.60       $659.53       $353.92
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.
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     6.3480      $344.63       $107.24        $68.93
43453.................  T....................  .....................  Dilate esophagus.......   0140     6.3480      $344.63       $107.24        $68.93
43456.................  T....................  .....................  Dilate esophagus.......   0140     6.3480      $344.63       $107.24        $68.93
43458.................  T....................  .....................  Dilate esophagus.......   0140     6.3480      $344.63       $107.24        $68.93
43460.................  C....................  .....................  Pressure treatment       .....  .........  ...........  ............  ............
                                                                       esophagus.
43496.................  C....................  .....................  Free jejunum flap,       .....  .........  ...........  ............  ............
                                                                       microvasc.
43499.................  T....................  .....................  Esophagus surgery         0141     7.8542      $426.40       $143.38        $85.28
                                                                       procedure.
43500.................  C....................  .....................  Surgical opening of      .....  .........  ...........  ............  ............
                                                                       stomach.
43501.................  C....................  .....................  Surgical repair of       .....  .........  ...........  ............  ............
                                                                       stomach.
43502.................  C....................  .....................  Surgical repair of       .....  .........  ...........  ............  ............
                                                                       stomach.
43510.................  C....................  .....................  Surgical opening of      .....  .........  ...........  ............  ............
                                                                       stomach.
43520.................  C....................  .....................  Incision of pyloric      .....  .........  ...........  ............  ............
                                                                       muscle.

[[Page 48082]]

 
43600.................  T....................  .....................  Biopsy of stomach......   0141     7.8542      $426.40       $143.38        $85.28
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        0132    56.6318    $3,074.48     $1,239.22       $614.90
                                                                       nerve.
43652.................  T....................  .....................  Laparoscopy, vagus        0132    56.6318    $3,074.48     $1,239.22       $614.90
                                                                       nerve.
43653.................  T....................  .....................  Laparoscopy,              0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       gastrostomy.
43659.................  T....................  .....................  Laparoscope proc, stom.   0130    32.5959    $1,769.60       $659.53       $353.92
43750.................  T....................  .....................  Place gastrostomy tube.   0141     7.8542      $426.40       $143.38        $85.28
43752.................  E....................  .....................  Nasal/orogastric w/      .....  .........  ...........  ............  ............
                                                                       stent.
43760.................  T....................  .....................  Change gastrostomy tube   0121     2.2058      $119.75        $43.80        $23.95
43761.................  T....................  .....................  Reposition gastrostomy    0121     2.2058      $119.75        $43.80        $23.95
                                                                       tube.
43800.................  C....................  .....................  Reconstruction of        .....  .........  ...........  ............  ............
                                                                       pylorus.
43810.................  C....................  .....................  Fusion of stomach and    .....  .........  ...........  ............  ............
                                                                       bowel.
43820.................  C....................  .....................  Fusion of stomach and    .....  .........  ...........  ............  ............
                                                                       bowel.
43825.................  C....................  .....................  Fusion of stomach and    .....  .........  ...........  ............  ............
                                                                       bowel.
43830.................  T....................  .....................  Place gastrostomy tube.   0141     7.8542      $426.40       $143.38        $85.28
43831.................  T....................  .....................  Place gastrostomy tube.   0141     7.8542      $426.40       $143.38        $85.28
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     7.8542      $426.40       $143.38        $85.28
43880.................  C....................  .....................  Repair stomach-bowel     .....  .........  ...........  ............  ............
                                                                       fistula.
43999.................  T....................  .....................  Stomach surgery           0141     7.8542      $426.40       $143.38        $85.28
                                                                       procedure.
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     7.8542      $426.40       $143.38        $85.28
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.

[[Page 48083]]

 
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,              0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       enterolysis.
44201.................  T....................  .....................  Laparoscopy,              0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       jejunostomy.
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....................  .....................  Lap part colectomy w/     0132    56.6318    $3,074.48     $1,239.22       $614.90
                                                                       stoma.
44207.................  T....................  .....................  L colectomy/              0132    56.6318    $3,074.48     $1,239.22       $614.90
                                                                       coloproctostomy.
44208.................  T....................  .....................  L colectomy/              0132    56.6318    $3,074.48     $1,239.22       $614.90
                                                                       coloproctostomy.
44210.................  C....................  .....................  Laparo total             .....  .........  ...........  ............  ............
                                                                       proctocolectomy.
44211.................  C....................  .....................  Laparo total             .....  .........  ...........  ............  ............
                                                                       proctocolectomy.
44212.................  C....................  .....................  Laparo total             .....  .........  ...........  ............  ............
                                                                       proctocolectomy.
44238.................  T....................  .....................  Laparoscope proc,         0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       intestine.
44239.................  T....................  .....................  Laparoscope proc,         0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       rectum.
44300.................  C....................  .....................  Open bowel to skin.....  .....  .........  ...........  ............  ............
44310.................  C....................  .....................  Ileostomy/jejunostomy..  .....  .........  ...........  ............  ............
44312.................  T....................  .....................  Revision of ileostomy..   0027    15.8319      $859.50       $329.72       $171.90
44314.................  C....................  .....................  Revision of ileostomy..  .....  .........  ...........  ............  ............
44316.................  C....................  .....................  Devise bowel pouch.....  .....  .........  ...........  ............  ............
44320.................  C....................  .....................  Colostomy..............  .....  .........  ...........  ............  ............
44322.................  C....................  .....................  Colostomy with biopsies  .....  .........  ...........  ............  ............
44340.................  T....................  .....................  Revision of colostomy..   0027    15.8319      $859.50       $329.72       $171.90
44345.................  C....................  .....................  Revision of colostomy..  .....  .........  ...........  ............  ............
44346.................  C....................  .....................  Revision of colostomy..  .....  .........  ...........  ............  ............
44360.................  T....................  .....................  Small bowel endoscopy..   0142     9.0138      $489.35       $152.78        $97.87
44361.................  T....................  .....................  Small bowel endoscopy/    0142     9.0138      $489.35       $152.78        $97.87
                                                                       biopsy.
44363.................  T....................  .....................  Small bowel endoscopy..   0142     9.0138      $489.35       $152.78        $97.87
44364.................  T....................  .....................  Small bowel endoscopy..   0142     9.0138      $489.35       $152.78        $97.87
44365.................  T....................  .....................  Small bowel endoscopy..   0142     9.0138      $489.35       $152.78        $97.87
44366.................  T....................  .....................  Small bowel endoscopy..   0142     9.0138      $489.35       $152.78        $97.87
44369.................  T....................  .....................  Small bowel endoscopy..   0142     9.0138      $489.35       $152.78        $97.87
44370.................  T....................  .....................  Small bowel endoscopy/    0384    36.0040    $1,954.62       $424.53       $390.92
                                                                       stent.
44372.................  T....................  .....................  Small bowel endoscopy..   0142     9.0138      $489.35       $152.78        $97.87
44373.................  T....................  .....................  Small bowel endoscopy..   0142     9.0138      $489.35       $152.78        $97.87
44376.................  T....................  .....................  Small bowel endoscopy..   0142     9.0138      $489.35       $152.78        $97.87
44377.................  T....................  .....................  Small bowel endoscopy/    0142     9.0138      $489.35       $152.78        $97.87
                                                                       biopsy.
44378.................  T....................  .....................  Small bowel endoscopy..   0142     9.0138      $489.35       $152.78        $97.87
44379.................  T....................  .....................  S bowel endoscope w/      0384    36.0040    $1,954.62       $424.53       $390.92
                                                                       stent.
44380.................  T....................  .....................  Small bowel endoscopy..   0142     9.0138      $489.35       $152.78        $97.87
44382.................  T....................  .....................  Small bowel endoscopy..   0142     9.0138      $489.35       $152.78        $97.87
44383.................  T....................  .....................  Ileoscopy w/stent......   0384    36.0040    $1,954.62       $424.53       $390.92
44385.................  T....................  .....................  Endoscopy of bowel        0143     8.3227      $451.83       $186.06        $90.37
                                                                       pouch.
44386.................  T....................  .....................  Endoscopy, bowel pouch/   0143     8.3227      $451.83       $186.06        $90.37
                                                                       biop.
44388.................  T....................  .....................  Colon endoscopy........   0143     8.3227      $451.83       $186.06        $90.37
44389.................  T....................  .....................  Colonoscopy with biopsy   0143     8.3227      $451.83       $186.06        $90.37
44390.................  T....................  .....................  Colonoscopy for foreign   0143     8.3227      $451.83       $186.06        $90.37
                                                                       body.
44391.................  T....................  .....................  Colonoscopy for           0143     8.3227      $451.83       $186.06        $90.37
                                                                       bleeding.
44392.................  T....................  .....................  Colonoscopy &             0143     8.3227      $451.83       $186.06        $90.37
                                                                       polypectomy.
44393.................  T....................  .....................  Colonoscopy, lesion       0143     8.3227      $451.83       $186.06        $90.37
                                                                       removal.
44394.................  T....................  .....................  Colonoscopy w/snare....   0143     8.3227      $451.83       $186.06        $90.37
44397.................  T....................  .....................  Colonoscopy w/stent....   0384    36.0040    $1,954.62       $424.53       $390.92

[[Page 48084]]

 
44500.................  T....................  .....................  Intro, gastrointestinal   0121     2.2058      $119.75        $43.80        $23.95
                                                                       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....................  .....................  Intraop colon lavage     .....  .........  ...........  ............  ............
                                                                       add-on.
44799.................  T....................  .....................  Intestine surgery         0142     9.0138      $489.35       $152.78        $97.87
                                                                       procedure.
44800.................  C....................  .....................  Excision of bowel pouch  .....  .........  ...........  ............  ............
44820.................  C....................  .....................  Excision of mesentery    .....  .........  ...........  ............  ............
                                                                       lesion.
44850.................  C....................  .....................  Repair of mesentery....  .....  .........  ...........  ............  ............
44899.................  C....................  .....................  Bowel surgery procedure  .....  .........  ...........  ............  ............
44900.................  C....................  .....................  Drain app abscess, open  .....  .........  ...........  ............  ............
44901.................  C....................  .....................  Drain app abscess,       .....  .........  ...........  ............  ............
                                                                       percut.
44950.................  C....................  .....................  Appendectomy...........  .....  .........  ...........  ............  ............
44955.................  C....................  .....................  Appendectomy add-on....  .....  .........  ...........  ............  ............
44960.................  C....................  .....................  Appendectomy...........  .....  .........  ...........  ............  ............
44970.................  T....................  .....................  Laparoscopy,              0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       appendectomy.
44979.................  T....................  .....................  Laparoscope proc, app..   0130    32.5959    $1,769.60       $659.53       $353.92
45000.................  T....................  .....................  Drainage of pelvic        0149    16.8557      $915.08       $293.06       $183.02
                                                                       abscess.
45005.................  T....................  .....................  Drainage of rectal        0148     4.1171      $223.51        $63.38        $44.70
                                                                       abscess.
45020.................  T....................  .....................  Drainage of rectal        0149    16.8557      $915.08       $293.06       $183.02
                                                                       abscess.
45100.................  T....................  .....................  Biopsy of rectum.......   0149    16.8557      $915.08       $293.06       $183.02
45108.................  T....................  .....................  Removal of anorectal      0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       lesion.
45110.................  C....................  .....................  Removal of rectum......  .....  .........  ...........  ............  ............
45111.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       rectum.
45112.................  C....................  .....................  Removal of rectum......  .....  .........  ...........  ............  ............
45113.................  C....................  .....................  Partial proctectomy....  .....  .........  ...........  ............  ............
45114.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       rectum.
45116.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       rectum.
45119.................  C....................  .....................  Remove rectum w/         .....  .........  ...........  ............  ............
                                                                       reservoir.
45120.................  C....................  .....................  Removal of rectum......  .....  .........  ...........  ............  ............
45121.................  C....................  .....................  Removal of rectum and    .....  .........  ...........  ............  ............
                                                                       colon.
45123.................  C....................  .....................  Partial proctectomy....  .....  .........  ...........  ............  ............
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    22.2565    $1,208.28       $437.12       $241.66
                                                                       stricture.
45160.................  T....................  .....................  Excision of rectal        0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       lesion.
45170.................  T....................  .....................  Excision of rectal        0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       lesion.
45190.................  T....................  .....................  Destruction, rectal       0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       tumor.
45300.................  T....................  .....................  Proctosigmoidoscopy dx.   0146     3.9986      $217.08        $64.40        $43.42
45303.................  T....................  .....................  Proctosigmoidoscopy       0146     3.9986      $217.08        $64.40        $43.42
                                                                       dilate.
45305.................  T....................  .....................  Proctosigmoidoscopy w/    0146     3.9986      $217.08        $64.40        $43.42
                                                                       bx.
45307.................  T....................  .....................  Proctosigmoidoscopy fb.   0146     3.9986      $217.08        $64.40        $43.42
45308.................  T....................  .....................  Proctosigmoidoscopy       0147     7.5876      $411.92  ............        $82.38
                                                                       removal.
45309.................  T....................  .....................  Proctosigmoidoscopy       0147     7.5876      $411.92  ............        $82.38
                                                                       removal.
45315.................  T....................  .....................  Proctosigmoidoscopy       0147     7.5876      $411.92  ............        $82.38
                                                                       removal.
45317.................  T....................  .....................  Proctosigmoidoscopy       0146     3.9986      $217.08        $64.40        $43.42
                                                                       bleed.
45320.................  T....................  .....................  Proctosigmoidoscopy       0147     7.5876      $411.92  ............        $82.38
                                                                       ablate.
45321.................  T....................  .....................  Proctosigmoidoscopy       0147     7.5876      $411.92  ............        $82.38
                                                                       volvul.
45327.................  T....................  .....................  Proctosigmoidoscopy w/    0384    36.0040    $1,954.62       $424.53       $390.92
                                                                       stent.
45330.................  T....................  .....................  Diagnostic                0146     3.9986      $217.08        $64.40        $43.42
                                                                       sigmoidoscopy.
45331.................  T....................  .....................  Sigmoidoscopy and         0146     3.9986      $217.08        $64.40        $43.42
                                                                       biopsy.
45332.................  T....................  .....................  Sigmoidoscopy w/fb        0146     3.9986      $217.08        $64.40        $43.42
                                                                       removal.
45333.................  T....................  .....................  Sigmoidoscopy &           0147     7.5876      $411.92  ............        $82.38
                                                                       polypectomy.

[[Page 48085]]

 
45334.................  T....................  .....................  Sigmoidoscopy for         0147     7.5876      $411.92  ............        $82.38
                                                                       bleeding.
45335.................  T....................  .....................  Sigmoidoscope w/submuc    0147     7.5876      $411.92  ............        $82.38
                                                                       inj.
45337.................  T....................  .....................  Sigmoidoscopy &           0147     7.5876      $411.92  ............        $82.38
                                                                       decompress.
45338.................  T....................  .....................  Sigmoidoscpy w/tumr       0147     7.5876      $411.92  ............        $82.38
                                                                       remove.
45339.................  T....................  .....................  Sigmoidoscopy w/ablate    0147     7.5876      $411.92  ............        $82.38
                                                                       tumr.
45340.................  T....................  .....................  Sig w/balloon dilation.   0147     7.5876      $411.92  ............        $82.38
45341.................  T....................  .....................  Sigmoidoscopy w/          0147     7.5876      $411.92  ............        $82.38
                                                                       ultrasound.
45342.................  T....................  .....................  Sigmoidoscopy w/us        0147     7.5876      $411.92  ............        $82.38
                                                                       guide bx.
45345.................  T....................  .....................  Sigmoidoscopy w/stent..   0384    36.0040    $1,954.62       $424.53       $390.92
45355.................  T....................  .....................  Surgical colonoscopy...   0143     8.3227      $451.83       $186.06        $90.37
45378.................  T....................  .....................  Diagnostic colonoscopy.   0143     8.3227      $451.83       $186.06        $90.37
45379.................  T....................  .....................  Colonoscopy w/fb          0143     8.3227      $451.83       $186.06        $90.37
                                                                       removal.
45380.................  T....................  .....................  Colonoscopy and biopsy.   0143     8.3227      $451.83       $186.06        $90.37
45381.................  T....................  .....................  Colonoscope, submucous    0143     8.3227      $451.83       $186.06        $90.37
                                                                       inj.
45382.................  T....................  .....................  Colonoscopy/control       0143     8.3227      $451.83       $186.06        $90.37
                                                                       bleeding.
45383.................  T....................  .....................  Lesion removal            0143     8.3227      $451.83       $186.06        $90.37
                                                                       colonoscopy.
45384.................  T....................  .....................  Lesion remove             0143     8.3227      $451.83       $186.06        $90.37
                                                                       colonoscopy.
45385.................  T....................  .....................  Lesion removal            0143     8.3227      $451.83       $186.06        $90.37
                                                                       colonoscopy.
45386.................  T....................  .....................  Colonoscope dilate        0143     8.3227      $451.83       $186.06        $90.37
                                                                       stricture.
45387.................  T....................  .....................  Colonoscopy w/stent....   0384    36.0040    $1,954.62       $424.53       $390.92
45500.................  T....................  .....................  Repair of rectum.......   0150    22.2565    $1,208.28       $437.12       $241.66
45505.................  T....................  .....................  Repair of rectum.......   0150    22.2565    $1,208.28       $437.12       $241.66
45520.................  T....................  .....................  Treatment of rectal       0098     1.1630       $63.14        $15.17        $12.63
                                                                       prolapse.
45540.................  C....................  .....................  Correct rectal prolapse  .....  .........  ...........  ............  ............
45541.................  C....................  .....................  Correct rectal prolapse  .....  .........  ...........  ............  ............
45550.................  C....................  .....................  Repair rectum/remove     .....  .........  ...........  ............  ............
                                                                       sigmoid.
45560.................  T....................  .....................  Repair of rectocele....   0150    22.2565    $1,208.28       $437.12       $241.66
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     4.1171      $223.51        $63.38        $44.70
                                                                       prolapse.
45905.................  T....................  .....................  Dilation of anal          0149    16.8557      $915.08       $293.06       $183.02
                                                                       sphincter.
45910.................  T....................  .....................  Dilation of rectal        0149    16.8557      $915.08       $293.06       $183.02
                                                                       narrowing.
45915.................  T....................  .....................  Remove rectal             0148     4.1171      $223.51        $63.38        $44.70
                                                                       obstruction.
45999.................  T....................  .....................  Rectum surgery            0148     4.1171      $223.51        $63.38        $44.70
                                                                       procedure.
46020.................  T....................  .....................  Placement of seton.....   0148     4.1171      $223.51        $63.38        $44.70
46030.................  T....................  .....................  Removal of rectal         0148     4.1171      $223.51        $63.38        $44.70
                                                                       marker.
46040.................  T....................  .....................  Incision of rectal        0149    16.8557      $915.08       $293.06       $183.02
                                                                       abscess.
46045.................  T....................  .....................  Incision of rectal        0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       abscess.
46050.................  T....................  .....................  Incision of anal          0148     4.1171      $223.51        $63.38        $44.70
                                                                       abscess.
46060.................  T....................  .....................  Incision of rectal        0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       abscess.
46070.................  T....................  .....................  Incision of anal septum   0155     9.9148      $538.26       $188.89       $107.65
46080.................  T....................  .....................  Incision of anal          0149    16.8557      $915.08       $293.06       $183.02
                                                                       sphincter.
46083.................  T....................  .....................  Incise external           0148     4.1171      $223.51        $63.38        $44.70
                                                                       hemorrhoid.
46200.................  T....................  .....................  Removal of anal fissure   0150    22.2565    $1,208.28       $437.12       $241.66
46210.................  T....................  .....................  Removal of anal crypt..   0149    16.8557      $915.08       $293.06       $183.02
46211.................  T....................  .....................  Removal of anal crypts.   0150    22.2565    $1,208.28       $437.12       $241.66
46220.................  T....................  .....................  Removal of anal tag....   0149    16.8557      $915.08       $293.06       $183.02
46221.................  T....................  .....................  Ligation of               0148     4.1171      $223.51        $63.38        $44.70
                                                                       hemorrhoid(s).
46230.................  T....................  .....................  Removal of anal tags...   0149    16.8557      $915.08       $293.06       $183.02
46250.................  T....................  .....................  Hemorrhoidectomy.......   0150    22.2565    $1,208.28       $437.12       $241.66
46255.................  T....................  .....................  Hemorrhoidectomy.......   0150    22.2565    $1,208.28       $437.12       $241.66
46257.................  T....................  .....................  Remove hemorrhoids &      0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       fissure.
46258.................  T....................  .....................  Remove hemorrhoids &      0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       fistula.
46260.................  T....................  .....................  Hemorrhoidectomy.......   0150    22.2565    $1,208.28       $437.12       $241.66
46261.................  T....................  .....................  Remove hemorrhoids &      0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       fissure.
46262.................  T....................  .....................  Remove hemorrhoids &      0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       fistula.
46270.................  T....................  .....................  Removal of anal fistula   0150    22.2565    $1,208.28       $437.12       $241.66
46275.................  T....................  .....................  Removal of anal fistula   0150    22.2565    $1,208.28       $437.12       $241.66
46280.................  T....................  .....................  Removal of anal fistula   0150    22.2565    $1,208.28       $437.12       $241.66
46285.................  T....................  .....................  Removal of anal fistula   0150    22.2565    $1,208.28       $437.12       $241.66
46288.................  T....................  .....................  Repair anal fistula....   0150    22.2565    $1,208.28       $437.12       $241.66
46320.................  T....................  .....................  Removal of hemorrhoid     0148     4.1171      $223.51        $63.38        $44.70
                                                                       clot.

[[Page 48086]]

 
46500.................  T....................  .....................  Injection into            0155     9.9148      $538.26       $188.89       $107.65
                                                                       hemorrhoid(s).
46600.................  X....................  .....................  Diagnostic anoscopy....   0340     0.6232       $33.83  ............         $6.77
46604.................  T....................  .....................  Anoscopy and dilation..   0147     7.5876      $411.92  ............        $82.38
46606.................  T....................  .....................  Anoscopy and biopsy....   0147     7.5876      $411.92  ............        $82.38
46608.................  T....................  .....................  Anoscopy, remove for      0147     7.5876      $411.92  ............        $82.38
                                                                       body.
46610.................  T....................  .....................  Anoscopy, remove lesion   0147     7.5876      $411.92  ............        $82.38
46611.................  T....................  .....................  Anoscopy...............   0147     7.5876      $411.92  ............        $82.38
46612.................  T....................  .....................  Anoscopy, remove          0147     7.5876      $411.92  ............        $82.38
                                                                       lesions.
46614.................  T....................  .....................  Anoscopy, control         0147     7.5876      $411.92  ............        $82.38
                                                                       bleeding.
46615.................  T....................  .....................  Anoscopy...............   0147     7.5876      $411.92  ............        $82.38
46700.................  T....................  .....................  Repair of anal            0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       stricture.
46705.................  C....................  .....................  Repair of anal           .....  .........  ...........  ............  ............
                                                                       stricture.
46706.................  T....................  .....................  Repr of anal fistula w/   0148     4.1171      $223.51        $63.38        $44.70
                                                                       glue.
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            0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       sphincter.
46751.................  C....................  .....................  Repair of anal           .....  .........  ...........  ............  ............
                                                                       sphincter.
46753.................  T....................  .....................  Reconstruction of anus.   0150    22.2565    $1,208.28       $437.12       $241.66
46754.................  T....................  .....................  Removal of suture from    0149    16.8557      $915.08       $293.06       $183.02
                                                                       anus.
46760.................  T....................  .....................  Repair of anal            0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       sphincter.
46761.................  T....................  .....................  Repair of anal            0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       sphincter.
46762.................  T....................  .....................  Implant artificial        0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       sphincter.
46900.................  T....................  .....................  Destruction, anal         0016     2.7343      $148.44        $57.31        $29.69
                                                                       lesion(s).
46910.................  T....................  .....................  Destruction, anal         0017    16.7332      $908.43       $227.84       $181.69
                                                                       lesion(s).
46916.................  T....................  .....................  Cryosurgery, anal         0013     1.1420       $62.00        $14.20        $12.40
                                                                       lesion(s).
46917.................  T....................  .....................  Laser surgery, anal       0695    19.1377    $1,038.97       $266.59       $207.79
                                                                       lesions.
46922.................  T....................  .....................  Excision of anal          0695    19.1377    $1,038.97       $266.59       $207.79
                                                                       lesion(s).
46924.................  T....................  .....................  Destruction, anal         0695    19.1377    $1,038.97       $266.59       $207.79
                                                                       lesion(s).
46934.................  T....................  .....................  Destruction of            0155     9.9148      $538.26       $188.89       $107.65
                                                                       hemorrhoids.
46935.................  T....................  .....................  Destruction of            0155     9.9148      $538.26       $188.89       $107.65
                                                                       hemorrhoids.
46936.................  T....................  .....................  Destruction of            0149    16.8557      $915.08       $293.06       $183.02
                                                                       hemorrhoids.
46937.................  T....................  .....................  Cryotherapy of rectal     0149    16.8557      $915.08       $293.06       $183.02
                                                                       lesion.
46938.................  T....................  .....................  Cryotherapy of rectal     0150    22.2565    $1,208.28       $437.12       $241.66
                                                                       lesion.
46940.................  T....................  .....................  Treatment of anal         0149    16.8557      $915.08       $293.06       $183.02
                                                                       fissure.
46942.................  T....................  .....................  Treatment of anal         0148     4.1171      $223.51        $63.38        $44.70
                                                                       fissure.
46945.................  T....................  .....................  Ligation of hemorrhoids   0155     9.9148      $538.26       $188.89       $107.65
46946.................  T....................  .....................  Ligation of hemorrhoids   0155     9.9148      $538.26       $188.89       $107.65
46999.................  T....................  .....................  Anus surgery procedure.   0148     4.1171      $223.51        $63.38        $44.70
47000.................  T....................  .....................  Needle biopsy of liver.   0685     4.8912      $265.54       $116.83        $53.11
47001.................  N....................  .....................  Needle biopsy, liver     .....  .........  ...........  ............  ............
                                                                       add-on.
47010.................  C....................  .....................  Open drainage, liver     .....  .........  ...........  ............  ............
                                                                       lesion.
47011.................  T....................  .....................  Percut drain, liver       0005     3.3675      $182.82        $71.59        $36.56
                                                                       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.....  .....  .........  ...........  ............  ............
47370.................  T....................  .....................  Laparo ablate liver       0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       tumor rf.
47371.................  T....................  .....................  Laparo ablate liver       0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       cryosurg.

[[Page 48087]]

 
47379.................  T....................  .....................  Laparoscope procedure,    0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       liver.
47380.................  C....................  .....................  Open ablate liver tumor  .....  .........  ...........  ............  ............
                                                                       rf.
47381.................  C....................  .....................  Open ablate liver tumor  .....  .........  ...........  ............  ............
                                                                       cryo.
47382.................  T....................  .....................  Percut ablate liver rf.   1557  .........    $1,850.00  ............       $370.00
47399.................  T....................  .....................  Liver surgery procedure   0005     3.3675      $182.82        $71.59        $36.56
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     8.2940      $450.27       $113.02        $90.05
47500.................  N....................  .....................  Injection for liver x-   .....  .........  ...........  ............  ............
                                                                       rays.
47505.................  N....................  .....................  Injection for liver x-   .....  .........  ...........  ............  ............
                                                                       rays.
47510.................  T....................  .....................  Insert catheter, bile     0152     8.2940      $450.27       $113.02        $90.05
                                                                       duct.
47511.................  T....................  .....................  Insert bile duct drain.   0152     8.2940      $450.27       $113.02        $90.05
47525.................  T....................  .....................  Change bile duct          0122     8.4398      $458.19        $93.97        $91.64
                                                                       catheter.
47530.................  T....................  .....................  Revise/reinsert bile      0122     8.4398      $458.19        $93.97        $91.64
                                                                       tube.
47550.................  C....................  .....................  Bile duct endoscopy add- .....  .........  ...........  ............  ............
                                                                       on.
47552.................  T....................  .....................  Biliary endoscopy thru    0152     8.2940      $450.27       $113.02        $90.05
                                                                       skin.
47553.................  T....................  .....................  Biliary endoscopy thru    0152     8.2940      $450.27       $113.02        $90.05
                                                                       skin.
47554.................  T....................  .....................  Biliary endoscopy thru    0152     8.2940      $450.27       $113.02        $90.05
                                                                       skin.
47555.................  T....................  .....................  Biliary endoscopy thru    0152     8.2940      $450.27       $113.02        $90.05
                                                                       skin.
47556.................  T....................  .....................  Biliary endoscopy thru    0152     8.2940      $450.27       $113.02        $90.05
                                                                       skin.
47560.................  T....................  .....................  Laparoscopy w/cholangio   0130    32.5959    $1,769.60       $659.53       $353.92
47561.................  T....................  .....................  Laparo w/cholangio/       0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       biopsy.
47562.................  T....................  .....................  Laparoscopic              0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       cholecystectomy.
47563.................  T....................  .....................  Laparo cholecystectomy/   0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       graph.
47564.................  T....................  .....................  Laparo cholecystectomy/   0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       explr.
47570.................  C....................  .....................  Laparo                   .....  .........  ...........  ............  ............
                                                                       cholecystoenterostomy.
47579.................  T....................  .....................  Laparoscope proc,         0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       biliary.
47600.................  C....................  .....................  Removal of gallbladder.  .....  .........  ...........  ............  ............
47605.................  C....................  .....................  Removal of gallbladder.  .....  .........  ...........  ............  ............
47610.................  C....................  .....................  Removal of gallbladder.  .....  .........  ...........  ............  ............
47612.................  C....................  .....................  Removal of gallbladder.  .....  .........  ...........  ............  ............
47620.................  C....................  .....................  Removal of gallbladder.  .....  .........  ...........  ............  ............
47630.................  T....................  .....................  Remove bile duct stone.   0152     8.2940      $450.27       $113.02        $90.05
47700.................  C....................  .....................  Exploration of bile      .....  .........  ...........  ............  ............
                                                                       ducts.
47701.................  C....................  .....................  Bile duct revision.....  .....  .........  ...........  ............  ............
47711.................  C....................  .....................  Excision of bile duct    .....  .........  ...........  ............  ............
                                                                       tumor.
47712.................  C....................  .....................  Excision of bile duct    .....  .........  ...........  ............  ............
                                                                       tumor.
47715.................  C....................  .....................  Excision of bile duct    .....  .........  ...........  ............  ............
                                                                       cyst.
47716.................  C....................  .....................  Fusion of bile duct      .....  .........  ...........  ............  ............
                                                                       cyst.
47720.................  C....................  .....................  Fuse gallbladder &       .....  .........  ...........  ............  ............
                                                                       bowel.
47721.................  C....................  .....................  Fuse upper gi            .....  .........  ...........  ............  ............
                                                                       structures.
47740.................  C....................  .....................  Fuse gallbladder &       .....  .........  ...........  ............  ............
                                                                       bowel.
47741.................  C....................  .....................  Fuse gallbladder &       .....  .........  ...........  ............  ............
                                                                       bowel.
47760.................  C....................  .....................  Fuse bile ducts and      .....  .........  ...........  ............  ............
                                                                       bowel.
47765.................  C....................  .....................  Fuse liver ducts &       .....  .........  ...........  ............  ............
                                                                       bowel.
47780.................  C....................  .....................  Fuse bile ducts and      .....  .........  ...........  ............  ............
                                                                       bowel.
47785.................  C....................  .....................  Fuse bile ducts and      .....  .........  ...........  ............  ............
                                                                       bowel.
47800.................  C....................  .....................  Reconstruction of bile   .....  .........  ...........  ............  ............
                                                                       ducts.
47801.................  C....................  .....................  Placement, bile duct     .....  .........  ...........  ............  ............
                                                                       support.
47802.................  C....................  .....................  Fuse liver duct &        .....  .........  ...........  ............  ............
                                                                       intestine.
47900.................  C....................  .....................  Suture bile duct injury  .....  .........  ...........  ............  ............
47999.................  T....................  .....................  Bile tract surgery        0152     8.2940      $450.27       $113.02        $90.05
                                                                       procedure.
48000.................  C....................  .....................  Drainage of abdomen....  .....  .........  ...........  ............  ............
48001.................  C....................  .....................  Placement of drain,      .....  .........  ...........  ............  ............
                                                                       pancreas.
48005.................  C....................  .....................  Resect/debride pancreas  .....  .........  ...........  ............  ............
48020.................  C....................  .....................  Removal of pancreatic    .....  .........  ...........  ............  ............
                                                                       stone.
48100.................  C....................  .....................  Biopsy of pancreas,      .....  .........  ...........  ............  ............
                                                                       open.
48102.................  T....................  .....................  Needle biopsy, pancreas   0685     4.8912      $265.54       $116.83        $53.11
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.

[[Page 48088]]

 
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          0005     3.3675      $182.82        $71.59        $36.56
                                                                       pseudocyst.
48520.................  C....................  .....................  Fuse pancreas cyst and   .....  .........  ...........  ............  ............
                                                                       bowel.
48540.................  C....................  .....................  Fuse pancreas cyst and   .....  .........  ...........  ............  ............
                                                                       bowel.
48545.................  C....................  .....................  Pancreatorrhaphy.......  .....  .........  ...........  ............  ............
48547.................  C....................  .....................  Duodenal exclusion.....  .....  .........  ...........  ............  ............
48550.................  E....................  .....................  Donor pancreatectomy...  .....  .........  ...........  ............  ............
48554.................  E....................  .....................  Transpl allograft        .....  .........  ...........  ............  ............
                                                                       pancreas.
48556.................  C....................  .....................  Removal, allograft       .....  .........  ...........  ............  ............
                                                                       pancreas.
48999.................  T....................  .....................  Pancreas surgery          0005     3.3675      $182.82        $71.59        $36.56
                                                                       procedure.
49000.................  C....................  .....................  Exploration of abdomen.  .....  .........  ...........  ............  ............
49002.................  C....................  .....................  Reopening of abdomen...  .....  .........  ...........  ............  ............
49010.................  C....................  .....................  Exploration behind       .....  .........  ...........  ............  ............
                                                                       abdomen.
49020.................  C....................  .....................  Drain abdominal abscess  .....  .........  ...........  ............  ............
49021.................  C....................  .....................  Drain abdominal abscess  .....  .........  ...........  ............  ............
49040.................  C....................  .....................  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      0070     3.1393      $170.43  ............        $34.09
                                                                       cavity.
49081.................  T....................  .....................  Removal of abdominal      0070     3.1393      $170.43  ............        $34.09
                                                                       fluid.
49085.................  T....................  .....................  Remove abdomen foreign    0153    21.2745    $1,154.97       $410.87       $230.99
                                                                       body.
49180.................  T....................  .....................  Biopsy, abdominal mass.   0685     4.8912      $265.54       $116.83        $53.11
49200.................  T....................  .....................  Removal of abdominal      0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       lesion.
49201.................  C....................  .....................  Remove abdom lesion,     .....  .........  ...........  ............  ............
                                                                       complex.
49215.................  C....................  .....................  Excise sacral spine      .....  .........  ...........  ............  ............
                                                                       tumor.
49220.................  C....................  .....................  Multiple surgery,        .....  .........  ...........  ............  ............
                                                                       abdomen.
49250.................  T....................  .....................  Excision of umbilicus..   0153    21.2745    $1,154.97       $410.87       $230.99
49255.................  C....................  .....................  Removal of omentum.....  .....  .........  ...........  ............  ............
49320.................  T....................  .....................  Diag laparo separate      0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       proc.
49321.................  T....................  .....................  Laparoscopy, biopsy....   0130    32.5959    $1,769.60       $659.53       $353.92
49322.................  T....................  .....................  Laparoscopy, aspiration   0130    32.5959    $1,769.60       $659.53       $353.92
49323.................  T....................  .....................  Laparo drain lymphocele   0130    32.5959    $1,769.60       $659.53       $353.92
49329.................  T....................  .....................  Laparo proc, abdm/per/    0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       oment.
49400.................  N....................  .....................  Air injection into       .....  .........  ...........  ............  ............
                                                                       abdomen.
49419.................  T....................  .....................  Insrt abdom cath for      0119   129.8988    $7,052.08  ............     $1,410.42
                                                                       chemotx.
49420.................  T....................  .....................  Insert abdom drain,       0652    28.0692    $1,523.85  ............       $304.77
                                                                       temp.
49421.................  T....................  .....................  Insert abdom drain,       0652    28.0692    $1,523.85  ............       $304.77
                                                                       perm.
49422.................  T....................  .....................  Remove perm cannula/      0105    18.9084    $1,026.52       $370.40       $205.30
                                                                       catheter.
49423.................  T....................  .....................  Exchange drainage         0152     8.2940      $450.27       $113.02        $90.05
                                                                       catheter.
49424.................  N....................  .....................  Assess cyst, contrast    .....  .........  ...........  ............  ............
                                                                       inject.
49425.................  C....................  .....................  Insert abdomen-venous    .....  .........  ...........  ............  ............
                                                                       drain.
49426.................  T....................  .....................  Revise abdomen-venous     0153    21.2745    $1,154.97       $410.87       $230.99
                                                                       shunt.
49427.................  N....................  .....................  Injection, abdominal     .....  .........  ...........  ............  ............
                                                                       shunt.
49428.................  C....................  .....................  Ligation of shunt......  .....  .........  ...........  ............  ............
49429.................  T....................  .....................  Removal of shunt.......   0105    18.9084    $1,026.52       $370.40       $205.30
49491.................  T....................  .....................  Rpr hern preemie reduc.   0154    26.8861    $1,459.62       $464.85       $291.92
49492.................  T....................  .....................  Rpr ing hern premie,      0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       blocked.
49495.................  T....................  .....................  Rpr ing hernia baby,      0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       reduc.
49496.................  T....................  .....................  Rpr ing hernia baby,      0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       blocked.
49500.................  T....................  .....................  Rpr ing hernia, init,     0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       reduce.
49501.................  T....................  .....................  Rpr ing hernia, init      0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       blocked.
49505.................  T....................  .....................  Prp i/hern init           0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       reduc5 yr.
49507.................  T....................  .....................  Prp i/hern init           0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       block5 yr.
49520.................  T....................  .....................  Rerepair ing hernia,      0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       reduce.
49521.................  T....................  .....................  Rerepair ing hernia,      0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       blocked.

[[Page 48089]]

 
49525.................  T....................  .....................  Repair ing hernia,        0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       sliding.
49540.................  T....................  .....................  Repair lumbar hernia...   0154    26.8861    $1,459.62       $464.85       $291.92
49550.................  T....................  .....................  Rpr rem hernia, init,     0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       reduce.
49553.................  T....................  .....................  Rpr fem hernia, init      0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       blocked.
49555.................  T....................  .....................  Rerepair fem hernia,      0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       reduce.
49557.................  T....................  .....................  Rerepair fem hernia,      0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       blocked.
49560.................  T....................  .....................  Rpr ventral hern init,    0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       reduc.
49561.................  T....................  .....................  Rpr ventral hern init,    0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       block.
49565.................  T....................  .....................  Rerepair ventrl hern,     0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       reduce.
49566.................  T....................  .....................  Rerepair ventrl hern,     0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       block.
49568.................  T....................  .....................  Hernia repair w/mesh...   0154    26.8861    $1,459.62       $464.85       $291.92
49570.................  T....................  .....................  Rpr epigastric hern,      0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       reduce.
49572.................  T....................  .....................  Rpr epigastric hern,      0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       blocked.
49580.................  T....................  .....................  Rpr umbil hern, reduc <   0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       5 yr.
49582.................  T....................  .....................  Rpr umbil hern, block <   0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       5 yr.
49585.................  T....................  .....................  Rpr umbil hern, reduc     0154    26.8861    $1,459.62       $464.85       $291.92
                                                                        5 yr.
49587.................  T....................  .....................  Rpr umbil hern, block     0154    26.8861    $1,459.62       $464.85       $291.92
                                                                        5 yr.
49590.................  T....................  .....................  Repair spigilian hernia   0154    26.8861    $1,459.62       $464.85       $291.92
49600.................  T....................  .....................  Repair umbilical lesion   0154    26.8861    $1,459.62       $464.85       $291.92
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    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       initial.
49651.................  T....................  .....................  Laparo hernia repair      0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       recur.
49659.................  T....................  .....................  Laparo proc, hernia       0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       repair.
49900.................  C....................  .....................  Repair of abdominal      .....  .........  ...........  ............  ............
                                                                       wall.
49904.................  C....................  .....................  Omental flap, extra-     .....  .........  ...........  ............  ............
                                                                       abdom.
49905.................  C....................  .....................  Omental flap...........  .....  .........  ...........  ............  ............
49906.................  C....................  .....................  Free omental flap,       .....  .........  ...........  ............  ............
                                                                       microvasc.
49999.................  T....................  .....................  Abdomen surgery           0153    21.2745    $1,154.97       $410.87       $230.99
                                                                       procedure.
50010.................  C....................  .....................  Exploration of kidney..  .....  .........  ...........  ............  ............
50020.................  C....................  .....................  Renal abscess, open      .....  .........  ...........  ............  ............
                                                                       drain.
50021.................  T....................  .....................  Renal abscess, percut     0005     3.3675      $182.82        $71.59        $36.56
                                                                       drain.
50040.................  C....................  .....................  Drainage of kidney.....  .....  .........  ...........  ............  ............
50045.................  C....................  .....................  Exploration of kidney..  .....  .........  ...........  ............  ............
50060.................  C....................  .....................  Removal of kidney stone  .....  .........  ...........  ............  ............
50065.................  C....................  .....................  Incision of kidney.....  .....  .........  ...........  ............  ............
50070.................  C....................  .....................  Incision of kidney.....  .....  .........  ...........  ............  ............
50075.................  C....................  .....................  Removal of kidney stone  .....  .........  ...........  ............  ............
50080.................  T....................  .....................  Removal of kidney stone   0163    33.6435    $1,826.47  ............       $365.29
50081.................  T....................  .....................  Removal of kidney stone   0163    33.6435    $1,826.47  ............       $365.29
50100.................  C....................  .....................  Revise kidney blood      .....  .........  ...........  ............  ............
                                                                       vessels.
50120.................  C....................  .....................  Exploration of kidney..  .....  .........  ...........  ............  ............
50125.................  C....................  .....................  Explore and drain        .....  .........  ...........  ............  ............
                                                                       kidney.
50130.................  C....................  .....................  Removal of kidney stone  .....  .........  ...........  ............  ............
50135.................  C....................  .....................  Exploration of kidney..  .....  .........  ...........  ............  ............
50200.................  T....................  .....................  Biopsy of kidney.......   0685     4.8912      $265.54       $116.83        $53.11
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        0685     4.8912      $265.54       $116.83        $53.11
                                                                       lesion.
50392.................  T....................  .....................  Insert kidney drain....   0161    16.5822      $900.23       $249.36       $180.05

[[Page 48090]]

 
50393.................  T....................  .....................  Insert ureteral tube...   0161    16.5822      $900.23       $249.36       $180.05
50394.................  N....................  .....................  Injection for kidney x-  .....  .........  ...........  ............  ............
                                                                       ray.
50395.................  T....................  .....................  Create passage to         0161    16.5822      $900.23       $249.36       $180.05
                                                                       kidney.
50396.................  T....................  .....................  Measure kidney pressure   0164     1.2115       $65.77        $17.59        $13.15
50398.................  T....................  .....................  Change kidney tube.....   0122     8.4398      $458.19        $93.97        $91.64
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       0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       cyst.
50542.................  T....................  .....................  Laparo ablate renal       0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       mass.
50543.................  T....................  .....................  Laparo partial            0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       nephrectomy.
50544.................  T....................  .....................  Laparoscopy,              0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       pyeloplasty.
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    32.5959    $1,769.60       $659.53       $353.92
50551.................  T....................  .....................  Kidney endoscopy.......   0160     6.8152      $369.99       $105.06        $74.00
50553.................  T....................  .....................  Kidney endoscopy.......   0161    16.5822      $900.23       $249.36       $180.05
50555.................  T....................  .....................  Kidney endoscopy &        0160     6.8152      $369.99       $105.06        $74.00
                                                                       biopsy.
50557.................  T....................  .....................  Kidney endoscopy &        0162    21.8578    $1,186.64  ............       $237.33
                                                                       treatment.
50559.................  T....................  .....................  Renal endoscopy/          0160     6.8152      $369.99       $105.06        $74.00
                                                                       radiotracer.
50561.................  T....................  .....................  Kidney endoscopy &        0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
50562.................  T....................  .....................  Renal scope w/tumor       0160     6.8152      $369.99       $105.06        $74.00
                                                                       resect.
50570.................  C....................  .....................  Kidney endoscopy.......  .....  .........  ...........  ............  ............
50572.................  C....................  .....................  Kidney endoscopy.......  .....  .........  ...........  ............  ............
50574.................  C....................  .....................  Kidney endoscopy &       .....  .........  ...........  ............  ............
                                                                       biopsy.
50575.................  C....................  .....................  Kidney endoscopy.......  .....  .........  ...........  ............  ............
50576.................  C....................  .....................  Kidney endoscopy &       .....  .........  ...........  ............  ............
                                                                       treatment.
50578.................  C....................  .....................  Renal endoscopy/         .....  .........  ...........  ............  ............
                                                                       radiotracer.
50580.................  C....................  .....................  Kidney endoscopy &       .....  .........  ...........  ............  ............
                                                                       treatment.
50590.................  T....................  .....................  Fragmenting of kidney     0169    44.5329    $2,417.65     $1,115.69       $483.53
                                                                       stone.
50600.................  C....................  .....................  Exploration of ureter..  .....  .........  ...........  ............  ............
50605.................  C....................  .....................  Insert ureteral support  .....  .........  ...........  ............  ............
50610.................  C....................  .....................  Removal of ureter stone  .....  .........  ...........  ............  ............
50620.................  C....................  .....................  Removal of ureter stone  .....  .........  ...........  ............  ............
50630.................  C....................  .....................  Removal of ureter stone  .....  .........  ...........  ............  ............
50650.................  C....................  .....................  Removal of ureter......  .....  .........  ...........  ............  ............
50660.................  C....................  .....................  Removal of ureter......  .....  .........  ...........  ............  ............
50684.................  N....................  .....................  Injection for ureter x-  .....  .........  ...........  ............  ............
                                                                       ray.
50686.................  T....................  .....................  Measure ureter pressure   0164     1.2115       $65.77        $17.59        $13.15
50688.................  T....................  .....................  Change of ureter tube..   0122     8.4398      $458.19        $93.97        $91.64
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  .....  .........  ...........  ............  ............

[[Page 48091]]

 
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    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       ureterolithotomy.
50947.................  T....................  .....................  Laparo new ureter/        0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       bladder.
50948.................  T....................  .....................  Laparo new ureter/        0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       bladder.
50949.................  T....................  .....................  Laparoscope proc,         0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       ureter.
50951.................  T....................  .....................  Endoscopy of ureter....   0160     6.8152      $369.99       $105.06        $74.00
50953.................  T....................  .....................  Endoscopy of ureter....   0160     6.8152      $369.99       $105.06        $74.00
50955.................  T....................  .....................  Ureter endoscopy &        0161    16.5822      $900.23       $249.36       $180.05
                                                                       biopsy.
50957.................  T....................  .....................  Ureter endoscopy &        0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
50959.................  T....................  .....................  Ureter endoscopy &        0161    16.5822      $900.23       $249.36       $180.05
                                                                       tracer.
50961.................  T....................  .....................  Ureter endoscopy &        0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
50970.................  T....................  .....................  Ureter endoscopy.......   0160     6.8152      $369.99       $105.06        $74.00
50972.................  T....................  .....................  Ureter endoscopy &        0160     6.8152      $369.99       $105.06        $74.00
                                                                       catheter.
50974.................  T....................  .....................  Ureter endoscopy &        0161    16.5822      $900.23       $249.36       $180.05
                                                                       biopsy.
50976.................  T....................  .....................  Ureter endoscopy &        0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
50978.................  T....................  .....................  Ureter endoscopy &        0161    16.5822      $900.23       $249.36       $180.05
                                                                       tracer.
50980.................  T....................  .....................  Ureter endoscopy &        0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
51000.................  T....................  .....................  Drainage of bladder....   0165    14.0780      $764.28  ............       $152.86
51005.................  T....................  .....................  Drainage of bladder....   0164     1.2115       $65.77        $17.59        $13.15
51010.................  T....................  .....................  Drainage of bladder....   0165    14.0780      $764.28  ............       $152.86
51020.................  T....................  .....................  Incise & treat bladder.   0162    21.8578    $1,186.64  ............       $237.33
51030.................  T....................  .....................  Incise & treat bladder.   0162    21.8578    $1,186.64  ............       $237.33
51040.................  T....................  .....................  Incise & drain bladder.   0162    21.8578    $1,186.64  ............       $237.33
51045.................  T....................  .....................  Incise bladder/drain      0160     6.8152      $369.99       $105.06        $74.00
                                                                       ureter.
51050.................  T....................  .....................  Removal of bladder        0162    21.8578    $1,186.64  ............       $237.33
                                                                       stone.
51060.................  C....................  .....................  Removal of ureter stone  .....  .........  ...........  ............  ............
51065.................  T....................  .....................  Remove ureter calculus.   0162    21.8578    $1,186.64  ............       $237.33
51080.................  T....................  .....................  Drainage of bladder       0007    11.4943      $624.01  ............       $124.80
                                                                       abscess.
51500.................  T....................  .....................  Removal of bladder cyst   0154    26.8861    $1,459.62       $464.85       $291.92
51520.................  T....................  .....................  Removal of bladder        0162    21.8578    $1,186.64  ............       $237.33
                                                                       lesion.
51525.................  C....................  .....................  Removal of bladder       .....  .........  ...........  ............  ............
                                                                       lesion.
51530.................  C....................  .....................  Removal of bladder       .....  .........  ...........  ............  ............
                                                                       lesion.
51535.................  C....................  .....................  Repair of ureter lesion  .....  .........  ...........  ............  ............
51550.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       bladder.
51555.................  C....................  .....................  Partial removal of       .....  .........  ...........  ............  ............
                                                                       bladder.
51565.................  C....................  .....................  Revise bladder &         .....  .........  ...........  ............  ............
                                                                       ureter(s).
51570.................  C....................  .....................  Removal of bladder.....  .....  .........  ...........  ............  ............
51575.................  C....................  .....................  Removal of bladder &     .....  .........  ...........  ............  ............
                                                                       nodes.
51580.................  C....................  .....................  Remove bladder/revise    .....  .........  ...........  ............  ............
                                                                       tract.
51585.................  C....................  .....................  Removal of bladder &     .....  .........  ...........  ............  ............
                                                                       nodes.
51590.................  C....................  .....................  Remove bladder/revise    .....  .........  ...........  ............  ............
                                                                       tract.
51595.................  C....................  .....................  Remove bladder/revise    .....  .........  ...........  ............  ............
                                                                       tract.
51596.................  C....................  .....................  Remove bladder/create    .....  .........  ...........  ............  ............
                                                                       pouch.
51597.................  C....................  .....................  Removal of pelvic        .....  .........  ...........  ............  ............
                                                                       structures.
51600.................  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     1.2115       $65.77        $17.59        $13.15
51701.................  N....................  .....................  Insert bladder catheter  .....  .........  ...........  ............  ............
51702.................  N....................  .....................  Insert temp bladder      .....  .........  ...........  ............  ............
                                                                       cath.
51703.................  N....................  .....................  Insert bladder cath,     .....  .........  ...........  ............  ............
                                                                       complex.
51705.................  T....................  .....................  Change of bladder tube.   0121     2.2058      $119.75        $43.80        $23.95
51710.................  T....................  .....................  Change of bladder tube.   0122     8.4398      $458.19        $93.97        $91.64
51715.................  T....................  .....................  Endoscopic injection/     0167    30.1066    $1,634.46       $555.84       $326.89
                                                                       implant.
51720.................  T....................  .....................  Treatment of bladder      0156     3.1438      $170.67        $46.55        $34.13
                                                                       lesion.
51725.................  T....................  .....................  Simple cystometrogram..   0156     3.1438      $170.67        $46.55        $34.13
51726.................  T....................  .....................  Complex cystometrogram.   0156     3.1438      $170.67        $46.55        $34.13
51736.................  T....................  .....................  Urine flow measurement.   0164     1.2115       $65.77        $17.59        $13.15
51741.................  T....................  .....................  Electro-uroflowmetry,     0164     1.2115       $65.77        $17.59        $13.15
                                                                       first.

[[Page 48092]]

 
51772.................  T....................  .....................  Urethra pressure          0164     1.2115       $65.77        $17.59        $13.15
                                                                       profile.
51784.................  T....................  .....................  Anal/urinary muscle       0164     1.2115       $65.77        $17.59        $13.15
                                                                       study.
51785.................  T....................  .....................  Anal/urinary muscle       0164     1.2115       $65.77        $17.59        $13.15
                                                                       study.
51792.................  T....................  .....................  Urinary reflex study...   0164     1.2115       $65.77        $17.59        $13.15
51795.................  T....................  .....................  Urine voiding pressure    0164     1.2115       $65.77        $17.59        $13.15
                                                                       study.
51797.................  T....................  .....................  Intraabdominal pressure   0164     1.2115       $65.77        $17.59        $13.15
                                                                       test.
51798.................  X....................  .....................  Us urine capacity         0340     0.6232       $33.83  ............         $6.77
                                                                       measure.
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         0162    21.8578    $1,186.64  ............       $237.33
                                                                       opening.
51900.................  C....................  .....................  Repair bladder/vagina    .....  .........  ...........  ............  ............
                                                                       lesion.
51920.................  C....................  .....................  Close bladder-uterus     .....  .........  ...........  ............  ............
                                                                       fistula.
51925.................  C....................  .....................  Hysterectomy/bladder     .....  .........  ...........  ............  ............
                                                                       repair.
51940.................  C....................  .....................  Correction of bladder    .....  .........  ...........  ............  ............
                                                                       defect.
51960.................  C....................  .....................  Revision of bladder &    .....  .........  ...........  ............  ............
                                                                       bowel.
51980.................  C....................  .....................  Construct bladder        .....  .........  ...........  ............  ............
                                                                       opening.
51990.................  T....................  .....................  Laparo urethral           0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       suspension.
51992.................  T....................  .....................  Laparo sling operation.   0132    56.6318    $3,074.48     $1,239.22       $614.90
52000.................  T....................  .....................  Cystoscopy.............   0160     6.8152      $369.99       $105.06        $74.00
52001.................  T....................  .....................  Cystoscopy, removal of    0160     6.8152      $369.99       $105.06        $74.00
                                                                       clots.
52005.................  T....................  .....................  Cystoscopy & ureter       0161    16.5822      $900.23       $249.36       $180.05
                                                                       catheter.
52007.................  T....................  .....................  Cystoscopy and biopsy..   0161    16.5822      $900.23       $249.36       $180.05
52010.................  T....................  .....................  Cystoscopy & duct         0160     6.8152      $369.99       $105.06        $74.00
                                                                       catheter.
52204.................  T....................  .....................  Cystoscopy.............   0161    16.5822      $900.23       $249.36       $180.05
52214.................  T....................  .....................  Cystoscopy and            0162    21.8578    $1,186.64  ............       $237.33
                                                                       treatment.
52224.................  T....................  .....................  Cystoscopy and            0162    21.8578    $1,186.64  ............       $237.33
                                                                       treatment.
52234.................  T....................  .....................  Cystoscopy and            0162    21.8578    $1,186.64  ............       $237.33
                                                                       treatment.
52235.................  T....................  .....................  Cystoscopy and            0162    21.8578    $1,186.64  ............       $237.33
                                                                       treatment.
52240.................  T....................  .....................  Cystoscopy and            0162    21.8578    $1,186.64  ............       $237.33
                                                                       treatment.
52250.................  T....................  .....................  Cystoscopy and            0162    21.8578    $1,186.64  ............       $237.33
                                                                       radiotracer.
52260.................  T....................  .....................  Cystoscopy and            0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
52265.................  T....................  .....................  Cystoscopy and            0160     6.8152      $369.99       $105.06        $74.00
                                                                       treatment.
52270.................  T....................  .....................  Cystoscopy & revise       0161    16.5822      $900.23       $249.36       $180.05
                                                                       urethra.
52275.................  T....................  .....................  Cystoscopy & revise       0161    16.5822      $900.23       $249.36       $180.05
                                                                       urethra.
52276.................  T....................  .....................  Cystoscopy and            0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
52277.................  T....................  .....................  Cystoscopy and            0162    21.8578    $1,186.64  ............       $237.33
                                                                       treatment.
52281.................  T....................  .....................  Cystoscopy and            0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
52282.................  T....................  .....................  Cystoscopy, implant       0385    66.4829    $3,609.29  ............       $721.86
                                                                       stent.
52283.................  T....................  .....................  Cystoscopy and            0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
52285.................  T....................  .....................  Cystoscopy and            0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
52290.................  T....................  .....................  Cystoscopy and            0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
52300.................  T....................  .....................  Cystoscopy and            0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
52301.................  T....................  .....................  Cystoscopy and            0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
52305.................  T....................  .....................  Cystoscopy and            0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
52310.................  T....................  .....................  Cystoscopy and            0160     6.8152      $369.99       $105.06        $74.00
                                                                       treatment.
52315.................  T....................  .....................  Cystoscopy and            0161    16.5822      $900.23       $249.36       $180.05
                                                                       treatment.
52317.................  T....................  .....................  Remove bladder stone...   0162    21.8578    $1,186.64  ............       $237.33
52318.................  T....................  .....................  Remove bladder stone...   0162    21.8578    $1,186.64  ............       $237.33
52320.................  T....................  .....................  Cystoscopy and            0162    21.8578    $1,186.64  ............       $237.33
                                                                       treatment.
52325.................  T....................  .....................  Cystoscopy, stone         0162    21.8578    $1,186.64  ............       $237.33
                                                                       removal.
52327.................  T....................  .....................  Cystoscopy, inject        0162    21.8578    $1,186.64  ............       $237.33
                                                                       material.
52330.................  T....................  .....................  Cystoscopy and            0162    21.8578    $1,186.64  ............       $237.33
                                                                       treatment.
52332.................  T....................  .....................  Cystoscopy and            0162    21.8578    $1,186.64  ............       $237.33
                                                                       treatment.
52334.................  T....................  .....................  Create passage to         0162    21.8578    $1,186.64  ............       $237.33
                                                                       kidney.
52341.................  T....................  .....................  Cysto w/ureter            0162    21.8578    $1,186.64  ............       $237.33
                                                                       stricture tx.
52342.................  T....................  .....................  Cysto w/up stricture tx   0162    21.8578    $1,186.64  ............       $237.33
52343.................  T....................  .....................  Cysto w/renal stricture   0162    21.8578    $1,186.64  ............       $237.33
                                                                       tx.
52344.................  T....................  .....................  Cysto/uretero, stone      0162    21.8578    $1,186.64  ............       $237.33
                                                                       remove.
52345.................  T....................  .....................  Cysto/uretero w/up        0162    21.8578    $1,186.64  ............       $237.33
                                                                       stricture.
52346.................  T....................  .....................  Cystouretero w/renal      0162    21.8578    $1,186.64  ............       $237.33
                                                                       strict.
52347.................  T....................  .....................  Cystoscopy, resect        0160     6.8152      $369.99       $105.06        $74.00
                                                                       ducts.

[[Page 48093]]

 
52351.................  T....................  .....................  Cystouretero & or         0160     6.8152      $369.99       $105.06        $74.00
                                                                       pyeloscope.
52352.................  T....................  .....................  Cystouretero w/stone      0162    21.8578    $1,186.64  ............       $237.33
                                                                       remove.
52353.................  T....................  .....................  Cystouretero w/           0163    33.6435    $1,826.47  ............       $365.29
                                                                       lithotripsy.
52354.................  T....................  .....................  Cystouretero w/biopsy..   0162    21.8578    $1,186.64  ............       $237.33
52355.................  T....................  .....................  Cystouretero w/excise     0162    21.8578    $1,186.64  ............       $237.33
                                                                       tumor.
52400.................  T....................  .....................  Cystouretero w/congen     0162    21.8578    $1,186.64  ............       $237.33
                                                                       repr.
52450.................  T....................  .....................  Incision of prostate...   0162    21.8578    $1,186.64  ............       $237.33
52500.................  T....................  .....................  Revision of bladder       0162    21.8578    $1,186.64  ............       $237.33
                                                                       neck.
52510.................  T....................  .....................  Dilation prostatic        0161    16.5822      $900.23       $249.36       $180.05
                                                                       urethra.
52601.................  T....................  .....................  Prostatectomy (TURP)...   0163    33.6435    $1,826.47  ............       $365.29
52606.................  T....................  .....................  Control postop bleeding   0162    21.8578    $1,186.64  ............       $237.33
52612.................  T....................  .....................  Prostatectomy, first      0163    33.6435    $1,826.47  ............       $365.29
                                                                       stage.
52614.................  T....................  .....................  Prostatectomy, second     0163    33.6435    $1,826.47  ............       $365.29
                                                                       stage.
52620.................  T....................  .....................  Remove residual           0163    33.6435    $1,826.47  ............       $365.29
                                                                       prostate.
52630.................  T....................  .....................  Remove prostate           0163    33.6435    $1,826.47  ............       $365.29
                                                                       regrowth.
52640.................  T....................  .....................  Relieve bladder           0162    21.8578    $1,186.64  ............       $237.33
                                                                       contracture.
52647.................  T....................  .....................  Laser surgery of          0163    33.6435    $1,826.47  ............       $365.29
                                                                       prostate.
52648.................  T....................  .....................  Laser surgery of          0163    33.6435    $1,826.47  ............       $365.29
                                                                       prostate.
52700.................  T....................  .....................  Drainage of prostate      0162    21.8578    $1,186.64  ............       $237.33
                                                                       abscess.
53000.................  T....................  .....................  Incision of urethra....   0166    16.8401      $914.23       $218.73       $182.85
53010.................  T....................  .....................  Incision of urethra....   0166    16.8401      $914.23       $218.73       $182.85
53020.................  T....................  .....................  Incision of urethra....   0166    16.8401      $914.23       $218.73       $182.85
53025.................  T....................  .....................  Incision of urethra....   0166    16.8401      $914.23       $218.73       $182.85
53040.................  T....................  .....................  Drainage of urethra       0166    16.8401      $914.23       $218.73       $182.85
                                                                       abscess.
53060.................  T....................  .....................  Drainage of urethra       0166    16.8401      $914.23       $218.73       $182.85
                                                                       abscess.
53080.................  T....................  .....................  Drainage of urinary       0166    16.8401      $914.23       $218.73       $182.85
                                                                       leakage.
53085.................  C....................  .....................  Drainage of urinary      .....  .........  ...........  ............  ............
                                                                       leakage.
53200.................  T....................  .....................  Biopsy of urethra......   0166    16.8401      $914.23       $218.73       $182.85
53210.................  T....................  .....................  Removal of urethra.....   0168    30.3485    $1,647.59       $405.60       $329.52
53215.................  T....................  .....................  Removal of urethra.....   0168    30.3485    $1,647.59       $405.60       $329.52
53220.................  T....................  .....................  Treatment of urethra      0168    30.3485    $1,647.59       $405.60       $329.52
                                                                       lesion.
53230.................  T....................  .....................  Removal of urethra        0168    30.3485    $1,647.59       $405.60       $329.52
                                                                       lesion.
53235.................  T....................  .....................  Removal of urethra        0168    30.3485    $1,647.59       $405.60       $329.52
                                                                       lesion.
53240.................  T....................  .....................  Surgery for urethra       0168    30.3485    $1,647.59       $405.60       $329.52
                                                                       pouch.
53250.................  T....................  .....................  Removal of urethra        0166    16.8401      $914.23       $218.73       $182.85
                                                                       gland.
53260.................  T....................  .....................  Treatment of urethra      0166    16.8401      $914.23       $218.73       $182.85
                                                                       lesion.
53265.................  T....................  .....................  Treatment of urethra      0166    16.8401      $914.23       $218.73       $182.85
                                                                       lesion.
53270.................  T....................  .....................  Removal of urethra        0167    30.1066    $1,634.46       $555.84       $326.89
                                                                       gland.
53275.................  T....................  .....................  Repair of urethra         0166    16.8401      $914.23       $218.73       $182.85
                                                                       defect.
53400.................  T....................  .....................  Revise urethra, stage 1   0168    30.3485    $1,647.59       $405.60       $329.52
53405.................  T....................  .....................  Revise urethra, stage 2   0168    30.3485    $1,647.59       $405.60       $329.52
53410.................  T....................  .....................  Reconstruction of         0168    30.3485    $1,647.59       $405.60       $329.52
                                                                       urethra.
53415.................  C....................  .....................  Reconstruction of        .....  .........  ...........  ............  ............
                                                                       urethra.
53420.................  T....................  .....................  Reconstruct urethra,      0168    30.3485    $1,647.59       $405.60       $329.52
                                                                       stage 1.
53425.................  T....................  .....................  Reconstruct urethra,      0168    30.3485    $1,647.59       $405.60       $329.52
                                                                       stage 2.
53430.................  T....................  .....................  Reconstruction of         0168    30.3485    $1,647.59       $405.60       $329.52
                                                                       urethra.
53431.................  T....................  .....................  Reconstruct urethra/      0168    30.3485    $1,647.59       $405.60       $329.52
                                                                       bladder.
53440.................  T....................  .....................  Correct bladder           0385    66.4829    $3,609.29  ............       $721.86
                                                                       function.
53442.................  T....................  .....................  Remove perineal           0166    16.8401      $914.23       $218.73       $182.85
                                                                       prosthesis.
53444.................  T....................  .....................  Insert tandem cuff.....   0385    66.4829    $3,609.29  ............       $721.86
53445.................  T....................  .....................  Insert uro/ves nck        0386   118.8122    $6,450.20  ............     $1,290.04
                                                                       sphincter.
53446.................  T....................  .....................  Remove uro sphincter...   0168    30.3485    $1,647.59       $405.60       $329.52
53447.................  T....................  .....................  Remove/replace ur         0386   118.8122    $6,450.20  ............    $1,290.014
                                                                       sphincter.
53448.................  C....................  .....................  Remov/replc ur sphinctr  .....  .........  ...........  ............  ............
                                                                       comp.
53449.................  T....................  .....................  Repair uro sphincter...   0168    30.3485    $1,647.59       $405.60       $329.52
53450.................  T....................  .....................  Revision of urethra....   0168    30.3485    $1,647.59       $405.60       $329.52
53460.................  T....................  .....................  Revision of urethra....   0168    30.3485    $1,647.59       $405.60       $329.52
53502.................  T....................  .....................  Repair of urethra         0166    16.8401      $914.23       $218.73       $182.85
                                                                       injury.
53505.................  T....................  .....................  Repair of urethra         0167    30.1066    $1,634.46       $555.84       $326.89
                                                                       injury.
53510.................  T....................  .....................  Repair of urethra         0166    16.8401      $914.23       $218.73       $182.85
                                                                       injury.
53515.................  T....................  .....................  Repair of urethra         0168    30.3485    $1,647.59       $405.60       $329.52
                                                                       injury.
53520.................  T....................  .....................  Repair of urethra         0168    30.3485    $1,647.59       $405.60       $329.52
                                                                       defect.
53600.................  T....................  .....................  Dilate urethra            0156     3.1438      $170.67        $46.55        $34.13
                                                                       stricture.
53601.................  T....................  .....................  Dilate urethra            0164     1.2115       $65.77        $17.59        $13.15
                                                                       stricture.
53605.................  T....................  .....................  Dilate urethra            0161    16.5822      $900.23       $249.36       $180.05
                                                                       stricture.
53620.................  T....................  .....................  Dilate urethra            0165    14.0780      $764.28  ............       $152.86
                                                                       stricture.

[[Page 48094]]

 
53621.................  T....................  .....................  Dilate urethra            0164     1.2115       $65.77        $17.59        $13.15
                                                                       stricture.
53660.................  T....................  .....................  Dilation of urethra....   0164     1.2115       $65.77        $17.59        $13.15
53661.................  T....................  .....................  Dilation of urethra....   0164     1.2115       $65.77        $17.59        $13.15
53665.................  T....................  .....................  Dilation of urethra....   0166    16.8401      $914.23       $218.73       $182.85
53850.................  T....................  .....................  Prostatic microwave       0675    49.3613    $2,679.78  ............       $535.96
                                                                       thermotx.
53852.................  T....................  .....................  Prostatic rf thermotx..   0675    49.3613    $2,679.78  ............       $535.96
53853.................  T....................  .....................  Prostatic water           1550  .........    $1,150.00  ............       $230.00
                                                                       thermother.
53899.................  T....................  .....................  Urology surgery           0164     1.2115       $65.77        $17.59        $13.15
                                                                       procedure.
54000.................  T....................  .....................  Slitting of prepuce....   0166    16.8401      $914.23       $218.73       $182.85
54001.................  T....................  .....................  Slitting of prepuce....   0166    16.8401      $914.23       $218.73       $182.85
54015.................  T....................  .....................  Drain penis lesion.....   0007    11.4943      $624.01  ............       $124.80
54050.................  T....................  .....................  Destruction, penis        0013     1.1420       $62.00        $14.20        $12.40
                                                                       lesion(s).
54055.................  T....................  .....................  Destruction, penis        0017    16.7332      $908.43       $227.84       $181.69
                                                                       lesion(s).
54056.................  T....................  .....................  Cryosurgery, penis        0012     0.8203       $44.53        $11.18         $8.91
                                                                       lesion(s).
54057.................  T....................  .....................  Laser surg, penis         0017    16.7332      $908.43       $227.84       $181.69
                                                                       lesion(s).
54060.................  T....................  .....................  Excision of penis         0017    16.7332      $908.43       $227.84       $181.69
                                                                       lesion(s).
54065.................  T....................  .....................  Destruction, penis        0695    19.1377    $1,038.97       $266.59       $207.79
                                                                       lesion(s).
54100.................  T....................  .....................  Biopsy of penis........   0021    14.5749      $791.26       $219.48       $158.25
54105.................  T....................  .....................  Biopsy of penis........   0022    18.6725    $1,013.71       $354.45       $202.74
54110.................  T....................  .....................  Treatment of penis        0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       lesion.
54111.................  T....................  .....................  Treat penis lesion,       0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       graft.
54112.................  T....................  .....................  Treat penis lesion,       0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       graft.
54115.................  T....................  .....................  Treatment of penis        0008    16.8303      $913.70  ............       $182.74
                                                                       lesion.
54120.................  T....................  .....................  Partial removal of        0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       penis.
54125.................  C....................  .....................  Removal of penis.......  .....  .........  ...........  ............  ............
54130.................  C....................  .....................  Remove penis & nodes...  .....  .........  ...........  ............  ............
54135.................  C....................  .....................  Remove penis & nodes...  .....  .........  ...........  ............  ............
54150.................  T....................  .....................  Circumcision...........   0180    18.4967    $1,004.17       $304.87       $200.83
54152.................  T....................  .....................  Circumcision...........   0180    18.4967    $1,004.17       $304.87       $200.83
54160.................  T....................  .....................  Circumcision...........   0180    18.4967    $1,004.17       $304.87       $200.83
54161.................  T....................  .....................  Circumcision...........   0180    18.4967    $1,004.17       $304.87       $200.83
54162.................  T....................  .....................  Lysis penil circumic      0180    18.4967    $1,004.17       $304.87       $200.83
                                                                       lesion.
54163.................  T....................  .....................  Repair of circumcision.   0180    18.4967    $1,004.17       $304.87       $200.83
54164.................  T....................  .....................  Frenulotomy of penis...   0180    18.4967    $1,004.17       $304.87       $200.83
54200.................  T....................  .....................  Treatment of penis        0156     3.1438      $170.67        $46.55        $34.13
                                                                       lesion.
54205.................  T....................  .....................  Treatment of penis        0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       lesion.
54220.................  T....................  .....................  Treatment of penis        0156     3.1438      $170.67        $46.55        $34.13
                                                                       lesion.
54230.................  N....................  .....................  Prepare penis study....  .....  .........  ...........  ............  ............
54231.................  T....................  .....................  Dynamic cavernosometry.   0165    14.0780      $764.28  ............       $152.86
54235.................  T....................  .....................  Penile injection.......   0164     1.2115       $65.77        $17.59        $13.15
54240.................  T....................  .....................  Penis study............   0164     1.2115       $65.77        $17.59        $13.15
54250.................  T....................  .....................  Penis study............   0165    14.0780      $764.28  ............       $152.86
54300.................  T....................  .....................  Revision of penis......   0181    29.0094    $1,574.89       $621.82       $314.98
54304.................  T....................  .....................  Revision of penis......   0181    29.0094    $1,574.89       $621.82       $314.98
54308.................  T....................  .....................  Reconstruction of         0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       urethra.
54312.................  T....................  .....................  Reconstruction of         0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       urethra.
54316.................  T....................  .....................  Reconstruction of         0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       urethra.
54318.................  T....................  .....................  Reconstruction of         0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       urethra.
54322.................  T....................  .....................  Reconstruction of         0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       urethra.
54324.................  T....................  .....................  Reconstruction of         0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       urethra.
54326.................  T....................  .....................  Reconstruction of         0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       urethra.
54328.................  T....................  .....................  Revise penis/urethra...   0181    29.0094    $1,574.89       $621.82       $314.98
54332.................  C....................  .....................  Revise penis/urethra...  .....  .........  ...........  ............  ............
54336.................  C....................  .....................  Revise penis/urethra...  .....  .........  ...........  ............  ............
54340.................  T....................  .....................  Secondary urethral        0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       surgery.
54344.................  T....................  .....................  Secondary urethral        0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       surgery.
54348.................  T....................  .....................  Secondary urethral        0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       surgery.
54352.................  T....................  .....................  Reconstruct urethra/      0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       penis.
54360.................  T....................  .....................  Penis plastic surgery..   0181    29.0094    $1,574.89       $621.82       $314.98
54380.................  T....................  .....................  Repair penis...........   0181    29.0094    $1,574.89       $621.82       $314.98
54385.................  T....................  .....................  Repair penis...........   0181    29.0094    $1,574.89       $621.82       $314.98
54390.................  C....................  .....................  Repair penis and         .....  .........  ...........  ............  ............
                                                                       bladder.
54400.................  T....................  .....................  Insert semi-rigid         0385    66.4829    $3,609.29  ............       $721.86
                                                                       prosthesis.
54401.................  T....................  .....................  Insert self-contd         0386   118.8122    $6,450.20  ............     $1,240.04
                                                                       prosthesis.
54405.................  T....................  .....................  Insert multi-comp penis   0386   118.8122    $6,450.20  ............     $1,240.04
                                                                       pros.
54406.................  T....................  .....................  Remove muti-comp penis    0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       pros.

[[Page 48095]]

 
54408.................  T....................  .....................  Repair multi-comp penis   0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       pros.
54410.................  T....................  .....................  Remove/replace penis      0386   118.8122    $6,450.20  ............     $1,290.04
                                                                       prosth.
54411.................  C....................  .....................  Remov/replc penis pros,  .....  .........  ...........  ............  ............
                                                                       comp.
54415.................  T....................  .....................  Remove self-contd penis   0181    29.0094    $1,574.89       $621.82       $314.98
                                                                       pros.
54416.................  T....................  .....................  Remv/repl penis contain   0385    66.4829    $3,609.29  ............       $721.86
                                                                       pros.
54417.................  C....................  .....................  Remv/replc penis pros,   .....  .........  ...........  ............  ............
                                                                       compl.
54420.................  T....................  .....................  Revision of penis......   0181    29.0094    $1,574.89       $621.82       $314.98
54430.................  C....................  .....................  Revision of penis......  .....  .........  ...........  ............  ............
54435.................  T....................  .....................  Revision of penis......   0181    29.0094    $1,574.89       $621.82       $314.98
54440.................  T....................  .....................  Repair of penis........   0181    29.0094    $1,574.89       $621.82       $314.98
54450.................  T....................  .....................  Preputial stretching...   0156     3.1438      $170.67        $46.55        $34.13
54500.................  T....................  .....................  Biopsy of testis.......   0005     3.3675      $182.82        $71.59        $36.56
54505.................  T....................  .....................  Biopsy of testis.......   0183    21.7612    $1,181.39  ............       $236.28
54512.................  T....................  .....................  Excise lesion testis...   0183    21.7612    $1,181.39  ............       $236.28
54520.................  T....................  .....................  Removal of testis......   0183    21.7612    $1,181.39  ............       $236.28
54522.................  T....................  .....................  Orchiectomy, partial...   0183    21.7612    $1,181.39  ............       $236.28
54530.................  T....................  .....................  Removal of testis......   0154    26.8861    $1,459.62       $464.85       $291.92
54535.................  C....................  .....................  Extensive testis         .....  .........  ...........  ............  ............
                                                                       surgery.
54550.................  T....................  .....................  Exploration for testis.   0154    26.8861    $1,459.62       $464.85       $291.92
54560.................  C....................  .....................  Exploration for testis.  .....  .........  ...........  ............  ............
54600.................  T....................  .....................  Reduce testis torsion..   0183    21.7612    $1,181.39  ............       $236.28
54620.................  T....................  .....................  Suspension of testis...   0183    21.7612    $1,181.39  ............       $236.28
54640.................  T....................  .....................  Suspension of testis...   0154    26.8861    $1,459.62       $464.85       $291.92
54650.................  C....................  .....................  Orchiopexy (Fowler-      .....  .........  ...........  ............  ............
                                                                       Stephens).
54660.................  T....................  .....................  Revision of testis.....   0183    21.7612    $1,181.39  ............       $236.28
54670.................  T....................  .....................  Repair testis injury...   0183    21.7612    $1,181.39  ............       $236.28
54680.................  T....................  .....................  Relocation of             0183    21.7612    $1,181.39  ............       $236.28
                                                                       testis(es).
54690.................  T....................  .....................  Laparoscopy,              0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       orchiectomy.
54692.................  T....................  .....................  Laparoscopy, orchiopexy   0132    56.6318    $3,074.48     $1,239.22       $614.90
54699.................  T....................  .....................  Laparoscope proc,         0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       testis.
54700.................  T....................  .....................  Drainage of scrotum....   0183    21.7612    $1,181.39  ............       $236.28
54800.................  T....................  .....................  Biopsy of epididymis...   0004     1.5774       $85.64        $22.10        $17.13
54820.................  T....................  .....................  Exploration of            0183    21.7612    $1,181.39  ............       $236.28
                                                                       epididymis.
54830.................  T....................  .....................  Remove epididymis         0183    21.7612    $1,181.39  ............       $236.28
                                                                       lesion.
54840.................  T....................  .....................  Remove epididymis         0183    21.7612    $1,181.39  ............       $236.28
                                                                       lesion.
54860.................  T....................  .....................  Removal of epididymis..   0183    21.7612    $1,181.39  ............       $236.28
54861.................  T....................  .....................  Removal of epididymis..   0183    21.7612    $1,181.39  ............       $236.28
54900.................  T....................  .....................  Fusion of spermatic       0183    21.7612    $1,181.39  ............       $236.28
                                                                       ducts.
54901.................  T....................  .....................  Fusion of spermatic       0183    21.7612    $1,181.39  ............       $236.28
                                                                       ducts.
55000.................  T....................  .....................  Drainage of hydrocele..   0004     1.5774       $85.64        $22.10        $17.13
55040.................  T....................  .....................  Removal of hydrocele...   0154    26.8861    $1,459.62       $464.85       $291.92
55041.................  T....................  .....................  Removal of hydroceles..   0154    26.8861    $1,459.62       $464.85       $291.92
55060.................  T....................  .....................  Repair of hydrocele....   0183    21.7612    $1,181.39  ............       $236.28
55100.................  T....................  .....................  Drainage of scrotum       0007    11.4943      $624.01  ............       $124.80
                                                                       abscess.
55110.................  T....................  .....................  Explore scrotum........   0183    21.7612    $1,181.39  ............       $236.28
55120.................  T....................  .....................  Removal of scrotum        0183    21.7612    $1,181.39  ............       $236.28
                                                                       lesion.
55150.................  T....................  .....................  Removal of scrotum.....   0183    21.7612    $1,181.39  ............       $236.28
55175.................  T....................  .....................  Revision of scrotum....   0183    21.7612    $1,181.39  ............       $236.28
55180.................  T....................  .....................  Revision of scrotum....   0183    21.7612    $1,181.39  ............       $236.28
55200.................  T....................  .....................  Incision of sperm duct.   0183    21.7612    $1,181.39  ............       $236.28
55250.................  T....................  .....................  Removal of sperm          0183    21.7612    $1,181.39  ............       $236.28
                                                                       duct(s).
55300.................  N....................  .....................  Prepare, sperm duct x-   .....  .........  ...........  ............  ............
                                                                       ray.
55400.................  T....................  .....................  Repair of sperm duct...   0183    21.7612    $1,181.39  ............       $236.28
55450.................  T....................  .....................  Ligation of sperm duct.   0183    21.7612    $1,181.39  ............       $236.28
55500.................  T....................  .....................  Removal of hydrocele...   0183    21.7612    $1,181.39  ............       $236.28
55520.................  T....................  .....................  Removal of sperm cord     0183    21.7612    $1,181.39  ............       $236.28
                                                                       lesion.
55530.................  T....................  .....................  Revise spermatic cord     0183    21.7612    $1,181.39  ............       $236.28
                                                                       veins.
55535.................  T....................  .....................  Revise spermatic cord     0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       veins.
55540.................  T....................  .....................  Revise hernia & sperm     0154    26.8861    $1,459.62       $464.85       $291.92
                                                                       veins.
55550.................  T....................  .....................  Laparo ligate spermatic   0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       vein.
55559.................  T....................  .....................  Laparo proc, spermatic    0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       cord.
55600.................  C....................  .....................  Incise sperm duct pouch  .....  .........  ...........  ............  ............
55605.................  C....................  .....................  Incise sperm duct pouch  .....  .........  ...........  ............  ............
55650.................  C....................  .....................  Remove sperm duct pouch  .....  .........  ...........  ............  ............
55680.................  T....................  .....................  Remove sperm pouch        0183    21.7612    $1,181.39  ............       $236.28
                                                                       lesion.
55700.................  T....................  .....................  Biopsy of prostate.....   0184     3.8073      $206.69        $96.27        $41.34

[[Page 48096]]

 
55705.................  T....................  .....................  Biopsy of prostate.....   0184     3.8073      $206.69        $96.27        $41.34
55720.................  T....................  .....................  Drainage of prostate      0162    21.8578    $1,186.64  ............       $237.33
                                                                       abscess.
55725.................  T....................  .....................  Drainage of prostate      0162    21.8578    $1,186.64  ............       $237.33
                                                                       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,     0163    33.6435    $1,826.47  ............       $365.29
                                                                       pros.
55860.................  T....................  .....................  Surgical exposure,        0165    14.0780      $764.28  ............       $152.86
                                                                       prostate.
55862.................  C....................  .....................  Extensive prostate       .....  .........  ...........  ............  ............
                                                                       surgery.
55865.................  C....................  .....................  Extensive prostate       .....  .........  ...........  ............  ............
                                                                       surgery.
55866.................  C....................  .....................  Laparo radical           .....  .........  ...........  ............  ............
                                                                       prostatectomy.
55870.................  T....................  .....................  Vag hyst w/enterocele     0197     5.1958      $282.07  ............        $56.41
                                                                       repair.
55873.................  T....................  .....................  Cryoablate prostate....   0674   101.1198    $5,489.69  ............     $1,097.94
55899.................  T....................  .....................  Genital surgery           0164     1.2115       $65.77        $17.59        $13.15
                                                                       procedure.
55970.................  E....................  .....................  Sex transformation, M    .....  .........  ...........  ............  ............
                                                                       to F.
55980.................  E....................  .....................  Sex transformation, F    .....  .........  ...........  ............  ............
                                                                       to M.
56405.................  T....................  .....................  I & D of vulva/perineum   0192     2.6966      $146.40        $39.11        $29.28
56420.................  T....................  .....................  Drainage of gland         0192     2.6966      $146.40        $39.11        $29.28
                                                                       abscess.
56440.................  T....................  .....................  Surgery for vulva         0194    18.8194    $1,021.69       $397.84       $204.34
                                                                       lesion.
56441.................  T....................  .....................  Lysis of labial           0193    15.7365      $854.32       $171.13       $170.86
                                                                       lesion(s).
56501.................  T....................  .....................  Destroy, vulva lesions,   0017    16.7332      $908.43       $227.84       $181.69
                                                                       sim.
56515.................  T....................  .....................  Destroy vulva lesion/s    0695    19.1377    $1,038.97       $266.59       $207.79
                                                                       compl.
56605.................  T....................  .....................  Biopsy of vulva/          0019     3.9807      $216.11        $71.87        $43.22
                                                                       perineum.
56606.................  T....................  .....................  Biopsy of vulva/          0019     3.9807      $216.11        $71.87        $43.22
                                                                       perineum.
56620.................  T....................  .....................  Partial removal of        0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       vulva.
56625.................  T....................  .....................  Complete removal of       0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       vulva.
56630.................  C....................  .....................  Extensive vulva surgery  .....  .........  ...........  ............  ............
56631.................  C....................  .....................  Extensive vulva surgery  .....  .........  ...........  ............  ............
56632.................  C....................  .....................  Extensive vulva surgery  .....  .........  ...........  ............  ............
56633.................  C....................  .....................  Extensive vulva surgery  .....  .........  ...........  ............  ............
56634.................  C....................  .....................  Extensive vulva surgery  .....  .........  ...........  ............  ............
56637.................  C....................  .....................  Extensive vulva surgery  .....  .........  ...........  ............  ............
56640.................  C....................  .....................  Extensive vulva surgery  .....  .........  ...........  ............  ............
56700.................  T....................  .....................  Partial removal of        0194    18.8194    $1,021.69       $397.84       $204.34
                                                                       hymen.
56720.................  T....................  .....................  Incision of hymen......   0193    15.7365      $854.32       $171.13       $170.86
56740.................  T....................  .....................  Remove vagina gland       0194    18.8194    $1,021.69       $397.84       $204.34
                                                                       lesion.
56800.................  T....................  .....................  Repair of vagina.......   0194    18.8194    $1,021.69       $397.84       $204.34
56805.................  T....................  .....................  Repair clitoris........   0194    18.8194    $1,021.69       $397.84       $204.34
56810.................  T....................  .....................  Repair of perineum.....   0194    18.8194    $1,021.69       $397.84       $204.34
56820.................  T....................  .....................  Exam of vulva w/scope..   0188     1.1079       $60.15  ............        $12.03
56821.................  T....................  .....................  Exam/biopsy of vulva w/   0189     1.3207       $71.70        $16.70        $14.34
                                                                       scope.
57000.................  T....................  .....................  Exploration of vagina..   0194    18.8194    $1,021.69       $397.84       $204.34
57010.................  T....................  .....................  Drainage of pelvic        0194    18.8194    $1,021.69       $397.84       $204.34
                                                                       abscess.
57020.................  T....................  .....................  Drainage of pelvic        0192     2.6966      $146.40        $39.11        $29.28
                                                                       fluid.
57022.................  T....................  .....................  I & d vaginal hematoma,   0007    11.4943      $624.01  ............       $124.80
                                                                       pp.
57023.................  T....................  .....................  I & d vag hematoma, non-  0007    11.4943      $624.01  ............       $124.80
                                                                       ob.
57061.................  T....................  .....................  Destroy vag lesions,      0194    18.8194    $1,021.69       $397.84       $204.34
                                                                       simple.
57065.................  T....................  .....................  Destroy vag lesions,      0194    18.8194    $1,021.69       $397.84       $204.34
                                                                       complex.
57100.................  T....................  .....................  Biopsy of vagina.......   0192     2.6966      $146.40        $39.11        $29.28
57105.................  T....................  .....................  Biopsy of vagina.......   0194    18.8194    $1,021.69       $397.84       $204.34
57106.................  T....................  .....................  Remove vagina wall,       0194    18.8194    $1,021.69       $397.84       $204.34
                                                                       partial.
57107.................  T....................  .....................  Remove vagina tissue,     0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       part.
57109.................  T....................  .....................  Vaginectomy partial w/    0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       nodes.
57110.................  C....................  .....................  Remove vagina wall,      .....  .........  ...........  ............  ............
                                                                       complete.
57111.................  C....................  .....................  Remove vagina tissue,    .....  .........  ...........  ............  ............
                                                                       compl.
57112.................  C....................  .....................  Vaginectomy w/nodes,     .....  .........  ...........  ............  ............
                                                                       compl.
57120.................  T....................  .....................  Closure of vagina......   0194    18.8194    $1,021.69       $397.84       $204.34
57130.................  T....................  .....................  Remove vagina lesion...   0194    18.8194    $1,021.69       $397.84       $204.34
57135.................  T....................  .....................  Remove vagina lesion...   0194    18.8194    $1,021.69       $397.84       $204.34
57150.................  T....................  .....................  Treat vagina infection.   0191     0.1679        $9.12         $2.65         $1.82

[[Page 48097]]

 
57155.................  T....................  .....................  Insert uteri tandems/     0193    15.7365      $854.32       $171.13       $170.86
                                                                       ovoids.
57160.................  T....................  .....................  Insert pessary/other      0188     1.1079       $60.15  ............        $12.03
                                                                       device.
57170.................  T....................  .....................  Fitting of diaphragm/     0191     0.1679        $9.12         $2.65         $1.82
                                                                       cap.
57180.................  T....................  .....................  Treat vaginal bleeding.   0192     2.6966      $146.40        $39.11        $29.28
57200.................  T....................  .....................  Repair of vagina.......   0194    18.8194    $1,021.69       $397.84       $204.34
57210.................  T....................  .....................  Repair vagina/perineum.   0194    18.8194    $1,021.69       $397.84       $204.34
57220.................  T....................  .....................  Revision of urethra....   0195    25.3207    $1,374.64       $483.80       $274.93
57230.................  T....................  .....................  Repair of urethral        0194    18.8194    $1,021.69       $397.84       $204.34
                                                                       lesion.
57240.................  T....................  .....................  Repair bladder & vagina   0195    25.3207    $1,374.64       $483.80       $274.93
57250.................  T....................  .....................  Repair rectum & vagina.   0195    25.3207    $1,374.64       $483.80       $274.93
57260.................  T....................  .....................  Repair of vagina.......   0195    25.3207    $1,374.64       $483.80       $274.93
57265.................  T....................  .....................  Extensive repair of       0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       vagina.
57268.................  T....................  .....................  Repair of bowel bulge..   0195    25.3207    $1,374.64       $483.80       $274.93
57270.................  C....................  .....................  Repair of bowel pouch..  .....  .........  ...........  ............  ............
57280.................  C....................  .....................  Suspension of vagina...  .....  .........  ...........  ............  ............
57282.................  C....................  .....................  Repair of vaginal        .....  .........  ...........  ............  ............
                                                                       prolapse.
57284.................  T....................  .....................  Repair paravaginal        0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       defect.
57287.................  T....................  .....................  Revise/remove sling       0202    38.8053    $2,106.70     $1,032.28       $421.34
                                                                       repair.
57288.................  T....................  .....................  Repair bladder defect..   0202    38.8053    $2,106.70     $1,032.28       $421.34
57289.................  T....................  .....................  Repair bladder & vagina   0195    25.3207    $1,374.64       $483.80       $274.93
57291.................  T....................  .....................  Construction of vagina.   0195    25.3207    $1,374.64       $483.80       $274.93
57292.................  C....................  .....................  Construct vagina with    .....  .........  ...........  ............  ............
                                                                       graft.
57300.................  T....................  .....................  Repair rectum-vagina      0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       fistula.
57305.................  C....................  .....................  Repair rectum-vagina     .....  .........  ...........  ............  ............
                                                                       fistula.
57307.................  C....................  .....................  Fistula repair &         .....  .........  ...........  ............  ............
                                                                       colostomy.
57308.................  C....................  .....................  Fistula repair,          .....  .........  ...........  ............  ............
                                                                       transperine.
57310.................  T....................  .....................  Repair urethrovaginal     0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       lesion.
57311.................  C....................  .....................  Repair urethrovaginal    .....  .........  ...........  ............  ............
                                                                       lesion.
57320.................  T....................  .....................  Repair bladder-vagina     0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       lesion.
57330.................  T....................  .....................  Repair bladder-vagina     0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       lesion.
57335.................  C....................  .....................  Repair vagina..........  .....  .........  ...........  ............  ............
57400.................  T....................  .....................  Dilation of vagina.....   0194    18.8194    $1,021.69       $397.84       $204.34
57410.................  T....................  .....................  Pelvic examination.....   0194    18.8194    $1,021.69       $397.84       $204.34
57415.................  T....................  .....................  Remove vaginal foreign    0194    18.8194    $1,021.69       $397.84       $204.34
                                                                       body.
57420.................  T....................  .....................  Exam of vagina w/scope.   0192     2.6966      $146.40        $39.11        $29.28
57421.................  T....................  .....................  Exam/biopsy of vag w/     0192     2.6966      $146.40        $39.11        $29.28
                                                                       scope.
57452.................  T....................  .....................  Examination of vagina..   0189     1.3207       $71.70        $16.70        $14.34
57454.................  T....................  .....................  Vagina examination &      0192     2.6966      $146.40        $39.11        $29.28
                                                                       biopsy.
57455.................  T....................  .....................  Biopsy of cervix w/       0192     2.6966      $146.40        $39.11        $29.28
                                                                       scope.
57456.................  T....................  .....................  Endocerv curettage w/     0192     2.6966      $146.40        $39.11        $29.28
                                                                       scope.
57460.................  T....................  .....................  Cervix excision........   0193    15.7365      $854.32       $171.13       $170.86
57461.................  T....................  .....................  Conz of cervix w/scope,   0194    18.8194    $1,021.69       $397.84       $204.34
                                                                       leep.
57500.................  T....................  .....................  Biopsy of cervix.......   0192     2.6966      $146.40        $39.11        $29.28
57505.................  T....................  .....................  Endocervical curettage.   0192     2.6966      $146.40        $39.11        $29.28
57510.................  T....................  .....................  Cauterization of cervix   0193    15.7365      $854.32       $171.13       $170.86
57511.................  T....................  .....................  Cryocautery of cervix..   0189     1.3207       $71.70        $16.70        $14.34
57513.................  T....................  .....................  Laser surgery of cervix   0193    15.7365      $854.32       $171.13       $170.86
57520.................  T....................  .....................  Conization of cervix...   0194    18.8194    $1,021.69       $397.84       $204.34
57522.................  T....................  .....................  Conization of cervix...   0195    25.3207    $1,374.64       $483.80       $274.93
57530.................  T....................  .....................  Removal of cervix......   0195    25.3207    $1,374.64       $483.80       $274.93
57531.................  C....................  .....................  Removal of cervix,       .....  .........  ...........  ............  ............
                                                                       radical.
57540.................  C....................  .....................  Removal of residual      .....  .........  ...........  ............  ............
                                                                       cervix.
57545.................  C....................  .....................  Remove cervix/repair     .....  .........  ...........  ............  ............
                                                                       pelvis.
57550.................  T....................  .....................  Removal of residual       0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       cervix.
57555.................  T....................  .....................  Remove cervix/repair      0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       vagina.
57556.................  T....................  .....................  Remove cervix, repair     0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       bowel.
57700.................  T....................  .....................  Revision of cervix.....   0194    18.8194    $1,021.69       $397.84       $204.34
57720.................  T....................  .....................  Revision of cervix.....   0194    18.8194    $1,021.69       $397.84       $204.34
57800.................  T....................  .....................  Dilation of cervical      0193    15.7365      $854.32       $171.13       $170.86
                                                                       canal.
57820.................  T....................  .....................  D & c of residual         0196    16.1823      $878.52       $338.23       $175.70
                                                                       cervix.
58100.................  T....................  .....................  Biopsy of uterus lining   0188     1.1079       $60.15  ............        $12.03
58120.................  T....................  .....................  Dilation and curettage.   0196    16.1823      $878.52       $338.23       $175.70
58140.................  C....................  .....................  Removal of uterus        .....  .........  ...........  ............  ............
                                                                       lesion.
58145.................  T....................  .....................  Myomectomy vag method..   0195    25.3207    $1,374.64       $483.80       $274.93
58146.................  C....................  .....................  Myomectomy abdom         .....  .........  ...........  ............  ............
                                                                       complex.
58150.................  C....................  .....................  Total hysterectomy.....  .....  .........  ...........  ............  ............

