[Federal Register Volume 68, Number 216 (Friday, November 7, 2003)]
[Rules and Regulations]
[Pages 63398-63690]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-27791]



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Part III





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; Final Rule

  Federal Register / Vol. 68, No. 216 / Friday, November 7, 2003 / 
Rules and Regulations  

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Medicare & Medicaid Services

42 CFR Parts 410 and 419

[CMS-1471-FC]
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: Final rule with comment period.

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SUMMARY: This final rule with comment period revises the Medicare 
hospital outpatient prospective payment system to implement applicable 
statutory requirements and changes arising from our continuing 
experience with this system. In addition, it describes changes to the 
amounts and factors used to determine the payment rates for Medicare 
hospital outpatient services paid under the prospective payment system. 
These changes are applicable to services furnished on or after January 
1, 2004. Finally, this rule responds to public comments received on the 
August 12, 2003 proposed rule for revisions to the hospital outpatient 
prospective payment system and payment rates (68 FR 47966).

DATES: Effective date: This final rule is effective January 1, 2004.
    Comment date: We will consider comments on the ambulatory payment 
classification assignments of Healthcare Common Procedure Coding System 
codes identified in Addendum B with new interim (NI) condition codes, 
if we receive them at the appropriate address, as provided below, no 
later than 5 p.m. on January 6, 2004.

ADDRESSES: In commenting, please refer to file code CMS-1471-FC. 
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-FC, P.O. 
Box 8018, Baltimore, MD 21244-8018.
    Please allow sufficient time for mailed comments to be timely 
received in the event of delivery delays.
    If you prefer, you may deliver (by hand or courier) your written 
comments (one original and two copies) to one of the following 
addresses: Room 445-G, Hubert H. Humphrey Building, 200 Independence 
Avenue, SW., Washington, DC 20201, or Room C5-14-03, 7500 Security 
Boulevard, Baltimore, MD 21244-1850.
    (Because access to the interior of the HHH Building is not readily 
available to persons without Federal Government identification, 
commenters are encouraged to leave their comments in the CMS drop slots 
located in the main lobby of the building. A stamp-in clock is 
available for persons wishing to retain a proof of filing by stamping 
in and retaining an extra copy of the comments being filed.)
    Comments mailed to the addresses indicated as appropriate for hand 
or courier delivery may be delayed and could be considered late.
    For information on viewing public comments, see the beginning of 
the SUPPLEMENTARY INFORMATION section.

FOR FURTHER INFORMATION CONTACT: Dana Burley, (410) 786-0378--
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) 786-7195.

Availability of Copies and Electronic Access

    Copies: To order copies of the Federal Register containing this 
document, send your request to: New Orders, Superintendent of 
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of the issue requested and enclose a check or money order payable to 
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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
    C. Summary of Changes in the August 12, 2003 Proposed Rule
    1. Changes Required by Statute
    2. Additional Changes to OPPS
    D. Public Comments and Responses to the August 12, 2003 Proposed 
Rule
II. Changes to the Ambulatory Payment Classification (APC) Groups 
and Relative Weights
    A. Recommendations of the Advisory Panel on APC Groups
    1. Establishment of the Advisory Panel on APC Groups
    2. August 2003 Meeting
    3. Recommendations of the Advisory Panel and Our Responses
    B. Other Changes Affecting the APCs
    1. Limit on Variation of Costs of Services Classified Within 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. Creation of APCs for Combinations of Device Procedures
III. Recalibration of APC Weights for CY 2004
    A. Data Issues
    1. Period of Claims Data Used
    2. Treatment of ``Multiple Procedure'' Claims
    B. Description of Our Calculation of Weights for CY 2004
    C. Discussion of Relative Weights for Specific Procedural APCs
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. Reinstitution of C Codes for Expired Device Categories
    D. Other Policy Issues Relating to Pass-Through Device 
Categories
    1. Reducing Transitional Pass-Through Device Categories To 
Offset Costs Packaged Into APC Groups
    2. Multiple Procedure Reduction for Devices
VI. Payment for Drugs, Biologicals, Radiopharmaceutical Agents, 
Blood, and Blood Products
    A. Pass-Through Drugs and Biologicals

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    B. Drugs, Biologicals, and Radiopharmaceuticals Without Pass-
Through Status
    1. Background
    2. Criteria for Packaging Payment for Drugs, Biologicals, and 
Radiopharmaceuticals
    3. Payment for Drugs, Biologicals, and Radiopharmaceuticals That 
Are Not Packaged
    4. Payment for Drug Administration
    5. Generic Drugs and Radiopharmaceuticals
    6. Orphan Drugs
    7. Vaccines
    8. Blood and Blood Products
    9. Intravenous Immune Globulin
    10. Payment for Split Unit of Blood
    11. Other Issues
VII. Wage Index Changes for CY 2004
VIII. Copayment for CY 2004
IX. Conversion Factor Update for CY 2004
X. Outlier Policy and Elimination of Transitional Corridor Payments 
for CY 2004
    A. Outlier Policy for CY 2004
    B. Elimination of Transitional Corridor Payments for CY 2004
XI. Other Policy Decisions and 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. General Data, Billing, and Coding Issues
XIII. Provisions of the Final Rule With Comment Period for 2004
    A. Changes Required by Statute
    B. Additional Changes
    C. Major Changes From the Proposed Rule
XIV. Collection of Information Requirements
XV. Response to Public Comments
XVI. Regulatory Impact Analysis
    A. General
    B. Changes in This Final Rule
    C. Limitations of Our Analysis
    D. Estimated Impacts of This Final Rule on Hospitals
    E. Projected Distribution of Outlier Payments
    F. Estimated Impacts of This Final 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 This Final Rule With 
Comment Period

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 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.
    [sbull] On April 7, 2000, we published a final rule with comment 
period (65 FR

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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. Subsequently, we announced a delay in implementation of the OPPS 
from July 1, 2000 to 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 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) to provide 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. It also 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.
    [sbull] On August 12, 2003, we published a proposed rule (68 FR 
47966) that proposed the Medicare OPPS conversion factor for CY 2004. 
In addition, it described proposed changes to the amounts and factors 
used to determine the payment rates for Medicare hospital outpatient 
services paid under the prospective payment system.

C. Summary of Changes in the August 12, 2003 Proposed Rule

    On August 12, 2003, we published a proposed rule (68 FR 47966) that 
proposed changes to the Medicare hospital OPPS and CY 2004 payment 
rates including proposed changes used to determine these payment rates. 
The following is a summary of the major changes that we proposed and 
the issues we addressed in the August 12, 2003 proposed rule.
1. Changes Required by Statute
    We proposed the following changes to implement statutory 
requirements:
    [sbull] Add APCs, delete APCs, and modify the composition of some 
existing APCs.
    [sbull] Recalibrate the relative payment weights of the APCs.
    [sbull] Update the conversion factor and the wage index.
    [sbull] Revise the APC payment amounts to reflect the APC 
reclassifications, the recalibration of payment weights, and the other 
required updates and adjustments.
    [sbull] Cease transitional pass-through payments for drugs and 
biologicals 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.
2. Additional Changes to OPPS
    We proposed 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 Healthcare Common Procedure 
Coding System (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 community mental health centers (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

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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.
    [sbull] Establish new payment bands for new technology APCs.