[[Page 48098]]

 
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....................  .....................  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.
58300.................  E....................  .....................  Insert intrauterine      .....  .........  ...........  ............  ............
                                                                       device.
58301.................  T....................  .....................  Remove intrauterine       0189     1.3207       $71.70        $16.70        $14.34
                                                                       device.
58321.................  T....................  .....................  Artificial insemination   0197     5.1958      $282.07  ............        $56.41
58322.................  T....................  .....................  Artificial insemination   0197     5.1958      $282.07  ............        $56.41
58323.................  T....................  .....................  Sperm washing..........   0197     5.1958      $282.07  ............        $56.41
58340.................  N....................  .....................  Catheter for             .....  .........  ...........  ............  ............
                                                                       hysterography.
58345.................  T....................  .....................  Reopen fallopian tube..   0194    18.8194    $1,021.69       $397.84       $204.34
58346.................  T....................  .....................  Insert heyman uteri       0193    15.7365      $854.32       $171.13       $170.86
                                                                       capsule.
58350.................  T....................  .....................  Reopen fallopian tube..   0194    18.8194    $1,021.69       $397.84       $204.34
58353.................  T....................  .....................  Endometr ablate,          0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       thermal.
58400.................  C....................  .....................  Suspension of uterus...  .....  .........  ...........  ............  ............
58410.................  C....................  .....................  Suspension of uterus...  .....  .........  ...........  ............  ............
58520.................  C....................  .....................  Repair of ruptured       .....  .........  ...........  ............  ............
                                                                       uterus.
58540.................  C....................  .....................  Revision of uterus.....  .....  .........  ...........  ............  ............
58545.................  T....................  .....................  Laparoscopic myomectomy   0130    32.5959    $1,769.60       $659.53       $353.92
58546.................  T....................  .....................  Laparo-myomectomy,        0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       complex.
58550.................  T....................  .....................  Laparo-asst vag           0132    56.6318    $3,074.48     $1,239.22       $614.90
                                                                       hysterectomy.
58552.................  T....................  .....................  Laparo-vag hyst incl t/   0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       o.
58553.................  T....................  .....................  Laparo-vag hyst,          0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       complex.
58554.................  T....................  .....................  Laparo-vag hyst w/t/o,    0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       compl.
58555.................  T....................  .....................  Hysteroscopy, dx, sep     0190    19.8088    $1,075.40       $424.28       $215.08
                                                                       proc.
58558.................  T....................  .....................  Hysteroscopy, biopsy...   0190    19.8088    $1,075.40       $424.28       $215.08
58559.................  T....................  .....................  Hysteroscopy, lysis....   0190    19.8088    $1,075.40       $424.28       $215.08
58560.................  T....................  .....................  Hysteroscopy, resect      0387    28.5174    $1,548.18       $660.84       $309.64
                                                                       septum.
58561.................  T....................  .....................  Hysteroscopy, remove      0387    28.5174    $1,548.18       $660.84       $309.64
                                                                       myoma.
58562.................  T....................  .....................  Hysteroscopy, remove fb   0190    19.8088    $1,075.40       $424.28       $215.08
58563.................  T....................  .....................  Hysteroscopy, ablation.   0387    28.5174    $1,548.18       $660.84       $309.64
58578.................  T....................  .....................  Laparo proc, uterus....   0130    32.5959    $1,769.60       $659.53       $353.92
58579.................  T....................  .....................  Hysteroscope procedure.   0190    19.8088    $1,075.40       $424.28       $215.08
58600.................  T....................  .....................  Division of fallopian     0194    18.8194    $1,021.69       $397.84       $204.34
                                                                       tube.
58605.................  C....................  .....................  Division of fallopian    .....  .........  ...........  ............  ............
                                                                       tube.
58611.................  C....................  .....................  Ligate oviduct(s) add-   .....  .........  ...........  ............  ............
                                                                       on.
58615.................  T....................  .....................  Occlude fallopian         0194    18.8194    $1,021.69       $397.84       $204.34
                                                                       tube(s).
58660.................  T....................  .....................  Laparoscopy, lysis.....   0131    40.8955    $2,220.18     $1,001.89       $444.04
58661.................  T....................  .....................  Laparoscopy, remove       0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       adnexa.
58662.................  T....................  .....................  Laparoscopy, excise       0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       lesions.
58670.................  T....................  .....................  Laparoscopy, tubal        0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       cautery.
58671.................  T....................  .....................  Laparoscopy, tubal        0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       block.
58672.................  T....................  .....................  Laparoscopy,              0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       fimbrioplasty.
58673.................  T....................  .....................  Laparoscopy,              0131    40.8955    $2,220.18     $1,001.89       $444.04
                                                                       salpingostomy.
58679.................  T....................  .....................  Laparo proc, oviduct-     0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       ovary.
58700.................  C....................  .....................  Removal of fallopian     .....  .........  ...........  ............  ............
                                                                       tube.
58720.................  C....................  .....................  Removal of ovary/        .....  .........  ...........  ............  ............
                                                                       tube(s).
58740.................  C....................  .....................  Revise fallopian         .....  .........  ...........  ............  ............
                                                                       tube(s).
58750.................  C....................  .....................  Repair oviduct.........  .....  .........  ...........  ............  ............
58752.................  C....................  .....................  Revise ovarian tube(s).  .....  .........  ...........  ............  ............
58760.................  C....................  .....................  Remove tubal             .....  .........  ...........  ............  ............
                                                                       obstruction.
58770.................  C....................  .....................  Create new tubal         .....  .........  ...........  ............  ............
                                                                       opening.

[[Page 48099]]

 
58800.................  T....................  .....................  Drainage of ovarian       0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       cyst(s).
58805.................  C....................  .....................  Drainage of ovarian      .....  .........  ...........  ............  ............
                                                                       cyst(s).
58820.................  T....................  .....................  Drain ovary abscess,      0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       open.
58822.................  C....................  .....................  Drain ovary abscess,     .....  .........  ...........  ............  ............
                                                                       percut.
58823.................  T....................  .....................  Drain pelvic abscess,     0193    15.7365      $854.32       $171.13       $170.86
                                                                       percut.
58825.................  C....................  .....................  Transposition, ovary(s)  .....  .........  ...........  ............  ............
58900.................  T....................  .....................  Biopsy of ovary(s).....   0195    25.3207    $1,374.64       $483.80       $274.93
58920.................  T....................  .....................  Partial removal of        0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       ovary(s).
58925.................  T....................  .....................  Removal of ovarian        0195    25.3207    $1,374.64       $483.80       $274.93
                                                                       cyst(s).
58940.................  C....................  .....................  Removal of ovary(s)....  .....  .........  ...........  ............  ............
58943.................  C....................  .....................  Removal of ovary(s)....  .....  .........  ...........  ............  ............
58950.................  C....................  .....................  Resect ovarian           .....  .........  ...........  ............  ............
                                                                       malignancy.
58951.................  C....................  .....................  Resect ovarian           .....  .........  ...........  ............  ............
                                                                       malignancy.
58952.................  C....................  .....................  Resect ovarian           .....  .........  ...........  ............  ............
                                                                       malignancy.
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    18.8194    $1,021.69       $397.84       $204.34
58974.................  T....................  .....................  Transfer of embryo.....   0197     5.1958      $282.07  ............        $56.41
58976.................  T....................  .....................  Transfer of embryo.....   0197     5.1958      $282.07  ............        $56.41
58999.................  T....................  .....................  Genital surgery           0191     0.1679        $9.12         $2.65         $1.82
                                                                       procedure.
59000.................  T....................  .....................  Amniocentesis,            0198     1.3718       $74.47        $32.19        $14.89
                                                                       diagnostic.
59001.................  T....................  .....................  Amniocentesis,            0198     1.3718       $74.47        $32.19        $14.89
                                                                       therapeutic.
59012.................  T....................  .....................  Fetal cord                0198     1.3718       $74.47        $32.19        $14.89
                                                                       puncture,prenatal.
59015.................  T....................  .....................  Chorion biopsy.........   0198     1.3718       $74.47        $32.19        $14.89
59020.................  T....................  .....................  Fetal contract stress     0198     1.3718       $74.47        $32.19        $14.89
                                                                       test.
59025.................  T....................  .....................  Fetal non-stress test..   0198     1.3718       $74.47        $32.19        $14.89
59030.................  T....................  .....................  Fetal scalp blood         0198     1.3718       $74.47        $32.19        $14.89
                                                                       sample.
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    40.8955    $2,220.18     $1,001.89       $444.04
59151.................  T....................  .....................  Treat ectopic pregnancy   0131    40.8955    $2,220.18     $1,001.89       $444.04
59160.................  T....................  .....................  D & c after delivery...   0196    16.1823      $878.52       $338.23       $175.70
59200.................  T....................  .....................  Insert cervical dilator   0189     1.3207       $71.70        $16.70        $14.34
59300.................  T....................  .....................  Episiotomy or vaginal     0193    15.7365      $854.32       $171.13       $170.86
                                                                       repair.
59320.................  T....................  .....................  Revision of cervix.....   0194    18.8194    $1,021.69       $397.84       $204.34
59325.................  C....................  .....................  Revision of cervix.....  .....  .........  ...........  ............  ............
59350.................  C....................  .....................  Repair of uterus.......  .....  .........  ...........  ............  ............
59400.................  E....................  .....................  Obstetrical care.......  .....  .........  ...........  ............  ............
59409.................  T....................  .....................  Obstetrical care.......   0199    16.8630      $915.48  ............       $183.10
59410.................  E....................  .....................  Obstetrical care.......  .....  .........  ...........  ............  ............
59412.................  T....................  .....................  Antepartum manipulation   0700     2.4359      $132.24        $37.03        $26.45
59414.................  T....................  .....................  Deliver placenta.......   0199    16.8630      $915.48  ............       $183.10
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    16.8630      $915.48  ............       $183.10
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              0201    17.2803      $938.13       $329.65       $187.63
                                                                       miscarriage.
59820.................  T....................  .....................  Care of miscarriage....   0201    17.2803      $938.13       $329.65       $187.63
59821.................  T....................  .....................  Treatment of              0201    17.2803      $938.13       $329.65       $187.63
                                                                       miscarriage.

[[Page 48100]]

 
59830.................  C....................  .....................  Treat uterus infection.  .....  .........  ...........  ............  ............
59840.................  T....................  .....................  Abortion...............   0200    18.3633      $996.93       $307.83       $199.39
59841.................  T....................  .....................  Abortion...............   0200    18.3633      $996.93       $307.83       $199.39
59850.................  C....................  .....................  Abortion...............  .....  .........  ...........  ............  ............
59851.................  C....................  .....................  Abortion...............  .....  .........  ...........  ............  ............
59852.................  C....................  .....................  Abortion...............  .....  .........  ...........  ............  ............
59855.................  C....................  .....................  Abortion...............  .....  .........  ...........  ............  ............
59856.................  C....................  .....................  Abortion...............  .....  .........  ...........  ............  ............
59857.................  C....................  .....................  Abortion...............  .....  .........  ...........  ............  ............
59866.................  T....................  .....................  Abortion (mpr).........   0198     1.3718       $74.47        $32.19        $14.89
59870.................  T....................  .....................  Evacuate mole of uterus   0201    17.2803      $938.13       $329.65       $187.63
59871.................  T....................  .....................  Remove cerclage suture.   0194    18.8194    $1,021.69       $397.84       $204.34
59898.................  T....................  .....................  Laparo proc, ob care/     0130    32.5959    $1,769.60       $659.53       $353.92
                                                                       deliver.
59899.................  T....................  .....................  Maternity care            0198     1.3718       $74.47        $32.19        $14.89
                                                                       procedure.
60000.................  T....................  .....................  Drain thyroid/tongue      0252     6.5416      $355.14       $113.41        $71.03
                                                                       cyst.
60001.................  T....................  .....................  Aspirate/inject thyriod   0004     1.5774       $85.64        $22.10        $17.13
                                                                       cyst.
60100.................  T....................  .....................  Biopsy of thyroid......   0004     1.5774       $85.64        $22.10        $17.13
60200.................  T....................  .....................  Remove thyroid lesion..   0114    37.3583    $2,028.14       $485.91       $405.63
60210.................  T....................  .....................  Partial thyroid           0114    37.3583    $2,028.14       $485.91       $405.63
                                                                       excision.
60212.................  T....................  .....................  Partial thyroid           0114    37.3583    $2,028.14       $485.91       $405.63
                                                                       excision.
60220.................  T....................  .....................  Partial removal of        0114    37.3583    $2,028.14       $485.91       $405.63
                                                                       thyroid.
60225.................  T....................  .....................  Partial removal of        0114    37.3583    $2,028.14       $485.91       $405.63
                                                                       thyroid.
60240.................  T....................  .....................  Removal of thyroid.....   0114    37.3583    $2,028.14       $485.91       $405.63
60252.................  T....................  .....................  Removal of thyroid.....   0256    35.0866    $1,904.82  ............       $380.96
60254.................  C....................  .....................  Extensive thyroid        .....  .........  ...........  ............  ............
                                                                       surgery.
60260.................  T....................  .....................  Repeat thyroid surgery.   0256    35.0866    $1,904.82  ............       $380.96
60270.................  C....................  .....................  Removal of thyroid.....  .....  .........  ...........  ............  ............
60271.................  C....................  .....................  Removal of thyroid.....  .....  .........  ...........  ............  ............
60280.................  T....................  .....................  Remove thyroid duct       0114    37.3583    $2,028.14       $485.91       $405.63
                                                                       lesion.
60281.................  T....................  .....................  Remove thyroid duct       0114    37.3583    $2,028.14       $485.91       $405.63
                                                                       lesion.
60500.................  T....................  .....................  Explore parathyroid       0256    35.0866    $1,904.82  ............       $380.96
                                                                       glands.
60502.................  C....................  .....................  Re-explore parathyroids  .....  .........  ...........  ............  ............
60505.................  C....................  .....................  Explore parathyroid      .....  .........  ...........  ............  ............
                                                                       glands.
60512.................  T....................  .....................  Autotransplant            0022    18.6725    $1,013.71       $354.45       $202.74
                                                                       parathyroid.
60520.................  C....................  .....................  Removal of thymus gland  .....  .........  ...........  ............  ............
60521.................  C....................  .....................  Removal of thymus gland  .....  .........  ...........  ............  ............
60522.................  C....................  .....................  Removal of thymus gland  .....  .........  ...........  ............  ............
60540.................  C....................  .....................  Explore adrenal gland..  .....  .........  ...........  ............  ............
60545.................  C....................  .....................  Explore adrenal gland..  .....  .........  ...........  ............  ............
60600.................  C....................  .....................  Remove carotid body      .....  .........  ...........  ............  ............
                                                                       lesion.
60605.................  C....................  .....................  Remove carotid body      .....  .........  ...........  ............  ............
                                                                       lesion.
60650.................  C....................  .....................  Laparoscopy              .....  .........  ...........  ............  ............
                                                                       adrenalectomy.
60659.................  T....................  .....................  Laparo proc, endocrine.   0130    32.5959    $1,769.60       $659.53       $353.92
60699.................  T....................  .....................  Endocrine surgery         0114    37.3583    $2,028.14       $485.91       $405.63
                                                                       procedure.
61000.................  T....................  .....................  Remove cranial cavity     0212     2.9989      $162.81        $74.92        $32.56
                                                                       fluid.
61001.................  T....................  .....................  Remove cranial cavity     0212     2.9989      $162.81        $74.92        $32.56
                                                                       fluid.
61020.................  T....................  .....................  Remove brain cavity       0212     2.9989      $162.81        $74.92        $32.56
                                                                       fluid.
61026.................  T....................  .....................  Injection into brain      0212     2.9989      $162.81        $74.92        $32.56
                                                                       canal.
61050.................  T....................  .....................  Remove brain canal        0212     2.9989      $162.81        $74.92        $32.56
                                                                       fluid.
61055.................  T....................  .....................  Injection into brain      0212     2.9989      $162.81        $74.92        $32.56
                                                                       canal.
61070.................  T....................  .....................  Brain canal shunt         0212     2.9989      $162.81        $74.92        $32.56
                                                                       procedure.
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        0224    34.0161    $1,846.70       $453.41       $369.34
                                                                       device.
61250.................  C....................  .....................  Pierce skull & explore.  .....  .........  ...........  ............  ............
61253.................  C....................  .....................  Pierce skull & explore.  .....  .........  ...........  ............  ............
61304.................  C....................  .....................  Open skull for           .....  .........  ...........  ............  ............
                                                                       exploration.
61305.................  C....................  .....................  Open skull for           .....  .........  ...........  ............  ............
                                                                       exploration.

[[Page 48101]]

 
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....................  .....................  Implt cran bone flap to  .....  .........  ...........  ............  ............
                                                                       abdo.
61320.................  C....................  .....................  Open skull for drainage  .....  .........  ...........  ............  ............
61321.................  C....................  .....................  Open skull for drainage  .....  .........  ...........  ............  ............
61322.................  C....................  .....................  Decompressive            .....  .........  ...........  ............  ............
                                                                       craniotomy.
61323.................  C....................  .....................  Decompressive lobectomy  .....  .........  ...........  ............  ............
61330.................  T....................  .....................  Decompress eye socket..   0256    35.0866    $1,904.82  ............       $380.96
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  .....  .........  ...........  ............  ............
61517.................  N....................  .....................  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.

[[Page 48102]]

 
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............  .....  .........  ...........  ............  ............
61623.................  T....................  .....................  Endovasc tempory vessel   1555  .........    $1,650.00  ............       $330.00
                                                                       occl.
61624.................  C....................  .....................  Occlusion/embolization   .....  .........  ...........  ............  ............
                                                                       cath.
61626.................  T....................  .....................  Transcath occlusion,      0081    34.8355    $1,891.18  ............       $378.24
                                                                       non-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    16.5293      $897.36  ............       $179.47
61791.................  T....................  .....................  Treat trigeminal tract.   0204     2.2209      $120.57        $40.13        $24.11
61793.................  E....................  .....................  Focus radiation beam...  .....  .........  ...........  ............  ............
61795.................  S....................  .....................  Brain surgery using       0302     6.1992      $336.55       $127.49        $67.31
                                                                       computer.
61850.................  C....................  .....................  Implant neuroelectrodes  .....  .........  ...........  ............  ............
61860.................  C....................  .....................  Implant neuroelectrodes  .....  .........  ...........  ............  ............
61862.................  C....................  .....................  Implant neurostimul,     .....  .........  ...........  ............  ............
                                                                       subcort.
61870.................  C....................  .....................  Implant neuroelectrodes  .....  .........  ...........  ............  ............
61875.................  C....................  .....................  Implant neuroelectrodes  .....  .........  ...........  ............  ............
61880.................  T....................  .....................  Revise/remove             0687    19.9913    $1,085.31       $499.24       $217.06
                                                                       neuroelectrode.
61885.................  T....................  .....................  Implant neurostim one     0222   188.7735   $10,248.32  ............     $2,049.66
                                                                       array.
61886.................  T....................  .....................  Implant neurostim         0222   188.7735   $10,248.32  ............     $2,049.66
                                                                       arrays.
61888.................  T....................  .....................  Revise/remove             0688    42.5880    $2,312.06     $1,132.91       $462.41
                                                                       neuroreceiver.
62000.................  C....................  .....................  Treat skull fracture...  .....  .........  ...........  ............  ............
62005.................  C....................  .....................  Treat skull fracture...  .....  .........  ...........  ............  ............

[[Page 48103]]

 
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....................  .....................  Retr bone flap to fix    .....  .........  ...........  ............  ............
                                                                       skull.
62160.................  N....................  .....................  Neuroendoscopy add-on..  .....  .........  ...........  ............  ............
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.
62194.................  T....................  .....................  Replace/irrigate          0121     2.2058      $119.75        $43.80        $23.95
                                                                       catheter.
62200.................  C....................  .....................  Establish brain cavity   .....  .........  ...........  ............  ............
                                                                       shunt.
62201.................  C....................  .....................  Establish brain cavity   .....  .........  ...........  ............  ............
                                                                       shunt.
62220.................  C....................  .....................  Establish brain cavity   .....  .........  ...........  ............  ............
                                                                       shunt.
62223.................  C....................  .....................  Establish brain cavity   .....  .........  ...........  ............  ............
                                                                       shunt.
62225.................  T....................  .....................  Replace/irrigate          0122     8.4398      $458.19        $93.97        $91.64
                                                                       catheter.
62230.................  T....................  .....................  Replace/revise brain      0224    34.0161    $1,846.70       $453.41       $369.34
                                                                       shunt.
62252.................  S....................  .....................  Csf shunt reprogram....   0691     2.9894      $162.29        $81.14        $32.46
62256.................  C....................  .....................  Remove brain cavity      .....  .........  ...........  ............  ............
                                                                       shunt.
62258.................  C....................  .....................  Replace brain cavity     .....  .........  ...........  ............  ............
                                                                       shunt.
62263.................  T....................  .....................  Lysis epidural            0203    11.8511      $643.38       $276.76       $128.68
                                                                       adhesions.
62264.................  T....................  .....................  Epidural lysis on         0203    11.8511      $643.38       $276.76       $128.68
                                                                       single day.
62268.................  T....................  .....................  Drain spinal cord cyst.   0212     2.9989      $162.81        $74.92        $32.56
62269.................  T....................  .....................  Needle biopsy, spinal     0005     3.3675      $182.82        $71.59        $36.56
                                                                       cord.
62270.................  T....................  .....................  Spinal fluid tap,         0206     5.2584      $285.47        $75.55        $57.09
                                                                       diagnostic.
62272.................  T....................  .....................  Drain cerebro spinal      0206     5.2584      $285.47        $75.55        $57.09
                                                                       fluid.
62273.................  T....................  .....................  Treat epidural spine      0206     5.2584      $285.47        $75.55        $57.09
                                                                       lesion.
62280.................  T....................  .....................  Treat spinal cord         0207     6.5998      $358.30       $123.69        $71.66
                                                                       lesion.
62281.................  T....................  .....................  Treat spinal cord         0207     6.5998      $358.30       $123.69        $71.66
                                                                       lesion.
62282.................  T....................  .....................  Treat spinal canal        0207     6.5998      $358.30       $123.69        $71.66
                                                                       lesion.
62284.................  N....................  .....................  Injection for myelogram  .....  .........  ...........  ............  ............
62287.................  T....................  .....................  Percutaneous diskectomy   0220    16.5293      $897.36  ............       $179.47
62290.................  N....................  .....................  Inject for spine disk x- .....  .........  ...........  ............  ............
                                                                       ray.
62291.................  N....................  .....................  Inject for spine disk x- .....  .........  ...........  ............  ............
                                                                       ray.
62292.................  T....................  .....................  Injection into disk       0212     2.9989      $162.81        $74.92        $32.56
                                                                       lesion.
62294.................  T....................  .....................  Injection into spinal     0212     2.9989      $162.81        $74.92        $32.56
                                                                       artery.
62310.................  T....................  .....................  Inject spine c/t.......   0206     5.2584      $285.47        $75.55        $57.09
62311.................  T....................  .....................  Inject spine l/s (cd)..   0206     5.2584      $285.47        $75.55        $57.09
62318.................  T....................  .....................  Inject spine w/cath, c/   0206     5.2584      $285.47        $75.55        $57.09
                                                                       t.
62319.................  T....................  .....................  Inject spine w/cath l/s   0206     5.2584      $285.47        $75.55        $57.09
                                                                       (cd).
62350.................  T....................  .....................  Implant spinal canal      0223    26.0352    $1,413.42  ............       $282.68
                                                                       cath.
62351.................  T....................  .....................  Implant spinal canal      0208    40.6521    $2,206.96  ............       $441.39
                                                                       cath.
62355.................  T....................  .....................  Remove spinal canal       0203    11.8511      $643.38       $276.76       $128.68
                                                                       catheter.
62360.................  T....................  .....................  Insert spine infusion     0226   159.6795    $8,668.84  ............     $1,733.77
                                                                       device.
62361.................  T....................  .....................  Implant spine infusion    0227   163.6124    $8,882.35  ............     $1,776.47
                                                                       pump.
62362.................  T....................  .....................  Implant spine infusion    0227   163.6124    $8,882.35  ............     $1,776.47
                                                                       pump.
62365.................  T....................  .....................  Remove spine infusion     0203    11.8511      $643.38       $276.76       $128.68
                                                                       device.
62367.................  S....................  .....................  Analyze spine infusion    0691     2.9894      $162.29        $81.14        $32.46
                                                                       pump.
62368.................  S....................  .....................  Analyze spine infusion    0691     2.9894      $162.29        $81.14        $32.46
                                                                       pump.
63001.................  T....................  .....................  Removal of spinal         0208    40.6521    $2,206.96  ............       $441.39
                                                                       lamina.
63003.................  T....................  .....................  Removal of spinal         0208    40.6521    $2,206.96  ............       $441.39
                                                                       lamina.
63005.................  T....................  .....................  Removal of spinal         0208    40.6521    $2,206.96  ............       $441.39
                                                                       lamina.

[[Page 48104]]

 
63011.................  T....................  .....................  Removal of spinal         0208    40.6521    $2,206.96  ............       $441.39
                                                                       lamina.
63012.................  T....................  .....................  Removal of spinal         0208    40.6521    $2,206.96  ............       $441.39
                                                                       lamina.
63015.................  T....................  .....................  Removal of spinal         0208    40.6521    $2,206.96  ............       $441.39
                                                                       lamina.
63016.................  T....................  .....................  Removal of spinal         0208    40.6521    $2,206.96  ............       $441.39
                                                                       lamina.
63017.................  T....................  .....................  Removal of spinal         0208    40.6521    $2,206.96  ............       $441.39
                                                                       lamina.
63020.................  T....................  .....................  Neck spine disk surgery   0208    40.6521    $2,206.96  ............       $441.39
63030.................  T....................  .....................  Low back disk surgery..   0208    40.6521    $2,206.96  ............       $441.39
63035.................  T....................  .....................  Spinal disk surgery add-  0208    40.6521    $2,206.96  ............       $441.39
                                                                       on.
63040.................  T....................  .....................  Laminotomy, single        0208    40.6521    $2,206.96  ............       $441.39
                                                                       cervical.
63042.................  T....................  .....................  Laminotomy, single        0208    40.6521    $2,206.96  ............       $441.39
                                                                       lumbar.
63043.................  C....................  .....................  Laminotomy, addl         .....  .........  ...........  ............  ............
                                                                       cervical.
63044.................  C....................  .....................  Laminotomy, addl lumbar  .....  .........  ...........  ............  ............
63045.................  T....................  .....................  Removal of spinal         0208    40.6521    $2,206.96  ............       $441.39
                                                                       lamina.
63046.................  T....................  .....................  Removal of spinal         0208    40.6521    $2,206.96  ............       $441.39
                                                                       lamina.
63047.................  T....................  .....................  Removal of spinal         0208    40.6521    $2,206.96  ............       $441.39
                                                                       lamina.
63048.................  T....................  .....................  Remove spinal lamina      0208    40.6521    $2,206.96  ............       $441.39
                                                                       add-on.
63055.................  T....................  .....................  Decompress spinal cord.   0208    40.6521    $2,206.96  ............       $441.39
63056.................  T....................  .....................  Decompress spinal cord.   0208    40.6521    $2,206.96  ............       $441.39
63057.................  T....................  .....................  Decompress spine cord     0208    40.6521    $2,206.96  ............       $441.39
                                                                       add-on.
63064.................  T....................  .....................  Decompress spinal cord.   0208    40.6521    $2,206.96  ............       $441.39
63066.................  T....................  .....................  Decompress spine cord     0208    40.6521    $2,206.96  ............       $441.39
                                                                       add-on.
63075.................  C....................  .....................  Neck spine disk surgery  .....  .........  ...........  ............  ............
63076.................  C....................  .....................  Neck spine disk surgery  .....  .........  ...........  ............  ............
63077.................  C....................  .....................  Spine disk surgery,      .....  .........  ...........  ............  ............
                                                                       thorax.
63078.................  C....................  .....................  Spine disk surgery,      .....  .........  ...........  ............  ............
                                                                       thorax.
63081.................  C....................  .....................  Removal of vertebral     .....  .........  ...........  ............  ............
                                                                       body.
63082.................  C....................  .....................  Remove vertebral body    .....  .........  ...........  ............  ............
                                                                       add-on.
63085.................  C....................  .....................  Removal of vertebral     .....  .........  ...........  ............  ............
                                                                       body.
63086.................  C....................  .....................  Remove vertebral body    .....  .........  ...........  ............  ............
                                                                       add-on.
63087.................  C....................  .....................  Removal of vertebral     .....  .........  ...........  ............  ............
                                                                       body.
63088.................  C....................  .....................  Remove vertebral body    .....  .........  ...........  ............  ............
                                                                       add-on.
63090.................  C....................  .....................  Removal of vertebral     .....  .........  ...........  ............  ............
                                                                       body.
63091.................  C....................  .....................  Remove vertebral body    .....  .........  ...........  ............  ............
                                                                       add-on.
63170.................  C....................  .....................  Incise spinal cord       .....  .........  ...........  ............  ............
                                                                       tract(s).
63172.................  C....................  .....................  Drainage of spinal cyst  .....  .........  ...........  ............  ............
63173.................  C....................  .....................  Drainage of spinal cyst  .....  .........  ...........  ............  ............
63180.................  C....................  .....................  Revise spinal cord       .....  .........  ...........  ............  ............
                                                                       ligaments.
63182.................  C....................  .....................  Revise spinal cord       .....  .........  ...........  ............  ............
                                                                       ligaments.
63185.................  C....................  .....................  Incise spinal column/    .....  .........  ...........  ............  ............
                                                                       nerves.
63190.................  C....................  .....................  Incise spinal column/    .....  .........  ...........  ............  ............
                                                                       nerves.
63191.................  C....................  .....................  Incise spinal column/    .....  .........  ...........  ............  ............
                                                                       nerves.
63194.................  C....................  .....................  Incise spinal column &   .....  .........  ...........  ............  ............
                                                                       cord.
63195.................  C....................  .....................  Incise spinal column &   .....  .........  ...........  ............  ............
                                                                       cord.
63196.................  C....................  .....................  Incise spinal column &   .....  .........  ...........  ............  ............
                                                                       cord.
63197.................  C....................  .....................  Incise spinal column &   .....  .........  ...........  ............  ............
                                                                       cord.
63198.................  C....................  .....................  Incise spinal column &   .....  .........  ...........  ............  ............
                                                                       cord.
63199.................  C....................  .....................  Incise spinal column &   .....  .........  ...........  ............  ............
                                                                       cord.
63200.................  C....................  .....................  Release of spinal cord.  .....  .........  ...........  ............  ............
63250.................  C....................  .....................  Revise spinal cord       .....  .........  ...........  ............  ............
                                                                       vessels.
63251.................  C....................  .....................  Revise spinal cord       .....  .........  ...........  ............  ............
                                                                       vessels.
63252.................  C....................  .....................  Revise spinal cord       .....  .........  ...........  ............  ............
                                                                       vessels.
63265.................  C....................  .....................  Excise intraspinal       .....  .........  ...........  ............  ............
                                                                       lesion.
63266.................  C....................  .....................  Excise intraspinal       .....  .........  ...........  ............  ............
                                                                       lesion.
63267.................  C....................  .....................  Excise intraspinal       .....  .........  ...........  ............  ............
                                                                       lesion.
63268.................  C....................  .....................  Excise intraspinal       .....  .........  ...........  ............  ............
                                                                       lesion.
63270.................  C....................  .....................  Excise intraspinal       .....  .........  ...........  ............  ............
                                                                       lesion.
63271.................  C....................  .....................  Excise intraspinal       .....  .........  ...........  ............  ............
                                                                       lesion.
63272.................  C....................  .....................  Excise intraspinal       .....  .........  ...........  ............  ............
                                                                       lesion.
63273.................  C....................  .....................  Excise intraspinal       .....  .........  ...........  ............  ............
                                                                       lesion.
63275.................  C....................  .....................  Biopsy/excise spinal     .....  .........  ...........  ............  ............
                                                                       tumor.
63276.................  C....................  .....................  Biopsy/excise spinal     .....  .........  ...........  ............  ............
                                                                       tumor.
63277.................  C....................  .....................  Biopsy/excise spinal     .....  .........  ...........  ............  ............
                                                                       tumor.
63278.................  C....................  .....................  Biopsy/excise spinal     .....  .........  ...........  ............  ............
                                                                       tumor.
63280.................  C....................  .....................  Biopsy/excise spinal     .....  .........  ...........  ............  ............
                                                                       tumor.
63281.................  C....................  .....................  Biopsy/excise spinal     .....  .........  ...........  ............  ............
                                                                       tumor.
63282.................  C....................  .....................  Biopsy/excise spinal     .....  .........  ...........  ............  ............
                                                                       tumor.

[[Page 48105]]

 
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        0220    16.5293      $897.36  ............       $179.47
                                                                       lesion.
63610.................  T....................  .....................  Stimulation of spinal     0220    16.5293      $897.36  ............       $179.47
                                                                       cord.
63615.................  T....................  .....................  Remove lesion of spinal   0220    16.5293      $897.36  ............       $179.47
                                                                       cord.
63650.................  S....................  .....................  Implant neuroelectrodes   0225    56.0375    $3,042.22  ............       $608.44
63655.................  S....................  .....................  Implant neuroelectrodes   0225    56.0375    $3,042.22  ............       $608.44
63660.................  T....................  .....................  Revise/remove             0687    19.9913    $1,085.31       $499.24       $217.06
                                                                       neuroelectrode.
63685.................  T....................  .....................  Implant neuroreceiver..   0222   188.7735   $10,248.32  ............     $2,049.66
63688.................  T....................  .....................  Revise/remove             0688    42.5880    $2,312.06     $1,132.91       $462.41
                                                                       neuroreceiver.
63700.................  C....................  .....................  Repair of spinal         .....  .........  ...........  ............  ............
                                                                       herniation.
63702.................  C....................  .....................  Repair of spinal         .....  .........  ...........  ............  ............
                                                                       herniation.
63704.................  C....................  .....................  Repair of spinal         .....  .........  ...........  ............  ............
                                                                       herniation.
63706.................  C....................  .....................  Repair of spinal         .....  .........  ...........  ............  ............
                                                                       herniation.
63707.................  C....................  .....................  Repair spinal fluid      .....  .........  ...........  ............  ............
                                                                       leakage.
63709.................  C....................  .....................  Repair spinal fluid      .....  .........  ...........  ............  ............
                                                                       leakage.
63710.................  C....................  .....................  Graft repair of spine    .....  .........  ...........  ............  ............
                                                                       defect.
63740.................  C....................  .....................  Install spinal shunt...  .....  .........  ...........  ............  ............
63741.................  T....................  .....................  Install spinal shunt...   0228    51.1329    $2,775.95       $621.80       $555.19
63744.................  T....................  .....................  Revision of spinal        0228    51.1329    $2,775.95       $621.80       $555.19
                                                                       shunt.
63746.................  T....................  .....................  Removal of spinal shunt   0109     7.7075      $418.43       $131.49        $83.69
64400.................  T....................  .....................  N block inj, trigeminal   0204     2.2209      $120.57        $40.13        $24.11
64402.................  T....................  .....................  N block inj, facial....   0204     2.2209      $120.57        $40.13        $24.11
64405.................  T....................  .....................  N block inj, occipital.   0204     2.2209      $120.57        $40.13        $24.11
64408.................  T....................  .....................  N block inj, vagus.....   0204     2.2209      $120.57        $40.13        $24.11
64410.................  T....................  .....................  N block inj, phrenic...   0204     2.2209      $120.57        $40.13        $24.11
64412.................  T....................  .....................  N block inj, spinal       0204     2.2209      $120.57        $40.13        $24.11
                                                                       accessor.
64413.................  T....................  .....................  N block inj, cervical     0204     2.2209      $120.57        $40.13        $24.11
                                                                       plexus.
64415.................  T....................  .....................  Injection for nerve       0204     2.2209      $120.57        $40.13        $24.11
                                                                       block.
64416.................  T....................  .....................  N block cont infuse, b    0204     2.2209      $120.57        $40.13        $24.11
                                                                       plex.
64417.................  T....................  .....................  N block inj, axillary..   0204     2.2209      $120.57        $40.13        $24.11
64418.................  T....................  .....................  N block inj,              0204     2.2209      $120.57        $40.13        $24.11
                                                                       suprascapular.
64420.................  T....................  .....................  N block inj, intercost,   0207     6.5998      $358.30       $123.69        $71.66
                                                                       sng.
64421.................  T....................  .....................  N block inj, intercost,   0207     6.5998      $358.30       $123.69        $71.66
                                                                       mlt.
64425.................  T....................  .....................  N block inj ilio-ing/     0204     2.2209      $120.57        $40.13        $24.11
                                                                       hypogi.
64430.................  T....................  .....................  N block inj, pudendal..   0204     2.2209      $120.57        $40.13        $24.11
64435.................  T....................  .....................  N block inj,              0204     2.2209      $120.57        $40.13        $24.11
                                                                       paracervical.
64445.................  T....................  .....................  Injection for nerve       0204     2.2209      $120.57        $40.13        $24.11
                                                                       block.
64446.................  T....................  .....................  N blk inj, sciatic,       0204     2.2209      $120.57        $40.13        $24.11
                                                                       cont inf.
64447.................  T....................  .....................  N block inj fem, single   0204     2.2209      $120.57        $40.13        $24.11
64448.................  T....................  .....................  N block inj fem, cont     0204     2.2209      $120.57        $40.13        $24.11
                                                                       inf.
64450.................  T....................  .....................  N block, other            0204     2.2209      $120.57        $40.13        $24.11
                                                                       peripheral.
64470.................  T....................  .....................  Inj paravertebral c/t..   0207     6.5998      $358.30       $123.69        $71.66
64472.................  T....................  .....................  Inj paravertebral c/t     0207     6.5998      $358.30       $123.69        $71.66
                                                                       add-on.
64475.................  T....................  .....................  Inj paravertebral l/s..   0207     6.5998      $358.30       $123.69        $71.66
64476.................  T....................  .....................  Inj paravertebral l/s     0207     6.5998      $358.30       $123.69        $71.66
                                                                       add-on.
64479.................  T....................  .....................  Inj foramen epidural c/   0207     6.5998      $358.30       $123.69        $71.66
                                                                       t.
64480.................  T....................  .....................  Inj foramen epidural      0207     6.5998      $358.30       $123.69        $71.66
                                                                       add-on.
64483.................  T....................  .....................  Inj foramen epidural l/   0207     6.5998      $358.30       $123.69        $71.66
                                                                       s.
64484.................  T....................  .....................  Inj foramen epidural      0207     6.5998      $358.30       $123.69        $71.66
                                                                       add-on.
64505.................  T....................  .....................  N block, spenopalatine    0204     2.2209      $120.57        $40.13        $24.11
                                                                       gangl.
64508.................  T....................  .....................  N block, carotid sinus    0204     2.2209      $120.57        $40.13        $24.11
                                                                       s/p.
64510.................  T....................  .....................  N block, stellate         0207     6.5998      $358.30       $123.69        $71.66
                                                                       ganglion.
64520.................  T....................  .....................  N block, lumbar/          0207     6.5998      $358.30       $123.69        $71.66
                                                                       thoracic.

[[Page 48106]]

 
64530.................  T....................  .....................  N block inj, celiac       0207     6.5998      $358.30       $123.69        $71.66
                                                                       pelus.
64550.................  A....................  .....................  Apply neurostimulator..  .....  .........  ...........  ............  ............
64553.................  S....................  .....................  Implant neuroelectrodes   0225    56.0375    $3,042.22  ............       $608.44
64555.................  S....................  .....................  Implant neuroelectrodes   0225    56.0375    $3,042.22  ............       $608.44
64560.................  S....................  .....................  Implant neuroelectrodes   0225    56.0375    $3,042.22  ............       $608.44
64561.................  S....................  .....................  Implant neuroelectrodes   0225    56.0375    $3,042.22  ............       $608.44
64565.................  S....................  .....................  Implant neuroelectrodes   0225    56.0375    $3,042.22  ............       $608.44
64573.................  S....................  .....................  Implant neuroelectrodes   0225    56.0375    $3,042.22  ............       $608.44
64575.................  S....................  .....................  Implant neuroelectrodes   0225    56.0375    $3,042.22  ............       $608.44
64577.................  S....................  .....................  Implant neuroelectrodes   0225    56.0375    $3,042.22  ............       $608.44
64580.................  S....................  .....................  Implant neuroelectrodes   0225    56.0375    $3,042.22  ............       $608.44
64581.................  S....................  .....................  Implant neuroelectrodes   0225    56.0375    $3,042.22  ............       $608.44
64585.................  T....................  .....................  Revise/remove             0687    19.9913    $1,085.31       $499.24       $217.06
                                                                       neuroelectrode.
64590.................  T....................  .....................  Implant neuroreceiver..   0222   188.7735   $10,248.32  ............     $2,049.66
64595.................  T....................  .....................  Revise/remove             0688    42.5880    $2,312.06     $1,132.91       $462.41
                                                                       neuroreceiver.
64600.................  T....................  .....................  Injection treatment of    0203    11.8511      $643.38       $276.76       $128.68
                                                                       nerve.
64605.................  T....................  .....................  Injection treatment of    0203    11.8511      $643.38       $276.76       $128.68
                                                                       nerve.
64610.................  T....................  .....................  Injection treatment of    0203    11.8511      $643.38       $276.76       $128.68
                                                                       nerve.
64612.................  T....................  .....................  Destroy nerve, face       0204     2.2209      $120.57        $40.13        $24.11
                                                                       muscle.
64613.................  T....................  .....................  Destroy nerve, spine      0204     2.2209      $120.57        $40.13        $24.11
                                                                       muscle.
64614.................  T....................  .....................  Destroy nerve, extrem     0204     2.2209      $120.57        $40.13        $24.11
                                                                       musc.
64620.................  T....................  .....................  Injection treatment of    0203    11.8511      $643.38       $276.76       $128.68
                                                                       nerve.
64622.................  T....................  .....................  Destr paravertebrl        0203    11.8511      $643.38       $276.76       $128.68
                                                                       nerve l/s.
64623.................  T....................  .....................  Destr paravertebral n     0203    11.8511      $643.38       $276.76       $128.68
                                                                       add-on.
64626.................  T....................  .....................  Destr paravertebrl        0203    11.8511      $643.38       $276.76       $128.68
                                                                       nerve c/t.
64627.................  T....................  .....................  Destr paravertebral n     0203    11.8511      $643.38       $276.76       $128.68
                                                                       add-on.
64630.................  T....................  .....................  Injection treatment of    0207     6.5998      $358.30       $123.69        $71.66
                                                                       nerve.
64640.................  T....................  .....................  Injection treatment of    0207     6.5998      $358.30       $123.69        $71.66
                                                                       nerve.
64680.................  T....................  .....................  Injection treatment of    0203    11.8511      $643.38       $276.76       $128.68
                                                                       nerve.
64702.................  T....................  .....................  Revise finger/toe nerve   0220    16.5293      $897.36  ............       $179.47
64704.................  T....................  .....................  Revise hand/foot nerve.   0220    16.5293      $897.36  ............       $179.47
64708.................  T....................  .....................  Revise arm/leg nerve...   0220    16.5293      $897.36  ............       $179.47
64712.................  T....................  .....................  Revision of sciatic       0220    16.5293      $897.36  ............       $179.47
                                                                       nerve.
64713.................  T....................  .....................  Revision of arm           0220    16.5293      $897.36  ............       $179.47
                                                                       nerve(s).
64714.................  T....................  .....................  Revise low back           0220    16.5293      $897.36  ............       $179.47
                                                                       nerve(s).
64716.................  T....................  .....................  Revision of cranial       0220    16.5293      $897.36  ............       $179.47
                                                                       nerve.
64718.................  T....................  .....................  Revise ulnar nerve at     0220    16.5293      $897.36  ............       $179.47
                                                                       elbow.
64719.................  T....................  .....................  Revise ulnar nerve at     0220    16.5293      $897.36  ............       $179.47
                                                                       wrist.
64721.................  T....................  .....................  Carpal tunnel surgery..   0220    16.5293      $897.36  ............       $179.47
64722.................  T....................  .....................  Relieve pressure on       0220    16.5293      $897.36  ............       $179.47
                                                                       nerve(s).
64726.................  T....................  .....................  Release foot/toe nerve.   0220    16.5293      $897.36  ............       $179.47
64727.................  T....................  .....................  Internal nerve revision   0220    16.5293      $897.36  ............       $179.47
64732.................  T....................  .....................  Incision of brow nerve.   0220    16.5293      $897.36  ............       $179.47
64734.................  T....................  .....................  Incision of cheek nerve   0220    16.5293      $897.36  ............       $179.47
64736.................  T....................  .....................  Incision of chin nerve.   0220    16.5293      $897.36  ............       $179.47
64738.................  T....................  .....................  Incision of jaw nerve..   0220    16.5293      $897.36  ............       $179.47
64740.................  T....................  .....................  Incision of tongue        0220    16.5293      $897.36  ............       $179.47
                                                                       nerve.
64742.................  T....................  .....................  Incision of facial        0220    16.5293      $897.36  ............       $179.47
                                                                       nerve.
64744.................  T....................  .....................  Incise nerve, back of     0220    16.5293      $897.36  ............       $179.47
                                                                       head.
64746.................  T....................  .....................  Incise diaphragm nerve.   0220    16.5293      $897.36  ............       $179.47
64752.................  C....................  .....................  Incision of vagus nerve  .....  .........  ...........  ............  ............
64755.................  C....................  .....................  Incision of stomach      .....  .........  ...........  ............  ............
                                                                       nerves.
64760.................  C....................  .....................  Incision of vagus nerve  .....  .........  ...........  ............  ............
64761.................  T....................  .....................  Incision of pelvis        0220    16.5293      $897.36  ............       $179.47
                                                                       nerve.
64763.................  C....................  .....................  Incise hip/thigh nerve.  .....  .........  ...........  ............  ............
64766.................  C....................  .....................  Incise hip/thigh nerve.  .....  .........  ...........  ............  ............
64771.................  T....................  .....................  Sever cranial nerve....   0220    16.5293      $897.36  ............       $179.47
64772.................  T....................  .....................  Incision of spinal        0220    16.5293      $897.36  ............       $179.47
                                                                       nerve.
64774.................  T....................  .....................  Remove skin nerve         0220    16.5293      $897.36  ............       $179.47
                                                                       lesion.
64776.................  T....................  .....................  Remove digit nerve        0220    16.5293      $897.36  ............       $179.47
                                                                       lesion.
64778.................  T....................  .....................  Digit nerve surgery add-  0220    16.5293      $897.36  ............       $179.47
                                                                       on.
64782.................  T....................  .....................  Remove limb nerve         0220    16.5293      $897.36  ............       $179.47
                                                                       lesion.
64783.................  T....................  .....................  Limb nerve surgery add-   0220    16.5293      $897.36  ............       $179.47
                                                                       on.
64784.................  T....................  .....................  Remove nerve lesion....   0220    16.5293      $897.36  ............       $179.47
64786.................  T....................  .....................  Remove sciatic nerve      0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       lesion.
64787.................  T....................  .....................  Implant nerve end......   0220    16.5293      $897.36  ............       $179.47

[[Page 48107]]

 
64788.................  T....................  .....................  Remove skin nerve         0220    16.5293      $897.36  ............       $179.47
                                                                       lesion.
64790.................  T....................  .....................  Removal of nerve lesion   0220    16.5293      $897.36  ............       $179.47
64792.................  T....................  .....................  Removal of nerve lesion   0221    25.8194    $1,401.71       $463.62       $280.34
64795.................  T....................  .....................  Biopsy of nerve........   0220    16.5293      $897.36  ............       $179.47
64802.................  T....................  .....................  Remove sympathetic        0220    16.5293      $897.36  ............       $179.47
                                                                       nerves.
64804.................  C....................  .....................  Remove sympathetic       .....  .........  ...........  ............  ............
                                                                       nerves.
64809.................  C....................  .....................  Remove sympathetic       .....  .........  ...........  ............  ............
                                                                       nerves.
64818.................  C....................  .....................  Remove sympathetic       .....  .........  ...........  ............  ............
                                                                       nerves.
64820.................  T....................  .....................  Remove sympathetic        0220    16.5293      $897.36  ............       $179.47
                                                                       nerves.
64821.................  T....................  .....................  Remove sympathestic       0054    24.2685    $1,317.51  ............       $263.50
                                                                       nerves.
64822.................  T....................  .....................  Remove sympathetic        0054    24.2685    $1,317.51  ............       $263.50
                                                                       nerves.
64823.................  T....................  .....................  Remove sympathetic        0054    24.2685    $1,317.51  ............       $263.50
                                                                       nerves.
64831.................  T....................  .....................  Repair of digit nerve..   0221    25.8194    $1,401.71       $463.62       $280.34
64832.................  T....................  .....................  Repair nerve add-on....   0221    25.8194    $1,401.71       $463.62       $280.34
64834.................  T....................  .....................  Repair of hand or foot    0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       nerve.
64835.................  T....................  .....................  Repair of hand or foot    0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       nerve.
64836.................  T....................  .....................  Repair of hand or foot    0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       nerve.
64837.................  T....................  .....................  Repair nerve add-on....   0221    25.8194    $1,401.71       $463.62       $280.34
64840.................  T....................  .....................  Repair of leg nerve....   0221    25.8194    $1,401.71       $463.62       $280.34
64856.................  T....................  .....................  Repair/transpose nerve.   0221    25.8194    $1,401.71       $463.62       $280.34
64857.................  T....................  .....................  Repair arm/leg nerve...   0221    25.8194    $1,401.71       $463.62       $280.34
64858.................  T....................  .....................  Repair sciatic nerve...   0221    25.8194    $1,401.71       $463.62       $280.34
64859.................  T....................  .....................  Nerve surgery..........   0221    25.8194    $1,401.71       $463.62       $280.34
64861.................  T....................  .....................  Repair of arm nerves...   0221    25.8194    $1,401.71       $463.62       $280.34
64862.................  T....................  .....................  Repair of low back        0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       nerves.
64864.................  T....................  .....................  Repair of facial nerve.   0221    25.8194    $1,401.71       $463.62       $280.34
64865.................  T....................  .....................  Repair of facial nerve.   0221    25.8194    $1,401.71       $463.62       $280.34
64866.................  C....................  .....................  Fusion of facial/other   .....  .........  ...........  ............  ............
                                                                       nerve.
64868.................  C....................  .....................  Fusion of facial/other   .....  .........  ...........  ............  ............
                                                                       nerve.
64870.................  T....................  .....................  Fusion of facial/other    0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       nerve.
64872.................  T....................  .....................  Subsequent repair of      0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       nerve.
64874.................  T....................  .....................  Repair & revise nerve     0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       add-on.
64876.................  T....................  .....................  Repair nerve/shorten      0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       bone.
64885.................  T....................  .....................  Nerve graft, head or      0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       neck.
64886.................  T....................  .....................  Nerve graft, head or      0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       neck.
64890.................  T....................  .....................  Nerve graft, hand or      0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       foot.
64891.................  T....................  .....................  Nerve graft, hand or      0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       foot.
64892.................  T....................  .....................  Nerve graft, arm or leg   0221    25.8194    $1,401.71       $463.62       $280.34
64893.................  T....................  .....................  Nerve graft, arm or leg   0221    25.8194    $1,401.71       $463.62       $280.34
64895.................  T....................  .....................  Nerve graft, hand or      0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       foot.
64896.................  T....................  .....................  Nerve graft, hand or      0221    25.8194    $1,401.71       $463.62       $280.34
                                                                       foot.
64897.................  T....................  .....................  Nerve graft, arm or leg   0221    25.8194    $1,401.71       $463.62       $280.34
64898.................  T....................  .....................  Nerve graft, arm or leg   0221    25.8194    $1,401.71       $463.62       $280.34
64901.................  T....................  .....................  Nerve graft add-on.....   0221    25.8194    $1,401.71       $463.62       $280.34
64902.................  T....................  .....................  Nerve graft add-on.....   0221    25.8194    $1,401.71       $463.62       $280.34
64905.................  T....................  .....................  Nerve pedicle transfer.   0221    25.8194    $1,401.71       $463.62       $280.34
64907.................  T....................  .....................  Nerve pedicle transfer.   0221    25.8194    $1,401.71       $463.62       $280.34
64999.................  T....................  .....................  Nervous system surgery.   0204     2.2209      $120.57        $40.13        $24.11
65091.................  T....................  .....................  Revise eye.............   0242    29.2193    $1,586.29       $597.36       $317.26
65093.................  T....................  .....................  Revise eye with implant   0241    21.9830    $1,193.44       $384.47       $238.69
65101.................  T....................  .....................  Removal of eye.........   0242    29.2193    $1,586.29       $597.36       $317.26
65103.................  T....................  .....................  Remove eye/insert         0242    29.2193    $1,586.29       $597.36       $317.26
                                                                       implant.
65105.................  T....................  .....................  Remove eye/attach         0242    29.2193    $1,586.29       $597.36       $317.26
                                                                       implant.
65110.................  T....................  .....................  Removal of eye.........   0242    29.2193    $1,586.29       $597.36       $317.26
65112.................  T....................  .....................  Remove eye/revise         0242    29.2193    $1,586.29       $597.36       $317.26
                                                                       socket.
65114.................  T....................  .....................  Remove eye/revise         0242    29.2193    $1,586.29       $597.36       $317.26
                                                                       socket.
65125.................  T....................  .....................  Revise ocular implant..   0240    17.3397      $941.35       $315.31       $188.27
65130.................  T....................  .....................  Insert ocular implant..   0241    21.9830    $1,193.44       $384.47       $238.69
65135.................  T....................  .....................  Insert ocular implant..   0241    21.9830    $1,193.44       $384.47       $238.69
65140.................  T....................  .....................  Attach ocular implant..   0242    29.2193    $1,586.29       $597.36       $317.26
65150.................  T....................  .....................  Revise ocular implant..   0241    21.9830    $1,193.44       $384.47       $238.69
65155.................  T....................  .....................  Reinsert ocular implant   0242    29.2193    $1,586.29       $597.36       $317.26
65175.................  T....................  .....................  Removal of ocular         0240    17.3397      $941.35       $315.31       $188.27
                                                                       implant.
65205.................  S....................  .....................  Remove foreign body       0698     0.9355       $50.79        $18.72        $10.16
                                                                       from eye.
65210.................  S....................  .....................  Remove foreign body       0231     2.0880      $113.36        $50.94        $22.67
                                                                       from eye.
65220.................  S....................  .....................  Remove foreign body       0231     2.0880      $113.36        $50.94        $22.67
                                                                       from eye.

[[Page 48108]]

 
65222.................  S....................  .....................  Remove foreign body       0231     2.0880      $113.36        $50.94        $22.67
                                                                       from eye.
65235.................  T....................  .....................  Remove foreign body       0233    14.5435      $789.55       $266.33       $157.91
                                                                       from eye.
65260.................  T....................  .....................  Remove foreign body       0236    19.6866    $1,068.77  ............       $213.75
                                                                       from eye.
65265.................  T....................  .....................  Remove foreign body       0236    19.6866    $1,068.77  ............       $213.75
                                                                       from eye.
65270.................  T....................  .....................  Repair of eye wound....   0240    17.3397      $941.35       $315.31       $188.27
65272.................  T....................  .....................  Repair of eye wound....   0233    14.5435      $789.55       $266.33       $157.91
65273.................  C....................  .....................  Repair of eye wound....  .....  .........  ...........  ............  ............
65275.................  T....................  .....................  Repair of eye wound....   0233    14.5435      $789.55       $266.33       $157.91
65280.................  T....................  .....................  Repair of eye wound....   0234    21.5482    $1,169.83       $511.31       $233.97
65285.................  T....................  .....................  Repair of eye wound....   0234    21.5482    $1,169.83       $511.31       $233.97
65286.................  T....................  .....................  Repair of eye wound....   0233    14.5435      $789.55       $266.33       $157.91
65290.................  T....................  .....................  Repair of eye socket      0243    21.1035    $1,145.69       $431.39       $229.14
                                                                       wound.
65400.................  T....................  .....................  Removal of eye lesion..   0233    14.5435      $789.55       $266.33       $157.91
65410.................  T....................  .....................  Biopsy of cornea.......   0233    14.5435      $789.55       $266.33       $157.91
65420.................  T....................  .....................  Removal of eye lesion..   0233    14.5435      $789.55       $266.33       $157.91
65426.................  T....................  .....................  Removal of eye lesion..   0234    21.5482    $1,169.83       $511.31       $233.97
65430.................  S....................  .....................  Corneal smear..........   0230     0.7379       $40.06        $14.97         $8.01
65435.................  T....................  .....................  Curette/treat cornea...   0239     6.2432      $338.94       $110.62        $67.79
65436.................  T....................  .....................  Curette/treat cornea...   0233    14.5435      $789.55       $266.33       $157.91
65450.................  S....................  .....................  Treatment of corneal      0231     2.0880      $113.36        $50.94        $22.67
                                                                       lesion.
65600.................  T....................  .....................  Revision of cornea.....   0240    17.3397      $941.35       $315.31       $188.27
65710.................  T....................  .....................  Corneal transplant.....   0244    37.4885    $2,035.21       $803.26       $407.04
65730.................  T....................  .....................  Corneal transplant.....   0244    37.4885    $2,035.21       $803.26       $407.04
65750.................  T....................  .....................  Corneal transplant.....   0244    37.4885    $2,035.21       $803.26       $407.04
65755.................  T....................  .....................  Corneal transplant.....   0244    37.4885    $2,035.21       $803.26       $407.04
65760.................  E....................  .....................  Revision of cornea.....  .....  .........  ...........  ............  ............
65765.................  E....................  .....................  Revision of cornea.....  .....  .........  ...........  ............  ............
65767.................  E....................  .....................  Corneal tissue           .....  .........  ...........  ............  ............
                                                                       transplant.
65770.................  T....................  .....................  Revise cornea with        0244    37.4885    $2,035.21       $803.26       $407.04
                                                                       implant.
65771.................  E....................  .....................  Radial keratotomy......  .....  .........  ...........  ............  ............
65772.................  T....................  .....................  Correction of             0233    14.5435      $789.55       $266.33       $157.91
                                                                       astigmatism.
65775.................  T....................  .....................  Correction of             0233    14.5435      $789.55       $266.33       $157.91
                                                                       astigmatism.
65800.................  T....................  .....................  Drainage of eye........   0233    14.5435      $789.55       $266.33       $157.91
65805.................  T....................  .....................  Drainage of eye........   0233    14.5435      $789.55       $266.33       $157.91
65810.................  T....................  .....................  Drainage of eye........   0234    21.5482    $1,169.83       $511.31       $233.97
65815.................  T....................  .....................  Drainage of eye........   0234    21.5482    $1,169.83       $511.31       $233.97
65820.................  T....................  .....................  Relieve inner eye         0232     4.9739      $270.03       $103.17        $54.01
                                                                       pressure.
65850.................  T....................  .....................  Incision of eye........   0234    21.5482    $1,169.83       $511.31       $233.97
65855.................  T....................  .....................  Laser surgery of eye...   0247     5.0192      $272.49       $104.31        $54.50
65860.................  T....................  .....................  Incise inner eye          0247     5.0192      $272.49       $104.31        $54.50
                                                                       adhesions.
65865.................  T....................  .....................  Incise inner eye          0233    14.5435      $789.55       $266.33       $157.91
                                                                       adhesions.
65870.................  T....................  .....................  Incise inner eye          0234    21.5482    $1,169.83       $511.31       $233.97
                                                                       adhesions.
65875.................  T....................  .....................  Incise inner eye          0234    21.5482    $1,169.83       $511.31       $233.97
                                                                       adhesions.
65880.................  T....................  .....................  Incise inner eye          0233    14.5435      $789.55       $266.33       $157.91
                                                                       adhesions.
65900.................  T....................  .....................  Remove eye lesion......   0233    14.5435      $789.55       $266.33       $157.91
65920.................  T....................  .....................  Remove implant of eye..   0233    14.5435      $789.55       $266.33       $157.91
65930.................  T....................  .....................  Remove blood clot from    0234    21.5482    $1,169.83       $511.31       $233.97
                                                                       eye.
66020.................  T....................  .....................  Injection treatment of    0233    14.5435      $789.55       $266.33       $157.91
                                                                       eye.
66030.................  T....................  .....................  Injection treatment of    0233    14.5435      $789.55       $266.33       $157.91
                                                                       eye.
66130.................  T....................  .....................  Remove eye lesion......   0234    21.5482    $1,169.83       $511.31       $233.97
66150.................  T....................  .....................  Glaucoma surgery.......   0233    14.5435      $789.55       $266.33       $157.91
66155.................  T....................  .....................  Glaucoma surgery.......   0234    21.5482    $1,169.83       $511.31       $233.97
66160.................  T....................  .....................  Glaucoma surgery.......   0234    21.5482    $1,169.83       $511.31       $233.97
66165.................  T....................  .....................  Glaucoma surgery.......   0234    21.5482    $1,169.83       $511.31       $233.97
66170.................  T....................  .....................  Glaucoma surgery.......   0234    21.5482    $1,169.83       $511.31       $233.97
66172.................  T....................  .....................  Incision of eye........   0673    26.7626    $1,452.91       $649.56       $290.58
66180.................  T....................  .....................  Implant eye shunt......   0673    26.7626    $1,452.91       $649.56       $290.58
66185.................  T....................  .....................  Revise eye shunt.......   0673    26.7626    $1,452.91       $649.56       $290.58
66220.................  T....................  .....................  Repair eye lesion......   0236    19.6866    $1,068.77  ............       $213.75
66225.................  T....................  .....................  Repair/graft eye lesion   0673    26.7626    $1,452.91       $649.56       $290.58
66250.................  T....................  .....................  Follow-up surgery of      0233    14.5435      $789.55       $266.33       $157.91
                                                                       eye.
66500.................  T....................  .....................  Incision of iris.......   0232     4.9739      $270.03       $103.17        $54.01
66505.................  T....................  .....................  Incision of iris.......   0232     4.9739      $270.03       $103.17        $54.01
66600.................  T....................  .....................  Remove iris and lesion.   0233    14.5435      $789.55       $266.33       $157.91
66605.................  T....................  .....................  Removal of iris........   0234    21.5482    $1,169.83       $511.31       $233.97
66625.................  T....................  .....................  Removal of iris........   0233    14.5435      $789.55       $266.33       $157.91

[[Page 48109]]

 
66630.................  T....................  .....................  Removal of iris........   0233    14.5435      $789.55       $266.33       $157.91
66635.................  T....................  .....................  Removal of iris........   0234    21.5482    $1,169.83       $511.31       $233.97
66680.................  T....................  .....................  Repair iris & ciliary     0234    21.5482    $1,169.83       $511.31       $233.97
                                                                       body.
66682.................  T....................  .....................  Repair iris & ciliary     0234    21.5482    $1,169.83       $511.31       $233.97
                                                                       body.
66700.................  T....................  .....................  Destruction, ciliary      0233    14.5435      $789.55       $266.33       $157.91
                                                                       body.
66710.................  T....................  .....................  Destruction, ciliary      0233    14.5435      $789.55       $266.33       $157.91
                                                                       body.
66720.................  T....................  .....................  Destruction, ciliary      0233    14.5435      $789.55       $266.33       $157.91
                                                                       body.
66740.................  T....................  .....................  Destruction, ciliary      0233    14.5435      $789.55       $266.33       $157.91
                                                                       body.
66761.................  T....................  .....................  Revision of iris.......   0247     5.0192      $272.49       $104.31        $54.50
66762.................  T....................  .....................  Revision of iris.......   0247     5.0192      $272.49       $104.31        $54.50
66770.................  T....................  .....................  Removal of inner eye      0247     5.0192      $272.49       $104.31        $54.50
                                                                       lesion.
66820.................  T....................  .....................  Incision, secondary       0232     4.9739      $270.03       $103.17        $54.01
                                                                       cataract.
66821.................  T....................  .....................  After cataract laser      0247     5.0192      $272.49       $104.31        $54.50
                                                                       surgery.
66825.................  T....................  .....................  Reposition intraocular    0234    21.5482    $1,169.83       $511.31       $233.97
                                                                       lens.
66830.................  T....................  .....................  Removal of lens lesion.   0232     4.9739      $270.03       $103.17        $54.01
66840.................  T....................  .....................  Removal of lens           0245    12.5751      $682.69       $226.11       $136.54
                                                                       material.
66850.................  T....................  .....................  Removal of lens           0249    28.3307    $1,538.05       $524.67       $307.61
                                                                       material.
66852.................  T....................  .....................  Removal of lens           0249    28.3307    $1,538.05       $524.67       $307.61
                                                                       material.
66920.................  T....................  .....................  Extraction of lens.....   0249    28.3307    $1,538.05       $524.67       $307.61
66930.................  T....................  .....................  Extraction of lens.....   0249    28.3307    $1,538.05       $524.67       $307.61
66940.................  T....................  .....................  Extraction of lens.....   0245    12.5751      $682.69       $226.11       $136.54
66982.................  T....................  .....................  Cataract surgery,         0246    22.8428    $1,240.11       $495.96       $248.02
                                                                       complex.
66983.................  T....................  .....................  Cataract surg w/iol, 1    0246    22.8428    $1,240.11       $495.96       $248.02
                                                                       stage.
66984.................  T....................  .....................  Cataract surg w/iol, 1    0246    22.8428    $1,240.11       $495.96       $248.02
                                                                       stage.
66985.................  T....................  .....................  Insert lens prosthesis.   0246    22.8428    $1,240.11       $495.96       $248.02
66986.................  T....................  .....................  Exchange lens             0246    22.8428    $1,240.11       $495.96       $248.02
                                                                       prosthesis.
66990.................  N....................  .....................  Ophthalmic endoscope     .....  .........  ...........  ............  ............
                                                                       add-on.
66999.................  T....................  .....................  Eye surgery procedure..   0232     4.9739      $270.03       $103.17        $54.01
67005.................  T....................  .....................  Partial removal of eye    0237    34.0324    $1,847.58       $818.54       $369.52
                                                                       fluid.
67010.................  T....................  .....................  Partial removal of eye    0237    34.0324    $1,847.58       $818.54       $369.52
                                                                       fluid.
67015.................  T....................  .....................  Release of eye fluid...   0237    34.0324    $1,847.58       $818.54       $369.52
67025.................  T....................  .....................  Replace eye fluid......   0236    19.6866    $1,068.77  ............       $213.75
67027.................  T....................  .....................  Implant eye drug system   0237    34.0324    $1,847.58       $818.54       $369.52
67028.................  T....................  .....................  Injection eye drug.....   0235     4.9900      $270.90        $72.04        $54.18
67030.................  T....................  .....................  Incise inner eye          0236    19.6866    $1,068.77  ............       $213.75
                                                                       strands.
67031.................  T....................  .....................  Laser surgery, eye        0247     5.0192      $272.49       $104.31        $54.50
                                                                       strands.
67036.................  T....................  .....................  Removal of inner eye      0237    34.0324    $1,847.58       $818.54       $369.52
                                                                       fluid.
67038.................  T....................  .....................  Strip retinal membrane.   0237    34.0324    $1,847.58       $818.54       $369.52
67039.................  T....................  .....................  Laser treatment of        0237    34.0324    $1,847.58       $818.54       $369.52
                                                                       retina.
67040.................  T....................  .....................  Laser treatment of        0672    39.1363    $2,124.67       $988.43       $424.93
                                                                       retina.
67101.................  T....................  .....................  Repair detached retina.   0235     4.9900      $270.90        $72.04        $54.18
67105.................  T....................  .....................  Repair detached retina.   0248     4.7544      $258.11        $95.08        $51.62
67107.................  T....................  .....................  Repair detached retina.   0672    39.1363    $2,124.67       $988.43       $424.93
67108.................  T....................  .....................  Repair detached retina.   0672    39.1363    $2,124.67       $988.43       $424.93
67110.................  T....................  .....................  Repair detached retina.   0236    19.6866    $1,068.77  ............       $213.75
67112.................  T....................  .....................  Rerepair detached         0672    39.1363    $2,124.67       $988.43       $424.93
                                                                       retina.
67115.................  T....................  .....................  Release encircling        0236    19.6866    $1,068.77  ............       $213.75
                                                                       material.
67120.................  T....................  .....................  Remove eye implant        0236    19.6866    $1,068.77  ............       $213.75
                                                                       material.
67121.................  T....................  .....................  Remove eye implant        0237    34.0324    $1,847.58       $818.54       $369.52
                                                                       material.
67141.................  T....................  .....................  Treatment of retina....   0235     4.9900      $270.90        $72.04        $54.18
67145.................  T....................  .....................  Treatment of retina....   0248     4.7544      $258.11        $95.08        $51.62
67208.................  T....................  .....................  Treatment of retinal      0235     4.9900      $270.90        $72.04        $54.18
                                                                       lesion.
67210.................  T....................  .....................  Treatment of retinal      0248     4.7544      $258.11        $95.08        $51.62
                                                                       lesion.
67218.................  T....................  .....................  Treatment of retinal      0236    19.6866    $1,068.77  ............       $213.75
                                                                       lesion.
67220.................  T....................  .....................  Treatment of choroid      0235     4.9900      $270.90        $72.04        $54.18
                                                                       lesion.
67221.................  T....................  .....................  Ocular photodynamic       0235     4.9900      $270.90        $72.04        $54.18
                                                                       ther.
67225.................  T....................  .....................  Eye photodynamic ther     0235     4.9900      $270.90        $72.04        $54.18
                                                                       add-on.
67227.................  T....................  .....................  Treatment of retinal      0235     4.9900      $270.90        $72.04        $54.18
                                                                       lesion.
67228.................  T....................  .....................  Treatment of retinal      0248     4.7544      $258.11        $95.08        $51.62
                                                                       lesion.
67250.................  T....................  .....................  Reinforce eye wall.....   0240    17.3397      $941.35       $315.31       $188.27
67255.................  T....................  .....................  Reinforce/graft eye       0237    34.0324    $1,847.58       $818.54       $369.52
                                                                       wall.
67299.................  T....................  .....................  Eye surgery procedure..   0235     4.9900      $270.90        $72.04        $54.18
67311.................  T....................  .....................  Revise eye muscle......   0243    21.1035    $1,145.69       $431.39       $229.14
67312.................  T....................  .....................  Revise two eye muscles.   0243    21.1035    $1,145.69       $431.39       $229.14
67314.................  T....................  .....................  Revise eye muscle......   0243    21.1035    $1,145.69       $431.39       $229.14
67316.................  T....................  .....................  Revise two eye muscles.   0243    21.1035    $1,145.69       $431.39       $229.14

[[Page 48110]]

 
67318.................  T....................  .....................  Revise eye muscle(s)...   0243    21.1035    $1,145.69       $431.39       $229.14
67320.................  T....................  .....................  Revise eye muscle(s)      0243    21.1035    $1,145.69       $431.39       $229.14
                                                                       add-on.
67331.................  T....................  .....................  Eye surgery follow-up     0243    21.1035    $1,145.69       $431.39       $229.14
                                                                       add-on.
67332.................  T....................  .....................  Rerevise eye muscles      0243    21.1035    $1,145.69       $431.39       $229.14
                                                                       add-on.
67334.................  T....................  .....................  Revise eye muscle w/      0243    21.1035    $1,145.69       $431.39       $229.14
                                                                       suture.
67335.................  T....................  .....................  Eye suture during         0243    21.1035    $1,145.69       $431.39       $229.14
                                                                       surgery.
67340.................  T....................  .....................  Revise eye muscle add-    0243    21.1035    $1,145.69       $431.39       $229.14
                                                                       on.
67343.................  T....................  .....................  Release eye tissue.....   0243    21.1035    $1,145.69       $431.39       $229.14
67345.................  T....................  .....................  Destroy nerve of eye      0238     3.2016      $173.81        $58.96        $34.76
                                                                       muscle.
67350.................  T....................  .....................  Biopsy eye muscle......   0699     2.2211      $120.58        $54.26        $24.12
67399.................  T....................  .....................  Eye muscle surgery        0243    21.1035    $1,145.69       $431.39       $229.14
                                                                       procedure.
67400.................  T....................  .....................  Explore/biopsy eye        0241    21.9830    $1,193.44       $384.47       $238.69
                                                                       socket.
67405.................  T....................  .....................  Explore/drain eye         0241    21.9830    $1,193.44       $384.47       $238.69
                                                                       socket.
67412.................  T....................  .....................  Explore/treat eye         0241    21.9830    $1,193.44       $384.47       $238.69
                                                                       socket.
67413.................  T....................  .....................  Explore/treat eye         0241    21.9830    $1,193.44       $384.47       $238.69
                                                                       socket.
67414.................  T....................  .....................  Explr/decompress eye      0242    29.2193    $1,586.29       $597.36       $317.26
                                                                       socket.
67415.................  T....................  .....................  Aspiration, orbital       0239     6.2432      $338.94       $110.62        $67.79
                                                                       contents.
67420.................  T....................  .....................  Explore/treat eye         0242    29.2193    $1,586.29       $597.36       $317.26
                                                                       socket.
67430.................  T....................  .....................  Explore/treat eye         0242    29.2193    $1,586.29       $597.36       $317.26
                                                                       socket.
67440.................  T....................  .....................  Explore/drain eye         0242    29.2193    $1,586.29       $597.36       $317.26
                                                                       socket.
67445.................  T....................  .....................  Explr/decompress eye      0242    29.2193    $1,586.29       $597.36       $317.26
                                                                       socket.
67450.................  T....................  .....................  Explore/biopsy eye        0242    29.2193    $1,586.29       $597.36       $317.26
                                                                       socket.
67500.................  S....................  .....................  Inject/treat eye socket   0231     2.0880      $113.36        $50.94        $22.67
67505.................  T....................  .....................  Inject/treat eye socket   0238     3.2016      $173.81        $58.96        $34.76
67515.................  T....................  .....................  Inject/treat eye socket   0239     6.2432      $338.94       $110.62        $67.79
67550.................  T....................  .....................  Insert eye socket         0242    29.2193    $1,586.29       $597.36       $317.26
                                                                       implant.
67560.................  T....................  .....................  Revise eye socket         0241    21.9830    $1,193.44       $384.47       $238.69
                                                                       implant.
67570.................  T....................  .....................  Decompress optic nerve.   0242    29.2193    $1,586.29       $597.36       $317.26
67599.................  T....................  .....................  Orbit surgery procedure   0239     6.2432      $338.94       $110.62        $67.79
67700.................  T....................  .....................  Drainage of eyelid        0238     3.2016      $173.81        $58.96        $34.76
                                                                       abscess.
67710.................  T....................  .....................  Incision of eyelid.....   0239     6.2432      $338.94       $110.62        $67.79
67715.................  T....................  .....................  Incision of eyelid fold   0240    17.3397      $941.35       $315.31       $188.27
67800.................  T....................  .....................  Remove eyelid lesion...   0238     3.2016      $173.81        $58.96        $34.76
67801.................  T....................  .....................  Remove eyelid lesions..   0239     6.2432      $338.94       $110.62        $67.79
67805.................  T....................  .....................  Remove eyelid lesions..   0238     3.2016      $173.81        $58.96        $34.76
67808.................  T....................  .....................  Remove eyelid lesion(s)   0240    17.3397      $941.35       $315.31       $188.27
67810.................  T....................  .....................  Biopsy of eyelid.......   0238     3.2016      $173.81        $58.96        $34.76
67820.................  S....................  .....................  Revise eyelashes.......   0698     0.9355       $50.79        $18.72        $10.16
67825.................  T....................  .....................  Revise eyelashes.......   0238     3.2016      $173.81        $58.96        $34.76
67830.................  T....................  .....................  Revise eyelashes.......   0239     6.2432      $338.94       $110.62        $67.79
67835.................  T....................  .....................  Revise eyelashes.......   0240    17.3397      $941.35       $315.31       $188.27
67840.................  T....................  .....................  Remove eyelid lesion...   0239     6.2432      $338.94       $110.62        $67.79
67850.................  T....................  .....................  Treat eyelid lesion....   0239     6.2432      $338.94       $110.62        $67.79
67875.................  T....................  .....................  Closure of eyelid by      0239     6.2432      $338.94       $110.62        $67.79
                                                                       suture.
67880.................  T....................  .....................  Revision of eyelid.....   0233    14.5435      $789.55       $266.33       $157.91
67882.................  T....................  .....................  Revision of eyelid.....   0240    17.3397      $941.35       $315.31       $188.27
67900.................  T....................  .....................  Repair brow defect.....   0240    17.3397      $941.35       $315.31       $188.27
67901.................  T....................  .....................  Repair eyelid defect...   0240    17.3397      $941.35       $315.31       $188.27
67902.................  T....................  .....................  Repair eyelid defect...   0240    17.3397      $941.35       $315.31       $188.27
67903.................  T....................  .....................  Repair eyelid defect...   0240    17.3397      $941.35       $315.31       $188.27
67904.................  T....................  .....................  Repair eyelid defect...   0240    17.3397      $941.35       $315.31       $188.27
67906.................  T....................  .....................  Repair eyelid defect...   0240    17.3397      $941.35       $315.31       $188.27
67908.................  T....................  .....................  Repair eyelid defect...   0240    17.3397      $941.35       $315.31       $188.27
67909.................  T....................  .....................  Revise eyelid defect...   0240    17.3397      $941.35       $315.31       $188.27
67911.................  T....................  .....................  Revise eyelid defect...   0240    17.3397      $941.35       $315.31       $188.27
67914.................  T....................  .....................  Repair eyelid defect...   0240    17.3397      $941.35       $315.31       $188.27
67915.................  T....................  .....................  Repair eyelid defect...   0239     6.2432      $338.94       $110.62        $67.79
67916.................  T....................  .....................  Repair eyelid defect...   0240    17.3397      $941.35       $315.31       $188.27
67917.................  T....................  .....................  Repair eyelid defect...   0240    17.3397      $941.35       $315.31       $188.27
67921.................  T....................  .....................  Repair eyelid defect...   0240    17.3397      $941.35       $315.31       $188.27
67922.................  T....................  .....................  Repair eyelid defect...   0239     6.2432      $338.94       $110.62        $67.79
67923.................  T....................  .....................  Repair eyelid defect...   0240    17.3397      $941.35       $315.31       $188.27
67924.................  T....................  .....................  Repair eyelid defect...   0240    17.3397      $941.35       $315.31       $188.27
67930.................  T....................  .....................  Repair eyelid wound....   0240    17.3397      $941.35       $315.31       $188.27
67935.................  T....................  .....................  Repair eyelid wound....   0240    17.3397      $941.35       $315.31       $188.27
67938.................  S....................  .....................  Remove eyelid foreign     0698     0.9355       $50.79        $18.72        $10.16
                                                                       body.