D. Public Comments and Responses to the August 12, 2003 Proposed Rule

    We received approximately 876 timely items of correspondence 
containing multiple comments on the August 12, 2003 proposed rule. 
Summaries of the public comments and our responses to those comments 
are set forth below under the appropriate section heading of this final 
rule with comment period.
    We received comments from various sources including but not limited 
to health care facilities, physicians, drug and device manufacturers, 
and beneficiaries. Hospital associations and the Medicare Payment 
Advisory Commission (MedPAC) generally supported our proposed approach 
to revising the relative weights for APCs. Pharmaceutical and medical 
device manufacturers and some individual hospitals that furnish 
particular devices or drugs were concerned with the proposed reductions 
in payment for medical devices and drugs. We received many thoughtful 
comments from a wide range of commenters with regard to methodological 
issues in OPPS. In addition, several comments provided external data to 
support their assertions. The following are the major issues addressed 
by the commenters:
    [sbull] The proposal to use $150 as the packaging threshold for 
separate payment of drugs.
    [sbull] The proposal to pay for orphan drugs within the OPPS, 
basing payment on claims data.
    [sbull] The proposal to pay for generic drugs at 43 percent of 
average wholesale prices (AWP) beginning with the time of the generic 
drug's Food and Drug Administration (FDA) approval.
    [sbull] The proposed payments for blood and blood products under 
OPPS.
    [sbull] The proposal to establish a separate outlier pool for 
community mental health centers(CMHCs).The proposal to apply an 
adjustment to increase payment to small rural hospitals' clinic and 
emergency room (ER) visit rates to ameliorate the effect of the 
sunsetting of the transitional corridor payments.
    [sbull] The proposal to reinstitute drug and device coding 
requirements.
    [sbull] Propose APC assignments and status indicators for numerous 
services.
    In addition to comments regarding the policy proposals in the 
August 12, 2003 proposed rule, we received comments about the 
publication date of the proposed rule and the comment period.
    Comment: Some commenters objected to the use of the date on which 
the August 12, 2003 proposed rule was made public by web posting and by 
public display at the Office of the Federal Register as the beginning 
of the comment period. They indicated that we should start the comment 
period only on the publication of the proposed rule in the Federal 
Register because that is where subscribers look for it. They objected 
to what they view as a 55-day comment period if it were to start on the 
date of Federal Register publication (August 12, 2003). Some commenters 
objected to the publication of the proposed rule so late in the year. 
They indicated that our publication on August 9 resulted in the comment 
period ending so close to the publication deadline for the final rule 
that they believed that their comments could not be fully analyzed and 
used and would not be as effective as if the proposed rule were 
published in June or early July. They urged us to publish the proposed 
rule in late spring. Some commenters objected to the scheduling of the 
APC Panel meeting so soon after the issuance of the proposed rule 
because they felt that it gave them inadequate time to prepare their 
presentations for the Panel.
    Response: The comment period on a proposed rule begins on the day 
that the proposed rule is available for public comment. We believe that 
putting the document on display at the Office of the Federal Register 
and also making it available on the CMS Web site meets the test of 
being publicly available and that, therefore, is the start of the 
comment period. The publication of the proposed rule on the internet 
makes it available to many more people than routinely access the 
Federal Register or can visit the Office of the Federal Register where 
the display copy is located. The public had 60 days to comment on the 
proposed rule. This is the standard amount of time generally allowed 
for comment on notices of proposed rulemaking. Therefore, we do not 
believe the public was at a disadvantage or limited in the amount of 
time available to make public comments.
    Our review of the public comments is extensive, with the comments 
being read and considered carefully, often by many staff. We agree that 
it is preferable, when possible, to issue the proposed rule as early as 
possible. However, the important issue is whether we have sufficient 
time to carefully and thoughtfully consider all comments in development 
of the final rule, rather than the amount of time between the end of 
the comment period and the publication of the final rule.

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

    Under the OPPS, we pay for hospital outpatient services on a rate-
per-service basis that varies according to the APC group to which the 
service is assigned. Each APC weight represents the median hospital 
cost of the services included in that APC relative to the median 
hospital cost of the services included in APC 0601, Mid-Level Clinic 
Visits. The APC weights are scaled to APC 0601 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 unusual cases, such as low volume items and 
services.''
    For purposes of the proposed rule and this final 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 Social Security Act (the Act) requires 
that we consult with an outside panel of experts, the Panel, to review 
the clinical integrity of the APC groups and their

[[Page 63402]]

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 have been identified on 
the CMS web site.
    We received one comment regarding our selection of Panel members.
    Comment: One commenter stated that Community Mental Health Centers 
(CMHCs) have not been represented on the APC Panel even though the 
names of qualified nominees have been submitted. The commenter went on 
to say that the Federal Register (February 28, 2003, at 68 FR 9671 
through 9672) specifically states, ``Qualified nominees will meet those 
requirements necessary to be a Panel member. Panel members must be 
representatives of Medicare providers (including Community Mental 
Health Centers) subject to the OPPS * * * [therefore,] I feel that it 
is imperative to have a freestanding CMHC representative on the 
Panel.''
    Response: The Federal Register notice on the APC Panel to which the 
commenter referred, states in section II, Criteria for Nominees, the 
following: ``The Panel shall consist of up to 15 members selected by 
the Secretary, or designee, from among representatives of Medicare 
providers (including Community Mental Health Centers) subject to the 
OPPS.'' The language does not mandate that a CMHC representative will 
be on the Panel. In the regulation, we simply identified 
representatives from CMHCs--or any other organizations--as possible 
nominees.
    This year, when we requested nominations for the APC Panel, the 
list of nominees was long, prestigious, and included representatives 
from all aspects of the health care industry: Doctors, nurses, hospital 
administrators, coders, etc. Therefore, our choices were difficult; 
however, since there are definite Federal guidelines governing our 
selections, and specific Panel and Agency needs to address, given the 
clinical range of services paid under the OPPS, we were able to 
identify the most qualified individuals. Since the needs of the Agency 
and the Panel change due to members leaving, we invite all concerned 
Medicare providers to continue to nominate qualified individuals when 
the need arises.
    The Panel's biannual meetings are forums to discuss APCs and 
representatives from the CMCHs--and other organizations--are invited to 
attend Panel meetings and to make presentations to the Panel on 
relevant agenda items.
    Comment: The commenter also stated that the APC Panel sets the 
payment rates for the outpatient services.
    Response: While the Panel is an advisory committee mandated by law 
to review the APC groups, and their associated weights, and to advise 
the Secretary of Health and Human Services and the Administrator of the 
Centers for Medicare & Medicaid Services concerning the clinical 
integrity of the APC groups and their weights, the APC Panel does not 
set payment rates for outpatient services. The advice provided by the 
Panel is considered by us in our development of the annual rulemaking 
to update the hospital OPPS. The APC Panel's activities most often 
address whether or not the HCPCS codes within the APCs are comparable 
clinically and with respect to resource use, assigning new codes to new 
or existing APCs, reassigning codes to different APCs, and the 
configuring of existing APCs into new APCs.
2. August 2003 Meeting
    The APC Panel met on August 22, 2003 to discuss issues presented in 
the proposed rule of August 12. We announced the meeting in the Federal 
Register on July 25 and invited the public to make presentations to the 
Panel on issues discussed in the proposed rule. In this section, we 
summarize the issues discussed by the Panel, their recommendations on 
those issues, and our decisions with respect to their recommendations.

a. Blood and Blood Products

    The Panel heard testimony by suppliers of blood and blood products 
and their representatives who expressed significant concerns about the 
proposed payment rates, particularly in light of new safety and testing 
requirements. These presenters to the Panel recommended that we exclude 
blood and blood products from the OPPS and pay for them at reasonable 
cost. After listening to the testimony, reviewing the median costs and 
proposed payments rate from our hospital claims data, and deliberating 
the issue, the Panel recommended that we continue to pay for blood and 
blood products within the OPPS. However, the Panel further recommended 
that we freeze the payment rates for blood and blood products at 2003 
levels for 2004 and 2005 while we undertake further analysis of the 
cost data. The Panel also recommended that hospitals be educated on the 
proper billing for blood and blood products.
    As discussed elsewhere in this final rule, we will accept the 
Panel's recommendation with respect to 2004. We will freeze the payment 
rates for blood and blood products at the 2003 payment levels. However, 
we are not making a decision with respect to 2005 at this time. Any 
proposals regarding our 2005 payment rates or policies for these items 
will be discussed in our proposed rule for the CY 2005 update. The 
Panel also recommended that the APCs for blood and blood products be on 
the agenda for the winter 2004 meeting in time for consideration of the 
2005 payment rates. We agree to place this item on the agenda for the 
next APC Panel meeting.

b. Nuclear Medicine, Brachytherapy, and Radiosurgery Services

(1) Nuclear Medicine APCs and Radiopharmaceuticals
    The Panel heard testimony on and considered the proposed 
restructuring of the nuclear medicine APCs discussed in the August 12, 
2003 proposed rule. The Panel recommended that we move forward with the 
categorization system in the proposed OPPS 2004 rule absent strong, 
reasoned opposition from provider groups. If strong opposition was 
revealed in the public comments,

[[Page 63403]]

the Panel recommended that we maintain the classification system that 
is in place for 2003. The Panel also recommended that we change the 
HCPCS code descriptors for radiopharmaceuticals to be on a ``per-dose'' 
basis--not on a ``per-unit'' basis.
    We have accepted the Panel's recommendation that we move forward 
with the proposed restructuring, after considering public comments on 
this issue. As discussed in section II.A.3 of this final rule, we will 
implement the restructuring with certain changes to the proposed 
reclassification based on our review of the public comments. For 
reasons discussed in section VI.B.3 of this final rule, we are not 
accepting the Panel's recommendation to change the HCPCS code 
descriptors at this time.
    The Panel further recommended that APCs for radiopharmaceuticals be 
on the agenda for the January 2004 meeting. In preparation for that 
meeting, the Panel recommended that our staff analyze the claims for 
the nuclear medicine APCs and do the following: Itemize the costs, 
determine what proportion of the median cost can be attributed to 
radiopharmaceuticals, and present the data at the Panel's January 2004 
meeting. The Panel recommended that the issue of packaging the costs of 
radiopharmaceuticals under the 2003 threshold of $150 be placed on the 
agenda for the Panel's winter 2004 meeting.
    We will consider this topic for placement on the agenda for the 
Panel's 2004 meeting. As discussed in section VI.B.3 of this rule, 
however, we are revising our threshold for packaging 
radiopharmaceuticals from $150 to $50.
(2) Brachytherapy Services
    The Panel recommended that we review whether the codes for needles 
and catheters were included in the payment rate proposed for APC 0313. 
The Panel also recommended that we consider outside data presented by 
commenters in establishing payment rates for APCs 312 and 651 to arrive 
at an appropriate payment rate. See our discussion, below, regarding 
APCs 312, 313, and 651 and our considerations concerning the claims 
used to set the relative weights for these APCs.
    The Panel further recommended that we discontinue use of G codes 
for prostate brachytherapy and use appropriate Current Procedural 
Terminology (CPT) codes paid in clinical APCs when making payment for 
these services. The Panel recommended we pay separately for 
brachytherapy sources for the treatment of prostate cancer in the same 
manner by which we are paying separately for the brachytherapy sources 
for the treatment of other types of cancer. We have accepted the 
Panel's recommendation. As discussed in section II.B.4 of this final 
rule, we will discontinue use of the special G codes for prostate 
brachytherapy and allow separate payment for the sources used in these 
treatments.
(3) Radiation Therapy and Radiosurgery APC Issues
    The APC Panel heard testimony concerning radiation treatment 
delivery codes CPT 77412 through 77416, which we proposed to assign to 
APC 0301 and CPT 77417, assigned to APC 0260. The presenter stated that 
many hospital billing departments had not updated their charge masters 
since the inception of OPPS to reflect the costs of newer technology, 
specifically with respect to the use of x-ray guidance during external 
beam radiation treatment delivery. The APC Panel recommended that we 
review whether the use of x-ray guidance (as opposed to CT or 
ultrasound guidance) for radiation therapy is being properly reported 
and included in the payment rates for the radiation treatment delivery 
codes. We agree that we should review these issues further and will do 
so in preparation for the 2005 update. However, we did not receive 
sufficient or convincing information upon which to base a change for 
2004. Therefore, we encourage interested parties to submit any 
additional information on the use of these codes and cost of providing 
these services in the outpatient hospital setting in response to this 
final rule with comment period.
    The APC Panel also heard testimony concerning the proposed payment 
rate for CPT 77418, assigned to APC 0412 (IMRT treatment delivery). The 
presenter stated that the proposed amount was too low. However, the APC 
Panel supported the proposal in the absence of compelling evidence that 
the rate derived from the claims data is wrong. We concur with the APC 
Panel's recommendation and will retain CPT 77418 in APC 0412. We used 
approximately 113,000 claims to set the weight for this procedure, 
which we believe is a sufficiently robust set of data.
    During this section of the APC Panel's August 22 meeting, the Panel 
members also heard testimony concerning HCPCS codes G0251 and G0173 
used to report stereotactic radiosurgery. The APC Panel supported the 
proposed payment rates for these codes until more data become 
available. The APC Panel also asked to review this issue further at its 
winter 2004 meeting. We discuss stereotactic radiosurgery in further 
detail below. We have decided to make certain changes to the payment 
for these procedures. However, the APC assignment for these codes for 
2004 is interim final. We solicit comments on the 2004 assignments, and 
we will also include this on the APC Panel's agenda for its winter 2004 
meeting.
    The final topic in this section of the APC Panel's August 22 
meeting pertained to HCPCS codes G0242 and G0243 (multi source photon 
stereotactic planning). The APC Panel was requested to recommend that 
we combine the coding for these procedures under one code, with the 
payment for the new code derived by adding the payment for G0242 and 
G0243 together. The information presented to the APC Panel stated that 
the services represented by the two G codes represent one continuous 
procedure, that it is a surgical procedure, and the cost center mapping 
should be to a surgical cost center. The APC Panel will review this 
request at its winter 2004 meeting. The APC Panel is interested in 
receiving comments on this topic from professional societies 
representing neurosurgeons, radiation oncologists and others concerning 
this proposal.