[[Page 48111]]

 
67950.................  T....................  .....................  Revision of eyelid.....   0240    17.3397      $941.35       $315.31       $188.27
67961.................  T....................  .....................  Revision of eyelid.....   0240    17.3397      $941.35       $315.31       $188.27
67966.................  T....................  .....................  Revision of eyelid.....   0240    17.3397      $941.35       $315.31       $188.27
67971.................  T....................  .....................  Reconstruction of         0241    21.9830    $1,193.44       $384.47       $238.69
                                                                       eyelid.
67973.................  T....................  .....................  Reconstruction of         0241    21.9830    $1,193.44       $384.47       $238.69
                                                                       eyelid.
67974.................  T....................  .....................  Reconstruction of         0241    21.9830    $1,193.44       $384.47       $238.69
                                                                       eyelid.
67975.................  T....................  .....................  Reconstruction of         0240    17.3397      $941.35       $315.31       $188.27
                                                                       eyelid.
67999.................  T....................  .....................  Revision of eyelid.....   0240    17.3397      $941.35       $315.31       $188.27
68020.................  T....................  .....................  Incise/drain eyelid       0240    17.3397      $941.35       $315.31       $188.27
                                                                       lining.
68040.................  S....................  .....................  Treatment of eyelid       0698     0.9355       $50.79        $18.72        $10.16
                                                                       lesions.
68100.................  T....................  .....................  Biopsy of eyelid lining   0232     4.9739      $270.03       $103.17        $54.01
68110.................  T....................  .....................  Remove eyelid lining      0699     2.2211      $120.58        $54.26        $24.12
                                                                       lesion.
68115.................  T....................  .....................  Remove eyelid lining      0239     6.2432      $338.94       $110.62        $67.79
                                                                       lesion.
68130.................  T....................  .....................  Remove eyelid lining      0233    14.5435      $789.55       $266.33       $157.91
                                                                       lesion.
68135.................  T....................  .....................  Remove eyelid lining      0239     6.2432      $338.94       $110.62        $67.79
                                                                       lesion.
68200.................  S....................  .....................  Treat eyelid by           0698     0.9355       $50.79        $18.72        $10.16
                                                                       injection.
68320.................  T....................  .....................  Revise/graft eyelid       0240    17.3397      $941.35       $315.31       $188.27
                                                                       lining.
68325.................  T....................  .....................  Revise/graft eyelid       0242    29.2193    $1,586.29       $597.36       $317.26
                                                                       lining.
68326.................  T....................  .....................  Revise/graft eyelid       0241    21.9830    $1,193.44       $384.47       $238.69
                                                                       lining.
68328.................  T....................  .....................  Revise/graft eyelid       0241    21.9830    $1,193.44       $384.47       $238.69
                                                                       lining.
68330.................  T....................  .....................  Revise eyelid lining...   0233    14.5435      $789.55       $266.33       $157.91
68335.................  T....................  .....................  Revise/graft eyelid       0241    21.9830    $1,193.44       $384.47       $238.69
                                                                       lining.
68340.................  T....................  .....................  Separate eyelid           0240    17.3397      $941.35       $315.31       $188.27
                                                                       adhesions.
68360.................  T....................  .....................  Revise eyelid lining...   0234    21.5482    $1,169.83       $511.31       $233.97
68362.................  T....................  .....................  Revise eyelid lining...   0234    21.5482    $1,169.83       $511.31       $233.97
68399.................  T....................  .....................  Eyelid lining surgery..   0239     6.2432      $338.94       $110.62        $67.79
68400.................  T....................  .....................  Incise/drain tear gland   0238     3.2016      $173.81        $58.96        $34.76
68420.................  T....................  .....................  Incise/drain tear sac..   0240    17.3397      $941.35       $315.31       $188.27
68440.................  T....................  .....................  Incise tear duct          0238     3.2016      $173.81        $58.96        $34.76
                                                                       opening.
68500.................  T....................  .....................  Removal of tear gland..   0241    21.9830    $1,193.44       $384.47       $238.69
68505.................  T....................  .....................  Partial removal, tear     0241    21.9830    $1,193.44       $384.47       $238.69
                                                                       gland.
68510.................  T....................  .....................  Biopsy of tear gland...   0240    17.3397      $941.35       $315.31       $188.27
68520.................  T....................  .....................  Removal of tear sac....   0241    21.9830    $1,193.44       $384.47       $238.69
68525.................  T....................  .....................  Biopsy of tear sac.....   0240    17.3397      $941.35       $315.31       $188.27
68530.................  T....................  .....................  Clearance of tear duct.   0240    17.3397      $941.35       $315.31       $188.27
68540.................  T....................  .....................  Remove tear gland         0241    21.9830    $1,193.44       $384.47       $238.69
                                                                       lesion.
68550.................  T....................  .....................  Remove tear gland         0242    29.2193    $1,586.29       $597.36       $317.26
                                                                       lesion.
68700.................  T....................  .....................  Repair tear ducts......   0241    21.9830    $1,193.44       $384.47       $238.69
68705.................  T....................  .....................  Revise tear duct          0238     3.2016      $173.81        $58.96        $34.76
                                                                       opening.
68720.................  T....................  .....................  Create tear sac drain..   0242    29.2193    $1,586.29       $597.36       $317.26
68745.................  T....................  .....................  Create tear duct drain.   0241    21.9830    $1,193.44       $384.47       $238.69
68750.................  T....................  .....................  Create tear duct drain.   0242    29.2193    $1,586.29       $597.36       $317.26
68760.................  S....................  .....................  Close tear duct opening   0698     0.9355       $50.79        $18.72        $10.16
68761.................  S....................  .....................  Close tear duct opening   0231     2.0880      $113.36        $50.94        $22.67
68770.................  T....................  .....................  Close tear system         0240    17.3397      $941.35       $315.31       $188.27
                                                                       fistula.
68801.................  S....................  .....................  Dilate tear duct          0231     2.0880      $113.36        $50.94        $22.67
                                                                       opening.
68810.................  T....................  .....................  Probe nasolacrimal duct   0699     2.2211      $120.58        $54.26        $24.12
68811.................  T....................  .....................  Probe nasolacrimal duct   0240    17.3397      $941.35       $315.31       $188.27
68815.................  T....................  .....................  Probe nasolacrimal duct   0240    17.3397      $941.35       $315.31       $188.27
68840.................  T....................  .....................  Explore/irrigate tear     0699     2.2211      $120.58        $54.26        $24.12
                                                                       ducts.
68850.................  N....................  .....................  Injection for tear sac   .....  .........  ...........  ............  ............
                                                                       x-ray.
68899.................  T....................  .....................  Tear duct system          0699     2.2211      $120.58        $54.26        $24.12
                                                                       surgery.
69000.................  T....................  .....................  Drain external ear        0006     1.7487       $94.94        $24.12        $18.99
                                                                       lesion.
69005.................  T....................  .....................  Drain external ear        0007    11.4943      $624.01  ............       $124.80
                                                                       lesion.
69020.................  T....................  .....................  Drain outer ear canal     0006     1.7487       $94.94        $24.12        $18.99
                                                                       lesion.
69090.................  E....................  .....................  Pierce earlobes........  .....  .........  ...........  ............  ............
69100.................  T....................  .....................  Biopsy of external ear.   0019     3.9807      $216.11        $71.87        $43.22
69105.................  T....................  .....................  Biopsy of external ear    0253    15.1698      $823.55       $282.29       $164.71
                                                                       canal.
69110.................  T....................  .....................  Remove external ear,      0021    14.5749      $791.26       $219.48       $158.25
                                                                       partial.
69120.................  T....................  .....................  Removal of external ear   0254    21.4368    $1,163.78       $321.35       $232.76
69140.................  T....................  .....................  Remove ear canal          0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       lesion(s).
69145.................  T....................  .....................  Remove ear canal          0021    14.5749      $791.26       $219.48       $158.25
                                                                       lesion(s).
69150.................  T....................  .....................  Extensive ear canal       0252     6.5416      $355.14       $113.41        $71.03
                                                                       surgery.
69155.................  C....................  .....................  Extensive ear/neck       .....  .........  ...........  ............  ............
                                                                       surgery.
69200.................  X....................  .....................  Clear outer ear canal..   0340     0.6232       $33.83  ............         $6.77
69205.................  T....................  .....................  Clear outer ear canal..   0022    18.6725    $1,013.71       $354.45       $202.74

[[Page 48112]]

 
69210.................  X....................  .....................  Remove impacted ear wax   0340     0.6232       $33.83  ............         $6.77
69220.................  T....................  .....................  Clean out mastoid         0012     0.8203       $44.53        $11.18         $8.91
                                                                       cavity.
69222.................  T....................  .....................  Clean out mastoid         0253    15.1698      $823.55       $282.29       $164.71
                                                                       cavity.
69300.................  T....................  .....................  Revise external ear....   0254    21.4368    $1,163.78       $321.35       $232.76
69310.................  T....................  .....................  Rebuild outer ear canal   0256    35.0866    $1,904.82  ............       $380.96
69320.................  T....................  .....................  Rebuild outer ear canal   0256    35.0866    $1,904.82  ............       $380.96
69399.................  T....................  .....................  Outer ear surgery         0251     1.8643      $101.21  ............        $20.24
                                                                       procedure.
69400.................  T....................  .....................  Inflate middle ear        0251     1.8643      $101.21  ............        $20.24
                                                                       canal.
69401.................  T....................  .....................  Inflate middle ear        0251     1.8643      $101.21  ............        $20.24
                                                                       canal.
69405.................  T....................  .....................  Catheterize middle ear    0252     6.5416      $355.14       $113.41        $71.03
                                                                       canal.
69410.................  T....................  .....................  Inset middle ear          0252     6.5416      $355.14       $113.41        $71.03
                                                                       (baffle).
69420.................  T....................  .....................  Incision of eardrum....   0252     6.5416      $355.14       $113.41        $71.03
69421.................  T....................  .....................  Incision of eardrum....   0253    15.1698      $823.55       $282.29       $164.71
69424.................  T....................  .....................  Remove ventilating tube   0252     6.5416      $355.14       $113.41        $71.03
69433.................  T....................  .....................  Create eardrum opening.   0252     6.5416      $355.14       $113.41        $71.03
69436.................  T....................  .....................  Create eardrum opening.   0253    15.1698      $823.55       $282.29       $164.71
69440.................  T....................  .....................  Exploration of middle     0254    21.4368    $1,163.78       $321.35       $232.76
                                                                       ear.
69450.................  T....................  .....................  Eardrum revision.......   0256    35.0866    $1,904.82  ............       $380.96
69501.................  T....................  .....................  Mastoidectomy..........   0256    35.0866    $1,904.82  ............       $380.96
69502.................  T....................  .....................  Mastoidectomy..........   0254    21.4368    $1,163.78       $321.35       $232.76
69505.................  T....................  .....................  Remove mastoid            0256    35.0866    $1,904.82  ............       $380.96
                                                                       structures.
69511.................  T....................  .....................  Extensive mastoid         0256    35.0866    $1,904.82  ............       $380.96
                                                                       surgery.
69530.................  T....................  .....................  Extensive mastoid         0256    35.0866    $1,904.82  ............       $380.96
                                                                       surgery.
69535.................  C....................  .....................  Remove part of temporal  .....  .........  ...........  ............  ............
                                                                       bone.
69540.................  T....................  .....................  Remove ear lesion......   0253    15.1698      $823.55       $282.29       $164.71
69550.................  T....................  .....................  Remove ear lesion......   0256    35.0866    $1,904.82  ............       $380.96
69552.................  T....................  .....................  Remove ear lesion......   0256    35.0866    $1,904.82  ............       $380.96
69554.................  C....................  .....................  Remove ear lesion......  .....  .........  ...........  ............  ............
69601.................  T....................  .....................  Mastoid surgery           0256    35.0866    $1,904.82  ............       $380.96
                                                                       revision.
69602.................  T....................  .....................  Mastoid surgery           0256    35.0866    $1,904.82  ............       $380.96
                                                                       revision.
69603.................  T....................  .....................  Mastoid surgery           0256    35.0866    $1,904.82  ............       $380.96
                                                                       revision.
69604.................  T....................  .....................  Mastoid surgery           0256    35.0866    $1,904.82  ............       $380.96
                                                                       revision.
69605.................  T....................  .....................  Mastoid surgery           0256    35.0866    $1,904.82  ............       $380.96
                                                                       revision.
69610.................  T....................  .....................  Repair of eardrum......   0254    21.4368    $1,163.78       $321.35       $232.76
69620.................  T....................  .....................  Repair of eardrum......   0254    21.4368    $1,163.78       $321.35       $232.76
69631.................  T....................  .....................  Repair eardrum            0256    35.0866    $1,904.82  ............       $380.96
                                                                       structures.
69632.................  T....................  .....................  Rebuild eardrum           0256    35.0866    $1,904.82  ............       $380.96
                                                                       structures.
69633.................  T....................  .....................  Rebuild eardrum           0256    35.0866    $1,904.82  ............       $380.96
                                                                       structures.
69635.................  T....................  .....................  Repair eardrum            0256    35.0866    $1,904.82  ............       $380.96
                                                                       structures.
69636.................  T....................  .....................  Rebuild eardrum           0256    35.0866    $1,904.82  ............       $380.96
                                                                       structures.
69637.................  T....................  .....................  Rebuild eardrum           0256    35.0866    $1,904.82  ............       $380.96
                                                                       structures.
69641.................  T....................  .....................  Revise middle ear &       0256    35.0866    $1,904.82  ............       $380.96
                                                                       mastoid.
69642.................  T....................  .....................  Revise middle ear &       0256    35.0866    $1,904.82  ............       $380.96
                                                                       mastoid.
69643.................  T....................  .....................  Revise middle ear &       0256    35.0866    $1,904.82  ............       $380.96
                                                                       mastoid.
69644.................  T....................  .....................  Revise middle ear &       0256    35.0866    $1,904.82  ............       $380.96
                                                                       mastoid.
69645.................  T....................  .....................  Revise middle ear &       0256    35.0866    $1,904.82  ............       $380.96
                                                                       mastoid.
69646.................  T....................  .....................  Revise middle ear &       0256    35.0866    $1,904.82  ............       $380.96
                                                                       mastoid.
69650.................  T....................  .....................  Release middle ear bone   0254    21.4368    $1,163.78       $321.35       $232.76
69660.................  T....................  .....................  Revise middle ear bone.   0256    35.0866    $1,904.82  ............       $380.96
69661.................  T....................  .....................  Revise middle ear bone.   0256    35.0866    $1,904.82  ............       $380.96
69662.................  T....................  .....................  Revise middle ear bone.   0256    35.0866    $1,904.82  ............       $380.96
69666.................  T....................  .....................  Repair middle ear         0256    35.0866    $1,904.82  ............       $380.96
                                                                       structures.
69667.................  T....................  .....................  Repair middle ear         0256    35.0866    $1,904.82  ............       $380.96
                                                                       structures.
69670.................  T....................  .....................  Remove mastoid air        0256    35.0866    $1,904.82  ............       $380.96
                                                                       cells.
69676.................  T....................  .....................  Remove middle ear nerve   0256    35.0866    $1,904.82  ............       $380.96
69700.................  T....................  .....................  Close mastoid fistula..   0256    35.0866    $1,904.82  ............       $380.96
69710.................  E....................  .....................  Implant/replace hearing  .....  .........  ...........  ............  ............
                                                                       aid.
69711.................  T....................  .....................  Remove/repair hearing     0256    35.0866    $1,904.82  ............       $380.96
                                                                       aid.
69714.................  T....................  .....................  Implant temple bone w/    0256    35.0866    $1,904.82  ............       $380.96
                                                                       stimul.
69715.................  T....................  .....................  Temple bne implnt w/      0256    35.0866    $1,904.82  ............       $380.96
                                                                       stimulat.
69717.................  T....................  .....................  Temple bone implant       0256    35.0866    $1,904.82  ............       $380.96
                                                                       revision.
69718.................  T....................  .....................  Revise temple bone        0256    35.0866    $1,904.82  ............       $380.96
                                                                       implant.
69720.................  T....................  .....................  Release facial nerve...   0256    35.0866    $1,904.82  ............       $380.96
69725.................  T....................  .....................  Release facial nerve...   0256    35.0866    $1,904.82  ............       $380.96
69740.................  T....................  .....................  Repair facial nerve....   0256    35.0866    $1,904.82  ............       $380.96
69745.................  T....................  .....................  Repair facial nerve....   0256    35.0866    $1,904.82  ............       $380.96

[[Page 48113]]

 
69799.................  T....................  .....................  Middle ear surgery        0253    15.1698      $823.55       $282.29       $164.71
                                                                       procedure.
69801.................  T....................  .....................  Incise inner ear.......   0256    35.0866    $1,904.82  ............       $380.96
69802.................  T....................  .....................  Incise inner ear.......   0256    35.0866    $1,904.82  ............       $380.96
69805.................  T....................  .....................  Explore inner ear......   0256    35.0866    $1,904.82  ............       $380.96
69806.................  T....................  .....................  Explore inner ear......   0256    35.0866    $1,904.82  ............       $380.96
69820.................  T....................  .....................  Establish inner ear       0256    35.0866    $1,904.82  ............       $380.96
                                                                       window.
69840.................  T....................  .....................  Revise inner ear window   0256    35.0866    $1,904.82  ............       $380.96
69905.................  T....................  .....................  Remove inner ear.......   0256    35.0866    $1,904.82  ............       $380.96
69910.................  T....................  .....................  Remove inner ear &        0256    35.0866    $1,904.82  ............       $380.96
                                                                       mastoid.
69915.................  T....................  .....................  Incise inner ear nerve.   0256    35.0866    $1,904.82  ............       $380.96
69930.................  T....................  .....................  Implant cochlear device   0259   389.1764   $21,128.00     $9,394.83     $4,225.60
69949.................  T....................  .....................  Inner ear surgery         0253    15.1698      $823.55       $282.29       $164.71
                                                                       procedure.
69950.................  C....................  .....................  Incise inner ear nerve.  .....  .........  ...........  ............  ............
69955.................  T....................  .....................  Release facial nerve...   0256    35.0866    $1,904.82  ............       $380.96
69960.................  T....................  .....................  Release inner ear canal   0256    35.0866    $1,904.82  ............       $380.96
69970.................  C....................  .....................  Remove inner ear lesion  .....  .........  ...........  ............  ............
69979.................  T....................  .....................  Temporal bone surgery..   0251     1.8643      $101.21  ............        $20.24
69990.................  N....................  .....................  Microsurgery add-on....  .....  .........  ...........  ............  ............
70010.................  S....................  .....................  Contrast x-ray of brain   0274     3.5837      $194.56        $92.92        $38.91
70015.................  S....................  .....................  Contrast x-ray of brain   0274     3.5837      $194.56        $92.92        $38.91
70030.................  X....................  .....................  X-ray eye for foreign     0260     0.7845       $42.59        $21.29         $8.52
                                                                       body.
70100.................  X....................  .....................  X-ray exam of jaw......   0260     0.7845       $42.59        $21.29         $8.52
70110.................  X....................  .....................  X-ray exam of jaw......   0260     0.7845       $42.59        $21.29         $8.52
70120.................  X....................  .....................  X-ray exam of mastoids.   0260     0.7845       $42.59        $21.29         $8.52
70130.................  X....................  .....................  X-ray exam of mastoids.   0260     0.7845       $42.59        $21.29         $8.52
70134.................  X....................  .....................  X-ray exam of middle      0261     1.3238       $71.87  ............        $14.37
                                                                       ear.
70140.................  X....................  .....................  X-ray exam of facial      0260     0.7845       $42.59        $21.29         $8.52
                                                                       bones.
70150.................  X....................  .....................  X-ray exam of facial      0260     0.7845       $42.59        $21.29         $8.52
                                                                       bones.
70160.................  X....................  .....................  X-ray exam of nasal       0260     0.7845       $42.59        $21.29         $8.52
                                                                       bones.
70170.................  X....................  .....................  X-ray exam of tear duct   0263     2.1875      $118.76        $43.58        $23.75
70190.................  X....................  .....................  X-ray exam of eye         0260     0.7845       $42.59        $21.29         $8.52
                                                                       sockets.
70200.................  X....................  .....................  X-ray exam of eye         0260     0.7845       $42.59        $21.29         $8.52
                                                                       sockets.
70210.................  X....................  .....................  X-ray exam of sinuses..   0260     0.7845       $42.59        $21.29         $8.52
70220.................  X....................  .....................  X-ray exam of sinuses..   0260     0.7845       $42.59        $21.29         $8.52
70240.................  X....................  .....................  X-ray exam, pituitary     0260     0.7845       $42.59        $21.29         $8.52
                                                                       saddle.
70250.................  X....................  .....................  X-ray exam of skull....   0260     0.7845       $42.59        $21.29         $8.52
70260.................  X....................  .....................  X-ray exam of skull....   0261     1.3238       $71.87  ............        $14.37
70300.................  X....................  .....................  X-ray exam of teeth....   0262     0.7851       $42.62         $9.82         $8.52
70310.................  X....................  .....................  X-ray exam of teeth....   0262     0.7851       $42.62         $9.82         $8.52
70320.................  X....................  .....................  Full mouth x-ray of       0262     0.7851       $42.62         $9.82         $8.52
                                                                       teeth.
70328.................  X....................  .....................  X-ray exam of jaw joint   0260     0.7845       $42.59        $21.29         $8.52
70330.................  X....................  .....................  X-ray exam of jaw         0260     0.7845       $42.59        $21.29         $8.52
                                                                       joints.
70332.................  S....................  .....................  X-ray exam of jaw joint   0275     3.2967      $178.97        $69.09        $35.79
70336.................  S....................  .....................  Magnetic image, jaw       0335     6.4453      $349.91       $151.46        $69.98
                                                                       joint.
70350.................  X....................  .....................  X-ray head for            0260     0.7845       $42.59        $21.29         $8.52
                                                                       orthodontia.
70355.................  X....................  .....................  Panoramic x-ray of jaws   0260     0.7845       $42.59        $21.29         $8.52
70360.................  X....................  .....................  X-ray exam of neck.....   0260     0.7845       $42.59        $21.29         $8.52
70370.................  X....................  .....................  Throat x-ray &            0272     1.4086       $76.47        $38.23        $15.29
                                                                       fluoroscopy.
70371.................  X....................  .....................  Speech evaluation,        0272     1.4086       $76.47        $38.23        $15.29
                                                                       complex.
70373.................  X....................  .....................  Contrast x-ray of         0263     2.1875      $118.76        $43.58        $23.75
                                                                       larynx.
70380.................  X....................  .....................  X-ray exam of salivary    0260     0.7845       $42.59        $21.29         $8.52
                                                                       gland.
70390.................  X....................  .....................  X-ray exam of salivary    0264     3.0022      $162.99        $79.41        $32.60
                                                                       duct.
70450.................  S....................  .....................  Ct head/brain w/o dye..   0332     3.3916      $184.13        $91.27        $36.83
70460.................  S....................  .....................  Ct head/brain w/dye....   0283     4.6121      $250.39       $125.19        $50.08
70470.................  S....................  .....................  Ct head/brain w/o&w dye   0333     5.4299      $294.78       $146.98        $58.96
70480.................  S....................  .....................  Ct orbit/ear/fossa w/o    0332     3.3916      $184.13        $91.27        $36.83
                                                                       dye.
70481.................  S....................  .....................  Ct orbit/ear/fossa w/     0283     4.6121      $250.39       $125.19        $50.08
                                                                       dye.
70482.................  S....................  .....................  Ct orbit/ear/fossa w/     0333     5.4299      $294.78       $146.98        $58.96
                                                                       o&w dye.
70486.................  S....................  .....................  Ct maxillofacial w/o      0332     3.3916      $184.13        $91.27        $36.83
                                                                       dye.
70487.................  S....................  .....................  Ct maxillofacial w/dye.   0283     4.6121      $250.39       $125.19        $50.08
70488.................  S....................  .....................  Ct maxillofacial w/o&w    0333     5.4299      $294.78       $146.98        $58.96
                                                                       dye.
70490.................  S....................  .....................  Ct soft tissue neck w/o   0332     3.3916      $184.13        $91.27        $36.83
                                                                       dye.
70491.................  S....................  .....................  Ct soft tissue neck w/    0283     4.6121      $250.39       $125.19        $50.08
                                                                       dye.
70492.................  S....................  .....................  Ct sft tsue nck w/o & w/  0333     5.4299      $294.78       $146.98        $58.96
                                                                       dye.
70496.................  S....................  .....................  Ct angiography, head...   0662     5.8751      $318.95       $156.47        $63.79
70498.................  S....................  .....................  Ct angiography, neck...   0662     5.8751      $318.95       $156.47        $63.79

[[Page 48114]]

 
70540.................  S....................  .....................  Mri orbit/face/neck w/o   0336     6.4817      $351.89       $175.94        $70.38
                                                                       dye.
70542.................  S....................  .....................  Mri orbit/face/neck w/    0284     7.0207      $381.15       $190.57        $76.23
                                                                       dye.
70543.................  S....................  .....................  Mri orbt/fac/nck w/o&w    0337     9.3215      $506.05       $240.77       $101.21
                                                                       dye.
70544.................  S....................  .....................  Mr angiography head w/o   0336     6.4817      $351.89       $175.94        $70.38
                                                                       dye.
70545.................  S....................  .....................  Mr angiography head w/    0284     7.0207      $381.15       $190.57        $76.23
                                                                       dye.
70546.................  S....................  .....................  Mr angiograph head w/     0337     9.3215      $506.05       $240.77       $101.21
                                                                       o&w dye.
70547.................  S....................  .....................  Mr angiography neck w/o   0336     6.4817      $351.89       $175.94        $70.38
                                                                       dye.
70548.................  S....................  .....................  Mr angiography neck w/    0284     7.0207      $381.15       $190.57        $76.23
                                                                       dye.
70549.................  S....................  .....................  Mr angiograph neck w/     0337     9.3215      $506.05       $240.77       $101.21
                                                                       o&w dye.
70551.................  S....................  .....................  Mri brain w/o dye......   0336     6.4817      $351.89       $175.94        $70.38
70552.................  S....................  .....................  Mri brain w/dye........   0284     7.0207      $381.15       $190.57        $76.23
70553.................  S....................  .....................  Mri brain w/o&w dye....   0337     9.3215      $506.05       $240.77       $101.21
71010.................  X....................  .....................  Chest x-ray............   0260     0.7845       $42.59        $21.29         $8.52
71015.................  X....................  .....................  Chest x-ray............   0260     0.7845       $42.59        $21.29         $8.52
71020.................  X....................  .....................  Chest x-ray............   0260     0.7845       $42.59        $21.29         $8.52
71021.................  X....................  .....................  Chest x-ray............   0260     0.7845       $42.59        $21.29         $8.52
71022.................  X....................  .....................  Chest x-ray............   0260     0.7845       $42.59        $21.29         $8.52
71023.................  X....................  .....................  Chest x-ray and           0272     1.4086       $76.47        $38.23        $15.29
                                                                       fluoroscopy.
71030.................  X....................  .....................  Chest x-ray............   0260     0.7845       $42.59        $21.29         $8.52
71034.................  X....................  .....................  Chest x-ray and           0272     1.4086       $76.47        $38.23        $15.29
                                                                       fluoroscopy.
71035.................  X....................  .....................  Chest x-ray............   0260     0.7845       $42.59        $21.29         $8.52
71040.................  X....................  .....................  Contrast x-ray of         0263     2.1875      $118.76        $43.58        $23.75
                                                                       bronchi.
71060.................  X....................  .....................  Contrast x-ray of         0264     3.0022      $162.99        $79.41        $32.60
                                                                       bronchi.
71090.................  X....................  .....................  X-ray & pacemaker         0272     1.4086       $76.47        $38.23        $15.29
                                                                       insertion.
71100.................  X....................  .....................  X-ray exam of ribs.....   0260     0.7845       $42.59        $21.29         $8.52
71101.................  X....................  .....................  X-ray exam of ribs/       0260     0.7845       $42.59        $21.29         $8.52
                                                                       chest.
71110.................  X....................  .....................  X-ray exam of ribs.....   0260     0.7845       $42.59        $21.29         $8.52
71111.................  X....................  .....................  X-ray exam of ribs/       0261     1.3238       $71.87  ............        $14.37
                                                                       chest.
71120.................  X....................  .....................  X-ray exam of             0260     0.7845       $42.59        $21.29         $8.52
                                                                       breastbone.
71130.................  X....................  .....................  X-ray exam of             0260     0.7845       $42.59        $21.29         $8.52
                                                                       breastbone.
71250.................  S....................  .....................  Ct thorax w/o dye......   0332     3.3916      $184.13        $91.27        $36.83
71260.................  S....................  .....................  Ct thorax w/dye........   0283     4.6121      $250.39       $125.19        $50.08
71270.................  S....................  .....................  Ct thorax w/o&w dye....   0333     5.4299      $294.78       $146.98        $58.96
71275.................  S....................  .....................  Ct angiography, chest..   0662     5.8751      $318.95       $156.47        $63.79
71550.................  S....................  .....................  Mri chest w/o dye......   0336     6.4817      $351.89       $175.94        $70.38
71551.................  S....................  .....................  Mri chest w/dye........   0284     7.0207      $381.15       $190.57        $76.23
71552.................  S....................  .....................  Mri chest w/o&w/dye....   0337     9.3215      $506.05       $240.77       $101.21
71555.................  E....................  .....................  Mri angio chest w or w/  .....  .........  ...........  ............  ............
                                                                       o dye.
72010.................  X....................  .....................  X-ray exam of spine....   0261     1.3238       $71.87  ............        $14.37
72020.................  X....................  .....................  X-ray exam of spine....   0260     0.7845       $42.59        $21.29         $8.52
72040.................  X....................  .....................  X-ray exam of neck        0260     0.7845       $42.59        $21.29         $8.52
                                                                       spine.
72050.................  X....................  .....................  X-ray exam of neck        0261     1.3238       $71.87  ............        $14.37
                                                                       spine.
72052.................  X....................  .....................  X-ray exam of neck        0261     1.3238       $71.87  ............        $14.37
                                                                       spine.
72069.................  X....................  .....................  X-ray exam of trunk       0260     0.7845       $42.59        $21.29         $8.52
                                                                       spine.
72070.................  X....................  .....................  X-ray exam of thoracic    0260     0.7845       $42.59        $21.29         $8.52
                                                                       spine.
72072.................  X....................  .....................  X-ray exam of thoracic    0260     0.7845       $42.59        $21.29         $8.52
                                                                       spine.
72074.................  X....................  .....................  X-ray exam of thoracic    0260     0.7845       $42.59        $21.29         $8.52
                                                                       spine.
72080.................  X....................  .....................  X-ray exam of trunk       0260     0.7845       $42.59        $21.29         $8.52
                                                                       spine.
72090.................  X....................  .....................  X-ray exam of trunk       0261     1.3238       $71.87  ............        $14.37
                                                                       spine.
72100.................  X....................  .....................  X-ray exam of lower       0260     0.7845       $42.59        $21.29         $8.52
                                                                       spine.
72110.................  X....................  .....................  X-ray exam of lower       0261     1.3238       $71.87  ............        $14.37
                                                                       spine.
72114.................  X....................  .....................  X-ray exam of lower       0261     1.3238       $71.87  ............        $14.37
                                                                       spine.
72120.................  X....................  .....................  X-ray exam of lower       0260     0.7845       $42.59        $21.29         $8.52
                                                                       spine.
72125.................  S....................  .....................  Ct neck spine w/o dye..   0332     3.3916      $184.13        $91.27        $36.83
72126.................  S....................  .....................  Ct neck spine w/dye....   0283     4.6121      $250.39       $125.19        $50.08
72127.................  S....................  .....................  Ct neck spine w/o&w/dye   0333     5.4299      $294.78       $146.98        $58.96
72128.................  S....................  .....................  Ct chest spine w/o dye.   0332     3.3916      $184.13        $91.27        $36.83
72129.................  S....................  .....................  Ct chest spine w/dye...   0283     4.6121      $250.39       $125.19        $50.08
72130.................  S....................  .....................  Ct chest spine w/o&w/     0333     5.4299      $294.78       $146.98        $58.96
                                                                       dye.
72131.................  S....................  .....................  Ct lumbar spine w/o dye   0332     3.3916      $184.13        $91.27        $36.83
72132.................  S....................  .....................  Ct lumbar spine w/dye..   0283     4.6121      $250.39       $125.19        $50.08
72133.................  S....................  .....................  Ct lumbar spine w/o&w/    0333     5.4299      $294.78       $146.98        $58.96
                                                                       dye.
72141.................  S....................  .....................  Mri neck spine w/o dye.   0336     6.4817      $351.89       $175.94        $70.38
72142.................  S....................  .....................  Mri neck spine w/dye...   0284     7.0207      $381.15       $190.57        $76.23
72146.................  S....................  .....................  Mri chest spine w/o dye   0336     6.4817      $351.89       $175.94        $70.38
72147.................  S....................  .....................  Mri chest spine w/dye..   0284     7.0207      $381.15       $190.57        $76.23

[[Page 48115]]

 
72148.................  S....................  .....................  Mri lumbar spine w/o      0336     6.4817      $351.89       $175.94        $70.38
                                                                       dye.
72149.................  S....................  .....................  Mri lumbar spine w/dye.   0284     7.0207      $381.15       $190.57        $76.23
72156.................  S....................  .....................  Mri neck spine w/o&w/     0337     9.3215      $506.05       $240.77       $101.21
                                                                       dye.
72157.................  S....................  .....................  Mri chest spine w/o&w/    0337     9.3215      $506.05       $240.77       $101.21
                                                                       dye.
72158.................  S....................  .....................  Mri lumbar spine w/o&w/   0337     9.3215      $506.05       $240.77       $101.21
                                                                       dye.
72159.................  E....................  .....................  Mr angio spine w/o&w/    .....  .........  ...........  ............  ............
                                                                       dye.
72170.................  X....................  .....................  X-ray exam of pelvis...   0260     0.7845       $42.59        $21.29         $8.52
72190.................  X....................  .....................  X-ray exam of pelvis...   0260     0.7845       $42.59        $21.29         $8.52
72191.................  S....................  .....................  Ct angiograph pelv w/     0662     5.8751      $318.95       $156.47        $63.79
                                                                       o&w/dye.
72192.................  S....................  .....................  Ct pelvis w/o dye......   0332     3.3916      $184.13        $91.27        $36.83
72193.................  S....................  .....................  Ct pelvis w/dye........   0283     4.6121      $250.39       $125.19        $50.08
72194.................  S....................  .....................  Ct pelvis w/o&w/dye....   0333     5.4299      $294.78       $146.98        $58.96
72195.................  S....................  .....................  Mri pelvis w/o dye.....   0336     6.4817      $351.89       $175.94        $70.38
72196.................  S....................  .....................  Mri pelvis w/dye.......   0284     7.0207      $381.15       $190.57        $76.23
72197.................  S....................  .....................  Mri pelvis w/o & w/dye.   0337     9.3215      $506.05       $240.77       $101.21
72198.................  E....................  .....................  Mr angio pelvis w/o&w/   .....  .........  ...........  ............  ............
                                                                       dye.
72200.................  X....................  .....................  X-ray exam sacroiliac     0260     0.7845       $42.59        $21.29         $8.52
                                                                       joints.
72202.................  X....................  .....................  X-ray exam sacroiliac     0260     0.7845       $42.59        $21.29         $8.52
                                                                       joints.
72220.................  X....................  .....................  X-ray exam of tailbone.   0260     0.7845       $42.59        $21.29         $8.52
72240.................  S....................  .....................  Contrast x-ray of neck    0274     3.5837      $194.56        $92.92        $38.91
                                                                       spine.
72255.................  S....................  .....................  Contrast x-ray, thorax    0274     3.5837      $194.56        $92.92        $38.91
                                                                       spine.
72265.................  S....................  .....................  Contrast x-ray, lower     0274     3.5837      $194.56        $92.92        $38.91
                                                                       spine.
72270.................  S....................  .....................  Contrast x-ray of spine   0274     3.5837      $194.56        $92.92        $38.91
72275.................  S....................  .....................  Epidurography..........   0274     3.5837      $194.56        $92.92        $38.91
72285.................  S....................  .....................  X-ray c/t spine disk...   0388    11.7450      $637.62       $304.54       $127.52
72295.................  S....................  .....................  X-ray of lower spine      0388    11.7450      $637.62       $304.54       $127.52
                                                                       disk.
73000.................  X....................  .....................  X-ray exam of collar      0260     0.7845       $42.59        $21.29         $8.52
                                                                       bone.
73010.................  X....................  .....................  X-ray exam of shoulder    0260     0.7845       $42.59        $21.29         $8.52
                                                                       blade.
73020.................  X....................  .....................  X-ray exam of shoulder.   0260     0.7845       $42.59        $21.29         $8.52
73030.................  X....................  .....................  X-ray exam of shoulder.   0260     0.7845       $42.59        $21.29         $8.52
73040.................  S....................  .....................  Contrast x-ray of         0275     3.2967      $178.97        $69.09        $35.79
                                                                       shoulder.
73050.................  X....................  .....................  X-ray exam of shoulders   0260     0.7845       $42.59        $21.29         $8.52
73060.................  X....................  .....................  X-ray exam of humerus..   0260     0.7845       $42.59        $21.29         $8.52
73070.................  X....................  .....................  X-ray exam of elbow....   0260     0.7845       $42.59        $21.29         $8.52
73080.................  X....................  .....................  X-ray exam of elbow....   0260     0.7845       $42.59        $21.29         $8.52
73085.................  S....................  .....................  Contrast x-ray of elbow   0275     3.2967      $178.97        $69.09        $35.79
73090.................  X....................  .....................  X-ray exam of forearm..   0260     0.7845       $42.59        $21.29         $8.52
73092.................  X....................  .....................  X-ray exam of arm,        0260     0.7845       $42.59        $21.29         $8.52
                                                                       infant.
73100.................  X....................  .....................  X-ray exam of wrist....   0260     0.7845       $42.59        $21.29         $8.52
73110.................  X....................  .....................  X-ray exam of wrist....   0260     0.7845       $42.59        $21.29         $8.52
73115.................  S....................  .....................  Contrast x-ray of wrist   0275     3.2967      $178.97        $69.09        $35.79
73120.................  X....................  .....................  X-ray exam of hand.....   0260     0.7845       $42.59        $21.29         $8.52
73130.................  X....................  .....................  X-ray exam of hand.....   0260     0.7845       $42.59        $21.29         $8.52
73140.................  X....................  .....................  X-ray exam of finger(s)   0260     0.7845       $42.59        $21.29         $8.52
73200.................  S....................  .....................  Ct upper extremity w/o    0332     3.3916      $184.13        $91.27        $36.83
                                                                       dye.
73201.................  S....................  .....................  Ct upper extremity w/     0283     4.6121      $250.39       $125.19        $50.08
                                                                       dye.
73202.................  S....................  .....................  Ct uppr extremity w/o&w/  0333     5.4299      $294.78       $146.98        $58.96
                                                                       dye.
73206.................  S....................  .....................  Ct angio upr extrm w/     0662     5.8751      $318.95       $156.47        $63.79
                                                                       o&w/dye.
73218.................  S....................  .....................  Mri upper extremity w/o   0336     6.4817      $351.89       $175.94        $70.38
                                                                       dye.
73219.................  S....................  .....................  Mri upper extremity w/    0284     7.0207      $381.15       $190.57        $76.23
                                                                       dye.
73220.................  S....................  .....................  Mri uppr extremity w/     0337     9.3215      $506.05       $240.77       $101.21
                                                                       o&w/dye.
73221.................  S....................  .....................  Mri joint upr extrem w/   0336     6.4817      $351.89       $175.94        $70.38
                                                                       o dye.
73222.................  S....................  .....................  Mri joint upr extrem w/   0284     7.0207      $381.15       $190.57        $76.23
                                                                       dye.
73223.................  S....................  .....................  Mri joint upr extr w/     0337     9.3215      $506.05       $240.77       $101.21
                                                                       o&w/dye.
73225.................  E....................  .....................  Mr angio upr extr w/o&w/ .....  .........  ...........  ............  ............
                                                                       dye.
73500.................  X....................  .....................  X-ray exam of hip......   0260     0.7845       $42.59        $21.29         $8.52
73510.................  X....................  .....................  X-ray exam of hip......   0260     0.7845       $42.59        $21.29         $8.52
73520.................  X....................  .....................  X-ray exam of hips.....   0260     0.7845       $42.59        $21.29         $8.52
73525.................  S....................  .....................  Contrast x-ray of hip..   0275     3.2967      $178.97        $69.09        $35.79
73530.................  X....................  .....................  X-ray exam of hip......   0261     1.3238       $71.87  ............        $14.37
73540.................  X....................  .....................  X-ray exam of pelvis &    0260     0.7845       $42.59        $21.29         $8.52
                                                                       hips.
73542.................  S....................  .....................  X-ray exam, sacroiliac    0275     3.2967      $178.97        $69.09        $35.79
                                                                       joint.
73550.................  X....................  .....................  X-ray exam of thigh....   0260     0.7845       $42.59        $21.29         $8.52
73560.................  X....................  .....................  X-ray exam of knee, 1     0260     0.7845       $42.59        $21.29         $8.52
                                                                       or 2.
73562.................  X....................  .....................  X-ray exam of knee, 3..   0260     0.7845       $42.59        $21.29         $8.52
73564.................  X....................  .....................  X-ray exam, knee, 4 or    0260     0.7845       $42.59        $21.29         $8.52
                                                                       more.

[[Page 48116]]

 
73565.................  X....................  .....................  X-ray exam of knees....   0260     0.7845       $42.59        $21.29         $8.52
73580.................  S....................  .....................  Contrast x-ray of knee    0275     3.2967      $178.97        $69.09        $35.79
                                                                       joint.
73590.................  X....................  .....................  X-ray exam of lower leg   0260     0.7845       $42.59        $21.29         $8.52
73592.................  X....................  .....................  X-ray exam of leg,        0260     0.7845       $42.59        $21.29         $8.52
                                                                       infant.
73600.................  X....................  .....................  X-ray exam of ankle....   0260     0.7845       $42.59        $21.29         $8.52
73610.................  X....................  .....................  X-ray exam of ankle....   0260     0.7845       $42.59        $21.29         $8.52
73615.................  S....................  .....................  Contrast x-ray of ankle   0275     3.2967      $178.97        $69.09        $35.79
73620.................  X....................  .....................  X-ray exam of foot.....   0260     0.7845       $42.59        $21.29         $8.52
73630.................  X....................  .....................  X-ray exam of foot.....   0260     0.7845       $42.59        $21.29         $8.52
73650.................  X....................  .....................  X-ray exam of heel.....   0260     0.7845       $42.59        $21.29         $8.52
73660.................  X....................  .....................  X-ray exam of toe(s)...   0260     0.7845       $42.59        $21.29         $8.52
73700.................  S....................  .....................  Ct lower extremity w/o    0332     3.3916      $184.13        $91.27        $36.83
                                                                       dye.
73701.................  S....................  .....................  Ct lower extremity w/     0283     4.6121      $250.39       $125.19        $50.08
                                                                       dye.
73702.................  S....................  .....................  Ct lwr extremity w/o&w/   0333     5.4299      $294.78       $146.98        $58.96
                                                                       dye.
73706.................  S....................  .....................  Ct angio lwr extr w/o&w/  0662     5.8751      $318.95       $156.47        $63.79
                                                                       dye.
73718.................  S....................  .....................  Mri lower extremity w/o   0336     6.4817      $351.89       $175.94        $70.38
                                                                       dye.
73719.................  S....................  .....................  Mri lower extremity w/    0284     7.0207      $381.15       $190.57        $76.23
                                                                       dye.
73720.................  S....................  .....................  Mri lwr extremity w/o&w/  0337     9.3215      $506.05       $240.77       $101.21
                                                                       dye.
73721.................  S....................  .....................  Mri jnt of lwr extre w/   0336     6.4817      $351.89       $175.94        $70.38
                                                                       o dye.
73722.................  S....................  .....................  Mri joint of lwr extr w/  0284     7.0207      $381.15       $190.57        $76.23
                                                                       dye.
73723.................  S....................  .....................  Mri joint lwr extr w/     0337     9.3215      $506.05       $240.77       $101.21
                                                                       o&w/dye.
73725.................  E....................  .....................  Mr ang lwr ext w or w/o  .....  .........  ...........  ............  ............
                                                                       dye.
74000.................  X....................  .....................  X-ray exam of abdomen..   0260     0.7845       $42.59        $21.29         $8.52
74010.................  X....................  .....................  X-ray exam of abdomen..   0260     0.7845       $42.59        $21.29         $8.52
74020.................  X....................  .....................  X-ray exam of abdomen..   0260     0.7845       $42.59        $21.29         $8.52
74022.................  X....................  .....................  X-ray exam series,        0261     1.3238       $71.87  ............        $14.37
                                                                       abdomen.
74150.................  S....................  .....................  Ct abdomen w/o dye.....   0332     3.3916      $184.13        $91.27        $36.83
74160.................  S....................  .....................  Ct abdomen w/dye.......   0283     4.6121      $250.39       $125.19        $50.08
74170.................  S....................  .....................  Ct abdomen w/o&w/dye...   0333     5.4299      $294.78       $146.98        $58.96
74175.................  S....................  .....................  Ct angio abdom w/o&w/     0662     5.8751      $318.95       $156.47        $63.79
                                                                       dye.
74181.................  S....................  .....................  Mri abdomen w/o dye....   0336     6.4817      $351.89       $175.94        $70.38
74182.................  S....................  .....................  Mri abdomen w/dye......   0284     7.0207      $381.15       $190.57        $76.23
74183.................  S....................  .....................  Mri abdomen w/o&w/dye..   0337     9.3215      $506.05       $240.77       $101.21
74185.................  E....................  .....................  Mri angio, abdom w or w/ .....  .........  ...........  ............  ............
                                                                       o dy.
74190.................  X....................  .....................  X-ray exam of             0263     2.1875      $118.76        $43.58        $23.75
                                                                       peritoneum.
74210.................  S....................  .....................  Contrst x-ray exam of     0276     1.6025       $87.00        $41.72        $17.40
                                                                       throat.
74220.................  S....................  .....................  Contrast x-ray,           0276     1.6025       $87.00        $41.72        $17.40
                                                                       esophagus.
74230.................  S....................  .....................  Cine/vid x-ray, throat/   0276     1.6025       $87.00        $41.72        $17.40
                                                                       esoph.
74235.................  S....................  .....................  Remove esophagus          0296     3.1381      $170.36        $69.20        $34.07
                                                                       obstruction.
74240.................  S....................  .....................  X-ray exam, upper gi      0276     1.6025       $87.00        $41.72        $17.40
                                                                       tract.
74241.................  S....................  .....................  X-ray exam, upper gi      0276     1.6025       $87.00        $41.72        $17.40
                                                                       tract.
74245.................  S....................  .....................  X-ray exam, upper gi      0277     2.4462      $132.80        $60.47        $26.56
                                                                       tract.
74246.................  S....................  .....................  Contrst x-ray uppr gi     0276     1.6025       $87.00        $41.72        $17.40
                                                                       tract.
74247.................  S....................  .....................  Contrst x-ray uppr gi     0276     1.6025       $87.00        $41.72        $17.40
                                                                       tract.
74249.................  S....................  .....................  Contrst x-ray uppr gi     0277     2.4462      $132.80        $60.47        $26.56
                                                                       tract.
74250.................  S....................  .....................  X-ray exam of small       0276     1.6025       $87.00        $41.72        $17.40
                                                                       bowel.
74251.................  S....................  .....................  X-ray exam of small       0277     2.4462      $132.80        $60.47        $26.56
                                                                       bowel.
74260.................  S....................  .....................  X-ray exam of small       0277     2.4462      $132.80        $60.47        $26.56
                                                                       bowel.
74270.................  S....................  .....................  Contrast x-ray exam of    0276     1.6025       $87.00        $41.72        $17.40
                                                                       colon.
74280.................  S....................  .....................  Contrast x-ray exam of    0277     2.4462      $132.80        $60.47        $26.56
                                                                       colon.
74283.................  S....................  .....................  Contrast x-ray exam of    0276     1.6025       $87.00        $41.72        $17.40
                                                                       colon.
74290.................  S....................  .....................  Contrast x-ray,           0276     1.6025       $87.00        $41.72        $17.40
                                                                       gallbladder.
74291.................  S....................  .....................  Contrast x-rays,          0276     1.6025       $87.00        $41.72        $17.40
                                                                       gallbladder.
74300.................  X....................  .....................  X-ray bile ducts/         0263     2.1875      $118.76        $43.58        $23.75
                                                                       pancreas.
74301.................  X....................  .....................  X-rays at surgery add-    0263     2.1875      $118.76        $43.58        $23.75
                                                                       on.
74305.................  X....................  .....................  X-ray bile ducts/         0263     2.1875      $118.76        $43.58        $23.75
                                                                       pancreas.
74320.................  X....................  .....................  Contrast x-ray of bile    0264     3.0022      $162.99        $79.41        $32.60
                                                                       ducts.
74327.................  S....................  .....................  X-ray bile stone          0296     3.1381      $170.36        $69.20        $34.07
                                                                       removal.
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     1.4086       $76.47        $38.23        $15.29
74350.................  X....................  .....................  X-ray guide, stomach      0263     2.1875      $118.76        $43.58        $23.75
                                                                       tube.
74355.................  X....................  .....................  X-ray guide, intestinal   0263     2.1875      $118.76        $43.58        $23.75
                                                                       tube.
74360.................  S....................  .....................  X-ray guide, GI           0296     3.1381      $170.36        $69.20        $34.07
                                                                       dilation.
74363.................  S....................  .....................  X-ray, bile duct          0297     8.1532      $442.63       $172.51        $88.53
                                                                       dilation.

[[Page 48117]]

 
74400.................  S....................  .....................  Contrst x-ray, urinary    0278     2.7365      $148.56        $66.07        $29.71
                                                                       tract.
74410.................  S....................  .....................  Contrst x-ray, urinary    0278     2.7365      $148.56        $66.07        $29.71
                                                                       tract.
74415.................  S....................  .....................  Contrst x-ray, urinary    0278     2.7365      $148.56        $66.07        $29.71
                                                                       tract.
74420.................  S....................  .....................  Contrst x-ray, urinary    0278     2.7365      $148.56        $66.07        $29.71
                                                                       tract.
74425.................  S....................  .....................  Contrst x-ray, urinary    0278     2.7365      $148.56        $66.07        $29.71
                                                                       tract.
74430.................  S....................  .....................  Contrast x-ray, bladder   0278     2.7365      $148.56        $66.07        $29.71
74440.................  S....................  .....................  X-ray, male genital       0278     2.7365      $148.56        $66.07        $29.71
                                                                       tract.
74445.................  S....................  .....................  X-ray exam of penis....   0278     2.7365      $148.56        $66.07        $29.71
74450.................  S....................  .....................  X-ray, urethra/bladder.   0278     2.7365      $148.56        $66.07        $29.71
74455.................  S....................  .....................  X-ray, urethra/bladder.   0278     2.7365      $148.56        $66.07        $29.71
74470.................  X....................  .....................  X-ray exam of kidney      0264     3.0022      $162.99        $79.41        $32.60
                                                                       lesion.
74475.................  S....................  .....................  X-ray control, cath       0297     8.1532      $442.63       $172.51        $88.53
                                                                       insert.
74480.................  S....................  .....................  X-ray control, cath       0296     3.1381      $170.36        $69.20        $34.07
                                                                       insert.
74485.................  S....................  .....................  X-ray guide, GU           0296     3.1381      $170.36        $69.20        $34.07
                                                                       dilation.
74710.................  X....................  .....................  X-ray measurement of      0260     0.7845       $42.59        $21.29         $8.52
                                                                       pelvis.
74740.................  X....................  .....................  X-ray, female genital     0264     3.0022      $162.99        $79.41        $32.60
                                                                       tract.
74742.................  X....................  .....................  X-ray, fallopian tube..   0263     2.1875      $118.76        $43.58        $23.75
74775.................  S....................  .....................  X-ray exam of perineum.   0278     2.7365      $148.56        $66.07        $29.71
75552.................  S....................  .....................  Heart mri for morph w/o   0336     6.4817      $351.89       $175.94        $70.38
                                                                       dye.
75553.................  S....................  .....................  Heart mri for morph w/    0284     7.0207      $381.15       $190.57        $76.23
                                                                       dye.
75554.................  S....................  .....................  Cardiac MRI/function...   0335     6.4453      $349.91       $151.46        $69.98
75555.................  S....................  .....................  Cardiac MRI/limited       0335     6.4453      $349.91       $151.46        $69.98
                                                                       study.
75556.................  E....................  .....................  Cardiac MRI/flow         .....  .........  ...........  ............  ............
                                                                       mapping.
75600.................  S....................  .....................  Contrast x-ray exam of    0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       aorta.
75605.................  S....................  .....................  Contrast x-ray exam of    0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       aorta.
75625.................  S....................  .....................  Contrast x-ray exam of    0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       aorta.
75630.................  S....................  .....................  X-ray aorta, leg          0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       arteries.
75635.................  S....................  .....................  Ct angio abdominal        0662     5.8751      $318.95       $156.47        $63.79
                                                                       arteries.
75650.................  S....................  .....................  Artery x-rays, head &     0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       neck.
75658.................  S....................  .....................  Artery x-rays, arm.....   0280    19.0237    $1,032.78       $353.85       $206.56
75660.................  S....................  .....................  Artery x-rays, head &     0279    11.0678      $600.86       $174.57       $120.17
                                                                       neck.
75662.................  S....................  .....................  Artery x-rays, head &     0279    11.0678      $600.86       $174.57       $120.17
                                                                       neck.
75665.................  S....................  .....................  Artery x-rays, head &     0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       neck.
75671.................  S....................  .....................  Artery x-rays, head &     0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       neck.
75676.................  S....................  .....................  Artery x-rays, neck....   0280    19.0237    $1,032.78       $353.85       $206.56
75680.................  S....................  .....................  Artery x-rays, neck....   0280    19.0237    $1,032.78       $353.85       $206.56
75685.................  S....................  .....................  Artery x-rays, spine...   0279    11.0678      $600.86       $174.57       $120.17
75705.................  S....................  .....................  Artery x-rays, spine...   0279    11.0678      $600.86       $174.57       $120.17
75710.................  S....................  .....................  Artery x-rays, arm/leg.   0280    19.0237    $1,032.78       $353.85       $206.56
75716.................  S....................  .....................  Artery x-rays, arms/      0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       legs.
75722.................  S....................  .....................  Artery x-rays, kidney..   0280    19.0237    $1,032.78       $353.85       $206.56
75724.................  S....................  .....................  Artery x-rays, kidneys.   0280    19.0237    $1,032.78       $353.85       $206.56
75726.................  S....................  .....................  Artery x-rays, abdomen.   0280    19.0237    $1,032.78       $353.85       $206.56
75731.................  S....................  .....................  Artery x-rays, adrenal    0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       gland.
75733.................  S....................  .....................  Artery x-rays, adrenals   0280    19.0237    $1,032.78       $353.85       $206.56
75736.................  S....................  .....................  Artery x-rays, pelvis..   0280    19.0237    $1,032.78       $353.85       $206.56
75741.................  S....................  .....................  Artery x-rays, lung....   0279    11.0678      $600.86       $174.57       $120.17
75743.................  S....................  .....................  Artery x-rays, lungs...   0280    19.0237    $1,032.78       $353.85       $206.56
75746.................  S....................  .....................  Artery x-rays, lung....   0279    11.0678      $600.86       $174.57       $120.17
75756.................  S....................  .....................  Artery x-rays, chest...   0279    11.0678      $600.86       $174.57       $120.17
75774.................  S....................  .....................  Artery x-ray, each        0668    10.4896      $569.47       $237.76       $113.89
                                                                       vessel.
75790.................  S....................  .....................  Visualize A-V shunt....   0281     6.6888      $363.13       $115.16        $72.63
75801.................  X....................  .....................  Lymph vessel x-ray, arm/  0264     3.0022      $162.99        $79.41        $32.60
                                                                       leg.
75803.................  X....................  .....................  Lymph vessel x-ray,arms/  0264     3.0022      $162.99        $79.41        $32.60
                                                                       legs.
75805.................  X....................  .....................  Lymph vessel x-ray,       0264     3.0022      $162.99        $79.41        $32.60
                                                                       trunk.
75807.................  X....................  .....................  Lymph vessel x-ray,       0264     3.0022      $162.99        $79.41        $32.60
                                                                       trunk.
75809.................  X....................  .....................  Nonvascular shunt, x-     0263     2.1875      $118.76        $43.58        $23.75
                                                                       ray.
75810.................  S....................  .....................  Vein x-ray, spleen/       0279    11.0678      $600.86       $174.57       $120.17
                                                                       liver.
75820.................  S....................  .....................  Vein x-ray, arm/leg....   0281     6.6888      $363.13       $115.16        $72.63
75822.................  S....................  .....................  Vein x-ray, arms/legs..   0281     6.6888      $363.13       $115.16        $72.63
75825.................  S....................  .....................  Vein x-ray, trunk......   0279    11.0678      $600.86       $174.57       $120.17
75827.................  S....................  .....................  Vein x-ray, chest......   0279    11.0678      $600.86       $174.57       $120.17
75831.................  S....................  .....................  Vein x-ray, kidney.....   0287     6.2829      $341.09       $107.20        $68.22
75833.................  S....................  .....................  Vein x-ray, kidneys....   0279    11.0678      $600.86       $174.57       $120.17
75840.................  S....................  .....................  Vein x-ray, adrenal       0287     6.2829      $341.09       $107.20        $68.22
                                                                       gland.
75842.................  S....................  .....................  Vein x-ray, adrenal       0287     6.2829      $341.09       $107.20        $68.22
                                                                       glands.

[[Page 48118]]

 
75860.................  S....................  .....................  Vein x-ray, neck.......   0287     6.2829      $341.09       $107.20        $68.22
75870.................  S....................  .....................  Vein x-ray, skull......   0287     6.2829      $341.09       $107.20        $68.22
75872.................  S....................  .....................  Vein x-ray, skull......   0287     6.2829      $341.09       $107.20        $68.22
75880.................  S....................  .....................  Vein x-ray, eye socket.   0287     6.2829      $341.09       $107.20        $68.22
75885.................  S....................  .....................  Vein x-ray, liver......   0279    11.0678      $600.86       $174.57       $120.17
75887.................  S....................  .....................  Vein x-ray, liver......   0280    19.0237    $1,032.78       $353.85       $206.56
75889.................  S....................  .....................  Vein x-ray, liver......   0279    11.0678      $600.86       $174.57       $120.17
75891.................  S....................  .....................  Vein x-ray, liver......   0279    11.0678      $600.86       $174.57       $120.17
75893.................  N....................  .....................  Venous sampling by       .....  .........  ...........  ............  ............
                                                                       catheter.
75894.................  S....................  .....................  X-rays, transcath         0297     8.1532      $442.63       $172.51        $88.53
                                                                       therapy.
75896.................  S....................  .....................  X-rays, transcath         0297     8.1532      $442.63       $172.51        $88.53
                                                                       therapy.
75898.................  X....................  .....................  Follow-up angiography..   0264     3.0022      $162.99        $79.41        $32.60
75900.................  C....................  .....................  Arterial catheter        .....  .........  ...........  ............  ............
                                                                       exchange.
75901.................  X....................  .....................  Remove cva device         0264     3.0022      $162.99        $79.41        $32.60
                                                                       obstruct.
75902.................  X....................  .....................  Remove cva lumen          0263     2.1875      $118.76        $43.58        $23.75
                                                                       obstruct.
75940.................  X....................  .....................  X-ray placement, vein     0187     4.4274      $240.36        $90.71        $48.07
                                                                       filter.
75945.................  S....................  .....................  Intravascular us.......   0267     2.4805      $134.66        $65.52        $26.93
75946.................  S....................  .....................  Intravascular us add-on   0267     2.4805      $134.66        $65.52        $26.93
75952.................  C....................  .....................  Endovasc repair abdom    .....  .........  ...........  ............  ............
                                                                       aorta.
75953.................  C....................  .....................  Abdom aneurysm endovas   .....  .........  ...........  ............  ............
                                                                       rpr.
75954.................  C....................  .....................  Iliac aneurysm endovas   .....  .........  ...........  ............  ............
                                                                       rpr.
75960.................  S....................  .....................  Transcatheter intro,      0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       stent.
75961.................  S....................  .....................  Retrieval, broken         0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       catheter.
75962.................  S....................  .....................  Repair arterial           0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       blockage.
75964.................  S....................  .....................  Repair artery blockage,   0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       each.
75966.................  S....................  .....................  Repair arterial           0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       blockage.
75968.................  S....................  .....................  Repair artery blockage,   0280    19.0237    $1,032.78       $353.85       $206.56
                                                                       each.
75970.................  S....................  .....................  Vascular biopsy........   0280    19.0237    $1,032.78       $353.85       $206.56
75978.................  S....................  .....................  Repair venous blockage.   0668    10.4896      $569.47       $237.76       $113.89
75980.................  S....................  .....................  Contrast xray exam bile   0296     3.1381      $170.36        $69.20        $34.07
                                                                       duct.
75982.................  S....................  .....................  Contrast xray exam bile   0297     8.1532      $442.63       $172.51        $88.53
                                                                       duct.
75984.................  X....................  .....................  Xray control catheter     0264     3.0022      $162.99        $79.41        $32.60
                                                                       change.
75989.................  N....................  .....................  Abscess drainage under   .....  .........  ...........  ............  ............
                                                                       x-ray.
75992.................  S....................  .....................  Atherectomy, x-ray exam   0280    19.0237    $1,032.78       $353.85       $206.56
75993.................  S....................  .....................  Atherectomy, x-ray exam   0280    19.0237    $1,032.78       $353.85       $206.56
75994.................  S....................  .....................  Atherectomy, x-ray exam   0280    19.0237    $1,032.78       $353.85       $206.56
75995.................  S....................  .....................  Atherectomy, x-ray exam   0280    19.0237    $1,032.78       $353.85       $206.56
75996.................  S....................  .....................  Atherectomy, x-ray exam   0280    19.0237    $1,032.78       $353.85       $206.56
76000.................  X....................  .....................  Fluoroscope examination   0272     1.4086       $76.47        $38.23        $15.29
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     0.7845       $42.59        $21.29         $8.52
76010.................  X....................  .....................  X-ray, nose to rectum..   0260     0.7845       $42.59        $21.29         $8.52
76012.................  S....................  .....................  Percut vertebroplasty     0274     3.5837      $194.56        $92.92        $38.91
                                                                       fluor.
76013.................  S....................  .....................  Percut vertebroplasty,    0274     3.5837      $194.56        $92.92        $38.91
                                                                       ct.
76020.................  X....................  .....................  X-rays for bone age....   0260     0.7845       $42.59        $21.29         $8.52
76040.................  X....................  .....................  X-rays, bone evaluation   0260     0.7845       $42.59        $21.29         $8.52
76061.................  X....................  .....................  X-rays, bone survey....   0261     1.3238       $71.87  ............        $14.37
76062.................  X....................  .....................  X-rays, bone survey....   0261     1.3238       $71.87  ............        $14.37
76065.................  X....................  .....................  X-rays, bone evaluation   0261     1.3238       $71.87  ............        $14.37
76066.................  X....................  .....................  Joint survey, single      0260     0.7845       $42.59        $21.29         $8.52
                                                                       view.
76070.................  S....................  .....................  CT scan, bone density     0288     1.2854       $69.78  ............        $13.96
                                                                       study.
76071.................  S....................  .....................  Ct bone density,          0282     1.6813       $91.28        $44.51        $18.26
                                                                       peripheral.
76075.................  S....................  .....................  Dexa, axial skeleton      0288     1.2854       $69.78  ............        $13.96
                                                                       study.
76076.................  S....................  .....................  Dexa, peripheral study.   0665     0.7225       $39.22  ............         $7.84
76078.................  X....................  .....................  Radiographic              0261     1.3238       $71.87  ............        $14.37
                                                                       absorptiometry.
76080.................  X....................  .....................  X-ray exam of fistula..   0263     2.1875      $118.76        $43.58        $23.75
76085.................  A....................  .....................  Computer mammogram add-  .....  .........  ...........  ............  ............
                                                                       on.
76086.................  X....................  .....................  X-ray of mammary duct..   0263     2.1875      $118.76        $43.58        $23.75
76088.................  X....................  .....................  X-ray of mammary ducts.   0263     2.1875      $118.76        $43.58        $23.75
76090.................  S....................  .....................  Mammogram, one breast..   0271     0.6548       $35.55        $16.80         $7.11
76091.................  S....................  .....................  Mammogram, both breasts   0271     0.6548       $35.55        $16.80         $7.11
76092.................  A....................  .....................  Mammogram, screening...  .....  .........  ...........  ............  ............
76093.................  E....................  .....................  Magnetic image, breast.  .....  .........  ...........  ............  ............
76094.................  E....................  .....................  Magnetic image, both     .....  .........  ...........  ............  ............
                                                                       breasts.

[[Page 48119]]

 
76095.................  X....................  .....................  Stereotactic breast       0187     4.4274      $240.36        $90.71        $48.07
                                                                       biopsy.
76096.................  X....................  .....................  X-ray of needle wire,     0289     3.6386      $197.54        $44.80        $39.51
                                                                       breast.
76098.................  X....................  .....................  X-ray exam, breast        0260     0.7845       $42.59        $21.29         $8.52
                                                                       specimen.
76100.................  X....................  .....................  X-ray exam of body        0261     1.3238       $71.87  ............        $14.37
                                                                       section.
76101.................  X....................  .....................  Complex body section x-   0264     3.0022      $162.99        $79.41        $32.60
                                                                       ray.
76102.................  X....................  .....................  Complex body section x-   0264     3.0022      $162.99        $79.41        $32.60
                                                                       rays.
76120.................  X....................  .....................  Cine/video x-rays......   0272     1.4086       $76.47        $38.23        $15.29
76125.................  X....................  .....................  Cine/video x-rays add-    0260     0.7845       $42.59        $21.29         $8.52
                                                                       on.
76140.................  E....................  .....................  X-ray consultation.....  .....  .........  ...........  ............  ............
76150.................  X....................  .....................  X-ray exam, dry process   0260     0.7845       $42.59        $21.29         $8.52
76350.................  N....................  .....................  Special x-ray contrast   .....  .........  ...........  ............  ............
                                                                       study.
76355.................  S....................  .....................  CAT scan for              0283     4.6121      $250.39       $125.19        $50.08
                                                                       localization.
76360.................  S....................  .....................  CAT scan for needle       0283     4.6121      $250.39       $125.19        $50.08
                                                                       biopsy.
76362.................  S....................  .....................  Cat scan for tissue       0332     3.3916      $184.13        $91.27        $36.83
                                                                       ablation.
76370.................  S....................  .....................  CAT scan for therapy      0282     1.6813       $91.28        $44.51        $18.26
                                                                       guide.
76375.................  S....................  .....................  3d/holograph reconstr     0282     1.6813       $91.28        $44.51        $18.26
                                                                       add-on.
76380.................  S....................  .....................  CAT scan follow-up        0282     1.6813       $91.28        $44.51        $18.26
                                                                       study.
76390.................  E....................  .....................  Mr spectroscopy........  .....  .........  ...........  ............  ............
76393.................  S....................  .....................  Mr guidance for needle    0335     6.4453      $349.91       $151.46        $69.98
                                                                       place.
76394.................  S....................  .....................  Mri for tissue ablation   0335     6.4453      $349.91       $151.46        $69.98
76400.................  S....................  .....................  Magnetic image, bone      0335     6.4453      $349.91       $151.46        $69.98
                                                                       marrow.
76490.................  S....................  .....................  Us for tissue ablation.   0268     1.2640       $68.62  ............        $13.72
76496.................  X....................  .....................  Fluoroscopic procedure.   0272     1.4086       $76.47        $38.23        $15.29
76497.................  S....................  .....................  Ct procedure...........   0282     1.6813       $91.28        $44.51        $18.26
76498.................  S....................  .....................  Mri procedure..........   0335     6.4453      $349.91       $151.46        $69.98
76499.................  X....................  .....................  Radiographic procedure.   0260     0.7845       $42.59        $21.29         $8.52
76506.................  S....................  .....................  Echo exam of head......   0266     1.6234       $88.13        $44.06        $17.63
76511.................  S....................  .....................  Echo exam of eye.......   0266     1.6234       $88.13        $44.06        $17.63
76512.................  S....................  .....................  Echo exam of eye.......   0266     1.6234       $88.13        $44.06        $17.63
76513.................  S....................  .....................  Echo exam of eye, water   0265     1.0245       $55.62        $27.81        $11.12
                                                                       bath.
76516.................  S....................  .....................  Echo exam of eye.......   0266     1.6234       $88.13        $44.06        $17.63
76519.................  S....................  .....................  Echo exam of eye.......   0266     1.6234       $88.13        $44.06        $17.63
76529.................  S....................  .....................  Echo exam of eye.......   0265     1.0245       $55.62        $27.81        $11.12
76536.................  S....................  .....................  Us exam of head and       0266     1.6234       $88.13        $44.06        $17.63
                                                                       neck.
76604.................  S....................  .....................  Us exam, chest, b-scan.   0266     1.6234       $88.13        $44.06        $17.63
76645.................  S....................  .....................  Us exam, breast(s).....   0265     1.0245       $55.62        $27.81        $11.12
76700.................  S....................  .....................  Us exam, abdom,           0266     1.6234       $88.13        $44.06        $17.63
                                                                       complete.
76705.................  S....................  .....................  Echo exam of abdomen...   0266     1.6234       $88.13        $44.06        $17.63
76770.................  S....................  .....................  Us exam abdo back wall,   0266     1.6234       $88.13        $44.06        $17.63
                                                                       comp.
76775.................  S....................  .....................  Us eam abdo back wall,    0266     1.6234       $88.13        $44.06        $17.63
                                                                       lim.
76778.................  S....................  .....................  Us exam kidney            0266     1.6234       $88.13        $44.06        $17.63
                                                                       transplant.
76800.................  S....................  .....................  Us exam, spinal canal..   0266     1.6234       $88.13        $44.06        $17.63
76801.................  S....................  .....................  Ob us < 14 wks, single    0265     1.0245       $55.62        $27.81        $11.12
                                                                       fetus.
76802.................  S....................  .....................  Ob us < 14 wks, addl      0265     1.0245       $55.62        $27.81        $11.12
                                                                       fetus.
76805.................  S....................  .....................  Us exam, pg uterus,       0266     1.6234       $88.13        $44.06        $17.63
                                                                       compl.
76810.................  S....................  .....................  Us exam, pg uterus,       0265     1.0245       $55.62        $27.81        $11.12
                                                                       mult.
76811.................  S....................  .....................  Ob us, detailed, sngl     0267     2.4805      $134.66        $65.52        $26.93
                                                                       fetus.
76812.................  S....................  .....................  Ob us, detailed, addl     0266     1.6234       $88.13        $44.06        $17.63
                                                                       fetus.
76815.................  S....................  .....................  Us exam, pg uterus        0265     1.0245       $55.62        $27.81        $11.12
                                                                       limit.
76816.................  S....................  .....................  Us exam pg uterus         0265     1.0245       $55.62        $27.81        $11.12
                                                                       repeat.
76817.................  S....................  .....................  Transvaginal us,          0265     1.0245       $55.62        $27.81        $11.12
                                                                       obstetric.
76818.................  S....................  .....................  Fetal biophys profile w/  0266     1.6234       $88.13        $44.06        $17.63
                                                                       nst.
76819.................  S....................  .....................  Fetal biophys profil w/   0266     1.6234       $88.13        $44.06        $17.63
                                                                       o nst.
76825.................  S....................  .....................  Echo exam of fetal        0671     1.6392       $88.99        $44.49        $17.80
                                                                       heart.
76826.................  S....................  .....................  Echo exam of fetal        0697     1.4621       $79.38        $39.69        $15.88
                                                                       heart.
76827.................  S....................  .....................  Echo exam of fetal        0671     1.6392       $88.99        $44.49        $17.80
                                                                       heart.
76828.................  S....................  .....................  Echo exam of fetal        0697     1.4621       $79.38        $39.69        $15.88
                                                                       heart.
76830.................  S....................  .....................  Transvaginal us, non-ob   0266     1.6234       $88.13        $44.06        $17.63
76831.................  S....................  .....................  Echo exam, uterus......   0266     1.6234       $88.13        $44.06        $17.63
76856.................  S....................  .....................  Us exam, pelvic,          0266     1.6234       $88.13        $44.06        $17.63
                                                                       complete.
76857.................  S....................  .....................  Us exam, pelvic,          0265     1.0245       $55.62        $27.81        $11.12
                                                                       limited.
76870.................  S....................  .....................  Us exam, scrotum.......   0266     1.6234       $88.13        $44.06        $17.63
76872.................  S....................  .....................  Echo exam, transrectal.   0266     1.6234       $88.13        $44.06        $17.63
76873.................  S....................  .....................  Echograp trans r, pros    0266     1.6234       $88.13        $44.06        $17.63
                                                                       study.
76880.................  S....................  .....................  Us exam, extremity.....   0266     1.6234       $88.13        $44.06        $17.63
76885.................  S....................  .....................  Us exam infant hips,      0266     1.6234       $88.13        $44.06        $17.63
                                                                       dynamic.

[[Page 48120]]

 
76886.................  S....................  .....................  Us exam infant hips,      0266     1.6234       $88.13        $44.06        $17.63
                                                                       static.
76930.................  S....................  .....................  Echo guide,               0268     1.2640       $68.62  ............        $13.72
                                                                       cardiocentesis.
76932.................  S....................  .....................  Echo guide for heart      0268     1.2640       $68.62  ............        $13.72
                                                                       biopsy.
76936.................  S....................  .....................  Echo guide for artery     0268     1.2640       $68.62  ............        $13.72
                                                                       repair.
76941.................  S....................  .....................  Echo guide for            0268     1.2640       $68.62  ............        $13.72
                                                                       transfusion.
76942.................  S....................  .....................  Echo guide for biopsy..   0268     1.2640       $68.62  ............        $13.72
76945.................  S....................  .....................  Echo guide, villus        0268     1.2640       $68.62  ............        $13.72
                                                                       sampling.
76946.................  S....................  .....................  Echo guide for            0268     1.2640       $68.62  ............        $13.72
                                                                       amniocentesis.
76948.................  S....................  .....................  Echo guide, ova           0268     1.2640       $68.62  ............        $13.72
                                                                       aspiration.
76950.................  S....................  .....................  Echo guidance             0268     1.2640       $68.62  ............        $13.72
                                                                       radiotherapy.
76965.................  S....................  .....................  Echo guidance             0268     1.2640       $68.62  ............        $13.72
                                                                       radiotherapy.
76970.................  S....................  .....................  Ultrasound exam follow-   0265     1.0245       $55.62        $27.81        $11.12
                                                                       up.
76975.................  S....................  .....................  GI endoscopic             0266     1.6234       $88.13        $44.06        $17.63
                                                                       ultrasound.
76977.................  X....................  .....................  Us bone density measure   0340     0.6232       $33.83  ............         $6.77
76986.................  S....................  .....................  Ultrasound guide          0266     1.6234       $88.13        $44.06        $17.63
                                                                       intraoper.
76999.................  S....................  .....................  Echo examination          0265     1.0245       $55.62        $27.81        $11.12
                                                                       procedure.
77261.................  E....................  .....................  Radiation therapy        .....  .........  ...........  ............  ............
                                                                       planning.
77262.................  E....................  .....................  Radiation therapy        .....  .........  ...........  ............  ............
                                                                       planning.
77263.................  E....................  .....................  Radiation therapy        .....  .........  ...........  ............  ............
                                                                       planning.
77280.................  X....................  .....................  Set radiation therapy     0304     1.6599       $90.11        $41.52        $18.02
                                                                       field.
77285.................  X....................  .....................  Set radiation therapy     0305     3.6649      $198.96        $91.38        $39.79
                                                                       field.
77290.................  X....................  .....................  Set radiation therapy     0305     3.6649      $198.96        $91.38        $39.79
                                                                       field.
77295.................  X....................  .....................  Set radiation therapy     0310    13.7085      $744.22       $325.27       $148.84
                                                                       field.
77299.................  E....................  .....................  Radiation therapy        .....  .........  ...........  ............  ............
                                                                       planning.
77300.................  X....................  .....................  Radiation therapy dose    0304     1.6599       $90.11        $41.52        $18.02
                                                                       plan.
77301.................  S....................  .....................  Radiotherapy dose plan,   0413     6.0369      $327.74  ............        $65.55
                                                                       imrt.
77305.................  X....................  .....................  Teletx isodose plan       0304     1.6599       $90.11        $41.52        $18.02
                                                                       simple.
77310.................  X....................  .....................  Teletx isodose plan       0304     1.6599       $90.11        $41.52        $18.02
                                                                       intermed.
77315.................  X....................  .....................  Teletx isodose plan       0305     3.6649      $198.96        $91.38        $39.79
                                                                       complex.
77321.................  X....................  .....................  Special teletx port       0305     3.6649      $198.96        $91.38        $39.79
                                                                       plan.
77326.................  X....................  .....................  Radiation therapy dose    0305     3.6649      $198.96        $91.38        $39.79
                                                                       plan.
77327.................  X....................  .....................  Brachytx isodose calc     0305     3.6649      $198.96        $91.38        $39.79
                                                                       interm.
77328.................  X....................  .....................  Brachytx isodose plan     0305     3.6649      $198.96        $91.38        $39.79
                                                                       compl.
77331.................  X....................  .....................  Special radiation         0304     1.6599       $90.11        $41.52        $18.02
                                                                       dosimetry.
77332.................  X....................  .....................  Radiation treatment       0303     2.8636      $155.46        $66.95        $31.09
                                                                       aid(s).
77333.................  X....................  .....................  Radiation treatment       0303     2.8636      $155.46        $66.95        $31.09
                                                                       aid(s).
77334.................  X....................  .....................  Radiation treatment       0303     2.8636      $155.46        $66.95        $31.09
                                                                       aid(s).
77336.................  X....................  .....................  Radiation physics         0304     1.6599       $90.11        $41.52        $18.02
                                                                       consult.
77370.................  X....................  .....................  Radiation physics         0305     3.6649      $198.96        $91.38        $39.79
                                                                       consult.
77399.................  X....................  .....................  External radiation        0304     1.6599       $90.11        $41.52        $18.02
                                                                       dosimetry.
77401.................  S....................  .....................  Radiation treatment       0300     1.5112       $82.04  ............        $16.41
                                                                       delivery.
77402.................  S....................  .....................  Radiation treatment       0300     1.5112       $82.04  ............        $16.41
                                                                       delivery.
77403.................  S....................  .....................  Radiation treatment       0300     1.5112       $82.04  ............        $16.41
                                                                       delivery.
77404.................  S....................  .....................  Radiation treatment       0300     1.5112       $82.04  ............        $16.41
                                                                       delivery.
77406.................  S....................  .....................  Radiation treatment       0300     1.5112       $82.04  ............        $16.41
                                                                       delivery.
77407.................  S....................  .....................  Radiation treatment       0300     1.5112       $82.04  ............        $16.41
                                                                       delivery.
77408.................  S....................  .....................  Radiation treatment       0300     1.5112       $82.04  ............        $16.41
                                                                       delivery.
77409.................  S....................  .....................  Radiation treatment       0300     1.5112       $82.04  ............        $16.41
                                                                       delivery.
77411.................  S....................  .....................  Radiation treatment       0300     1.5112       $82.04  ............        $16.41
                                                                       delivery.
77412.................  S....................  .....................  Radiation treatment       0301     2.1337      $115.84        $23.17        $23.17
                                                                       delivery.
77413.................  S....................  .....................  Radiation treatment       0301     2.1337      $115.84        $23.17        $23.17
                                                                       delivery.
77414.................  S....................  .....................  Radiation treatment       0301     2.1337      $115.84        $23.17        $23.17
                                                                       delivery.
77416.................  S....................  .....................  Radiation treatment       0301     2.1337      $115.84        $23.17        $23.17
                                                                       delivery.
77417.................  X....................  .....................  Radiology port film(s).   0260     0.7845       $42.59        $21.29         $8.52
77418.................  S....................  .....................  Radiation tx delivery,    0412     5.2832      $286.82  ............        $57.36
                                                                       imrt.
77427.................  E....................  .....................  Radiation tx             .....  .........  ...........  ............  ............
                                                                       management, x5.
77431.................  E....................  .....................  Radiation therapy        .....  .........  ...........  ............  ............
                                                                       management.
77432.................  E....................  .....................  Stereotactic radiation   .....  .........  ...........  ............  ............
                                                                       trmt.
77470.................  S....................  .....................  Special radiation         0299     5.7427      $311.77        $62.36        $62.35
                                                                       treatment.
77499.................  E....................  .....................  Radiation therapy        .....  .........  ...........  ............  ............
                                                                       management.
77520.................  S....................  .....................  Proton trmt, simple w/o   0664     9.6828      $525.67  ............       $105.13
                                                                       comp.
77522.................  S....................  .....................  Proton trmt, simple w/    0664     9.6828      $525.67  ............       $105.13
                                                                       comp.
77523.................  S....................  .....................  Proton trmt,              1511  .........      $950.00  ............       $190.00
                                                                       intermediate.
77525.................  S....................  .....................  Proton treatment,         1511  .........      $950.00  ............       $190.00
                                                                       complex.
77600.................  S....................  .....................  Hyperthermia treatment.   0314     5.0930      $276.49       $101.77        $55.30
77605.................  S....................  .....................  Hyperthermia treatment.   0314     5.0930      $276.49       $101.77        $55.30

[[Page 48121]]

 
77610.................  S....................  .....................  Hyperthermia treatment.   0314     5.0930      $276.49       $101.77        $55.30
77615.................  S....................  .....................  Hyperthermia treatment.   0314     5.0930      $276.49       $101.77        $55.30
77620.................  S....................  .....................  Hyperthermia treatment.   0314     5.0930      $276.49       $101.77        $55.30
77750.................  S....................  .....................  Infuse radioactive        0300     1.5112       $82.04  ............        $16.41
                                                                       materials.
77761.................  S....................  .....................  Apply intrcav radiat      0312     3.6892      $200.28        $40.06        $40.06
                                                                       simple.
77762.................  S....................  .....................  Apply intrcav radiat      0312     3.6892      $200.28        $40.06        $40.06
                                                                       interm.
77763.................  S....................  .....................  Apply intrcav radiat      0312     3.6892      $200.28        $40.06        $40.06
                                                                       compl.
77776.................  S....................  .....................  Apply interstit radiat    0312     3.6892      $200.28        $40.06        $40.06
                                                                       simpl.
77777.................  S....................  .....................  Apply interstit radiat    0312     3.6892      $200.28        $40.06        $40.06
                                                                       inter.
77778.................  S....................  .....................  Apply interstit radiat    0651    10.0459      $545.38       $109.08       $109.08
                                                                       compl.
77781.................  S....................  .....................  High intensity            0313    13.1258      $712.59  ............       $142.52
                                                                       brachytherapy.
77782.................  S....................  .....................  High intensity            0313    13.1258      $712.59  ............       $142.52
                                                                       brachytherapy.
77783.................  S....................  .....................  High intensity            0313    13.1258      $712.59  ............       $142.52
                                                                       brachytherapy.
77784.................  S....................  .....................  High intensity            0313    13.1258      $712.59  ............       $142.52
                                                                       brachytherapy.
77789.................  S....................  .....................  Apply surface radiation   0300     1.5112       $82.04  ............        $16.41
77790.................  N....................  .....................  Radiation handling.....  .....  .........  ...........  ............  ............
77799.................  S....................  .....................  Radium/radioisotope       0313    13.1258      $712.59  ............       $142.52
                                                                       therapy.
78000.................  S....................  .....................  Thyroid, single uptake.   0389     1.6475       $89.44        $44.72        $17.89
78001.................  S....................  .....................  Thyroid, multiple         0389     1.6475       $89.44        $44.72        $17.89
                                                                       uptakes.
78003.................  S....................  .....................  Thyroid suppress/stimul   0389     1.6475       $89.44        $44.72        $17.89
78006.................  S....................  .....................  Thyroid imaging with      0390     2.8434      $154.37        $77.18        $30.87
                                                                       uptake.
78007.................  S....................  .....................  Thyroid image, mult       0391     3.7174      $201.81       $100.90        $40.36
                                                                       uptakes.
78010.................  S....................  .....................  Thyroid imaging........   0390     2.8434      $154.37        $77.18        $30.87
78011.................  S....................  .....................  Thyroid imaging with      0391     3.7174      $201.81       $100.90        $40.36
                                                                       flow.
78015.................  S....................  .....................  Thyroid met imaging....   0390     2.8434      $154.37        $77.18        $30.87
78016.................  S....................  .....................  Thyroid met imaging/      0390     2.8434      $154.37        $77.18        $30.87
                                                                       studies.
78018.................  S....................  .....................  Thyroid met imaging,      0391     3.7174      $201.81       $100.90        $40.36
                                                                       body.
78020.................  S....................  .....................  Thyroid met uptake.....   0389     1.6475       $89.44        $44.72        $17.89
78070.................  S....................  .....................  Parathyroid nuclear       0391     3.7174      $201.81       $100.90        $40.36
                                                                       imaging.
78075.................  S....................  .....................  Adrenal nuclear imaging   0392     6.7081      $364.18       $182.08        $72.84
78099.................  S....................  .....................  Endocrine nuclear         0389     1.6475       $89.44        $44.72        $17.89
                                                                       procedure.
78102.................  S....................  .....................  Bone marrow imaging,      0400     3.8691      $210.05       $105.02        $42.01
                                                                       ltd.
78103.................  S....................  .....................  Bone marrow imaging,      0400     3.8691      $210.05       $105.02        $42.01
                                                                       mult.
78104.................  S....................  .....................  Bone marrow imaging,      0400     3.8691      $210.05       $105.02        $42.01
                                                                       body.
78110.................  S....................  .....................  Plasma volume, single..   0393     4.0720      $221.06       $110.53        $44.21
78111.................  S....................  .....................  Plasma volume, multiple   0393     4.0720      $221.06       $110.53        $44.21
78120.................  S....................  .....................  Red cell mass, single..   0393     4.0720      $221.06       $110.53        $44.21
78121.................  S....................  .....................  Red cell mass, multiple   0393     4.0720      $221.06       $110.53        $44.21
78122.................  S....................  .....................  Blood volume...........   0393     4.0720      $221.06       $110.53        $44.21
78130.................  S....................  .....................  Red cell survival study   0393     4.0720      $221.06       $110.53        $44.21
78135.................  S....................  .....................  Red cell survival         0393     4.0720      $221.06       $110.53        $44.21
                                                                       kinetics.
78140.................  S....................  .....................  Red cell sequestration.   0393     4.0720      $221.06       $110.53        $44.21
78160.................  S....................  .....................  Plasma iron turnover...   0393     4.0720      $221.06       $110.53        $44.21
78162.................  S....................  .....................  Radioiron absorption      0393     4.0720      $221.06       $110.53        $44.21
                                                                       exam.
78170.................  S....................  .....................  Red cell iron             0393     4.0720      $221.06       $110.53        $44.21
                                                                       utilization.
78172.................  S....................  .....................  Total body iron           0393     4.0720      $221.06       $110.53        $44.21
                                                                       estimation.
78185.................  S....................  .....................  Spleen imaging.........   0400     3.8691      $210.05       $105.02        $42.01
78190.................  S....................  .....................  Platelet survival,        0389     1.6475       $89.44        $44.72        $17.89
                                                                       kinetics.
78191.................  S....................  .....................  Platelet survival......   0389     1.6475       $89.44        $44.72        $17.89
78195.................  S....................  .....................  Lymph system imaging...   0400     3.8691      $210.05       $105.02        $42.01
78199.................  S....................  .....................  Blood/lymph nuclear       0389     1.6475       $89.44        $44.72        $17.89
                                                                       exam.
78201.................  S....................  .....................  Liver imaging..........   0394     4.4370      $240.88       $120.44        $48.18
78202.................  S....................  .....................  Liver imaging with flow   0394     4.4370      $240.88       $120.44        $48.18
78205.................  S....................  .....................  Liver imaging (3D).....   0394     4.4370      $240.88       $120.44        $48.18
78206.................  S....................  .....................  Liver image (3d) with     0394     4.4370      $240.88       $120.44        $48.18
                                                                       flow.
78215.................  S....................  .....................  Liver and spleen          0394     4.4370      $240.88       $120.44        $48.18
                                                                       imaging.
78216.................  S....................  .....................  Liver & spleen image/     0394     4.4370      $240.88       $120.44        $48.18
                                                                       flow.
78220.................  S....................  .....................  Liver function study...   0394     4.4370      $240.88       $120.44        $48.18
78223.................  S....................  .....................  Hepatobiliary imaging..   0394     4.4370      $240.88       $120.44        $48.18
78230.................  S....................  .....................  Salivary gland imaging.   0395     3.9372      $213.75       $106.87        $42.75
78231.................  S....................  .....................  Serial salivary imaging   0395     3.9372      $213.75       $106.87        $42.75
78232.................  S....................  .....................  Salivary gland function   0395     3.9372      $213.75       $106.87        $42.75
                                                                       exam.
78258.................  S....................  .....................  Esophageal motility       0395     3.9372      $213.75       $106.87        $42.75
                                                                       study.
78261.................  S....................  .....................  Gastric mucosa imaging.   0395     3.9372      $213.75       $106.87        $42.75
78262.................  S....................  .....................  Gastroesophageal reflux   0395     3.9372      $213.75       $106.87        $42.75
                                                                       exam.
78264.................  S....................  .....................  Gastric emptying study.   0395     3.9372      $213.75       $106.87        $42.75

[[Page 48122]]

 
78267.................  A....................  .....................  Breath tst attain/anal   .....  .........  ...........  ............  ............
                                                                       c-14.
78268.................  A....................  .....................  Breath test analysis, c- .....  .........  ...........  ............  ............
                                                                       14.
78270.................  S....................  .....................  Vit B-12 absorption       0395     3.9372      $213.75       $106.87        $42.75
                                                                       exam.
78271.................  S....................  .....................  Vit b-12 absrp exam,      0395     3.9372      $213.75       $106.87        $42.75
                                                                       int fac.
78272.................  S....................  .....................  Vit B-12 absorp,          0395     3.9372      $213.75       $106.87        $42.75
                                                                       combined.
78278.................  S....................  .....................  Acute GI blood loss       0395     3.9372      $213.75       $106.87        $42.75
                                                                       imaging.
78282.................  S....................  .....................  GI protein loss exam...   0395     3.9372      $213.75       $106.87        $42.75
78290.................  S....................  .....................  Meckel's divert exam...   0395     3.9372      $213.75       $106.87        $42.75
78291.................  S....................  .....................  Leveen/shunt patency      0395     3.9372      $213.75       $106.87        $42.75
                                                                       exam.
78299.................  S....................  .....................  GI nuclear procedure...   0389     1.6475       $89.44        $44.72        $17.89
78300.................  S....................  .....................  Bone imaging, limited     0396     4.2445      $230.43       $115.21        $46.09
                                                                       area.
78305.................  S....................  .....................  Bone imaging, multiple    0396     4.2445      $230.43       $115.21        $46.09
                                                                       areas.
78306.................  S....................  .....................  Bone imaging, whole       0396     4.2445      $230.43       $115.21        $46.09
                                                                       body.
78315.................  S....................  .....................  Bone imaging, 3 phase..   0396     4.2445      $230.43       $115.21        $46.09
78320.................  S....................  .....................  Bone imaging (3D)......   0396     4.2445      $230.43       $115.21        $46.09
78350.................  X....................  .....................  Bone mineral, single      0261     1.3238       $71.87  ............        $14.37
                                                                       photon.
78351.................  E....................  .....................  Bone mineral, dual       .....  .........  ...........  ............  ............
                                                                       photon.
78399.................  S....................  .....................  Musculoskeletal nuclear   0389     1.6475       $89.44        $44.72        $17.89
                                                                       exam.
78414.................  S....................  .....................  Non-imaging heart         0397     2.4737      $134.29        $67.14        $26.86
                                                                       function.
78428.................  S....................  .....................  Cardiac shunt imaging..   0398     6.6521      $361.14       $180.57        $72.23
78445.................  S....................  .....................  Vascular flow imaging..   0397     2.4737      $134.29        $67.14        $26.86
78455.................  S....................  .....................  Venous thrombosis study   0397     2.4737      $134.29        $67.14        $26.86
78456.................  S....................  .....................  Acute venous thrombus     0397     2.4737      $134.29        $67.14        $26.86
                                                                       image.
78457.................  S....................  .....................  Venous thrombosis         0397     2.4737      $134.29        $67.14        $26.86
                                                                       imaging.
78458.................  S....................  .....................  Ven thrombosis images,    0397     2.4737      $134.29        $67.14        $26.86
                                                                       bilat.
78459.................  S....................  .....................  Heart muscle imaging      0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       (PET).
78460.................  S....................  .....................  Heart muscle blood,       0398     6.6521      $361.14       $180.57        $72.23
                                                                       single.
78461.................  S....................  .....................  Heart muscle blood,       0398     6.6521      $361.14       $180.57        $72.23
                                                                       multiple.
78464.................  S....................  .....................  Heart image (3d),         0398     6.6521      $361.14       $180.57        $72.23
                                                                       single.
78465.................  S....................  .....................  Heart image (3d),         0398     6.6521      $361.14       $180.57        $72.23
                                                                       multiple.
78466.................  S....................  .....................  Heart infarct image....   0398     6.6521      $361.14       $180.57        $72.23
78468.................  S....................  .....................  Heart infarct image       0398     6.6521      $361.14       $180.57        $72.23
                                                                       (ef).
78469.................  S....................  .....................  Heart infarct image       0398     6.6521      $361.14       $180.57        $72.23
                                                                       (3D).
78472.................  S....................  .....................  Gated heart, planar,      0398     6.6521      $361.14       $180.57        $72.23
                                                                       single.
78473.................  S....................  .....................  Gated heart, multiple..   0398     6.6521      $361.14       $180.57        $72.23
78478.................  S....................  .....................  Heart wall motion add-    0399     1.6033       $87.04        $43.52        $17.41
                                                                       on.
78480.................  S....................  .....................  Heart function add-on..   0399     1.6033       $87.04        $43.52        $17.41
78481.................  S....................  .....................  Heart first pass,         0398     6.6521      $361.14       $180.57        $72.23
                                                                       single.
78483.................  S....................  .....................  Heart first pass,         0398     6.6521      $361.14       $180.57        $72.23
                                                                       multiple.
78491.................  E....................  .....................  Heart image (pet),       .....  .........  ...........  ............  ............
                                                                       single.
78492.................  E....................  .....................  Heart image (pet),       .....  .........  ...........  ............  ............
                                                                       multiple.
78494.................  S....................  .....................  Heart image, spect.....   0398     6.6521      $361.14       $180.57        $72.23
78496.................  S....................  .....................  Heart first pass add-on   0399     1.6033       $87.04        $43.52        $17.41
78499.................  S....................  .....................  Cardiovascular nuclear    0389     1.6475       $89.44        $44.72        $17.89
                                                                       exam.
78580.................  S....................  .....................  Lung perfusion imaging.   0401     4.9130      $266.72       $133.35        $53.34
78584.................  S....................  .....................  Lung V/Q image single     0401     4.9130      $266.72       $133.35        $53.34
                                                                       breath.
78585.................  S....................  .....................  Lung V/Q imaging.......   0401     4.9130      $266.72       $133.35        $53.34
78586.................  S....................  .....................  Aerosol lung image,       0401     4.9130      $266.72       $133.35        $53.34
                                                                       single.
78587.................  S....................  .....................  Aerosol lung image,       0401     4.9130      $266.72       $133.35        $53.34
                                                                       multiple.
78588.................  S....................  .....................  Perfusion lung image...   0401     4.9130      $266.72       $133.35        $53.34
78591.................  S....................  .....................  Vent image, 1 breath, 1   0401     4.9130      $266.72       $133.35        $53.34
                                                                       proj.
78593.................  S....................  .....................  Vent image, 1 proj, gas   0401     4.9130      $266.72       $133.35        $53.34
78594.................  S....................  .....................  Vent image, mult proj,    0401     4.9130      $266.72       $133.35        $53.34
                                                                       gas.
78596.................  S....................  .....................  Lung differential         0401     4.9130      $266.72       $133.35        $53.34
                                                                       function.
78599.................  S....................  .....................  Respiratory nuclear       0389     1.6475       $89.44        $44.72        $17.89
                                                                       exam.
78600.................  S....................  .....................  Brain imaging, ltd        0402     5.4818      $297.60       $148.79        $59.52
                                                                       static.
78601.................  S....................  .....................  Brain imaging, ltd w/     0402     5.4818      $297.60       $148.79        $59.52
                                                                       flow.
78605.................  S....................  .....................  Brain imaging, complete   0402     5.4818      $297.60       $148.79        $59.52
78606.................  S....................  .....................  Brain imaging, compl w/   0402     5.4818      $297.60       $148.79        $59.52
                                                                       flow.
78607.................  S....................  .....................  Brain imaging (3D).....   0402     5.4818      $297.60       $148.79        $59.52
78608.................  E....................  .....................  Brain imaging (PET)....  .....  .........  ...........  ............  ............
78609.................  E....................  .....................  Brain imaging (PET)....  .....  .........  ...........  ............  ............
78610.................  S....................  .....................  Brain flow imaging only   0402     5.4818      $297.60       $148.79        $59.52
78615.................  S....................  .....................  Cerebral vascular flow    0402     5.4818      $297.60       $148.79        $59.52
                                                                       image.
78630.................  S....................  .....................  Cerebrospinal fluid       0403     3.9265      $213.17       $106.58        $42.63
                                                                       scan.
78635.................  S....................  .....................  CSF ventriculography...   0403     3.9265      $213.17       $106.58        $42.63

[[Page 48123]]

 
78645.................  S....................  .....................  CSF shunt evaluation...   0403     3.9265      $213.17       $106.58        $42.63
78647.................  S....................  .....................  Cerebrospinal fluid       0403     3.9265      $213.17       $106.58        $42.63
                                                                       scan.
78650.................  S....................  .....................  CSF leakage imaging....   0403     3.9265      $213.17       $106.58        $42.63
78660.................  S....................  .....................  Nuclear exam of tear      0403     3.9265      $213.17       $106.58        $42.63
                                                                       flow.
78699.................  S....................  .....................  Nervous system nuclear    0389     1.6475       $89.44        $44.72        $17.89
                                                                       exam.
78700.................  S....................  .....................  Kidney imaging, static.   0404     5.1538      $279.79       $139.89        $55.96
78701.................  S....................  .....................  Kidney imaging with       0404     5.1538      $279.79       $139.89        $55.96
                                                                       flow.
78704.................  S....................  .....................  Imaging renogram.......   0404     5.1538      $279.79       $139.89        $55.96
78707.................  S....................  .....................  Kidney flow/function      0404     5.1538      $279.79       $139.89        $55.96
                                                                       image.
78708.................  S....................  .....................  Kidney flow/function      0404     5.1538      $279.79       $139.89        $55.96
                                                                       image.
78709.................  S....................  .....................  Kidney flow/function      0404     5.1538      $279.79       $139.89        $55.96
                                                                       image.
78710.................  S....................  .....................  Kidney imaging (3D)....   0404     5.1538      $279.79       $139.89        $55.96
78715.................  S....................  .....................  Renal vascular flow       0404     5.1538      $279.79       $139.89        $55.96
                                                                       exam.
78725.................  S....................  .....................  Kidney function study..   0389     1.6475       $89.44        $44.72        $17.89
78730.................  S....................  .....................  Urinary bladder           0405     0.7739       $42.01        $21.00         $8.40
                                                                       retention.
78740.................  S....................  .....................  Ureteral reflux study..   0405     0.7739       $42.01        $21.00         $8.40
78760.................  S....................  .....................  Testicular imaging.....   0405     0.7739       $42.01        $21.00         $8.40
78761.................  S....................  .....................  Testicular imaging/flow   0405     0.7739       $42.01        $21.00         $8.40
78799.................  S....................  .....................  Genitourinary nuclear     0389     1.6475       $89.44        $44.72        $17.89
                                                                       exam.
78800.................  S....................  .....................  Tumor imaging, limited    0406     4.7542      $258.10  ............        $51.62
                                                                       area.
78801.................  S....................  .....................  Tumor imaging, mult       0406     4.7542      $258.10  ............        $51.62
                                                                       areas.
78802.................  S....................  .....................  Tumor imaging, whole      0406     4.7542      $258.10  ............        $51.62
                                                                       body.
78803.................  S....................  .....................  Tumor imaging (3D).....   0406     4.7542      $258.10  ............        $51.62
78805.................  S....................  .....................  Abscess imaging, ltd      0406     4.7542      $258.10  ............        $51.62
                                                                       area.
78806.................  S....................  .....................  Abscess imaging, whole    0406     4.7542      $258.10  ............        $51.62
                                                                       body.
78807.................  S....................  .....................  Nuclear localization/     0406     4.7542      $258.10  ............        $51.62
                                                                       abscess.
78810.................  E....................  .....................  Tumor imaging (PET)....  .....  .........  ...........  ............  ............
78890.................  N....................  .....................  Nuclear medicine data    .....  .........  ...........  ............  ............
                                                                       proc.
78891.................  N....................  .....................  Nuclear med data proc..  .....  .........  ...........  ............  ............
78990.................  E....................  .....................  Provide diag             .....  .........  ...........  ............  ............
                                                                       radionuclide(s).
78999.................  S....................  .....................  Nuclear diagnostic exam   0389     1.6475       $89.44        $44.72        $17.89
79000.................  S....................  .....................  Init hyperthyroid         0407     4.2797      $232.34       $116.17        $46.47
                                                                       therapy.
79001.................  S....................  .....................  Repeat hyperthyroid       0407     4.2797      $232.34       $116.17        $46.47
                                                                       therapy.
79020.................  S....................  .....................  Thyroid ablation.......   0407     4.2797      $232.34       $116.17        $46.47
79030.................  S....................  .....................  Thyroid ablation,         0407     4.2797      $232.34       $116.17        $46.47
                                                                       carcinoma.
79035.................  S....................  .....................  Thyroid metastatic        0407     4.2797      $232.34       $116.17        $46.47
                                                                       therapy.
79100.................  S....................  .....................  Hematopoetic nuclear      0408     4.0000      $217.16  ............        $43.43
                                                                       therapy.
79200.................  S....................  .....................  Intracavitary nuclear     0408     4.0000      $217.16  ............        $43.43
                                                                       trmt.
79300.................  S....................  .....................  Interstitial nuclear      0408     4.0000      $217.16  ............        $43.43
                                                                       therapy.
79400.................  S....................  .....................  Nonhemato nuclear         0408     4.0000      $217.16  ............        $43.43
                                                                       therapy.
79420.................  S....................  .....................  Intravascular nuclear     0408     4.0000      $217.16  ............        $43.43
                                                                       ther.
79440.................  S....................  .....................  Nuclear joint therapy..   0408     4.0000      $217.16  ............        $43.43
79900.................  N....................  .....................  Provide ther             .....  .........  ...........  ............  ............
                                                                       radiopharm(s).
79999.................  S....................  .....................  Nuclear medicine          0389     1.6475       $89.44        $44.72        $17.89
                                                                       therapy.
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.  .....  .........  ...........  ............  ............
80100.................  A....................  .....................  Drug screen, qualitate/  .....  .........  ...........  ............  ............
                                                                       multi.
80101.................  A....................  .....................  Drug screen, single....  .....  .........  ...........  ............  ............
80102.................  A....................  .....................  Drug confirmation......  .....  .........  ...........  ............  ............
80103.................  N....................  .....................  Drug analysis, tissue    .....  .........  ...........  ............  ............
                                                                       prep.
80150.................  A....................  .....................  Assay of amikacin......  .....  .........  ...........  ............  ............
80152.................  A....................  .....................  Assay of amitriptyline.  .....  .........  ...........  ............  ............
80154.................  A....................  .....................  Assay of                 .....  .........  ...........  ............  ............
                                                                       benzodiazepines.
80156.................  A....................  .....................  Assay, carbamazepine,    .....  .........  ...........  ............  ............
                                                                       total.
80157.................  A....................  .....................  Assay, carbamazepine,    .....  .........  ...........  ............  ............
                                                                       free.
80158.................  A....................  .....................  Assay of cyclosporine..  .....  .........  ...........  ............  ............
80160.................  A....................  .....................  Assay of desipramine...  .....  .........  ...........  ............  ............
80162.................  A....................  .....................  Assay of digoxin.......  .....  .........  ...........  ............  ............
80164.................  A....................  .....................  Assay, dipropylacetic    .....  .........  ...........  ............  ............
                                                                       acid.

[[Page 48124]]

 
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             0343     0.4662       $25.31        $12.55         $5.06
                                                                       consultation.
80502.................  X....................  .....................  Lab pathology             0342     0.2169       $11.78         $5.88         $2.36
                                                                       consultation.
81000.................  A....................  .....................  Urinalysis, nonauto w/   .....  .........  ...........  ............  ............
                                                                       scope.
81001.................  A....................  .....................  Urinalysis, auto w/      .....  .........  ...........  ............  ............
                                                                       scope.
81002.................  A....................  .....................  Urinalysis nonauto w/o   .....  .........  ...........  ............  ............
                                                                       scope.
81003.................  A....................  .....................  Urinalysis, auto, w/o    .....  .........  ...........  ............  ............
                                                                       scope.
81005.................  A....................  .....................  Urinalysis.............  .....  .........  ...........  ............  ............
81007.................  A....................  .....................  Urine screen for         .....  .........  ...........  ............  ............
                                                                       bacteria.
81015.................  A....................  .....................  Microscopic exam of      .....  .........  ...........  ............  ............
                                                                       urine.
81020.................  A....................  .....................  Urinalysis, glass test.  .....  .........  ...........  ............  ............
81025.................  A....................  .....................  Urine pregnancy test...  .....  .........  ...........  ............  ............
81050.................  A....................  .....................  Urinalysis, volume       .....  .........  ...........  ............  ............
                                                                       measure.
81099.................  A....................  .....................  Urinalysis test          .....  .........  ...........  ............  ............
                                                                       procedure.
82000.................  A....................  .....................  Assay of blood           .....  .........  ...........  ............  ............
                                                                       acetaldehyde.
82003.................  A....................  .....................  Assay of acetaminophen.  .....  .........  ...........  ............  ............
82009.................  A....................  .....................  Test for acetone/        .....  .........  ...........  ............  ............
                                                                       ketones.
82010.................  A....................  .....................  Acetone assay..........  .....  .........  ...........  ............  ............
82013.................  A....................  .....................  Acetylcholinesterase     .....  .........  ...........  ............  ............
                                                                       assay.
82016.................  A....................  .....................  Acylcarnitines, qual...  .....  .........  ...........  ............  ............

[[Page 48125]]

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

[[Page 48126]]

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

[[Page 48127]]

 
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.
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.

[[Page 48128]]

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

[[Page 48129]]

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

[[Page 48130]]

 
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....................  .....................  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).
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.  .....  .........  ...........  ............  ............

[[Page 48131]]

 
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....................  .....................  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.............  .....  .........  ...........  ............  ............
85025.................  A....................  .....................  Automated hemogram.....  .....  .........  ...........  ............  ............
85027.................  A....................  .....................  Automated hemogram.....  .....  .........  ...........  ............  ............
85032.................  A....................  .....................  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....................  .....................  Automated platelet       .....  .........  ...........  ............  ............
                                                                       count.
85060.................  X....................  .....................  Blood smear               0342     0.2169       $11.78         $5.88         $2.36
                                                                       interpretation.
85097.................  X....................  .....................  Bone marrow               0343     0.4662       $25.31        $12.55         $5.06
                                                                       interpretation.
85130.................  A....................  .....................  Chromogenic substrate    .....  .........  ...........  ............  ............
                                                                       assay.
85170.................  A....................  .....................  Blood clot retraction..  .....  .........  ...........  ............  ............
85175.................  A....................  .....................  Blood clot lysis time..  .....  .........  ...........  ............  ............
85210.................  A....................  .....................  Blood clot factor II     .....  .........  ...........  ............  ............
                                                                       test.
85220.................  A....................  .....................  Blood clot factor V      .....  .........  ...........  ............  ............
                                                                       test.
85230.................  A....................  .....................  Blood clot factor VII    .....  .........  ...........  ............  ............
                                                                       test.
85240.................  A....................  .....................  Blood clot factor VIII   .....  .........  ...........  ............  ............
                                                                       test.
85244.................  A....................  .....................  Blood clot factor VIII   .....  .........  ...........  ............  ............
                                                                       test.
85245.................  A....................  .....................  Blood clot factor VIII   .....  .........  ...........  ............  ............
                                                                       test.
85246.................  A....................  .....................  Blood clot factor VIII   .....  .........  ...........  ............  ............
                                                                       test.
85247.................  A....................  .....................  Blood clot factor VIII   .....  .........  ...........  ............  ............
                                                                       test.
85250.................  A....................  .....................  Blood clot factor IX     .....  .........  ...........  ............  ............
                                                                       test.
85260.................  A....................  .....................  Blood clot factor X      .....  .........  ...........  ............  ............
                                                                       test.
85270.................  A....................  .....................  Blood clot factor XI     .....  .........  ...........  ............  ............
                                                                       test.
85280.................  A....................  .....................  Blood clot factor XII    .....  .........  ...........  ............  ............
                                                                       test.
85290.................  A....................  .....................  Blood clot factor XIII   .....  .........  ...........  ............  ............
                                                                       test.
85291.................  A....................  .....................  Blood clot factor XIII   .....  .........  ...........  ............  ............
                                                                       test.
85292.................  A....................  .....................  Blood clot factor assay  .....  .........  ...........  ............  ............
85293.................  A....................  .....................  Blood clot factor assay  .....  .........  ...........  ............  ............
85300.................  A....................  .....................  Antithrombin III test..  .....  .........  ...........  ............  ............

[[Page 48132]]

 
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....................  .....................  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.
85597.................  A....................  .....................  Platelet neutralization  .....  .........  ...........  ............  ............
85610.................  A....................  .....................  Prothrombin time.......  .....  .........  ...........  ............  ............
85611.................  A....................  .....................  Prothrombin test.......  .....  .........  ...........  ............  ............
85612.................  A....................  .....................  Viper venom prothrombin  .....  .........  ...........  ............  ............
                                                                       time.
85613.................  A....................  .....................  Russell viper venom,     .....  .........  ...........  ............  ............
                                                                       diluted.
85635.................  A....................  .....................  Reptilase test.........  .....  .........  ...........  ............  ............
85651.................  A....................  .....................  Rbc sed rate,            .....  .........  ...........  ............  ............
                                                                       nonautomated.
85652.................  A....................  .....................  Rbc sed rate, automated  .....  .........  ...........  ............  ............
85660.................  A....................  .....................  RBC sickle cell test...  .....  .........  ...........  ............  ............
85670.................  A....................  .....................  Thrombin time, plasma..  .....  .........  ...........  ............  ............
85675.................  A....................  .....................  Thrombin time, titer...  .....  .........  ...........  ............  ............
85705.................  A....................  .....................  Thromboplastin           .....  .........  ...........  ............  ............
                                                                       inhibition.
85730.................  A....................  .....................  Thromboplastin time,     .....  .........  ...........  ............  ............
                                                                       partial.
85732.................  A....................  .....................  Thromboplastin time,     .....  .........  ...........  ............  ............
                                                                       partial.
85810.................  A....................  .....................  Blood viscosity          .....  .........  ...........  ............  ............
                                                                       examination.
85999.................  A....................  .....................  Hematology procedure...  .....  .........  ...........  ............  ............
86000.................  A....................  .....................  Agglutinins, febrile...  .....  .........  ...........  ............  ............
86001.................  A....................  .....................  Allergen specific igg..  .....  .........  ...........  ............  ............
86003.................  A....................  .....................  Allergen specific IgE..  .....  .........  ...........  ............  ............
86005.................  A....................  .....................  Allergen specific IgE..  .....  .........  ...........  ............  ............
86021.................  A....................  .....................  WBC antibody             .....  .........  ...........  ............  ............
                                                                       identification.
86022.................  A....................  .....................  Platelet antibodies....  .....  .........  ...........  ............  ............
86023.................  A....................  .....................  Immunoglobulin assay...  .....  .........  ...........  ............  ............
86038.................  A....................  .....................  Antinuclear antibodies.  .....  .........  ...........  ............  ............
86039.................  A....................  .....................  Antinuclear antibodies   .....  .........  ...........  ............  ............
                                                                       (ANA).

[[Page 48133]]

 
86060.................  A....................  .....................  Antistreptolysin o,      .....  .........  ...........  ............  ............
                                                                       titer.
86063.................  A....................  .....................  Antistreptolysin o,      .....  .........  ...........  ............  ............
                                                                       screen.
86077.................  A....................  .....................  Physician blood bank     .....  .........  ...........  ............  ............
                                                                       service.
86078.................  A....................  .....................  Physician blood bank     .....  .........  ...........  ............  ............
                                                                       service.
86079.................  A....................  .....................  Physician blood bank     .....  .........  ...........  ............  ............
                                                                       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....................  .....................  Counterimmunoelectropho  .....  .........  ...........  ............  ............
                                                                       resis.
86215.................  A....................  .....................  Deoxyribonuclease,       .....  .........  ...........  ............  ............
                                                                       antibody.
86225.................  A....................  .....................  DNA antibody...........  .....  .........  ...........  ............  ............
86226.................  A....................  .....................  DNA antibody, single     .....  .........  ...........  ............  ............
                                                                       strand.
86235.................  A....................  .....................  Nuclear antigen          .....  .........  ...........  ............  ............
                                                                       antibody.
86243.................  A....................  .....................  Fc receptor............  .....  .........  ...........  ............  ............
86255.................  A....................  .....................  Fluorescent antibody,    .....  .........  ...........  ............  ............
                                                                       screen.
86256.................  A....................  .....................  Fluorescent antibody,    .....  .........  ...........  ............  ............
                                                                       titer.
86277.................  A....................  .....................  Growth hormone antibody  .....  .........  ...........  ............  ............
86280.................  A....................  .....................  Hemagglutination         .....  .........  ...........  ............  ............
                                                                       inhibition.
86294.................  A....................  .....................  Immunoassay, tumor qual  .....  .........  ...........  ............  ............
86300.................  A....................  .....................  Immunoassay, tumor ca    .....  .........  ...........  ............  ............
                                                                       15-3.
86301.................  A....................  .....................  Immunoassay, tumor ca    .....  .........  ...........  ............  ............
                                                                       19-9.
86304.................  A....................  .....................  Immunoassay, tumor, ca   .....  .........  ...........  ............  ............
                                                                       125.
86308.................  A....................  .....................  Heterophile antibodies.  .....  .........  ...........  ............  ............
86309.................  A....................  .....................  Heterophile antibodies.  .....  .........  ...........  ............  ............
86310.................  A....................  .....................  Heterophile antibodies.  .....  .........  ...........  ............  ............
86316.................  A....................  .....................  Immunoassay, tumor       .....  .........  ...........  ............  ............
                                                                       other.
86317.................  A....................  .....................  Immunoassay,infectious   .....  .........  ...........  ............  ............
                                                                       agent.
86318.................  A....................  .....................  Immunoassay,infectious   .....  .........  ...........  ............  ............
                                                                       agent.
86320.................  A....................  .....................  Serum                    .....  .........  ...........  ............  ............
                                                                       immunoelectrophoresis.
86325.................  A....................  .....................  Other                    .....  .........  ...........  ............  ............
                                                                       immunoelectrophoresis.
86327.................  A....................  .....................  Immunoelectrophoresis    .....  .........  ...........  ............  ............
                                                                       assay.
86329.................  A....................  .....................  Immunodiffusion........  .....  .........  ...........  ............  ............
86331.................  A....................  .....................  Immunodiffusion          .....  .........  ...........  ............  ............
                                                                       ouchterlony.
86332.................  A....................  .....................  Immune complex assay...  .....  .........  ...........  ............  ............
86334.................  A....................  .....................  Immunofixation           .....  .........  ...........  ............  ............
                                                                       procedure.
86336.................  A....................  .....................  Inhibin A..............  .....  .........  ...........  ............  ............
86337.................  A....................  .....................  Insulin antibodies.....  .....  .........  ...........  ............  ............
86340.................  A....................  .....................  Intrinsic factor         .....  .........  ...........  ............  ............
                                                                       antibody.
86341.................  A....................  .....................  Islet cell antibody....  .....  .........  ...........  ............  ............
86343.................  A....................  .....................  Leukocyte histamine      .....  .........  ...........  ............  ............
                                                                       release.
86344.................  A....................  .....................  Leukocyte phagocytosis.  .....  .........  ...........  ............  ............
86353.................  A....................  .....................  Lymphocyte               .....  .........  ...........  ............  ............
                                                                       transformation.
86359.................  A....................  .....................  T cells, total count...  .....  .........  ...........  ............  ............
86360.................  A....................  .....................  T cell, absolute count/  .....  .........  ...........  ............  ............
                                                                       ratio.
86361.................  A....................  .....................  T cell, absolute count.  .....  .........  ...........  ............  ............
86376.................  A....................  .....................  Microsomal antibody....  .....  .........  ...........  ............  ............
86378.................  A....................  .....................  Migration inhibitory     .....  .........  ...........  ............  ............
                                                                       factor.
86382.................  A....................  .....................  Neutralization test,     .....  .........  ...........  ............  ............
                                                                       viral.
86384.................  A....................  .....................  Nitroblue tetrazolium    .....  .........  ...........  ............  ............
                                                                       dye.
86403.................  A....................  .....................  Particle agglutination   .....  .........  ...........  ............  ............
                                                                       test.
86406.................  A....................  .....................  Particle agglutination   .....  .........  ...........  ............  ............
                                                                       test.
86430.................  A....................  .....................  Rheumatoid factor test.  .....  .........  ...........  ............  ............
86431.................  A....................  .....................  Rheumatoid factor,       .....  .........  ...........  ............  ............
                                                                       quant.
86485.................  X....................  .....................  Skin test, candida.....   0341     0.1468        $7.97         $3.08         $1.59
86490.................  X....................  .....................  Coccidioidomycosis skin   0341     0.1468        $7.97         $3.08         $1.59
                                                                       test.
86510.................  X....................  .....................  Histoplasmosis skin       0341     0.1468        $7.97         $3.08         $1.59
                                                                       test.
86580.................  X....................  .....................  TB intradermal test....   0341     0.1468        $7.97         $3.08         $1.59

[[Page 48134]]

 
86585.................  X....................  .....................  TB tine test...........   0341     0.1468        $7.97         $3.08         $1.59
86586.................  X....................  .....................  Skin test, unlisted....   0341     0.1468        $7.97         $3.08         $1.59
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.
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..  .....  .........  ...........  ............  ............

[[Page 48135]]

 
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     0.2589       $14.06         $3.10         $2.81
86860.................  X....................  .....................  RBC antibody elution...   0346     0.3877       $21.05         $5.31         $4.21
86870.................  X....................  .....................  RBC antibody              0346     0.3877       $21.05         $5.31         $4.21
                                                                       identification.
86880.................  X....................  .....................  Coombs test, direct....   0409     0.1385        $7.52         $2.31         $1.50
86885.................  X....................  .....................  Coombs test, indirect,    0409     0.1385        $7.52         $2.31         $1.50
                                                                       qual.
86886.................  X....................  .....................  Coombs test, indirect,    0409     0.1385        $7.52         $2.31         $1.50
                                                                       titer.
86890.................  X....................  .....................  Autologous blood          0347     0.9646       $52.37        $13.19        $10.47
                                                                       process.
86891.................  X....................  .....................  Autologous blood, op      0345     0.2589       $14.06         $3.10         $2.81
                                                                       salvage.
86900.................  X....................  .....................  Blood typing, ABO......   0409     0.1385        $7.52         $2.31         $1.50
86901.................  X....................  .....................  Blood typing, Rh (D)...   0409     0.1385        $7.52         $2.31         $1.50
86903.................  X....................  .....................  Blood typing, antigen     0345     0.2589       $14.06         $3.10         $2.81
                                                                       screen.
86904.................  X....................  .....................  Blood typing, patient     0345     0.2589       $14.06         $3.10         $2.81
                                                                       serum.
86905.................  X....................  .....................  Blood typing, RBC         0345     0.2589       $14.06         $3.10         $2.81
                                                                       antigens.
86906.................  X....................  .....................  Blood typing, Rh          0345     0.2589       $14.06         $3.10         $2.81
                                                                       phenotype.
86910.................  E....................  .....................  Blood typing, paternity  .....  .........  ...........  ............  ............
                                                                       test.
86911.................  E....................  .....................  Blood typing, antigen    .....  .........  ...........  ............  ............
                                                                       system.
86920.................  X....................  .....................  Compatibility test.....   0346     0.3877       $21.05         $5.31         $4.21
86921.................  X....................  .....................  Compatibility test.....   0345     0.2589       $14.06         $3.10         $2.81
86922.................  X....................  .....................  Compatibility test.....   0346     0.3877       $21.05         $5.31         $4.21
86927.................  X....................  .....................  Plasma, fresh frozen...   0346     0.3877       $21.05         $5.31         $4.21
86930.................  X....................  .....................  Frozen blood prep......   0347     0.9646       $52.37        $13.19        $10.47
86931.................  X....................  .....................  Frozen blood thaw......   0347     0.9646       $52.37        $13.19        $10.47
86932.................  X....................  .....................  Frozen blood freeze/      0347     0.9646       $52.37        $13.19        $10.47
                                                                       thaw.
86940.................  A....................  .....................  Hemolysins/agglutinins,  .....  .........  ...........  ............  ............
                                                                       auto.
86941.................  A....................  .....................  Hemolysins/agglutinins.  .....  .........  ...........  ............  ............
86945.................  X....................  .....................  Blood product/            0346     0.3877       $21.05         $5.31         $4.21
                                                                       irradiation.
86950.................  X....................  .....................  Leukacyte transfusion..   0347     0.9646       $52.37        $13.19        $10.47
86965.................  X....................  .....................  Pooling blood platelets   0346     0.3877       $21.05         $5.31         $4.21
86970.................  X....................  .....................  RBC pretreatment.......   0345     0.2589       $14.06         $3.10         $2.81
86971.................  X....................  .....................  RBC pretreatment.......   0345     0.2589       $14.06         $3.10         $2.81

[[Page 48136]]

 
86972.................  X....................  .....................  RBC pretreatment.......   0345     0.2589       $14.06         $3.10         $2.81
86975.................  X....................  .....................  RBC pretreatment, serum   0345     0.2589       $14.06         $3.10         $2.81
86976.................  X....................  .....................  RBC pretreatment, serum   0345     0.2589       $14.06         $3.10         $2.81
86977.................  X....................  .....................  RBC pretreatment, serum   0345     0.2589       $14.06         $3.10         $2.81
86978.................  X....................  .....................  RBC pretreatment, serum   0345     0.2589       $14.06         $3.10         $2.81
86985.................  X....................  .....................  Split blood or products   0347     0.9646       $52.37        $13.19        $10.47
86999.................  X....................  .....................  Transfusion procedure..   0345     0.2589       $14.06         $3.10         $2.81
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.
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.
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....................  .....................  Genet virus isolate,     .....  .........  ...........  ............  ............
                                                                       hsv.
87260.................  A....................  .....................  Adenovirus ag, if......  .....  .........  ...........  ............  ............
87265.................  A....................  .....................  Pertussis ag, if.......  .....  .........  ...........  ............  ............

[[Page 48137]]

 
87267.................  A....................  .....................  Enterovirus antibody,    .....  .........  ...........  ............  ............
                                                                       dfa.
87270.................  A....................  .....................  Chlamydia trachomatis    .....  .........  ...........  ............  ............
                                                                       ag, if.
87271.................  A....................  .....................  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.  .....  .........  ...........  ............  ............
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.

[[Page 48138]]

 
87516.................  A....................  .....................  Hepatitis b, dna, amp    .....  .........  ...........  ............  ............
                                                                       probe.
87517.................  A....................  .....................  Hepatitis b, dna, quant  .....  .........  ...........  ............  ............
87520.................  A....................  .....................  Hepatitis c, rna, dir    .....  .........  ...........  ............  ............
                                                                       probe.
87521.................  A....................  .....................  Hepatitis c, rna, amp    .....  .........  ...........  ............  ............
                                                                       probe.
87522.................  A....................  .....................  Hepatitis c, rna, quant  .....  .........  ...........  ............  ............
87525.................  A....................  .....................  Hepatitis g, dna, dir    .....  .........  ...........  ............  ............
                                                                       probe.
87526.................  A....................  .....................  Hepatitis g, dna, amp    .....  .........  ...........  ............  ............
                                                                       probe.
87527.................  A....................  .....................  Hepatitis g, dna, quant  .....  .........  ...........  ............  ............
87528.................  A....................  .....................  Hsv, dna, dir probe....  .....  .........  ...........  ............  ............
87529.................  A....................  .....................  Hsv, dna, amp probe....  .....  .........  ...........  ............  ............
87530.................  A....................  .....................  Hsv, dna, quant........  .....  .........  ...........  ............  ............
87531.................  A....................  .....................  Hhv-6, dna, dir probe..  .....  .........  ...........  ............  ............
87532.................  A....................  .....................  Hhv-6, dna, amp probe..  .....  .........  ...........  ............  ............
87533.................  A....................  .....................  Hhv-6, dna, quant......  .....  .........  ...........  ............  ............
87534.................  A....................  .....................  Hiv-1, dna, dir probe..  .....  .........  ...........  ............  ............
87535.................  A....................  .....................  Hiv-1, dna, amp probe..  .....  .........  ...........  ............  ............
87536.................  A....................  .....................  Hiv-1, dna, quant......  .....  .........  ...........  ............  ............
87537.................  A....................  .....................  Hiv-2, dna, dir probe..  .....  .........  ...........  ............  ............
87538.................  A....................  .....................  Hiv-2, dna, amp probe..  .....  .........  ...........  ............  ............
87539.................  A....................  .....................  Hiv-2, dna, quant......  .....  .........  ...........  ............  ............
87540.................  A....................  .....................  Legion pneumo, dna, dir  .....  .........  ...........  ............  ............
                                                                       prob.
87541.................  A....................  .....................  Legion pneumo, dna, amp  .....  .........  ...........  ............  ............
                                                                       prob.
87542.................  A....................  .....................  Legion pneumo, dna,      .....  .........  ...........  ............  ............
                                                                       quant.
87550.................  A....................  .....................  Mycobacteria, dna, dir   .....  .........  ...........  ............  ............
                                                                       probe.
87551.................  A....................  .....................  Mycobacteria, dna, amp   .....  .........  ...........  ............  ............
                                                                       probe.
87552.................  A....................  .....................  Mycobacteria, dna,       .....  .........  ...........  ............  ............
                                                                       quant.
87555.................  A....................  .....................  M.tuberculo, dna, dir    .....  .........  ...........  ............  ............
                                                                       probe.
87556.................  A....................  .....................  M.tuberculo, dna, amp    .....  .........  ...........  ............  ............
                                                                       probe.
87557.................  A....................  .....................  M.tuberculo, dna, quant  .....  .........  ...........  ............  ............
87560.................  A....................  .....................  M.avium-intra, dna, dir  .....  .........  ...........  ............  ............
                                                                       prob.
87561.................  A....................  .....................  M.avium-intra, dna, amp  .....  .........  ...........  ............  ............
                                                                       prob.
87562.................  A....................  .....................  M.avium-intra, dna,      .....  .........  ...........  ............  ............
                                                                       quant.
87580.................  A....................  .....................  M.pneumon, dna, dir      .....  .........  ...........  ............  ............
                                                                       probe.
87581.................  A....................  .....................  M.pneumon, dna, amp      .....  .........  ...........  ............  ............
                                                                       probe.
87582.................  A....................  .....................  M.pneumon, dna, quant..  .....  .........  ...........  ............  ............
87590.................  A....................  .....................  N.gonorrhoeae, dna, dir  .....  .........  ...........  ............  ............
                                                                       prob.
87591.................  A....................  .....................  N.gonorrhoeae, dna, amp  .....  .........  ...........  ............  ............
                                                                       prob.
87592.................  A....................  .....................  N.gonorrhoeae, dna,      .....  .........  ...........  ............  ............
                                                                       quant.
87620.................  A....................  .....................  Hpv, dna, dir probe....  .....  .........  ...........  ............  ............
87621.................  A....................  .....................  Hpv, dna, amp probe....  .....  .........  ...........  ............  ............
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.

[[Page 48139]]

 
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     0.4662       $25.31        $12.55         $5.06
88106.................  X....................  .....................  Cytopathology, fluids..   0343     0.4662       $25.31        $12.55         $5.06
88107.................  X....................  .....................  Cytopathology, fluids..   0343     0.4662       $25.31        $12.55         $5.06
88108.................  X....................  .....................  Cytopath, concentrate     0343     0.4662       $25.31        $12.55         $5.06
                                                                       tech.
88125.................  X....................  .....................  Forensic cytopathology.   0342     0.2169       $11.78         $5.88         $2.36
88130.................  A....................  .....................  Sex chromatin            .....  .........  ...........  ............  ............
                                                                       identification.
88140.................  A....................  .....................  Sex chromatin            .....  .........  ...........  ............  ............
                                                                       identification.
88141.................  N....................  .....................  Cytopath, c/v,           .....  .........  ...........  ............  ............
                                                                       interpret.
88142.................  A....................  .....................  Cytopath, c/v, thin      .....  .........  ...........  ............  ............
                                                                       layer.
88143.................  A....................  .....................  Cytopath c/v thin layer  .....  .........  ...........  ............  ............
                                                                       redo.
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     0.2169       $11.78         $5.88         $2.36
                                                                       source.
88161.................  X....................  .....................  Cytopath smear, other     0343     0.4662       $25.31        $12.55         $5.06
                                                                       source.
88162.................  X....................  .....................  Cytopath smear, other     0343     0.4662       $25.31        $12.55         $5.06
                                                                       source.
88164.................  A....................  .....................  Cytopath tbs, c/v,       .....  .........  ...........  ............  ............
                                                                       manual.
88165.................  A....................  .....................  Cytopath tbs, c/v, redo  .....  .........  ...........  ............  ............
88166.................  A....................  .....................  Cytopath tbs, c/v, auto  .....  .........  ...........  ............  ............
                                                                       redo.
88167.................  A....................  .....................  Cytopath tbs, c/v,       .....  .........  ...........  ............  ............
                                                                       select.
88172.................  X....................  .....................  Cytopathology eval of     0343     0.4662       $25.31        $12.55         $5.06
                                                                       fna.
88173.................  X....................  .....................  Cytopath eval, fna,       0343     0.4662       $25.31        $12.55         $5.06
                                                                       report.
88174.................  A....................  .....................  Cytopath, c/v auto, in   .....  .........  ...........  ............  ............
                                                                       fluid.
88175.................  A....................  .....................  Cytopath c/v auto fluid  .....  .........  ...........  ............  ............
                                                                       redo.
88180.................  X....................  .....................  Cell marker study......   0343     0.4662       $25.31        $12.55         $5.06
88182.................  X....................  .....................  Cell marker study......   0344     0.6278       $34.08        $17.04         $6.82
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.

[[Page 48140]]

 
88289.................  A....................  .....................  Chromosome study,        .....  .........  ...........  ............  ............
                                                                       additional.
88291.................  A....................  .....................  Cyto/molecular report..  .....  .........  ...........  ............  ............
88299.................  X....................  .....................  Cytogenetic study......   0342     0.2169       $11.78         $5.88         $2.36
88300.................  X....................  .....................  Surgical path, gross...   0342     0.2169       $11.78         $5.88         $2.36
88302.................  X....................  .....................  Tissue exam by            0342     0.2169       $11.78         $5.88         $2.36
                                                                       pathologist.
88304.................  X....................  .....................  Tissue exam by            0343     0.4662       $25.31        $12.55         $5.06
                                                                       pathologist.
88305.................  X....................  .....................  Tissue exam by            0343     0.4662       $25.31        $12.55         $5.06
                                                                       pathologist.
88307.................  X....................  .....................  Tissue exam by            0344     0.6278       $34.08        $17.04         $6.82
                                                                       pathologist.
88309.................  X....................  .....................  Tissue exam by            0344     0.6278       $34.08        $17.04         $6.82
                                                                       pathologist.
88311.................  X....................  .....................  Decalcify tissue.......   0342     0.2169       $11.78         $5.88         $2.36
88312.................  X....................  .....................  Special stains.........   0342     0.2169       $11.78         $5.88         $2.36
88313.................  X....................  .....................  Special stains.........   0342     0.2169       $11.78         $5.88         $2.36
88314.................  X....................  .....................  Histochemical stain....   0342     0.2169       $11.78         $5.88         $2.36
88318.................  X....................  .....................  Chemical histochemistry   0342     0.2169       $11.78         $5.88         $2.36
88319.................  X....................  .....................  Enzyme histochemistry..   0342     0.2169       $11.78         $5.88         $2.36
88321.................  X....................  .....................  Microslide consultation   0342     0.2169       $11.78         $5.88         $2.36
88323.................  X....................  .....................  Microslide consultation   0343     0.4662       $25.31        $12.55         $5.06
88325.................  X....................  .....................  Comprehensive review of   0344     0.6278       $34.08        $17.04         $6.82
                                                                       data.
88329.................  X....................  .....................  Path consult introp....   0342     0.2169       $11.78         $5.88         $2.36
88331.................  X....................  .....................  Path consult intraop, 1   0343     0.4662       $25.31        $12.55         $5.06
                                                                       bloc.
88332.................  X....................  .....................  Path consult intraop,     0342     0.2169       $11.78         $5.88         $2.36
                                                                       addl.
88342.................  X....................  .....................  Immunocytochemistry....   0344     0.6278       $34.08        $17.04         $6.82
88346.................  X....................  .....................  Immunofluorescent study   0343     0.4662       $25.31        $12.55         $5.06
88347.................  X....................  .....................  Immunofluorescent study   0344     0.6278       $34.08        $17.04         $6.82
88348.................  X....................  .....................  Electron microscopy....   0661     3.3215      $180.32        $90.16        $36.06
88349.................  X....................  .....................  Scanning electron         0661     3.3215      $180.32        $90.16        $36.06
                                                                       microscopy.
88355.................  X....................  .....................  Analysis, skeletal        0344     0.6278       $34.08        $17.04         $6.82
                                                                       muscle.
88356.................  X....................  .....................  Analysis, nerve........   0344     0.6278       $34.08        $17.04         $6.82
88358.................  X....................  .....................  Analysis, tumor........   0344     0.6278       $34.08        $17.04         $6.82
88362.................  X....................  .....................  Nerve teasing             0343     0.4662       $25.31        $12.55         $5.06
                                                                       preparations.
88365.................  X....................  .....................  Tissue hybridization...   0344     0.6278       $34.08        $17.04         $6.82
88371.................  A....................  .....................  Protein, western blot    .....  .........  ...........  ............  ............
                                                                       tissue.
88372.................  A....................  .....................  Protein analysis w/      .....  .........  ...........  ............  ............
                                                                       probe.
88380.................  A....................  .....................  Microdissection........  .....  .........  ...........  ............  ............
88399.................  A....................  .....................  Surgical pathology       .....  .........  ...........  ............  ............
                                                                       procedure.
88400.................  A....................  .....................  Bilirubin total          .....  .........  ...........  ............  ............
                                                                       transcut.
89050.................  A....................  .....................  Body fluid cell count..  .....  .........  ...........  ............  ............
89051.................  A....................  .....................  Body fluid cell count..  .....  .........  ...........  ............  ............
89055.................  A....................  .....................  Leukocyte count, fecal.  .....  .........  ...........  ............  ............
89060.................  A....................  .....................  Exam,synovial fluid      .....  .........  ...........  ............  ............
                                                                       crystals.
89100.................  X....................  .....................  Sample intestinal         0360     1.7088       $92.77        $42.45        $18.55
                                                                       contents.
89105.................  X....................  .....................  Sample intestinal         0360     1.7088       $92.77        $42.45        $18.55
                                                                       contents.
89125.................  A....................  .....................  Specimen fat stain.....  .....  .........  ...........  ............  ............
89130.................  X....................  .....................  Sample stomach contents   0360     1.7088       $92.77        $42.45        $18.55
89132.................  X....................  .....................  Sample stomach contents   0360     1.7088       $92.77        $42.45        $18.55
89135.................  X....................  .....................  Sample stomach contents   0360     1.7088       $92.77        $42.45        $18.55
89136.................  X....................  .....................  Sample stomach contents   0360     1.7088       $92.77        $42.45        $18.55
89140.................  X....................  .....................  Sample stomach contents   0360     1.7088       $92.77        $42.45        $18.55
89141.................  X....................  .....................  Sample stomach contents   0360     1.7088       $92.77        $42.45        $18.55
89160.................  A....................  .....................  Exam feces for meat      .....  .........  ...........  ............  ............
                                                                       fibers.
89190.................  A....................  .....................  Nasal smear for          .....  .........  ...........  ............  ............
                                                                       eosinophils.
89250.................  X....................  .....................  Fertilization of oocyte   0348     1.2207       $66.27  ............        $13.25
89251.................  X....................  .....................  Culture oocyte w/         0348     1.2207       $66.27  ............        $13.25
                                                                       embryos.
89252.................  X....................  .....................  Assist oocyte             0348     1.2207       $66.27  ............        $13.25
                                                                       fertilization.
89253.................  X....................  .....................  Embryo hatching........   0348     1.2207       $66.27  ............        $13.25
89254.................  X....................  .....................  Oocyte identification..   0348     1.2207       $66.27  ............        $13.25
89255.................  X....................  .....................  Prepare embryo for        0348     1.2207       $66.27  ............        $13.25
                                                                       transfer.
89256.................  X....................  .....................  Prepare cryopreserved     0348     1.2207       $66.27  ............        $13.25
                                                                       embryo.
89257.................  X....................  .....................  Sperm identification...   0348     1.2207       $66.27  ............        $13.25
89258.................  X....................  .....................  Cryopreservation,         0348     1.2207       $66.27  ............        $13.25
                                                                       embryo.
89259.................  X....................  .....................  Cryopreservation, sperm   0348     1.2207       $66.27  ............        $13.25
89260.................  X....................  .....................  Sperm isolation, simple   0348     1.2207       $66.27  ............        $13.25
89261.................  X....................  .....................  Sperm isolation,          0348     1.2207       $66.27  ............        $13.25
                                                                       complex.
89264.................  X....................  .....................  Identify sperm tissue..   0348     1.2207       $66.27  ............        $13.25
89300.................  A....................  .....................  Semen analysis w/huhner  .....  .........  ...........  ............  ............
89310.................  A....................  .....................  Semen analysis.........  .....  .........  ...........  ............  ............

[[Page 48141]]

 
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           0344     0.6278       $34.08        $17.04         $6.82
                                                                       collection.
89355.................  A....................  .....................  Exam feces for starch..  .....  .........  ...........  ............  ............
89360.................  X....................  .....................  Collect sweat for test.   0344     0.6278       $34.08        $17.04         $6.82
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     0.4353       $23.63  ............         $4.73
90371.................  E....................  .....................  Hep b ig, im...........  .....  .........  ...........  ............  ............
90375.................  K....................  .....................  Rabies ig, im/sc.......   0356     0.4353       $23.63  ............         $4.73
90376.................  K....................  .....................  Rabies ig, heat treated   0356     0.4353       $23.63  ............         $4.73
90378.................  E....................  .....................  Rsv ig, im, 50mg.......  .....  .........  ...........  ............  ............
90379.................  K....................  .....................  Rsv ig, iv.............   0356     0.4353       $23.63  ............         $4.73
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.
90476.................  N....................  .....................  Adenovirus vaccine,      .....  .........  ...........  ............  ............
                                                                       type 4.
90477.................  N....................  .....................  Adenovirus vaccine,      .....  .........  ...........  ............  ............
                                                                       type 7.
90581.................  K....................  .....................  Anthrax vaccine, sc....   0356     0.4353       $23.63  ............         $4.73
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   0355     0.2667       $14.48  ............         $2.90
                                                                       im.
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,     0356     0.4353       $23.63  ............         $4.73
                                                                       sc.
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........  .....  .........  ...........  ............  ............

[[Page 48142]]

 
90708.................  N....................  .....................  Measles-rubella          .....  .........  ...........  ............  ............
                                                                       vaccine, sc.
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,   0356     0.4353       $23.63  ............         $4.73
                                                                       im.
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.................  K....................  .....................  Hepb vacc, ill pat 3      0356     0.4353       $23.63  ............         $4.73
                                                                       dose im.
90743.................  K....................  .....................  Hep b vacc, adol, 2       0356     0.4353       $23.63  ............         $4.73
                                                                       dose, im.
90744.................  K....................  .....................  Hepb vacc ped/adol 3      0356     0.4353       $23.63  ............         $4.73
                                                                       dose im.
90746.................  K....................  .....................  Hep b vaccine, adult,     0356     0.4353       $23.63  ............         $4.73
                                                                       im.
90747.................  K....................  .....................  Hepb vacc, ill pat 4      0356     0.4353       $23.63  ............         $4.73
                                                                       dose im.
90748.................  K....................  .....................  Hep b/hib vaccine, im..   0356     0.4353       $23.63  ............         $4.73
90749.................  N....................  .....................  Vaccine toxoid.........  .....  .........  ...........  ............  ............
90780.................  E....................  .....................  IV infusion therapy, 1   .....  .........  ...........  ............  ............
                                                                       hour.
90781.................  E....................  .....................  IV infusion, additional  .....  .........  ...........  ............  ............
                                                                       hour.
90782.................  X....................  .....................  Injection, sc/im.......   0353     0.4106       $22.29  ............         $4.46
90783.................  X....................  .....................  Injection, ia..........   0359     0.8794       $47.74  ............         $9.55
90784.................  X....................  .....................  Injection, iv..........   0359     0.8794       $47.74  ............         $9.55
90788.................  X....................  .....................  Injection of antibiotic   0359     0.8794       $47.74  ............         $9.55
90799.................  X....................  .....................  Ther/prophylactic/dx      0352     0.1076        $5.84  ............         $1.17
                                                                       inject.
90801.................  S....................  .....................  Psy dx interview.......   0323     1.7955       $97.48        $21.26        $19.50
90802.................  S....................  .....................  Intac psy dx interview.   0323     1.7955       $97.48        $21.26        $19.50
90804.................  S....................  .....................  Psytx, office, 20-30      0322     1.3091       $71.07  ............        $14.21
                                                                       min.
90805.................  S....................  .....................  Psytx, off, 20-30 min w/  0322     1.3091       $71.07  ............        $14.21
                                                                       e&m.
90806.................  S....................  .....................  Psytx, off, 45-50 min..   0323     1.7955       $97.48        $21.26        $19.50
90807.................  S....................  .....................  Psytx, off, 45-50 min w/  0323     1.7955       $97.48        $21.26        $19.50
                                                                       e&m.
90808.................  S....................  .....................  Psytx, office, 75-80      0323     1.7955       $97.48        $21.26        $19.50
                                                                       min.
90809.................  S....................  .....................  Psytx, off, 75-80, w/     0323     1.7955       $97.48        $21.26        $19.50
                                                                       e&m.
90810.................  S....................  .....................  Intac psytx, off, 20-30   0322     1.3091       $71.07  ............        $14.21
                                                                       min.
90811.................  S....................  .....................  Intac psytx, 20-30, w/    0322     1.3091       $71.07  ............        $14.21
                                                                       e&m.
90812.................  S....................  .....................  Intac psytx, off, 45-50   0323     1.7955       $97.48        $21.26        $19.50
                                                                       min.
90813.................  S....................  .....................  Intac psytx, 45-50 min    0323     1.7955       $97.48        $21.26        $19.50
                                                                       w/e&m.
90814.................  S....................  .....................  Intac psytx, off, 75-80   0323     1.7955       $97.48        $21.26        $19.50
                                                                       min.
90815.................  S....................  .....................  Intac psytx, 75-80 w/     0323     1.7955       $97.48        $21.26        $19.50
                                                                       e&m.
90816.................  S....................  .....................  Psytx, hosp, 20-30 min.   0322     1.3091       $71.07  ............        $14.21
90817.................  S....................  .....................  Psytx, hosp, 20-30 min    0322     1.3091       $71.07  ............        $14.21
                                                                       w/e&m.
90818.................  S....................  .....................  Psytx, hosp, 45-50 min.   0323     1.7955       $97.48        $21.26        $19.50
90819.................  S....................  .....................  Psytx, hosp, 45-50 min    0323     1.7955       $97.48        $21.26        $19.50
                                                                       w/e&m.
90821.................  S....................  .....................  Psytx, hosp, 75-80 min.   0323     1.7955       $97.48        $21.26        $19.50
90822.................  S....................  .....................  Psytx, hosp, 75-80 min    0323     1.7955       $97.48        $21.26        $19.50
                                                                       w/e&m.
90823.................  S....................  .....................  Intac psytx, hosp, 20-    0322     1.3091       $71.07  ............        $14.21
                                                                       30 min.
90824.................  S....................  .....................  Intac psytx, hsp 20-30    0322     1.3091       $71.07  ............        $14.21
                                                                       w/e&m.
90826.................  S....................  .....................  Intac psytx, hosp, 45-    0323     1.7955       $97.48        $21.26        $19.50
                                                                       50 min.
90827.................  S....................  .....................  Intac psytx, hsp 45-50    0323     1.7955       $97.48        $21.26        $19.50
                                                                       w/e&m.
90828.................  S....................  .....................  Intac psytx, hosp, 75-    0323     1.7955       $97.48        $21.26        $19.50
                                                                       80 min.
90829.................  S....................  .....................  Intac psytx, hsp 75-80    0323     1.7955       $97.48        $21.26        $19.50
                                                                       w/e&m.
90845.................  S....................  .....................  Psychoanalysis.........   0323     1.7955       $97.48        $21.26        $19.50
90846.................  S....................  .....................  Family psytx w/o          0324     2.8219      $153.20  ............        $30.64
                                                                       patient.
90847.................  S....................  .....................  Family psytx w/patient.   0324     2.8219      $153.20  ............        $30.64
90849.................  S....................  .....................  Multiple family group     0325     1.5820       $85.89        $18.27        $17.18
                                                                       psytx.
90853.................  S....................  .....................  Group psychotherapy....   0325     1.5820       $85.89        $18.27        $17.18
90857.................  S....................  .....................  Intac group psytx......   0325     1.5820       $85.89        $18.27        $17.18
90862.................  X....................  .....................  Medication management..   0374     1.1062       $60.05  ............        $12.01
90865.................  S....................  .....................  Narcosynthesis.........   0323     1.7955       $97.48        $21.26        $19.50
90870.................  S....................  .....................  Electroconvulsive         0320     5.4480      $295.77        $80.06        $59.15
                                                                       therapy.
90871.................  E....................  .....................  Electroconvulsive        .....  .........  ...........  ............  ............
                                                                       therapy.

[[Page 48143]]

 
90875.................  E....................  .....................  Psychophysiological      .....  .........  ...........  ............  ............
                                                                       therapy.
90876.................  E....................  .....................  Psychophysiological      .....  .........  ...........  ............  ............
                                                                       therapy.
90880.................  S....................  .....................  Hypnotherapy...........   0323     1.7955       $97.48        $21.26        $19.50
90882.................  E....................  .....................  Environmental            .....  .........  ...........  ............  ............
                                                                       manipulation.
90885.................  N....................  .....................  Psy evaluation of        .....  .........  ...........  ............  ............
                                                                       records.
90887.................  N....................  .....................  Consultation with        .....  .........  ...........  ............  ............
                                                                       family.
90889.................  N....................  .....................  Preparation of report..  .....  .........  ...........  ............  ............
90899.................  S....................  .....................  Psychiatric service/      0322     1.3091       $71.07  ............        $14.21
                                                                       therapy.
90901.................  S....................  .....................  Biofeedback train, any    0321     1.2462       $67.65        $21.78        $13.53
                                                                       meth.
90911.................  S....................  .....................  Biofeedback peri/uro/     0321     1.2462       $67.65        $21.78        $13.53
                                                                       rectal.
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     5.9427      $322.62  ............        $64.52
                                                                       evaluation.
90937.................  E....................  .....................  Hemodialysis, repeated   .....  .........  ...........  ............  ............
                                                                       eval.
90939.................  N....................  .....................  Hemodialysis study,      .....  .........  ...........  ............  ............
                                                                       transcut.
90940.................  N....................  .....................  Hemodialysis access      .....  .........  ...........  ............  ............
                                                                       study.
90945.................  S....................  .....................  Dialysis, one             0170     5.9427      $322.62  ............        $64.52
                                                                       evaluation.
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     3.5574      $193.13        $83.23        $38.63
91010.................  X....................  .....................  Esophagus motility        0361     3.5574      $193.13        $83.23        $38.63
                                                                       study.
91011.................  X....................  .....................  Esophagus motility        0361     3.5574      $193.13        $83.23        $38.63
                                                                       study.
91012.................  X....................  .....................  Esophagus motility        0361     3.5574      $193.13        $83.23        $38.63
                                                                       study.
91020.................  X....................  .....................  Gastric motility.......   0361     3.5574      $193.13        $83.23        $38.63
91030.................  X....................  .....................  Acid perfusion of         0361     3.5574      $193.13        $83.23        $38.63
                                                                       esophagus.
91032.................  X....................  .....................  Esophagus, acid reflux    0361     3.5574      $193.13        $83.23        $38.63
                                                                       test.
91033.................  X....................  .....................  Prolonged acid reflux     0361     3.5574      $193.13        $83.23        $38.63
                                                                       test.
91052.................  X....................  .....................  Gastric analysis test..   0361     3.5574      $193.13        $83.23        $38.63
91055.................  X....................  .....................  Gastric intubation for    0360     1.7088       $92.77        $42.45        $18.55
                                                                       smear.
91060.................  X....................  .....................  Gastric saline load       0360     1.7088       $92.77        $42.45        $18.55
                                                                       test.
91065.................  X....................  .....................  Breath hydrogen test...   0360     1.7088       $92.77        $42.45        $18.55
91100.................  X....................  .....................  Pass intestine bleeding   0360     1.7088       $92.77        $42.45        $18.55
                                                                       tube.
91105.................  X....................  .....................  Gastric intubation        0360     1.7088       $92.77        $42.45        $18.55
                                                                       treatment.
91122.................  T....................  .....................  Anal pressure record...   0156     3.1438      $170.67        $46.55        $34.13
91123.................  N....................  .....................  Irrigate fecal           .....  .........  ...........  ............  ............
                                                                       impaction.
91132.................  X....................  .....................  Electrogastrography....   0360     1.7088       $92.77        $42.45        $18.55
91133.................  X....................  .....................  Electrogastrography w/    0360     1.7088       $92.77        $42.45        $18.55
                                                                       test.
91299.................  X....................  .....................  Gastroenterology          0360     1.7088       $92.77        $42.45        $18.55
                                                                       procedure.
92002.................  V....................  .....................  Eye exam, new patient..   0601     1.0031       $54.46  ............        $10.89
92004.................  V....................  .....................  Eye exam, new patient..   0602     1.5603       $84.71  ............        $16.94
92012.................  V....................  .....................  Eye exam established      0600     0.9376       $50.90  ............        $10.18
                                                                       pat.
92014.................  V....................  .....................  Eye exam & treatment...   0602     1.5603       $84.71  ............        $16.94
92015.................  E....................  .....................  Refraction.............  .....  .........  ...........  ............  ............
92018.................  T....................  .....................  New eye exam &            0699     2.2211      $120.58        $54.26        $24.12
                                                                       treatment.
92019.................  S....................  .....................  Eye exam & treatment...   0698     0.9355       $50.79        $18.72        $10.16
92020.................  S....................  .....................  Special eye evaluation.   0230     0.7379       $40.06        $14.97         $8.01
92060.................  S....................  .....................  Special eye evaluation.   0230     0.7379       $40.06        $14.97         $8.01
92065.................  S....................  .....................  Orthoptic/pleoptic        0230     0.7379       $40.06        $14.97         $8.01
                                                                       training.
92070.................  N....................  .....................  Fitting of contact lens  .....  .........  ...........  ............  ............
92081.................  S....................  .....................  Visual field              0230     0.7379       $40.06        $14.97         $8.01
                                                                       examination(s).
92082.................  S....................  .....................  Visual field              0698     0.9355       $50.79        $18.72        $10.16
                                                                       examination(s).
92083.................  S....................  .....................  Visual field              0698     0.9355       $50.79        $18.72        $10.16
                                                                       examination(s).
92100.................  N....................  .....................  Serial tonometry         .....  .........  ...........  ............  ............
                                                                       exam(s).
92120.................  S....................  .....................  Tonography & eye          0230     0.7379       $40.06        $14.97         $8.01
                                                                       evaluation.
92130.................  S....................  .....................  Water provocation         0698     0.9355       $50.79        $18.72        $10.16
                                                                       tonography.
92135.................  S....................  .....................  Opthalmic dx imaging...   0230     0.7379       $40.06        $14.97         $8.01
92136.................  S....................  .....................  Ophthalmic biometry....   0230     0.7379       $40.06        $14.97         $8.01

[[Page 48144]]

 
92140.................  S....................  .....................  Glaucoma provocative      0698     0.9355       $50.79        $18.72        $10.16
                                                                       tests.
92225.................  S....................  .....................  Special eye exam,         0698     0.9355       $50.79        $18.72        $10.16
                                                                       initial.
92226.................  S....................  .....................  Special eye exam,         0698     0.9355       $50.79        $18.72        $10.16
                                                                       subsequent.
92230.................  T....................  .....................  Eye exam with photos...   0699     2.2211      $120.58        $54.26        $24.12
92235.................  T....................  .....................  Eye exam with photos...   0699     2.2211      $120.58        $54.26        $24.12
92240.................  S....................  .....................  Icg angiography........   0231     2.0880      $113.36        $50.94        $22.67
92250.................  S....................  .....................  Eye exam with photos...   0230     0.7379       $40.06        $14.97         $8.01
92260.................  S....................  .....................  Ophthalmoscopy/           0230     0.7379       $40.06        $14.97         $8.01
                                                                       dynamometry.
92265.................  S....................  .....................  Eye muscle evaluation..   0231     2.0880      $113.36        $50.94        $22.67
92270.................  S....................  .....................  Electro-oculography....   0698     0.9355       $50.79        $18.72        $10.16
92275.................  S....................  .....................  Electroretinography....   0231     2.0880      $113.36        $50.94        $22.67
92283.................  S....................  .....................  Color vision              0230     0.7379       $40.06        $14.97         $8.01
                                                                       examination.
92284.................  S....................  .....................  Dark adaptation eye       0698     0.9355       $50.79        $18.72        $10.16
                                                                       exam.
92285.................  S....................  .....................  Eye photography........   0230     0.7379       $40.06        $14.97         $8.01
92286.................  S....................  .....................  Internal eye              0698     0.9355       $50.79        $18.72        $10.16
                                                                       photography.
92287.................  S....................  .....................  Internal eye              0231     2.0880      $113.36        $50.94        $22.67
                                                                       photography.
92310.................  E....................  .....................  Contact lens fitting...  .....  .........  ...........  ............  ............
92311.................  X....................  .....................  Contact lens fitting...   0362     2.5384      $137.81  ............        $27.56
92312.................  X....................  .....................  Contact lens fitting...   0362     2.5384      $137.81  ............        $27.56
92313.................  X....................  .....................  Contact lens fitting...   0362     2.5384      $137.81  ............        $27.56
92314.................  E....................  .....................  Prescription of contact  .....  .........  ...........  ............  ............
                                                                       lens.
92315.................  X....................  .....................  Prescription of contact   0362     2.5384      $137.81  ............        $27.56
                                                                       lens.
92316.................  X....................  .....................  Prescription of contact   0362     2.5384      $137.81  ............        $27.56
                                                                       lens.
92317.................  X....................  .....................  Prescription of contact   0362     2.5384      $137.81  ............        $27.56
                                                                       lens.
92325.................  X....................  .....................  Modification of contact   0362     2.5384      $137.81  ............        $27.56
                                                                       lens.
92326.................  X....................  .....................  Replacement of contact    0362     2.5384      $137.81  ............        $27.56
                                                                       lens.
92330.................  S....................  .....................  Fitting of artificial     0230     0.7379       $40.06        $14.97         $8.01
                                                                       eye.
92335.................  N....................  .....................  Fitting of artificial    .....  .........  ...........  ............  ............
                                                                       eye.
92340.................  E....................  .....................  Fitting of spectacles..  .....  .........  ...........  ............  ............
92341.................  E....................  .....................  Fitting of spectacles..  .....  .........  ...........  ............  ............
92342.................  E....................  .....................  Fitting of spectacles..  .....  .........  ...........  ............  ............
92352.................  X....................  .....................  Special spectacles        0362     2.5384      $137.81  ............        $27.56
                                                                       fitting.
92353.................  X....................  .....................  Special spectacles        0362     2.5384      $137.81  ............        $27.56
                                                                       fitting.
92354.................  X....................  .....................  Special spectacles        0362     2.5384      $137.81  ............        $27.56
                                                                       fitting.
92355.................  X....................  .....................  Special spectacles        0362     2.5384      $137.81  ............        $27.56
                                                                       fitting.
92358.................  X....................  .....................  Eye prosthesis service.   0362     2.5384      $137.81  ............        $27.56
92370.................  E....................  .....................  Repair & adjust          .....  .........  ...........  ............  ............
                                                                       spectacles.
92371.................  X....................  .....................  Repair & adjust           0362     2.5384      $137.81  ............        $27.56
                                                                       spectacles.
92390.................  E....................  .....................  Supply of spectacles...  .....  .........  ...........  ............  ............
92391.................  E....................  .....................  Supply of contact        .....  .........  ...........  ............  ............
                                                                       lenses.
92392.................  E....................  .....................  Supply of low vision     .....  .........  ...........  ............  ............
                                                                       aids.
92393.................  E....................  .....................  Supply of artificial     .....  .........  ...........  ............  ............
                                                                       eye.
92395.................  E....................  .....................  Supply of spectacles...  .....  .........  ...........  ............  ............
92396.................  E....................  .....................  Supply of contact        .....  .........  ...........  ............  ............
                                                                       lenses.
92499.................  S....................  .....................  Eye service or            0230     0.7379       $40.06        $14.97         $8.01
                                                                       procedure.
92502.................  T....................  .....................  Ear and throat            0251     1.8643      $101.21  ............        $20.24
                                                                       examination.
92504.................  N....................  .....................  Ear microscopy           .....  .........  ...........  ............  ............
                                                                       examination.
92506.................  A....................  .....................  Speech/hearing           .....  .........  ...........  ............  ............
                                                                       evaluation.
92507.................  A....................  .....................  Speech/hearing therapy.  .....  .........  ...........  ............  ............
92508.................  A....................  .....................  Speech/hearing therapy.  .....  .........  ...........  ............  ............
92510.................  A....................  .....................  Rehab for ear implant..  .....  .........  ...........  ............  ............
92511.................  T....................  .....................  Nasopharyngoscopy......   0071     0.9012       $48.93        $12.89         $9.79
92512.................  X....................  .....................  Nasal function studies.   0363     0.8536       $46.34        $17.15         $9.27
92516.................  X....................  .....................  Facial nerve function     0660     1.7330       $94.08        $30.66        $18.82
                                                                       test.
92520.................  X....................  .....................  Laryngeal function        0660     1.7330       $94.08        $30.66        $18.82
                                                                       studies.
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     0363     0.8536       $46.34        $17.15         $9.27
                                                                       test.
92542.................  X....................  .....................  Positional nystagmus      0363     0.8536       $46.34        $17.15         $9.27
                                                                       test.
92543.................  X....................  .....................  Caloric vestibular test   0363     0.8536       $46.34        $17.15         $9.27
92544.................  X....................  .....................  Optokinetic nystagmus     0363     0.8536       $46.34        $17.15         $9.27
                                                                       test.
92545.................  X....................  .....................  Oscillating tracking      0363     0.8536       $46.34        $17.15         $9.27
                                                                       test.
92546.................  X....................  .....................  Sinusoidal rotational     0660     1.7330       $94.08        $30.66        $18.82
                                                                       test.

[[Page 48145]]

 
92547.................  X....................  .....................  Supplemental electrical   0363     0.8536       $46.34        $17.15         $9.27
                                                                       test.
92548.................  X....................  .....................  Posturography..........   0660     1.7330       $94.08        $30.66        $18.82
92551.................  E....................  .....................  Pure tone hearing test,  .....  .........  ...........  ............  ............
                                                                       air.
92552.................  X....................  .....................  Pure tone audiometry,     0364     0.4415       $23.97         $9.06         $4.79
                                                                       air.
92553.................  X....................  .....................  Audiometry, air & bone.   0365     1.1915       $64.69        $18.95        $12.94
92555.................  X....................  .....................  Speech threshold          0364     0.4415       $23.97         $9.06         $4.79
                                                                       audiometry.
92556.................  X....................  .....................  Speech audiometry,        0364     0.4415       $23.97         $9.06         $4.79
                                                                       complete.
92557.................  X....................  .....................  Comprehensive hearing     0365     1.1915       $64.69        $18.95        $12.94
                                                                       test.
92559.................  E....................  .....................  Group audiometric        .....  .........  ...........  ............  ............
                                                                       testing.
92560.................  E....................  .....................  Bekesy audiometry,       .....  .........  ...........  ............  ............
                                                                       screen.
92561.................  X....................  .....................  Bekesy audiometry,        0365     1.1915       $64.69        $18.95        $12.94
                                                                       diagnosis.
92562.................  X....................  .....................  Loudness balance test..   0364     0.4415       $23.97         $9.06         $4.79
92563.................  X....................  .....................  Tone decay hearing test   0364     0.4415       $23.97         $9.06         $4.79
92564.................  X....................  .....................  Sisi hearing test......   0364     0.4415       $23.97         $9.06         $4.79
92565.................  X....................  .....................  Stenger test, pure tone   0364     0.4415       $23.97         $9.06         $4.79
92567.................  X....................  .....................  Tympanometry...........   0364     0.4415       $23.97         $9.06         $4.79
92568.................  X....................  .....................  Acoustic reflex testing   0364     0.4415       $23.97         $9.06         $4.79
92569.................  X....................  .....................  Acoustic reflex decay     0364     0.4415       $23.97         $9.06         $4.79
                                                                       test.
92571.................  X....................  .....................  Filtered speech hearing   0364     0.4415       $23.97         $9.06         $4.79
                                                                       test.
92572.................  X....................  .....................  Staggered spondaic word   0364     0.4415       $23.97         $9.06         $4.79
                                                                       test.
92573.................  X....................  .....................  Lombard test...........   0364     0.4415       $23.97         $9.06         $4.79
92575.................  X....................  .....................  Sensorineural acuity      0365     1.1915       $64.69        $18.95        $12.94
                                                                       test.
92576.................  X....................  .....................  Synthetic sentence test   0364     0.4415       $23.97         $9.06         $4.79
92577.................  X....................  .....................  Stenger test, speech...   0365     1.1915       $64.69        $18.95        $12.94
92579.................  X....................  .....................  Visual audiometry (vra)   0365     1.1915       $64.69        $18.95        $12.94
92582.................  X....................  .....................  Conditioning play         0365     1.1915       $64.69        $18.95        $12.94
                                                                       audiometry.
92583.................  X....................  .....................  Select picture            0364     0.4415       $23.97         $9.06         $4.79
                                                                       audiometry.
92584.................  X....................  .....................  Electrocochleography...   0660     1.7330       $94.08        $30.66        $18.82
92585.................  S....................  .....................  Auditor evoke potent,     0216     2.8332      $153.81        $67.98        $30.76
                                                                       compre.
92586.................  S....................  .....................  Auditor evoke potent,     0218     1.1296       $61.32  ............        $12.26
                                                                       limit.
92587.................  X....................  .....................  Evoked auditory test...   0363     0.8536       $46.34        $17.15         $9.27
92588.................  X....................  .....................  Evoked auditory test...   0363     0.8536       $46.34        $17.15         $9.27
92589.................  X....................  .....................  Auditory function         0364     0.4415       $23.97         $9.06         $4.79
                                                                       test(s).
92590.................  E....................  .....................  Hearing aid exam, one    .....  .........  ...........  ............  ............
                                                                       ear.
92591.................  E....................  .....................  Hearing aid exam, both   .....  .........  ...........  ............  ............
                                                                       ears.
92592.................  E....................  .....................  Hearing aid check, one   .....  .........  ...........  ............  ............
                                                                       ear.
92593.................  E....................  .....................  Hearing aid check, both  .....  .........  ...........  ............  ............
                                                                       ears.
92594.................  E....................  .....................  Electro hearng aid       .....  .........  ...........  ............  ............
                                                                       test, one.
92595.................  E....................  .....................  Electro hearng aid tst,  .....  .........  ...........  ............  ............
                                                                       both.
92596.................  X....................  .....................  Ear protector             0365     1.1915       $64.69        $18.95        $12.94
                                                                       evaluation.
92597.................  E....................  .....................  Voice Prosthetic         .....  .........  ...........  ............  ............
                                                                       Evaluation.
92601.................  A....................  .....................  Cochlear implt f/up      .....  .........  ...........  ............  ............
                                                                       exam < 7.
92602.................  A....................  .....................  Reprogram cochlear       .....  .........  ...........  ............  ............
                                                                       implt < 7.
92603.................  A....................  .....................  Cochlear implt f/up      .....  .........  ...........  ............  ............
                                                                       exam 7 .
92604.................  A....................  .....................  Reprogram cochlear       .....  .........  ...........  ............  ............
                                                                       implt 7 .
92605.................  A....................  .....................  Eval for nonspeech       .....  .........  ...........  ............  ............
                                                                       device rx.
92606.................  A....................  .....................  Non-speech device        .....  .........  ...........  ............  ............
                                                                       service.
92607.................  A....................  .....................  Ex for speech device     .....  .........  ...........  ............  ............
                                                                       rx, 1hr.
92608.................  A....................  .....................  Ex for speech device rx  .....  .........  ...........  ............  ............
                                                                       addl.
92609.................  A....................  .....................  Use of speech device     .....  .........  ...........  ............  ............
                                                                       service.
92610.................  A....................  .....................  Evaluate swallowing      .....  .........  ...........  ............  ............
                                                                       function.
92611.................  A....................  .....................  Motion fluoroscopy/      .....  .........  ...........  ............  ............
                                                                       swallow.
92612.................  A....................  .....................  Endoscopy swallow tst    .....  .........  ...........  ............  ............
                                                                       (fees).
92613.................  E....................  .....................  Endoscopy swallow tst    .....  .........  ...........  ............  ............
                                                                       (fees).
92614.................  A....................  .....................  Laryngoscopic sensory    .....  .........  ...........  ............  ............
                                                                       test.
92615.................  E....................  .....................  Eval laryngoscopy sense  .....  .........  ...........  ............  ............
                                                                       tst.
92616.................  A....................  .....................  Fees w/laryngeal sense   .....  .........  ...........  ............  ............
                                                                       test.
92617.................  E....................  .....................  Interprt fees/laryngeal  .....  .........  ...........  ............  ............
                                                                       test.
92700.................  X....................  .....................  Ent procedure/service..   0364     0.4415       $23.97         $9.06         $4.79
92950.................  S....................  .....................  Heart/lung                0094     2.6412      $143.39        $48.46        $28.68
                                                                       resuscitation cpr.
92953.................  S....................  .....................  Temporary external        0094     2.6412      $143.39        $48.46        $28.68
                                                                       pacing.
92960.................  S....................  .....................  Cardioversion electric,   0679     5.4862      $297.84        $95.30        $59.57
                                                                       ext.
92961.................  S....................  .....................  Cardioversion,            0679     5.4862      $297.84        $95.30        $59.57
                                                                       electric, int.
92970.................  C....................  .....................  Cardioassist, internal.  .....  .........  ...........  ............  ............
92971.................  C....................  .....................  Cardioassist, external.  .....  .........  ...........  ............  ............
92973.................  T....................  .....................  Percut coronary           1541  .........      $250.00  ............        $50.00
                                                                       thrombectomy.

[[Page 48146]]

 
92974.................  T....................  .....................  Cath place, cardio        1559  .........    $2,250.00  ............       $450.00
                                                                       brachytx.
92975.................  C....................  .....................  Dissolve clot, heart     .....  .........  ...........  ............  ............
                                                                       vessel.
92977.................  T....................  .....................  Dissolve clot, heart      0676     3.7505      $203.61        $55.06        $40.72
                                                                       vessel.
92978.................  S....................  .....................  Intravasc us, heart add-  0670    26.5472    $1,441.22       $521.95       $288.24
                                                                       on.
92979.................  S....................  .....................  Intravasc us, heart add-  0670    26.5472    $1,441.22       $521.95       $288.24
                                                                       on.
92980.................  T....................  .....................  Insert intracoronary      0104    80.8877    $4,391.31  ............       $878.26
                                                                       stent.
92981.................  T....................  .....................  Insert intracoronary      0104    80.8877    $4,391.31  ............       $878.26
                                                                       stent.
92982.................  T....................  .....................  Coronary artery           0083    59.3417    $3,221.60  ............       $644.32
                                                                       dilation.
92984.................  T....................  .....................  Coronary artery           0083    59.3417    $3,221.60  ............       $644.32
                                                                       dilation.
92986.................  T....................  .....................  Revision of aortic        0083    59.3417    $3,221.60  ............       $644.32
                                                                       valve.
92987.................  T....................  .....................  Revision of mitral        0083    59.3417    $3,221.60  ............       $644.32
                                                                       valve.
92990.................  T....................  .....................  Revision of pulmonary     0083    59.3417    $3,221.60  ............       $644.32
                                                                       valve.
92992.................  C....................  .....................  Revision of heart        .....  .........  ...........  ............  ............
                                                                       chamber.
92993.................  C....................  .....................  Revision of heart        .....  .........  ...........  ............  ............
                                                                       chamber.
92995.................  T....................  .....................  Coronary atherectomy...   0082   100.3996    $5,450.59     $1,293.59     $1,090.12
92996.................  T....................  .....................  Coronary atherectomy      0082   100.3996    $5,450.59     $1,293.59     $1,090.12
                                                                       add-on.
92997.................  T....................  .....................  Pul art balloon repr,     0081    34.8355    $1,891.18  ............       $378.24
                                                                       percut.
92998.................  T....................  .....................  Pul art balloon repr,     0081    34.8355    $1,891.18  ............       $378.24
                                                                       percut.
93000.................  E....................  .....................  Electrocardiogram,       .....  .........  ...........  ............  ............
                                                                       complete.
93005.................  S....................  .....................  Electrocardiogram,        0099     0.3708       $20.13  ............         $4.03
                                                                       tracing.
93010.................  A....................  .....................  Electrocardiogram        .....  .........  ...........  ............  ............
                                                                       report.
93012.................  N....................  .....................  Transmission of ecg....  .....  .........  ...........  ............  ............
93014.................  E....................  .....................  Report on transmitted    .....  .........  ...........  ............  ............
                                                                       ecg.
93015.................  E....................  .....................  Cardiovascular stress    .....  .........  ...........  ............  ............
                                                                       test.
93016.................  E....................  .....................  Cardiovascular stress    .....  .........  ...........  ............  ............
                                                                       test.
93017.................  X....................  .....................  Cardiovascular stress     0100     1.6726       $90.80        $41.44        $18.16
                                                                       test.
93018.................  E....................  .....................  Cardiovascular stress    .....  .........  ...........  ............  ............
                                                                       test.
93024.................  X....................  .....................  Cardiac drug stress       0100     1.6726       $90.80        $41.44        $18.16
                                                                       test.
93025.................  X....................  .....................  Microvolt t-wave assess   0100     1.6726       $90.80        $41.44        $18.16
93040.................  E....................  .....................  Rhythm ECG with report.  .....  .........  ...........  ............  ............
93041.................  S....................  .....................  Rhythm ECG, tracing....   0099     0.3708       $20.13  ............         $4.03
93042.................  E....................  .....................  Rhythm ECG, report.....  .....  .........  ...........  ............  ............
93224.................  E....................  .....................  ECG monitor/report, 24   .....  .........  ...........  ............  ............
                                                                       hrs.
93225.................  X....................  .....................  ECG monitor/record, 24    0097     1.0565       $57.36        $23.80        $11.47
                                                                       hrs.
93226.................  X....................  .....................  ECG monitor/report, 24    0097     1.0565       $57.36        $23.80        $11.47
                                                                       hrs.
93227.................  E....................  .....................  ECG monitor/review, 24   .....  .........  ...........  ............  ............
                                                                       hrs.
93230.................  E....................  .....................  ECG monitor/report, 24   .....  .........  ...........  ............  ............
                                                                       hrs.
93231.................  X....................  .....................  Ecg monitor/record, 24    0097     1.0565       $57.36        $23.80        $11.47
                                                                       hrs.
93232.................  X....................  .....................  ECG monitor/report, 24    0097     1.0565       $57.36        $23.80        $11.47
                                                                       hrs.
93233.................  E....................  .....................  ECG monitor/review, 24   .....  .........  ...........  ............  ............
                                                                       hrs.
93235.................  E....................  .....................  ECG monitor/report, 24   .....  .........  ...........  ............  ............
                                                                       hrs.
93236.................  X....................  .....................  ECG monitor/report, 24    0097     1.0565       $57.36        $23.80        $11.47
                                                                       hrs.
93237.................  E....................  .....................  ECG monitor/review, 24   .....  .........  ...........  ............  ............
                                                                       hrs.
93268.................  E....................  .....................  ECG record/review......  .....  .........  ...........  ............  ............
93270.................  X....................  .....................  ECG recording..........   0097     1.0565       $57.36        $23.80        $11.47
93271.................  X....................  .....................  Ecg/monitoring and        0097     1.0565       $57.36        $23.80        $11.47
                                                                       analysis.
93272.................  E....................  .....................  Ecg/review, interpret    .....  .........  ...........  ............  ............
                                                                       only.
93278.................  S....................  .....................  ECG/signal-averaged....   0099     0.3708       $20.13  ............         $4.03
93303.................  S....................  .....................  Echo transthoracic.....   0269     3.2517      $176.53        $87.24        $35.31
93304.................  S....................  .....................  Echo transthoracic.....   0697     1.4621       $79.38        $39.69        $15.88
93307.................  S....................  .....................  Echo exam of heart.....   0269     3.2517      $176.53        $87.24        $35.31
93308.................  S....................  .....................  Echo exam of heart.....   0697     1.4621       $79.38        $39.69        $15.88
93312.................  S....................  .....................  Echo transesophageal...   0270     5.9057      $320.61       $146.79        $64.12
93313.................  S....................  .....................  Echo transesophageal...   0270     5.9057      $320.61       $146.79        $64.12
93314.................  N....................  .....................  Echo transesophageal...  .....  .........  ...........  ............  ............
93315.................  S....................  .....................  Echo transesophageal...   0270     5.9057      $320.61       $146.79        $64.12
93316.................  S....................  .....................  Echo transesophageal...   0270     5.9057      $320.61       $146.79        $64.12
93317.................  N....................  .....................  Echo transesophageal...  .....  .........  ...........  ............  ............
93318.................  S....................  .....................  Echo transesophageal      0270     5.9057      $320.61       $146.79        $64.12
                                                                       intraop.
93320.................  S....................  .....................  Doppler echo exam,        0671     1.6392       $88.99        $44.49        $17.80
                                                                       heart.
93321.................  S....................  .....................  Doppler echo exam,        0697     1.4621       $79.38        $39.69        $15.88
                                                                       heart.
93325.................  S....................  .....................  Doppler color flow add-   0697     1.4621       $79.38        $39.69        $15.88
                                                                       on.
93350.................  S....................  .....................  Echo transthoracic.....   0269     3.2517      $176.53        $87.24        $35.31
93501.................  T....................  .....................  Right heart               0080    36.0982    $1,959.74       $838.92       $391.95
                                                                       catheterization.
93503.................  T....................  .....................  Insert/place heart        0103    12.1256      $658.29       $223.63       $131.66
                                                                       catheter.
93505.................  T....................  .....................  Biopsy of heart lining.   0103    12.1256      $658.29       $223.63       $131.66

[[Page 48147]]

 
93508.................  T....................  .....................  Cath placement,           0080    36.0982    $1,959.74       $838.92       $391.95
                                                                       angiography.
93510.................  T....................  .....................  Left heart                0080    36.0982    $1,959.74       $838.92       $391.95
                                                                       catheterization.
93511.................  T....................  .....................  Left heart                0080    36.0982    $1,959.74       $838.92       $391.95
                                                                       catheterization.
93514.................  T....................  .....................  Left heart                0080    36.0982    $1,959.74       $838.92       $391.95
                                                                       catheterization.
93524.................  T....................  .....................  Left heart                0080    36.0982    $1,959.74       $838.92       $391.95
                                                                       catheterization.
93526.................  T....................  .....................  Rt & Lt heart catheters   0080    36.0982    $1,959.74       $838.92       $391.95
93527.................  T....................  .....................  Rt & Lt heart catheters   0080    36.0982    $1,959.74       $838.92       $391.95
93528.................  T....................  .....................  Rt & Lt heart catheters   0080    36.0982    $1,959.74       $838.92       $391.95
93529.................  T....................  .....................  Rt, lt heart              0080    36.0982    $1,959.74       $838.92       $391.95
                                                                       catheterization.
93530.................  T....................  .....................  Rt heart cath,            0080    36.0982    $1,959.74       $838.92       $391.95
                                                                       congenital.
93531.................  T....................  .....................  R & l heart cath,         0080    36.0982    $1,959.74       $838.92       $391.95
                                                                       congenital.
93532.................  T....................  .....................  R & l heart cath,         0080    36.0982    $1,959.74       $838.92       $391.95
                                                                       congenital.
93533.................  T....................  .....................  R & l heart cath,         0080    36.0982    $1,959.74       $838.92       $391.95
                                                                       congenital.
93539.................  N....................  .....................  Injection, cardiac cath  .....  .........  ...........  ............  ............
93540.................  N....................  .....................  Injection, cardiac cath  .....  .........  ...........  ............  ............
93541.................  N....................  .....................  Injection for lung       .....  .........  ...........  ............  ............
                                                                       angiogram.
93542.................  N....................  .....................  Injection for heart x-   .....  .........  ...........  ............  ............
                                                                       rays.
93543.................  N....................  .....................  Injection for heart x-   .....  .........  ...........  ............  ............
                                                                       rays.
93544.................  N....................  .....................  Injection for            .....  .........  ...........  ............  ............
                                                                       aortography.
93545.................  N....................  .....................  Inject for coronary x-   .....  .........  ...........  ............  ............
                                                                       rays.
93555.................  N....................  .....................  Imaging, cardiac cath..  .....  .........  ...........  ............  ............
93556.................  N....................  .....................  Imaging, cardiac cath..  .....  .........  ...........  ............  ............
93561.................  N....................  .....................  Cardiac output           .....  .........  ...........  ............  ............
                                                                       measurement.
93562.................  N....................  .....................  Cardiac output           .....  .........  ...........  ............  ............
                                                                       measurement.
93571.................  N....................  .....................  Heart flow reserve       .....  .........  ...........  ............  ............
                                                                       measure.
93572.................  N....................  .....................  Heart flow reserve       .....  .........  ...........  ............  ............
                                                                       measure.
93580.................  T....................  .....................  Transcath closure of      1559  .........    $2,250.00  ............       $450.00
                                                                       asd.
93581.................  T....................  .....................  Transcath closure of      1559  .........    $2,250.00  ............       $450.00
                                                                       vsd.
93600.................  T....................  .....................  Bundle of His recording   0087    40.4579    $2,196.42  ............       $439.28
93602.................  T....................  .....................  Intra-atrial recording.   0087    40.4579    $2,196.42  ............       $439.28
93603.................  T....................  .....................  Right ventricular         0087    40.4579    $2,196.42  ............       $439.28
                                                                       recording.
93609.................  T....................  .....................  Map tachycardia, add-on   0087    40.4579    $2,196.42  ............       $439.28
93610.................  T....................  .....................  Intra-atrial pacing....   0087    40.4579    $2,196.42  ............       $439.28
93612.................  T....................  .....................  Intraventricular pacing   0087    40.4579    $2,196.42  ............       $439.28
93613.................  T....................  .....................  Electrophys map 3d, add-  0087    40.4579    $2,196.42  ............       $439.28
                                                                       on.
93615.................  T....................  .....................  Esophageal recording...   0087    40.4579    $2,196.42  ............       $439.28
93616.................  T....................  .....................  Esophageal recording...   0087    40.4579    $2,196.42  ............       $439.28
93618.................  T....................  .....................  Heart rhythm pacing....   0087    40.4579    $2,196.42  ............       $439.28
93619.................  T....................  .....................  Electrophysiology         0085    36.3284    $1,972.23       $435.09       $394.45
                                                                       evaluation.
93620.................  T....................  .....................  Electrophysiology         0085    36.3284    $1,972.23       $435.09       $394.45
                                                                       evaluation.
93621.................  T....................  .....................  Electrophysiology         0085    36.3284    $1,972.23       $435.09       $394.45
                                                                       evaluation.
93622.................  T....................  .....................  Electrophysiology         0085    36.3284    $1,972.23       $435.09       $394.45
                                                                       evaluation.
93623.................  T....................  .....................  Stimulation, pacing       0087    40.4579    $2,196.42  ............       $439.28
                                                                       heart.
93624.................  S....................  .....................  Electrophysiologic        0084    10.3392      $561.30  ............       $112.26
                                                                       study.
93631.................  T....................  .....................  Heart pacing, mapping..   0087    40.4579    $2,196.42  ............       $439.28
93640.................  S....................  .....................  Evaluation heart device   0084    10.3392      $561.30  ............       $112.26
93641.................  S....................  .....................  Electrophysiology         0084    10.3392      $561.30  ............       $112.26
                                                                       evaluation.
93642.................  S....................  .....................  Electrophysiology         0084    10.3392      $561.30  ............       $112.26
                                                                       evaluation.
93650.................  T....................  .....................  Ablate heart dysrhythm    0086    44.5652    $2,419.40       $822.28       $483.88
                                                                       focus.
93651.................  T....................  .....................  Ablate heart dysrhythm    0086    44.5652    $2,419.40       $822.28       $483.88
                                                                       focus.
93652.................  T....................  .....................  Ablate heart dysrhythm    0086    44.5652    $2,419.40       $822.28       $483.88
                                                                       focus.
93660.................  S....................  .....................  Tilt table evaluation..   0101     4.3675      $237.11       $105.27        $47.42
93662.................  S....................  .....................  Intracardiac ecg (ice).   0670    26.5472    $1,441.22       $521.95       $288.24
93668.................  E....................  .....................  Peripheral vascular      .....  .........  ...........  ............  ............
                                                                       rehab.
93701.................  S....................  .....................  Bioimpedance, thoracic.   0099     0.3708       $20.13  ............         $4.03
93720.................  E....................  .....................  Total body               .....  .........  ...........  ............  ............
                                                                       plethysmography.
93721.................  X....................  .....................  Plethysmography tracing   0368     0.9321       $50.60        $25.30        $10.12
93722.................  E....................  .....................  Plethysmography report.  .....  .........  ...........  ............  ............
93724.................  S....................  .....................  Analyze pacemaker         0690     0.3986       $21.64        $10.35         $4.33
                                                                       system.
93727.................  S....................  .....................  Analyze ilr system.....   0690     0.3986       $21.64        $10.35         $4.33
93731.................  S....................  .....................  Analyze pacemaker         0690     0.3986       $21.64        $10.35         $4.33
                                                                       system.
93732.................  S....................  .....................  Analyze pacemaker         0690     0.3986       $21.64        $10.35         $4.33
                                                                       system.
93733.................  S....................  .....................  Telephone analy,          0690     0.3986       $21.64        $10.35         $4.33
                                                                       pacemaker.
93734.................  S....................  .....................  Analyze pacemaker         0690     0.3986       $21.64        $10.35         $4.33
                                                                       system.
93735.................  S....................  .....................  Analyze pacemaker         0690     0.3986       $21.64        $10.35         $4.33
                                                                       system.
93736.................  S....................  .....................  Telephone analy,          0690     0.3986       $21.64        $10.35         $4.33
                                                                       pacemaker.