c. Payment and Coding for Drug Administration and for Certain Drugs, 
Biologicals, and Radiopharmaceuticals

    The APC Panel heard testimony and discussed the proposals described 
in the August 12, 2003 proposed rule on payment for drug administration 
and the packaging of the costs of drugs, biologicals, and 
radiopharmaceuticals. The APC Panel recommended that:
    [sbull] We continue to use the current ``Q'' codes for drug 
administration and not institute new ``G'' codes to represent the 
administration of either packaged or separately paid drugs.
    [sbull] We allow billing of Q0081 on a per-visit basis, rather than 
on a per-day basis as proposed.
    [sbull] We delete Q0085 and allow hospitals to use both Q0083 and 
Q0084 when billing for chemotherapy administered by both infusion and 
other techniques in a given visit.
    [sbull] That we consider adopting the final option among the three 
new methods of paying for drug administration that we proposed, as 
options to the current policy, in the August 12, 2003 proposed rule.
    [sbull] That we look further at hospital pharmacies' costs for 
preparing drugs and radiopharmaceuticals and this issue be examined 
more closely by the Panel during its winter 2004 meeting.
    The APC Panel also expressed serious concern about the dollar 
threshold for

[[Page 63404]]

the packaging of drugs and the adequacy of payment for separately paid 
drugs. However, in the absence of alternative proposals by us, the APC 
Panel did not make further recommendations on that issue. The APC Panel 
requested that we present alternative options during the winter 2004 
meeting, including a new APC structure for drugs and 
radiopharmaceuticals. As for specific drug issues, after hearing 
testimony concerning the codes for Baclofin refill kits, the APC Panel 
recommended that we delete code C9010 and retain the other codes for 
this product used in the treatment of Parkinson's disease and 
spasticity.
    We have carefully considered each of the APC Panel's 
recommendations along with comments on the subject of drug 
administration and payment for drugs, biologicals, and 
radiopharmaceuticals. For the reasons discussed more fully elsewhere in 
this final rule, we have decided to accept the APC Panel's 
recommendations that we continue using Q0081 through Q0084 in 2004; 
that we continue to define these codes on a per-visit, rather than per-
day basis; that we delete code Q0085; and that we delete code C9010. We 
have decided to continue paying for the drug administration ``Q'' codes 
according to our current rules and discuss that decision further in 
section VI.B.4 of this final rule. We will consider the Panel's 
recommendation that we investigate other approaches for paying for 
drugs and radiopharmaceuticals. However, for 2004, we have determined 
that we will pay separately under their own APCs for drugs, biologicals 
and radiopharmaceuticals for which the median per day costs are in 
excess of $50.
(4) Device-Related Procedures
    The APC Panel heard testimony from the device manufacturing 
community and others concerning payment for procedures that involve the 
implantation of devices. The presenters discussed concerns that 
affected such procedures in general, such as the absence of a proposal 
to limit payment reductions for such procedures between 2003 and 2004 
and issues related to the hospital claims for these procedures. 
Presentations to the APC Panel also discussed inadequacies in the 
claims data or our methodology for using the claims data to set 
relative weights for specific device-related APCs (APCs 0046, 0107, 
0108, 0222, 0225, 0385, and 0386. Presenters urged that the APC Panel 
advise us to use the best external data possible, including proprietary 
data that would be held confidential. Presentations to the APC Panel 
also addressed the multiple surgical reduction with respect to device-
related APCs.
    The APC Panel recommended:
    [sbull] That we use credible external data that can be made 
publicly available for establishing the median costs for APCs 0107 and 
0386.
    [sbull] That we change the status indicator for CPT 61885 so that 
it is not subject to the multiple procedure discounting.
    [sbull] That we assign the new CPT codes for central venous access 
devices into appropriate APCs, either clinical APCs or new technology 
APCs.
    [sbull] That the APC assignments of the new central venous access 
devices be reviewed by the APC Panel at its next meeting.
    [sbull] That we provide the APC Panel with median cost data for all 
APCs in spreadsheet format for its consideration in advance of and 
during its next meeting.
    [sbull] That we review the presenter's suggestions with respect to 
APC 0046 and make recommendations for any changes to this APC to the 
APC Panel at its next meeting.
    [sbull] That we change the status indicator for CPT 93571 and 93572 
from ``N'' (packaged status) to an appropriate indicator that allows 
separate payment under the APC.
    We considered the final set of recommendations from the APC Panel's 
August 2003 meeting and have accepted several of them. Specifically, we 
decided to use external data in setting the median cost for 2004 for 
APC 0107. We have not used external data for APC 0386. Each of these 
decisions is discussed in greater detail elsewhere in this final rule. 
We accepted the Panel's recommendation to change the status indicator 
for CPT 61885. In order to do so, we moved this code into its own APC, 
0039, Implant neurostim, one array. We have assigned the new CPT codes 
for central venous access devices to New Technology APCs as displayed 
in Addendum B. The range of new CPT codes is 36555 through 36597, and 
the new APC assignments include APCs 0032, 0115, 0109, 0187, and 1541.
    The assignment of these codes is subject to public comment and will 
be placed on the APC Panel's agenda for its next meeting. During that 
meeting, we will also provide the APC Panel with spreadsheet data on 
the median costs of all APCs. With respect to APC 0046, we are 
sympathetic to the presenter's concerns. However, we were not provided 
with data that we considered sufficient to assess whether a new coding 
structure with increased payment rates is warranted for the treatment 
of bone fractures with external fixation devices. However, we would 
support the specialty societies' efforts to request changes to the 
existing CPT coding structure. For reasons discussed elsewhere, we have 
not accepted the Panel's recommendation with respect to CPT codes 93571 
and 93572.
    Comment: An association voiced concern that the Panel meeting on 
August 22, 2003 came too soon after the publication of the August 12, 
2003 proposed rule for its members to prepare adequately for 
presentation to the Panel.
    Response: The agency must schedule the Panel meetings sufficiently 
in advance of the meeting in order to provide ample notice to the 
public of the meeting and to allow sufficient time for the Panel 
members to arrange their schedules. We attempted to balance those needs 
with the goal of conducting the first mid-year meeting of the Panel 
during the comment period so that issues discussed in the August 12, 
2003 proposed rule could be topics for the Panel's consideration and 
interested parties' testimony before the Panel. The July 25, 2003 
Federal Register notice (68 FR 44089) announced the second 2003 meeting 
of the APC Panel, which we believe provided sufficient advance notice 
of the meeting.
    While it is true that the proposed rule was placed on display on 
August 6, published on August 12, and the meeting was held on August 
22, 2003, many interested parties attended the meeting and presented 
thoughtful comments on most issues discussed in the proposed rule. 
Nevertheless, we will take this comment into consideration for future 
planning of APC Panel meetings.
    Comment: Several commenters expressed concern about the length of 
the meeting and time allotted on the agenda to particular issues. One 
commenter stated that scheduling only [1] day for Panel deliberations 
was inadequate. A commenter was concerned that device-related issues 
were relegated to the last hour, that presenters were given only 2 
minutes, and that there was little time for Panel discussion and 
consideration of the issues presented.
    Response: We appreciate the commenter's interest in ensuring that 
adequate time be allowed for the public to present issues for the 
Panel's consideration and for the Panel to have sufficient time for 
their discussion and deliberation.
    Although the device issues were scheduled for the last hour of the 
meeting, the Panel members received the written presentations 
beforehand, and had an opportunity to review them

[[Page 63405]]

before the meeting. Placing a limit on presentations is a prerogative 
of the Panel Chair and must at times be done in order to allow all 
interested parties to make presentations on agenda items. However, we 
will take all of the concerns into consideration when scheduling future 
meetings.
3. Recommendations of the Advisory Panel and Our Responses

January 2003 Meeting

    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 final 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 believed violated 
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 the August 12, 2003 proposed rule, we discuss our 
proposals regarding the 2 times rule based on the April 1 through 
December 31, 2002 data that we used to determine the final 2004 APC 
relative weights. Section II.B (68 FR 47977) of the August 12, 2003 
proposed rule also details the criteria we used when deciding to 
propose exceptions to the 2 times rule.
    Unless otherwise specified in each of the following discussions of 
the APC Panel's recommendations, our proposed actions are finalized in 
this final 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.
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 proposed to accept the Panel's recommendation.
    However, we received comments from a group of hospitals concerning 
the proposed change for CPT code 15851, removal of sutures under 
anesthesia (other than local), same surgeon. In their comments, the 
hospitals noted that the descriptor for CPT codes 15851 and 15850 
(removal of sutures under anesthesia (other than local), other surgeon, 
were virtually identical with the exception of which surgeon performs 
the suture removal. The commenters did not believe that the identity of 
the surgeon could result in a significant difference in resource costs 
to the hospital. Our clinical staff agree and believe that the 
difference in hospital median costs derived from our claims data may be 
due to a misunderstanding about the coding. For 2004, we have decided 
that we will place both CPT codes for suture remove under anesthesia in 
APC 0016.

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.
------------------------------------------------------------------------

    The APC Panel recommended that we make these changes, and we 
proposed to do so in our August 12, 2003 proposed rule.
    (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. In August, we proposed to accept the Panel's 
recommendation that we make no changes to the structure of these APCs 
for 2004. However, following our review of the median costs developed 
for the final rule, using a more complete set of claims for services 
from April through December 2002, we determined that CPT codes 11404 
and 11623 should be moved to APC 0021. 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 changes below.
    Move the following HCPCS codes as described below:

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

    The Panel recommended that we make the above changes. We proposed 
to accept the Panel's recommendation, with the exception of CPT code 
31720. After reviewing an additional quarter of claims data that were 
not available at the time the Panel convened, placement of CPT code 
31720 into APC 0072 better reflects its resource consumption. 
Therefore, we proposed to keep CPT code 31720 in APC 0072.

[[Page 63406]]

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 proposed 
to accept the Panel's recommendation that we make no changes to APC 
0097 for 2004. We received no comments disagreeing with this proposal, 
and we will adopt it for 2004. We also 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 believed, however, that 
the structure of APC 0099 should not be changed at this time based on 
clinical homogeneity considerations. We proposed 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 believed the data presented are insufficient to merit 
moving the code and recommended that CPT code 93025 remain in APC 0100 
until more data are available for review. We proposed to accept the 
Panel's recommendation that CPT code 93025 remain in APC 0100 until 
more claims data become available for review. We will adopt this 
proposal for 2004.

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 proposed 
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. We will adopt this proposal for 2004.

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 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 proposed to accept the Panel's recommendation that we 
make no changes to APCs 0146 and 0147. We will adopt this proposal for 
2004. However, 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 proposed to accept the Panel's recommendation, and we will 
adopt it for 2004.

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:

                                APC 0385
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
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
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
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 proposed to accept the Panel's recommendation to eliminate APCs 
0179 and 0182 and create two new APCs, 0385 and 0386, 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

[[Page 63407]]

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 proposed to split 
APC 0190 (Surgical Hysteroscopy) into two APCs that are more clinically 
homogeneous. We proposed 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 proposed 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 proposed to move the following HCPCS codes as 
described below:

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

    We believe these final 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.
1. 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 proposed to accept the 
Panel's recommendation to move CPT codes 57109, 58920, and 58925 from 
APC 0202 to APC 0195. We will adopt the Panel's recommendation for 
2004.

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 proposed to accept the Panel's 
recommendation that we make no changes to the structure of these APCs 
until more data become available for review. We will adopt the Panel's 
recommendation for 2004.

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 believed 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 
proposed to accept the Panel's recommendation that CPT code 62351 
remain in APC 0208 until more claims data become available for review. 
We will adopt the Panel's recommendation for 2004.

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 proposed 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

[[Page 63408]]

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 proposed 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: Implantation of programmable 
spine infusion pumps, 62362, and 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 0227 does 
not violate the 2 times rule, the Panel recommended that CPT codes 
62361 and 62362 remain in APC 0227. We proposed to accept the Panel's 
recommendation, which we will adopt for 2004.

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 proposed to 
accept the Panel's recommendation and monitor the data for APC 0235 for 
possible review next year. We will adopt this recommendation for 2004. 
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 proposed 
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. We will 
adopt the Panel's recommendation for 2004.

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 
proposed to accept the Panel's recommendation to move CPT codes 92543 
and 92588 from APC 0660 to APC 0363, and we will adopt the proposal for 
2004.

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 
proposed to accept the Panel's recommendation to move CPT codes 47530, 
50688, 51710, and 62225 from APC 0121 to APC 0122. We will adopt the 
proposal for 2004.

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 
proposed to accept the Panel's recommendation to move CPT codes 72285 
and 72295 from APC 0274 to new APC 0388. We will adopt the 
recommendation for 2004.

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 us 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 proposed to accept the Panel's 
recommendation that we make no CPT code changes to APCs 0296 and 0297, 
and we are adopting the proposal for 2004.

x. Vascular Procedures; Cannula/Access Device Procedures

    APC 0103: Miscellaneous Vascular Procedures

[[Page 63409]]

    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 recommended that CPT code 36860 remain in 
APC 0103 until more data are available for review. We proposed to 
accept the Panel's recommendation that CPT code 36860 remain in APC 
0103 until more claims data become available for review. We will adopt 
this proposal for 2004.

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 0280. The Panel believed 
that APCs 0279, 0280, and 0668 were clinically homogenous and 
recommended that we only make changes after consulting with experts in 
the field. We proposed to accept the Panel's recommendation to make no 
changes to APCs 0279, 0280, and 0668 until we have consulted 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 believed 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 be 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 To Be Designated as Separately Payable
------------------------------------------------------------------------
                                                           2004    2004
            HCPCS                 Description    2003 SI    SI      APC
------------------------------------------------------------------------
76362........................  CT scan for       N......  S.....    0332
                                tissue ablation.
76394........................  MRI for tissue    N......  S.....    0335
                                ablation.
76490........................  US for tissue     N......  S.....    0268
                                ablation.
------------------------------------------------------------------------

    We proposed 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. HCPCS 76490 has been deleted for 
2004. However, we will pay for it under APC 0268 during the grace 
period from January through March 2004.

aa. Magnetic Resonance Imaging and Magnetic Resonance Angiography 
Without Contrast

    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 proposed 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 proposed 
to accept the Panel's recommendation, and we will adopt the proposal 
for 2004.