[[Page 48148]]

 
93740.................  X....................  .....................  Temperature gradient      0367     0.5828       $31.64        $15.16         $6.33
                                                                       studies.
93741.................  S....................  .....................  Analyze ht pace device    0689     0.5427       $29.46  ............         $5.89
                                                                       sngl.
93742.................  S....................  .....................  Analyze ht pace device    0689     0.5427       $29.46  ............         $5.89
                                                                       sngl.
93743.................  S....................  .....................  Analyze ht pace device    0689     0.5427       $29.46  ............         $5.89
                                                                       dual.
93744.................  S....................  .....................  Analyze ht pace device    0689     0.5427       $29.46  ............         $5.89
                                                                       dual.
93760.................  E....................  .....................  Cephalic thermogram....  .....  .........  ...........  ............  ............
93762.................  E....................  .....................  Peripheral thermogram..  .....  .........  ...........  ............  ............
93770.................  N....................  .....................  Measure venous pressure  .....  .........  ...........  ............  ............
93784.................  E....................  .....................  Ambulatory BP            .....  .........  ...........  ............  ............
                                                                       monitoring.
93786.................  X....................  .....................  Ambulatory BP recording   0097     1.0565       $57.36        $23.80        $11.47
93788.................  E....................  .....................  Ambulatory BP analysis.  .....  .........  ...........  ............  ............
93790.................  E....................  .....................  Review/report BP         .....  .........  ...........  ............  ............
                                                                       recording.
93797.................  S....................  .....................  Cardiac rehab..........   0095     0.5984       $32.49        $16.24         $6.50
93798.................  S....................  .....................  Cardiac rehab/monitor..   0095     0.5984       $32.49        $16.24         $6.50
93799.................  S....................  .....................  Cardiovascular            0096     1.7332       $94.09        $47.04        $18.82
                                                                       procedure.
93875.................  S....................  .....................  Extracranial study.....   0096     1.7332       $94.09        $47.04        $18.82
93880.................  S....................  .....................  Extracranial study.....   0267     2.4805      $134.66        $65.52        $26.93
93882.................  S....................  .....................  Extracranial study.....   0267     2.4805      $134.66        $65.52        $26.93
93886.................  S....................  .....................  Intracranial study.....   0267     2.4805      $134.66        $65.52        $26.93
93888.................  S....................  .....................  Intracranial study.....   0266     1.6234       $88.13        $44.06        $17.63
93922.................  S....................  .....................  Extremity study........   0096     1.7332       $94.09        $47.04        $18.82
93923.................  S....................  .....................  Extremity study........   0096     1.7332       $94.09        $47.04        $18.82
93924.................  S....................  .....................  Extremity study........   0096     1.7332       $94.09        $47.04        $18.82
93925.................  S....................  .....................  Lower extremity study..   0267     2.4805      $134.66        $65.52        $26.93
93926.................  S....................  .....................  Lower extremity study..   0267     2.4805      $134.66        $65.52        $26.93
93930.................  S....................  .....................  Upper extremity study..   0267     2.4805      $134.66        $65.52        $26.93
93931.................  S....................  .....................  Upper extremity study..   0266     1.6234       $88.13        $44.06        $17.63
93965.................  S....................  .....................  Extremity study........   0096     1.7332       $94.09        $47.04        $18.82
93970.................  S....................  .....................  Extremity study........   0267     2.4805      $134.66        $65.52        $26.93
93971.................  S....................  .....................  Extremity study........   0267     2.4805      $134.66        $65.52        $26.93
93975.................  S....................  .....................  Vascular study.........   0267     2.4805      $134.66        $65.52        $26.93
93976.................  S....................  .....................  Vascular study.........   0267     2.4805      $134.66        $65.52        $26.93
93978.................  S....................  .....................  Vascular study.........   0267     2.4805      $134.66        $65.52        $26.93
93979.................  S....................  .....................  Vascular study.........   0267     2.4805      $134.66        $65.52        $26.93
93980.................  S....................  .....................  Penile vascular study..   0267     2.4805      $134.66        $65.52        $26.93
93981.................  S....................  .....................  Penile vascular study..   0267     2.4805      $134.66        $65.52        $26.93
93990.................  S....................  .....................  Doppler flow testing...   0267     2.4805      $134.66        $65.52        $26.93
94010.................  X....................  .....................  Breathing capacity test   0368     0.9321       $50.60        $25.30        $10.12
94014.................  X....................  .....................  Patient recorded          0367     0.5828       $31.64        $15.16         $6.33
                                                                       spirometry.
94015.................  X....................  .....................  Patient recorded          0367     0.5828       $31.64        $15.16         $6.33
                                                                       spirometry.
94016.................  A....................  .....................  Review patient           .....  .........  ...........  ............  ............
                                                                       spirometry.
94060.................  X....................  .....................  Evaluation of wheezing.   0368     0.9321       $50.60        $25.30        $10.12
94070.................  X....................  .....................  Evaluation of wheezing.   0369     2.5282      $137.25        $44.18        $27.45
94150.................  X....................  .....................  Vital capacity test....   0367     0.5828       $31.64        $15.16         $6.33
94200.................  X....................  .....................  Lung function test (MBC/  0367     0.5828       $31.64        $15.16         $6.33
                                                                       MVV).
94240.................  X....................  .....................  Residual lung capacity.   0368     0.9321       $50.60        $25.30        $10.12
94250.................  X....................  .....................  Expired gas collection.   0367     0.5828       $31.64        $15.16         $6.33
94260.................  X....................  .....................  Thoracic gas volume....   0368     0.9321       $50.60        $25.30        $10.12
94350.................  X....................  .....................  Lung nitrogen washout     0368     0.9321       $50.60        $25.30        $10.12
                                                                       curve.
94360.................  X....................  .....................  Measure airflow           0367     0.5828       $31.64        $15.16         $6.33
                                                                       resistance.
94370.................  X....................  .....................  Breath airway closing     0367     0.5828       $31.64        $15.16         $6.33
                                                                       volume.
94375.................  X....................  .....................  Respiratory flow volume   0367     0.5828       $31.64        $15.16         $6.33
                                                                       loop.
94400.................  X....................  .....................  CO2 breathing response    0367     0.5828       $31.64        $15.16         $6.33
                                                                       curve.
94450.................  X....................  .....................  Hypoxia response curve.   0367     0.5828       $31.64        $15.16         $6.33
94620.................  X....................  .....................  Pulmonary stress test/    0368     0.9321       $50.60        $25.30        $10.12
                                                                       simple.
94621.................  X....................  .....................  Pulm stress test/         0369     2.5282      $137.25        $44.18        $27.45
                                                                       complex.
94640.................  S....................  .....................  Airway inhalation         0077     0.2772       $15.05         $7.52         $3.01
                                                                       treatment.
94642.................  S....................  .....................  Aerosol inhalation        0078     0.7731       $41.97        $14.55         $8.39
                                                                       treatment.
94656.................  S....................  .....................  Initial ventilator mgmt   0079     2.2837      $123.98  ............        $24.80
94657.................  S....................  .....................  Continued ventilator      0079     2.2837      $123.98  ............        $24.80
                                                                       mgmt.
94660.................  S....................  .....................  Pos airway pressure,      0068     1.1234       $60.99        $30.49        $12.20
                                                                       CPAP.
94662.................  S....................  .....................  Neg press ventilation,    0079     2.2837      $123.98  ............        $24.80
                                                                       cnp.
94664.................  S....................  .....................  Aerosol or vapor          0077     0.2772       $15.05         $7.52         $3.01
                                                                       inhalations.
94667.................  S....................  .....................  Chest wall manipulation   0077     0.2772       $15.05         $7.52         $3.01
94668.................  S....................  .....................  Chest wall manipulation   0077     0.2772       $15.05         $7.52         $3.01
94680.................  X....................  .....................  Exhaled air analysis,     0367     0.5828       $31.64        $15.16         $6.33
                                                                       o2.

[[Page 48149]]

 
94681.................  X....................  .....................  Exhaled air analysis,     0368     0.9321       $50.60        $25.30        $10.12
                                                                       o2/co2.
94690.................  X....................  .....................  Exhaled air analysis...   0367     0.5828       $31.64        $15.16         $6.33
94720.................  X....................  .....................  Monoxide diffusing        0368     0.9321       $50.60        $25.30        $10.12
                                                                       capacity.
94725.................  X....................  .....................  Membrane diffusion        0368     0.9321       $50.60        $25.30        $10.12
                                                                       capacity.
94750.................  X....................  .....................  Pulmonary compliance      0367     0.5828       $31.64        $15.16         $6.33
                                                                       study.
94760.................  N....................  .....................  Measure blood oxygen     .....  .........  ...........  ............  ............
                                                                       level.
94761.................  N....................  .....................  Measure blood oxygen     .....  .........  ...........  ............  ............
                                                                       level.
94762.................  N....................  .....................  Measure blood oxygen     .....  .........  ...........  ............  ............
                                                                       level.
94770.................  X....................  .....................  Exhaled carbon dioxide    0367     0.5828       $31.64        $15.16         $6.33
                                                                       test.
94772.................  X....................  .....................  Breath recording,         0369     2.5282      $137.25        $44.18        $27.45
                                                                       infant.
94799.................  X....................  .....................  Pulmonary service/        0367     0.5828       $31.64        $15.16         $6.33
                                                                       procedure.
95004.................  X....................  .....................  Percut allergy skin       0370     0.8858       $48.09        $11.58         $9.62
                                                                       tests.
95010.................  X....................  .....................  Percut allergy titrate    0370     0.8858       $48.09        $11.58         $9.62
                                                                       test.
95015.................  X....................  .....................  Id allergy titrate-drug/  0370     0.8858       $48.09        $11.58         $9.62
                                                                       bug.
95024.................  X....................  .....................  Id allergy test, drug/    0370     0.8858       $48.09        $11.58         $9.62
                                                                       bug.
95027.................  X....................  .....................  Skin end point            0370     0.8858       $48.09        $11.58         $9.62
                                                                       titration.
95028.................  X....................  .....................  Id allergy test-delayed   0370     0.8858       $48.09        $11.58         $9.62
                                                                       type.
95044.................  X....................  .....................  Allergy patch tests....   0370     0.8858       $48.09        $11.58         $9.62
95052.................  X....................  .....................  Photo patch test.......   0370     0.8858       $48.09        $11.58         $9.62
95056.................  X....................  .....................  Photosensitivity tests.   0370     0.8858       $48.09        $11.58         $9.62
95060.................  X....................  .....................  Eye allergy tests......   0370     0.8858       $48.09        $11.58         $9.62
95065.................  X....................  .....................  Nose allergy test......   0370     0.8858       $48.09        $11.58         $9.62
95070.................  X....................  .....................  Bronchial allergy tests   0369     2.5282      $137.25        $44.18        $27.45
95071.................  X....................  .....................  Bronchial allergy tests   0369     2.5282      $137.25        $44.18        $27.45
95075.................  X....................  .....................  Ingestion challenge       0361     3.5574      $193.13        $83.23        $38.63
                                                                       test.
95078.................  X....................  .....................  Provocative testing....   0370     0.8858       $48.09        $11.58         $9.62
95115.................  X....................  .....................  Immunotherapy, one        0352     0.1076        $5.84  ............         $1.17
                                                                       injection.
95117.................  X....................  .....................  Immunotherapy             0353     0.4106       $22.29  ............         $4.46
                                                                       injections.
95120.................  E....................  .....................  Immunotherapy, one       .....  .........  ...........  ............  ............
                                                                       injection.
95125.................  E....................  .....................  Immunotherapy, many      .....  .........  ...........  ............  ............
                                                                       antigens.
95130.................  E....................  .....................  Immunotherapy, insect    .....  .........  ...........  ............  ............
                                                                       venom.
95131.................  E....................  .....................  Immunotherapy, insect    .....  .........  ...........  ............  ............
                                                                       venoms.
95132.................  E....................  .....................  Immunotherapy, insect    .....  .........  ...........  ............  ............
                                                                       venoms.
95133.................  E....................  .....................  Immunotherapy, insect    .....  .........  ...........  ............  ............
                                                                       venoms.
95134.................  E....................  .....................  Immunotherapy, insect    .....  .........  ...........  ............  ............
                                                                       venoms.
95144.................  X....................  .....................  Antigen therapy           0371     0.4084       $22.17         $4.44         $4.43
                                                                       services.
95145.................  X....................  .....................  Antigen therapy           0371     0.4084       $22.17         $4.44         $4.43
                                                                       services.
95146.................  X....................  .....................  Antigen therapy           0371     0.4084       $22.17         $4.44         $4.43
                                                                       services.
95147.................  X....................  .....................  Antigen therapy           0371     0.4084       $22.17         $4.44         $4.43
                                                                       services.
95148.................  X....................  .....................  Antigen therapy           0371     0.4084       $22.17         $4.44         $4.43
                                                                       services.
95149.................  X....................  .....................  Antigen therapy           0371     0.4084       $22.17         $4.44         $4.43
                                                                       services.
95165.................  X....................  .....................  Antigen therapy           0371     0.4084       $22.17         $4.44         $4.43
                                                                       services.
95170.................  X....................  .....................  Antigen therapy           0371     0.4084       $22.17         $4.44         $4.43
                                                                       services.
95180.................  X....................  .....................  Rapid desensitization..   0370     0.8858       $48.09        $11.58         $9.62
95199.................  X....................  .....................  Allergy immunology        0370     0.8858       $48.09        $11.58         $9.62
                                                                       services.
95250.................  T....................  .....................  Glucose monitoring,       1540  .........      $150.00  ............        $30.00
                                                                       cont.
95805.................  S....................  .....................  Multiple sleep latency    0209    11.5352      $626.23       $280.58       $125.25
                                                                       test.
95806.................  S....................  .....................  Sleep study, unattended   0213     3.2422      $176.02        $70.41        $35.20
95807.................  S....................  .....................  Sleep study, attended..   0209    11.5352      $626.23       $280.58       $125.25
95808.................  S....................  .....................  Polysomnography, 1-3...   0209    11.5352      $626.23       $280.58       $125.25
95810.................  S....................  .....................  Polysomnography, 4 or     0209    11.5352      $626.23       $280.58       $125.25
                                                                       more.
95811.................  S....................  .....................  Polysomnography w/cpap.   0209    11.5352      $626.23       $280.58       $125.25
95812.................  S....................  .....................  Electroencephalogram      0213     3.2422      $176.02        $70.41        $35.20
                                                                       (EEG).
95813.................  S....................  .....................  Eeg, over 1 hour.......   0213     3.2422      $176.02        $70.41        $35.20
95816.................  S....................  .....................  Electroencephalogram      0214     2.2459      $121.93        $58.12        $24.39
                                                                       (EEG).
95819.................  S....................  .....................  Electroencephalogram      0214     2.2459      $121.93        $58.12        $24.39
                                                                       (EEG).
95822.................  S....................  .....................  Sleep                     0214     2.2459      $121.93        $58.12        $24.39
                                                                       electroencephalogram.
95824.................  S....................  .....................  Eeg, cerebral death       0214     2.2459      $121.93        $58.12        $24.39
                                                                       only.
95827.................  S....................  .....................  Night                     0209    11.5352      $626.23       $280.58       $125.25
                                                                       electroencephalogram.
95829.................  S....................  .....................  Surgery                   0214     2.2459      $121.93        $58.12        $24.39
                                                                       electrocorticogram.
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.

[[Page 48150]]

 
95852.................  N....................  .....................  Range of motion          .....  .........  ...........  ............  ............
                                                                       measurements.
95857.................  S....................  .....................  Tensilon test..........   0218     1.1296       $61.32  ............        $12.26
95858.................  S....................  .....................  Tensilon test & myogram   0215     0.6390       $34.69        $15.76         $6.94
95860.................  S....................  .....................  Muscle test, one limb..   0218     1.1296       $61.32  ............        $12.26
95861.................  S....................  .....................  Muscle test, 2 limbs...   0218     1.1296       $61.32  ............        $12.26
95863.................  S....................  .....................  Muscle test, 3 limbs...   0218     1.1296       $61.32  ............        $12.26
95864.................  S....................  .....................  Muscle test, 4 limbs...   0218     1.1296       $61.32  ............        $12.26
95867.................  S....................  .....................  Muscle test, head or      0218     1.1296       $61.32  ............        $12.26
                                                                       neck.
95868.................  S....................  .....................  Muscle test cran nerve    0218     1.1296       $61.32  ............        $12.26
                                                                       bilat.
95869.................  S....................  .....................  Muscle test, thor         0215     0.6390       $34.69        $15.76         $6.94
                                                                       paraspinal.
95870.................  S....................  .....................  Muscle test,              0215     0.6390       $34.69        $15.76         $6.94
                                                                       nonparaspinal.
95872.................  S....................  .....................  Muscle test, one fiber.   0218     1.1296       $61.32  ............        $12.26
95875.................  S....................  .....................  Limb exercise test.....   0215     0.6390       $34.69        $15.76         $6.94
95900.................  S....................  .....................  Motor nerve conduction    0215     0.6390       $34.69        $15.76         $6.94
                                                                       test.
95903.................  S....................  .....................  Motor nerve conduction    0215     0.6390       $34.69        $15.76         $6.94
                                                                       test.
95904.................  S....................  .....................  Sense nerve conduction    0215     0.6390       $34.69        $15.76         $6.94
                                                                       test.
95920.................  S....................  .....................  Intraop nerve test add-   0216     2.8332      $153.81        $67.98        $30.76
                                                                       on.
95921.................  S....................  .....................  Autonomic nerv function   0218     1.1296       $61.32  ............        $12.26
                                                                       test.
95922.................  S....................  .....................  Autonomic nerv function   0218     1.1296       $61.32  ............        $12.26
                                                                       test.
95923.................  S....................  .....................  Autonomic nerv function   0215     0.6390       $34.69        $15.76         $6.94
                                                                       test.
95925.................  S....................  .....................  Somatosensory testing..   0216     2.8332      $153.81        $67.98        $30.76
95926.................  S....................  .....................  Somatosensory testing..   0216     2.8332      $153.81        $67.98        $30.76
95927.................  S....................  .....................  Somatosensory testing..   0216     2.8332      $153.81        $67.98        $30.76
95930.................  S....................  .....................  Visual evoked potential   0218     1.1296       $61.32  ............        $12.26
                                                                       test.
95933.................  S....................  .....................  Blink reflex test......   0215     0.6390       $34.69        $15.76         $6.94
95934.................  S....................  .....................  H-reflex test..........   0215     0.6390       $34.69        $15.76         $6.94
95936.................  S....................  .....................  H-reflex test..........   0215     0.6390       $34.69        $15.76         $6.94
95937.................  S....................  .....................  Neuromuscular junction    0218     1.1296       $61.32  ............        $12.26
                                                                       test.
95950.................  S....................  .....................  Ambulatory eeg            0213     3.2422      $176.02        $70.41        $35.20
                                                                       monitoring.
95951.................  S....................  .....................  EEG monitoring/           0209    11.5352      $626.23       $280.58       $125.25
                                                                       videorecord.
95953.................  S....................  .....................  EEG monitoring/computer   0209    11.5352      $626.23       $280.58       $125.25
95954.................  S....................  .....................  EEG monitoring/giving     0214     2.2459      $121.93        $58.12        $24.39
                                                                       drugs.
95955.................  S....................  .....................  EEG during surgery.....   0213     3.2422      $176.02        $70.41        $35.20
95956.................  S....................  .....................  Eeg monitoring, cable/    0214     2.2459      $121.93        $58.12        $24.39
                                                                       radio.
95957.................  S....................  .....................  EEG digital analysis...   0214     2.2459      $121.93        $58.12        $24.39
95958.................  S....................  .....................  EEG monitoring/function   0213     3.2422      $176.02        $70.41        $35.20
                                                                       test.
95961.................  S....................  .....................  Electrode stimulation,    0216     2.8332      $153.81        $67.98        $30.76
                                                                       brain.
95962.................  S....................  .....................  Electrode stim, brain     0216     2.8332      $153.81        $67.98        $30.76
                                                                       add-on.
95965.................  S....................  .....................  Meg, spontaneous.......   1528  .........    $5,250.00  ............     $1,050.00
95966.................  S....................  .....................  Meg, evoked, single....   1516  .........    $1,450.00  ............       $290.00
95967.................  S....................  .....................  Meg, evoked, each addl.   1511  .........      $950.00  ............       $190.00
95970.................  S....................  .....................  Analyze neurostim, no     0692     0.9625       $52.25        $26.12        $10.45
                                                                       prog.
95971.................  S....................  .....................  Analyze neurostim,        0692     0.9625       $52.25        $26.12        $10.45
                                                                       simple.
95972.................  S....................  .....................  Analyze neurostim,        0692     0.9625       $52.25        $26.12        $10.45
                                                                       complex.
95973.................  S....................  .....................  Analyze neurostim,        0692     0.9625       $52.25        $26.12        $10.45
                                                                       complex.
95974.................  S....................  .....................  Cranial neurostim,        0692     0.9625       $52.25        $26.12        $10.45
                                                                       complex.
95975.................  S....................  .....................  Cranial neurostim,        0692     0.9625       $52.25        $26.12        $10.45
                                                                       complex.
95990.................  T....................  .....................  Spin/brain pump refil &   0125     2.5105      $136.29  ............        $27.26
                                                                       main.
95999.................  S....................  .....................  Neurological procedure.   0215     0.6390       $34.69        $15.76         $6.94
96000.................  S....................  .....................  Motion analysis, video/   1503  .........      $150.00  ............        $30.00
                                                                       3d.
96001.................  S....................  .....................  Motion test w/ft press    1503  .........      $150.00  ............        $30.00
                                                                       meas.
96002.................  S....................  .....................  Dynamic surface emg....   1503  .........      $150.00  ............        $30.00
96003.................  S....................  .....................  Dynamic fine wire emg..   1503  .........      $150.00  ............        $30.00
96004.................  E....................  .....................  Phys review of motion    .....  .........  ...........  ............  ............
                                                                       tests.
96100.................  X....................  .....................  Psychological testing..   0373     2.1165      $114.90        $22.98        $22.98
96105.................  X....................  .....................  Assessment of aphasia..   0373     2.1165      $114.90        $22.98        $22.98
96110.................  X....................  .....................  Developmental test, lim   0373     2.1165      $114.90        $22.98        $22.98
96111.................  X....................  .....................  Developmental test,       0373     2.1165      $114.90        $22.98        $22.98
                                                                       extend.
96115.................  X....................  .....................  Neurobehavior status      0373     2.1165      $114.90        $22.98        $22.98
                                                                       exam.
96117.................  X....................  .....................  Neuropsych test battery   0373     2.1165      $114.90        $22.98        $22.98
96150.................  S....................  .....................  Assess lth/behave, init   0322     1.3091       $71.07  ............        $14.21
96151.................  S....................  .....................  Assess hlth/behave,       0322     1.3091       $71.07  ............        $14.21
                                                                       subseq.
96152.................  S....................  .....................  Intervene hlth/behave,    0322     1.3091       $71.07  ............        $14.21
                                                                       indiv.
96153.................  S....................  .....................  Intervene hlth/behave,    0322     1.3091       $71.07  ............        $14.21
                                                                       group.
96154.................  S....................  .....................  Interv hlth/behav, fam    0322     1.3091       $71.07  ............        $14.21
                                                                       w/pt.
96155.................  S....................  .....................  Interv hlth/behav fam     0322     1.3091       $71.07  ............        $14.21
                                                                       no pt.

[[Page 48151]]

 
96400.................  E....................  .....................  Chemotherapy, sc/im....  .....  .........  ...........  ............  ............
96405.................  E....................  .....................  Intralesional chemo      .....  .........  ...........  ............  ............
                                                                       admin.
96406.................  E....................  .....................  Intralesional chemo      .....  .........  ...........  ............  ............
                                                                       admin.
96408.................  E....................  .....................  Chemotherapy, push       .....  .........  ...........  ............  ............
                                                                       technique.
96410.................  E....................  .....................  Chemotherapy, infusion   .....  .........  ...........  ............  ............
                                                                       method.
96412.................  E....................  .....................  Chemo, infuse method     .....  .........  ...........  ............  ............
                                                                       add-on.
96414.................  E....................  .....................  Chemo, infuse method     .....  .........  ...........  ............  ............
                                                                       add-on.
96420.................  E....................  .....................  Chemotherapy, push       .....  .........  ...........  ............  ............
                                                                       technique.
96422.................  E....................  .....................  Chemotherapy,infusion    .....  .........  ...........  ............  ............
                                                                       method.
96423.................  E....................  .....................  Chemo, infuse method     .....  .........  ...........  ............  ............
                                                                       add-on.
96425.................  E....................  .....................  Chemotherapy, infusion   .....  .........  ...........  ............  ............
                                                                       method.
96440.................  E....................  .....................  Chemotherapy,            .....  .........  ...........  ............  ............
                                                                       intracavitary.
96445.................  E....................  .....................  Chemotherapy,            .....  .........  ...........  ............  ............
                                                                       intracavitary.
96450.................  E....................  .....................  Chemotherapy, into CNS.  .....  .........  ...........  ............  ............
96520.................  T....................  .....................  Port pump refill & main   0125     2.5105      $136.29  ............        $27.26
96530.................  T....................  .....................  Pump refilling,           0125     2.5105      $136.29  ............        $27.26
                                                                       maintenance.
96542.................  E....................  .....................  Chemotherapy injection.  .....  .........  ...........  ............  ............
96545.................  E....................  .....................  Provide chemotherapy     .....  .........  ...........  ............  ............
                                                                       agent.
96549.................  E....................  .....................  Chemotherapy,            .....  .........  ...........  ............  ............
                                                                       unspecified.
96567.................  T....................  .....................  Photodynamic tx, skin..   1540  .........      $150.00  ............        $30.00
96570.................  T....................  .....................  Photodynamic tx, 30 min   1541  .........      $250.00  ............        $50.00
96571.................  T....................  .....................  Photodynamic tx, addl     1541  .........      $250.00  ............        $50.00
                                                                       15 min.
96900.................  S....................  .....................  Ultraviolet light         0001     0.3940       $21.39         $7.09         $4.28
                                                                       therapy.
96902.................  N....................  .....................  Trichogram.............  .....  .........  ...........  ............  ............
96910.................  S....................  .....................  Photochemotherapy with    0001     0.3940       $21.39         $7.09         $4.28
                                                                       UV-B.
96912.................  S....................  .....................  Photochemotherapy with    0001     0.3940       $21.39         $7.09         $4.28
                                                                       UV-A.
96913.................  S....................  .....................  Photochemotherapy, UV-A   0683     1.7915       $97.26        $35.01        $19.45
                                                                       or B.
96920.................  T....................  .....................  Laser tx, skin < 250 sq   0012     0.8203       $44.53        $11.18         $8.91
                                                                       cm.
96921.................  T....................  .....................  Laser tx, skin 250-500    0012     0.8203       $44.53        $11.18         $8.91
                                                                       sq cm.
96922.................  T....................  .....................  Laser tx, skin  500 sq cm.
96999.................  T....................  .....................  Dermatological            0010     0.6806       $36.95        $10.08         $7.39
                                                                       procedure.
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.................  E....................  .....................  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....  .....  .........  ...........  ............  ............

[[Page 48152]]

 
97535.................  A....................  .....................  Self care mngment        .....  .........  ...........  ............  ............
                                                                       training.
97537.................  A....................  .....................  Community/work           .....  .........  ...........  ............  ............
                                                                       reintegration.
97542.................  A....................  .....................  Wheelchair mngment       .....  .........  ...........  ............  ............
                                                                       training.
97545.................  A....................  .....................  Work hardening.........  .....  .........  ...........  ............  ............
97546.................  A....................  .....................  Work hardening add-on..  .....  .........  ...........  ............  ............
97601.................  A....................  .....................  Wound(s) care,           .....  .........  ...........  ............  ............
                                                                       selective.
97602.................  N....................  .....................  Wound(s) care non-       .....  .........  ...........  ............  ............
                                                                       selective.
97703.................  A....................  .....................  Prosthetic checkout....  .....  .........  ...........  ............  ............
97750.................  A....................  .....................  Physical performance     .....  .........  ...........  ............  ............
                                                                       test.
97780.................  E....................  .....................  Acupuncture w/o stimul.  .....  .........  ...........  ............  ............
97781.................  E....................  .....................  Acupuncture w/stimul...  .....  .........  ...........  ............  ............
97799.................  A....................  .....................  Physical medicine        .....  .........  ...........  ............  ............
                                                                       procedure.
97802.................  A....................  .....................  Medical nutrition,       .....  .........  ...........  ............  ............
                                                                       indiv, in.
97803.................  A....................  .....................  Med nutrition, indiv,    .....  .........  ...........  ............  ............
                                                                       subseq.
97804.................  A....................  .....................  Medical nutrition,       .....  .........  ...........  ............  ............
                                                                       group.
98925.................  S....................  .....................  Osteopathic               0060     0.3151       $17.11         $3.43         $3.42
                                                                       manipulation.
98926.................  S....................  .....................  Osteopathic               0060     0.3151       $17.11         $3.43         $3.42
                                                                       manipulation.
98927.................  S....................  .....................  Osteopathic               0060     0.3151       $17.11         $3.43         $3.42
                                                                       manipulation.
98928.................  S....................  .....................  Osteopathic               0060     0.3151       $17.11         $3.43         $3.42
                                                                       manipulation.
98929.................  S....................  .....................  Osteopathic               0060     0.3151       $17.11         $3.43         $3.42
                                                                       manipulation.
98940.................  S....................  .....................  Chiropractic              0060     0.3151       $17.11         $3.43         $3.42
                                                                       manipulation.
98941.................  S....................  .....................  Chiropractic              0060     0.3151       $17.11         $3.43         $3.42
                                                                       manipulation.
98942.................  S....................  .....................  Chiropractic              0060     0.3151       $17.11         $3.43         $3.42
                                                                       manipulation.
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....................  .....................  In-hospital on call      .....  .........  ...........  ............  ............
                                                                       service.
99027.................  E....................  .....................  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     0.1679        $9.12         $2.65         $1.82
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     0.5529       $30.02        $10.09         $6.00
99199.................  E....................  .....................  Special service/proc/    .....  .........  ...........  ............  ............
                                                                       report.
99201.................  V....................  .....................  Office/outpatient         0600     0.9376       $50.90  ............        $10.18
                                                                       visit, new.
99202.................  V....................  .....................  Office/outpatient         0600     0.9376       $50.90  ............        $10.18
                                                                       visit, new.
99203.................  V....................  .....................  Office/outpatient         0601     1.0031       $54.46  ............        $10.89
                                                                       visit, new.
99204.................  V....................  .....................  Office/outpatient         0602     1.5603       $84.71  ............        $16.94
                                                                       visit, new.

[[Page 48153]]

 
99205.................  V....................  .....................  Office/outpatient         0602     1.5603       $84.71  ............        $16.94
                                                                       visit, new.
99211.................  V....................  .....................  Office/outpatient         0600     0.9376       $50.90  ............        $10.18
                                                                       visit, est.
99212.................  V....................  .....................  Office/outpatient         0600     0.9376       $50.90  ............        $10.18
                                                                       visit, est.
99213.................  V....................  .....................  Office/outpatient         0601     1.0031       $54.46  ............        $10.89
                                                                       visit, est.
99214.................  V....................  .....................  Office/outpatient         0602     1.5603       $84.71  ............        $16.94
                                                                       visit, est.
99215.................  V....................  .....................  Office/outpatient         0602     1.5603       $84.71  ............        $16.94
                                                                       visit, est.
99217.................  N....................  .....................  Observation care         .....  .........  ...........  ............  ............
                                                                       discharge.
99218.................  N....................  .....................  Observation care.......  .....  .........  ...........  ............  ............
99219.................  N....................  .....................  Observation care.......  .....  .........  ...........  ............  ............
99220.................  N....................  .....................  Observation care.......  .....  .........  ...........  ............  ............
99221.................  E....................  .....................  Initial hospital care..  .....  .........  ...........  ............  ............
99222.................  E....................  .....................  Initial hospital care..  .....  .........  ...........  ............  ............
99223.................  E....................  .....................  Initial hospital care..  .....  .........  ...........  ............  ............
99231.................  E....................  .....................  Subsequent hospital      .....  .........  ...........  ............  ............
                                                                       care.
99232.................  E....................  .....................  Subsequent hospital      .....  .........  ...........  ............  ............
                                                                       care.
99233.................  E....................  .....................  Subsequent hospital      .....  .........  ...........  ............  ............
                                                                       care.
99234.................  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     0.9376       $50.90  ............        $10.18
99242.................  V....................  .....................  Office consultation....   0600     0.9376       $50.90  ............        $10.18
99243.................  V....................  .....................  Office consultation....   0601     1.0031       $54.46  ............        $10.89
99244.................  V....................  .....................  Office consultation....   0602     1.5603       $84.71  ............        $16.94
99245.................  V....................  .....................  Office consultation....   0602     1.5603       $84.71  ............        $16.94
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              0600     0.9376       $50.90  ............        $10.18
                                                                       consultation.
99272.................  V....................  .....................  Confirmatory              0600     0.9376       $50.90  ............        $10.18
                                                                       consultation.
99273.................  V....................  .....................  Confirmatory              0601     1.0031       $54.46  ............        $10.89
                                                                       consultation.
99274.................  V....................  .....................  Confirmatory              0602     1.5603       $84.71  ............        $16.94
                                                                       consultation.
99275.................  V....................  .....................  Confirmatory              0602     1.5603       $84.71  ............        $16.94
                                                                       consultation.
99281.................  V....................  .....................  Emergency dept visit...   0610     1.4146       $76.80        $19.57        $15.36
99282.................  V....................  .....................  Emergency dept visit...   0610     1.4146       $76.80        $19.57        $15.36
99283.................  V....................  .....................  Emergency dept visit...   0611     2.4881      $135.08        $36.47        $27.02
99284.................  V....................  .....................  Emergency dept visit...   0612     4.3235      $234.72        $54.14        $46.94
99285.................  V....................  .....................  Emergency dept visit...   0612     4.3235      $234.72        $54.14        $46.94
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      0620     9.2657      $503.03       $145.78       $100.61
                                                                       hour.
99292.................  N....................  .....................  Critical care, addl 30   .....  .........  ...........  ............  ............
                                                                       min.
99293.................  C....................  .....................  Ped critical care,       .....  .........  ...........  ............  ............
                                                                       initial.
99294.................  C....................  .....................  Ped critical care,       .....  .........  ...........  ............  ............
                                                                       subseq.
99295.................  C....................  .....................  Neonatal critical care.  .....  .........  ...........  ............  ............
99296.................  C....................  .....................  Neonatal critical care.  .....  .........  ...........  ............  ............
99298.................  C....................  .....................  Neonatal critical care.  .....  .........  ...........  ............  ............
99299.................  C....................  .....................  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.

[[Page 48154]]

 
99331.................  E....................  .....................  Rest home visit, est     .....  .........  ...........  ............  ............
                                                                       pat.
99332.................  E....................  .....................  Rest home visit, est     .....  .........  ...........  ............  ............
                                                                       pat.
99333.................  E....................  .....................  Rest home visit, est     .....  .........  ...........  ............  ............
                                                                       pat.
99341.................  E....................  .....................  Home visit, new patient  .....  .........  ...........  ............  ............
99342.................  E....................  .....................  Home visit, new patient  .....  .........  ...........  ............  ............
99343.................  E....................  .....................  Home visit, new patient  .....  .........  ...........  ............  ............
99344.................  E....................  .....................  Home visit, new patient  .....  .........  ...........  ............  ............
99345.................  E....................  .....................  Home visit, new patient  .....  .........  ...........  ............  ............
99347.................  E....................  .....................  Home visit, est patient  .....  .........  ...........  ............  ............
99348.................  E....................  .....................  Home visit, est patient  .....  .........  ...........  ............  ............
99349.................  E....................  .....................  Home visit, est patient  .....  .........  ...........  ............  ............
99350.................  E....................  .....................  Home visit, est patient  .....  .........  ...........  ............  ............
99354.................  N....................  .....................  Prolonged service,       .....  .........  ...........  ............  ............
                                                                       office.
99355.................  N....................  .....................  Prolonged service,       .....  .........  ...........  ............  ............
                                                                       office.
99356.................  C....................  .....................  Prolonged service,       .....  .........  ...........  ............  ............
                                                                       inpatient.
99357.................  C....................  .....................  Prolonged service,       .....  .........  ...........  ............  ............
                                                                       inpatient.
99358.................  N....................  .....................  Prolonged serv, w/o      .....  .........  ...........  ............  ............
                                                                       contact.
99359.................  N....................  .....................  Prolonged serv, w/o      .....  .........  ...........  ............  ............
                                                                       contact.
99360.................  E....................  .....................  Physician standby        .....  .........  ...........  ............  ............
                                                                       services.
99361.................  E....................  .....................  Physician/team           .....  .........  ...........  ............  ............
                                                                       conference.
99362.................  E....................  .....................  Physician/team           .....  .........  ...........  ............  ............
                                                                       conference.
99371.................  E....................  .....................  Physician phone          .....  .........  ...........  ............  ............
                                                                       consultation.
99372.................  E....................  .....................  Physician phone          .....  .........  ...........  ............  ............
                                                                       consultation.
99373.................  E....................  .....................  Physician phone          .....  .........  ...........  ............  ............
                                                                       consultation.
99374.................  E....................  .....................  Home health care         .....  .........  ...........  ............  ............
                                                                       supervision.
99377.................  E....................  .....................  Hospice care             .....  .........  ...........  ............  ............
                                                                       supervision.
99379.................  E....................  .....................  Nursing fac care         .....  .........  ...........  ............  ............
                                                                       supervision.
99380.................  E....................  .....................  Nursing fac care         .....  .........  ...........  ............  ............
                                                                       supervision.
99381.................  E....................  .....................  Prev visit, new, infant  .....  .........  ...........  ............  ............
99382.................  E....................  .....................  Prev visit, new, age 1-  .....  .........  ...........  ............  ............
                                                                       4.
99383.................  E....................  .....................  Prev visit, new, age 5-  .....  .........  ...........  ............  ............
                                                                       11.
99384.................  E....................  .....................  Prev visit, new, age 12- .....  .........  ...........  ............  ............
                                                                       17.
99385.................  E....................  .....................  Prev visit, new, age 18- .....  .........  ...........  ............  ............
                                                                       39.
99386.................  E....................  .....................  Prev visit, new, age 40- .....  .........  ...........  ............  ............
                                                                       64.
99387.................  E....................  .....................  Prev visit, new, 65 &    .....  .........  ...........  ............  ............
                                                                       over.
99391.................  E....................  .....................  Prev visit, est, infant  .....  .........  ...........  ............  ............
99392.................  E....................  .....................  Prev visit, est, age 1-  .....  .........  ...........  ............  ............
                                                                       4.
99393.................  E....................  .....................  Prev visit, est, age 5-  .....  .........  ...........  ............  ............
                                                                       11.
99394.................  E....................  .....................  Prev visit, est, age 12- .....  .........  ...........  ............  ............
                                                                       17.
99395.................  E....................  .....................  Prev visit, est, age 18- .....  .........  ...........  ............  ............
                                                                       39.
99396.................  E....................  .....................  Prev visit, est, age 40- .....  .........  ...........  ............  ............
                                                                       64.
99397.................  E....................  .....................  Prev visit, est, 65 &    .....  .........  ...........  ............  ............
                                                                       over.
99401.................  E....................  .....................  Preventive counseling,   .....  .........  ...........  ............  ............
                                                                       indiv.
99402.................  E....................  .....................  Preventive counseling,   .....  .........  ...........  ............  ............
                                                                       indiv.
99403.................  E....................  .....................  Preventive counseling,   .....  .........  ...........  ............  ............
                                                                       indiv.
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     0.9376       $50.90  ............        $10.18
                                                                       newborn.
99432.................  N....................  .....................  Newborn care, not in     .....  .........  ...........  ............  ............
                                                                       hosp.
99433.................  C....................  .....................  Normal newborn care/     .....  .........  ...........  ............  ............
                                                                       hospital.
99435.................  E....................  .....................  Newborn discharge day    .....  .........  ...........  ............  ............
                                                                       hosp.
99436.................  N....................  .....................  Attendance, birth......  .....  .........  ...........  ............  ............
99440.................  S....................  .....................  Newborn resuscitation..   0094     2.6412      $143.39        $48.46        $28.68
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.  .....  .........  ...........  ............  ............

[[Page 48155]]

 
99506.................  E....................  .....................  Home visit, im           .....  .........  ...........  ............  ............
                                                                       injection.
99507.................  E....................  .....................  Home visit, cath         .....  .........  ...........  ............  ............
                                                                       maintain.
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.
99551.................  E....................  .....................  Home infus, pain mgmt,   .....  .........  ...........  ............  ............
                                                                       iv/sc.
99552.................  E....................  .....................  Hm infus pain mgmt,      .....  .........  ...........  ............  ............
                                                                       epid/ith.
99553.................  E....................  .....................  Home infuse, tocolytic   .....  .........  ...........  ............  ............
                                                                       tx.
99554.................  E....................  .....................  Home infus, hormone/     .....  .........  ...........  ............  ............
                                                                       platelet.
99555.................  E....................  .....................  Home infuse,             .....  .........  ...........  ............  ............
                                                                       chemotheraphy.
99556.................  E....................  .....................  Home infus, antibio/     .....  .........  ...........  ............  ............
                                                                       fung/vir.
99557.................  E....................  .....................  Home infuse,             .....  .........  ...........  ............  ............
                                                                       anticoagulant.
99558.................  E....................  .....................  Home infuse,             .....  .........  ...........  ............  ............
                                                                       immunotherapy.
99559.................  E....................  .....................  Home infus, periton      .....  .........  ...........  ............  ............
                                                                       dialysis.
99560.................  E....................  .....................  Home infus, entero       .....  .........  ...........  ............  ............
                                                                       nutrition.
99561.................  E....................  .....................  Home infuse, hydration   .....  .........  ...........  ............  ............
                                                                       tx.
99562.................  E....................  .....................  Home infus, parent       .....  .........  ...........  ............  ............
                                                                       nutrition.
99563.................  E....................  .....................  Home admin, pentamidine  .....  .........  ...........  ............  ............
99564.................  E....................  .....................  Hme infus, antihemophil  .....  .........  ...........  ............  ............
                                                                       agnt.
99565.................  E....................  .....................  Home infus, proteinase   .....  .........  ...........  ............  ............
                                                                       inhib.
99566.................  E....................  .....................  Home infuse, iv therapy  .....  .........  ...........  ............  ............
99567.................  E....................  .....................  Home infuse, sympath     .....  .........  ...........  ............  ............
                                                                       agent.
99568.................  E....................  .....................  Home infus, misc drug,   .....  .........  ...........  ............  ............
                                                                       daily.
99569.................  E....................  .....................  Home infuse, each addl   .....  .........  ...........  ............  ............
                                                                       tx.
99600.................  E....................  .....................  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.

[[Page 48156]]

 
A4206.................  A....................  .....................  1 CC sterile             .....  .........  ...........  ............  ............
                                                                       syringe&needle.
A4207.................  A....................  .....................  2 CC sterile             .....  .........  ...........  ............  ............
                                                                       syringe&needle.
A4208.................  A....................  .....................  3 CC sterile             .....  .........  ...........  ............  ............
                                                                       syringe&needle.
A4209.................  E....................  .....................  5+ CC sterile            .....  .........  ...........  ............  ............
                                                                       syringe&needle.
A4210.................  E....................  .....................  Nonneedle injection      .....  .........  ...........  ............  ............
                                                                       device.
A4211.................  E....................  .....................  Supp for self-adm        .....  .........  ...........  ............  ............
                                                                       injections.
A4212.................  E....................  .....................  Non coring needle or     .....  .........  ...........  ............  ............
                                                                       stylet.
A4213.................  E....................  .....................  20+ CC syringe only....  .....  .........  ...........  ............  ............
A4214.................  A....................  .....................  30 CC sterile water/     .....  .........  ...........  ............  ............
                                                                       saline.
A4215.................  E....................  .....................  Sterile needle.........  .....  .........  ...........  ............  ............
A4220.................  A....................  .....................  Infusion pump refill     .....  .........  ...........  ............  ............
                                                                       kit.
A4221.................  A....................  .....................  Maint drug infus cath    .....  .........  ...........  ............  ............
                                                                       per wk.
A4222.................  A....................  .....................  Drug infusion pump       .....  .........  ...........  ............  ............
                                                                       supplies.
A4230.................  A....................  .....................  Infus insulin pump non   .....  .........  ...........  ............  ............
                                                                       needl.
A4231.................  A....................  .....................  Infusion insulin pump    .....  .........  ...........  ............  ............
                                                                       needle.
A4232.................  E....................  .....................  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....................  .....................  Diaphragm..............  .....  .........  ...........  ............  ............
A4267.................  E....................  .....................  Male condom............  .....  .........  ...........  ............  ............
A4268.................  E....................  .....................  Female condom..........  .....  .........  ...........  ............  ............
A4269.................  E....................  .....................  Spermicide.............  .....  .........  ...........  ............  ............
A4270.................  A....................  .....................  Disposable endoscope     .....  .........  ...........  ............  ............
                                                                       sheath.
A4280.................  A....................  .....................  Brst prsths adhsv        .....  .........  ...........  ............  ............
                                                                       attchmnt.
A4281.................  E....................  .....................  Replacement breastpump   .....  .........  ...........  ............  ............
                                                                       tube.
A4282.................  E....................  .....................  Replacement breastpump   .....  .........  ...........  ............  ............
                                                                       adpt.
A4283.................  E....................  .....................  Replacement breastpump   .....  .........  ...........  ............  ............
                                                                       cap.
A4284.................  E....................  .....................  Replcmnt breast pump     .....  .........  ...........  ............  ............
                                                                       shield.
A4285.................  E....................  .....................  Replcmnt breast pump     .....  .........  ...........  ............  ............
                                                                       bottle.
A4286.................  E....................  .....................  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.

[[Page 48157]]

 
A4328.................  A....................  .....................  Fem urinary collect      .....  .........  ...........  ............  ............
                                                                       pouch.
A4330.................  A....................  .....................  Stool collection pouch.  .....  .........  ...........  ............  ............
A4331.................  A....................  .....................  Extension drainage       .....  .........  ...........  ............  ............
                                                                       tubing.
A4332.................  A....................  .....................  Lubricant for cath       .....  .........  ...........  ............  ............
                                                                       insertion.
A4333.................  A....................  .....................  Urinary cath anchor      .....  .........  ...........  ............  ............
                                                                       device.
A4334.................  A....................  .....................  Urinary cath leg strap.  .....  .........  ...........  ............  ............
A4335.................  A....................  .....................  Incontinence supply....  .....  .........  ...........  ............  ............
A4338.................  A....................  .....................  Indwelling catheter      .....  .........  ...........  ............  ............
                                                                       latex.
A4340.................  A....................  .....................  Indwelling catheter      .....  .........  ...........  ............  ............
                                                                       special.
A4344.................  A....................  .....................  Cath indw foley 2 way    .....  .........  ...........  ............  ............
                                                                       silicn.
A4346.................  A....................  .....................  Cath indw foley 3 way..  .....  .........  ...........  ............  ............
A4347.................  A....................  .....................  Male external catheter.  .....  .........  ...........  ............  ............
A4348.................  A....................  .....................  Male ext cath extended   .....  .........  ...........  ............  ............
                                                                       wear.
A4351.................  A....................  .....................  Straight tip urine       .....  .........  ...........  ............  ............
                                                                       catheter.
A4352.................  A....................  .....................  Coude tip urinary        .....  .........  ...........  ............  ............
                                                                       catheter.
A4353.................  A....................  .....................  Intermittent urinary     .....  .........  ...........  ............  ............
                                                                       cath.
A4354.................  A....................  .....................  Cath insertion tray w/   .....  .........  ...........  ............  ............
                                                                       bag.
A4355.................  A....................  .....................  Bladder irrigation       .....  .........  ...........  ............  ............
                                                                       tubing.
A4356.................  A....................  .....................  Ext ureth clmp or compr  .....  .........  ...........  ............  ............
                                                                       dvc.
A4357.................  A....................  .....................  Bedside drainage bag...  .....  .........  ...........  ............  ............
A4358.................  A....................  .....................  Urinary leg or abdomen   .....  .........  ...........  ............  ............
                                                                       bag.
A4359.................  A....................  .....................  Urinary suspensory w/o   .....  .........  ...........  ............  ............
                                                                       leg b.
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.
A4371.................  A....................  .....................  Skin barrier powder per  .....  .........  ...........  ............  ............
                                                                       oz.
A4372.................  A....................  .....................  Skin barrier solid 4x4   .....  .........  ...........  ............  ............
                                                                       equiv.
A4373.................  A....................  .....................  Skin barrier with        .....  .........  ...........  ............  ............
                                                                       flange.
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.
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....................  .....................  Nonpectin based ostomy   .....  .........  ...........  ............  ............
                                                                       paste.
A4406.................  A....................  .....................  Pectin based ostomy      .....  .........  ...........  ............  ............
                                                                       paste.
A4407.................  A....................  .....................  Ext wear ost skn barr    .....  .........  ...........  ............  ............
                                                                       <=4sq''.
A4408.................  A....................  .....................  Ext wear ost skn barr    .....  .........  ...........  ............  ............
                                                                       4sq''.
A4409.................  A....................  .....................  Ost skn barr w flng <=4  .....  .........  ...........  ............  ............
                                                                       ''.
A4410.................  A....................  .....................  Ost skn barr w flng 4sq''.
A4413.................  A....................  .....................  2 pc drainable ost       .....  .........  ...........  ............  ............
                                                                       pouch.

[[Page 48158]]

 
A4414.................  A....................  .....................  Ostomy sknbarr w flng    .....  .........  ...........  ............  ............
                                                                       <=4sq''.
A4415.................  A....................  .....................  Ostomy skn barr w flng   .....  .........  ...........  ............  ............
                                                                       4sq''.
A4421.................  A....................  .....................  Ostomy supply misc.....  .....  .........  ...........  ............  ............
A4422.................  A....................  .....................  Ost pouch absorbent      .....  .........  ...........  ............  ............
                                                                       material.
A4450.................  A....................  .....................  Non-waterproof tape....  .....  .........  ...........  ............  ............
A4452.................  A....................  .....................  Waterproof tape........  .....  .........  ...........  ............  ............
A4455.................  A....................  .....................  Adhesive remover per     .....  .........  ...........  ............  ............
                                                                       ounce.
A4458.................  E....................  .....................  Reusable enema bag.....  .....  .........  ...........  ............  ............
A4462.................  A....................  .....................  Abdmnl drssng holder/    .....  .........  ...........  ............  ............
                                                                       binder.
A4465.................  A....................  .....................  Non-elastic extremity    .....  .........  ...........  ............  ............
                                                                       binder.
A4470.................  A....................  .....................  Gravlee jet washer.....  .....  .........  ...........  ............  ............
A4480.................  A....................  .....................  Vabra aspirator........  .....  .........  ...........  ............  ............
A4481.................  A....................  .....................  Tracheostoma filter....  .....  .........  ...........  ............  ............
A4483.................  A....................  .....................  Moisture exchanger.....  .....  .........  ...........  ............  ............
A4490.................  E....................  .....................  Above knee surgical      .....  .........  ...........  ............  ............
                                                                       stocking.
A4495.................  E....................  .....................  Thigh length surg        .....  .........  ...........  ............  ............
                                                                       stocking.
A4500.................  E....................  .....................  Below knee surgical      .....  .........  ...........  ............  ............
                                                                       stocking.
A4510.................  E....................  .....................  Full length surg         .....  .........  ...........  ............  ............
                                                                       stocking.
A4521.................  E....................  .....................  Adult size diaper sm     .....  .........  ...........  ............  ............
                                                                       each.
A4522.................  E....................  .....................  Adult size diaper med    .....  .........  ...........  ............  ............
                                                                       each.
A4523.................  E....................  .....................  Adult size diaper lg     .....  .........  ...........  ............  ............
                                                                       each.
A4524.................  E....................  .....................  Adult size diaper xl     .....  .........  ...........  ............  ............
                                                                       each.
A4525.................  E....................  .....................  Adult size brief sm      .....  .........  ...........  ............  ............
                                                                       each.
A4526.................  E....................  .....................  Adult size brief med     .....  .........  ...........  ............  ............
                                                                       each.
A4527.................  E....................  .....................  Adult size brief lg      .....  .........  ...........  ............  ............
                                                                       each.
A4528.................  E....................  .....................  Adult size brief xl      .....  .........  ...........  ............  ............
                                                                       each.
A4529.................  E....................  .....................  Child size diaper sm/    .....  .........  ...........  ............  ............
                                                                       med ea.
A4530.................  E....................  .....................  Child size diaper lg     .....  .........  ...........  ............  ............
                                                                       each.
A4531.................  E....................  .....................  Child size brief sm/med  .....  .........  ...........  ............  ............
                                                                       each.
A4532.................  E....................  .....................  Child size brief lg      .....  .........  ...........  ............  ............
                                                                       each.
A4533.................  E....................  .....................  Youth size diaper each.  .....  .........  ...........  ............  ............
A4534.................  E....................  .....................  Youth size brief each..  .....  .........  ...........  ............  ............
A4535.................  E....................  .....................  Disp incont liner/       .....  .........  ...........  ............  ............
                                                                       shield ea.
A4536.................  E....................  .....................  Prot underwr wshbl any   .....  .........  ...........  ............  ............
                                                                       sz ea.
A4537.................  E....................  .....................  Under pad reusable any   .....  .........  ...........  ............  ............
                                                                       sz ea.
A4538.................  E....................  .....................  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.................  .....  .........  ...........  ............  ............
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....................  .....................  Oxygen probe used w      .....  .........  ...........  ............  ............
                                                                       oximeter.
A4608.................  A....................  .....................  Transtracheal oxygen     .....  .........  ...........  ............  ............
                                                                       cath.
A4609.................  A....................  .....................  Trach suction cath       .....  .........  ...........  ............  ............
                                                                       clsed sys.
A4610.................  A....................  .....................  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.....  .....  .........  ...........  ............  ............
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.

[[Page 48159]]

 
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.................  E....................  .....................  Infus pump rplcemnt      .....  .........  ...........  ............  ............
                                                                       battery.
A4633.................  A....................  .....................  Uvl replacement bulb...  .....  .........  ...........  ............  ............
A4634.................  A....................  .....................  Replacement bulb th      .....  .........  ...........  ............  ............
                                                                       lightbox.
A4635.................  A....................  .....................  Underarm crutch pad....  .....  .........  ...........  ............  ............
A4636.................  A....................  .....................  Handgrip for cane etc..  .....  .........  ...........  ............  ............
A4637.................  A....................  .....................  Repl tip cane/crutch/    .....  .........  ...........  ............  ............
                                                                       walker.
A4639.................  A....................  .....................  Infrared ht sys          .....  .........  ...........  ............  ............
                                                                       replcmnt pad.
A4640.................  A....................  .....................  Alternating pressure     .....  .........  ...........  ............  ............
                                                                       pad.
A4641.................  N....................  .....................  Diagnostic imaging       .....  .........  ...........  ............  ............
                                                                       agent.
A4642.................  K....................  .....................  Satumomab pendetide per   0704     2.9212      $158.59  ............        $31.72
                                                                       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....................  .....................  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....................  .....................  ``Y set'' tubing.......  .....  .........  ...........  ............  ............
A4720.................  A....................  .....................  Dialysat sol fld vol     .....  .........  ...........  ............  ............
                                                                        249cc.
A4721.................  A....................  .....................  Dialysat sol fld vol     .....  .........  ...........  ............  ............
                                                                        999cc.
A4722.................  A....................  .....................  Dialys sol fld vol  1999cc.
A4723.................  A....................  .....................  Dialys sol fld vol  2999cc.
A4724.................  A....................  .....................  Dialys sol fld vol  3999cc.
A4725.................  A....................  .....................  Dialys sol fld vol  999cc.
A4726.................  A....................  .....................  Dialys sol fld vol  5999cc.
A4730.................  A....................  .....................  Fistula cannulation      .....  .........  ...........  ............  ............
                                                                       set, ea.
A4736.................  A....................  .....................  Topical anesthetic, per  .....  .........  ...........  ............  ............
                                                                       gram.
A4737.................  A....................  .....................  Inj anesthetic per 10    .....  .........  ...........  ............  ............
                                                                       ml.
A4740.................  A....................  .....................  Shunt accessory........  .....  .........  ...........  ............  ............
A4750.................  A....................  .....................  Art or venous blood      .....  .........  ...........  ............  ............
                                                                       tubing.
A4755.................  A....................  .....................  Comb art/venous blood    .....  .........  ...........  ............  ............
                                                                       tubing.
A4760.................  A....................  .....................  Dialysate sol test kit,  .....  .........  ...........  ............  ............
                                                                       each.
A4765.................  A....................  .....................  Dialysate conc pow per   .....  .........  ...........  ............  ............
                                                                       pack.
A4766.................  A....................  .....................  Dialysate conc sol add   .....  .........  ...........  ............  ............
                                                                       10 ml.
A4770.................  A....................  .....................  Blood collection tube/   .....  .........  ...........  ............  ............
                                                                       vacuum.
A4771.................  A....................  .....................  Serum clotting time      .....  .........  ...........  ............  ............
                                                                       tube.
A4772.................  A....................  .....................  Blood glucose test       .....  .........  ...........  ............  ............
                                                                       strips.
A4773.................  A....................  .....................  Occult blood test        .....  .........  ...........  ............  ............
                                                                       strips.
A4774.................  A....................  .....................  Ammonia test strips....  .....  .........  ...........  ............  ............
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.

[[Page 48160]]

 
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....................  .....................  Sterile, gloves per      .....  .........  ...........  ............  ............
                                                                       pair.
A4931.................  A....................  .....................  Reusable oral            .....  .........  ...........  ............  ............
                                                                       thermometer.
A4932.................  E....................  .....................  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.  .....  .........  ...........  ............  ............
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....................  .....................  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.
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.

[[Page 48161]]

 
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.
A6266.................  A....................  .....................  Impreg gauze no h20/sal/ .....  .........  ...........  ............  ............
                                                                       yard.
A6402.................  A....................  .....................  Sterile gauze <= 16 sq   .....  .........  ...........  ............  ............
                                                                       in.
A6403.................  A....................  .....................  Sterile gauze16 <= 48 sq in.
A6404.................  A....................  .....................  Sterile gauze  48 sq in.
A6410.................  A....................  .....................  Sterile eye pad........  .....  .........  ...........  ............  ............
A6411.................  A....................  .....................  Non-sterile eye pad....  .....  .........  ...........  ............  ............
A6412.................  E....................  .....................  Occlusive eye patch....  .....  .........  ...........  ............  ............
A6421.................  A....................  .....................  Pad bandage =3 <5in w /roll.
A6422.................  A....................  .....................  Conf bandage ns =3<5``w/roll.
A6424.................  A....................  .....................  Conf bandage ns =5``w /roll.
A6426.................  A....................  .....................  Conf bandage s =3<5`` w/roll.
A6428.................  A....................  .....................  Conf bandage s =5`` w /roll.
A6430.................  A....................  .....................  Lt compres bdg =3<5``w /roll.
A6432.................  A....................  .....................  Lt compres bdg =5``w /roll.
A6434.................  A....................  .....................  Mo compres bdg =3<5``w /roll.

[[Page 48162]]

 
A6436.................  A....................  .....................  Hi compres bdg =3<5``w /roll.
A6438.................  A....................  .....................  Self-adher bdg =3<5``w /roll.
A6440.................  A....................  .....................  Zinc paste bdg =3<5``w /roll.
A6501.................  A....................  .....................  Compres burngarment      .....  .........  ...........  ............  ............
                                                                       bodysuit.
A6502.................  A....................  .....................  Compres burngarment      .....  .........  ...........  ............  ............
                                                                       chinstrp.
A6503.................  A....................  .....................  Compres burngarment      .....  .........  ...........  ............  ............
                                                                       facehood.
A6504.................  A....................  .....................  Cmprsburngarment glove-  .....  .........  ...........  ............  ............
                                                                       wrist.
A6505.................  A....................  .....................  Cmprsburngarment glove-  .....  .........  ...........  ............  ............
                                                                       elbow.
A6506.................  A....................  .....................  Cmprsburngrmnt glove-    .....  .........  ...........  ............  ............
                                                                       axilla.
A6507.................  A....................  .....................  Cmprs burngarment foot-  .....  .........  ...........  ............  ............
                                                                       knee.
A6508.................  A....................  .....................  Cmprs burngarment foot-  .....  .........  ...........  ............  ............
                                                                       thigh.
A6509.................  A....................  .....................  Compres burn garment     .....  .........  ...........  ............  ............
                                                                       jacket.
A6510.................  A....................  .....................  Compres burn garment     .....  .........  ...........  ............  ............
                                                                       leotard.
A6511.................  A....................  .....................  Compres burn garment     .....  .........  ...........  ............  ............
                                                                       panty.
A6512.................  A....................  .....................  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....................  .....................  Replace chest compress   .....  .........  ...........  ............  ............
                                                                       vest.
A7026.................  A....................  .....................  Replace chst cmprss sys  .....  .........  ...........  ............  ............
                                                                       hose.
A7030.................  A....................  .....................  CPAP full face mask....  .....  .........  ...........  ............  ............
A7031.................  A....................  .....................  Replacement facemask     .....  .........  ...........  ............  ............
                                                                       interfa.
A7032.................  A....................  .....................  Replacement nasal        .....  .........  ...........  ............  ............
                                                                       cushion.
A7033.................  A....................  .....................  Replacement nasal        .....  .........  ...........  ............  ............
                                                                       pillows.
A7034.................  A....................  .....................  Nasal application        .....  .........  ...........  ............  ............
                                                                       device.
A7035.................  A....................  .....................  Pos airway press         .....  .........  ...........  ............  ............
                                                                       headgear.
A7036.................  A....................  .....................  Pos airway press         .....  .........  ...........  ............  ............
                                                                       chinstrap.
A7037.................  A....................  .....................  Pos airway pressure      .....  .........  ...........  ............  ............
                                                                       tubing.
A7038.................  A....................  .....................  Pos airway pressure      .....  .........  ...........  ............  ............
                                                                       filter.
A7039.................  A....................  .....................  Filter, non disposable   .....  .........  ...........  ............  ............
                                                                       w pap.
A7042.................  A....................  .....................  Implanted pleural        .....  .........  ...........  ............  ............
                                                                       catheter.
A7043.................  A....................  .....................  Vacuum drainagebottle/   .....  .........  ...........  ............  ............
                                                                       tubing.
A7044.................  A....................  .....................  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.

[[Page 48163]]

 
A9504.................  N....................  .....................  Technetium tc 99m        .....  .........  ...........  ............  ............
                                                                       apcitide.
A9505.................  N....................  .....................  Thallous chloride TL     .....  .........  ...........  ............  ............
                                                                       201/mci.
A9507.................  K....................  .....................  Indium/111 capromab       1604    12.4029      $673.34  ............       $134.67
                                                                       pendetid.
A9508.................  K....................  .....................  Iobenguane sulfate I-     1045     2.9293      $159.03  ............        $31.81
                                                                       131, per 0.5 mCi.
A9510.................  N....................  .....................  Technetium TC99m         .....  .........  ...........  ............  ............
                                                                       Disofenin.
A9511.................  K....................  .....................  Technetium TC 99m         1095     3.7042      $201.10  ............        $40.22
                                                                       depreotide.
A9512.................  N....................  .....................  Technetiumtc99mpertechn  .....  .........  ...........  ............  ............
                                                                       etate.
A9513.................  N....................  .....................  Technetium tc-99m        .....  .........  ...........  ............  ............
                                                                       mebrofenin.
A9514.................  N....................  .....................  Technetiumtc99mpyrophos  .....  .........  ...........  ............  ............
                                                                       phate.
A9515.................  N....................  .....................  Technetium tc-99m        .....  .........  ...........  ............  ............
                                                                       pentetate.
A9516.................  N....................  .....................  I-123 sodium iodide      .....  .........  ...........  ............  ............
                                                                       capsule.
A9517.................  K....................  .....................  I-131 sodium iodide       1064     0.1007        $5.47  ............         $1.09
                                                                       capsule.
A9518.................  K....................  .....................  I-131 sodium iodide       1065     0.0002         $.01  ............  ............
                                                                       solution.
A9519.................  N....................  .....................  Technetiumtc-99mmacroag  .....  .........  ...........  ............  ............
                                                                       albu.
A9520.................  N....................  .....................  Technetiumtc-99m sulfur  .....  .........  ...........  ............  ............
                                                                       clld.
A9521.................  K....................  .....................  Technetiumtc-99m          1096     3.8103      $206.86  ............        $41.37
                                                                       exametazine.
A9522.................  K....................  .....................  Indium111ibritumomabtiu   9118    38.3972    $2,084.55  ............       $416.91
                                                                       xetan.
A9523.................  K....................  .....................  Yttrium90ibritumomabtiu   9117   332.7763   $18,066.09  ............     $3,613.22
                                                                       xetan.
A9524.................  K....................  .....................  Iodinated I-131           9100     0.0071         $.39  ............          $.08
                                                                       serumalbumin, per 5uci.
A9600.................  K....................  .....................  Strontium-89 chloride..   0701     7.4586      $404.92  ............        $80.98
A9605.................  K....................  .....................  Samarium sm153            0702    16.1415      $876.31  ............       $175.26
                                                                       lexidronamm.
A9699.................  N....................  .....................  Noc therapeutic          .....  .........  ...........  ............  ............
                                                                       radiopharm.
A9700.................  E....................  .....................  Echocardiography         .....  .........  ...........  ............  ............
                                                                       Contrast.
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....................  .....................  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%.
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.

[[Page 48164]]

 
B9999.................  A....................  .....................  Parenteral supp not      .....  .........  ...........  ............  ............
                                                                       othrws c.
C1010.................  K....................  .....................  Blood, L/R, CMV-NEG....   1010     2.1361      $115.97  ............        $23.19
C1011.................  K....................  .....................  Platelets, HLA-m, L/R,    1011     8.2851      $449.79  ............        $89.96
                                                                       unit.
C1015.................  K....................  .....................  Plt, pher,L/R,CMV,        1020     9.6266      $522.62  ............       $104.52
                                                                       irrad.
C1016.................  K....................  .....................  BLOOD,L/R,FROZ/DEGLY/     1016     5.0012      $271.51  ............        $54.30
                                                                       Washed.
C1017.................  K....................  .....................  Plt, APH/PHER,L/R,CMV-    1017     6.5175      $353.83  ............        $70.77
                                                                       NEG.
C1018.................  K....................  .....................  Blood, L/R, IRRADIATED.   1018     2.1950      $119.16  ............        $23.83
C1020.................  K....................  .....................  RBC, frz/deg/wsh, L/R,    1021     6.5287      $354.44  ............        $70.89
                                                                       irrad.
C1021.................  K....................  .....................  RBC, L/R, CMV neg,        1022     3.9139      $212.48  ............        $42.50
                                                                       irrad.
C1022.................  K....................  .....................  Plasma, frz within 24     0955     1.5750       $85.51  ............        $17.10
                                                                       hour.
C1079.................  N....................  .....................  CO 57/58 per 0.5 uCi...  .....  .........  ...........  ............  ............
C1088.................  T....................  .....................  LASER OPTIC TR Sys.....   1557  .........    $1,850.00  ............       $370.00
C1091.................  K....................  .....................  IN111                     1091     4.0535      $220.06  ............        $44.01
                                                                       oxyquinoline,per0.5mCi.
C1092.................  K....................  .....................  IN 111 pentetate per      1092     4.0824      $221.63  ............        $44.33
                                                                       0.5 mCi.
C1122.................  K....................  .....................  Tc 99M ARCITUMOMAB PER    1122     9.6556      $524.19  ............       $104.84
                                                                       VIAL.
C1166.................  N....................  .....................  CYTARABINE LIPOSOMAL,    .....  .........  ...........  ............  ............
                                                                       10 mg.
C1167.................  K....................  .....................  EPIRUBICIN HCL, 2 mg...   1167     0.3597       $19.53  ............         $3.91
C1178.................  K....................  .....................  BUSULFAN IV, 6 Mg......   1178     6.0245      $327.06  ............        $65.41
C1200.................  N....................  .....................  TC 99M Sodium            .....  .........  ...........  ............  ............
                                                                       Glucoheptonat.
C1201.................  N....................  .....................  TC 99M SUCCIMER, PER     .....  .........  ...........  ............  ............
                                                                       Vial.
C1300.................  S....................  .....................  HYPERBARIC Oxygen......   0659     3.2220      $174.92  ............        $34.98
C1305.................  K....................  .....................  Apligraf...............   1305    11.2075      $608.44  ............       $121.69
C1716.................  K....................  .....................  Brachytx source, Gold     1716     1.3399       $72.74  ............        $14.55
                                                                       198.
C1718.................  K....................  .....................  Brachytx source, Iodine   1718     0.6695       $36.35  ............         $7.27
                                                                       125.
C1719.................  K....................  .....................  Brachytx sour,Non-HDR     1719     0.3053       $16.57  ............         $3.31
                                                                       Ir-192.
C1720.................  K....................  .....................  Brachytx sour,            1720     0.8104       $44.00  ............         $8.80
                                                                       Palladium 103.
C1765.................  N....................  .....................  Adhesion barrier.......  .....  .........  ...........  ............  ............
C1774.................  K....................  .....................  Darbepoetin alfa, 1 mcg   0734     0.0463        $2.51  ............          $.50
C1775.................  K....................  .....................  FDG, per dose (4-40 mCi/  1775     5.8606      $318.17  ............        $63.63
                                                                       ml).
C1783.................  H....................  .....................  Ocular imp, aqueous       1783  .........  ...........  ............  ............
                                                                       drain dev.
C1814.................  H....................  .....................  Retinal tamp, silicone    1814  .........  ...........  ............  ............
                                                                       oil.
C1818.................  H....................  .....................  Integrated                1818  .........  ...........  ............  ............
                                                                       keratoprosthesis.
C1900.................  H....................  .....................  Lead coronary venous...   1900  .........  ...........  ............  ............
C2614.................  H....................  .....................  Probe, perc lumb disc..   2614  .........  ...........  ............  ............
C2616.................  K....................  .....................  Brachytx source,          2616   163.4011    $8,870.88  ............     $1,774.18
                                                                       Yttrium-90.
C2618.................  N....................  .....................  Probe, cryoablation....  .....  .........  ...........  ............  ............
C2632.................  H....................  .....................  Brachytx sol, I-125,      2632  .........  ...........  ............  ............
                                                                       per mCi.
C8900.................  S....................  .....................  MRA w/cont, abd........   0284     7.0207      $381.15       $190.57        $76.23
C8901.................  S....................  .....................  MRA w/o cont, abd......   0336     6.4817      $351.89       $175.94        $70.38
C8902.................  S....................  .....................  MRA w/o fol w/cont, abd   0337     9.3215      $506.05       $240.77       $101.21
C8903.................  S....................  .....................  MRI w/cont, breast, uni   0284     7.0207      $381.15       $190.57        $76.23
C8904.................  S....................  .....................  MRI w/o cont, breast,     0336     6.4817      $351.89       $175.94        $70.38
                                                                       uni.
C8905.................  S....................  .....................  MRI w/o fol w/cont,       0337     9.3215      $506.05       $240.77       $101.21
                                                                       brst, un.
C8906.................  S....................  .....................  MRI w/cont, breast, bi.   0284     7.0207      $381.15       $190.57        $76.23
C8907.................  S....................  .....................  MRI w/o cont, breast,     0336     6.4817      $351.89       $175.94        $70.38
                                                                       bi.
C8908.................  S....................  .....................  MRI w/o fol w/cont,       0337     9.3215      $506.05       $240.77       $101.21
                                                                       breast,.
C8909.................  S....................  .....................  MRA w/cont, chest......   0284     7.0207      $381.15       $190.57        $76.23
C8910.................  S....................  .....................  MRA w/o cont, chest....   0336     6.4817      $351.89       $175.94        $70.38
C8911.................  S....................  .....................  MRA w/o fol w/cont,       0337     9.3215      $506.05       $240.77       $101.21
                                                                       chest.
C8912.................  S....................  .....................  MRA w/cont, lwr ext....   0284     7.0207      $381.15       $190.57        $76.23
C8913.................  S....................  .....................  MRA w/o cont, lwr ext..   0336     6.4817      $351.89       $175.94        $70.38
C8914.................  S....................  .....................  MRA w/o fol w/cont, lwr   0337     9.3215      $506.05       $240.77       $101.21
                                                                       ext.
C8918.................  S....................  .....................  MRA w/cont, pelvis.....   0284     7.0207      $381.15       $190.57        $76.23
C8919.................  S....................  .....................  MRA w/o cont, pelvis...   0336     6.4817      $351.89       $175.94        $70.38
C8920.................  S....................  .....................  MRA w/o fol w/cont,       0337     9.3215      $506.05       $240.77       $101.21
                                                                       pelvis.
C9000.................  K....................  .....................  Na chromateCr51, per      9000     1.2631       $68.57  ............        $13.71
                                                                       0.25mCi.
C9003.................  K....................  .....................  Palivizumab, per 50 mg.   9003     6.3850      $346.64  ............        $69.33
C9007.................  N....................  .....................  Baclofen Intrathecal     .....  .........  ...........  ............  ............
                                                                       kit-1am.
C9008.................  N....................  .....................  Baclofen Refill Kit-     .....  .........  ...........  ............  ............
                                                                       500mcg.
C9009.................  K....................  .....................  Baclofen Refill Kit-      9009     0.7478       $40.60  ............         $8.12
                                                                       2000mcg.
C9010.................  K....................  .....................  Baclofen Refill Kit--     9010     0.7340       $39.85  ............         $7.97
                                                                       4000mcg.
C9013.................  N....................  .....................  Co 57 cobaltous          .....  .........  ...........  ............  ............
                                                                       chloride.
C9102.................  N....................  .....................  51 Na Chromate, 50mCi..  .....  .........  ...........  ............  ............
C9103.................  N....................  .....................  Na Iothalamate I-125,    .....  .........  ...........  ............  ............
                                                                       10 uCi.
C9105.................  K....................  .....................  Hep B imm glob, per 1     9105     1.5621       $84.80  ............        $16.96
                                                                       ml.
C9109.................  K....................  .....................  Tirofiban hcl, 6.25 mg.   9109     2.2328      $121.22  ............        $24.24

[[Page 48165]]

 
C9111.................  G....................  .....................  Inj, bivalirudin, 250mg   9111  .........      $397.81  ............        $59.46
                                                                       vial.
C9112.................  G....................  .....................  Perflutren lipid micro,   9112  .........      $148.20  ............        $22.15
                                                                       2ml.
C9113.................  G....................  .....................  Inj pantoprazole          9113  .........       $22.80  ............         $3.41
                                                                       sodium, via.
C9116.................  G....................  .....................  Ertapenem sodium, per 1   9116  .........       $45.31  ............         $6.77
                                                                       gm.
C9120.................  G....................  .....................  Injection, fulvestrant.   9120  .........      $175.16  ............        $26.18
C9121.................  G....................  .....................  Injection, argatroban..   9121  .........       $14.25  ............         $2.13
C9200.................  G....................  .....................  Orcel, per 36 cm2......   9200  .........    $1,135.25  ............       $169.69
C9201.................  K....................  .....................  Dermagraft, per 37.5 sq   9201     7.9288      $430.45  ............        $86.09
                                                                       cm.
C9202.................  K....................  .....................  Octafluoropropane......   9202     2.1253      $115.38  ............        $23.08
C9203.................  G....................  .....................  Perflexane lipid micro.   9203  .........      $142.50  ............        $21.30
C9204.................  G....................  .....................  Ziprasidone mesylate...   9204  .........       $41.56  ............         $6.21
C9205.................  G....................  .....................  Oxaliplatin............   9205  .........       $94.46  ............        $14.12
C9503.................  K....................  .....................  Fresh frozen plasma, ea   9503     1.1560       $62.76  ............        $12.55
                                                                       unit.
C9701.................  T....................  .....................  Stretta System.........   1557  .........    $1,850.00  ............       $370.00
C9703.................  T....................  .....................  Bard Endoscopic           1555  .........    $1,650.00  ............       $330.00
                                                                       Suturing Sys.
C9711.................  T....................  .....................  H.E.L.P. Apheresis        1552  .........    $1,350.00  ............       $270.00
                                                                       System.
D0120.................  E....................  .....................  Periodic oral            .....  .........  ...........  ............  ............
                                                                       evaluation.
D0140.................  E....................  .....................  Limit oral eval problm   .....  .........  ...........  ............  ............
                                                                       focus.
D0150.................  S....................  .....................  Comprehensve oral         0330     0.5609       $30.45         $6.09         $6.09
                                                                       evaluation.
D0160.................  E....................  .....................  Extensv oral eval prob   .....  .........  ...........  ............  ............
                                                                       focus.
D0170.................  E....................  .....................  Re-eval,est pt,problem   .....  .........  ...........  ............  ............
                                                                       focus.
D0180.................  E....................  .....................  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     0.5609       $30.45         $6.09         $6.09
D0250.................  S....................  .....................  Extraoral first film...   0330     0.5609       $30.45         $6.09         $6.09
D0260.................  S....................  .....................  Extraoral ea additional   0330     0.5609       $30.45         $6.09         $6.09
                                                                       film.
D0270.................  S....................  .....................  Dental bitewing single    0330     0.5609       $30.45         $6.09         $6.09
                                                                       film.
D0272.................  S....................  .....................  Dental bitewings two      0330     0.5609       $30.45         $6.09         $6.09
                                                                       films.
D0274.................  S....................  .....................  Dental bitewings four     0330     0.5609       $30.45         $6.09         $6.09
                                                                       films.
D0277.................  S....................  .....................  Vert bitewings-sev to     0330     0.5609       $30.45         $6.09         $6.09
                                                                       eight.
D0290.................  E....................  .....................  Dental film skull/       .....  .........  ...........  ............  ............
                                                                       facial bon.
D0310.................  E....................  .....................  Dental saliography.....  .....  .........  ...........  ............  ............
D0320.................  E....................  .....................  Dental tmj arthrogram    .....  .........  ...........  ............  ............
                                                                       incl i.
D0321.................  E....................  .....................  Dental other tmj films.  .....  .........  ...........  ............  ............
D0322.................  E....................  .....................  Dental tomographic       .....  .........  ...........  ............  ............
                                                                       survey.
D0330.................  E....................  .....................  Dental panoramic film..  .....  .........  ...........  ............  ............
D0340.................  E....................  .....................  Dental cephalometric     .....  .........  ...........  ............  ............
                                                                       film.
D0350.................  E....................  .....................  Oral/facial images.....  .....  .........  ...........  ............  ............
D0415.................  E....................  .....................  Bacteriologic study....  .....  .........  ...........  ............  ............
D0425.................  E....................  .....................  Caries susceptibility    .....  .........  ...........  ............  ............
                                                                       test.
D0460.................  S....................  .....................  Pulp vitality test.....   0330     0.5609       $30.45         $6.09         $6.09
D0470.................  E....................  .....................  Diagnostic casts.......  .....  .........  ...........  ............  ............
D0472.................  S....................  .....................  Gross exam, prep &        0330     0.5609       $30.45         $6.09         $6.09
                                                                       report.
D0473.................  S....................  .....................  Micro exam, prep &        0330     0.5609       $30.45         $6.09         $6.09
                                                                       report.
D0474.................  S....................  .....................  Micro w exam of surg      0330     0.5609       $30.45         $6.09         $6.09
                                                                       margins.
D0480.................  S....................  .....................  Cytopath smear prep &     0330     0.5609       $30.45         $6.09         $6.09
                                                                       report.
D0502.................  S....................  .....................  Other oral pathology      0330     0.5609       $30.45         $6.09         $6.09
                                                                       procedu.
D0999.................  S....................  .....................  Unspecified diagnostic    0330     0.5609       $30.45         $6.09         $6.09
                                                                       proce.
D1110.................  E....................  .....................  Dental prophylaxis       .....  .........  ...........  ............  ............
                                                                       adult.
D1120.................  E....................  .....................  Dental prophylaxis       .....  .........  ...........  ............  ............
                                                                       child.
D1201.................  E....................  .....................  Topical fluor w prophy   .....  .........  ...........  ............  ............
                                                                       child.
D1203.................  E....................  .....................  Topical fluor w/o        .....  .........  ...........  ............  ............
                                                                       prophy chi.
D1204.................  E....................  .....................  Topical fluor w/o        .....  .........  ...........  ............  ............
                                                                       prophy adu.
D1205.................  E....................  .....................  Topical fluoride w/      .....  .........  ...........  ............  ............
                                                                       prophy a.
D1310.................  E....................  .....................  Nutri counsel-control    .....  .........  ...........  ............  ............
                                                                       caries.
D1320.................  E....................  .....................  Tobacco counseling.....  .....  .........  ...........  ............  ............
D1330.................  E....................  .....................  Oral hygiene             .....  .........  ...........  ............  ............
                                                                       instruction.
D1351.................  E....................  .....................  Dental sealant per       .....  .........  ...........  ............  ............
                                                                       tooth.
D1510.................  S....................  .....................  Space maintainer fxd      0330     0.5609       $30.45         $6.09         $6.09
                                                                       unilat.
D1515.................  S....................  .....................  Fixed bilat space         0330     0.5609       $30.45         $6.09         $6.09
                                                                       maintainer.
D1520.................  S....................  .....................  Remove unilat space       0330     0.5609       $30.45         $6.09         $6.09
                                                                       maintain.
D1525.................  S....................  .....................  Remove bilat space        0330     0.5609       $30.45         $6.09         $6.09
                                                                       maintain.
D1550.................  S....................  .....................  Recement space            0330     0.5609       $30.45         $6.09         $6.09
                                                                       maintainer.
D2140.................  E....................  .....................  Amalgam one surface      .....  .........  ...........  ............  ............
                                                                       permanen.

[[Page 48166]]

 
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.
D2390.................  E....................  .....................  Ant resin-based cmpst    .....  .........  ...........  ............  ............
                                                                       crown.
D2391.................  E....................  .....................  Post 1 srfc resinbased   .....  .........  ...........  ............  ............
                                                                       cmpst.
D2392.................  E....................  .....................  Post 2 srfc resinbased   .....  .........  ...........  ............  ............
                                                                       cmpst.
D2393.................  E....................  .....................  Post 3 srfc resinbased   .....  .........  ...........  ............  ............
                                                                       cmpst.
D2394.................  E....................  .....................  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.
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.

[[Page 48167]]

 
D2970.................  S....................  .....................  Temporary- fractured      0330     0.5609       $30.45         $6.09         $6.09
                                                                       tooth.
D2980.................  E....................  .....................  Crown repair...........  .....  .........  ...........  ............  ............
D2999.................  S....................  .....................  Dental unspec             0330     0.5609       $30.45         $6.09         $6.09
                                                                       restorative 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     0.5609       $30.45         $6.09         $6.09
                                                                       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     0.5609       $30.45         $6.09         $6.09
D4210.................  E....................  .....................  Gingivectomy/plasty per  .....  .........  ...........  ............  ............
                                                                       quad.
D4211.................  E....................  .....................  Gingivectomy/plasty per  .....  .........  ...........  ............  ............
                                                                       toot.
D4240.................  E....................  .....................  Gingival flap proc w/    .....  .........  ...........  ............  ............
                                                                       planin.
D4241.................  E....................  .....................  Gngvl flap w rootplan 1- .....  .........  ...........  ............  ............
                                                                       3 th.
D4245.................  E....................  .....................  Apically positioned      .....  .........  ...........  ............  ............
                                                                       flap.
D4249.................  E....................  .....................  Crown lengthen hard      .....  .........  ...........  ............  ............
                                                                       tissue.
D4260.................  S....................  .....................  Osseous surgery per       0330     0.5609       $30.45         $6.09         $6.09
                                                                       quadrant.
D4261.................  E....................  .....................  Osseous surgl-           .....  .........  ...........  ............  ............
                                                                       3teethperquad.
D4263.................  S....................  .....................  Bone replce graft first   0330     0.5609       $30.45         $6.09         $6.09
                                                                       site.
D4264.................  S....................  .....................  Bone replce graft each    0330     0.5609       $30.45         $6.09         $6.09
                                                                       add.
D4265.................  E....................  .....................  Bio mtrls to aid soft/   .....  .........  ...........  ............  ............
                                                                       os reg.
D4266.................  E....................  .....................  Guided tiss regen        .....  .........  ...........  ............  ............
                                                                       resorble.
D4267.................  E....................  .....................  Guided tiss regen        .....  .........  ...........  ............  ............
                                                                       nonresorb.
D4268.................  S....................  .....................  Surgical revision         0330     0.5609       $30.45         $6.09         $6.09
                                                                       procedure.
D4270.................  S....................  .....................  Pedicle soft tissue       0330     0.5609       $30.45         $6.09         $6.09
                                                                       graft pr.
D4271.................  S....................  .....................  Free soft tissue graft    0330     0.5609       $30.45         $6.09         $6.09
                                                                       proc.
D4273.................  S....................  .....................  Subepithelial tissue      0330     0.5609       $30.45         $6.09         $6.09
                                                                       graft.
D4274.................  E....................  .....................  Distal/proximal wedge    .....  .........  ...........  ............  ............
                                                                       proc.
D4275.................  E....................  .....................  Soft tissue allograft..  .....  .........  ...........  ............  ............
D4276.................  E....................  .....................  Con tissue w dble ped    .....  .........  ...........  ............  ............
                                                                       graft.
D4320.................  E....................  .....................  Provision splnt          .....  .........  ...........  ............  ............
                                                                       intracoronal.
D4321.................  E....................  .....................  Provisional splint       .....  .........  ...........  ............  ............
                                                                       extracoro.
D4341.................  E....................  .....................  Periodontal scaling &    .....  .........  ...........  ............  ............
                                                                       root.
D4342.................  E....................  .....................  Periodontal scaling 1-   .....  .........  ...........  ............  ............
                                                                       3teeth.
D4355.................  S....................  .....................  Full mouth debridement.   0330     0.5609       $30.45         $6.09         $6.09
D4381.................  S....................  .....................  Localized chemo           0330     0.5609       $30.45         $6.09         $6.09
                                                                       delivery.
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.

[[Page 48168]]

 
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....................  .....................  Replc tth&acrlc on mtl   .....  .........  ...........  ............  ............
                                                                       frmwk.
D5671.................  E....................  .....................  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            0330     0.5609       $30.45         $6.09         $6.09
                                                                       sectional.
D5912.................  S....................  .....................  Facial moulage complete   0330     0.5609       $30.45         $6.09         $6.09
D5913.................  E....................  .....................  Nasal prosthesis.......  .....  .........  ...........  ............  ............
D5914.................  E....................  .....................  Auricular prosthesis...  .....  .........  ...........  ............  ............
D5915.................  E....................  .....................  Orbital prosthesis.....  .....  .........  ...........  ............  ............
D5916.................  E....................  .....................  Ocular prosthesis......  .....  .........  ...........  ............  ............
D5919.................  E....................  .....................  Facial prosthesis......  .....  .........  ...........  ............  ............
D5922.................  E....................  .....................  Nasal septal prosthesis  .....  .........  ...........  ............  ............
D5923.................  E....................  .....................  Ocular prosthesis        .....  .........  ...........  ............  ............
                                                                       interim.
D5924.................  E....................  .....................  Cranial prosthesis.....  .....  .........  ...........  ............  ............
D5925.................  E....................  .....................  Facial augmentation      .....  .........  ...........  ............  ............
                                                                       implant.
D5926.................  E....................  .....................  Replacement nasal        .....  .........  ...........  ............  ............
                                                                       prosthesis.
D5927.................  E....................  .....................  Auricular replacement..  .....  .........  ...........  ............  ............
D5928.................  E....................  .....................  Orbital replacement....  .....  .........  ...........  ............  ............
D5929.................  E....................  .....................  Facial replacement.....  .....  .........  ...........  ............  ............
D5931.................  E....................  .....................  Surgical obturator.....  .....  .........  ...........  ............  ............
D5932.................  E....................  .....................  Postsurgical obturator.  .....  .........  ...........  ............  ............
D5933.................  E....................  .....................  Refitting of obturator.  .....  .........  ...........  ............  ............
D5934.................  E....................  .....................  Mandibular flange        .....  .........  ...........  ............  ............
                                                                       prosthesis.
D5935.................  E....................  .....................  Mandibular denture       .....  .........  ...........  ............  ............
                                                                       prosth.
D5936.................  E....................  .....................  Temp obturator           .....  .........  ...........  ............  ............
                                                                       prosthesis.
D5937.................  E....................  .....................  Trismus appliance......  .....  .........  ...........  ............  ............
D5951.................  E....................  .....................  Feeding aid............  .....  .........  ...........  ............  ............

[[Page 48169]]

 
D5952.................  E....................  .....................  Pediatric speech aid...  .....  .........  ...........  ............  ............
D5953.................  E....................  .....................  Adult speech aid.......  .....  .........  ...........  ............  ............
D5954.................  E....................  .....................  Superimposed prosthesis  .....  .........  ...........  ............  ............
D5955.................  E....................  .....................  Palatal lift prosthesis  .....  .........  ...........  ............  ............
D5958.................  E....................  .....................  Intraoral con def inter  .....  .........  ...........  ............  ............
                                                                       plt.
D5959.................  E....................  .....................  Intraoral con def mod    .....  .........  ...........  ............  ............
                                                                       palat.
D5960.................  E....................  .....................  Modify speech aid        .....  .........  ...........  ............  ............
                                                                       prosthesis.
D5982.................  E....................  .....................  Surgical stent.........  .....  .........  ...........  ............  ............
D5983.................  S....................  .....................  Radiation applicator...   0330     0.5609       $30.45         $6.09         $6.09
D5984.................  S....................  .....................  Radiation shield.......   0330     0.5609       $30.45         $6.09         $6.09
D5985.................  S....................  .....................  Radiation cone locator.   0330     0.5609       $30.45         $6.09         $6.09
D5986.................  E....................  .....................  Fluoride applicator....  .....  .........  ...........  ............  ............
D5987.................  S....................  .....................  Commissure splint......   0330     0.5609       $30.45         $6.09         $6.09
D5988.................  E....................  .....................  Surgical splint........  .....  .........  ...........  ............  ............
D5999.................  E....................  .....................  Maxillofacial            .....  .........  ...........  ............  ............
                                                                       prosthesis.
D6010.................  E....................  .....................  Odontics endosteal       .....  .........  ...........  ............  ............
                                                                       implant.
D6020.................  E....................  .....................  Odontics abutment        .....  .........  ...........  ............  ............
                                                                       placement.
D6040.................  E....................  .....................  Odontics eposteal        .....  .........  ...........  ............  ............
                                                                       implant.
D6050.................  E....................  .....................  Odontics transosteal     .....  .........  ...........  ............  ............
                                                                       implnt.
D6053.................  E....................  .....................  Implnt/abtmnt spprt      .....  .........  ...........  ............  ............
                                                                       remv dnt.
D6054.................  E....................  .....................  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.........  .....  .........  ...........  ............  ............
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....................  .....................  Provisional pontic.....  .....  .........  ...........  ............  ............
D6545.................  E....................  .....................  Dental retainr cast      .....  .........  ...........  ............  ............
                                                                       metl.
D6548.................  E....................  .....................  Porcelain/ceramic        .....  .........  ...........  ............  ............
                                                                       retainer.
D6600.................  E....................  .....................  Porcelain/ceramic inlay  .....  .........  ...........  ............  ............
                                                                       2srf.
D6601.................  E....................  .....................  Porc/ceram inlay = 3 surfac.

[[Page 48170]]

 
D6602.................  E....................  .....................  Cst hgh nble mtl inlay   .....  .........  ...........  ............  ............
                                                                       2 srf.
D6603.................  E....................  .....................  Cst hgh nble mtl inlay   .....  .........  ...........  ............  ............
                                                                       =3sr.
D6604.................  E....................  .....................  Cst bse mtl inlay 2      .....  .........  ...........  ............  ............
                                                                       surfaces.
D6605.................  E....................  .....................  Cst bse mtl inlay = 3 surfa.
D6606.................  E....................  .....................  Cast noble metal inlay   .....  .........  ...........  ............  ............
                                                                       2 sur.
D6607.................  E....................  .....................  Cst noble mtl inlay =3 surf.
D6608.................  E....................  .....................  Onlay porc/crmc 2        .....  .........  ...........  ............  ............
                                                                       surfaces.
D6609.................  E....................  .....................  Onlay porc/crmc =3 surfaces.
D6610.................  E....................  .....................  Onlay cst hgh nbl mtl 2  .....  .........  ...........  ............  ............
                                                                       srfc.
D6611.................  E....................  .....................  Onlay cst hgh nbl mtl    .....  .........  ...........  ............  ............
                                                                       =3srf.
D6612.................  E....................  .....................  Onlay cst base mtl 2     .....  .........  ...........  ............  ............
                                                                       surface.
D6613.................  E....................  .....................  Onlay cst base mtl =3 surfa.
D6614.................  E....................  .....................  Onlay cst nbl mtl 2      .....  .........  ...........  ............  ............
                                                                       surfaces.
D6615.................  E....................  .....................  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....................  .....................  Provisional retainer     .....  .........  ...........  ............  ............
                                                                       crown.
D6920.................  S....................  .....................  Dental connector bar...   0330     0.5609       $30.45         $6.09         $6.09
D6930.................  E....................  .....................  Dental recement bridge.  .....  .........  ...........  ............  ............
D6940.................  E....................  .....................  Stress breaker.........  .....  .........  ...........  ............  ............
D6950.................  E....................  .....................  Precision attachment...  .....  .........  ...........  ............  ............
D6970.................  E....................  .....................  Post & core plus         .....  .........  ...........  ............  ............
                                                                       retainer.
D6971.................  E....................  .....................  Cast post bridge         .....  .........  ...........  ............  ............
                                                                       retainer.
D6972.................  E....................  .....................  Prefab post & core plus  .....  .........  ...........  ............  ............
                                                                       reta.
D6973.................  E....................  .....................  Core build up for        .....  .........  ...........  ............  ............
                                                                       retainer.
D6975.................  E....................  .....................  Coping metal...........  .....  .........  ...........  ............  ............
D6976.................  E....................  .....................  Each addtnl cast post..  .....  .........  ...........  ............  ............
D6977.................  E....................  .....................  Each addtl prefab post.  .....  .........  ...........  ............  ............
D6980.................  E....................  .....................  Bridge repair..........  .....  .........  ...........  ............  ............
D6985.................  E....................  .....................  Pediatric partial        .....  .........  ...........  ............  ............
                                                                       denture fx.
D6999.................  E....................  .....................  Fixed prosthodontic      .....  .........  ...........  ............  ............
                                                                       proc.
D7111.................  S....................  .....................  Coronal remnants          0330     0.5609       $30.45         $6.09         $6.09
                                                                       deciduous t.
D7140.................  S....................  .....................  Extraction erupted        0330     0.5609       $30.45         $6.09         $6.09
                                                                       tooth/exr.
D7210.................  S....................  .....................  Rem imp tooth w mucoper   0330     0.5609       $30.45         $6.09         $6.09
                                                                       flp.
D7220.................  S....................  .....................  Impact tooth remov soft   0330     0.5609       $30.45         $6.09         $6.09
                                                                       tiss.
D7230.................  S....................  .....................  Impact tooth remov part   0330     0.5609       $30.45         $6.09         $6.09
                                                                       bony.
D7240.................  S....................  .....................  Impact tooth remov comp   0330     0.5609       $30.45         $6.09         $6.09
                                                                       bony.
D7241.................  S....................  .....................  Impact tooth rem bony w/  0330     0.5609       $30.45         $6.09         $6.09
                                                                       comp.
D7250.................  S....................  .....................  Tooth root removal.....   0330     0.5609       $30.45         $6.09         $6.09
D7260.................  S....................  .....................  Oral antral fistula       0330     0.5609       $30.45         $6.09         $6.09
                                                                       closure.
D7261.................  S....................  .....................  Primary closure sinus     0330     0.5609       $30.45         $6.09         $6.09
                                                                       perf.
D7270.................  E....................  .....................  Tooth reimplantation...  .....  .........  ...........  ............  ............
D7272.................  E....................  .....................  Tooth transplantation..  .....  .........  ...........  ............  ............
D7280.................  E....................  .....................  Exposure impact tooth    .....  .........  ...........  ............  ............
                                                                       orthod.
D7281.................  E....................  .....................  Exposure tooth aid       .....  .........  ...........  ............  ............
                                                                       eruption.
D7282.................  E....................  .....................  Mobilize erupted/malpos  .....  .........  ...........  ............  ............
                                                                       toot.
D7285.................  E....................  .....................  Biopsy of oral tissue    .....  .........  ...........  ............  ............
                                                                       hard.
D7286.................  E....................  .....................  Biopsy of oral tissue    .....  .........  ...........  ............  ............
                                                                       soft.
D7287.................  E....................  .....................  Cytology sample          .....  .........  ...........  ............  ............
                                                                       collection.
D7290.................  E....................  .....................  Repositioning of teeth.  .....  .........  ...........  ............  ............
D7291.................  S....................  .....................  Transseptal fiberotomy.   0330     0.5609       $30.45         $6.09         $6.09
D7310.................  E....................  .....................  Alveoplasty w/           .....  .........  ...........  ............  ............
                                                                       extraction.
D7320.................  E....................  .....................  Alveoplasty w/o          .....  .........  ...........  ............  ............
                                                                       extraction.
D7340.................  E....................  .....................  Vestibuloplasty ridge    .....  .........  ...........  ............  ............
                                                                       extens.

[[Page 48171]]

 
D7350.................  E....................  .....................  Vestibuloplasty exten    .....  .........  ...........  ............  ............
                                                                       graft.
D7410.................  E....................  .....................  Rad exc lesion up to     .....  .........  ...........  ............  ............
                                                                       1.25 cm.
D7411.................  E....................  .....................  Excision benign          .....  .........  ...........  ............  ............
                                                                       lesion1.25c.
D7412.................  E....................  .....................  Excision benign lesion   .....  .........  ...........  ............  ............
                                                                       compl.
D7413.................  E....................  .....................  Excision malig           .....  .........  ...........  ............  ............
                                                                       lesion<=1.25c.
D7414.................  E....................  .....................  Excision malig           .....  .........  ...........  ............  ............
                                                                       lesion1.25c
                                                                       m.
D7415.................  E....................  .....................  Excision malig les       .....  .........  ...........  ............  ............
                                                                       complicat.
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....................  .....................  Removal of torus         .....  .........  ...........  ............  ............
                                                                       palatinus.
D7473.................  E....................  .....................  Remove torus             .....  .........  ...........  ............  ............
                                                                       mandibularis.
D7485.................  E....................  .....................  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....................  .....................  Alveolus open reduction  .....  .........  ...........  ............  ............
D7680.................  E....................  .....................  Reduct simple facial     .....  .........  ...........  ............  ............
                                                                       bone fx.
D7710.................  E....................  .....................  Maxilla open reduct      .....  .........  ...........  ............  ............
                                                                       compound.
D7720.................  E....................  .....................  Clsd reduct compd        .....  .........  ...........  ............  ............
                                                                       maxilla fx.
D7730.................  E....................  .....................  Open reduct compd        .....  .........  ...........  ............  ............
                                                                       mandble fx.
D7740.................  E....................  .....................  Clsd reduct compd        .....  .........  ...........  ............  ............
                                                                       mandble fx.
D7750.................  E....................  .....................  Open red comp malar/     .....  .........  ...........  ............  ............
                                                                       zygma fx.
D7760.................  E....................  .....................  Clsd red comp malar/     .....  .........  ...........  ............  ............
                                                                       zygma fx.
D7770.................  E....................  .....................  Open reduc compd         .....  .........  ...........  ............  ............
                                                                       alveolus fx.
D7771.................  E....................  .....................  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.

[[Page 48172]]

 
D7912.................  E....................  .....................  Suture complicate wnd    .....  .........  ...........  ............  ............
                                                                        5 cm.
D7920.................  E....................  .....................  Dental skin graft......  .....  .........  ...........  ............  ............
D7940.................  S....................  .....................  Reshaping bone            0330     0.5609       $30.45         $6.09         $6.09
                                                                       orthognathic.
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....................  .....................  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.
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....................  .....................  Case presentation tx     .....  .........  ...........  ............  ............
                                                                       plan.
D9610.................  E....................  .....................  Dent therapeutic drug    .....  .........  ...........  ............  ............
                                                                       inject.
D9630.................  S....................  .....................  Other drugs/medicaments   0330     0.5609       $30.45         $6.09         $6.09
D9910.................  E....................  .....................  Dent appl desensitizing  .....  .........  ...........  ............  ............
                                                                       med.
D9911.................  E....................  .....................  Appl desensitizing       .....  .........  ...........  ............  ............
                                                                       resin.

[[Page 48173]]

 
D9920.................  E....................  .....................  Behavior management....  .....  .........  ...........  ............  ............
D9930.................  S....................  .....................  Treatment of              0330     0.5609       $30.45         $6.09         $6.09
                                                                       complications.
D9940.................  S....................  .....................  Dental occlusal guard..   0330     0.5609       $30.45         $6.09         $6.09
D9941.................  E....................  .....................  Fabrication athletic     .....  .........  ...........  ............  ............
                                                                       guard.
D9950.................  S....................  .....................  Occlusion analysis.....   0330     0.5609       $30.45         $6.09         $6.09
D9951.................  S....................  .....................  Limited occlusal          0330     0.5609       $30.45         $6.09         $6.09
                                                                       adjustment.
D9952.................  S....................  .....................  Complete occlusal         0330     0.5609       $30.45         $6.09         $6.09
                                                                       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....................  .....................  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.
E0149.................  A....................  .....................  Heavy duty wheeled       .....  .........  ...........  ............  ............
                                                                       walker.
E0153.................  A....................  .....................  Forearm crutch platform  .....  .........  ...........  ............  ............
                                                                       atta.
E0154.................  A....................  .....................  Walker platform          .....  .........  ...........  ............  ............
                                                                       attachment.
E0155.................  A....................  .....................  Walker wheel             .....  .........  ...........  ............  ............
                                                                       attachment,pair.
E0156.................  A....................  .....................  Walker seat attachment.  .....  .........  ...........  ............  ............
E0157.................  A....................  .....................  Walker crutch            .....  .........  ...........  ............  ............
                                                                       attachment.
E0158.................  A....................  .....................  Walker leg extenders     .....  .........  ...........  ............  ............
                                                                       set of4.
E0159.................  A....................  .....................  Brake for wheeled        .....  .........  ...........  ............  ............
                                                                       walker.
E0160.................  A....................  .....................  Sitz type bath or        .....  .........  ...........  ............  ............
                                                                       equipment.
E0161.................  A....................  .....................  Sitz bath/equipment w/   .....  .........  ...........  ............  ............
                                                                       faucet.
E0162.................  A....................  .....................  Sitz bath chair........  .....  .........  ...........  ............  ............
E0163.................  A....................  .....................  Commode chair stationry  .....  .........  ...........  ............  ............
                                                                       fxd.
E0164.................  A....................  .....................  Commode chair mobile     .....  .........  ...........  ............  ............
                                                                       fixed a.
E0165.................  A....................  .....................  Commode chair stationry  .....  .........  ...........  ............  ............
                                                                       det.
E0166.................  A....................  .....................  Commode chair mobile     .....  .........  ...........  ............  ............
                                                                       detach.
E0167.................  A....................  .....................  Commode chair pail or    .....  .........  ...........  ............  ............
                                                                       pan.
E0168.................  A....................  .....................  Heavyduty/wide commode   .....  .........  ...........  ............  ............
                                                                       chair.
E0169.................  A....................  .....................  Seatlift incorp          .....  .........  ...........  ............  ............
                                                                       commodechair.
E0175.................  A....................  .....................  Commode chair foot rest  .....  .........  ...........  ............  ............
E0176.................  A....................  .....................  Air pressre pad/cushion  .....  .........  ...........  ............  ............
                                                                       nonp.
E0177.................  A....................  .....................  Water press pad/cushion  .....  .........  ...........  ............  ............
                                                                       nonp.
E0178.................  A....................  .....................  Gel pressre pad/cushion  .....  .........  ...........  ............  ............
                                                                       nonp.
E0179.................  A....................  .....................  Dry pressre pad/cushion  .....  .........  ...........  ............  ............
                                                                       nonp.
E0180.................  A....................  .....................  Press pad alternating w  .....  .........  ...........  ............  ............
                                                                       pump.
E0181.................  A....................  .....................  Press pad alternating w/ .....  .........  ...........  ............  ............
                                                                        pum.
E0182.................  A....................  .....................  Pressure pad             .....  .........  ...........  ............  ............
                                                                       alternating pum.
E0184.................  A....................  .....................  Dry pressure mattress..  .....  .........  ...........  ............  ............
E0185.................  A....................  .....................  Gel pressure mattress    .....  .........  ...........  ............  ............
                                                                       pad.
E0186.................  A....................  .....................  Air pressure mattress..  .....  .........  ...........  ............  ............
E0187.................  A....................  .....................  Water pressure mattress  .....  .........  ...........  ............  ............
E0188.................  E....................  .....................  Synthetic sheepskin pad  .....  .........  ...........  ............  ............
E0189.................  E....................  .....................  Lambswool sheepskin pad  .....  .........  ...........  ............  ............
E0191.................  A....................  .....................  Protector heel or elbow  .....  .........  ...........  ............  ............
E0192.................  A....................  .....................  Pad wheelchr low press/  .....  .........  ...........  ............  ............
                                                                       posit.

[[Page 48174]]

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

[[Page 48175]]

 
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....................  .....................  Oximeter non-invasive..  .....  .........  ...........  ............  ............
E0450.................  A....................  .....................  Volume vent stationary/  .....  .........  ...........  ............  ............
                                                                       porta.
E0454.................  A....................  .....................  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....................  .....................  Vol vent noninvasive     .....  .........  ...........  ............  ............
                                                                       interfa.
E0462.................  A....................  .....................  Rocking bed w/ or w/o    .....  .........  ...........  ............  ............
                                                                       side r.
E0480.................  A....................  .....................  Percussor elect/pneum    .....  .........  ...........  ............  ............
                                                                       home m.
E0481.................  E....................  .....................  Intrpulmnry percuss      .....  .........  ...........  ............  ............
                                                                       vent sys.
E0482.................  A....................  .....................  Cough stimulating        .....  .........  ...........  ............  ............
                                                                       device.
E0483.................  A....................  .....................  Chest compression gen    .....  .........  ...........  ............  ............
                                                                       system.
E0484.................  A....................  .....................  Non-elec oscillatory     .....  .........  ...........  ............  ............
                                                                       pep dvc.
E0500.................  A....................  .....................  Ippb all types.........  .....  .........  ...........  ............  ............
E0550.................  A....................  .....................  Humidif extens supple w  .....  .........  ...........  ............  ............
                                                                       ippb.
E0555.................  A....................  .....................  Humidifier for use w/    .....  .........  ...........  ............  ............
                                                                       regula.
E0560.................  A....................  .....................  Humidifier supplemental  .....  .........  ...........  ............  ............
                                                                       w/ i.
E0565.................  A....................  .....................  Compressor air power     .....  .........  ...........  ............  ............
                                                                       source.
E0570.................  A....................  .....................  Nebulizer with           .....  .........  ...........  ............  ............
                                                                       compression.
E0571.................  A....................  .....................  Aerosol compressor for   .....  .........  ...........  ............  ............
                                                                       svneb.
E0572.................  A....................  .....................  Aerosol compressor       .....  .........  ...........  ............  ............
                                                                       adjust pr.
E0574.................  A....................  .....................  Ultrasonic generator w   .....  .........  ...........  ............  ............
                                                                       svneb.
E0575.................  A....................  .....................  Nebulizer ultrasonic...  .....  .........  ...........  ............  ............
E0580.................  A....................  .....................  Nebulizer for use w/     .....  .........  ...........  ............  ............
                                                                       regulat.
E0585.................  A....................  .....................  Nebulizer w/ compressor  .....  .........  ...........  ............  ............
                                                                       & he.
E0590.................  A....................  .....................  Dispensing fee dme neb   .....  .........  ...........  ............  ............
                                                                       drug.
E0600.................  A....................  .....................  Suction pump portab hom  .....  .........  ...........  ............  ............
                                                                       modl.
E0601.................  A....................  .....................  Cont airway pressure     .....  .........  ...........  ............  ............
                                                                       device.
E0602.................  E....................  .....................  Manual breast pump.....  .....  .........  ...........  ............  ............
E0603.................  A....................  .....................  Electric breast pump...  .....  .........  ...........  ............  ............
E0604.................  A....................  .....................  Hosp grade elec breast   .....  .........  ...........  ............  ............
                                                                       pump.
E0605.................  A....................  .....................  Vaporizer room type....  .....  .........  ...........  ............  ............
E0606.................  A....................  .....................  Drainage board postural  .....  .........  ...........  ............  ............
E0607.................  A....................  .....................  Blood glucose monitor    .....  .........  ...........  ............  ............
                                                                       home.
E0610.................  A....................  .....................  Pacemaker monitr         .....  .........  ...........  ............  ............
                                                                       audible/vis.
E0615.................  A....................  .....................  Pacemaker monitr         .....  .........  ...........  ............  ............
                                                                       digital/vis.
E0616.................  N....................  .....................  Cardiac event recorder.  .....  .........  ...........  ............  ............
E0617.................  A....................  .....................  Automatic ext            .....  .........  ...........  ............  ............
                                                                       defibrillator.
E0618.................  A....................  .....................  Apnea monitor..........  .....  .........  ...........  ............  ............
E0619.................  A....................  .....................  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....................  .....................  PT support &             .....  .........  ...........  ............  ............
                                                                       positioning sys.
E0650.................  A....................  .....................  Pneuma compresor non-    .....  .........  ...........  ............  ............
                                                                       segment.
E0651.................  A....................  .....................  Pneum compressor         .....  .........  ...........  ............  ............
                                                                       segmental.

[[Page 48176]]

 
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.
E0691.................  A....................  .....................  Uvl pnl 2 sq ft or less  .....  .........  ...........  ............  ............
E0692.................  A....................  .....................  Uvl sys panel 4 ft.....  .....  .........  ...........  ............  ............
E0693.................  A....................  .....................  Uvl sys panel 6 ft.....  .....  .........  ...........  ............  ............
E0694.................  A....................  .....................  Uvl md cabinet sys 6 ft  .....  .........  ...........  ............  ............
E0700.................  E....................  .....................  Safety equipment.......  .....  .........  ...........  ............  ............
E0701.................  A....................  .....................  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.
E0749.................  N....................  .....................  Elec osteogen stim       .....  .........  ...........  ............  ............
                                                                       implanted.
E0752.................  N....................  .....................  Neurostimulator          .....  .........  ...........  ............  ............
                                                                       electrode.
E0754.................  A....................  .....................  Pulsegenerator pt        .....  .........  ...........  ............  ............
                                                                       programmer.
E0755.................  E....................  .....................  Electronic salivary      .....  .........  ...........  ............  ............
                                                                       reflex s.
E0756.................  N....................  .....................  Implantable pulse        .....  .........  ...........  ............  ............
                                                                       generator.
E0757.................  N....................  .....................  Implantable RF receiver  .....  .........  ...........  ............  ............
E0758.................  A....................  .....................  External RF transmitter  .....  .........  ...........  ............  ............
E0759.................  A....................  .....................  Replace rdfrquncy        .....  .........  ...........  ............  ............
                                                                       transmittr.
E0760.................  E....................  .....................  Osteogen ultrasound      .....  .........  ...........  ............  ............
                                                                       stimltor.
E0761.................  E....................  .....................  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.................  N....................  .....................  Non-programble infusion  .....  .........  ...........  ............  ............
                                                                       pump.
E0783.................  N....................  .....................  Programmable infusion    .....  .........  ...........  ............  ............
                                                                       pump.
E0784.................  A....................  .....................  Ext amb infusn pump      .....  .........  ...........  ............  ............
                                                                       insulin.
E0785.................  N....................  .....................  Replacement impl pump    .....  .........  ...........  ............  ............
                                                                       cathet.
E0786.................  N....................  .....................  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.

[[Page 48177]]

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

[[Page 48178]]

 
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....................  .....................  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.
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....................  .....................  Rigid ped w/c tilt-in-   .....  .........  ...........  ............  ............
                                                                       space.
E1232.................  A....................  .....................  Folding ped wc tilt-in-  .....  .........  ...........  ............  ............
                                                                       space.
E1233.................  A....................  .....................  Rig ped wc tltnspc w/o   .....  .........  ...........  ............  ............
                                                                       seat.
E1234.................  A....................  .....................  Fld ped wc tltnspc w/o   .....  .........  ...........  ............  ............
                                                                       seat.
E1235.................  A....................  .....................  Rigid ped wc adjustable  .....  .........  ...........  ............  ............
E1236.................  A....................  .....................  Folding ped wc           .....  .........  ...........  ............  ............
                                                                       adjustable.
E1237.................  A....................  .....................  Rgd ped wc adjstabl w/o  .....  .........  ...........  ............  ............
                                                                       seat.
E1238.................  A....................  .....................  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.

[[Page 48179]]

 
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.
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....................  .....................  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.
G0008.................  L....................  .....................  Admin influenza virus    .....  .........  ...........  ............  ............
                                                                       vac.
G0009.................  L....................  .....................  Admin pneumococcal       .....  .........  ...........  ............  ............
                                                                       vaccine.
G0010.................  K....................  .....................  Admin hepatitis b         0355     0.2667       $14.48  ............         $2.90
                                                                       vaccine.
G0025.................  N....................  .....................  Collagen skin test kit.  .....  .........  ...........  ............  ............
G0030.................  S....................  .....................  PET imaging prev PET      0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       single.
G0031.................  S....................  .....................  PET imaging prev PET      0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       multple.
G0032.................  S....................  .....................  PET follow SPECT 78464    0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       singl.
G0033.................  S....................  .....................  PET follow SPECT 78464    0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       mult.
G0034.................  S....................  .....................  PET follow SPECT 76865    0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       singl.
G0035.................  S....................  .....................  PET follow SPECT 78465    0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       mult.
G0036.................  S....................  .....................  PET follow cornry angio   0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       sing.
G0037.................  S....................  .....................  PET follow cornry angio   0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       mult.
G0038.................  S....................  .....................  PET follow myocard perf   0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       sing.
G0039.................  S....................  .....................  PET follow myocard perf   0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       mult.
G0040.................  S....................  .....................  PET follow stress echo    0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       singl.
G0041.................  S....................  .....................  PET follow stress echo    0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       mult.
G0042.................  S....................  .....................  PET follow ventriculogm   0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       sing.

[[Page 48180]]

 
G0043.................  S....................  .....................  PET follow ventriculogm   0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       mult.
G0044.................  S....................  .....................  PET following rest ECG    0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       singl.
G0045.................  S....................  .....................  PET following rest ECG    0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       mult.
G0046.................  S....................  .....................  PET follow stress ECG     0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       singl.
G0047.................  S....................  .....................  PET follow stress ECG     0285    19.5044    $1,058.87       $409.56       $211.77
                                                                       mult.
G0101.................  V....................  .....................  CA screen;pelvic/breast   0600     0.9376       $50.90  ............        $10.18
                                                                       exam.
G0102.................  N....................  .....................  Prostate ca screening;   .....  .........  ...........  ............  ............
                                                                       dre.
G0103.................  A....................  .....................  Psa, total screening...  .....  .........  ...........  ............  ............
G0104.................  S....................  .....................  CA screen;flexi           0159     2.7168      $147.49        $36.87        $29.50
                                                                       sigmoidscope.
G0105.................  T....................  .....................  Colorectal scrn; hi       0158     7.4187      $402.75       $100.69        $80.55
                                                                       risk ind.
G0106.................  S....................  .....................  Colon CA screen;barium    0157     2.4771      $134.48  ............        $26.90
                                                                       enema.
G0107.................  A....................  .....................  CA screen; fecal blood   .....  .........  ...........  ............  ............
                                                                       test.
G0108.................  A....................  .....................  Diab manage trn per      .....  .........  ...........  ............  ............
                                                                       indiv.
G0109.................  A....................  .....................  Diab manage trn ind/     .....  .........  ...........  ............  ............
                                                                       group.
G0110.................  A....................  .....................  Nett pulm-rehab educ;    .....  .........  ...........  ............  ............
                                                                       ind.
G0111.................  A....................  .....................  Nett pulm-rehab educ;    .....  .........  ...........  ............  ............
                                                                       group.
G0112.................  A....................  .....................  Nett;nutrition guid,     .....  .........  ...........  ............  ............
                                                                       initial.
G0113.................  A....................  .....................  Nett;nutrition           .....  .........  ...........  ............  ............
                                                                       guid,subseqnt.
G0114.................  A....................  .....................  Nett; psychosocial       .....  .........  ...........  ............  ............
                                                                       consult.
G0115.................  A....................  .....................  Nett; psychological      .....  .........  ...........  ............  ............
                                                                       testing.
G0116.................  A....................  .....................  Nett; psychosocial       .....  .........  ...........  ............  ............
                                                                       counsel.
G0117.................  S....................  .....................  Glaucoma scrn hgh risk    0230     0.7379       $40.06        $14.97         $8.01
                                                                       direc.
G0118.................  S....................  .....................  Glaucoma scrn hgh risk    0230     0.7379       $40.06        $14.97         $8.01
                                                                       direc.
G0120.................  S....................  .....................  Colon ca scrn; barium     0157     2.4771      $134.48  ............        $26.90
                                                                       enema.
G0121.................  T....................  .....................  Colon ca scrn not hi      0158     7.4187      $402.75       $100.69        $80.55
                                                                       rsk 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     1516  .........    $1,450.00  ............       $290.00
                                                                       ring.
G0127.................  T....................  .....................  Trim nail(s)...........   0009     0.6597       $35.81         $8.34         $7.16
G0128.................  E....................  .....................  CORF skilled nursing     .....  .........  ...........  ............  ............
                                                                       service.
G0129.................  P....................  .....................  Partial hosp prog         0033     3.8397      $208.45        $41.83        $41.69
                                                                       service.
G0130.................  X....................  .....................  Single energy x-ray       0260     0.7845       $42.59        $21.29         $8.52
                                                                       study.
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,      0678     2.0622      $111.95  ............        $22.39
                                                                       per tx.
G0167.................  E....................  .....................  Hyperbaric oz tx;no md   .....  .........  ...........  ............  ............
                                                                       reqrd.
G0168.................  X....................  .....................  Wound closure by          0340     0.6232       $33.83  ............         $6.77
                                                                       adhesive.
G0173.................  S....................  .....................  Stereo                    1528  .........    $5,250.00  ............     $1,050.00
                                                                       radoisurgery,complete.
G0175.................  V....................  .....................  OPPS Service,sched team   0602     1.5603       $84.71  ............        $16.94
                                                                       conf.
G0176.................  P....................  .....................  OPPS/PHP;activity         0033     3.8397      $208.45        $41.83        $41.69
                                                                       therapy.
G0177.................  P....................  .....................  OPPS/PHP; train & educ    0033     3.8397      $208.45        $41.83        $41.69
                                                                       serv.
G0179.................  E....................  .....................  MD recertification HHA   .....  .........  ...........  ............  ............
                                                                       PT.
G0180.................  E....................  .....................  MD certification HHA     .....  .........  ...........  ............  ............
                                                                       patient.
G0181.................  E....................  .....................  Home health care         .....  .........  ...........  ............  ............
                                                                       supervision.
G0182.................  E....................  .....................  Hospice care             .....  .........  ...........  ............  ............
                                                                       supervision.
G0186.................  T....................  .....................  Dstry eye lesn,fdr vssl   0235     4.9900      $270.90        $72.04        $54.18
                                                                       tech.
G0202.................  A....................  .....................  Screeningmammographydig  .....  .........  ...........  ............  ............
                                                                       ital.
G0204.................  S....................  .....................  Diagnosticmammographydi   0669     0.9111       $49.46  ............         $9.89
                                                                       gital.
G0206.................  S....................  .....................  Diagnosticmammographydi   0669     0.9111       $49.46  ............         $9.89
                                                                       gital.
G0210.................  S....................  .....................  PET img whbd ring         1516  .........    $1,450.00  ............       $290.00
                                                                       dxlung ca.
G0211.................  S....................  .....................  PET img whbd ring init    1516  .........    $1,450.00  ............       $290.00
                                                                       lung.
G0212.................  S....................  .....................  PET img whbd ring         1516  .........    $1,450.00  ............       $290.00
                                                                       restag lun.
G0213.................  S....................  .....................  PET img whbd ring dx      1516  .........    $1,450.00  ............       $290.00
                                                                       colorec.
G0214.................  S....................  .....................  PET img whbd ring init    1516  .........    $1,450.00  ............       $290.00
                                                                       colre.
G0215.................  S....................  .....................  PET img whbd restag col   1516  .........    $1,450.00  ............       $290.00

[[Page 48181]]

 
G0216.................  S....................  .....................  PET img whbd ring dx      1516  .........    $1,450.00  ............       $290.00
                                                                       melanom.
G0217.................  S....................  .....................  PET img whbd ring init    1516  .........    $1,450.00  ............       $290.00
                                                                       melan.
G0218.................  S....................  .....................  PET img whbd ring         1516  .........    $1,450.00  ............       $290.00
                                                                       restag mel.
G0219.................  E....................  .....................  PET img whbd ring        .....  .........  ...........  ............  ............
                                                                       noncov ind.
G0220.................  S....................  .....................  PET img whbd ring dx      1516  .........    $1,450.00  ............       $290.00
                                                                       lymphom.
G0221.................  S....................  .....................  PET img whbd ring init    1516  .........    $1,450.00  ............       $290.00
                                                                       lymph.
G0222.................  S....................  .....................  PET img whbd ring resta   1516  .........    $1,450.00  ............       $290.00
                                                                       lymp.
G0223.................  S....................  .....................  PET img whbd reg ring     1516  .........    $1,450.00  ............       $290.00
                                                                       dx hea.
G0224.................  S....................  .....................  PETimg whbd reg ring      1516  .........    $1,450.00  ............       $290.00
                                                                       ini hea.
G0225.................  S....................  .....................  PET img whbd ring         1516  .........    $1,450.00  ............       $290.00
                                                                       restag hea.
G0226.................  S....................  .....................  PET img whbd dx esophag   1516  .........    $1,450.00  ............       $290.00
G0227.................  S....................  .....................  PET img whbd ring ini     1516  .........    $1,450.00  ............       $290.00
                                                                       esopha.
G0228.................  S....................  .....................  PET img whbd ring restg   1516  .........    $1,450.00  ............       $290.00
                                                                       esop.
G0229.................  S....................  .....................  PET img metabolic brain   1516  .........    $1,450.00  ............       $290.00
                                                                       ring.
G0230.................  S....................  .....................  PET myocard viability     1516  .........    $1,450.00  ............       $290.00
                                                                       ring.
G0231.................  S....................  .....................  PET WhBD colorec; gamma   1516  .........    $1,450.00  ............       $290.00
                                                                       cam.
G0232.................  S....................  .....................  PET whbd lymphoma;        1516  .........    $1,450.00  ............       $290.00
                                                                       gamma cam.
G0233.................  S....................  .....................  PET whbd melanoma;        1516  .........    $1,450.00  ............       $290.00
                                                                       gamma cam.
G0234.................  S....................  .....................  PET WhBD pulm nod;        1516  .........    $1,450.00  ............       $290.00
                                                                       gamma cam.
G0236.................  S....................  .....................  Digital film convert      0410     0.1473        $8.00  ............         $1.60
                                                                       diag ma.
G0237.................  S....................  .....................  Therapeutic procd strg    0411     0.4207       $22.84  ............         $4.57
                                                                       endur.
G0238.................  S....................  .....................  Oth resp proc, indiv...   0411     0.4207       $22.84  ............         $4.57
G0239.................  S....................  .....................  Oth resp proc, group...   0411     0.4207       $22.84  ............         $4.57
G0242.................  S....................  .....................  Multisource photon ster   1516  .........    $1,450.00  ............       $290.00
                                                                       plan.
G0243.................  S....................  .....................  Multisour photon stero    1528  .........    $5,250.00  ............     $1,050.00
                                                                       treat.
G0244.................  S....................  .....................  Observ care by facility   0339     7.2016      $390.97  ............        $78.19
                                                                       topt.
G0245.................  V....................  .....................  Initial Foot Exam         0600     0.9376       $50.90  ............        $10.18
                                                                       PTLOPS.
G0246.................  V....................  .....................  Follow-up Eval of Foot    0600     0.9376       $50.90  ............        $10.18
                                                                       PTLOPS.
G0247.................  T....................  .....................  Routine footcare w LOPS   0009     0.6597       $35.81         $8.34         $7.16
G0248.................  S....................  .....................  Demonstrate use home      1503  .........      $150.00  ............        $30.00
                                                                       INR mon.
G0249.................  S....................  .....................  Provide test              1503  .........      $150.00  ............        $30.00
                                                                       material,equipm.
G0250.................  E....................  .....................  MD review interpret of   .....  .........  ...........  ............  ............
                                                                       test.
G0251.................  S....................  .....................  Linear acc based stero    1513  .........    $1,150.00  ............       $230.00
                                                                       radio.
G0252.................  E....................  .....................  PET imaging initial dx.  .....  .........  ...........  ............  ............
G0253.................  S....................  .....................  PET image brst dection    1516  .........    $1,450.00  ............       $290.00
                                                                       recur.
G0254.................  S....................  .....................  PET image brst eval to    1516  .........    $1,450.00  ............       $290.00
                                                                       tx.
G0255.................  E....................  .....................  Current percep           .....  .........  ...........  ............  ............
                                                                       threshold tst.
G0256.................  T....................  .....................  Prostate brachy w         0649   119.0281    $6,461.92  ............     $1,292.38
                                                                       palladium.
G0257.................  S....................  .....................  Unsched dialysis ESRD     0170     5.9427      $322.62  ............        $64.52
                                                                       pt hos.
G0259.................  N....................  .....................  Inject for sacroiliac    .....  .........  ...........  ............  ............
                                                                       joint.
G0260.................  T....................  .....................  Inj for sacroiliac jt     0204     2.2209      $120.57        $40.13        $24.11
                                                                       anesth.
G0261.................  T....................  .....................  Prostate brachy w         0684   104.7194    $5,685.11  ............     $1,137.02
                                                                       iodine see.
G0262.................  S....................  .....................  Sm intestinal image       1508  .........      $650.00  ............       $130.00
                                                                       capsule.
G0263.................  N....................  .....................  Adm with CHF, CP,        .....  .........  ...........  ............  ............
                                                                       asthma.
G0264.................  V....................  .....................  Assmt otr CHF, CP,        0600     0.9376       $50.90  ............        $10.18
                                                                       asthma.
G0265.................  A....................  .....................  Cryopresevation          .....  .........  ...........  ............  ............
                                                                       Freeze+stora.
G0266.................  A....................  .....................  Thawing + expansion      .....  .........  ...........  ............  ............
                                                                       froz cel.
G0267.................  S....................  .....................  Bone marrow or psc        0110     3.7128      $201.56  ............        $40.31
                                                                       harvest.
G0268.................  X....................  .....................  Removal of impacted wax   0340     0.6232       $33.83  ............         $6.77
                                                                       md.
G0269.................  N....................  .....................  Occlusive device in      .....  .........  ...........  ............  ............
                                                                       vein art.
G0270.................  A....................  .....................  MNT subs tx for change   .....  .........  ...........  ............  ............
                                                                       dx.
G0271.................  A....................  .....................  Group MNT 2 or more 30   .....  .........  ...........  ............  ............
                                                                       mins.
G0272.................  X....................  .....................  Naso/oro gastric tube     0272     1.4086       $76.47        $38.23        $15.29
                                                                       pl MD.
G0273.................  S....................  .....................  Pretx planning, non-      0406     4.7542      $258.10  ............        $51.62
                                                                       Hodgkins.
G0274.................  S....................  .....................  Radiopharm tx, non-       0408     4.0000      $217.16  ............        $43.43
                                                                       Hodgkins.
G0275.................  N....................  .....................  Renal angio, cardiac     .....  .........  ...........  ............  ............
                                                                       cath.
G0278.................  N....................  .....................  Iliac art angio,cardiac  .....  .........  ...........  ............  ............
                                                                       cath.
G0279.................  A....................  .....................  Excorp shock tx, elbow   .....  .........  ...........  ............  ............
                                                                       epi.
G0280.................  A....................  .....................  Excorp shock tx other    .....  .........  ...........  ............  ............
                                                                       than.
G0281.................  A....................  .....................  Elec stim unattend for   .....  .........  ...........  ............  ............
                                                                       press.
G0282.................  A....................  .....................  Elect stim wound care    .....  .........  ...........  ............  ............
                                                                       not pd.
G0283.................  A....................  .....................  Elec stim other than     .....  .........  ...........  ............  ............
                                                                       wound.
G0288.................  S....................  .....................  Recon, CTA for surg       0414     4.8012      $260.65  ............        $52.13
                                                                       plan.
G0289.................  N....................  .....................  Arthro, loose body +     .....  .........  ...........  ............  ............
                                                                       chondro.
G0290.................  T....................  .....................  Drug-eluting stents,      0656   101.3662    $5,503.07  ............     $1,100.61
                                                                       single.
G0291.................  T....................  .....................  Drug-eluting              0656   101.3662    $5,503.07  ............     $1,100.61
                                                                       stents,each add.

[[Page 48182]]

 
G0292.................  S....................  .....................  Adm exp drugs,clinical    1503  .........      $150.00  ............        $30.00
                                                                       trial.
G0293.................  S....................  .....................  Non-cov surg proc,clin    1505  .........      $350.00  ............        $70.00
                                                                       trial.
G0294.................  S....................  .....................  Non-cov proc, clinical    1502  .........       $75.00  ............        $15.00
                                                                       trial.
G0295.................  E....................  .....................  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.
GXXX1.................  S....................  .....................  Infusion, pkgd            0382     4.6839      $254.28  ............        $50.86
                                                                       noncancer.
GXXX3.................  S....................  .....................  Pkgd cancer chemo,        0376     2.1479      $116.61  ............        $23.32
                                                                       other.
GXXX4.................  S....................  .....................  Infusion of pkgd cancer   0378     4.3955      $238.63  ............        $47.73
GXXX5.................  S....................  .....................  Pkgd cancer chemo, both   0380     5.1857      $281.53  ............        $56.31
GYYY1.................  S....................  .....................  Infusion, separate        0383     1.8419       $99.99  ............        $20.00
                                                                       noncancer.
GYYY3.................  S....................  .....................  Sep cancer chemo, other   0377     0.6673       $36.23  ............         $7.25
GYYY4.................  S....................  .....................  Infusion, separate        0379     2.4298      $131.91  ............        $26.38
                                                                       cancer.
GYYY5.................  S....................  .....................  Sep cancer chemo, both.   0381     2.1596      $117.24  ............        $23.45
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....................  .....................  MH health assess by non- .....  .........  ...........  ............  ............
                                                                       md.
H0032.................  E....................  .....................  MH svc plan dev by non-  .....  .........  ...........  ............  ............
                                                                       md.
H0033.................  E....................  .....................  Oral med adm direct      .....  .........  ...........  ............  ............
                                                                       observe.
H0034.................  E....................  .....................  Med trng & support per   .....  .........  ...........  ............  ............
                                                                       15min.
H0035.................  E....................  .....................  MH partial hosp tx       .....  .........  ...........  ............  ............
                                                                       under 24h.
H0036.................  E....................  .....................  Comm psy face-face per   .....  .........  ...........  ............  ............
                                                                       15min.
H0037.................  E....................  .....................  Comm psy sup tx pgm per  .....  .........  ...........  ............  ............
                                                                       diem.
H0038.................  E....................  .....................  Self-help/peer svc per   .....  .........  ...........  ............  ............
                                                                       15min.
H0039.................  E....................  .....................  Asser com tx face-face/  .....  .........  ...........  ............  ............
                                                                       15min.
H0040.................  E....................  .....................  Assert comm tx pgm per   .....  .........  ...........  ............  ............
                                                                       diem.
H0041.................  E....................  .....................  Fos c chld non-ther per  .....  .........  ...........  ............  ............
                                                                       diem.

[[Page 48183]]

 
H0042.................  E....................  .....................  Fos c chld non-ther per  .....  .........  ...........  ............  ............
                                                                       mon.
H0043.................  E....................  .....................  Supported housing, per   .....  .........  ...........  ............  ............
                                                                       diem.
H0044.................  E....................  .....................  Supported housing, per   .....  .........  ...........  ............  ............
                                                                       month.
H0045.................  E....................  .....................  Respite not-in-home per  .....  .........  ...........  ............  ............
                                                                       diem.
H0046.................  E....................  .....................  Mental health service,   .....  .........  ...........  ............  ............
                                                                       nos.
H0047.................  E....................  .....................  Alcohol/drug abuse svc   .....  .........  ...........  ............  ............
                                                                       nos.
H0048.................  E....................  .....................  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....................  .....................  Nonmed family planning   .....  .........  ...........  ............  ............
                                                                       ed.
H1011.................  E....................  .....................  Family assessment......  .....  .........  ...........  ............  ............
H2000.................  E....................  .....................  Comp multidisipln        .....  .........  ...........  ............  ............
                                                                       evaluation.
H2001.................  E....................  .....................  Rehabilitation program   .....  .........  ...........  ............  ............
                                                                       1/2 d.
J0120.................  N....................  .....................  Tetracyclin injection..  .....  .........  ...........  ............  ............
J0130.................  K....................  .....................  Abciximab injection....   1605     5.2806      $286.68  ............        $57.34
J0150.................  N....................  .....................  Injection adenosine 6    .....  .........  ...........  ............  ............
                                                                       MG.
J0151.................  K....................  .....................  Adenosine injection....   0917     2.3474      $127.44  ............        $25.49
J0170.................  N....................  .....................  Adrenalin epinephrin     .....  .........  ...........  ............  ............
                                                                       inject.
J0190.................  N....................  .....................  Inj biperiden lactate/5  .....  .........  ...........  ............  ............
                                                                       mg.
J0200.................  N....................  .....................  Alatrofloxacin mesylate  .....  .........  ...........  ............  ............
J0205.................  K....................  .....................  Alglucerase injection..   0900     0.5473       $29.71  ............         $5.94
J0207.................  K....................  .....................  Amifostine.............   7000     3.9932      $216.79  ............        $43.36
J0210.................  N....................  .....................  Methyldopate hcl         .....  .........  ...........  ............  ............
                                                                       injection.
J0256.................  K....................  .....................  Alpha 1 proteinase        0901     0.0214        $1.16  ............          $.23
                                                                       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.........  .....  .........  ...........  ............  ............
J0287.................  K....................  .....................  Amphotericin b lipid      9024     0.4174       $22.66  ............         $4.53
                                                                       complex.
J0288.................  N....................  .....................  Ampho b cholesteryl      .....  .........  ...........  ............  ............
                                                                       sulfate.
J0289.................  N....................  .....................  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.................  K....................  .....................  Injection anistreplase    1606    25.3116    $1,374.14  ............       $274.83
                                                                       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     0902     0.0460        $2.50  ............          $.50
                                                                       unit.
J0587.................  K....................  .....................  Botulinum toxin type B.   9018     0.1272        $6.91  ............         $1.38
J0592.................  N....................  .....................  Buprenorphine            .....  .........  ...........  ............  ............
                                                                       hydrochloride.
J0600.................  N....................  .....................  Edetate calcium          .....  .........  ...........  ............  ............
                                                                       disodium inj.
J0610.................  N....................  .....................  Calcium gluconate        .....  .........  ...........  ............  ............
                                                                       injection.
J0620.................  N....................  .....................  Calcium glycer & lact/   .....  .........  ...........  ............  ............
                                                                       10 ML.
J0630.................  N....................  .....................  Calcitonin salmon        .....  .........  ...........  ............  ............
                                                                       injection.

[[Page 48184]]

 
J0636.................  N....................  .....................  Inj calcitriol per 0.1   .....  .........  ...........  ............  ............
                                                                       mcg.
J0637.................  K....................  .....................  Caspofungin acetate....   9019     0.5334       $28.96  ............         $5.79
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     5.0754      $275.54  ............        $55.11
                                                                       vial.
J0880.................  E....................  .....................  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.
J1051.................  N....................  .....................  Medroxyprogesterone inj  .....  .........  ...........  ............  ............
J1055.................  E....................  .....................  Medrxyprogester acetate  .....  .........  ...........  ............  ............
                                                                       inj.
J1056.................  E....................  .....................  MA/EC                    .....  .........  ...........  ............  ............
                                                                       contraceptiveinjection.
J1060.................  N....................  .....................  Testosterone cypionate   .....  .........  ...........  ............  ............
                                                                       1 ML.
J1070.................  N....................  .....................  Testosterone cypionat    .....  .........  ...........  ............  ............
                                                                       100 MG.
J1080.................  N....................  .....................  Testosterone cypionat    .....  .........  ...........  ............  ............
                                                                       200 MG.
J1094.................  N....................  .....................  Inj dexamethasone        .....  .........  ...........  ............  ............
                                                                       acetate.
J1100.................  N....................  .....................  Dexamethasone sodium     .....  .........  ...........  ............  ............
                                                                       phos.
J1110.................  N....................  .....................  Inj dihydroergotamine    .....  .........  ...........  ............  ............
                                                                       mesylt.
J1120.................  N....................  .....................  Acetazolamid sodium      .....  .........  ...........  ............  ............
                                                                       injectio.
J1160.................  N....................  .....................  Digoxin injection......  .....  .........  ...........  ............  ............
J1165.................  N....................  .....................  Phenytoin sodium         .....  .........  ...........  ............  ............
                                                                       injection.
J1170.................  N....................  .....................  Hydromorphone injection  .....  .........  ...........  ............  ............
J1180.................  N....................  .....................  Dyphylline injection...  .....  .........  ...........  ............  ............
J1190.................  K....................  .....................  Dexrazoxane HCl           0726     1.9860      $107.82  ............        $21.56
                                                                       injection.
J1200.................  N....................  .....................  Diphenhydramine hcl      .....  .........  ...........  ............  ............
                                                                       injectio.
J1205.................  N....................  .....................  Chlorothiazide sodium    .....  .........  ...........  ............  ............
                                                                       inj.
J1212.................  N....................  .....................  Dimethyl sulfoxide 50%   .....  .........  ...........  ............  ............
                                                                       50 ML.
J1230.................  N....................  .....................  Methadone injection....  .....  .........  ...........  ............  ............
J1240.................  N....................  .....................  Dimenhydrinate           .....  .........  ...........  ............  ............
                                                                       injection.
J1245.................  N....................  .....................  Dipyridamole injection.  .....  .........  ...........  ............  ............
J1250.................  N....................  .....................  Inj dobutamine HCL/250   .....  .........  ...........  ............  ............
                                                                       mg.
J1260.................  N....................  .....................  Dolasetron mesylate....  .....  .........  ...........  ............  ............
J1270.................  N....................  .....................  Injection,               .....  .........  ...........  ............  ............
                                                                       doxercalciferol.
J1320.................  N....................  .....................  Amitriptyline injection  .....  .........  ...........  ............  ............
J1325.................  N....................  .....................  Epoprostenol injection.  .....  .........  ...........  ............  ............
J1327.................  K....................  .....................  Eptifibatide injection.   1607     0.1426        $7.74  ............         $1.55
J1330.................  N....................  .....................  Ergonovine maleate       .....  .........  ...........  ............  ............
                                                                       injection.

[[Page 48185]]

 
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     2.2544      $122.39  ............        $24.48
                                                                       injection.
J1441.................  K....................  .....................  Filgrastim 480 mcg        7049     3.1998      $173.71  ............        $34.74
                                                                       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.
J1563.................  K....................  .....................  Immune globulin, 1 g...   0905     0.8103       $43.99  ............         $8.80
J1564.................  K....................  .....................  Immune globulin 10 mg..   9021     0.0080         $.43  ............          $.09
J1565.................  K....................  .....................  RSV-ivig...............   0906     6.0142      $326.50  ............        $65.30
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....................  .....................  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     0.6841       $37.14  ............         $7.43
J1750.................  N....................  .....................  Iron dextran...........  .....  .........  ...........  ............  ............
J1756.................  N....................  .....................  Iron sucrose injection.  .....  .........  ...........  ............  ............
J1785.................  K....................  .....................  Injection imiglucerase /  0916     0.0531        $2.88  ............          $.58
                                                                       unit.
J1790.................  N....................  .....................  Droperidol injection...  .....  .........  ...........  ............  ............
J1800.................  N....................  .....................  Propranolol injection..  .....  .........  ...........  ............  ............
J1810.................  E....................  .....................  Droperidol/fentanyl inj  .....  .........  ...........  ............  ............
J1815.................  N....................  .....................  Insulin injection......  .....  .........  ...........  ............  ............
J1817.................  N....................  .....................  Insulin for insulin      .....  .........  ...........  ............  ............
                                                                       pump use.
J1825.................  K....................  .....................  Interferon beta-1a.....   0909     2.8010      $152.06  ............        $30.41
J1830.................  K....................  .....................  Interferon beta-1b /      0910     1.9843      $107.73  ............        $21.55
                                                                       .25 MG.
J1835.................  N....................  .....................  Itraconazole injection.  .....  .........  ...........  ............  ............
J1840.................  N....................  .....................  Kanamycin sulfate 500    .....  .........  ...........  ............  ............
                                                                       MG inj.
J1850.................  N....................  .....................  Kanamycin sulfate 75 MG  .....  .........  ...........  ............  ............
                                                                       inj.
J1885.................  N....................  .....................  Ketorolac tromethamine   .....  .........  ...........  ............  ............
                                                                       inj.
J1890.................  N....................  .....................  Cephalothin sodium       .....  .........  ...........  ............  ............
                                                                       injection.
J1910.................  N....................  .....................  Kutapressin injection..  .....  .........  ...........  ............  ............
J1940.................  N....................  .....................  Furosemide injection...  .....  .........  ...........  ............  ............
J1950.................  K....................  .....................  Leuprolide acetate /      0800     3.3020      $179.26  ............        $35.85
                                                                       3.75 MG.

[[Page 48186]]

 
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,   .....  .........  ...........  ............  ............
                                                                       per 5 mg.
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....................  .....................  Nesiritide, per 0.5 mg    9114  .........      $144.40  ............        $21.58
                                                                       vial.
J2352.................  K....................  .....................  Octreotide acetate        7031     1.0339       $56.13  ............        $11.23
                                                                       injection.
J2355.................  K....................  .....................  Oprelvekin injection...   7011     2.7246      $147.92  ............        $29.58
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 /    0730     2.0537      $111.49  ............        $22.30
                                                                       30 MG.
J2440.................  N....................  .....................  Papaverin hcl injection  .....  .........  ...........  ............  ............
J2460.................  N....................  .....................  Oxytetracycline          .....  .........  ...........  ............  ............
                                                                       injection.
J2501.................  N....................  .....................  Paricalcitol...........  .....  .........  ...........  ............  ............
J2510.................  N....................  .....................  Penicillin g procaine    .....  .........  ...........  ............  ............
                                                                       inj.
J2515.................  N....................  .....................  Pentobarbital sodium     .....  .........  ...........  ............  ............
                                                                       inj.
J2540.................  N....................  .....................  Penicillin g potassium   .....  .........  ...........  ............  ............
                                                                       inj.
J2543.................  N....................  .....................  Piperacillin/tazobactam  .....  .........  ...........  ............  ............
J2545.................  A....................  .....................  Pentamidine isethionte/  .....  .........  ...........  ............  ............
                                                                       300mg.
J2550.................  N....................  .....................  Promethazine hcl         .....  .........  ...........  ............  ............
                                                                       injection.
J2560.................  N....................  .....................  Phenobarbital sodium     .....  .........  ...........  ............  ............
                                                                       inj.
J2590.................  N....................  .....................  Oxytocin injection.....  .....  .........  ...........  ............  ............
J2597.................  N....................  .....................  Inj desmopressin         .....  .........  ...........  ............  ............
                                                                       acetate.
J2650.................  N....................  .....................  Prednisolone acetate     .....  .........  ...........  ............  ............
                                                                       inj.
J2670.................  N....................  .....................  Totazoline hcl           .....  .........  ...........  ............  ............
                                                                       injection.
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.
J2765.................  N....................  .....................  Metoclopramide hcl       .....  .........  ...........  ............  ............
                                                                       injection.
J2770.................  N....................  .....................  Quinupristin/            .....  .........  ...........  ............  ............
                                                                       dalfopristin.
J2780.................  N....................  .....................  Ranitidine               .....  .........  ...........  ............  ............
                                                                       hydrochloride inj.
J2788.................  K....................  .....................  Rho d immune globulin     9023     0.0523        $2.84  ............          $.57
                                                                       50 mcg.
J2790.................  K....................  .....................  Rho d immune globulin     0884     0.2312       $12.55  ............         $2.51
                                                                       inj.
J2792.................  K....................  .....................  Rho(D) immune globulin    1609     0.1863       $10.11  ............         $2.02
                                                                       h, 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.

[[Page 48187]]

 
J2912.................  N....................  .....................  Sodium chloride          .....  .........  ...........  ............  ............
                                                                       injection.
J2916.................  N....................  .....................  Na ferric gluconate      .....  .........  ...........  ............  ............
                                                                       complex.
J2920.................  N....................  .....................  Methylprednisolone       .....  .........  ...........  ............  ............
                                                                       injection.
J2930.................  N....................  .....................  Methylprednisolone       .....  .........  ...........  ............  ............
                                                                       injection.
J2940.................  N....................  .....................  Somatrem injection.....  .....  .........  ...........  ............  ............
J2941.................  K....................  .....................  Somatropin injection...   7034     0.9206       $49.98  ............        $10.00
J2950.................  N....................  .....................  Promazine hcl injection  .....  .........  ...........  ............  ............
J2993.................  K....................  .....................  Reteplase injection....   9005    10.1332      $550.12  ............       $110.02
J2995.................  K....................  .....................  Inj streptokinase /       0911     1.6055       $87.16  ............        $17.43
                                                                       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    23.2303    $1,261.15  ............       $252.23
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     6.6059      $358.63  ............        $71.73
J3245.................  K....................  .....................  Tirofiban hydrochloride   7041     4.2976      $233.31  ............        $46.66
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     1.2099       $65.68  ............        $13.14
                                                                       glucoronate.
J3310.................  N....................  .....................  Perphenazine injeciton.  .....  .........  ...........  ............  ............
J3315.................  G....................  .....................  Triptorelin pamoate....   9122  .........      $415.24  ............        $62.07
J3320.................  N....................  .....................  Spectinomycn di-hcl inj  .....  .........  ...........  ............  ............
J3350.................  N....................  .....................  Urea injection.........  .....  .........  ...........  ............  ............
J3360.................  N....................  .....................  Diazepam injection.....  .....  .........  ...........  ............  ............
J3364.................  N....................  .....................  Urokinase 5000 IU        .....  .........  ...........  ............  ............
                                                                       injection.
J3365.................  K....................  .....................  Urokinase 250,000 IU      7036     5.1032      $277.05  ............        $55.41
                                                                       inj.
J3370.................  N....................  .....................  Vancomycin hcl           .....  .........  ...........  ............  ............
                                                                       injection.
J3395.................  K....................  .....................  Verteporfin injection..   1203    16.1946      $879.19  ............       $175.84
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....................  .....................  Zoledronic acid........   9115  .........      $203.40  ............        $30.40
J3490.................  N....................  .....................  Drugs unclassified       .....  .........  ...........  ............  ............
                                                                       injection.
J3520.................  E....................  .....................  Edetate disodium per     .....  .........  ...........  ............  ............
                                                                       150 mg.
J3530.................  N....................  .....................  Nasal vaccine            .....  .........  ...........  ............  ............
                                                                       inhalation.
J3535.................  E....................  .....................  Metered dose inhaler     .....  .........  ...........  ............  ............
                                                                       drug.
J3570.................  E....................  .....................  Laetrile amygdalin vit   .....  .........  ...........  ............  ............
                                                                       B17.
J3590.................  N....................  .....................  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.

[[Page 48188]]

 
J7190.................  K....................  .....................  Factor viii............   0925     0.0085         $.46  ............          $.09
J7191.................  K....................  .....................  Factor VIII (porcine)..   0926     0.0253        $1.37  ............          $.27
J7192.................  K....................  .....................  Factor viii recombinant   0927     0.0168         $.91  ............          $.18
J7193.................  K....................  .....................  Factor IX non-            0931     0.0104         $.56  ............          $.11
                                                                       recombinant.
J7194.................  K....................  .....................  Factor ix complex......   0928     0.0085         $.46  ............          $.09
J7195.................  K....................  .....................  Factor IX recombinant..   0932     0.0168         $.91  ............          $.18
J7197.................  K....................  .....................  Antithrombin iii          0930     0.0117         $.64  ............          $.13
                                                                       injection.
J7198.................  K....................  .....................  Anti-inhibitor.........   0929     0.0168         $.91  ............          $.18
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.
J7317.................  N....................  .....................  Sodium hyaluronate       .....  .........  ...........  ............  ............
                                                                       injection.
J7320.................  K....................  .....................  Hylan G-F 20 injection.   1611     2.1566      $117.08  ............        $23.42
J7330.................  E....................  .....................  Cultured chondrocytes    .....  .........  ...........  ............  ............
                                                                       implnt.
J7340.................  E....................  .....................  Metabolic active D/E     .....  .........  ...........  ............  ............
                                                                       tissue.
J7342.................  N....................  .....................  Metabolically active     .....  .........  ...........  ............  ............
                                                                       tissue.
J7350.................  N....................  .....................  Injectable human tissue  .....  .........  ...........  ............  ............
J7500.................  N....................  .....................  Azathioprine oral 50mg.  .....  .........  ...........  ............  ............
J7501.................  N....................  .....................  Azathioprine parenteral  .....  .........  ...........  ............  ............
J7502.................  K....................  .....................  Cyclosporine oral 100     0888     0.0482        $2.62  ............          $.52
                                                                       mg.
J7504.................  K....................  .....................  Lymphocyte immune         0890     2.1958      $119.21  ............        $23.84
                                                                       globulin.
J7505.................  K....................  .....................  Monoclonal antibodies..   7038     5.8452      $317.33  ............        $63.47
J7506.................  N....................  .....................  Prednisone oral........  .....  .........  ...........  ............  ............
J7507.................  K....................  .....................  Tacrolimus oral per 1     0891     0.0236        $1.28  ............          $.26
                                                                       MG.
J7508.................  E....................  .....................  Tacrolimus oral per 5    .....  .........  ...........  ............  ............
                                                                       MG.
J7509.................  N....................  .....................  Methylprednisolone oral  .....  .........  ...........  ............  ............
J7510.................  N....................  .....................  Prednisolone oral per 5  .....  .........  ...........  ............  ............
                                                                       mg.
J7511.................  K....................  .....................  Antithymocyte globuln     9104     2.9801      $161.79  ............        $32.36
                                                                       rabbit.
J7513.................  K....................  .....................  Daclizumab, parenteral.   1612     3.7304      $202.52  ............        $40.50
J7515.................  N....................  .....................  Cyclosporine oral 25 mg  .....  .........  ...........  ............  ............
J7516.................  N....................  .....................  Cyclosporin parenteral   .....  .........  ...........  ............  ............
                                                                       250mg.
J7517.................  K....................  .....................  Mycophenolate mofetil     9015     0.0373        $2.02  ............          $.40
                                                                       oral.
J7520.................  K....................  .....................  Sirolimus, oral........   9020     0.0520        $2.82  ............          $.56
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....................  .....................  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.
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.

[[Page 48189]]

 
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.................  K....................  .....................  Oral busulfan..........   7015     0.0263        $1.43  ............          $.29
J8520.................  K....................  .....................  Capecitabine, oral, 150   7042     0.0290        $1.57  ............          $.31
                                                                       mg.
J8521.................  E....................  .....................  Capecitabine, oral, 500  .....  .........  ...........  ............  ............
                                                                       mg.
J8530.................  N....................  .....................  Cyclophosphamide oral    .....  .........  ...........  ............  ............
                                                                       25 MG.
J8560.................  K....................  .....................  Etoposide oral 50 MG...   0802     0.4830       $26.22  ............         $5.24
J8600.................  N....................  .....................  Melphalan oral 2 MG....  .....  .........  ...........  ............  ............
J8610.................  N....................  .....................  Methotrexate oral 2.5    .....  .........  ...........  ............  ............
                                                                       MG.
J8700.................  K....................  .....................  Temozolmide............   1086     0.0643        $3.49  ............          $.70
J8999.................  E....................  .....................  Oral prescription drug   .....  .........  ...........  ............  ............
                                                                       chemo.
J9000.................  N....................  .....................  Doxorubic hcl 10 MG vl   .....  .........  ...........  ............  ............
                                                                       chemo.
J9001.................  K....................  .....................  Doxorubicin hcl           7046     4.6362      $251.69  ............        $50.34
                                                                       liposome inj.
J9010.................  K....................  .....................  Alemtuzumab injection..   9110     7.6422      $414.89  ............        $82.98
J9015.................  K....................  .....................  Aldesleukin/single use    0807     7.0936      $385.10  ............        $77.02
                                                                       vial.
J9017.................  K....................  .....................  Arsenic trioxide.......   9012     0.4837       $26.26  ............         $5.25
J9020.................  N....................  .....................  Asparaginase injection.  .....  .........  ...........  ............  ............
J9031.................  N....................  .....................  Bcg live intravesical    .....  .........  ...........  ............  ............
                                                                       vac.
J9040.................  K....................  .....................  Bleomycin sulfate         0857     2.2352      $121.35  ............        $24.27
                                                                       injection.
J9045.................  K....................  .....................  Carboplatin injection..   0811     1.5475       $84.01  ............        $16.80
J9050.................  K....................  .....................  Carmus bischl nitro inj   0812     0.9972       $54.14  ............        $10.83
J9060.................  K....................  .....................  Cisplatin 10 MG           0813     0.3594       $19.51  ............         $3.90
                                                                       injection.
J9062.................  E....................  .....................  Cisplatin 50 MG          .....  .........  ...........  ............  ............
                                                                       injection.
J9065.................  K....................  .....................  Inj cladribine per 1 MG   0858     0.7031       $38.17  ............         $7.63
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      .6052       $32.86  ............         $6.57
J9151.................  K....................  .....................  Daunorubicin citrate      0821     2.9697      $161.22  ............        $32.24
                                                                       liposom.
J9160.................  K....................  .....................  Denileukin diftitox,      1084    15.0913      $819.29  ............       $163.86
                                                                       300 mcg.
J9165.................  K....................  .....................  Diethylstilbestrol        0822     1.3274       $72.06  ............        $14.41
                                                                       injection.
J9170.................  K....................  .....................  Docetaxel..............   0823     4.0041      $217.38  ............        $43.48
J9180.................  E....................  .....................  Epirubicin HCl           .....  .........  ...........  ............  ............
                                                                       injection.
J9181.................  N....................  .....................  Etoposide 10 MG inj....  .....  .........  ...........  ............  ............
J9182.................  E....................  .....................  Etoposide 100 MG inj...  .....  .........  ...........  ............  ............
J9185.................  K....................  .....................  Fludarabine phosphate     0842     3.6854      $200.08  ............        $40.02
                                                                       inj.
J9190.................  N....................  .....................  Fluorouracil injection.  .....  .........  ...........  ............  ............
J9200.................  K....................  .....................  Floxuridine injection..   0827     2.1836      $118.55  ............        $23.71
J9201.................  K....................  .....................  Gemcitabine HCl........   0828     1.4523       $78.84  ............        $15.77
J9202.................  K....................  .....................  Goserelin acetate         0810     4.9549      $269.00  ............        $53.80
                                                                       implant.
J9206.................  K....................  .....................  Irinotecan injection...   0830     1.8626      $101.12  ............        $20.22
J9208.................  K....................  .....................  Ifosfomide injection...   0831     1.1616       $63.06  ............        $12.61
J9209.................  K....................  .....................  Mesna injection........   0732     0.4908       $26.65  ............         $5.33
J9211.................  K....................  .....................  Idarubicin hcl            0832     3.2438      $176.10  ............        $35.22
                                                                       injection.
J9212.................  N....................  .....................  Interferon alfacon-1...  .....  .........  ...........  ............  ............
J9213.................  N....................  .....................  Interferon alfa-2a inj.  .....  .........  ...........  ............  ............
J9214.................  K....................  .....................  Interferon alfa-2b inj.   0836     0.2000       $10.86  ............         $2.17
J9215.................  K....................  .....................  Interferon alfa-n3 inj.   0865     1.5823       $85.90  ............        $17.18
J9216.................  K....................  .....................  Interferon gamma 1-b      0838     2.4742      $134.32  ............        $26.86
                                                                       inj.
J9217.................  K....................  .....................  Leuprolide acetate        9217     5.5128      $299.28  ............        $59.86
                                                                       suspnsion.
J9218.................  K....................  .....................  Leuprolide acetate        0861     0.8223       $44.64  ............         $8.93
                                                                       injeciton.
J9219.................  K....................  .....................  Leuprolide acetate        7051    68.9392    $3,742.64  ............       $748.53
                                                                       implant.

[[Page 48190]]

 
J9230.................  N....................  .....................  Mechlorethamine hcl inj  .....  .........  ...........  ............  ............
J9245.................  K....................  .....................  Inj melphalan hydrochl    0840     4.4072      $239.26  ............        $47.85
                                                                       50 MG.
J9250.................  N....................  .....................  Methotrexate sodium inj  .....  .........  ...........  ............  ............
J9260.................  E....................  .....................  Methotrexate sodium inj  .....  .........  ...........  ............  ............
J9265.................  K....................  .....................  Paclitaxel injection...   0863     1.2674       $68.81  ............        $13.76
J9266.................  K....................  .....................  Pegaspargase/singl dose   0843     5.7621      $312.82  ............        $62.56
                                                                       vial.
J9268.................  K....................  .....................  Pentostatin injection..   0844    17.4201      $945.72  ............       $189.14
J9270.................  N....................  .....................  Plicamycin               .....  .........  ...........  ............  ............
                                                                       (mithramycin) inj.
J9280.................  K....................  .....................  Mitomycin 5 MG inj.....   0862     0.9557       $51.88  ............        $10.38
J9290.................  E....................  .....................  Mitomycin 20 MG inj....  .....  .........  ...........  ............  ............
J9291.................  E....................  .....................  Mitomycin 40 MG inj....  .....  .........  ...........  ............  ............
J9293.................  K....................  .....................  Mitoxantrone hydrochl /   0864     3.1513      $171.08  ............        $34.22
                                                                       5 MG.
J9300.................  K....................  .....................  Gemtuzumab ozogamicin..   9004    17.5020      $950.17  ............       $190.03
J9310.................  K....................  .....................  Rituximab cancer          0849     5.5636      $302.04  ............        $60.41
                                                                       treatment.
J9320.................  K....................  .....................  Streptozocin injection.   0850     1.3942       $75.69  ............        $15.14
J9340.................  N....................  .....................  Thiotepa injection.....  .....  .........  ...........  ............  ............
J9350.................  K....................  .....................  Topotecan..............   0852     7.9075      $429.29  ............        $85.86
J9355.................  K....................  .....................  Trastuzumab............   1613     0.7384       $40.09  ............         $8.02
J9357.................  K....................  .....................  Valrubicin, 200 mg.....   1614     9.6183      $522.17  ............       $104.43
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   0855     1.1683       $63.43  ............        $12.69
                                                                       mg.
J9600.................  K....................  .....................  Porfimer sodium........   0856    25.3788    $1,377.79  ............       $275.56
J9999.................  N....................  .....................  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.
K0022.................  A....................  .....................  Reinforced back          .....  .........  ...........  ............  ............
                                                                       upholstery.
K0023.................  A....................  .....................  Planr back insrt foam w/ .....  .........  ...........  ............  ............
                                                                       strp.
K0024.................  A....................  .....................  Plnr back insrt foam w/  .....  .........  ...........  ............  ............
                                                                       hrdwr.
K0025.................  A....................  .....................  Hook-on headrest         .....  .........  ...........  ............  ............
                                                                       extension.
K0026.................  A....................  .....................  Back upholst lgtwt       .....  .........  ...........  ............  ............
                                                                       whlchr.
K0027.................  A....................  .....................  Back upholst other       .....  .........  ...........  ............  ............
                                                                       whlchr.
K0028.................  A....................  .....................  Manual fully reclining   .....  .........  ...........  ............  ............
                                                                       back.
K0029.................  A....................  .....................  Reinforced seat          .....  .........  ...........  ............  ............
                                                                       upholstery.
K0030.................  A....................  .....................  Solid plnr seat sngl     .....  .........  ...........  ............  ............
                                                                       dnsfoam.
K0031.................  A....................  .....................  Safety belt/pelvic       .....  .........  ...........  ............  ............
                                                                       strap.
K0032.................  A....................  .....................  Seat uphols lgtwt        .....  .........  ...........  ............  ............
                                                                       whlchr.
K0033.................  A....................  .....................  Seat upholstery other    .....  .........  ...........  ............  ............
                                                                       whlchr.
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.

[[Page 48191]]

 
K0045.................  A....................  .....................  Footrest complete        .....  .........  ...........  ............  ............
                                                                       assembly.
K0046.................  A....................  .....................  Elevat legrst low        .....  .........  ...........  ............  ............
                                                                       extension.
K0047.................  A....................  .....................  Elevat legrst up hangr   .....  .........  ...........  ............  ............
                                                                       brack.
K0048.................  A....................  .....................  Elevate legrest          .....  .........  ...........  ............  ............
                                                                       complete.
K0049.................  A....................  .....................  Calf pad each..........  .....  .........  ...........  ............  ............
K0050.................  A....................  .....................  Ratchet assembly.......  .....  .........  ...........  ............  ............
K0051.................  A....................  .....................  Cam relese assem ftrst/  .....  .........  ...........  ............  ............
                                                                       lgrst.
K0052.................  A....................  .....................  Swingaway detach         .....  .........  ...........  ............  ............
                                                                       footrest.
K0053.................  A....................  .....................  Elevate footrest         .....  .........  ...........  ............  ............
                                                                       articulate.
K0054.................  A....................  .....................  Seat wdth 10-12/15/17/   .....  .........  ...........  ............  ............
                                                                       20 wc.
K0055.................  A....................  .....................  Seat dpth 15/17/18 ltwt  .....  .........  ...........  ............  ............
                                                                       wc.
K0056.................  A....................  .....................  Seat ht 17    .....  .........  ...........  ............  ............
                                                                       or <=21 ltwt wc.
K0057.................  A....................  .....................  Seat wdth 19/20 hvy dty  .....  .........  ...........  ............  ............
                                                                       wc.
K0058.................  A....................  .....................  Seat dpth 17/18 power    .....  .........  ...........  ............  ............
                                                                       wc.
K0059.................  A....................  .....................  Plastic coated handrim   .....  .........  ...........  ............  ............
                                                                       each.
K0060.................  A....................  .....................  Steel handrim each.....  .....  .........  ...........  ............  ............
K0061.................  A....................  .....................  Aluminum handrim each..  .....  .........  ...........  ............  ............
K0062.................  A....................  .....................  Handrim 8-10 vert/obliq  .....  .........  ...........  ............  ............
                                                                       proj.
K0063.................  A....................  .....................  Hndrm 12-16 vert/obliq   .....  .........  ...........  ............  ............
                                                                       proj.
K0064.................  A....................  .....................  Zero pressure tube flat  .....  .........  ...........  ............  ............
                                                                       free.
K0065.................  A....................  .....................  Spoke protectors.......  .....  .........  ...........  ............  ............
K0066.................  A....................  .....................  Solid tire any size      .....  .........  ...........  ............  ............
                                                                       each.
K0067.................  A....................  .....................  Pneumatic tire any size  .....  .........  ...........  ............  ............
                                                                       each.
K0068.................  A....................  .....................  Pneumatic tire tube      .....  .........  ...........  ............  ............
                                                                       each.
K0069.................  A....................  .....................  Rear whl complete solid  .....  .........  ...........  ............  ............
                                                                       tire.
K0070.................  A....................  .....................  Rear whl compl pneum     .....  .........  ...........  ............  ............
                                                                       tire.
K0071.................  A....................  .....................  Front castr compl pneum  .....  .........  ...........  ............  ............
                                                                       tire.
K0072.................  A....................  .....................  Frnt cstr cmpl sem-      .....  .........  ...........  ............  ............
                                                                       pneum tir.
K0073.................  A....................  .....................  Caster pin lock each...  .....  .........  ...........  ............  ............
K0074.................  A....................  .....................  Pneumatic caster tire    .....  .........  ...........  ............  ............
                                                                       each.
K0075.................  A....................  .....................  Semi-pneumatic caster    .....  .........  ...........  ............  ............
                                                                       tire.
K0076.................  A....................  .....................  Solid caster tire each.  .....  .........  ...........  ............  ............
K0077.................  A....................  .....................  Front caster assem       .....  .........  ...........  ............  ............
                                                                       complete.
K0078.................  A....................  .....................  Pneumatic caster tire    .....  .........  ...........  ............  ............
                                                                       tube.
K0079.................  A....................  .....................  Wheel lock extension     .....  .........  ...........  ............  ............
                                                                       pair.
K0080.................  A....................  .....................  Anti-rollback device     .....  .........  ...........  ............  ............
                                                                       pair.
K0081.................  A....................  .....................  Wheel lock assembly      .....  .........  ...........  ............  ............
                                                                       complete.
K0082.................  A....................  .....................  22 nf deep cycl acid     .....  .........  ...........  ............  ............
                                                                       battery.
K0083.................  A....................  .....................  22 nf gel cell battery   .....  .........  ...........  ............  ............
                                                                       each.
K0084.................  A....................  .....................  Grp 24 deep cycl acid    .....  .........  ...........  ............  ............
                                                                       battry.
K0085.................  A....................  .....................  Group 24 gel cell        .....  .........  ...........  ............  ............
                                                                       battery.
K0086.................  A....................  .....................  U-1 lead acid battery    .....  .........  ...........  ............  ............
                                                                       each.
K0087.................  A....................  .....................  U-1 gel cell battery     .....  .........  ...........  ............  ............
                                                                       each.
K0088.................  A....................  .....................  Battry chrgr acid/gel    .....  .........  ...........  ............  ............
                                                                       cell.
K0089.................  A....................  .....................  Battery charger dual     .....  .........  ...........  ............  ............
                                                                       mode.
K0090.................  A....................  .....................  Rear tire power          .....  .........  ...........  ............  ............
                                                                       wheelchair.
K0091.................  A....................  .....................  Rear tire tube power     .....  .........  ...........  ............  ............
                                                                       whlchr.
K0092.................  A....................  .....................  Rear assem cmplt powr    .....  .........  ...........  ............  ............
                                                                       whlchr.
K0093.................  A....................  .....................  Rear zero pressure tire  .....  .........  ...........  ............  ............
                                                                       tube.
K0094.................  A....................  .....................  Wheel tire for power     .....  .........  ...........  ............  ............
                                                                       base.
K0095.................  A....................  .....................  Wheel tire tube each     .....  .........  ...........  ............  ............
                                                                       base.
K0096.................  A....................  .....................  Wheel assem powr base    .....  .........  ...........  ............  ............
                                                                       complt.
K0097.................  A....................  .....................  Wheel zero presure tire  .....  .........  ...........  ............  ............
                                                                       tube.
K0098.................  A....................  .....................  Drive belt power         .....  .........  ...........  ............  ............
                                                                       wheelchair.
K0099.................  A....................  .....................  Pwr wheelchair front     .....  .........  ...........  ............  ............
                                                                       caster.
K0100.................  A....................  .....................  Amputee adapter pair...  .....  .........  ...........  ............  ............
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.

[[Page 48192]]

 
K0115.................  A....................  .....................  Back module orthotic     .....  .........  ...........  ............  ............
                                                                       system.
K0116.................  A....................  .....................  Back & seat modul        .....  .........  ...........  ............  ............
                                                                       orthot sys.
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.
K0556.................  A....................  .....................  Socket insert w lock     .....  .........  ...........  ............  ............
                                                                       mech.
K0557.................  A....................  .....................  Socket insert w/o lock   .....  .........  ...........  ............  ............
                                                                       mech.
K0558.................  A....................  .....................  Intl custm cong/atyp     .....  .........  ...........  ............  ............
                                                                       insert.
K0559.................  A....................  .....................  Initial custom socket    .....  .........  ...........  ............  ............
                                                                       insert.
K0560.................  N....................  .....................  Mcp joint 2-piece for    .....  .........  ...........  ............  ............
                                                                       implant.
K0581.................  A....................  .....................  Ost pch clsd w barrier/  .....  .........  ...........  ............  ............
                                                                       filtr.
K0582.................  A....................  .....................  Ost pch w bar/bltinconv/ .....  .........  ...........  ............  ............
                                                                       fltr.
K0583.................  A....................  .....................  Ost pch clsd w/o bar w   .....  .........  ...........  ............  ............
                                                                       filtr.
K0584.................  A....................  .....................  Ost pch for bar w        .....  .........  ...........  ............  ............
                                                                       flange/flt.
K0585.................  A....................  .....................  Ost pch clsd for bar w   .....  .........  ...........  ............  ............
                                                                       lk fl.
K0586.................  A....................  .....................  Ost pch for bar w lk fl/ .....  .........  ...........  ............  ............
                                                                       fltr.
K0587.................  A....................  .....................  Ost pch drain w bar &    .....  .........  ...........  ............  ............
                                                                       filter.
K0588.................  A....................  .....................  Ost pch drain for        .....  .........  ...........  ............  ............
                                                                       barrier fl.
K0589.................  A....................  .....................  Ost pch drain 2 piece    .....  .........  ...........  ............  ............
                                                                       system.
K0590.................  A....................  .....................  Ost pch drain/barr lk    .....  .........  ...........  ............  ............
                                                                       flng/f.
K0591.................  A....................  .....................  Urine ost pouch w        .....  .........  ...........  ............  ............
                                                                       faucet/tap.
K0592.................  A....................  .....................  Urine ost pouch w        .....  .........  ...........  ............  ............
                                                                       bltinconv.
K0593.................  A....................  .....................  Ost urine pch w b/bltin  .....  .........  ...........  ............  ............
                                                                       conv.
K0594.................  A....................  .....................  Ost pch urine w barrier/ .....  .........  ...........  ............  ............
                                                                       tapv.
K0595.................  A....................  .....................  Os pch urine w bar/      .....  .........  ...........  ............  ............
                                                                       fange/tap.
K0596.................  A....................  .....................  Urine ost pch bar w      .....  .........  ...........  ............  ............
                                                                       lock fln.
K0597.................  A....................  .....................  Ost pch urine w lock     .....  .........  ...........  ............  ............
                                                                       flng/ft.
K0600.................  A....................  .....................  Functional               .....  .........  ...........  ............  ............
                                                                       neuromuscular stim.
K0601.................  A....................  .....................  Repl batt silver oxide   .....  .........  ...........  ............  ............
                                                                       1.5 v.
K0602.................  A....................  .....................  Repl batt silver oxide   .....  .........  ...........  ............  ............
                                                                       3 v.
K0603.................  A....................  .....................  Repl batt alkaline 1.5   .....  .........  ...........  ............  ............
                                                                       v.
K0604.................  A....................  .....................  Repl batt lithium 3.6 v  .....  .........  ...........  ............  ............
K0605.................  A....................  .....................  Repl batt lithium 4.5 v  .....  .........  ...........  ............  ............
K0606.................  A....................  .....................  AED garment w/elec       .....  .........  ...........  ............  ............
                                                                       analysis.
K0607.................  A....................  .....................  Repl batt for AED        .....  .........  ...........  ............  ............
                                                                       device.
K0608.................  A....................  .....................  Repl garment for AED...  .....  .........  ...........  ............  ............
K0609.................  A....................  .....................  Repl electrode for AED.  .....  .........  ...........  ............  ............
K0610.................  A....................  .....................  Peritoneal dialysis      .....  .........  ...........  ............  ............
                                                                       clamp.
K0611.................  A....................  .....................  Disposable cycler set..  .....  .........  ...........  ............  ............
K0612.................  A....................  .....................  Drainage ext line,       .....  .........  ...........  ............  ............
                                                                       dialysis.
K0613.................  A....................  .....................  Ext line w/easy lock     .....  .........  ...........  ............  ............
                                                                       connect.
K0614.................  A....................  .....................  Chem/antiseptic          .....  .........  ...........  ............  ............
                                                                       solution, 8oz.
K0615.................  A....................  .....................  SGD prerec mes 8min <20min.

[[Page 48193]]

 
K0616.................  A....................  .....................  SGD prerec mes 20min <40min.
K0617.................  A....................  .....................  SGD prerec mes 40min.
K0618.................  A....................  .....................  TLSO 2 piece rigid       .....  .........  ...........  ............  ............
                                                                       shell.
K0619.................  A....................  .....................  TLSO 3 piece rigid       .....  .........  ...........  ............  ............
                                                                       shell.
K0620.................  A....................  .....................  Tubular elastic          .....  .........  ...........  ............  ............
                                                                       dressing.
K0621.................  A....................  .....................  Gauze, non-impreg pack   .....  .........  ...........  ............  ............
                                                                       strip.
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.
L0450.................  A....................  .....................  TLSO flex prefab         .....  .........  ...........  ............  ............
                                                                       thoracic.
L0452.................  A....................  .....................  tlso flex custom fab     .....  .........  ...........  ............  ............
                                                                       thoraci.
L0454.................  A....................  .....................  TLSO flex prefab         .....  .........  ...........  ............  ............
                                                                       sacrococ-T9.
L0456.................  A....................  .....................  TLSO flex prefab.......  .....  .........  ...........  ............  ............
L0458.................  A....................  .....................  TLSO 2Mod symphis-xipho  .....  .........  ...........  ............  ............
                                                                       pre.
L0460.................  A....................  .....................  TLSO2Mod symphysis-      .....  .........  ...........  ............  ............
                                                                       stern pre.
L0462.................  A....................  .....................  TLSO 3Mod sacro-scap     .....  .........  ...........  ............  ............
                                                                       pre.
L0464.................  A....................  .....................  TLSO 4Mod sacro-scap     .....  .........  ...........  ............  ............
                                                                       pre.
L0466.................  A....................  .....................  TLSO rigid frame pre     .....  .........  ...........  ............  ............
                                                                       soft ap.
L0468.................  A....................  .....................  TLSO rigid frame prefab  .....  .........  ...........  ............  ............
                                                                       pelv.
L0470.................  A....................  .....................  TLSO rigid frame pre     .....  .........  ...........  ............  ............
                                                                       subclav.
L0472.................  A....................  .....................  TLSO rigid frame         .....  .........  ...........  ............  ............
                                                                       hyperex pre.
L0474.................  A....................  .....................  TLSO rigid frame pre     .....  .........  ...........  ............  ............
                                                                       pelvic.
L0476.................  A....................  .....................  TLSO flexion compres     .....  .........  ...........  ............  ............
                                                                       jac pre.
L0478.................  A....................  .....................  TLSO flexion compres     .....  .........  ...........  ............  ............
                                                                       jac cus.
L0480.................  A....................  .....................  TLSO rigid plastic       .....  .........  ...........  ............  ............
                                                                       custom fa.
L0482.................  A....................  .....................  TLSO rigid lined custom  .....  .........  ...........  ............  ............
                                                                       fab.
L0484.................  A....................  .....................  TLSO rigid plastic cust  .....  .........  ...........  ............  ............
                                                                       fab.
L0486.................  A....................  .....................  TLSO rigidlined cust     .....  .........  ...........  ............  ............
                                                                       fab two.
L0488.................  A....................  .....................  TLSO rigid lined pre     .....  .........  ...........  ............  ............
                                                                       one pie.
L0490.................  A....................  .....................  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.
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........  .....  .........  ...........  ............  ............