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 will 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

[[Page 63410]]

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 will be used to determine whether to change 
the APC structure for chemotherapy administration.
    We proposed not to accept the Panel's recommendations to split APC 
0116 into three APCs and to use CPT codes for administration of 
chemotherapy. We will consider such a split in the future but would 
like to first address the administration of drugs issue. Based on the 
comments we received on our proposed drug administration coding, we 
believe that making a change in APC 0116 will be too complicated and 
burdensome for hospitals at this time. (See a full discussion of this 
in section VI.B.4 of this final rule.)
    We will consider such a split for APC 0116 for CY 2005. We also 
believe the use of CPT codes will be burdensome to hospitals, will 
require extensive education, and will 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 are 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 
will 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. See section VI of this final rule for further discussion on 
payments for drugs and drug administration.

dd. Capturing the Costs of Drugs, Biologicals and Radiopharmaceuticals 
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
    At the January 2003 meeting, 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 stated 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 will have no incentive to code, 
and thereby identify, packaged drugs.
    Pass-through payments for 236 drugs, biologicals, and 
radiopharmaceuticals expired as of 2003, were then 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 do not provide specific cost information for packaged items. We 
requested input from the Panel on methods for determining drug costs in 
the future.
    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 radionuclides 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 
radiopharmaceuticals and believe that restructuring the APCs for 
nuclear medicine will result in greater clinical and resource 
homogeneity. Therefore, we proposed to eliminate APCs 0286, 0290, 0291, 
0292, 0294, and 0666 and create 20 new APCs for nuclear medicine.
    Comment: We received many comments about the proposed nuclear 
medicine APCs. Generally, commenters supported our proposal for the new 
APCs but had suggestions for modifications to improve clinical and 
resource use homogeneity. The suggested modifications are:
    [sbull] Split APC 0398 into three levels to account for differences 
in the number of sessions provided and type and amount of 
radiopharmaceutical used with these procedures.
    [sbull] Split APC 0401 into two levels to account for the different 
number of sessions, type and amount of radiopharmaceuticals used, and 
whether or not ventilation imaging and perfusion imaging are part of 
the procedure.
    [sbull] Delete codes G0273 and G0274 and use the newly created CPT 
codes 78804 and 79403. They recommended that we assign 78804 to a new 
APC 0406T, Tumor/Infection Imaging Level II and that we assign 79403 to 
the new APC for Radionucliide Therapy APC, created by combining 
proposed APCs 0407 and 0408.
    [sbull] Move codes 78015, 78016, and 78018 from APC 0390 to APC 
0406 because they are for metastatic tumor imaging rather than for one 
organ system.
    [sbull] Move all of the nuclear medicine ``add-on'' codes into one 
APC to be named ``Nuclear Medicine Add-On Imaging.'' Three of the 
codes, 78478, Heart wall motion add-on, 78480 Heart function add-on, 
and 78496, Heart function first pass add-on, are assigned to proposed 
APC 0399. They recommended moving the remaining add-on code, 78020, 
Thyroid carcinoma metastases uptake, to proposed APC 0399 with the 
other three add-on codes, to create an APC comprised of add-on codes 
with a status indicator ``X.''
    [sbull] Move each of the codes in the series of codes, 78X99 into 
the appropriate APCs based on the organ system to be consistent with 
the proposed APC structure.
    [sbull] Reassign codes 78270, 78271, and 78272 to APC 0389 because 
they are

[[Page 63411]]

non-imaging nuclear medicine procedures with resource use more similar 
to the procedures in APC 0389.
    [sbull] Combine APCs 0390, 0391, and 0392 to create two new APCs 
composed of thyroid, parathyroid, and adrenal systems. They suggest 
that the codes should be reassigned to two levels of endocrine imaging 
based on the number of sessions and radiopharmaceuticals used in the 
procedure. The titles suggested for the new APCs are ``Endocrine Level 
I'' and ``Endocrine Level II.''
    [sbull] Combine proposed APCs 0407 and 0408 into one APC because 
hospital claims data do not reflect any logical division between the 
two proposed APCs. Further, they request that all of the nuclear 
medicine therapy codes in the new APC should be paid separately since 
they know of no nuclear medicine therapeutic radiopharmaceutical that 
has costs below the proposed $150 threshold for packaging.
    [sbull] Collapse and redistribute code assignments in APCs 0404 and 
0405 to create two new APCs for Level I and Level II Renal and 
Genitourinary Studies. They recommended assigning only one code, 78709, 
Kidney imaging, multiple studies, with and without pharmaceutical 
intervention, to the Level II APC.
    Response: After careful review of the recommendations, with one 
exception, we concur with the commenters that their recommended 
modifications to the proposed APC classifications improve clinical 
homogeneity and payment equity. The shifts in median cost that result 
from the adjustments are minor in most cases and overall, the increased 
cost is not significant.
    The one exception to our agreement with the commenters' 
recommendation is regarding the assignment of 78708, Kidney imaging 
with vascular flow and function, single study. Commenters recommended 
that it be assigned to APC 0404. We believe that it is more 
appropriately assigned to APC 0405 based on both clinical and resource 
use considerations.
    Although we do not disagree with the commenters' suggestions, we 
also will not assign the new code 78804, pre-treatment planning, non-
Hodgkins to the APC suggested by the commenters. Instead, we will 
assign it to new technology APC 1508. A detailed discussion of this 
assignment and other issues related to Zevalin is below in section 
VI.B.
    Thus, we will finalize the nuclear medicine APCs as shown below.

                   APC 0376: Cardiac Imaging Level II
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78473.....................................  Gated heart, multiple.
78483.....................................  Heart first pass, multiple.
------------------------------------------------------------------------


                   APC 0377: Cardiac Imaging Level III
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78461.....................................  Heart muscle blood,
                                             multiple.
78465.....................................  Heart image (3D), multiple.
------------------------------------------------------------------------


                  APC 0378: Pulmonary Imaging Level II
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78584.....................................  Lung V/Q image gas, single
                                             breath.
78585.....................................  Lung V/Q imaging gas.
78588.....................................  Lung V/Q imaging aerosol.
78596.....................................  Lung differential function.
------------------------------------------------------------------------


                 APC 0389: Non-Imaging Nuclear Medicine
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78000.....................................  Thyroid, single uptake.
78001.....................................  Thyroid, multiple uptakes.
78003.....................................  Thyroid suppress/stimuli.
78190.....................................  Platelet survival, kinetics.
78191.....................................  Platelet survival.
78270.....................................  Vitamin B-12 absorption
                                             exam.
78271.....................................  Vitamin B-12 absorp. exam,
                                             intrin. Fac.
78272.....................................  Vitamin B-12 absorp,
                                             combined.
78725.....................................  Kidney function study.
------------------------------------------------------------------------