[[Page 48194]]

 
L0978.................  A....................  .....................  Axillary crutch          .....  .........  ...........  ............  ............
                                                                       extension.
L0980.................  A....................  .....................  Peroneal straps pair...  .....  .........  ...........  ............  ............
L0982.................  A....................  .....................  Stocking supp grips set  .....  .........  ...........  ............  ............
                                                                       of f.
L0984.................  A....................  .....................  Protective body sock     .....  .........  ...........  ............  ............
                                                                       each.
L0999.................  A....................  .....................  Add to spinal orthosis   .....  .........  ...........  ............  ............
                                                                       NOS.
L1000.................  A....................  .....................  Ctlso milwauke initial   .....  .........  ...........  ............  ............
                                                                       model.
L1005.................  A....................  .....................  Tension based scoliosis  .....  .........  ...........  ............  ............
                                                                       orth.
L1010.................  A....................  .....................  Ctlso axilla sling.....  .....  .........  ...........  ............  ............
L1020.................  A....................  .....................  Kyphosis pad...........  .....  .........  ...........  ............  ............
L1025.................  A....................  .....................  Kyphosis pad floating..  .....  .........  ...........  ............  ............
L1030.................  A....................  .....................  Lumbar bolster pad.....  .....  .........  ...........  ............  ............
L1040.................  A....................  .....................  Lumbar or lumbar rib     .....  .........  ...........  ............  ............
                                                                       pad.
L1050.................  A....................  .....................  Sternal pad............  .....  .........  ...........  ............  ............
L1060.................  A....................  .....................  Thoracic pad...........  .....  .........  ...........  ............  ............
L1070.................  A....................  .....................  Trapezius sling........  .....  .........  ...........  ............  ............
L1080.................  A....................  .....................  Outrigger..............  .....  .........  ...........  ............  ............
L1085.................  A....................  .....................  Outrigger bil w/ vert    .....  .........  ...........  ............  ............
                                                                       extens.
L1090.................  A....................  .....................  Lumbar sling...........  .....  .........  ...........  ............  ............
L1100.................  A....................  .....................  Ring flange plastic/     .....  .........  ...........  ............  ............
                                                                       leather.
L1110.................  A....................  .....................  Ring flange plas/        .....  .........  ...........  ............  ............
                                                                       leather mol.
L1120.................  A....................  .....................  Covers for upright each  .....  .........  ...........  ............  ............
L1200.................  A....................  .....................  Furnsh initial orthosis  .....  .........  ...........  ............  ............
                                                                       only.
L1210.................  A....................  .....................  Lateral thoracic         .....  .........  ...........  ............  ............
                                                                       extension.
L1220.................  A....................  .....................  Anterior thoracic        .....  .........  ...........  ............  ............
                                                                       extension.
L1230.................  A....................  .....................  Milwaukee type           .....  .........  ...........  ............  ............
                                                                       superstructur.
L1240.................  A....................  .....................  Lumbar derotation pad..  .....  .........  ...........  ............  ............
L1250.................  A....................  .....................  Anterior asis pad......  .....  .........  ...........  ............  ............
L1260.................  A....................  .....................  Anterior thoracic        .....  .........  ...........  ............  ............
                                                                       derotation.
L1270.................  A....................  .....................  Abdominal pad..........  .....  .........  ...........  ............  ............
L1280.................  A....................  .....................  Rib gusset (elastic)     .....  .........  ...........  ............  ............
                                                                       each.
L1290.................  A....................  .....................  Lateral trochanteric     .....  .........  ...........  ............  ............
                                                                       pad.
L1300.................  A....................  .....................  Body jacket mold to      .....  .........  ...........  ............  ............
                                                                       patient.
L1310.................  A....................  .....................  Post-operative body      .....  .........  ...........  ............  ............
                                                                       jacket.
L1499.................  A....................  .....................  Spinal orthosis NOS....  .....  .........  ...........  ............  ............
L1500.................  A....................  .....................  Thkao mobility frame...  .....  .........  ...........  ............  ............
L1510.................  A....................  .....................  Thkao standing frame...  .....  .........  ...........  ............  ............
L1520.................  A....................  .....................  Thkao swivel walker....  .....  .........  ...........  ............  ............
L1600.................  A....................  .....................  Abduct hip flex frejka   .....  .........  ...........  ............  ............
                                                                       w cvr.
L1610.................  A....................  .....................  Abduct hip flex frejka   .....  .........  ...........  ............  ............
                                                                       covr.
L1620.................  A....................  .....................  Abduct hip flex pavlik   .....  .........  ...........  ............  ............
                                                                       harne.
L1630.................  A....................  .....................  Abduct control hip semi- .....  .........  ...........  ............  ............
                                                                       flex.
L1640.................  A....................  .....................  Pelv band/spread bar     .....  .........  ...........  ............  ............
                                                                       thigh c.
L1650.................  A....................  .....................  HO abduction hip         .....  .........  ...........  ............  ............
                                                                       adjustable.
L1652.................  A....................  .....................  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....................  .....................  Rigid KO wo joints.....  .....  .........  ...........  ............  ............
L1840.................  A....................  .....................  Ko derot ant cruciate    .....  .........  ...........  ............  ............
                                                                       custom.
L1843.................  A....................  .....................  KO single upright        .....  .........  ...........  ............  ............
                                                                       custom fit.

[[Page 48195]]

 
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....................  .....................  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/.
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.

[[Page 48196]]

 
L2240.................  A....................  .....................  Round caliper and plate  .....  .........  ...........  ............  ............
                                                                       atta.
L2250.................  A....................  .....................  Foot plate molded        .....  .........  ...........  ............  ............
                                                                       stirrup at.
L2260.................  A....................  .....................  Reinforced solid         .....  .........  ...........  ............  ............
                                                                       stirrup.
L2265.................  A....................  .....................  Long tongue stirrup....  .....  .........  ...........  ............  ............
L2270.................  A....................  .....................  Varus/valgus strap       .....  .........  ...........  ............  ............
                                                                       padded/li.
L2275.................  A....................  .....................  Plastic mod low ext pad/ .....  .........  ...........  ............  ............
                                                                       line.
L2280.................  A....................  .....................  Molded inner boot......  .....  .........  ...........  ............  ............
L2300.................  A....................  .....................  Abduction bar jointed    .....  .........  ...........  ............  ............
                                                                       adjust.
L2310.................  A....................  .....................  Abduction bar-straight.  .....  .........  ...........  ............  ............
L2320.................  A....................  .....................  Non-molded lacer.......  .....  .........  ...........  ............  ............
L2330.................  A....................  .....................  Lacer molded to patient  .....  .........  ...........  ............  ............
                                                                       mode.
L2335.................  A....................  .....................  Anterior swing band....  .....  .........  ...........  ............  ............
L2340.................  A....................  .....................  Pre-tibial shell molded  .....  .........  ...........  ............  ............
                                                                       to p.
L2350.................  A....................  .....................  Prosthetic type socket   .....  .........  ...........  ............  ............
                                                                       molde.
L2360.................  A....................  .....................  Extended steel shank...  .....  .........  ...........  ............  ............
L2370.................  A....................  .....................  Patten bottom..........  .....  .........  ...........  ............  ............
L2375.................  A....................  .....................  Torsion ank & half       .....  .........  ...........  ............  ............
                                                                       solid sti.
L2380.................  A....................  .....................  Torsion straight knee    .....  .........  ...........  ............  ............
                                                                       joint.
L2385.................  A....................  .....................  Straight knee joint      .....  .........  ...........  ............  ............
                                                                       heavy du.
L2390.................  A....................  .....................  Offset knee joint each.  .....  .........  ...........  ............  ............
L2395.................  A....................  .....................  Offset knee joint heavy  .....  .........  ...........  ............  ............
                                                                       duty.
L2397.................  A....................  .....................  Suspension sleeve lower  .....  .........  ...........  ............  ............
                                                                       ext.
L2405.................  A....................  .....................  Knee joint drop lock ea  .....  .........  ...........  ............  ............
                                                                       jnt.
L2415.................  A....................  .....................  Knee joint cam lock      .....  .........  ...........  ............  ............
                                                                       each joi.
L2425.................  A....................  .....................  Knee disc/dial lock/adj  .....  .........  ...........  ............  ............
                                                                       flex.
L2430.................  A....................  .....................  Knee jnt ratchet lock    .....  .........  ...........  ............  ............
                                                                       ea jnt.
L2435.................  A....................  .....................  Knee joint polycentric   .....  .........  ...........  ............  ............
                                                                       joint.
L2492.................  A....................  .....................  Knee lift loop drop      .....  .........  ...........  ............  ............
                                                                       lock rin.
L2500.................  A....................  .....................  Thi/glut/ischia wgt      .....  .........  ...........  ............  ............
                                                                       bearing.
L2510.................  A....................  .....................  Th/wght bear quad-lat    .....  .........  ...........  ............  ............
                                                                       brim m.
L2520.................  A....................  .....................  Th/wght bear quad-lat    .....  .........  ...........  ............  ............
                                                                       brim c.
L2525.................  A....................  .....................  Th/wght bear nar m-l     .....  .........  ...........  ............  ............
                                                                       brim mo.
L2526.................  A....................  .....................  Th/wght bear nar m-l     .....  .........  ...........  ............  ............
                                                                       brim cu.
L2530.................  A....................  .....................  Thigh/wght bear lacer    .....  .........  ...........  ............  ............
                                                                       non-mo.
L2540.................  A....................  .....................  Thigh/wght bear lacer    .....  .........  ...........  ............  ............
                                                                       molded.
L2550.................  A....................  .....................  Thigh/wght bear high     .....  .........  ...........  ............  ............
                                                                       roll cu.
L2570.................  A....................  .....................  Hip clevis type 2 posit  .....  .........  ...........  ............  ............
                                                                       jnt.
L2580.................  A....................  .....................  Pelvic control pelvic    .....  .........  ...........  ............  ............
                                                                       sling.
L2600.................  A....................  .....................  Hip clevis/thrust        .....  .........  ...........  ............  ............
                                                                       bearing fr.
L2610.................  A....................  .....................  Hip clevis/thrust        .....  .........  ...........  ............  ............
                                                                       bearing lo.
L2620.................  A....................  .....................  Pelvic control hip       .....  .........  ...........  ............  ............
                                                                       heavy dut.
L2622.................  A....................  .....................  Hip joint adjustable     .....  .........  ...........  ............  ............
                                                                       flexion.
L2624.................  A....................  .....................  Hip adj flex ext abduct  .....  .........  ...........  ............  ............
                                                                       cont.
L2627.................  A....................  .....................  Plastic mold recipro     .....  .........  ...........  ............  ............
                                                                       hip & c.
L2628.................  A....................  .....................  Metal frame recipro hip  .....  .........  ...........  ............  ............
                                                                       & ca.
L2630.................  A....................  .....................  Pelvic control band &    .....  .........  ...........  ............  ............
                                                                       belt u.
L2640.................  A....................  .....................  Pelvic control band &    .....  .........  ...........  ............  ............
                                                                       belt b.
L2650.................  A....................  .....................  Pelv & thor control      .....  .........  ...........  ............  ............
                                                                       gluteal.
L2660.................  A....................  .....................  Thoracic control         .....  .........  ...........  ............  ............
                                                                       thoracic ba.
L2670.................  A....................  .....................  Thorac cont paraspinal   .....  .........  ...........  ............  ............
                                                                       uprig.
L2680.................  A....................  .....................  Thorac cont lat support  .....  .........  ...........  ............  ............
                                                                       upri.
L2750.................  A....................  .....................  Plating chrome/nickel    .....  .........  ...........  ............  ............
                                                                       pr bar.
L2755.................  A....................  .....................  Carbon graphite          .....  .........  ...........  ............  ............
                                                                       lamination.
L2760.................  A....................  .....................  Extension per extension  .....  .........  ...........  ............  ............
                                                                       per.
L2768.................  A....................  .....................  Ortho sidebar            .....  .........  ...........  ............  ............
                                                                       disconnect.
L2770.................  A....................  .....................  Low ext orthosis per     .....  .........  ...........  ............  ............
                                                                       bar/jnt.
L2780.................  A....................  .....................  Non-corrosive finish...  .....  .........  ...........  ............  ............
L2785.................  A....................  .....................  Drop lock retainer each  .....  .........  ...........  ............  ............
L2795.................  A....................  .....................  Knee control full        .....  .........  ...........  ............  ............
                                                                       kneecap.
L2800.................  A....................  .....................  Knee cap medial or       .....  .........  ...........  ............  ............
                                                                       lateral p.
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.

[[Page 48197]]

 
L2999.................  A....................  .....................  Lower extremity          .....  .........  ...........  ............  ............
                                                                       orthosis NOS.
L3000.................  E....................  .....................  Ft insert ucb berkeley   .....  .........  ...........  ............  ............
                                                                       shell.
L3001.................  E....................  .....................  Foot insert remov        .....  .........  ...........  ............  ............
                                                                       molded spe.
L3002.................  E....................  .....................  Foot insert plastazote   .....  .........  ...........  ............  ............
                                                                       or eq.
L3003.................  E....................  .....................  Foot insert silicone     .....  .........  ...........  ............  ............
                                                                       gel eac.
L3010.................  E....................  .....................  Foot longitudinal arch   .....  .........  ...........  ............  ............
                                                                       suppo.
L3020.................  E....................  .....................  Foot longitud/           .....  .........  ...........  ............  ............
                                                                       metatarsal sup.
L3030.................  E....................  .....................  Foot arch support remov  .....  .........  ...........  ............  ............
                                                                       prem.
L3040.................  E....................  .....................  Ft arch suprt premold    .....  .........  ...........  ............  ............
                                                                       longit.
L3050.................  E....................  .....................  Foot arch supp premold   .....  .........  ...........  ............  ............
                                                                       metat.
L3060.................  E....................  .....................  Foot arch supp longitud/ .....  .........  ...........  ............  ............
                                                                       meta.
L3070.................  E....................  .....................  Arch suprt att to sho    .....  .........  ...........  ............  ............
                                                                       longit.
L3080.................  E....................  .....................  Arch supp att to shoe    .....  .........  ...........  ............  ............
                                                                       metata.
L3090.................  E....................  .....................  Arch supp att to shoe    .....  .........  ...........  ............  ............
                                                                       long/m.
L3100.................  E....................  .....................  Hallus-valgus nght       .....  .........  ...........  ............  ............
                                                                       dynamic s.
L3140.................  E....................  .....................  Abduction rotation bar   .....  .........  ...........  ............  ............
                                                                       shoe.
L3150.................  E....................  .....................  Abduct rotation bar w/o  .....  .........  ...........  ............  ............
                                                                       shoe.
L3160.................  E....................  .....................  Shoe styled positioning  .....  .........  ...........  ............  ............
                                                                       dev.
L3170.................  E....................  .....................  Foot plastic heel        .....  .........  ...........  ............  ............
                                                                       stabilizer.
L3201.................  E....................  .....................  Oxford w supinat/pronat  .....  .........  ...........  ............  ............
                                                                       inf.
L3202.................  E....................  .....................  Oxford w/ supinat/       .....  .........  ...........  ............  ............
                                                                       pronator c.
L3203.................  E....................  .....................  Oxford w/ supinator/     .....  .........  ...........  ............  ............
                                                                       pronator.
L3204.................  E....................  .....................  Hightop w/ supp/         .....  .........  ...........  ............  ............
                                                                       pronator inf.
L3206.................  E....................  .....................  Hightop w/ supp/         .....  .........  ...........  ............  ............
                                                                       pronator chi.
L3207.................  E....................  .....................  Hightop w/ supp/         .....  .........  ...........  ............  ............
                                                                       pronator jun.
L3208.................  E....................  .....................  Surgical boot each       .....  .........  ...........  ............  ............
                                                                       infant.
L3209.................  E....................  .....................  Surgical boot each       .....  .........  ...........  ............  ............
                                                                       child.
L3211.................  E....................  .....................  Surgical boot each       .....  .........  ...........  ............  ............
                                                                       junior.
L3212.................  E....................  .....................  Benesch boot pair        .....  .........  ...........  ............  ............
                                                                       infant.
L3213.................  E....................  .....................  Benesch boot pair child  .....  .........  ...........  ............  ............
L3214.................  E....................  .....................  Benesch boot pair        .....  .........  ...........  ............  ............
                                                                       junior.
L3215.................  E....................  .....................  Orthopedic ftwear        .....  .........  ...........  ............  ............
                                                                       ladies oxf.
L3216.................  E....................  .....................  Orthoped ladies shoes    .....  .........  ...........  ............  ............
                                                                       dpth i.
L3217.................  E....................  .....................  Ladies shoes hightop     .....  .........  ...........  ............  ............
                                                                       depth i.
L3219.................  E....................  .....................  Orthopedic mens shoes    .....  .........  ...........  ............  ............
                                                                       oxford.
L3221.................  E....................  .....................  Orthopedic mens shoes    .....  .........  ...........  ............  ............
                                                                       dpth i.
L3222.................  E....................  .....................  Mens shoes hightop       .....  .........  ...........  ............  ............
                                                                       depth inl.
L3224.................  A....................  .....................  Woman's shoe oxford      .....  .........  ...........  ............  ............
                                                                       brace.
L3225.................  A....................  .....................  Man's shoe oxford brace  .....  .........  ...........  ............  ............
L3230.................  E....................  .....................  Custom shoes depth       .....  .........  ...........  ............  ............
                                                                       inlay.
L3250.................  E....................  .....................  Custom mold shoe remov   .....  .........  ...........  ............  ............
                                                                       prost.
L3251.................  E....................  .....................  Shoe molded to pt        .....  .........  ...........  ............  ............
                                                                       silicone s.
L3252.................  E....................  .....................  Shoe molded plastazote   .....  .........  ...........  ............  ............
                                                                       cust.
L3253.................  E....................  .....................  Shoe molded plastazote   .....  .........  ...........  ............  ............
                                                                       cust.
L3254.................  E....................  .....................  Orth foot non-stndard    .....  .........  ...........  ............  ............
                                                                       size/w.
L3255.................  E....................  .....................  Orth foot non-standard   .....  .........  ...........  ............  ............
                                                                       size/.
L3257.................  E....................  .....................  Orth foot add charge     .....  .........  ...........  ............  ............
                                                                       split s.
L3260.................  E....................  .....................  Ambulatory surgical      .....  .........  ...........  ............  ............
                                                                       boot eac.
L3265.................  E....................  .....................  Plastazote sandal each.  .....  .........  ...........  ............  ............
L3300.................  E....................  .....................  Sho lift taper to        .....  .........  ...........  ............  ............
                                                                       metatarsal.
L3310.................  E....................  .....................  Shoe lift elev heel/     .....  .........  ...........  ............  ............
                                                                       sole neo.
L3320.................  E....................  .....................  Shoe lift elev heel/     .....  .........  ...........  ............  ............
                                                                       sole cor.
L3330.................  E....................  .....................  Lifts elevation metal    .....  .........  ...........  ............  ............
                                                                       extens.
L3332.................  E....................  .....................  Shoe lifts tapered to    .....  .........  ...........  ............  ............
                                                                       one-ha.
L3334.................  E....................  .....................  Shoe lifts elevation     .....  .........  ...........  ............  ............
                                                                       heel /i.
L3340.................  E....................  .....................  Shoe wedge sach........  .....  .........  ...........  ............  ............
L3350.................  E....................  .....................  Shoe heel wedge........  .....  .........  ...........  ............  ............
L3360.................  E....................  .....................  Shoe sole wedge outside  .....  .........  ...........  ............  ............
                                                                       sole.
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  .....  .........  ...........  ............  ............

[[Page 48198]]

 
L3450.................  E....................  .....................  Shoe heel sach cushion   .....  .........  ...........  ............  ............
                                                                       type.
L3455.................  E....................  .....................  Shoe heel new leather    .....  .........  ...........  ............  ............
                                                                       standa.
L3460.................  E....................  .....................  Shoe heel new rubber     .....  .........  ...........  ............  ............
                                                                       standar.
L3465.................  E....................  .....................  Shoe heel thomas with    .....  .........  ...........  ............  ............
                                                                       wedge.
L3470.................  E....................  .....................  Shoe heel thomas extend  .....  .........  ...........  ............  ............
                                                                       to b.
L3480.................  E....................  .....................  Shoe heel pad & depress  .....  .........  ...........  ............  ............
                                                                       for.
L3485.................  E....................  .....................  Shoe heel pad removable  .....  .........  ...........  ............  ............
                                                                       for.
L3500.................  E....................  .....................  Ortho shoe add leather   .....  .........  ...........  ............  ............
                                                                       insol.
L3510.................  E....................  .....................  Orthopedic shoe add rub  .....  .........  ...........  ............  ............
                                                                       insl.
L3520.................  E....................  .....................  O shoe add felt w leath  .....  .........  ...........  ............  ............
                                                                       insl.
L3530.................  E....................  .....................  Ortho shoe add half      .....  .........  ...........  ............  ............
                                                                       sole.
L3540.................  E....................  .....................  Ortho shoe add full      .....  .........  ...........  ............  ............
                                                                       sole.
L3550.................  E....................  .....................  O shoe add standard toe  .....  .........  ...........  ............  ............
                                                                       tap.
L3560.................  E....................  .....................  O shoe add horseshoe     .....  .........  ...........  ............  ............
                                                                       toe tap.
L3570.................  E....................  .....................  O shoe add instep        .....  .........  ...........  ............  ............
                                                                       extension.
L3580.................  E....................  .....................  O shoe add instep        .....  .........  ...........  ............  ............
                                                                       velcro clo.
L3590.................  E....................  .....................  O shoe convert to sof    .....  .........  ...........  ............  ............
                                                                       counte.
L3595.................  E....................  .....................  Ortho shoe add march     .....  .........  ...........  ............  ............
                                                                       bar.
L3600.................  E....................  .....................  Trans shoe calip plate   .....  .........  ...........  ............  ............
                                                                       exist.
L3610.................  E....................  .....................  Trans shoe caliper       .....  .........  ...........  ............  ............
                                                                       plate new.
L3620.................  E....................  .....................  Trans shoe solid         .....  .........  ...........  ............  ............
                                                                       stirrup exi.
L3630.................  E....................  .....................  Trans shoe solid         .....  .........  ...........  ............  ............
                                                                       stirrup new.
L3640.................  E....................  .....................  Shoe dennis browne       .....  .........  ...........  ............  ............
                                                                       splint bo.
L3649.................  E....................  .....................  Orthopedic shoe          .....  .........  ...........  ............  ............
                                                                       modifica NOS.
L3650.................  A....................  .....................  Shlder fig 8 abduct      .....  .........  ...........  ............  ............
                                                                       restrain.
L3651.................  A....................  .....................  Prefab shoulder          .....  .........  ...........  ............  ............
                                                                       orthosis.
L3652.................  A....................  .....................  Prefab dbl shoulder      .....  .........  ...........  ............  ............
                                                                       orthosis.
L3660.................  A....................  .....................  Abduct restrainer        .....  .........  ...........  ............  ............
                                                                       canvas&web.
L3670.................  A....................  .....................  Acromio/clavicular       .....  .........  ...........  ............  ............
                                                                       canvas&we.
L3675.................  A....................  .....................  Canvas vest SO.........  .....  .........  ...........  ............  ............
L3677.................  E....................  .....................  SO hard plastic          .....  .........  ...........  ............  ............
                                                                       stabilizer.
L3700.................  A....................  .....................  Elbow orthoses elas w    .....  .........  ...........  ............  ............
                                                                       stays.
L3701.................  A....................  .....................  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....................  .....................  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....................  .....................  Prefab wrist orthosis..  .....  .........  ...........  ............  ............
L3910.................  A....................  .....................  Whfo swanson design....  .....  .........  ...........  ............  ............
L3911.................  A....................  .....................  Prefab hand finger       .....  .........  ...........  ............  ............
                                                                       orthosis.
L3912.................  A....................  .....................  Flex glove w/elastic     .....  .........  ...........  ............  ............
                                                                       finger.
L3914.................  A....................  .....................  WHO wrist extension      .....  .........  ...........  ............  ............
                                                                       cock-up.

[[Page 48199]]

 
L3916.................  A....................  .....................  Whfo wrist extens w/     .....  .........  ...........  ............  ............
                                                                       outrigg.
L3918.................  A....................  .....................  HFO knuckle bender.....  .....  .........  ...........  ............  ............
L3920.................  A....................  .....................  Knuckle bender with      .....  .........  ...........  ............  ............
                                                                       outrigge.
L3922.................  A....................  .....................  Knuckle bend 2 seg to    .....  .........  ...........  ............  ............
                                                                       flex j.
L3923.................  A....................  .....................  HFO, no joint,           .....  .........  ...........  ............  ............
                                                                       prefabricated.
L3924.................  A....................  .....................  Oppenheimer............  .....  .........  ...........  ............  ............
L3926.................  A....................  .....................  Thomas suspension......  .....  .........  ...........  ............  ............
L3928.................  A....................  .....................  Finger extension w/      .....  .........  ...........  ............  ............
                                                                       clock sp.
L3930.................  A....................  .....................  Finger extension with    .....  .........  ...........  ............  ............
                                                                       wrist.
L3932.................  A....................  .....................  Safety pin spring wire.  .....  .........  ...........  ............  ............
L3934.................  A....................  .....................  Safety pin modified....  .....  .........  ...........  ............  ............
L3936.................  A....................  .....................  Palmer.................  .....  .........  ...........  ............  ............
L3938.................  A....................  .....................  Dorsal wrist...........  .....  .........  ...........  ............  ............
L3940.................  A....................  .....................  Dorsal wrist w/          .....  .........  ...........  ............  ............
                                                                       outrigger at.
L3942.................  A....................  .....................  Reverse knuckle bender.  .....  .........  ...........  ............  ............
L3944.................  A....................  .....................  Reverse knuckle bend w/  .....  .........  ...........  ............  ............
                                                                       outr.
L3946.................  A....................  .....................  HFO composite elastic..  .....  .........  ...........  ............  ............
L3948.................  A....................  .....................  Finger knuckle bender..  .....  .........  ...........  ............  ............
L3950.................  A....................  .....................  Oppenheimer w/ knuckle   .....  .........  ...........  ............  ............
                                                                       bend.
L3952.................  A....................  .....................  Oppenheimer w/ rev       .....  .........  ...........  ............  ............
                                                                       knuckle 2.
L3954.................  A....................  .....................  Spreading hand.........  .....  .........  ...........  ............  ............
L3956.................  A....................  .....................  Add joint upper ext      .....  .........  ...........  ............  ............
                                                                       orthosis.
L3960.................  A....................  .....................  Sewho airplan desig      .....  .........  ...........  ............  ............
                                                                       abdu pos.
L3962.................  A....................  .....................  Sewho erbs palsey        .....  .........  ...........  ............  ............
                                                                       design abd.
L3963.................  A....................  .....................  Molded w/ articulating   .....  .........  ...........  ............  ............
                                                                       elbow.
L3964.................  A....................  .....................  Seo mobile arm sup att   .....  .........  ...........  ............  ............
                                                                       to wc.
L3965.................  A....................  .....................  Arm supp att to wc       .....  .........  ...........  ............  ............
                                                                       rancho ty.
L3966.................  A....................  .....................  Mobile arm supports      .....  .........  ...........  ............  ............
                                                                       reclinin.
L3968.................  A....................  .....................  Friction dampening arm   .....  .........  ...........  ............  ............
                                                                       supp.
L3969.................  A....................  .....................  Monosuspension arm/hand  .....  .........  ...........  ............  ............
                                                                       supp.
L3970.................  A....................  .....................  Elevat proximal arm      .....  .........  ...........  ............  ............
                                                                       support.
L3972.................  A....................  .....................  Offset/lat rocker arm w/ .....  .........  ...........  ............  ............
                                                                        ela.
L3974.................  A....................  .....................  Mobile arm support       .....  .........  ...........  ............  ............
                                                                       supinator.
L3980.................  A....................  .....................  Upp ext fx orthosis      .....  .........  ...........  ............  ............
                                                                       humeral.
L3982.................  A....................  .....................  Upper ext fx orthosis    .....  .........  ...........  ............  ............
                                                                       rad/ul.
L3984.................  A....................  .....................  Upper ext fx orthosis    .....  .........  ...........  ............  ............
                                                                       wrist.
L3985.................  A....................  .....................  Forearm hand fx orth w/  .....  .........  ...........  ............  ............
                                                                       wr h.
L3986.................  A....................  .....................  Humeral rad/ulna wrist   .....  .........  ...........  ............  ............
                                                                       fx or.
L3995.................  A....................  .....................  Sock fracture or equal   .....  .........  ...........  ............  ............
                                                                       each.
L3999.................  A....................  .....................  Upper limb orthosis NOS  .....  .........  ...........  ............  ............
L4000.................  A....................  .....................  Repl girdle milwaukee    .....  .........  ...........  ............  ............
                                                                       orth.
L4010.................  A....................  .....................  Replace trilateral       .....  .........  ...........  ............  ............
                                                                       socket br.
L4020.................  A....................  .....................  Replace quadlat socket   .....  .........  ...........  ............  ............
                                                                       brim.
L4030.................  A....................  .....................  Replace socket brim      .....  .........  ...........  ............  ............
                                                                       cust fit.
L4040.................  A....................  .....................  Replace molded thigh     .....  .........  ...........  ............  ............
                                                                       lacer.
L4045.................  A....................  .....................  Replace non-molded       .....  .........  ...........  ............  ............
                                                                       thigh lac.
L4050.................  A....................  .....................  Replace molded calf      .....  .........  ...........  ............  ............
                                                                       lacer.
L4055.................  A....................  .....................  Replace non-molded calf  .....  .........  ...........  ............  ............
                                                                       lace.
L4060.................  A....................  .....................  Replace high roll cuff.  .....  .........  ...........  ............  ............
L4070.................  A....................  .....................  Replace prox & dist      .....  .........  ...........  ............  ............
                                                                       upright.
L4080.................  A....................  .....................  Repl met band kafo-afo   .....  .........  ...........  ............  ............
                                                                       prox.
L4090.................  A....................  .....................  Repl met band kafo-afo   .....  .........  ...........  ............  ............
                                                                       calf/.
L4100.................  A....................  .....................  Repl leath cuff kafo     .....  .........  ...........  ............  ............
                                                                       prox th.
L4110.................  A....................  .....................  Repl leath cuff kafo-    .....  .........  ...........  ............  ............
                                                                       afo cal.
L4130.................  A....................  .....................  Replace pretibial shell  .....  .........  ...........  ............  ............
L4205.................  A....................  .....................  Ortho dvc repair per 15  .....  .........  ...........  ............  ............
                                                                       min.
L4210.................  A....................  .....................  Orth dev repair/repl     .....  .........  ...........  ............  ............
                                                                       minor p.
L4350.................  A....................  .....................  Pneumatic ankle cntrl    .....  .........  ...........  ............  ............
                                                                       splint.
L4360.................  A....................  .....................  Pneumatic walking        .....  .........  ...........  ............  ............
                                                                       splint.
L4370.................  A....................  .....................  Pneumatic full leg       .....  .........  ...........  ............  ............
                                                                       splint.
L4380.................  A....................  .....................  Pneumatic knee splint..  .....  .........  ...........  ............  ............
L4386.................  A....................  .....................  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.

[[Page 48200]]

 
L5000.................  A....................  .....................  Sho insert w arch toe    .....  .........  ...........  ............  ............
                                                                       filler.
L5010.................  A....................  .....................  Mold socket ank hgt w/   .....  .........  ...........  ............  ............
                                                                       toe f.
L5020.................  A....................  .....................  Tibial tubercle hgt w/   .....  .........  ...........  ............  ............
                                                                       toe f.
L5050.................  A....................  .....................  Ank symes mold sckt      .....  .........  ...........  ............  ............
                                                                       sach ft.
L5060.................  A....................  .....................  Symes met fr leath       .....  .........  ...........  ............  ............
                                                                       socket ar.
L5100.................  A....................  .....................  Molded socket shin sach  .....  .........  ...........  ............  ............
                                                                       foot.
L5105.................  A....................  .....................  Plast socket jts/thgh    .....  .........  ...........  ............  ............
                                                                       lacer.
L5150.................  A....................  .....................  Mold sckt ext knee shin  .....  .........  ...........  ............  ............
                                                                       sach.
L5160.................  A....................  .....................  Mold socket bent knee    .....  .........  ...........  ............  ............
                                                                       shin s.
L5200.................  A....................  .....................  Kne sing axis fric shin  .....  .........  ...........  ............  ............
                                                                       sach.
L5210.................  A....................  .....................  No knee/ankle joints w/  .....  .........  ...........  ............  ............
                                                                       ft b.
L5220.................  A....................  .....................  No knee joint with       .....  .........  ...........  ............  ............
                                                                       artic ali.
L5230.................  A....................  .....................  Fem focal defic          .....  .........  ...........  ............  ............
                                                                       constant fri.
L5250.................  A....................  .....................  Hip canad sing axi cons  .....  .........  ...........  ............  ............
                                                                       fric.
L5270.................  A....................  .....................  Tilt table locking hip   .....  .........  ...........  ............  ............
                                                                       sing.
L5280.................  A....................  .....................  Hemipelvect canad sing   .....  .........  ...........  ............  ............
                                                                       axis.
L5301.................  A....................  .....................  BK mold socket SACH ft   .....  .........  ...........  ............  ............
                                                                       endo.
L5311.................  A....................  .....................  Knee disart, SACH ft,    .....  .........  ...........  ............  ............
                                                                       endo.
L5321.................  A....................  .....................  AK open end SACH.......  .....  .........  ...........  ............  ............
L5331.................  A....................  .....................  Hip disart canadian      .....  .........  ...........  ............  ............
                                                                       SACH ft.
L5341.................  A....................  .....................  Hemipelvectomy canadian  .....  .........  ...........  ............  ............
                                                                       SACH.
L5400.................  A....................  .....................  Postop dress & 1 cast    .....  .........  ...........  ............  ............
                                                                       chg bk.
L5410.................  A....................  .....................  Postop dsg bk ea add     .....  .........  ...........  ............  ............
                                                                       cast ch.
L5420.................  A....................  .....................  Postop dsg & 1 cast chg  .....  .........  ...........  ............  ............
                                                                       ak/d.
L5430.................  A....................  .....................  Postop dsg ak ea add     .....  .........  ...........  ............  ............
                                                                       cast ch.
L5450.................  A....................  .....................  Postop app non-wgt bear  .....  .........  ...........  ............  ............
                                                                       dsg.
L5460.................  A....................  .....................  Postop app non-wgt bear  .....  .........  ...........  ............  ............
                                                                       dsg.
L5500.................  A....................  .....................  Init bk ptb plaster      .....  .........  ...........  ............  ............
                                                                       direct.
L5505.................  A....................  .....................  Init ak ischal plstr     .....  .........  ...........  ............  ............
                                                                       direct.
L5510.................  A....................  .....................  Prep BK ptb plaster      .....  .........  ...........  ............  ............
                                                                       molded.
L5520.................  A....................  .....................  Perp BK ptb thermopls    .....  .........  ...........  ............  ............
                                                                       direct.
L5530.................  A....................  .....................  Prep BK ptb thermopls    .....  .........  ...........  ............  ............
                                                                       molded.
L5535.................  A....................  .....................  Prep BK ptb open end     .....  .........  ...........  ............  ............
                                                                       socket.
L5540.................  A....................  .....................  Prep BK ptb laminated    .....  .........  ...........  ............  ............
                                                                       socket.
L5560.................  A....................  .....................  Prep AK ischial plast    .....  .........  ...........  ............  ............
                                                                       molded.
L5570.................  A....................  .....................  Prep AK ischial direct   .....  .........  ...........  ............  ............
                                                                       form.
L5580.................  A....................  .....................  Prep AK ischial thermo   .....  .........  ...........  ............  ............
                                                                       mold.
L5585.................  A....................  .....................  Prep AK ischial open     .....  .........  ...........  ............  ............
                                                                       end.
L5590.................  A....................  .....................  Prep AK ischial          .....  .........  ...........  ............  ............
                                                                       laminated.
L5595.................  A....................  .....................  Hip disartic sach        .....  .........  ...........  ............  ............
                                                                       thermopls.
L5600.................  A....................  .....................  Hip disart sach laminat  .....  .........  ...........  ............  ............
                                                                       mold.
L5610.................  A....................  .....................  Above knee hydracadence  .....  .........  ...........  ............  ............
L5611.................  A....................  .....................  Ak 4 bar link w/fric     .....  .........  ...........  ............  ............
                                                                       swing.
L5613.................  A....................  .....................  Ak 4 bar ling w/hydraul  .....  .........  ...........  ............  ............
                                                                       swig.
L5614.................  A....................  .....................  4-bar link above knee w/ .....  .........  ...........  ............  ............
                                                                       swng.
L5616.................  A....................  .....................  Ak univ multiplex sys    .....  .........  ...........  ............  ............
                                                                       frict.
L5617.................  A....................  .....................  AK/BK self-aligning      .....  .........  ...........  ............  ............
                                                                       unit ea.
L5618.................  A....................  .....................  Test socket symes......  .....  .........  ...........  ............  ............
L5620.................  A....................  .....................  Test socket below knee.  .....  .........  ...........  ............  ............
L5622.................  A....................  .....................  Test socket knee         .....  .........  ...........  ............  ............
                                                                       disarticula.
L5624.................  A....................  .....................  Test socket above knee.  .....  .........  ...........  ............  ............
L5626.................  A....................  .....................  Test socket hip          .....  .........  ...........  ............  ............
                                                                       disarticulat.
L5628.................  A....................  .....................  Test socket              .....  .........  ...........  ............  ............
                                                                       hemipelvectomy.
L5629.................  A....................  .....................  Below knee acrylic       .....  .........  ...........  ............  ............
                                                                       socket.
L5630.................  A....................  .....................  Syme typ expandabl wall  .....  .........  ...........  ............  ............
                                                                       sckt.
L5631.................  A....................  .....................  Ak/knee disartic         .....  .........  ...........  ............  ............
                                                                       acrylic soc.
L5632.................  A....................  .....................  Symes type ptb brim      .....  .........  ...........  ............  ............
                                                                       design s.
L5634.................  A....................  .....................  Symes type poster        .....  .........  ...........  ............  ............
                                                                       opening so.
L5636.................  A....................  .....................  Symes type medial        .....  .........  ...........  ............  ............
                                                                       opening so.
L5637.................  A....................  .....................  Below knee total         .....  .........  ...........  ............  ............
                                                                       contact.
L5638.................  A....................  .....................  Below knee leather       .....  .........  ...........  ............  ............
                                                                       socket.
L5639.................  A....................  .....................  Below knee wood socket.  .....  .........  ...........  ............  ............
L5640.................  A....................  .....................  Knee disarticulat        .....  .........  ...........  ............  ............
                                                                       leather so.
L5642.................  A....................  .....................  Above knee leather       .....  .........  ...........  ............  ............
                                                                       socket.
L5643.................  A....................  .....................  Hip flex inner socket    .....  .........  ...........  ............  ............
                                                                       ext fr.
L5644.................  A....................  .....................  Above knee wood socket.  .....  .........  ...........  ............  ............

[[Page 48201]]

 
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.
L5661.................  A....................  .....................  Multi-durometer symes..  .....  .........  ...........  ............  ............
L5665.................  A....................  .....................  Multi-durometer below    .....  .........  ...........  ............  ............
                                                                       knee.
L5666.................  A....................  .....................  Below knee cuff          .....  .........  ...........  ............  ............
                                                                       suspension.
L5668.................  A....................  .....................  Socket insert w/o lock   .....  .........  ...........  ............  ............
                                                                       lower.
L5670.................  A....................  .....................  Bk molded supracondylar  .....  .........  ...........  ............  ............
                                                                       susp.
L5671.................  A....................  .....................  BK/AK locking mechanism  .....  .........  ...........  ............  ............
L5672.................  A....................  .....................  Bk removable medial      .....  .........  ...........  ............  ............
                                                                       brim sus.
L5674.................  A....................  .....................  Bk suspension sleeve...  .....  .........  ...........  ............  ............
L5675.................  A....................  .....................  Bk heavy duty susp       .....  .........  ...........  ............  ............
                                                                       sleeve.
L5676.................  A....................  .....................  Bk knee joints single    .....  .........  ...........  ............  ............
                                                                       axis p.
L5677.................  A....................  .....................  Bk knee joints           .....  .........  ...........  ............  ............
                                                                       polycentric p.
L5678.................  A....................  .....................  Bk joint covers pair...  .....  .........  ...........  ............  ............
L5680.................  A....................  .....................  Bk thigh lacer non-      .....  .........  ...........  ............  ............
                                                                       molded.
L5682.................  A....................  .....................  Bk thigh lacer glut/     .....  .........  ...........  ............  ............
                                                                       ischia m.
L5684.................  A....................  .....................  Bk fork strap..........  .....  .........  ...........  ............  ............
L5686.................  A....................  .....................  Bk back check..........  .....  .........  ...........  ............  ............
L5688.................  A....................  .....................  Bk waist belt webbing..  .....  .........  ...........  ............  ............
L5690.................  A....................  .....................  Bk waist belt padded     .....  .........  ...........  ............  ............
                                                                       and lin.
L5692.................  A....................  .....................  Ak pelvic control belt   .....  .........  ...........  ............  ............
                                                                       light.
L5694.................  A....................  .....................  Ak pelvic control belt   .....  .........  ...........  ............  ............
                                                                       pad/l.
L5695.................  A....................  .....................  Ak sleeve susp neoprene/ .....  .........  ...........  ............  ............
                                                                       equa.
L5696.................  A....................  .....................  Ak/knee disartic pelvic  .....  .........  ...........  ............  ............
                                                                       join.
L5697.................  A....................  .....................  Ak/knee disartic pelvic  .....  .........  ...........  ............  ............
                                                                       band.
L5698.................  A....................  .....................  Ak/knee disartic         .....  .........  ...........  ............  ............
                                                                       silesian ba.
L5699.................  A....................  .....................  Shoulder harness.......  .....  .........  ...........  ............  ............
L5700.................  A....................  .....................  Replace socket below     .....  .........  ...........  ............  ............
                                                                       knee.
L5701.................  A....................  .....................  Replace socket above     .....  .........  ...........  ............  ............
                                                                       knee.
L5702.................  A....................  .....................  Replace socket hip.....  .....  .........  ...........  ............  ............
L5704.................  A....................  .....................  Custom shape cover BK..  .....  .........  ...........  ............  ............
L5705.................  A....................  .....................  Custom shape cover AK..  .....  .........  ...........  ............  ............
L5706.................  A....................  .....................  Custom shape cvr knee    .....  .........  ...........  ............  ............
                                                                       disart.
L5707.................  A....................  .....................  Custom shape cvr hip     .....  .........  ...........  ............  ............
                                                                       disart.
L5710.................  A....................  .....................  Kne-shin exo sng axi     .....  .........  ...........  ............  ............
                                                                       mnl loc.
L5711.................  A....................  .....................  Knee-shin exo mnl lock   .....  .........  ...........  ............  ............
                                                                       ultra.
L5712.................  A....................  .....................  Knee-shin exo frict swg  .....  .........  ...........  ............  ............
                                                                       & st.
L5714.................  A....................  .....................  Knee-shin exo variable   .....  .........  ...........  ............  ............
                                                                       frict.
L5716.................  A....................  .....................  Knee-shin exo mech       .....  .........  ...........  ............  ............
                                                                       stance ph.
L5718.................  A....................  .....................  Knee-shin exo frct swg   .....  .........  ...........  ............  ............
                                                                       & sta.
L5722.................  A....................  .....................  Knee-shin pneum swg      .....  .........  ...........  ............  ............
                                                                       frct exo.
L5724.................  A....................  .....................  Knee-shin exo fluid      .....  .........  ...........  ............  ............
                                                                       swing ph.
L5726.................  A....................  .....................  Knee-shin ext jnts fld   .....  .........  ...........  ............  ............
                                                                       swg e.
L5728.................  A....................  .....................  Knee-shin fluid swg &    .....  .........  ...........  ............  ............
                                                                       stance.
L5780.................  A....................  .....................  Knee-shin pneum/hydra    .....  .........  ...........  ............  ............
                                                                       pneum.
L5781.................  A....................  .....................  Lower limb pros vacuum   .....  .........  ...........  ............  ............
                                                                       pump.
L5782.................  A....................  .....................  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.

[[Page 48202]]

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

[[Page 48203]]

 
L6388.................  A....................  .....................  Postop applicat rigid    .....  .........  ...........  ............  ............
                                                                       dsg on.
L6400.................  A....................  .....................  Below elbow prosth tiss  .....  .........  ...........  ............  ............
                                                                       shap.
L6450.................  A....................  .....................  Elb disart prosth tiss   .....  .........  ...........  ............  ............
                                                                       shap.
L6500.................  A....................  .....................  Above elbow prosth tiss  .....  .........  ...........  ............  ............
                                                                       shap.
L6550.................  A....................  .....................  Shldr disar prosth tiss  .....  .........  ...........  ............  ............
                                                                       shap.
L6570.................  A....................  .....................  Scap thorac prosth tiss  .....  .........  ...........  ............  ............
                                                                       shap.
L6580.................  A....................  .....................  Wrist/elbow bowden       .....  .........  ...........  ............  ............
                                                                       cable mol.
L6582.................  A....................  .....................  Wrist/elbow bowden cbl   .....  .........  ...........  ............  ............
                                                                       dir f.
L6584.................  A....................  .....................  Elbow fair lead cable    .....  .........  ...........  ............  ............
                                                                       molded.
L6586.................  A....................  .....................  Elbow fair lead cable    .....  .........  ...........  ............  ............
                                                                       dir fo.
L6588.................  A....................  .....................  Shdr fair lead cable     .....  .........  ...........  ............  ............
                                                                       molded.
L6590.................  A....................  .....................  Shdr fair lead cable     .....  .........  ...........  ............  ............
                                                                       direct.
L6600.................  A....................  .....................  Polycentric hinge pair.  .....  .........  ...........  ............  ............
L6605.................  A....................  .....................  Single pivot hinge pair  .....  .........  ...........  ............  ............
L6610.................  A....................  .....................  Flexible metal hinge     .....  .........  ...........  ............  ............
                                                                       pair.
L6615.................  A....................  .....................  Disconnect locking       .....  .........  ...........  ............  ............
                                                                       wrist uni.
L6616.................  A....................  .....................  Disconnect insert        .....  .........  ...........  ............  ............
                                                                       locking wr.
L6620.................  A....................  .....................  Flexion-friction wrist   .....  .........  ...........  ............  ............
                                                                       unit.
L6623.................  A....................  .....................  Spring-ass rot wrst w/   .....  .........  ...........  ............  ............
                                                                       latch.
L6625.................  A....................  .....................  Rotation wrst w/ cable   .....  .........  ...........  ............  ............
                                                                       lock.
L6628.................  A....................  .....................  Quick disconn hook       .....  .........  ...........  ............  ............
                                                                       adapter o.
L6629.................  A....................  .....................  Lamination collar w/     .....  .........  ...........  ............  ............
                                                                       couplin.
L6630.................  A....................  .....................  Stainless steel any      .....  .........  ...........  ............  ............
                                                                       wrist.
L6632.................  A....................  .....................  Latex suspension sleeve  .....  .........  ...........  ............  ............
                                                                       each.
L6635.................  A....................  .....................  Lift assist for elbow..  .....  .........  ...........  ............  ............
L6637.................  A....................  .....................  Nudge control elbow      .....  .........  ...........  ............  ............
                                                                       lock.
L6638.................  A....................  .....................  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....................  .....................  Multipo locking          .....  .........  ...........  ............  ............
                                                                       shoulder jnt.
L6647.................  A....................  .....................  Shoulder lock actuator.  .....  .........  ...........  ............  ............
L6648.................  A....................  .....................  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.

[[Page 48204]]

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

[[Page 48205]]

 
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....................  .....................  Replacemnt lithium       .....  .........  ...........  ............  ............
                                                                       ionbatter.
L7368.................  A....................  .....................  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.........  .....  .........  ...........  ............  ............
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.

[[Page 48206]]

 
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.................  N....................  .....................  Synthetic implnt         .....  .........  ...........  ............  ............
                                                                       urinary 1ml.
L8610.................  N....................  .....................  Ocular implant.........  .....  .........  ...........  ............  ............
L8612.................  N....................  .....................  Aqueous shunt            .....  .........  ...........  ............  ............
                                                                       prosthesis.
L8613.................  N....................  .....................  Ossicular implant......  .....  .........  ...........  ............  ............
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            0374     1.1062       $60.05  ............        $12.01
                                                                       monitoring.
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           0950     1.4575       $79.13  ............        $15.83
                                                                       transfusion.
P9011.................  K....................  .....................  Blood split unit.......   0957     0.6870       $37.30  ............         $7.46
P9012.................  K....................  .....................  Cryoprecipitate each      0952     0.4860       $26.38  ............         $5.28
                                                                       unit.
P9016.................  K....................  .....................  RBC leukocytes reduced.   0954     1.9770      $107.33  ............        $21.47
P9017.................  K....................  .....................  One donor fresh frozn     0955     1.5750       $85.51  ............        $17.10
                                                                       plasma.
P9019.................  K....................  .....................  Platelets, each unit...   0957     0.6870       $37.30  ............         $7.46
P9020.................  K....................  .....................  Plaelet rich plasma       0958     1.1296       $61.32  ............        $12.26
                                                                       unit.
P9021.................  K....................  .....................  Red blood cells unit...   0959     1.4326       $77.77  ............        $15.55
P9022.................  K....................  .....................  Washed red blood cells    0960     2.6638      $144.62  ............        $28.92
                                                                       unit.
P9023.................  K....................  .....................  Frozen plasma, pooled,    0949     2.0608      $111.88  ............        $22.38
                                                                       sd.
P9031.................  K....................  .....................  Platelets leukocytes      1013     0.9101       $49.41  ............         $9.88
                                                                       reduced.
P9032.................  K....................  .....................  Platelets, irradiated..   9500     1.2398       $67.31  ............        $13.46
P9033.................  K....................  .....................  Platelets leukoreduced    0954     1.9770      $107.33  ............        $21.47
                                                                       irrad.
P9034.................  K....................  .....................  Platelets, pheresis....   9501     6.7772      $367.93  ............        $73.59
P9035.................  K....................  .....................  Platelet pheres           9501     6.7772      $367.93  ............        $73.59
                                                                       leukoreduced.
P9036.................  K....................  .....................  Platelet pheresis         9502     7.3552      $399.31  ............        $79.86
                                                                       irradiated.
P9037.................  K....................  .....................  Plate pheres leukoredu    1019     6.7353      $365.65  ............        $73.13
                                                                       irrad.
P9038.................  K....................  .....................  RBC irradiated.........   9505     1.8011       $97.78  ............        $19.56
P9039.................  K....................  .....................  RBC deglycerolized.....   9504     3.9764      $215.87  ............        $43.17
P9040.................  K....................  .....................  RBC leukoreduced          9504     3.9764      $215.87  ............        $43.17
                                                                       irradiated.
P9041.................  K....................  .....................  Albumin (human),5%,       0961     0.7319       $39.73  ............         $7.95
                                                                       50ml.
P9043.................  K....................  .....................  Plasma protein            0956     1.5414       $83.68  ............        $16.74
                                                                       fract,5%,50ml.
P9044.................  K....................  .....................  Cryoprecipitatereducedp   1009     0.9447       $51.29  ............        $10.26
                                                                       lasma.
P9045.................  K....................  .....................  Albumin (human), 5%,      0963     3.4713      $188.45  ............        $37.69
                                                                       250 ml.
P9046.................  K....................  .....................  Albumin (human), 25%,     0964     0.7911       $42.95  ............         $8.59
                                                                       20 ml.
P9047.................  K....................  .....................  Albumin (human), 25%,     0965     1.9432      $105.49  ............        $21.10
                                                                       50ml.
P9048.................  K....................  .....................  Plasmaprotein             0966     7.7071      $418.41  ............        $83.68
                                                                       fract,5%,250ml.
P9050.................  K....................  .....................  Granulocytes, pheresis    9506    20.7004    $1,123.80  ............       $224.76
                                                                       unit.
P9603.................  A....................  .....................  One-way allow prorated   .....  .........  ...........  ............  ............
                                                                       miles.
P9604.................  A....................  .....................  One-way allow prorated   .....  .........  ...........  ............  ............
                                                                       trip.
P9612.................  N....................  .....................  Catheterize for urine    .....  .........  ...........  ............  ............
                                                                       spec.

[[Page 48207]]

 
P9615.................  N....................  .....................  Urine specimen collect   .....  .........  ...........  ............  ............
                                                                       mult.
Q0035.................  X....................  .....................  Cardiokymography.......   0100     1.6726       $90.80        $41.44        $18.16
Q0081.................  E....................  .....................  Infusion ther other      .....  .........  ...........  ............  ............
                                                                       than che.
Q0083.................  E....................  .....................  Chemo by other than      .....  .........  ...........  ............  ............
                                                                       infusion.
Q0084.................  E....................  .....................  Chemotherapy by          .....  .........  ...........  ............  ............
                                                                       infusion.
Q0085.................  E....................  .....................  Chemo by both infusion   .....  .........  ...........  ............  ............
                                                                       and o.
Q0086.................  A....................  .....................  Physical therapy         .....  .........  ...........  ............  ............
                                                                       evaluation/.
Q0091.................  T....................  .....................  Obtaining screen pap      0191     0.1679        $9.12         $2.65         $1.82
                                                                       smear.
Q0092.................  N....................  .....................  Set up port xray         .....  .........  ...........  ............  ............
                                                                       equipment.
Q0111.................  A....................  .....................  Wet mounts/ w            .....  .........  ...........  ............  ............
                                                                       preparations.
Q0112.................  A....................  .....................  Potassium hydroxide      .....  .........  ...........  ............  ............
                                                                       preps.
Q0113.................  A....................  .....................  Pinworm examinations...  .....  .........  ...........  ............  ............
Q0114.................  A....................  .....................  Fern test..............  .....  .........  ...........  ............  ............
Q0115.................  A....................  .....................  Post-coital mucous exam  .....  .........  ...........  ............  ............
Q0136.................  K....................  .....................  Non esrd epoetin alpha    0733     0.1782        $9.67  ............         $1.93
                                                                       inj.
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.
Q0187.................  K....................  .....................  Factor viia recombinant   1409    17.9693      $975.54  ............       $195.11
Q1001.................  N....................  .....................  Ntiol category 1.......  .....  .........  ...........  ............  ............
Q1002.................  N....................  .....................  Ntiol category 2.......  .....  .........  ...........  ............  ............
Q1003.................  N....................  .....................  Ntiol category 3.......  .....  .........  ...........  ............  ............
Q1004.................  N....................  .....................  Ntiol category 4.......  .....  .........  ...........  ............  ............
Q1005.................  N....................  .....................  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     3.4880      $189.36  ............        $37.87
                                                                       triflutat.
Q2006.................  K....................  .....................  Digoxin immune fab        7025     4.4789      $243.16  ............        $48.63
                                                                       (ovine).
Q2007.................  N....................  .....................  Ethanolamine oleate 100  .....  .........  ...........  ............  ............
                                                                       mg.
Q2008.................  K....................  .....................  Fomepizole, 15 mg......   7027     0.2215       $12.03  ............         $2.41
Q2009.................  N....................  .....................  Fosphenytoin, 50 mg....  .....  .........  ...........  ............  ............
Q2010.................  N....................  .....................  Glatiramer acetate, per  .....  .........  ...........  ............  ............
                                                                       dose.
Q2011.................  K....................  .....................  Hemin, per 1 mg........   7030     0.0119         $.65  ............          $.13
Q2012.................  N....................  .....................  Pegademase bovine, 25    .....  .........  ...........  ............  ............
                                                                       iu.
Q2013.................  N....................  .....................  Pentastarch 10%          .....  .........  ...........  ............  ............
                                                                       solution.
Q2014.................  N....................  .....................  Sermorelin acetate, 0.5  .....  .........  ...........  ............  ............
                                                                       mg.
Q2017.................  K....................  .....................  Teniposide, 50 mg......   7035     1.5530       $84.31  ............        $16.86
Q2018.................  K....................  .....................  Urofollitropin, 75 iu..   7037     1.1321       $61.46  ............        $12.29
Q2019.................  K....................  .....................  Basiliximab............   1615    11.2007      $608.07  ............       $121.61
Q2020.................  E....................  .....................  Histrelin acetate......  .....  .........  ...........  ............  ............
Q2021.................  N....................  .....................  Lepirudin..............  .....  .........  ...........  ............  ............
Q2022.................  K....................  .....................  VonWillebrandFactrCmplx   1618     0.0168         $.91  ............          $.18
                                                                       perIU.
Q3000.................  K....................  .....................  Rubidium-Rb-82.........   9025     2.5939      $140.82  ............        $28.16
Q3001.................  N....................  .....................  Brachytherapy            .....  .........  ...........  ............  ............
                                                                       Radioelements.
Q3002.................  N....................  .....................  Gallium ga 67..........  .....  .........  ...........  ............  ............
Q3003.................  K....................  .....................  Technetium tc99m          1620     3.3106      $179.73  ............        $35.95
                                                                       bicisate.

[[Page 48208]]

 
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             1625     6.8170      $370.09  ............        $74.02
                                                                       pentetreotide.
Q3009.................  N....................  .....................  Technetium tc99m         .....  .........  ...........  ............  ............
                                                                       oxidronate.
Q3010.................  N....................  .....................  Technetium               .....  .........  ...........  ............  ............
                                                                       tc99mlabeledrbcs.
Q3011.................  K....................  .....................  Chromic phosphate p32..   1628     2.0103      $109.14  ............        $21.83
Q3012.................  N....................  .....................  Cyanocobalamin cobalt    .....  .........  ...........  ............  ............
                                                                       co57.
Q3014.................  A....................  .....................  Telehealth facility fee  .....  .........  ...........  ............  ............
Q3019.................  A....................  .....................  ALS emer trans no ALS    .....  .........  ...........  ............  ............
                                                                       serv.
Q3020.................  A....................  .....................  ALS nonemer trans no     .....  .........  ...........  ............  ............
                                                                       ALS se.
Q3021.................  E....................  .....................  Ped hepatitis b vaccine  .....  .........  ...........  ............  ............
                                                                       inj.
Q3022.................  E....................  .....................  Hepatitis b vaccine      .....  .........  ...........  ............  ............
                                                                       adult ds.
Q3023.................  E....................  .....................  Injection hepatitis      .....  .........  ...........  ............  ............
                                                                       Bvaccine.
Q3025.................  K....................  .....................  IM inj interferon beta    9022     0.9417       $51.12  ............        $10.22
                                                                       1-a.
Q3026.................  N....................  .....................  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..  .....  .........  ...........  ............  ............

[[Page 48209]]

 
Q4050.................  A....................  .....................  Cast supplies unlisted.  .....  .........  ...........  ............  ............
Q4051.................  A....................  .....................  Splint supplies misc...  .....  .........  ...........  ............  ............
Q4052.................  K....................  .....................  Octreotide injection,     1207     1.1849       $64.33  ............        $12.87
                                                                       depot.
Q4053.................  G....................  .....................  Pegfilgrastim, per 1 mg   9119  .........      $467.09  ............        $69.82
Q9920.................  A....................  .....................  Epoetin with hct <= 20.  .....  .........  ...........  ............  ............
Q9921.................  A....................  .....................  Epoetin with hct = 21..  .....  .........  ...........  ............  ............
Q9922.................  A....................  .....................  Epoetin with hct = 22..  .....  .........  ...........  ............  ............
Q9923.................  A....................  .....................  Epoetin with hct = 23..  .....  .........  ...........  ............  ............
Q9924.................  A....................  .....................  Epoetin with hct = 24..  .....  .........  ...........  ............  ............
Q9925.................  A....................  .....................  Epoetin with hct = 25..  .....  .........  ...........  ............  ............
Q9926.................  A....................  .....................  Epoetin with hct = 26..  .....  .........  ...........  ............  ............
Q9927.................  A....................  .....................  Epoetin with hct = 27..  .....  .........  ...........  ............  ............
Q9928.................  A....................  .....................  Epoetin with hct = 28..  .....  .........  ...........  ............  ............
Q9929.................  A....................  .....................  Epoetin with hct = 29..  .....  .........  ...........  ............  ............
Q9930.................  A....................  .....................  Epoetin with hct = 30..  .....  .........  ...........  ............  ............
Q9931.................  A....................  .....................  Epoetin with hct = 31..  .....  .........  ...........  ............  ............
Q9932.................  A....................  .....................  Epoetin with hct = 32..  .....  .........  ...........  ............  ............
Q9933.................  A....................  .....................  Epoetin with hct = 33..  .....  .........  ...........  ............  ............
Q9934.................  A....................  .....................  Epoetin with hct = 34..  .....  .........  ...........  ............  ............
Q9935.................  A....................  .....................  Epoetin with hct = 35..  .....  .........  ...........  ............  ............
Q9936.................  A....................  .....................  Epoetin with hct = 36..  .....  .........  ...........  ............  ............
Q9937.................  A....................  .....................  Epoetin with hct = 37..  .....  .........  ...........  ............  ............
Q9938.................  A....................  .....................  Epoetin with hct = 38..  .....  .........  ...........  ............  ............
Q9939.................  A....................  .....................  Epoetin with hct = 39..  .....  .........  ...........  ............  ............
Q9940.................  A....................  .....................  Epoetin with hct = 40.
R0070.................  N....................  .....................  Transport portable x-    .....  .........  ...........  ............  ............
                                                                       ray.
R0075.................  N....................  .....................  Transport port x-ray     .....  .........  ...........  ............  ............
                                                                       multipl.
R0076.................  N....................  .....................  Transport portable EKG.  .....  .........  ...........  ............  ............
T1015.................  E....................  .....................  Clinic service.........  .....  .........  ...........  ............  ............
T1016.................  E....................  .....................  Case management........  .....  .........  ...........  ............  ............
T1017.................  E....................  .....................  Targeted case            .....  .........  ...........  ............  ............
                                                                       management.
T1018.................  E....................  .....................  School-based IEP ser     .....  .........  ...........  ............  ............
                                                                       bundled.
T1019.................  E....................  .....................  Personal care ser per    .....  .........  ...........  ............  ............
                                                                       15 min.
T1020.................  E....................  .....................  Personal care ser per    .....  .........  ...........  ............  ............
                                                                       diem.
T1021.................  E....................  .....................  HH Aide or cn aide per   .....  .........  ...........  ............  ............
                                                                       visit.
T1022.................  E....................  .....................  Contracted services per  .....  .........  ...........  ............  ............
                                                                       day.
T1023.................  E....................  .....................  Program intake           .....  .........  ...........  ............  ............
                                                                       assessment.
T1024.................  E....................  .....................  Team evaluation &        .....  .........  ...........  ............  ............
                                                                       management.
T1025.................  E....................  .....................  Ped compr care pkg, per  .....  .........  ...........  ............  ............
                                                                       diem.
T1026.................  E....................  .....................  Ped compr care pkg, per  .....  .........  ...........  ............  ............
                                                                       hour.
T1027.................  E....................  .....................  Family training &        .....  .........  ...........  ............  ............
                                                                       counseling.
T1028.................  E....................  .....................  Home environment         .....  .........  ...........  ............  ............
                                                                       assessment.
T1029.................  E....................  .....................  Dwelling lead            .....  .........  ...........  ............  ............
                                                                       investigation.
T1030.................  E....................  .....................  RN home care per diem..  .....  .........  ...........  ............  ............
T1031.................  E....................  .....................  LPN home care per diem.  .....  .........  ...........  ............  ............
T1500.................  E....................  .....................  Reusable diaper/pant...  .....  .........  ...........  ............  ............
T1502.................  E....................  .....................  Medication admin visit.  .....  .........  ...........  ............  ............
T1999.................  E....................  .....................  NOC retail items         .....  .........  ...........  ............  ............
                                                                       andsupplies.
T2001.................  E....................  .....................  N-et; patient attend/    .....  .........  ...........  ............  ............
                                                                       escort.
T2002.................  E....................  .....................  N-et; per diem.........  .....  .........  ...........  ............  ............
T2003.................  E....................  .....................  N-et; encounter/trip...  .....  .........  ...........  ............  ............
T2004.................  E....................  .....................  N-et; commerc carrier    .....  .........  ...........  ............  ............
                                                                       pass.
T2005.................  E....................  .....................  N-et; stretcher van....  .....  .........  ...........  ............  ............
T2006.................  E....................  .....................  Amb response & trt, no   .....  .........  ...........  ............  ............
                                                                       trans.
T2007.................  E....................  .....................  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.

[[Page 48210]]

 
V2109.................  A....................  .....................  Spherocylinder 4.25d/    .....  .........  ...........  ............  ............
                                                                       4.25-6d.
V2110.................  A....................  .....................  Spherocylinder 4.25d/    .....  .........  ...........  ............  ............
                                                                       over 6d.
V2111.................  A....................  .....................  Spherocylindr 7.25d/.25- .....  .........  ...........  ............  ............
                                                                       2.25.
V2112.................  A....................  .....................  Spherocylindr 7.25d/     .....  .........  ...........  ............  ............
                                                                       2.25-4d.
V2113.................  A....................  .....................  Spherocylindr 7.25d/     .....  .........  ...........  ............  ............
                                                                       4.25-6d.
V2114.................  A....................  .....................  Spherocylinder over      .....  .........  ...........  ............  ............
                                                                       12.00d.
V2115.................  A....................  .....................  Lens lenticular bifocal  .....  .........  ...........  ............  ............
V2116.................  A....................  .....................  Nonaspheric lens         .....  .........  ...........  ............  ............
                                                                       bifocal.
V2117.................  A....................  .....................  Aspheric lens bifocal..  .....  .........  ...........  ............  ............
V2118.................  A....................  .....................  Lens aniseikonic single  .....  .........  ...........  ............  ............
V2199.................  A....................  .....................  Lens single vision not   .....  .........  ...........  ............  ............
                                                                       oth c.
V2200.................  A....................  .....................  Lens spher bifoc plano   .....  .........  ...........  ............  ............
                                                                       4.00d.
V2201.................  A....................  .....................  Lens sphere bifocal      .....  .........  ...........  ............  ............
                                                                       4.12-7.0.
V2202.................  A....................  .....................  Lens sphere bifocal      .....  .........  ...........  ............  ............
                                                                       7.12-20..
V2203.................  A....................  .....................  Lens sphcyl bifocal      .....  .........  ...........  ............  ............
                                                                       4.00d/.1.
V2204.................  A....................  .....................  Lens sphcy bifocal       .....  .........  ...........  ............  ............
                                                                       4.00d/2.1.
V2205.................  A....................  .....................  Lens sphcy bifocal       .....  .........  ...........  ............  ............
                                                                       4.00d/4.2.
V2206.................  A....................  .....................  Lens sphcy bifocal       .....  .........  ...........  ............  ............
                                                                       4.00d/ove.
V2207.................  A....................  .....................  Lens sphcy bifocal 4.25- .....  .........  ...........  ............  ............
                                                                       7d/..
V2208.................  A....................  .....................  Lens sphcy bifocal 4.25- .....  .........  ...........  ............  ............
                                                                       7/2..
V2209.................  A....................  .....................  Lens sphcy bifocal 4.25- .....  .........  ...........  ............  ............
                                                                       7/4..
V2210.................  A....................  .....................  Lens sphcy bifocal 4.25- .....  .........  ...........  ............  ............
                                                                       7/ov.
V2211.................  A....................  .....................  Lens sphcy bifo 7.25-12/ .....  .........  ...........  ............  ............
                                                                       .25-.
V2212.................  A....................  .....................  Lens sphcyl bifo 7.25-   .....  .........  ...........  ............  ............
                                                                       12/2.2.
V2213.................  A....................  .....................  Lens sphcyl bifo 7.25-   .....  .........  ...........  ............  ............
                                                                       12/4.2.
V2214.................  A....................  .....................  Lens sphcyl bifocal      .....  .........  ...........  ............  ............
                                                                       over 12..
V2215.................  A....................  .....................  Lens lenticular bifocal  .....  .........  ...........  ............  ............
V2216.................  A....................  .....................  Lens lenticular          .....  .........  ...........  ............  ............
                                                                       nonaspheric.
V2217.................  A....................  .....................  Lens lenticular          .....  .........  ...........  ............  ............
                                                                       aspheric bif.
V2218.................  A....................  .....................  Lens aniseikonic         .....  .........  ...........  ............  ............
                                                                       bifocal.
V2219.................  A....................  .....................  Lens bifocal seg width   .....  .........  ...........  ............  ............
                                                                       over.
V2220.................  A....................  .....................  Lens bifocal add over    .....  .........  ...........  ............  ............
                                                                       3.25d.
V2299.................  A....................  .....................  Lens bifocal speciality  .....  .........  ...........  ............  ............
V2300.................  A....................  .....................  Lens sphere trifocal     .....  .........  ...........  ............  ............
                                                                       4.00d.
V2301.................  A....................  .....................  Lens sphere trifocal     .....  .........  ...........  ............  ............
                                                                       4.12-7..
V2302.................  A....................  .....................  Lens sphere trifocal     .....  .........  ...........  ............  ............
                                                                       7.12-20.
V2303.................  A....................  .....................  Lens sphcy trifocal 4.0/ .....  .........  ...........  ............  ............
                                                                       .12-.
V2304.................  A....................  .....................  Lens sphcy trifocal 4.0/ .....  .........  ...........  ............  ............
                                                                       2.25.
V2305.................  A....................  .....................  Lens sphcy trifocal 4.0/ .....  .........  ...........  ............  ............
                                                                       4.25.
V2306.................  A....................  .....................  Lens sphcyl trifocal     .....  .........  ...........  ............  ............
                                                                       4.00/6.
V2307.................  A....................  .....................  Lens sphcy trifocal      .....  .........  ...........  ............  ............
                                                                       4.25-7/..
V2308.................  A....................  .....................  Lens sphc trifocal 4.25- .....  .........  ...........  ............  ............
                                                                       7/2..
V2309.................  A....................  .....................  Lens sphc trifocal 4.25- .....  .........  ...........  ............  ............
                                                                       7/4..
V2310.................  A....................  .....................  Lens sphc trifocal 4.25- .....  .........  ...........  ............  ............
                                                                       7/6.
V2311.................  A....................  .....................  Lens sphc trifo 7.25-12/ .....  .........  ...........  ............  ............
                                                                       .25-.
V2312.................  A....................  .....................  Lens sphc trifo 7.25-12/ .....  .........  ...........  ............  ............
                                                                       2.25.
V2313.................  A....................  .....................  Lens sphc trifo 7.25-12/ .....  .........  ...........  ............  ............
                                                                       4.25.
V2314.................  A....................  .....................  Lens sphcyl trifocal     .....  .........  ...........  ............  ............
                                                                       over 12.
V2315.................  A....................  .....................  Lens lenticular          .....  .........  ...........  ............  ............
                                                                       trifocal.
V2316.................  A....................  .....................  Lens lenticular          .....  .........  ...........  ............  ............
                                                                       nonaspheric.
V2317.................  A....................  .....................  Lens lenticular          .....  .........  ...........  ............  ............
                                                                       aspheric tri.
V2318.................  A....................  .....................  Lens aniseikonic         .....  .........  ...........  ............  ............
                                                                       trifocal.
V2319.................  A....................  .....................  Lens trifocal seg width  .....  .........  ...........  ............  ............
                                                                        28.
V2320.................  A....................  .....................  Lens trifocal add over   .....  .........  ...........  ............  ............
                                                                       3.25d.
V2399.................  A....................  .....................  Lens trifocal            .....  .........  ...........  ............  ............
                                                                       speciality.
V2410.................  A....................  .....................  Lens variab asphericity  .....  .........  ...........  ............  ............
                                                                       sing.
V2430.................  A....................  .....................  Lens variable            .....  .........  ...........  ............  ............
                                                                       asphericity bi.
V2499.................  A....................  .....................  Variable asphericity     .....  .........  ...........  ............  ............
                                                                       lens.
V2500.................  A....................  .....................  Contact lens pmma        .....  .........  ...........  ............  ............
                                                                       spherical.
V2501.................  A....................  .....................  Cntct lens pmma-toric/   .....  .........  ...........  ............  ............
                                                                       prism.
V2502.................  A....................  .....................  Contact lens pmma        .....  .........  ...........  ............  ............
                                                                       bifocal.
V2503.................  A....................  .....................  Cntct lens pmma color    .....  .........  ...........  ............  ............
                                                                       vision.
V2510.................  A....................  .....................  Cntct gas permeable      .....  .........  ...........  ............  ............
                                                                       sphericl.
V2511.................  A....................  .....................  Cntct toric prism        .....  .........  ...........  ............  ............
                                                                       ballast.
V2512.................  A....................  .....................  Cntct lens gas permbl    .....  .........  ...........  ............  ............
                                                                       bifocl.
V2513.................  A....................  .....................  Contact lens extended    .....  .........  ...........  ............  ............
                                                                       wear.

[[Page 48211]]

 
V2520.................  A....................  .....................  Contact lens             .....  .........  ...........  ............  ............
                                                                       hydrophilic.
V2521.................  A....................  .....................  Cntct lens hydrophilic   .....  .........  ...........  ............  ............
                                                                       toric.
V2522.................  A....................  .....................  Cntct lens hydrophil     .....  .........  ...........  ............  ............
                                                                       bifocl.
V2523.................  A....................  .....................  Cntct lens hydrophil     .....  .........  ...........  ............  ............
                                                                       extend.
V2530.................  A....................  .....................  Contact lens gas         .....  .........  ...........  ............  ............
                                                                       impermeable.
V2531.................  A....................  .....................  Contact lens gas         .....  .........  ...........  ............  ............
                                                                       permeable.
V2599.................  A....................  .....................  Contact lens/es other    .....  .........  ...........  ............  ............
                                                                       type.
V2600.................  A....................  .....................  Hand held low vision     .....  .........  ...........  ............  ............
                                                                       aids.
V2610.................  A....................  .....................  Single lens spectacle    .....  .........  ...........  ............  ............
                                                                       mount.
V2615.................  A....................  .....................  Telescop/othr compound   .....  .........  ...........  ............  ............
                                                                       lens.
V2623.................  A....................  .....................  Plastic eye prosth       .....  .........  ...........  ............  ............
                                                                       custom.
V2624.................  A....................  .....................  Polishing artifical eye  .....  .........  ...........  ............  ............
V2625.................  A....................  .....................  Enlargemnt of eye        .....  .........  ...........  ............  ............
                                                                       prosthesis.
V2626.................  A....................  .....................  Reduction of eye         .....  .........  ...........  ............  ............
                                                                       prosthesis.
V2627.................  A....................  .....................  Scleral cover shell....  .....  .........  ...........  ............  ............
V2628.................  A....................  .....................  Fabrication & fitting..  .....  .........  ...........  ............  ............
V2629.................  A....................  .....................  Prosthetic eye other     .....  .........  ...........  ............  ............
                                                                       type.
V2630.................  N....................  .....................  Anter chamber intraocul  .....  .........  ...........  ............  ............
                                                                       lens.
V2631.................  N....................  .....................  Iris support intraoclr   .....  .........  ...........  ............  ............
                                                                       lens.
V2632.................  N....................  .....................  Post chmbr intraocular   .....  .........  ...........  ............  ............
                                                                       lens.
V2700.................  A....................  .....................  Balance lens...........  .....  .........  ...........  ............  ............
V2710.................  A....................  .....................  Glass/plastic slab off   .....  .........  ...........  ............  ............
                                                                       prism.
V2715.................  A....................  .....................  Prism lens/es..........  .....  .........  ...........  ............  ............
V2718.................  A....................  .....................  Fresnell prism press-on  .....  .........  ...........  ............  ............
                                                                       lens.
V2730.................  A....................  .....................  Special base curve.....  .....  .........  ...........  ............  ............
V2740.................  A....................  .....................  Rose tint plastic......  .....  .........  ...........  ............  ............
V2741.................  A....................  .....................  Non-rose tint plastic..  .....  .........  ...........  ............  ............
V2742.................  A....................  .....................  Rose tint glass........  .....  .........  ...........  ............  ............
V2743.................  A....................  .....................  Non-rose tint glass....  .....  .........  ...........  ............  ............
V2744.................  A....................  .....................  Tint photochromatic      .....  .........  ...........  ............  ............
                                                                       lens/es.
V2750.................  A....................  .....................  Anti-reflective coating  .....  .........  ...........  ............  ............
V2755.................  A....................  .....................  UV lens/es.............  .....  .........  ...........  ............  ............
V2760.................  A....................  .....................  Scratch resistant        .....  .........  ...........  ............  ............
                                                                       coating.
V2770.................  A....................  .....................  Occluder lens/es.......  .....  .........  ...........  ............  ............
V2780.................  A....................  .....................  Oversize lens/es.......  .....  .........  ...........  ............  ............
V2781.................  E....................  .....................  Progressive lens per     .....  .........  ...........  ............  ............
                                                                       lens.
V2785.................  F....................  .....................  Corneal tissue           .....  .........  ...........  ............  ............
                                                                       processing.
V2790.................  N....................  .....................  Amniotic membrane......  .....  .........  ...........  ............  ............
V2799.................  A....................  .....................  Miscellaneous vision     .....  .........  ...........  ............  ............
                                                                       service.
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....................  .....................  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.

[[Page 48212]]

 
V5240.................  E....................  .....................  Dispensing fee bicros..  .....  .........  ...........  ............  ............
V5241.................  E....................  .....................  Dispensing fee,          .....  .........  ...........  ............  ............
                                                                       monaural.
V5242.................  E....................  .....................  Hearing aid, monaural,   .....  .........  ...........  ............  ............
                                                                       cic.
V5243.................  E....................  .....................  Hearing aid, monaural,   .....  .........  ...........  ............  ............
                                                                       itc.
V5244.................  E....................  .....................  Hearing aid, prog, mon,  .....  .........  ...........  ............  ............
                                                                       cic.
V5245.................  E....................  .....................  Hearing aid, prog, mon,  .....  .........  ...........  ............  ............
                                                                       itc.
V5246.................  E....................  .....................  Hearing aid, prog, mon,  .....  .........  ...........  ............  ............
                                                                       ite.
V5247.................  E....................  .....................  Hearing aid, prog, mon,  .....  .........  ...........  ............  ............
                                                                       bte.
V5248.................  E....................  .....................  Hearing aid, binaural,   .....  .........  ...........  ............  ............
                                                                       cic.
V5249.................  E....................  .....................  Hearing aid, binaural,   .....  .........  ...........  ............  ............
                                                                       itc.
V5250.................  E....................  .....................  Hearing aid, prog, bin,  .....  .........  ...........  ............  ............
                                                                       cic.
V5251.................  E....................  .....................  Hearing aid, prog, bin,  .....  .........  ...........  ............  ............
                                                                       itc.
V5252.................  E....................  .....................  Hearing aid, prog, bin,  .....  .........  ...........  ............  ............
                                                                       ite.
V5253.................  E....................  .....................  Hearing aid, prog, bin,  .....  .........  ...........  ............  ............
                                                                       bte.
V5254.................  E....................  .....................  Hearing id, digit, mon,  .....  .........  ...........  ............  ............
                                                                       cic.
V5255.................  E....................  .....................  Hearing aid, digit,      .....  .........  ...........  ............  ............
                                                                       mon, itc.
V5256.................  E....................  .....................  Hearing aid, digit,      .....  .........  ...........  ............  ............
                                                                       mon, ite.
V5257.................  E....................  .....................  Hearing aid, digit,      .....  .........  ...........  ............  ............
                                                                       mon, bte.
V5258.................  E....................  .....................  Hearing aid, digit,      .....  .........  ...........  ............  ............
                                                                       bin, cic.
V5259.................  E....................  .....................  Hearing aid, digit,      .....  .........  ...........  ............  ............
                                                                       bin, itc.
V5260.................  E....................  .....................  Hearing aid, digit,      .....  .........  ...........  ............  ............
                                                                       bin, ite.
V5261.................  E....................  .....................  Hearing aid, digit,      .....  .........  ...........  ............  ............
                                                                       bin, bte.
V5262.................  E....................  .....................  Hearing aid, disp,       .....  .........  ...........  ............  ............
                                                                       monaural.
V5263.................  E....................  .....................  Hearing aid, disp,       .....  .........  ...........  ............  ............
                                                                       binaural.
V5264.................  E....................  .....................  Ear mold/insert........  .....  .........  ...........  ............  ............
V5265.................  E....................  .....................  Ear mold/insert, disp..  .....  .........  ...........  ............  ............
V5266.................  E....................  .....................  Battery for hearing      .....  .........  ...........  ............  ............
                                                                       device.
V5267.................  E....................  .....................  Hearing aid supply/      .....  .........  ...........  ............  ............
                                                                       accessory.
V5268.................  E....................  .....................  ALD Telephone Amplifier  .....  .........  ...........  ............  ............
V5269.................  E....................  .....................  Alerting device, any     .....  .........  ...........  ............  ............
                                                                       type.
V5270.................  E....................  .....................  ALD, TV amplifier, any   .....  .........  ...........  ............  ............
                                                                       type.
V5271.................  E....................  .....................  ALD, TV caption decoder  .....  .........  ...........  ............  ............
V5272.................  E....................  .....................  Tdd....................  .....  .........  ...........  ............  ............
V5273.................  E....................  .....................  ALD for cochlear         .....  .........  ...........  ............  ............
                                                                       implant.
V5274.................  E....................  .....................  ALD unspecified........  .....  .........  ...........  ............  ............
V5275.................  E....................  .....................  Ear impression.........  .....  .........  ...........  ............  ............
V5298.................  E....................  .....................  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 escriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
Copyright American Dental Association. All right reserved.






  Federal Register / Vol. 68, No. 155 / Tuesday, August 12, 2003 / 
Proposed Rules  

[[Page 48212]]




   Addendum D.--Payment Status Indicators for the Hospital Outpatient
                       Prospective Payment System
------------------------------------------------------------------------
     Indicator               Service                     Status
------------------------------------------------------------------------
A.................  Services Paid under a Fee  Paid under a Payment
                     Schedule Other than        System other than OPPS.
                     OPPS, e.g., Clinical
                     Diagnostic Laboratory
                     Services; Physical,
                     Occupational and Speech
                     Therapy; and Screening
                     Mammography.
C.................  Inpatient Procedures.....  Not Paid under OPPS;
                                                Admit Patient; Bill as
                                                Inpatient.
D.................  Deleted Code.............  Not Paid under Medicare.
E.................  Non-Covered Items and      Not Covered under
                     Services; Codes not        Medicare, or not an
                     Payable in Hospital        Allowed Code when
                     Outpatient Setting;        Performed in a Hospital
                     Codes Not Recognized by    Outpatient Setting.
                     OPPS but for Which an
                     Alternate Code may be
                     Applicable..
F.................  Corneal Tissue             Paid at Reasonable Cost.
                     Acquisition.
G.................  Drug/Biological Pass-      Paid under OPPS; Separate
                     Through.                   APC Payment Includes
                                                Pass-Through Amount.
H.................  Device Category Pass-      Paid under OPPS; Separate
                     Through.                   Cost-Based Pass-Through
                                                Payment.
K.................  Non Pass-Through Drug/     Paid under OPPS; Separate
                     Biological,                APC.
                     Radiopharmaceutical
                     Agent, Certain
                     Brachytherapy Sources.
L.................  Influenza Vaccine;         Paid at Reasonable Cost;
                     Pneumococcal Pneumonia     Not Subject to
                     Vaccine.                   Deductible or
                                                Coinsurance.

[[Page 48213]]

 
N.................  Items and Services         Paid under OPPS; Payment
                     Packaged into APC Rate.    is Packaged into Payment
                                                for Other Services.
P.................  Partial Hospitalization..  Paid under OPPS; Per Diem
                                                APC.
S.................  Significant Procedure,     Paid under OPPS; Separate
                     Not Discounted when        APC.
                     Multiple.
T.................  Significant Procedure,     Paid under OPPS; Separate
                     Multiple Procedure         APC.
                     Reduction Applies.
V.................  Clinic or Emergency        Paid under OPPS; Separate
                     Department Visit.          APC.
X.................  Ancillary Service........  Paid under OPPS; Separate
                                                APC.
------------------------------------------------------------------------






[[Page 48214]]





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

Copyright American Dental Association. All rights reserved.