                       APC 0390: Endocrine Level I
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78006.....................................  Thyroid imaging with uptake.
78010.....................................  Thyroid imaging.
78011.....................................  Thyroid imaging with flow.
78099.....................................  Endocrine nuclear procedure.
------------------------------------------------------------------------


                      APC 0391: Endocrine Level II
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78007.....................................  Thyroid image, mult uptakes.
78070.....................................  Parathyroid nuclear imaging.
78075.....................................  Adrenal nuclear imaging.
------------------------------------------------------------------------


                    APC 0393: Red Cell/Plasma Studies
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
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 0394: Hepatobiliary Imaging
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
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: Gastrointestinal Imaging
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
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.
78282.....................................  GI protein loss exam.
78290.....................................  Meckel's divert exam.
78291.....................................  Leveen/shunt patency exam.
78299.....................................  GI nuclear procedure.
------------------------------------------------------------------------


                         APC 0396: Bone Imaging
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78300.....................................  Bone imaging, limited area.
78305.....................................  Bone imaging, multiple
                                             areas.
78306.....................................  Bone imaging, whole body.
78315.....................................  Bone imaging, 3 phase.
78320.....................................  Bone imaging (3D).
78399.....................................  Musculoskeletal nuclear
                                             exam.
------------------------------------------------------------------------


                       APC 0397: Vascular Imaging
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78445.....................................  Venous thrombosis study.
78455.....................................  Venous thrombosis study.

[[Page 63412]]

 
78456.....................................  Acute venous thrombus image.
78457.....................................  Venous thrombosis imaging.
78458.....................................  Ven thrombosis images,
                                             bilat.
------------------------------------------------------------------------


                    APC 0398: Cardiac Imaging Level I
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78414.....................................  Non-imaging heart function.
78428.....................................  Cardiac shunt imaging.
78460.....................................  Heart muscle blood, single.
78464.....................................  Heart image (3D), single.
78466.....................................  Heart infarct image.
78468.....................................  Heart infarct image (ef).
78469.....................................  Heart infarct image (3D).
78472.....................................  Gated heart, planar, single.
78481.....................................  Heart first pass, single.
78494.....................................  Heart image, spect.
78499.....................................  Unlisted cardiovascular.
------------------------------------------------------------------------


                APC 0399: Nuclear Medicine Add-On Imaging
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78020.....................................  Thyroid met uptake.
78478.....................................  Heart wall motion add-on.
78480.....................................  Heart function add-on.
78496.....................................  Heart first pass add-on.
------------------------------------------------------------------------


                     APC 0400: Hematopoietic Imaging
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78102.....................................  Bone marrow imaging, ltd.
78103.....................................  Bone marrow imaging, mult.
78104.....................................  Bone marrow imaging, body.
78185.....................................  Spleen imaging.
78195.....................................  Lymph system imaging.
78199.....................................  Blood/lymph nuclear exam.
------------------------------------------------------------------------


                  APC 0401: Pulmonary Imaging, Level 1
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78580.....................................  Lung perfusion imaging.
78586.....................................  Aerosol lung image, single.
78587.....................................  Aerosol lung image,
                                             multiple.
78591.....................................  Vent image, 1 breath, 1
                                             proj.
78593.....................................  Vent image, 1 proj, gas.
78594.....................................  Vent image, mult proj, gas.
78599.....................................  Respiratory Nuclear Exam.
------------------------------------------------------------------------


                         APC 0402: Brain Imaging
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
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.
78699.....................................  Nervous system nuclear exam.
------------------------------------------------------------------------


                          APC 0403: CSF Imaging
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
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: Renal & Genitourinary Studies Level I
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78700.....................................  Kidney imaging, static.
78701.....................................  Kidney imaging with flow.
78704.....................................  Imaging renogram.
78707.....................................  Kidney flow/function image.
78710.....................................  Kidney imaging (3D).
78715.....................................  Renal vascular flow exam.
------------------------------------------------------------------------


            APC 0405: Renal & Genitourinary Studies Level II
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78708.....................................  Kidney flow/function image.
78709.....................................  Kidney flow/function image.
------------------------------------------------------------------------


                    APC 0406: Tumor/Infection Imaging
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78015.....................................  Thyroid metastases imaging.
78016.....................................  Thyroid metastases imaging/
                                             studies.
78018.....................................  Thyroid metastases imaging/
                                             body.
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.
------------------------------------------------------------------------


                     APC 0407: Radionucliide Therapy
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
79000.....................................  Init hyperthyroid therapy.
79001.....................................  Repeat hyperthyroid therapy.
79020.....................................  Thyroid ablation.
79030.....................................  Thyroid ablation, carcinoma.
79035.....................................  Thyroid metastatic therapy.
79100.....................................  Hematopoetic nuclear
                                             therapy.
79200.....................................  Intracavitary nuclear
                                             treatment.
79300.....................................  Interstitial nuclear
                                             therapy.
79400.....................................  Nonhemato nuclear therapy.
79420.....................................  Intravascular nuclear
                                             therapy.
79440.....................................  Nuclear joint therapy.
79999.....................................  Nuclear medicine therapy.
------------------------------------------------------------------------


             APC 1507: New Technology Level VII ($500-$600)
------------------------------------------------------------------------
 
------------------------------------------------------------------------
79403.....................................  Hematopoetic nuclear
                                             therapy.
------------------------------------------------------------------------


               APC 1508: Tumor/Infection Imaging Level II
------------------------------------------------------------------------
                   HCPCS                             Description
------------------------------------------------------------------------
78804.....................................  Pre-tx planning, non-
                                             Hodgkins.
------------------------------------------------------------------------

    We believe that the final 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.

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 will 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 proposed to accept the Panel's recommendation that we move CPT 
codes 31630, 31631, 31640, and 31641 from APC 0076 to new APC 0415. We

[[Page 63413]]

received no comments disagreeing with this proposal and will adopt this 
recommendation for 2004.

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 will 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 0384
----------------------------------------------------------------------------------------------------------------
                HCPCS                                    Description                      2003 APC     2004 APC
----------------------------------------------------------------------------------------------------------------
43219...............................  Esophagus endoscopy.............................         0141         0384
43256...............................  Upper GI endoscopy w/stent......................         0141         0384
44370...............................  Small bowel endoscopy w/stent...................         0142         0384
44379...............................  Small bowel endoscopy w/stent...................         0142         0384
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 proposed 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, 45345 (from APC 
0147). We received no comments disagreeing with this proposal, and we 
will adopt it for 2004.

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 II.B of 
this preamble, 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 
modeling a variety of possible dollar amounts). In addition, the Panel 
recommended that we not create 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.