[[Page 48214]]



                     Addendum E.--CPT Codes Which Would Be Paid Only as Inpatient Procedures
                                              [Calendar Year 2004]
----------------------------------------------------------------------------------------------------------------
               CPT/HCPCS                      Status  indicator                       Description
----------------------------------------------------------------------------------------------------------------
0001T.................................  C...........................  Endovas repr abdo ao aneurys
0002T.................................  C...........................  Endovas repr abdo ao aneurys
0005T.................................  C...........................  Perc cath stent/brain cv art
0006T.................................  C...........................  Perc cath stent/brain cv art
0007T.................................  C...........................  Perc cath stent/brain cv art
00174.................................  C...........................  Anesth, pharyngeal surgery
00176.................................  C...........................  Anesth, pharyngeal surgery
00192.................................  C...........................  Anesth, facial bone surgery
00214.................................  C...........................  Anesth, skull drainage
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
00562.................................  C...........................  Anesth, open heart surgery
00580.................................  C...........................  Anesth, heart/lung transplnt
00604.................................  C...........................  Anesth, sitting procedure
00622.................................  C...........................  Anesth, removal of nerves
00632.................................  C...........................  Anesth, removal of nerves
00634.................................  C...........................  Anesth for chemonucleolysis
00670.................................  C...........................  Anesth, spine, cord surgery
00792.................................  C...........................  Anesth, hemorr/excise liver
00794.................................  C...........................  Anesth, pancreas removal
00796.................................  C...........................  Anesth, for liver transplant
00802.................................  C...........................  Anesth, fat layer removal
00844.................................  C...........................  Anesth, pelvis surgery
00846.................................  C...........................  Anesth, hysterectomy
00848.................................  C...........................  Anesth, pelvic organ surg
00864.................................  C...........................  Anesth, removal of bladder
00865.................................  C...........................  Anesth, removal of prostate
00866.................................  C...........................  Anesth, removal of adrenal
00868.................................  C...........................  Anesth, kidney transplant
00882.................................  C...........................  Anesth, major vein ligation
00904.................................  C...........................  Anesth, perineal surgery
00908.................................  C...........................  Anesth, removal of prostate
00928.................................  C...........................  Anesth, removal of testis
00932.................................  C...........................  Anesth, amputation of penis
00934.................................  C...........................  Anesth, penis, nodes removal
00936.................................  C...........................  Anesth, penis, nodes removal
00944.................................  C...........................  Anesth, vaginal hysterectomy
01140.................................  C...........................  Anesth, amputation at pelvis
01150.................................  C...........................  Anesth, pelvic tumor surgery
01190.................................  C...........................  Anesth, pelvis nerve removal
01212.................................  C...........................  Anesth, hip disarticulation
01214.................................  C...........................  Anesth, hip arthroplasty
01232.................................  C...........................  Anesth, amputation of femur
01234.................................  C...........................  Anesth, radical femur surg

[[Page 48215]]

 
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
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
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

[[Page 48216]]

 
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
01638.................................  C...........................  Anesth, shoulder replacement
01652.................................  C...........................  Anesth, shoulder vessel surg
01654.................................  C...........................  Anesth, shoulder vessel surg
01656.................................  C...........................  Anesth, arm-leg vessel surg
01756.................................  C...........................  Anesth, radical humerus surg
01990.................................  C...........................  Support for organ donor
15756.................................  C...........................  Free muscle flap, microvasc
15757.................................  C...........................  Free skin flap, microvasc
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, 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
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

[[Page 48217]]

 
20955.................................  C...........................  Fibula bone graft, microvasc
20956.................................  C...........................  Iliac bone graft, microvasc
20957.................................  C...........................  Mt bone graft, microvasc
20962.................................  C...........................  Other bone graft, microvasc
20969.................................  C...........................  Bone/skin graft, microvasc
20970.................................  C...........................  Bone/skin graft, iliac crest
20972.................................  C...........................  Bone/skin graft, metatarsal
20973.................................  C...........................  Bone/skin graft, great toe
21045.................................  C...........................  Extensive jaw surgery
21141.................................  C...........................  Reconstruct midface, lefort
21142.................................  C...........................  Reconstruct midface, lefort
21143.................................  C...........................  Reconstruct midface, lefort
21145.................................  C...........................  Reconstruct midface, lefort
21146.................................  C...........................  Reconstruct midface, lefort
21147.................................  C...........................  Reconstruct midface, lefort
21150.................................  C...........................  Reconstruct midface, lefort
21151.................................  C...........................  Reconstruct midface, lefort
21154.................................  C...........................  Reconstruct midface, lefort
21155.................................  C...........................  Reconstruct midface, lefort
21159.................................  C...........................  Reconstruct midface, lefort
21160.................................  C...........................  Reconstruct midface, lefort
21172.................................  C...........................  Reconstruct orbit/forehead
21175.................................  C...........................  Reconstruct orbit/forehead
21179.................................  C...........................  Reconstruct entire forehead
21180.................................  C...........................  Reconstruct entire forehead
21182.................................  C...........................  Reconstruct cranial bone
21183.................................  C...........................  Reconstruct cranial bone
21184.................................  C...........................  Reconstruct cranial bone
21188.................................  C...........................  Reconstruction of midface
21193.................................  C...........................  Reconst lwr jaw w/o graft
21194.................................  C...........................  Reconst lwr jaw w/graft
21195.................................  C...........................  Reconst lwr jaw w/o fixation
21196.................................  C...........................  Reconst lwr jaw w/fixation
21247.................................  C...........................  Reconstruct lower jaw bone
21255.................................  C...........................  Reconstruct lower jaw bone
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

[[Page 48218]]

 
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
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

[[Page 48219]]

 
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
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

[[Page 48220]]

 
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
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

[[Page 48221]]

 
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
32815.................................  C...........................  Close bronchial fistula
32820.................................  C...........................  Reconstruct injured chest
32850.................................  C...........................  Donor pneumonectomy
32851.................................  C...........................  Lung transplant, single
32852.................................  C...........................  Lung transplant with bypass
32853.................................  C...........................  Lung transplant, double
32854.................................  C...........................  Lung transplant with bypass
32900.................................  C...........................  Removal of rib(s)
32905.................................  C...........................  Revise & repair chest wall
32906.................................  C...........................  Revise & repair chest wall
32940.................................  C...........................  Revision of lung
32997.................................  C...........................  Total lung lavage
33015.................................  C...........................  Incision of heart sac
33020.................................  C...........................  Incision of heart sac
33025.................................  C...........................  Incision of heart sac
33030.................................  C...........................  Partial removal of heart sac
33031.................................  C...........................  Partial removal of heart sac
33050.................................  C...........................  Removal of heart sac lesion
33120.................................  C...........................  Removal of heart lesion
33130.................................  C...........................  Removal of heart lesion
33140.................................  C...........................  Heart revascularize (tmr)
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

[[Page 48222]]

 
33412.................................  C...........................  Replacement of aortic valve
33413.................................  C...........................  Replacement of aortic valve
33414.................................  C...........................  Repair of aortic valve
33415.................................  C...........................  Revision, subvalvular tissue
33416.................................  C...........................  Revise ventricle muscle
33417.................................  C...........................  Repair of aortic valve
33420.................................  C...........................  Revision of mitral valve
33422.................................  C...........................  Revision of mitral valve
33425.................................  C...........................  Repair of mitral valve
33426.................................  C...........................  Repair of mitral valve
33427.................................  C...........................  Repair of mitral valve
33430.................................  C...........................  Replacement of mitral valve
33460.................................  C...........................  Revision of tricuspid valve
33463.................................  C...........................  Valvuloplasty, tricuspid
33464.................................  C...........................  Valvuloplasty, tricuspid
33465.................................  C...........................  Replace tricuspid valve
33468.................................  C...........................  Revision of tricuspid valve
33470.................................  C...........................  Revision of pulmonary valve
33471.................................  C...........................  Valvotomy, pulmonary valve
33472.................................  C...........................  Revision of pulmonary valve
33474.................................  C...........................  Revision of pulmonary valve
33475.................................  C...........................  Replacement, pulmonary valve
33476.................................  C...........................  Revision of heart chamber
33478.................................  C...........................  Revision of heart chamber
33496.................................  C...........................  Repair, prosth valve clot
33500.................................  C...........................  Repair heart vessel fistula
33501.................................  C...........................  Repair heart vessel fistula
33502.................................  C...........................  Coronary artery correction
33503.................................  C...........................  Coronary artery graft
33504.................................  C...........................  Coronary artery graft
33505.................................  C...........................  Repair artery w/tunnel
33506.................................  C...........................  Repair artery, translocation
33510.................................  C...........................  CABG, vein, single
33511.................................  C...........................  CABG, vein, two
33512.................................  C...........................  CABG, vein, three
33513.................................  C...........................  CABG, vein, four
33514.................................  C...........................  CABG, vein, five
33516.................................  C...........................  Cabg, vein, six or more
33517.................................  C...........................  CABG, artery-vein, single
33518.................................  C...........................  CABG, artery-vein, two
33519.................................  C...........................  CABG, artery-vein, three
33521.................................  C...........................  CABG, artery-vein, four
33522.................................  C...........................  CABG, artery-vein, five
33523.................................  C...........................  Cabg, art-vein, six or more
33530.................................  C...........................  Coronary artery, bypass/reop
33533.................................  C...........................  CABG, arterial, single
33534.................................  C...........................  CABG, arterial, two
33535.................................  C...........................  CABG, arterial, three
33536.................................  C...........................  Cabg, arterial, four or more
33542.................................  C...........................  Removal of heart lesion
33545.................................  C...........................  Repair of heart damage
33572.................................  C...........................  Open coronary endarterectomy
33600.................................  C...........................  Closure of valve
33602.................................  C...........................  Closure of valve
33606.................................  C...........................  Anastomosis/artery-aorta
33608.................................  C...........................  Repair anomaly w/conduit
33610.................................  C...........................  Repair by enlargement
33611.................................  C...........................  Repair double ventricle
33612.................................  C...........................  Repair double ventricle
33615.................................  C...........................  Repair, modified fontan
33617.................................  C...........................  Repair single ventricle
33619.................................  C...........................  Repair single ventricle
33641.................................  C...........................  Repair heart septum defect
33645.................................  C...........................  Revision of heart veins
33647.................................  C...........................  Repair heart septum defects

[[Page 48223]]

 
33660.................................  C...........................  Repair of heart defects
33665.................................  C...........................  Repair of heart defects
33670.................................  C...........................  Repair of heart chambers
33681.................................  C...........................  Repair heart septum defect
33684.................................  C...........................  Repair heart septum defect
33688.................................  C...........................  Repair heart septum defect
33690.................................  C...........................  Reinforce pulmonary artery
33692.................................  C...........................  Repair of heart defects
33694.................................  C...........................  Repair of heart defects
33697.................................  C...........................  Repair of heart defects
33702.................................  C...........................  Repair of heart defects
33710.................................  C...........................  Repair of heart defects
33720.................................  C...........................  Repair of heart defect
33722.................................  C...........................  Repair of heart defect
33730.................................  C...........................  Repair heart-vein defect(s)
33732.................................  C...........................  Repair heart-vein defect
33735.................................  C...........................  Revision of heart chamber
33736.................................  C...........................  Revision of heart chamber
33737.................................  C...........................  Revision of heart chamber
33750.................................  C...........................  Major vessel shunt
33755.................................  C...........................  Major vessel shunt
33762.................................  C...........................  Major vessel shunt
33764.................................  C...........................  Major vessel shunt & graft
33766.................................  C...........................  Major vessel shunt
33767.................................  C...........................  Major vessel shunt
33770.................................  C...........................  Repair great vessels defect
33771.................................  C...........................  Repair great vessels defect
33774.................................  C...........................  Repair great vessels defect
33775.................................  C...........................  Repair great vessels defect
33776.................................  C...........................  Repair great vessels defect
33777.................................  C...........................  Repair great vessels defect
33778.................................  C...........................  Repair great vessels defect
33779.................................  C...........................  Repair great vessels defect
33780.................................  C...........................  Repair great vessels defect
33781.................................  C...........................  Repair great vessels defect
33786.................................  C...........................  Repair arterial trunk
33788.................................  C...........................  Revision of pulmonary artery
33800.................................  C...........................  Aortic suspension
33802.................................  C...........................  Repair vessel defect
33803.................................  C...........................  Repair vessel defect
33813.................................  C...........................  Repair septal defect
33814.................................  C...........................  Repair septal defect
33820.................................  C...........................  Revise major vessel
33822.................................  C...........................  Revise major vessel
33824.................................  C...........................  Revise major vessel
33840.................................  C...........................  Remove aorta constriction
33845.................................  C...........................  Remove aorta constriction
33851.................................  C...........................  Remove aorta constriction
33852.................................  C...........................  Repair septal defect
33853.................................  C...........................  Repair septal defect
33860.................................  C...........................  Ascending aortic graft
33861.................................  C...........................  Ascending aortic graft
33863.................................  C...........................  Ascending aortic graft
33870.................................  C...........................  Transverse aortic arch graft
33875.................................  C...........................  Thoracic aortic graft
33877.................................  C...........................  Thoracoabdominal graft
33910.................................  C...........................  Remove lung artery emboli
33915.................................  C...........................  Remove lung artery emboli
33916.................................  C...........................  Surgery of great vessel
33917.................................  C...........................  Repair pulmonary artery
33918.................................  C...........................  Repair pulmonary atresia
33919.................................  C...........................  Repair pulmonary atresia
33920.................................  C...........................  Repair pulmonary atresia
33922.................................  C...........................  Transect pulmonary artery
33924.................................  C...........................  Remove pulmonary shunt

[[Page 48224]]

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

[[Page 48225]]

 
35189.................................  C...........................  Repair blood vessel lesion
35211.................................  C...........................  Repair blood vessel lesion
35216.................................  C...........................  Repair blood vessel lesion
35221.................................  C...........................  Repair blood vessel lesion
35241.................................  C...........................  Repair blood vessel lesion
35246.................................  C...........................  Repair blood vessel lesion
35251.................................  C...........................  Repair blood vessel lesion
35271.................................  C...........................  Repair blood vessel lesion
35276.................................  C...........................  Repair blood vessel lesion
35281.................................  C...........................  Repair blood vessel lesion
35301.................................  C...........................  Rechanneling of artery
35311.................................  C...........................  Rechanneling of artery
35331.................................  C...........................  Rechanneling of artery
35341.................................  C...........................  Rechanneling of artery
35351.................................  C...........................  Rechanneling of artery
35355.................................  C...........................  Rechanneling of artery
35361.................................  C...........................  Rechanneling of artery
35363.................................  C...........................  Rechanneling of artery
35371.................................  C...........................  Rechanneling of artery
35372.................................  C...........................  Rechanneling of artery
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

[[Page 48226]]

 
35616.................................  C...........................  Artery bypass graft
35621.................................  C...........................  Artery bypass graft
35623.................................  C...........................  Bypass graft, not vein
35626.................................  C...........................  Artery bypass graft
35631.................................  C...........................  Artery bypass graft
35636.................................  C...........................  Artery bypass graft
35641.................................  C...........................  Artery bypass graft
35642.................................  C...........................  Artery bypass graft
35645.................................  C...........................  Artery bypass graft
35646.................................  C...........................  Artery bypass graft
35647.................................  C...........................  Artery bypass graft
35650.................................  C...........................  Artery bypass graft
35651.................................  C...........................  Artery bypass graft
35654.................................  C...........................  Artery bypass graft
35656.................................  C...........................  Artery bypass graft
35661.................................  C...........................  Artery bypass graft
35663.................................  C...........................  Artery bypass graft
35665.................................  C...........................  Artery bypass graft
35666.................................  C...........................  Artery bypass graft
35671.................................  C...........................  Artery bypass graft
35681.................................  C...........................  Composite bypass graft
35682.................................  C...........................  Composite bypass graft
35683.................................  C...........................  Composite bypass graft
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

[[Page 48227]]

 
38746.................................  C...........................  Remove thoracic lymph nodes
38747.................................  C...........................  Remove abdominal lymph nodes
38765.................................  C...........................  Remove groin lymph nodes
38770.................................  C...........................  Remove pelvis lymph nodes
38780.................................  C...........................  Remove abdomen lymph nodes
39000.................................  C...........................  Exploration of chest
39010.................................  C...........................  Exploration of chest
39200.................................  C...........................  Removal chest lesion
39220.................................  C...........................  Removal chest lesion
39499.................................  C...........................  Chest procedure
39501.................................  C...........................  Repair diaphragm laceration
39502.................................  C...........................  Repair paraesophageal hernia
39503.................................  C...........................  Repair of diaphragm hernia
39520.................................  C...........................  Repair of diaphragm hernia
39530.................................  C...........................  Repair of diaphragm hernia
39531.................................  C...........................  Repair of diaphragm hernia
39540.................................  C...........................  Repair of diaphragm hernia
39541.................................  C...........................  Repair of diaphragm hernia
39545.................................  C...........................  Revision of diaphragm
39560.................................  C...........................  Resect diaphragm, simple
39561.................................  C...........................  Resect diaphragm, complex
39599.................................  C...........................  Diaphragm surgery procedure
41130.................................  C...........................  Partial removal of tongue
41135.................................  C...........................  Tongue and neck surgery
41140.................................  C...........................  Removal of tongue
41145.................................  C...........................  Tongue removal, neck surgery
41150.................................  C...........................  Tongue, mouth, jaw surgery
41153.................................  C...........................  Tongue, mouth, neck surgery
41155.................................  C...........................  Tongue, jaw, & neck surgery
42426.................................  C...........................  Excise parotid gland/lesion
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...........................  Partial 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 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

[[Page 48228]]

 
43351.................................  C...........................  Surgical opening, esophagus
43352.................................  C...........................  Surgical opening, esophagus
43360.................................  C...........................  Gastrointestinal repair
43361.................................  C...........................  Gastrointestinal repair
43400.................................  C...........................  Ligate esophagus veins
43401.................................  C...........................  Esophagus surgery for veins
43405.................................  C...........................  Ligate/staple esophagus
43410.................................  C...........................  Repair esophagus wound
43415.................................  C...........................  Repair esophagus wound
43420.................................  C...........................  Repair esophagus opening
43425.................................  C...........................  Repair esophagus opening
43460.................................  C...........................  Pressure treatment esophagus
43496.................................  C...........................  Free jejunum flap, microvasc
43500.................................  C...........................  Surgical opening of stomach
43501.................................  C...........................  Surgical repair of stomach
43502.................................  C...........................  Surgical repair of stomach
43510.................................  C...........................  Surgical opening of stomach
43520.................................  C...........................  Incision of pyloric muscle
43605.................................  C...........................  Biopsy of stomach
43610.................................  C...........................  Excision of stomach lesion
43611.................................  C...........................  Excision of stomach lesion
43620.................................  C...........................  Removal of stomach
43621.................................  C...........................  Removal of stomach
43622.................................  C...........................  Removal of stomach
43631.................................  C...........................  Removal of stomach, partial
43632.................................  C...........................  Removal of stomach, partial
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/o taper, cong
44127.................................  C...........................  Enterectomy w/taper, cong
44128.................................  C...........................  Enterectomy cong, add-on

[[Page 48229]]

 
44130.................................  C...........................  Bowel to bowel fusion
44132.................................  C...........................  Enterectomy, cadaver donor
44133.................................  C...........................  Enterectomy, live donor
44135.................................  C...........................  Intestine transplnt, cadaver
44136.................................  C...........................  Intestine transplant, live
44139.................................  C...........................  Mobilization of colon
44140.................................  C...........................  Partial removal of colon
44141.................................  C...........................  Partial removal of colon
44143.................................  C...........................  Partial removal of colon
44144.................................  C...........................  Partial removal of colon
44145.................................  C...........................  Partial removal of colon
44146.................................  C...........................  Partial removal of colon
44147.................................  C...........................  Partial removal of colon
44150.................................  C...........................  Removal of colon
44151.................................  C...........................  Removal of colon/ileostomy
44152.................................  C...........................  Removal of colon/ileostomy
44153.................................  C...........................  Removal of colon/ileostomy
44155.................................  C...........................  Removal of colon/ileostomy
44156.................................  C...........................  Removal of colon/ileostomy
44160.................................  C...........................  Removal of colon
44202.................................  C...........................  Lap resect s/intestine singl
44203.................................  C...........................  Lap resect s/intestine, addl
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

[[Page 48230]]

 
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 reservior
45540.................................  C...........................  Correct rectal prolapse
45541.................................  C...........................  Correct rectal prolapse
45550.................................  C...........................  Repair rectum/remove sigmoid
45562.................................  C...........................  Exploration/repair of rectum
45563.................................  C...........................  Exploration/repair of rectum
45800.................................  C...........................  Repair rect/bladder fistula
45805.................................  C...........................  Repair fistula w/colostomy
45820.................................  C...........................  Repair rectourethral fistula
45825.................................  C...........................  Repair fistula w/colostomy
46705.................................  C...........................  Repair of anal stricture
46715.................................  C...........................  Repair of anovaginal fistula
46716.................................  C...........................  Repair of anovaginal fistula
46730.................................  C...........................  Construction of absent anus
46735.................................  C...........................  Construction of absent anus
46740.................................  C...........................  Construction of absent anus
46742.................................  C...........................  Repair of imperforated anus
46744.................................  C...........................  Repair of cloacal anomaly
46746.................................  C...........................  Repair of cloacal anomaly
46748.................................  C...........................  Repair of cloacal anomaly
46751.................................  C...........................  Repair of anal sphincter
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

[[Page 48231]]

 
47740.................................  C...........................  Fuse gallbladder & bowel
47741.................................  C...........................  Fuse gallbladder & bowel
47760.................................  C...........................  Fuse bile ducts and bowel
47765.................................  C...........................  Fuse liver ducts & bowel
47780.................................  C...........................  Fuse bile ducts and bowel
47785.................................  C...........................  Fuse bile ducts and bowel
47800.................................  C...........................  Reconstruction of bile ducts
47801.................................  C...........................  Placement, bile duct support
47802.................................  C...........................  Fuse liver duct & intestine
47900.................................  C...........................  Suture bile duct injury
48000.................................  C...........................  Drainage of abdomen
48001.................................  C...........................  Placement of drain, pancreas
48005.................................  C...........................  Resect/debride pancreas
48020.................................  C...........................  Removal of pancreatic stone
48100.................................  C...........................  Biopsy of pancreas, open
48120.................................  C...........................  Removal of pancreas lesion
48140.................................  C...........................  Partial removal of pancreas
48145.................................  C...........................  Partial removal of pancreas
48146.................................  C...........................  Pancreatectomy
48148.................................  C...........................  Removal of pancreatic duct
48150.................................  C...........................  Partial removal of pancreas
48152.................................  C...........................  Pancreatectomy
48153.................................  C...........................  Pancreatectomy
48154.................................  C...........................  Pancreatectomy
48155.................................  C...........................  Removal of pancreas
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...........................  Remove abdom lesion, complex
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

[[Page 48232]]

 
50075.................................  C...........................  Removal of kidney stone
50100.................................  C...........................  Revise kidney blood vessels
50120.................................  C...........................  Exploration of kidney
50125.................................  C...........................  Explore and drain kidney
50130.................................  C...........................  Removal of kidney stone
50135.................................  C...........................  Exploration of kidney
50205.................................  C...........................  Biopsy of kidney
50220.................................  C...........................  Remove kidney, open
50225.................................  C...........................  Removal kidney open, complex
50230.................................  C...........................  Removal kidney open, radical
50234.................................  C...........................  Removal of kidney & ureter
50236.................................  C...........................  Removal of kidney & ureter
50240.................................  C...........................  Partial removal of kidney
50280.................................  C...........................  Removal of kidney lesion
50290.................................  C...........................  Removal of kidney lesion
50300.................................  C...........................  Removal of donor kidney
50320.................................  C...........................  Removal of donor kidney
50340.................................  C...........................  Removal of kidney
50360.................................  C...........................  Transplantation of kidney
50365.................................  C...........................  Transplantation of kidney
50370.................................  C...........................  Remove transplanted kidney
50380.................................  C...........................  Reimplantation of kidney
50400.................................  C...........................  Revision of kidney/ureter
50405.................................  C...........................  Revision of kidney/ureter
50500.................................  C...........................  Repair of kidney wound
50520.................................  C...........................  Close kidney-skin fistula
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

[[Page 48233]]

 
50825.................................  C...........................  Construct bowel bladder
50830.................................  C...........................  Revise urine flow
50840.................................  C...........................  Replace ureter by bowel
50845.................................  C...........................  Appendico-vesicostomy
50860.................................  C...........................  Transplant ureter to skin
50900.................................  C...........................  Repair of ureter
50920.................................  C...........................  Closure ureter/skin fistula
50930.................................  C...........................  Closure ureter/bowel fistula
50940.................................  C...........................  Release of ureter
51060.................................  C...........................  Removal of ureter stone
51525.................................  C...........................  Removal of bladder lesion
51530.................................  C...........................  Removal of bladder lesion
51535.................................  C...........................  Repair of ureter lesion
51550.................................  C...........................  Partial removal of bladder
51555.................................  C...........................  Partial removal of bladder
51565.................................  C...........................  Revise bladder & ureter(s)
51570.................................  C...........................  Removal of bladder
51575.................................  C...........................  Removal of bladder & nodes
51580.................................  C...........................  Remove bladder/revise tract
51585.................................  C...........................  Removal of bladder & nodes
51590.................................  C...........................  Remove bladder/revise tract
51595.................................  C...........................  Remove bladder/revise tract
51596.................................  C...........................  Remove bladder/create pouch
51597.................................  C...........................  Removal of pelvic structures
51800.................................  C...........................  Revision of bladder/urethra
51820.................................  C...........................  Revision of urinary tract
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...........................  Remov/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

[[Page 48234]]

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

[[Page 48235]]

 
58952.................................  C...........................  Resect ovarian malignancy
58953.................................  C...........................  Tah, rad dissect for debulk
58954.................................  C...........................  Tah rad debulk/lymph remove
58960.................................  C...........................  Exploration of abdomen
59100.................................  C...........................  Remove uterus lesion
59120.................................  C...........................  Treat ectopic pregnancy
59121.................................  C...........................  Treat ectopic pregnancy
59130.................................  C...........................  Treat ectopic pregnancy
59135.................................  C...........................  Treat ectopic pregnancy
59136.................................  C...........................  Treat ectopic pregnancy
59140.................................  C...........................  Treat ectopic pregnancy
59325.................................  C...........................  Revision of cervix
59350.................................  C...........................  Repair of uterus
59514.................................  C...........................  Cesarean delivery only
59525.................................  C...........................  Remove uterus after cesarean
59620.................................  C...........................  Attempted vbac delivery only
59830.................................  C...........................  Treat uterus infection
59850.................................  C...........................  Abortion
59851.................................  C...........................  Abortion
59852.................................  C...........................  Abortion
59855.................................  C...........................  Abortion
59856.................................  C...........................  Abortion
59857.................................  C...........................  Abortion
60254.................................  C...........................  Extensive thyroid surgery
60270.................................  C...........................  Removal of thyroid
60271.................................  C...........................  Removal of thyroid
60502.................................  C...........................  Re-explore parathyroids
60505.................................  C...........................  Explore parathyroid glands
60520.................................  C...........................  Removal of thymus gland
60521.................................  C...........................  Removal of thymus gland
60522.................................  C...........................  Removal of thymus gland
60540.................................  C...........................  Explore adrenal gland
60545.................................  C...........................  Explore adrenal gland
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

[[Page 48236]]

 
61450.................................  C...........................  Incise skull for surgery
61458.................................  C...........................  Incise skull for brain wound
61460.................................  C...........................  Incise skull for surgery
61470.................................  C...........................  Incise skull for surgery
61480.................................  C...........................  Incise skull for surgery
61490.................................  C...........................  Incise skull for surgery
61500.................................  C...........................  Removal of skull lesion
61501.................................  C...........................  Remove infected skull bone
61510.................................  C...........................  Removal of brain lesion
61512.................................  C...........................  Remove brain lining lesion
61514.................................  C...........................  Removal of brain abscess
61516.................................  C...........................  Removal of brain lesion
61518.................................  C...........................  Removal of brain lesion
61519.................................  C...........................  Remove brain lining lesion
61520.................................  C...........................  Removal of brain lesion
61521.................................  C...........................  Removal of brain lesion
61522.................................  C...........................  Removal of brain abscess
61524.................................  C...........................  Removal of brain lesion
61526.................................  C...........................  Removal of brain lesion
61530.................................  C...........................  Removal of brain lesion
61531.................................  C...........................  Implant brain electrodes
61533.................................  C...........................  Implant brain electrodes
61534.................................  C...........................  Removal of brain lesion
61535.................................  C...........................  Remove brain electrodes
61536.................................  C...........................  Removal of brain lesion
61538.................................  C...........................  Removal of brain tissue
61539.................................  C...........................  Removal of brain tissue
61541.................................  C...........................  Incision of brain tissue
61542.................................  C...........................  Removal of brain tissue
61543.................................  C...........................  Removal of brain tissue
61544.................................  C...........................  Remove & treat brain lesion
61545.................................  C...........................  Excision of brain tumor
61546.................................  C...........................  Removal of pituitary gland
61548.................................  C...........................  Removal of pituitary gland
61550.................................  C...........................  Release of skull seams
61552.................................  C...........................  Release of skull seams
61556.................................  C...........................  Incise skull/sutures
61557.................................  C...........................  Incise skull/sutures
61558.................................  C...........................  Excision of skull/sutures
61559.................................  C...........................  Excision of skull/sutures
61563.................................  C...........................  Excision of skull tumor
61564.................................  C...........................  Excision of skull tumor
61570.................................  C...........................  Remove foreign body, brain
61571.................................  C...........................  Incise skull for brain wound
61575.................................  C...........................  Skull base/brainstem surgery
61576.................................  C...........................  Skull base/brainstem surgery
61580.................................  C...........................  Craniofacial approach, skull
61581.................................  C...........................  Craniofacial approach, skull
61582.................................  C...........................  Craniofacial approach, skull
61583.................................  C...........................  Craniofacial approach, skull
61584.................................  C...........................  Orbitocranial approach/skull
61585.................................  C...........................  Orbitocranial approach/skull
61586.................................  C...........................  Resect nasopharynx, skull
61590.................................  C...........................  Infratemporal approach/skull
61591.................................  C...........................  Infratemporal approach/skull
61592.................................  C...........................  Orbitocranial approach/skull
61595.................................  C...........................  Transtemporal approach/skull
61596.................................  C...........................  Transcochlear approach/skull
61597.................................  C...........................  Transcondylar approach/skull
61598.................................  C...........................  Transpetrosal approach/skull
61600.................................  C...........................  Resect/excise cranial lesion
61601.................................  C...........................  Resect/excise cranial lesion
61605.................................  C...........................  Resect/excise cranial lesion
61606.................................  C...........................  Resect/excise cranial lesion
61607.................................  C...........................  Resect/excise cranial lesion

[[Page 48237]]

 
61608.................................  C...........................  Resect/excise cranial lesion
61609.................................  C...........................  Transect artery, sinus
61610.................................  C...........................  Transect artery, sinus
61611.................................  C...........................  Transect artery, sinus
61612.................................  C...........................  Transect artery, sinus
61613.................................  C...........................  Remove aneurysm, sinus
61615.................................  C...........................  Resect/excise lesion, skull
61616.................................  C...........................  Resect/excise lesion, skull
61618.................................  C...........................  Repair dura
61619.................................  C...........................  Repair dura
61624.................................  C...........................  Occlusion/embolization cath
61680.................................  C...........................  Intracranial vessel surgery
61682.................................  C...........................  Intracranial vessel surgery
61684.................................  C...........................  Intracranial vessel surgery
61686.................................  C...........................  Intracranial vessel surgery
61690.................................  C...........................  Intracranial vessel surgery
61692.................................  C...........................  Intracranial vessel surgery
61697.................................  C...........................  Brain aneurysm repr, complx
61698.................................  C...........................  Brain aneurysm repr, complx
61700.................................  C...........................  Brain aneurysm repr, simple
61702.................................  C...........................  Inner skull vessel surgery
61703.................................  C...........................  Clamp neck artery
61705.................................  C...........................  Revise circulation to head
61708.................................  C...........................  Revise circulation to head
61710.................................  C...........................  Revise circulation to head
61711.................................  C...........................  Fusion of skull arteries
61720.................................  C...........................  Incise skull/brain surgery
61735.................................  C...........................  Incise skull/brain surgery
61750.................................  C...........................  Incise skull/brain biopsy
61751.................................  C...........................  Brain biopsy w/ ct/mr guide
61760.................................  C...........................  Implant brain electrodes
61770.................................  C...........................  Incise skull for treatment
61850.................................  C...........................  Implant neuroelectrodes
61860.................................  C...........................  Implant neuroelectrodes
61862.................................  C...........................  Implant neurostimul, subcort
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

[[Page 48238]]

 
62256.................................  C...........................  Remove brain cavity shunt
62258.................................  C...........................  Replace brain cavity shunt
63043.................................  C...........................  Laminotomy, addl cervical
63044.................................  C...........................  Laminotomy, addl lumbar
63075.................................  C...........................  Neck spine disk surgery
63076.................................  C...........................  Neck spine disk surgery
63077.................................  C...........................  Spine disk surgery, thorax
63078.................................  C...........................  Spine disk surgery, thorax
63081.................................  C...........................  Removal of vertebral body
63082.................................  C...........................  Remove vertebral body add-on
63085.................................  C...........................  Removal of vertebral body
63086.................................  C...........................  Remove vertebral body add-on
63087.................................  C...........................  Removal of vertebral body
63088.................................  C...........................  Remove vertebral body add-on
63090.................................  C...........................  Removal of vertebral body
63091.................................  C...........................  Remove vertebral body add-on
63170.................................  C...........................  Incise spinal cord tract(s)
63172.................................  C...........................  Drainage of spinal cyst
63173.................................  C...........................  Drainage of spinal cyst
63180.................................  C...........................  Revise spinal cord ligaments
63182.................................  C...........................  Revise spinal cord ligaments
63185.................................  C...........................  Incise spinal column/nerves
63190.................................  C...........................  Incise spinal column/nerves
63191.................................  C...........................  Incise spinal column/nerves
63194.................................  C...........................  Incise spinal column & cord
63195.................................  C...........................  Incise spinal column & cord
63196.................................  C...........................  Incise spinal column & cord
63197.................................  C...........................  Incise spinal column & cord
63198.................................  C...........................  Incise spinal column & cord
63199.................................  C...........................  Incise spinal column & cord
63200.................................  C...........................  Release of spinal cord
63250.................................  C...........................  Revise spinal cord vessels
63251.................................  C...........................  Revise spinal cord vessels
63252.................................  C...........................  Revise spinal cord vessels
63265.................................  C...........................  Excise intraspinal lesion
63266.................................  C...........................  Excise intraspinal lesion
63267.................................  C...........................  Excise intraspinal lesion
63268.................................  C...........................  Excise intraspinal lesion
63270.................................  C...........................  Excise intraspinal lesion
63271.................................  C...........................  Excise intraspinal lesion
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

[[Page 48239]]

 
63704.................................  C...........................  Repair of spinal herniation
63706.................................  C...........................  Repair of spinal herniation
63707.................................  C...........................  Repair spinal fluid leakage
63709.................................  C...........................  Repair spinal fluid leakage
63710.................................  C...........................  Graft repair of spine defect
63740.................................  C...........................  Install spinal shunt
64752.................................  C...........................  Incision of vagus nerve
64755.................................  C...........................  Incision of stomach nerves
64760.................................  C...........................  Incision of vagus nerve
64763.................................  C...........................  Incise hip/thigh nerve
64766.................................  C...........................  Incise hip/thigh nerve
64804.................................  C...........................  Remove sympathetic nerves
64809.................................  C...........................  Remove sympathetic nerves
64818.................................  C...........................  Remove sympathetic nerves
64866.................................  C...........................  Fusion of facial/other nerve
64868.................................  C...........................  Fusion of facial/other nerve
65273.................................  C...........................  Repair of eye wound
69155.................................  C...........................  Extensive ear/neck surgery
69535.................................  C...........................  Remove part of temporal bone
69554.................................  C...........................  Remove ear lesion
69950.................................  C...........................  Incise inner ear nerve
69970.................................  C...........................  Remove inner ear lesion
75900.................................  C...........................  Arterial catheter exchange
75952.................................  C...........................  Endovasc repair abdom aorta
75953.................................  C...........................  Abdom aneurysm endovas rpr
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
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
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
----------------------------------------------------------------------------------------------------------------
CPT codes and escriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/
  DFARS Apply.
Copyright American Dental Association. All right reserved.






  Federal Register / Vol. 68, No. 155 / Tuesday, August 12, 2003 / 
Proposed Rules  

[[Page 48239]]




                 Addendum H.--Wage Index for Urban Areas
------------------------------------------------------------------------
                                                                  Wage
              Urban area  (constituent counties)                  index
------------------------------------------------------------------------
0040 Abilene, TX..............................................    0.7678
  Taylor, TX
0060 Aguadilla, PR............................................    0.4335
  Aguada, PR
  Aguadilla, PR
  Moca, PR
0080 Akron, OH................................................    0.9445
  Portage, OH
  Summit, OH
0120 Albany, GA...............................................    1.0838
  Dougherty, GA
  Lee, GA
0160 Albany-Schenectady-Troy, NY..............................    0.8693
  Albany, NY
  Montgomery, NY
  Rensselaer, NY
  Saratoga, NY
  Schenectady, NY
  Schoharie, NY
0200 Albuquerque, NM..........................................    0.9431
  Bernalillo, NM
  Sandoval, NM
  Valencia, NM

[[Page 48240]]

 
0220 Alexandria, LA...........................................    0.8087
  Rapides, LA
0240 Allentown-Bethlehem-Easton, PA...........................    0.9576
  Carbon, PA
  Lehigh, PA
  Northampton, PA
0280 Altoona, PA..............................................    0.8886
  Blair, PA
0320 Amarillo, TX.............................................    0.8968
  Potter, TX
  Randall, TX
0380 Anchorage, AK............................................    1.2433
  Anchorage, AK
0440 Ann Arbor, MI............................................    1.1069
  Lenawee, MI
  Livingston, MI
  Washtenaw, MI
0450 Anniston, AL.............................................    0.8140
  Calhoun, AL
0460 Appleton-Oshkosh-Neenah, WI \2\..........................    0.9130
  Calumet, WI
  Outagamie, WI
  Winnebago, WI
0470 Arecibo, PR..............................................    0.4130
  Arecibo, PR
  Camuy, PR
  Hatillo, PR
0480 Asheville, NC............................................    0.9697
  Buncombe, NC
  Madison, NC
0500 Athens, GA...............................................    0.9664
  Clarke, GA
  Madison, GA
  Oconee, GA
0520 Atlanta, GA \1\..........................................    1.0027
  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....................................    1.0862
  Atlantic, NJ
  Cape May, NJ
0580 Auburn-Opelika, AL.......................................    0.8540
  Lee, AL
0600 Augusta-Aiken, GA-SC.....................................    0.9725
  Columbia, GA
  McDuffie, GA
  Richmond, GA
  Aiken, SC
  Edgefield, SC
0640 Austin-San Marcos, TX \1\................................    0.9551
  Bastrop, TX
  Caldwell, TX
  Hays, TX
  Travis, TX
  Williamson, TX
0680 Bakersfield, CA \2\......................................    0.9907
  Kern, CA
0720 Baltimore, MD \1\........................................    0.9951
  Anne Arundel, MD
  Baltimore, MD
  Baltimore City, MD
  Carroll, MD
  Harford, MD
  Howard, MD
  Queen Anne's, MD
0733 Bangor, ME...............................................    0.9750
  Penobscot, ME
0743 Barnstable-Yarmouth, MA..................................    1.2893
  Barnstable, MA
0760 Baton Rouge, LA..........................................    0.8271
  Ascension, LA
  East Baton Rouge, LA
  Livingston, LA
  West Baton Rouge, LA
0840 Beaumont-Port Arthur, TX.................................    0.8503
  Hardin, TX
  Jefferson, TX
  Orange, TX
0860 Bellingham, WA...........................................    1.1834
  Whatcom, WA
0870 Benton Harbor, MI........................................    0.8949
  Berrien, MI
0875 Bergen-Passaic, NJ \1\...................................    1.1655
  Bergen, NJ
  Passaic, NJ
0880 Billings, MT.............................................    0.8889
  Yellowstone, MT
0920 Biloxi-Gulfport-Pascagoula, MS...........................    0.9089
  Hancock, MS
  Harrison, MS
  Jackson, MS
0960 Binghamton, NY \2\.......................................    0.8530
  Broome, NY
  Tioga, NY
1000 Birmingham, AL...........................................    0.9251
  Blount, AL
  Jefferson, AL
  St. Clair, AL
  Shelby, AL
1010 Bismarck, ND.............................................    0.8101
  Burleigh, ND
  Morton, ND
1020 Bloomington, IN..........................................    0.8968
  Monroe, IN
1040 Bloomington-Normal, IL...................................    0.8954
  McLean, IL
1080 Boise City, ID...........................................    0.9295
  Ada, ID
  Canyon, ID
1123 Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH \1\.....    1.1269
  Bristol, MA
  Essex, MA
  Middlesex, MA
  Norfolk, MA
  Plymouth, MA
  Suffolk, MA
  Worcester, MA
  Hillsborough, NH
  Merrimack, NH
  Rockingham, NH
  Strafford, NH
1125 Boulder-Longmont, CO.....................................    1.0119
  Boulder, CO
1145 Brazoria, TX.............................................    0.8324
  Brazoria, TX
1150 Bremerton, WA............................................    1.0601
  Kitsap, WA
1240 Brownsville-Harlingen-San Benito, TX.....................   21.0231
  Cameron, TX
1260 Bryan-College Station, TX................................
  Brazos, TX
  0.9044......................................................
1280 Buffalo-Niagara Falls, NY \1\............................    0.9600
  Erie, NY
  Niagara, NY
1303 Burlington, VT...........................................    0.9768
  Chittenden, VT
  Franklin, VT
  Grand Isle, VT
1310 Caguas, PR...............................................    0.4229
  Caguas, PR
  Cayey, PR
  Cidra, PR
  Gurabo, PR
  San Lorenzo, PR
1320 Canton-Massillon, OH.....................................    0.9128
  Carroll, OH
  Stark, OH
1350 Casper, WY...............................................    0.9239
  Natrona, WY
1360 Cedar Rapids, IA.........................................    0.8933
  Linn, IA
1400 Champaign-Urbana, IL.....................................    0.9907
  Champaign, IL
1440 Charleston-North Charleston, SC..........................    0.9307
  Berkeley, SC
  Charleston, SC
  Dorchester, SC
1480 Charleston, WV...........................................    0.8753
  Kanawha, WV
  Putnam, WV
1520 Charlotte-Gastonia-Rock Hill, NC-SC \1\..................    0.9766
  Cabarrus, NC
  Gaston, NC
  Lincoln, NC
  Mecklenburg, NC
  Rowan, NC
  Stanly, NC
  Union, NC
  York, SC
1540 Charlottesville, VA......................................    1.0092
  Albemarle, VA
  Charlottesville City, VA
  Fluvanna, VA
  Greene, VA
1560 Chattanooga, TN-GA.......................................    0.8985
  Catoosa, GA
  Dade, GA
  Walker, GA
  Hamilton, TN
  Marion, TN
1580 Cheyenne, WY \2\.........................................    0.9137
  Laramie, WY
1600 Chicago, IL \1\..........................................    1.1012
  Cook, IL
  DeKalb, IL

[[Page 48241]]

 
  DuPage, IL
  Grundy, IL
  Kane, IL
  Kendall, IL
  Lake, IL
  McHenry, IL
  Will, IL
1620 Chico-Paradise, CA.......................................    1.0147
  Butte, CA
1640 Cincinnati, OH-KY-IN \1\.................................    0.9452
  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..........................    0.8410
  Christian, KY
  Montgomery, TN
1680 Cleveland-Lorain-Elyria, OH \1\..........................    0.9686
  Ashtabula, OH
  Cuyahoga, OH
  Geauga, OH
  Lake, OH
  Lorain, OH
  Medina, OH
1720 Colorado Springs, CO \2\.................................    0.8897
  El Paso, CO
1740 Columbia, MO.............................................    0.8745
  Boone, MO
1760 Columbia, SC.............................................    0.8958
  Lexington, SC
  Richland, SC
1800 Columbus, GA-AL..........................................    0.8700
  Russell, AL
  Chattahoochee, GA
  Harris, GA
  Muscogee, GA
1840 Columbus, OH \1\.........................................    0.9649
  Delaware, OH
  Fairfield, OH
  Franklin, OH
  Licking, OH
  Madison, OH
  Pickaway, OH
1880 Corpus Christi, TX.......................................    0.8565
  Nueces, TX
  San Patricio, TX
1890 Corvallis, OR............................................    1.1593
  Benton, OR
1900 Cumberland, MD-WV \2\ (MD Hospitals).....................    0.9175
  Allegany, MD
  Mineral, WV
1900 Cumberland, MD-WV (WV Hospitals).........................    0.8224
  Allegany, MD
  Mineral, WV
1920 Dallas, TX \1\...........................................    0.9733
  Collin, TX
  Dallas, TX
  Denton, TX
  Ellis, TX
  Henderson, TX
  Hunt, TX
  Kaufman, TX
  Rockwall, TX
1950 Danville, VA.............................................    0.9095
  Danville City, VA
  Pittsylvania, VA
1960 Davenport-Moline-Rock Island, IA-IL......................    0.8727
  Scott, IA
  Henry, IL
  Rock Island, IL
2000 Dayton-Springfield, OH...................................    0.9432
  Clark, OH
  Greene, OH
  Miami, OH
  Montgomery, OH
2020 Daytona Beach, FL........................................    0.9208
  Flagler, FL
  Volusia, FL
2030 Decatur, AL..............................................    0.8882
  Lawrence, AL
  Morgan, AL
2040 Decatur, IL \2\..........................................    0.8282
  Macon, IL
2080 Denver, CO \1\...........................................    1.0776
  Adams, CO
  Arapahoe, CO
  Broomfield, CO
  Denver, CO
  Douglas, CO
  Jefferson, CO
2120 Des Moines, IA...........................................    0.9053
  Dallas, IA
  Polk, IA
  Warren, IA
2160 Detroit, MI \1\..........................................    1.0097
  Lapeer, MI
  Macomb, MI
  Monroe, MI
  Oakland, MI
  St. Clair, MI
  Wayne, MI
2180 Dothan, AL...............................................    0.7931
  Dale, AL
  Houston, AL
2190 Dover, DE................................................    0.9870
  Kent, DE
2200 Dubuque, IA..............................................    0.8946
  Dubuque, IA
2240 Duluth-Superior, MN-WI...................................    1.0133
  St. Louis, MN
  Douglas, WI
2281 Dutchess County, NY......................................    1.0966
  Dutchess, NY
2290 Eau Claire, WI...........................................    0.9141
  Chippewa, WI
  Eau Claire, WI
2320 El Paso, TX..............................................    0.9267
  El Paso, TX
2330 Elkhart-Goshen, IN.......................................    0.9848
  Elkhart, IN
2335 Elmira, NY \2\...........................................    0.8530
  Chemung, NY
2340 Enid, OK.................................................    0.8616
  Garfield, OK
2360 Erie, PA.................................................    0.8636
  Erie, PA
2400 Eugene-Springfield, OR...................................    1.1212
  Lane, OR
2440 Evansville-Henderson, IN-KY \2\ (IN Hospitals)...........    0.8770
  Posey, IN
  Vanderburgh, IN
  Warrick, IN
  Henderson, KY
2440 Evansville-Henderson, IN-KY (KY Hospitals)...............    0.8442
  Posey, IN
  Vanderburgh, IN
  Warrick, IN
  Henderson, KY
2520 Fargo-Moorhead, ND-MN....................................    0.9650
  Clay, MN
  Cass, ND
2560 Fayetteville, NC.........................................    0.8957
  Cumberland, NC
2580 Fayetteville-Springdale-Rogers, AR.......................    0.8038
  Benton, AR
  Washington, AR
2620 Flagstaff, AZ-UT.........................................    1.1283
  Coconino, AZ
  Kane, UT
2640 Flint, MI................................................    1.0929
  Genesee, MI
2650 Florence, AL.............................................    0.7824
  Colbert, AL
  Lauderdale, AL
2655 Florence, SC.............................................    0.8763
  Florence, SC
2670 Fort Collins-Loveland, CO................................    1.0201
  Larimer, CO
2680 Ft. Lauderdale, FL \1\...................................    1.0534
  Broward, FL
2700 Fort Myers-Cape Coral, FL................................    0.9877
  Lee, FL
2710 Fort Pierce-Port St. Lucie, FL...........................    1.0227
  Martin, FL
  St. Lucie, FL
2720 Fort Smith, AR-OK \2\ (AR Hospitals).....................    0.7746
  Crawford, AR
  Sebastian, AR
  Sequoyah, OK
2720 Fort Smith, AR-OK (OK Hospitals).........................    0.7740
  Crawford, AR
  Sebastian, AR
  Sequoyah, OK
2750 Fort Walton Beach, FL....................................    0.8929
  Okaloosa, FL
2760 Fort Wayne, IN...........................................    0.9674
  Adams, IN
  Allen, IN
  De Kalb, IN
  Huntington, IN
  Wells, IN
  Whitley, IN
2800 Forth Worth-Arlington, TX \1\............................    0.9268
  Hood, TX
  Johnson, TX
  Parker, TX
  Tarrant, TX
2840 Fresno, CA...............................................    1.0157
  Fresno, CA
  Madera, CA
2880 Gadsden, AL..............................................    0.8295

[[Page 48242]]

 
  Etowah, AL
2900 Gainesville, FL \2\......................................    0.8782
  Alachua, FL
2920 Galveston-Texas City, TX.................................    0.9360
  Galveston, TX
2960 Gary, IN.................................................    0.9462
  Lake, IN
  Porter, IN
2975 Glens Falls, NY \2\......................................    0.8530
  Warren, NY
  Washington, NY
2980 Goldsboro, NC............................................    0.8679
  Wayne, NC
2985 Grand Forks, ND-MN (ND Hospitals)........................    0.9031
  Polk, MN
  Grand Forks, ND
2985 Grand Forks, ND-MN \2\ (MN Hospitals)....................    0.9243
  Polk, MN
  Grand Forks, ND
2995 Grand Junction, CO.......................................    0.9940
  Mesa, CO
3000 Grand Rapids-Muskegon-Holland, MI \1\....................    0.9406
  Allegan, MI
  Kent, MI
  Muskegon, MI
  Ottawa, MI
3040 Great Falls, MT..........................................    0.8977
  Cascade, MT
3060 Greeley, CO..............................................    0.9516
  Weld, CO
3080 Green Bay, WI............................................    0.9524
  Brown, WI
3120 Greensboro-Winston-Salem-High Point, NC \1\..............    0.8533
  Alamance, NC
  Davidson, NC
  Davie, NC
  Forsyth, NC
  Guilford, NC
  Randolph, NC
  Stokes, NC
  Yadkin, NC
3150 Greenville, NC...........................................    0.9621
  Pitt, NC
3160 Greenville-Spartanburg-Anderson, SC......................    0.9289
  Anderson, SC
  Cherokee, SC
  Greenville, SC
  Pickens, SC
  Spartanburg, SC
3180 Hagerstown, MD...........................................    0.9233
  Washington, MD
3200 Hamilton-Middletown, OH..................................    0.9236
  Butler, OH
3240 Harrisburg-Lebanon-Carlisle, PA..........................    0.9178
  Cumberland, PA
  Dauphin, PA
  Lebanon, PA
  Perry, PA
3283 Hartford, CT 1, 2........................................    1.2199
  Hartford, CT
  Litchfield, CT
  Middlesex, CT
  Tolland, CT
3285 Hattiesburg, MS \2\......................................    0.7810
  Forrest, MS
  Lamar, MS
3290 Hickory-Morganton-Lenoir, NC.............................    0.9090
  Alexander, NC
  Burke, NC
  Caldwell, NC
  Catawba, NC
3320 Honolulu, HI.............................................    1.1176
  Honolulu, HI
3350 Houma, LA................................................    0.7763
  Lafourche, LA
  Terrebonne, LA
3360 Houston, TX \1\..........................................    0.9591
  Chambers, TX
  Fort Bend, TX
  Harris, TX
  Liberty, TX
  Montgomery, TX
  Waller, TX
3400 Huntington-Ashland, WV-KY-OH.............................    0.9620
  Boyd, KY
  Carter, KY
  Greenup, KY
  Lawrence, OH
  Cabell, WV
  Wayne, WV
3440 Huntsville, AL...........................................    0.9238
  Limestone, AL
  Madison, AL
3480 Indianapolis, IN \1\.....................................    0.9934
  Boone, IN
  Hamilton, IN
  Hancock, IN
  Hendricks, IN
  Johnson, IN
  Madison, IN
  Marion, IN
  Morgan, IN
  Shelby, IN
3500 Iowa City, IA............................................    0.9605
  Johnson, IA
3520 Jackson, MI..............................................    0.9043
  Jackson, MI
3560 Jackson, MS..............................................    0.8459
  Hinds, MS
  Madison, MS
  Rankin, MS
3580 Jackson, TN..............................................    0.8602
  Madison, TN
  Chester, TN
3600 Jacksonville, FL \1\.....................................    0.9426
  Clay, FL
  Duval, FL
  Nassau, FL
  St. Johns, FL
3605 Jacksonville, NC.........................................    0.8589
  Onslow, NC
3610 Jamestown, NY \2\........................................    0.8530
  Chautauqua, NY
3620 Janesville-Beloit, WI....................................    0.9344
  Rock, WI
3640 Jersey City, NJ..........................................    1.1203
  Hudson, NJ
3660 Johnson City-Kingsport-Bristol, TN-VA (TN Hospitals).....    0.8371
  Carter, TN
  Hawkins, TN
  Sullivan, TN
  Unicoi, TN
  Washington, TN
  Bristol City, VA
  Scott, VA
  Washington, VA
3660 Johnson City-Kingsport-Bristol, TN-VA \2\ (VA Hospitals).    0.8542
  Carter, TN
  Hawkins, TN
  Sullivan, TN
  Unicoi, TN
  Washington, TN
  Bristol City, VA
  Scott, VA
  Washington, VA
3680 Johnstown, PA \2\........................................    0.8429
  Cambria, PA
  Somerset, PA
3700 Jonesboro, AR \2\........................................    0.7755
  Craighead, AR
3710 Joplin, MO...............................................    0.8739
  Jasper, MO
  Newton, MO
3720 Kalamazoo-Battlecreek, MI................................    1.0554
  Calhoun, MI
  Kalamazoo, MI
  Van Buren, MI
3740 Kankakee, IL.............................................    1.1074
  Kankakee, IL
3760 Kansas City, KS-MO \1\...................................    0.9551
  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..............................................    0.9826
  Kenosha, WI
3810 Killeen-Temple, TX.......................................    0.9221
  Bell, TX
  Coryell, TX
3840 Knoxville, TN............................................    0.8987
  Anderson, TN
  Blount, TN
  Knox, TN
  Loudon, TN
  Sevier, TN
  Union, TN
3850 Kokomo, IN...............................................    0.8963
  Howard, IN
  Tipton, IN
3870 La Crosse, WI-MN.........................................    0.9259
  Houston, MN
  La Crosse, WI
3880 Lafayette, LA............................................    0.8271
  Acadia, LA
  Lafayette, LA
  St. Landry, LA
  St. Martin, LA
3920 Lafayette, IN............................................    0.9052
  Clinton, IN
  Tippecanoe, IN
3960 Lake Charles, LA.........................................    0.8460
  Calcasieu, LA

[[Page 48243]]

 
3980 Lakeland-Winter Haven, FL \2\............................    0.8782
  Polk, FL
4000 Lancaster, PA............................................    0.9325
  Lancaster, PA
4040 Lansing-East Lansing, MI.................................    0.9270
  Clinton, MI
  Eaton, MI
  Ingham, MI
4080 Laredo, TX...............................................    0.8145
  Webb, TX
4100 Las Cruces, NM...........................................    0.8532
  Dona Ana, NM
4120 Las Vegas, NV-AZ \1\.....................................    1.1457
  Mohave, AZ
  Clark, NV
  Nye, NV
4150 Lawrence, KS \2\.........................................    0.7860
  Douglas, KS
4200 Lawton, OK...............................................    0.8322
  Comanche, OK
4243 Lewiston-Auburn, ME......................................    0.9389
  Androscoggin, ME
4280 Lexington, KY............................................    0.8622
  Bourbon, KY
  Clark, KY
  Fayette, KY
  Jessamine, KY
  Madison, KY
  Scott, KY
  Woodford, KY
4320 Lima, OH.................................................    0.9457
  Allen, OH
  Auglaize, OH
4360 Lincoln, NE..............................................    1.0101
  Lancaster, NE
4400 Little Rock-North Little Rock, AR........................    0.8905
  Faulkner, AR
  Lonoke, AR
  Pulaski, AR
  Saline, AR
4420 Longview-Marshall, TX....................................    0.9141
  Gregg, TX
  Harrison, TX
  Upshur, TX
4480 Los Angeles-Long Beach, CA \1\...........................    1.1656
  Los Angeles, CA
4520 Louisville, KY-IN \1\....................................    0.9174
  Clark, IN
  Floyd, IN
  Harrison, IN
  Scott, IN
  Bullitt, KY
  Jefferson, KY
  Oldham, KY
4600 Lubbock, TX..............................................    0.8330
  Lubbock, TX
4640 Lynchburg, VA............................................    0.9202
  Amherst, VA
  Bedford, VA
  Bedford City, VA
  Campbell, VA
  Lynchburg City, VA
4680 Macon, GA................................................    0.9011
  Bibb, GA
  Houston, GA
  Jones, GA
  Peach, GA
  Twiggs, GA
4720 Madison, WI..............................................    1.0235
  Dane, WI
4800 Mansfield, OH............................................    0.9059
  Crawford, OH
  Richland, OH
4840 Mayaguez, PR.............................................    0.4780
  Anasco, PR
  Cabo Rojo, PR
  Hormigueros, PR
  Mayaguez, PR
  Sabana Grande, PR
  San German, PR
4880 McAllen-Edinburg-Mission, TX.............................    0.9084
  Hidalgo, TX
4890 Medford-Ashland, OR......................................    1.0844
  Jackson, OR
4900 Melbourne-Titusville-Palm Bay, FL........................    0.9837
  Brevard, Fl
4920 Memphis, TN-AR-MS \1\....................................    0.9325
  Crittenden, AR
  DeSoto, MS
  Fayette, TN
  Shelby, TN
  Tipton, TN
4940 Merced, CA \2\...........................................    0.9907
  Merced, CA
5000 Miami, FL \1\............................................    0.9888
  Dade, FL
5015 Middlesex-Somerset-Hunterdon, NJ \1\.....................    1.1437
  Hunterdon, NJ
  Middlesex, NJ
  Somerset, NJ
5080 Milwaukee-Waukesha, WI \1\...............................    0.9888
  Milwaukee, WI
  Ozaukee, WI
  Washington, WI
  Waukesha, WI
5120 Minneapolis-St. Paul, MN-WI \1\..........................    1.1064
  Anoka, MN
  Carver, MN
  Chisago, MN
  Dakota, MN
  Hennepin, MN
  Isanti, MN
  Ramsey, MN
  Scott, MN
  Sherburne, MN
  Washington, MN
  Wright, MN
  Pierce, WI
  St. Croix, WI
5140 Missoula, MT.............................................    0.8943
  Missoula, MT
5160 Mobile, AL...............................................    0.7948
  Baldwin, AL
  Mobile, AL
5170 Modesto, CA..............................................    1.1344
  Stanislaus, CA
5190 Monmouth-Ocean, NJ \1\...................................    1.1094
  Monmouth, NJ
  Ocean, NJ
5200 Monroe, LA...............................................    0.7978
  Ouachita, LA
5240 Montgomery, AL...........................................    0.7856
  Autauga, AL
  Elmore, AL
  Montgomery, AL
5280 Muncie, IN \2\...........................................    0.8770
  Delaware, IN
5330 Myrtle Beach, SC.........................................    0.8950
  Horry, SC
5345 Naples, FL...............................................    0.9866
  Collier, FL
5360 Nashville, TN \1\........................................    0.9836
  Cheatham, TN
  Davidson, TN
  Dickson, TN
  Robertson, TN
  Rutherford TN
  Sumner, TN
  Williamson, TN
  Wilson, TN
5380 Nassau-Suffolk, NY \1\...................................    1.3011
  Nassau, NY
  Suffolk, NY
5483 New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT \1\..    1.2525
  Fairfield, CT
  New Haven, CT
5523 New London-Norwich, CT \2\...............................    1.2199
  New London, CT
5560 New Orleans, LA \1\......................................    0.9167
  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\.........................................    1.3867
  Bronx, NY
  Kings, NY
  New York, NY
  Putnam, NY
  Queens, NY
  Richmond, NY
  Rockland, NY
  Westchester, NY
5640 Newark, NJ \1\...........................................    1.1417
  Essex, NJ
  Morris, NJ
  Sussex, NJ
  Union, NJ
  Warren, NJ
5660 Newburgh, NY-PA..........................................    1.1377
  Orange, NY
  Pike, PA
5720 Norfolk-Virginia Beach-Newport News, VA-NC \1\...........    0.8659
  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

[[Page 48244]]

 
  York, VA
5775 Oakland, CA \1\..........................................    1.5204
  Alameda, CA
  Contra Costa, CA
5790 Ocala, FL................................................    0.9788
  Marion, FL
5800 Odessa-Midland, TX.......................................    0.9447
  Ector, TX
  Midland, TX
5880 Oklahoma City, OK \1\....................................    0.9027
  Canadian, OK
  Cleveland, OK
  Logan, OK
  McClain, OK
  Oklahoma, OK
  Pottawatomie, OK
5910 Olympia, WA..............................................    1.1030
  Thurston, WA
5920 Omaha, NE-IA.............................................    0.9744
  Pottawattamie, IA
  Cass, NE
  Douglas, NE
  Sarpy, NE
  Washington, NE
5945 Orange County, CA \1\....................................    1.1235
  Orange, CA
5960 Orlando, FL \1\..........................................    0.9612
  Lake, FL
  Orange, FL
  Osceola, FL
  Seminole, FL
5990 Owensboro, KY............................................    0.8429
  Daviess, KY
6015 Panama City, FL \2\......................................    0.8782
  Bay, FL
6020 Parkersburg-Marietta, WV-OH (WV Hospitals)...............    0.8093
  Washington, OH
  Wood, WV
6020 Parkersburg-Marietta, WV-OH \2\ (OH Hospitals)...........    0.8756
  Washington, OH
  Wood, WV
6080 Pensacola, FL \2\........................................    0.8782
  Escambia, FL
  Santa Rosa, FL
6120 Peoria-Pekin, IL.........................................    0.8811
  Peoria, IL
  Tazewell, IL
  Woodford, IL
6160 Philadelphia, PA-NJ \1\..................................    1.0947
  Burlington, NJ
  Camden, NJ
  Gloucester, NJ
  Salem, NJ
  Bucks, PA
  Chester, PA
  Delaware, PA
  Montgomery, PA
  Philadelphia, PA
6200 Phoenix-Mesa, AZ \1\.....................................    1.0213
  Maricopa, AZ
  Pinal, AZ
6240 Pine Bluff, AR...........................................    0.7753
  Jefferson, AR
6280 Pittsburgh, PA \1\.......................................    0.8788
  Allegheny, PA
  Beaver, PA
  Butler, PA
  Fayette, PA
  Washington, PA
  Westmoreland, PA
6323 Pittsfield, MA \2\.......................................    1.1234
  Berkshire, MA
6340 Pocatello, ID............................................    0.9103
  Bannock, ID
6360 Ponce, PR................................................    0.4762
  Guayanilla, PR
  Juana Diaz, PR
  Penuelas, PR
  Ponce, PR
  Villalba, PR
  Yauco, PR
6403 Portland, ME.............................................    0.9985
  Cumberland, ME
  Sagadahoc, ME
  York, ME
6440 Portland-Vancouver, OR-WA \1\............................    1.1193
  Clackamas, OR
  Columbia, OR
  Multnomah, OR
  Washington, OR
  Yamhill, OR
  Clark, WA
6483 Providence-Warwick-Pawtucket, RI \1\.....................    1.1025
  Bristol, RI
  Kent, RI
  Newport, RI
  Providence, RI
  Washington, RI
6520 Provo-Orem, UT...........................................    1.0043
  Utah, UT
6560 Pueblo, CO \2\...........................................    0.8897
  Pueblo, CO
6580 Punta Gorda, FL..........................................    0.9518
  Charlotte, FL
6600 Racine, WI \2\...........................................    0.9130
  Racine, WI
6640 Raleigh-Durham-Chapel Hill, NC \1\.......................    1.0084
  Chatham, NC
  Durham, NC
  Franklin, NC
  Johnston, NC
  Orange, NC
  Wake, NC
6660 Rapid City, SD...........................................    0.8865
  Pennington, SD
6680 Reading, PA..............................................    0.9042
  Berks, PA
6690 Redding, CA..............................................    1.1357
  Shasta, CA
6720 Reno, NV.................................................    1.0758
  Washoe, NV
6740 Richland-Kennewick-Pasco, WA.............................    1.0639
  Benton, WA
  Franklin, WA
6760 Richmond-Petersburg, VA..................................    0.9402
  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\.........................    1.1318
  Riverside, CA
  San Bernardino, CA
6800 Roanoke, VA..............................................    0.8759
  Botetourt, VA
  Roanoke, VA
  Roanoke City, VA
  Salem City, VA
6820 Rochester, MN............................................    1.1802
  Olmsted, MN
6840 Rochester, NY \1\........................................    0.9556
  Genesee, NY
  Livingston, NY
  Monroe, NY
  Ontario, NY
  Orleans, NY
  Wayne, NY
6880 Rockford, IL.............................................    0.9730
  Boone, IL
  Ogle, IL
  Winnebago, IL
6895 Rocky Mount, NC..........................................    0.9058
  Edgecombe, NC
  Nash, NC
6920 Sacramento, CA \1\.......................................    1.1911
  El Dorado, CA
  Placer, CA
  Sacramento, CA
6960 Saginaw-Bay City-Midland, MI.............................    0.9620
  Bay, MI
  Midland, MI
  Saginaw, MI
6980 St. Cloud, MN............................................    0.9723
  Benton, MN
  Stearns, MN
7000 St. Joseph, MO \2\.......................................    0.7793
  Andrew, MO
  Buchanan, MO
7040 St. Louis, MO-IL \1\.....................................    0.9049
  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................................................    1.0594
  Marion, OR
  Polk, OR
7120 Salinas, CA..............................................    1.4435
  Monterey, CA
7160 Salt Lake City-Ogden, UT \1\.............................    0.9899
  Davis, UT
  Salt Lake, UT
  Weber, UT
7200 San Angelo, TX...........................................    0.8288
  Tom Green, TX
7240 San Antonio, TX \1\......................................    0.8876
  Bexar, TX

[[Page 48245]]

 
  Comal, TX
  Guadalupe, TX
  Wilson, TX
7320 San Diego, CA \1\........................................    1.1206
  San Diego, CA
7360 San Francisco, CA \1\....................................    1.4349
  Marin, CA
  San Francisco, CA
  San Mateo, CA
7400 San Jose, CA \1\.........................................    1.4642
  Santa Clara, CA
7440 San Juan-Bayamon, PR \1\.................................    0.4904
  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...............    1.1484
  San Luis Obispo, CA
7480 Santa Barbara-Santa Maria-Lompoc, CA.....................    1.0511
  Santa Barbara, CA
7485 Santa Cruz-Watsonville, CA...............................    1.3012
  Santa Cruz, CA
7490 Santa Fe, NM.............................................    1.0639
  Los Alamos, NM
  Santa Fe, NM
7500 Santa Rosa, CA...........................................    1.2836
  Sonoma, CA
7510 Sarasota-Bradenton, FL...................................    0.9834
  Manatee, FL
  Sarasota, FL
7520 Savannah, GA.............................................    0.9556
  Bryan, GA
  Chatham, GA
  Effingham, GA
7560 Scranton--Wilkes-Barre--Hazleton, PA \2\.................    0.8429
  Columbia, PA
  Lackawanna, PA
  Luzerne, PA
  Wyoming, PA
7600 Seattle-Bellevue-Everett, WA \1\.........................    1.1557
  Island, WA
  King, WA
  Snohomish, WA
7610 Sharon, PA \2\...........................................    0.8429
  Mercer, PA
7620 Sheboygan, WI \2\........................................    0.9130
  Sheboygan, WI
7640 Sherman-Denison, TX......................................    0.9508
  Grayson, TX
7680 Shreveport-Bossier City, LA..............................    0.9127
  Bossier, LA
  Caddo, LA
  Webster, LA
7720 Sioux City, IA-NE........................................    0.9052
  Woodbury, IA
  Dakota, NE
7760 Sioux Falls, SD..........................................    0.9371
  Lincoln, SD
  Minnehaha, SD
7800 South Bend, IN...........................................    0.9887
  St. Joseph, IN
7840 Spokane, WA..............................................    1.0954
  Spokane, WA
7880 Springfield, IL..........................................    0.9004
  Menard, IL
  Sangamon, IL
7920 Springfield, MO..........................................    0.8470
  Christian, MO
  Greene, MO
  Webster, MO
8003 Springfield, MA \2\......................................    1.1234
  Hampden, MA
  Hampshire, MA
8050 State College, PA........................................    0.8798
  Centre, PA
8080 Steubenville-Weirton, OH-WV..............................    0.8454
  Jefferson, OH
  Brooke, WV
  Hancock, WV
8120 Stockton-Lodi, CA........................................    1.1168
  San Joaquin, CA
8140 Sumter, SC \2\...........................................    0.8489
  Sumter, SC
8160 Syracuse, NY.............................................    0.9482
  Cayuga, NY
  Madison, NY
  Onondaga, NY
  Oswego, NY
8200 Tacoma, WA \2\...........................................    1.0242
  Pierce, WA
8240 Tallahassee, FL \2\......................................    0.8782
  Gadsden, FL
  Leon, FL
8280 Tampa-St. Petersburg-Clearwater, FL \1\..................    0.9111
  Hernando, FL
  Hillsborough, FL
  Pasco, FL
  Pinellas, FL
8320 Terre Haute, IN \2\......................................    0.8770
  Clay, IN
  Vermillion, IN
  Vigo, IN
8360 Texarkana, AR-Texarkana, TX..............................    0.8198
  Miller, AR
  Bowie, TX
8400 Toledo, OH...............................................    0.9551
  Fulton, OH
  Lucas, OH
  Wood, OH
8440 Topeka, KS...............................................    0.9021
  Shawnee, KS
8480 Trenton, NJ..............................................    1.0556
  Mercer, NJ
8520 Tucson, AZ...............................................    0.8958
  Pima, AZ
8560 Tulsa, OK................................................    0.9093
  Creek, OK
  Osage, OK
  Rogers, OK
  Tulsa, OK
  Wagoner, OK
8600 Tuscaloosa, AL...........................................    0.8239
  Tuscaloosa, AL
8640 Tyler, TX................................................    0.8789
  Smith, TX
8680 Utica-Rome, NY \2\.......................................    0.8530
  Herkimer, NY
  Oneida, NY
8720 Vallejo-Fairfield-Napa, CA...............................    1.3500
  Napa, CA
  Solano, CA
8735 Ventura, CA..............................................    1.0472
  Ventura, CA
8750 Victoria, TX.............................................    0.8105
  Victoria, TX
8760 Vineland-Millville-Bridgeton, NJ.........................    1.0475
  Cumberland, NJ
8780 Visalia-Tulare-Porterville, CA \2\.......................    0.9907
  Tulare, CA
8800 Waco, TX.................................................    0.8449
  McLennan, TX
8840 Washington, DC-MD-VA-WV \1\..............................    1.0707
  District of Columbia, DC
  Calvert, MD
  Charles, MD
  Frederick, MD
  Montgomery, MD
  Prince Georges, MD
  Alexandria City, VA
  Arlington, VA
  Clarke, VA
  Culpepper, 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.................................    0.8422
  Black Hawk, IA
8940 Wausau, WI...............................................    0.9806
  Marathon, WI
8960 West Palm Beach-Boca Raton, FL \1\.......................    0.9784
  Palm Beach, FL

[[Page 48246]]

 
9000 Wheeling, WV-OH \2\ (WV Hospitals).......................    0.8008
  Belmont, OH
  Marshall, WV
  Ohio, WV
9000 Wheeling, WV-OH \2\ (OH Hospitals).......................    0.8756
  Belmont, OH
  Marshall, WV
  Ohio, WV
9040 Wichita, KS..............................................    0.9300
  Butler, KS
  Harvey, KS
  Sedgwick, KS
9080 Wichita Falls, TX........................................    0.8407
  Archer, TX
  Wichita, TX
9140 Williamsport, PA \2\.....................................    0.8429
  Lycoming, PA
9160 Wilmington-Newark, DE-MD.................................    1.0955
  New Castle, DE
  Cecil, MD
9200 Wilmington, NC...........................................    0.9604
  New Hanover, NC
  Brunswick, NC
9260 Yakima, WA...............................................    1.0320
  Yakima, WA
9270Yolo, CA \2\..............................................    0.9907
  Yolo, CA
9280 York, PA.................................................    0.9154
  York, PA
9320 Youngstown-Warren, OH....................................    0.9273
  Columbiana, OH
  Mahoning, OH
  Trumbull, OH
9340 Yuba City, CA............................................    1.0264
  Sutter, CA
  Yuba, CA
9360 Yuma, AZ.................................................    0.8954
  Yuma, AZ
------------------------------------------------------------------------
\1\ Large urban area.
\2\ Hospitals geographically located in the area are assigned the
  statewide rural wage index for FY 2004.


                 Addendum I.--Wage Index for Rural Areas
------------------------------------------------------------------------
                                                                  Wage
                         Nonurban area                            index
------------------------------------------------------------------------
Alaska........................................................    1.1958
Arizona.......................................................    0.8906
Arkansas......................................................    0.7746
California....................................................    0.9907
Colorado......................................................    0.8897
Connecticut...................................................    1.2199
Delaware......................................................    0.9669
Florida.......................................................    0.8782
Georgia.......................................................    0.8365
Hawaii........................................................    0.9896
Idaho.........................................................    0.8907
Illinois......................................................    0.8282
Indiana.......................................................    0.8770
Iowa..........................................................    0.8278
Kansas........................................................    0.7860
Kentucky......................................................    0.7924
Louisiana.....................................................    0.7565
Maine.........................................................    0.8995
Maryland......................................................    0.9175
Massachusetts.................................................    1.1234
Michigan......................................................    0.8807
Minnesota.....................................................    0.9243
Mississippi...................................................    0.7810
Missouri......................................................    0.7793
Montana.......................................................    0.8530
Nebraska......................................................    0.8326
Nevada........................................................    0.9758
New Hampshire.................................................    0.9944
New Jersey\1\.................................................  ........
New Mexico....................................................    0.8314
New York......................................................    0.8530
North Carolina................................................    0.8355
North Dakota..................................................    0.7536
Ohio..........................................................    0.8756
Oklahoma......................................................    0.7577
Oregon........................................................    0.9939
Pennsylvania..................................................    0.8429
Puerto Rico...................................................    0.4037
Rhode Island\1\...............................................  ........
South Carolina................................................    0.8489
South Dakota..................................................    0.8093
Tennessee.....................................................    0.7945
Texas.........................................................    0.7673
Utah..........................................................    0.9034
Vermont.......................................................    0.9401
Virginia......................................................    0.8542
Washington....................................................    1.0242
West Virginia.................................................    0.8008
Wisconsin.....................................................    0.9130
Wyoming.......................................................   0.9137
------------------------------------------------------------------------
\1\All counties within the State are classified as urban.


       Addendum J.--Wage Index for Hospitals That are Reclassified
------------------------------------------------------------------------
                                                                  Wage
                             Area                                 index
------------------------------------------------------------------------
Akron, OH.....................................................    0.9445
Albany, GA....................................................    1.0643
Albuquerque, NM...............................................    0.9431
Alexandria, LA................................................    0.8087
Altoona, PA...................................................    0.8886
Amarillo, TX..................................................    0.8814
Anchorage, AK.................................................    1.2433
Ann Arbor, MI.................................................    1.0859
Anniston, AL..................................................    0.8025
Asheville, NC.................................................    0.9503
Athens, GA....................................................    0.9437
Atlanta, GA...................................................    0.9912
Atlantic-Cape May, NJ.........................................    1.0597
Augusta-Aiken, GA-SC..........................................    0.9491
Austin-San Marcos, TX.........................................    0.9551
Bangor, ME....................................................    0.9750
Barnstable-Yarmouth, MA.......................................    1.2703
Baton Rouge, LA...............................................    0.8271
Bellingham, WA................................................    1.1834
Benton Harbor, MI.............................................    0.8949
Bergen-Passaic, NJ............................................    1.1655
Billings, MT..................................................    0.8889
Biloxi-Gulfport-Pascagoula, MS................................    0.8449
Binghamton, NY................................................    0.8433
Birmingham, AL................................................    0.9251
Bismarck, ND..................................................    0.8101
Bloomington-Normal, IL........................................    0.8954
Boise City, ID................................................    0.9295
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH..............    1.1269
Burlington, VT................................................    0.9442
Caguas, PR....................................................    0.4229
Casper, WY....................................................    0.9239
Champaign-Urbana, IL..........................................    0.9385
Charleston-North Charleston, SC...............................    0.9307
Charleston, WV (WV Hospitals).................................    0.8510
Charleston, WV (OH Hospitals).................................    0.8756
Charlotte-Gastonia-Rock Hill, NC-SC...........................    0.9636
Charlottesville, VA...........................................    0.9946
Chattanooga, TN-GA............................................    0.8985
Chicago, IL...................................................    1.0863
Cincinnati, OH-KY-IN..........................................    0.9452
Clarksville-Hopkinsville, TN-KY...............................    0.8410
Cleveland-Lorain-Elyria, OH...................................    0.9686
Columbia, MO..................................................    0.8607
Columbia, SC..................................................    0.8958
Columbus, GA-AL...............................................    0.8505
Columbus, OH..................................................    0.9649
Corpus Christi, TX............................................    0.8565
Corvallis, OR.................................................    1.1316
Dallas, TX....................................................    0.9733
Davenport-Moline-Rock Island, IA-IL...........................    0.8727
Dayton-Springfield, OH........................................    0.9432
Decatur, AL...................................................    0.8633
Denver, CO....................................................    1.0581
Des Moines, IA................................................    0.9053
Detroit, MI...................................................    1.0097
Dothan, AL....................................................    0.7931
Dover, DE.....................................................    0.9669
Duluth-Superior, MN-WI........................................    1.0133
Dutchess County, NY...........................................    1.0769
Eau Claire, WI................................................    0.9141
Elkhart-Goshen, IN............................................    0.9613
Erie, PA......................................................    0.8530
Eugene-Springfield, OR........................................    1.0889
Fargo-Moorhead, ND-MN.........................................    0.9444
Fayetteville, NC..............................................    0.8957
Flagstaff, AZ-UT..............................................    1.1086
Flint, MI.....................................................    1.0929
Florence, AL..................................................    0.7824
Florence, SC..................................................    0.8763
Fort Collins-Loveland, CO.....................................    1.0201
Ft. Lauderdale, FL............................................    1.0534
Fort Pierce-Port St. Lucie, FL................................    1.0227
Fort Smith, AR-OK.............................................    0.7577
Fort Walton Beach, FL.........................................    0.8700
Forth Worth-Arlington, TX.....................................    0.9268
Gadsden, AL...................................................    0.8295
Grand Forks, ND-MN (ND Hospitals).............................    0.9031
Grand Forks, ND-MN (MN Hospitals).............................    0.9243
Grand Junction, CO............................................    0.9940
Grand Rapids-Muskegon-Holland, MI.............................    0.9406
Great Falls, MT...............................................    0.8977
Greeley, CO...................................................    0.9516
Green Bay, WI.................................................    0.9201
Greensboro-Winston-Salem-High Point, NC (NC Hospitals)........    0.8533
Greensboro-Winston-Salem-High Point, NC (VA Hospitals)........    0.8542
Greenville, NC................................................    0.9621
Hamilton-Middletown, OH.......................................    0.9236
Harrisburg-Lebanon-Carlisle, PA...............................    0.9178

[[Page 48247]]

 
Hartford, CT (MA Hospitals)...................................    1.1234
Hartford, CT (NY Hospitals)...................................    1.1211
Hattiesburg, MS...............................................    0.7810
Hickory-Morganton-Lenoir, NC..................................    0.8987
Honolulu, HI..................................................    1.1176
Houston, TX...................................................    0.9591
Huntington-Ashland, WV-KY-OH..................................    0.9080
Huntsville, AL................................................    0.8954
Indianapolis, IN..............................................    0.9934
Iowa City, IA.................................................    0.9460
Jackson, MS...................................................    0.8459
Jackson, TN...................................................    0.8602
Jacksonville, FL..............................................    0.9426
Johnson City-Kingsport-Bristol, TN-VA (VA Hospitals)..........    0.8542
Johnson City-Kingsport-Bristol, TN-VA (KY Hospitals)..........    0.8371
Jonesboro, AR (AR Hospitals)..................................    0.7755
Jonesboro, AR (MO Hospitals)..................................    0.7793
Joplin, MO....................................................    0.8621
Kalamazoo-Battlecreek, MI.....................................    1.0554
Kansas City, KS-MO............................................    0.9551
Knoxville, TN.................................................    0.8987
Kokomo, IN....................................................    0.8963
Lafayette, LA.................................................    0.8271
Lakeland-Winter Haven, FL.....................................    0.8782
Las Vegas, NV-AZ..............................................    1.1341
Lawton, OK....................................................    0.8194
Lexington, KY.................................................    0.8424
Lima, OH......................................................    0.9457
Lincoln, NE...................................................    0.9613
Little Rock-North Little Rock, AR.............................    0.8905
Longview-Marshall, TX.........................................    0.8969
Los Angeles-Long Beach, CA....................................    1.1656
Louisville, KY-IN.............................................    0.9056
Lubbock, TX...................................................    0.8330
Lynchburg, VA.................................................    0.9004
Macon, GA.....................................................    0.9011
Madison, WI...................................................    1.0108
Medford-Ashland, OR...........................................    1.0494
Melbourne-Titusville-Palm Bay, FL.............................    0.9837
Memphis, TN-AR-MS.............................................    0.9010
Miami, FL.....................................................    0.9888
Milwaukee-Waukesha, WI........................................    0.9760
Minneapolis-St. Paul, MN-WI...................................    1.1064
Missoula, MT..................................................    0.8943
Mobile, AL....................................................    0.7948
Modesto, CA...................................................    1.1183
Monmouth-Ocean, NJ............................................    1.1094
Monroe, LA....................................................    0.7978
Montgomery, AL................................................    0.7856
Nashville, TN.................................................    0.9582
New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT...........    1.2525
New Orleans, LA...............................................    0.9167
New York, NY..................................................    1.3867
Newark, NJ....................................................    1.1417
Newburgh, NY-PA...............................................    1.1377
Norfolk-Virginia Beach-Newport News, VA-NC....................    0.8659
Oakland, CA...................................................    1.5204
Ocala, FL.....................................................    0.9646
Odessa-Midland, TX............................................    0.9156
Oklahoma City, OK.............................................    0.9027
Olympia, WA...................................................    1.1030
Omaha, NE-IA..................................................    0.9744
Orange County, CA.............................................    1.1235
Orlando, FL...................................................    0.9612
Peoria-Pekin, IL..............................................    0.8811
Philadelphia, PA-NJ...........................................    1.0947
Phoenix-Mesa, AZ..............................................    1.0213
Pine Bluff, AR................................................    0.7810
Pittsburgh, PA................................................    0.8788
Pittsfield, MA................................................    0.9861
Pocatello, ID (ID Hospitals)..................................    0.9103
Pocatello, ID (WY Hospitals)..................................    0.9137
Portland, ME..................................................    0.9784
Portland-Vancouver, OR-WA.....................................    1.1193
Provo-Orem, UT................................................    0.9912
Raleigh-Durham-Chapel Hill, NC................................    0.9756
Rapid City, SD................................................    0.8865
Reading, PA...................................................    0.8910
Redding, CA...................................................    1.1357
Reno, NV......................................................    1.0758
Richland-Kennewick-Pasco, WA..................................    1.0639
Richmond-Petersburg, VA.......................................    0.9402
Roanoke, VA...................................................    0.8759
Rochester, MN.................................................    1.1802
Rockford, IL..................................................    0.9500
Sacramento, CA................................................    1.1911
Saginaw-Bay City-Midland, MI..................................    0.9470
St. Cloud, MN.................................................    0.9723
St. Joseph, MO................................................    0.9694
St. Louis, MO-IL..............................................    0.9049
Salinas, CA...................................................    1.4435
Salt Lake City-Ogden, UT......................................    0.9899
San Antonio, TX...............................................    0.8876
Santa Fe, NM..................................................    0.9543
Santa Rosa, CA................................................    1.2836
Sarasota-Bradenton, FL........................................    0.9834
Savannah, GA..................................................    0.9556
Seattle-Bellevue-Everett, WA..................................    1.1557
Sherman-Denison, TX...........................................    0.9084
Shreveport-Bossier City, LA...................................    0.9127
Sioux City, IA-NE.............................................    0.8806
Sioux Falls, SD...............................................    0.9246
South Bend, IN................................................    0.9780
Spokane, WA...................................................    1.0770
Springfield, IL...............................................    0.9004
Springfield, MO...............................................    0.8269
Stockton-Lodi, CA.............................................    1.1168
Syracuse, NY..................................................    0.9381
Tampa-St. Petersburg-Clearwater, FL...........................    0.9111
Texarkana, AR-Texarkana, TX...................................    0.8018
Toledo, OH....................................................    0.9551
Topeka, KS....................................................    0.8791
Tucson, AZ....................................................    0.8958
Tulsa, OK.....................................................    0.8876
Tuscaloosa, AL................................................    0.8134
Tyler, TX.....................................................    0.8789
Vallejo-Fairfield-Napa, CA....................................    1.3500
Victoria, TX..................................................    0.8105
Waco, TX......................................................    0.8449
Washington, DC-MD-VA-WV.......................................    1.0707
Waterloo-Cedar Falls, IA......................................    0.8422
Wausau, WI....................................................    0.9806
West Palm Beach-Boca Raton, FL................................    0.9784
Wichita, KS...................................................    0.9053
Wichita Falls, TX.............................................    0.8407
Wilmington-Newark, DE-MD......................................    1.0782
Wilmington, NC................................................    0.9402
York, PA......................................................    0.9154
Youngstown-Warren, OH.........................................    0.9273
Rural Alabama.................................................    0.7517
Rural Florida.................................................    0.8782
Rural Illinois................................................    0.8282
Rural Kentucky................................................    0.7924
Rural Louisiana...............................................    0.7565
Rural Michigan................................................    0.8807
Rural Minnesota...............................................    0.9243
Rural Mississippi.............................................    0.7810
Rural Missouri................................................    0.7793
Rural Nebraska................................................    0.8326
Rural New Hampshire...........................................    0.9944
Rural Texas...................................................    0.7673
Rural Washington..............................................    1.0242
Rural Wyoming.................................................    0.9020
------------------------------------------------------------------------


 Addendum L.--Packaged Nonchemotherapy Infusion Drugs Calendar Year 2004
------------------------------------------------------------------------
               HCPCS                             Descriptor
------------------------------------------------------------------------
J0706.............................  Caffeine citrate injection
J1260.............................  Dolasetron mesylate
J1325.............................  Epoprostenol injection
J1436.............................  Etidronate disodium inj
J1570.............................  Ganciclovir sodium injection
J1626.............................  Granisetron HCl injection
J2020.............................  Linezolid injection
J2260.............................  Inj milrinone lactate, per 5
J2275.............................  Morphine sulfate injection
J2405.............................  Ondansetron hcl injection
J2765.............................  Metoclopramide hcl injection
J2770.............................  Quinupristin/dalfopristin
J2820.............................  Sargramostim injection
J2997.............................  Alteplase recombinant
J3010.............................  Fentanyl citrate injeciton
J7501.............................  Azathioprine parenteral
J7516.............................  Cyclosporin parenteral 250mg
J7525.............................  Tacrolimus injection
Q2003.............................  Aprotinin, 10,000 kiu
Q2007.............................  Ethanolamine oleate 100 mg
Q2009.............................  Fosphenytoin, 50 mg
Q2013.............................  Pentastarch 10% solution
Q2021.............................  Lepirudin
------------------------------------------------------------------------


Addendum M.--Separately Paid Nonchemotology Infusion Drugs Calendar Year
                                  2004
------------------------------------------------------------------------
               HCPCS                             Descriptor
------------------------------------------------------------------------
C1178.............................  BUSULFAN IV, 6 Mg
C9019.............................  Caspofungin acetate, 5 mg
C9109.............................  Tirofiban hcl, 6.25 mg
J0130.............................  Abciximab injection
J0151.............................  Adenosine injection
J0286.............................  Amphotericin B lipid complex
J0350.............................  Injection anistreplase 30 u
J0850.............................  Cytomegalovirus imm IV /vial
J1327.............................  Eptifibatide injection
J1440.............................  Filgrastim 300 mcg injection
J1441.............................  Filgrastim 480 mcg injection
J1561.............................  Immune globulin 500 mg
J1563.............................  Immune globulin, 1 g
J1564.............................  Immune globulin 10 mg
J1565.............................  RSV-ivig
J1745.............................  Infliximab injection
J2792.............................  Rho(D) immune globulin h, sd
J2993.............................  Reteplase injection
J2995.............................  Inj streptokinase /250000 IU

[[Page 48248]]

 
J3245.............................  Tirofiban hydrochloride
J3305.............................  Inj trimetrexate glucoronate
J3365.............................  Urokinase 250,000 IU inj
J3395.............................  Verteporfin injection
J7197.............................  Antithrombin iii injection
J7504.............................  Lymphocyte immune globulin
J7511.............................  Antithymocyte globuln rabbit
J9200.............................  Floxuridine injection
J9600.............................  Porfimer sodium
P9041.............................  Albumin (human),5%, 50ml
P9045.............................  Albumin (human), 5%, 250 ml
P9046.............................  Albumin (human), 25%, 20 ml
P9047.............................  Albumin (human), 25%, 50ml
Q2006.............................  Digoxin immune fab (ovine)
Q2008.............................  Fomepizole, 15 mg
Q2011.............................  Hemin, per 1 mg
------------------------------------------------------------------------


  Addendum N.--Packaged Chemotherapy Drug Other Than Infusion Calendar
                                Year 2004
------------------------------------------------------------------------
              HCPCS                           Short descriptor
------------------------------------------------------------------------
J9000............................  Doxorubic hcl 10 MG vl chemo
J9190............................  Fluorouracil injection
J9212............................  Interferon alfacon-1
J9213............................  Interferon alfa-2a inj
J9230............................  Mechlorethamine hcl inj
J9250............................  Methotrexate sodium inj
J9360............................  Vinblastine sulfate inj
J9370............................  Vincristine sulfate 1 MG inj
------------------------------------------------------------------------


   Addendum O.--Separately Paid Chemotherapy Drugs Other than Infusion
                           Calendar Year 2004
------------------------------------------------------------------------
              HCPCS                           Short descriptor
------------------------------------------------------------------------
J2352............................  Octreotide acetate injection
J9202............................  Goserelin acetate implant
J9214............................  Interferon alfa-2b inj
J9217............................  Leuprolide acetate suspnsion
J9218............................  Leuprolide acetate inj
J9219............................  Leuprolide acetate implant
------------------------------------------------------------------------


  Addendum P.--Packaged Chemotherapy Drugs Infusion Only Calendar Year
                                  2004
------------------------------------------------------------------------
               HCPCS                          Short descriptor
------------------------------------------------------------------------
C1166.............................  CYTARABINE LIPOSOMAL, 10 mg
J1620.............................  Gonadorelin hydroch/100 mcg
J9020.............................  Asparaginase injection
J9031.............................  Bcg live intravesical vac
J9070.............................  Cyclophosphamide 100 MG inj
J9093.............................  Cyclophosphamide lyophilized
J9100.............................  Cytarabine hcl 100 MG inj
J9120.............................  Dactinomycin actinomycin d
J9130.............................  Dacarbazine 10 MG inj
J9181.............................  Etoposide 10 MG inj
J9270.............................  Plicamycin (mithramycin) inj
J9340.............................  Thiotepa injection
------------------------------------------------------------------------


 Addendum Q.--Separately Paid Chemotherapy Drugs Infusion Only Calendar
                                Year 2004
------------------------------------------------------------------------
               HCPCS                          Short descriptor
------------------------------------------------------------------------
C1167.............................  EPIRUBICIN HCL, 2 mg
C1207.............................  OCTREOTIDE ACETATE DEPOT 1mg
C9110.............................  Alemtuzumab, per 10mg/ml
J0207.............................  Amifostine
J1190.............................  Dexrazoxane HCl injection
J1950.............................  Leuprolide acetate /3.75 MG
J2355.............................  Oprelvekin injection
J2430.............................  Pamidronate disodium /30 MG
J9001.............................  Doxorubicin hcl liposome inj
J9015.............................  Aldesleukin/single use vial
J9017.............................  Arsenic trioxide
J9040.............................  Bleomycin sulfate injection
J9045.............................  Carboplatin injection
J9050.............................  Carmus bischl nitro inj
J9060.............................  Cisplatin 10 MG injection
J9065.............................  Inj cladribine per 1 MG
J9150.............................  Daunorubicin
J9151.............................  Daunorubicin citrate liposom
J9160.............................  Denileukin diftitox, 300 mcg
J9165.............................  Diethylstilbestrol injection
J9170.............................  Docetaxel
J9185.............................  Fludarabine phosphate inj
J9201.............................  Gemcitabine HCl
J9206.............................  Irinotecan injection
J9208.............................  Ifosfomide injection
J9209.............................  Mesna injection
J9211.............................  Idarubicin hcl injection
J9245.............................  Inj melphalan hydrochl 50 MG
J9265.............................  Paclitaxel injection
J9266.............................  Pegaspargase/singl dose vial
J9268.............................  Pentostatin injection
J9280.............................  Mitomycin 5 MG inj
J9293.............................  Mitoxantrone hydrochl/5 MG
J9300.............................  Gemtuzumab ozogamicin
J9310.............................  Rituximab cancer treatment
J9320.............................  Streptozocin injection
J9350.............................  Topotecan
J9355.............................  Trastuzumab
J9357.............................  Valrubicin, 200 mg
J9390.............................  Vinorelbine tartrate/10 mg
Q2017.............................  Teniposide, 50 mg
------------------------------------------------------------------------

[FR Doc. 03-20280 Filed 8-6-03; 8:45 am]
BILLING CODE 4120-01-P