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 preamble and 
the use of 2002 claims data to calculate the

[[Page 63414]]

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 the final list of APCs that we 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.--APCS Exempted From 2 Times Rule
----------------------------------------------------------------------------------------------------------------
               Final Rule APC                                             Description
----------------------------------------------------------------------------------------------------------------
0006........................................  Level I Incision & Drainage.
0012........................................  Level I Debridement & Destruction.
0018........................................  Biopsy of Skin/Puncture of Lesion.
0019........................................  Level I Excision/Biopsy.
0020........................................  Level II Excision/Biopsy.
0043........................................  Closed Treatment Fracture Finger/Toe/Trunk.
0046........................................  Open/Percutaneous Treatment Fracture or Dislocation.
0058........................................  Level I Strapping and Cast Application.
0060........................................  Manipulation Therapy.
0071........................................  Level I Endoscopy Upper Airway.
0074........................................  Level IV Endoscopy Upper Airway.
0084........................................  Level I Electrophysiologic Evaluation.
0093........................................  Vascular Reconstruction/Fistula Repair without Device.
0097........................................  Cardiac and Ambulatory Blood Pressure Monitoring.
0099........................................  Electrocardiograms.
0103........................................  Miscellaneous Vascular Procedures.
0105........................................  Revision/Removal of Pacemakers, AICD, or Vascular.
0109........................................  Removal of Implanted Devices.
0130........................................  Level I Laparoscopy.
0147........................................  Level II Sigmoidoscopy.
0148........................................  Level I Anal/Rectal Procedure.
0155........................................  Level II Anal/Rectal Procedure.
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.
0279........................................  Level II Angiography and Venography except Extremity.
0297........................................  Level II Therapeutic Radiologic Procedures.
0303........................................  Treatment Device Construction.
0314........................................  Hyperthermic Therapies.
0323........................................  Extended Individual Psychotherapy.
0340........................................  Minor Ancillary Procedures.
0341........................................  Skin Tests.
0344........................................  Level III Pathology.
0355........................................  Level III Immunizations.
0356........................................  Level IV Immunizations.
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.
0397........................................  Vascular Imaging.
0398........................................  Level I Cardiac Imaging.
0402........................................  Brain Imaging.
0404........................................  Renal and Genitourinary Studies Level I.

[[Page 63415]]

 
0407........................................  Radionuclide Therapy.
0409........................................  Red Blood Cell Tests.
0688........................................  Revision/Removal of Neurostimulator Pulse Generator Receiver.
0692........................................  Electronic Analysis of Neurostimulator Pulse Generators.
0698........................................  Level II Eye Tests & Treatments.
0699........................................  Level IV Eye Tests & Treatments.
1528........................................  New Technology--Level XXVIII ($5000-$5500).
----------------------------------------------------------------------------------------------------------------

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. Beginning in 2002, the policy is to 
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 below, we proposed to delete four HCPCS codes that are 
currently paid in new technology APCs. We believed that 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, we stated 
that there soon would exist, CPT codes to describe all of 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 which we proposed to delete effective January 1, 
2004 were:

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.

    A full description of these HCPCS is available in the proposed rule 
(67 FR 47978).
    We received no comments in response to this proposal. However, we 
have determined that our proposal to delete codes C9701 and C9703 was 
in error. Upon further review of this issue, we have determined that 
these codes were in fact established to represent complete procedures. 
Therefore, we will retain codes C9701 and C9703.
    Comment: A provider of treatment planning software submitted 
several comments regarding this service. In their first set of comments 
on the 2003 OPPS final rule with comment, the commenter agreed with our 
decision to create a new G-code, G0288, for their product, Preview, and 
other similar treatment planning software and to assign this service to 
new technology APC 0975. G0288 was created and assigned to new 
technology APC 0975 for the 2003 final rule and was subject to comment 
after its publication. In their comments in response to the 2003 final 
rule with comment, they indicated that the $625 payment rate associated 
with new technology APC 0975 appropriately reflected the costs of 
Preview to providers. However, this party recommended that we pay for 
G0288 under certain circumstances. These included payment only for 
treatment planning imaging services that are FDA approved; that is, to 
follow FDA's determinations concerning which imaging software programs 
are sufficiently comprehensive and accurate. Further, the commenter 
recommended that we pay for both pre-surgical and post-surgical 
imaging, claiming optimum effectiveness of the related endovascular 
repair procedures only occurs when imaging studies are performed both 
before and after surgery. Third, this party recommended that we use 
G0288 in the OPPS but not in other Medicare payment systems until cost 
data were more complete. The commenter believed that we should 
encourage use of the CPT process to develop codes that describe a wide 
range of applications for the treatment planning imaging that may 
develop.
    The commenter also commented on our August 12, 2003 proposed rule, 
in which we proposed assigning G0288 to new APC 0414, with a payment 
rate of $260.65. This commenter stated that the proposed payment is 
inadequate and based on flawed, imputed cost data. It also asserted 
that the descriptors for APC 0414 and G0288 do not restrict the use of 
this code to services that meet the ``recognized standards and 
specifications'' for three-dimensional computer-aided measurement 
planning simulation (``3D-CAMPS'') services and recommended that we 
revise the proposed payment for APC 0414 based on hospital acquisition 
cost data that they provided. The commenter also recommended that we 
create a revenue code specifically for APC 0414 to enable more rational 
charge determination for the service and that we revise the descriptors 
for APC 0414 and G0288 to ensure that the codes only are used for the 
3D-CAMPS systems, and to clarify that the service may be applied pre- 
or post-surgically. The recommended descriptor is: ``Three-dimensional 
computer-aided measurement simulation (3D-CAMPS) services for pre-
surgical and post-surgical imaging.''
    Response: We proposed to move G0288 from new technology APC 0975 to 
APC 0414 because we believe that we had sufficient 2002 claims data for 
our analysis. The predecessor C-code for Preview, C9708, was reported 
approximately 1,300 times in 2002, with a median cost of $272.48. 
However, we have reviewed the hospital cost data that the commenting 
party provided, and believe that there may be some claims in our data 
that understate the cost of the treatment planning software. We have 
decided to give equal weight to the median cost based on our claims 
data and the median cost of $625 provided by the commenter, based on 
its analysis. Therefore, we are establishing the appropriate cost

[[Page 63416]]

amount as $448.74. As a result, we are assigning G0288 to new 
technology service APC 1506, for a payment rate of $450.00. We are 
continuing the assignment of G0288 to a new technology APC because this 
is still a relatively new procedure and we still have concerns 
regarding our cost data.
    We agree that this can be used for treatment planning prior to 
surgery and for post-surgical monitoring and have revised the code 
descriptor to clarify this point. The descriptor for this code is 
revised as follows: G0288 Reconstruction, computed tomographic 
angiography of aorta for preoperative planning and evaluation post 
vascular surgery. We assume that hospitals providing this service will 
abide by the FDA labeling requirements for equipment used in providing 
this service.
3. Revision of Cost Bands and Payment Amounts for New Technology APCs
    We proposed 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 inaccurate 
payment 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 proposed 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 proposed 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 solicited comments on the hierarchy of cost 
levels of the restructured new technology APCs.
    The final list of restructured new technology APCs is in Addendum 
A.
    We received a number of comments in support of this proposal to 
restructure the new technology APC bands. Therefore, we will finalize 
our proposal.
4. Creation of APCs for Combinations of Device Procedures
    In the August 12, 2003 proposed rule, we discussed data development 
that we had undertaken to create median costs for combinations of HCPCS 
codes in different APCs that we believed were frequently performed on 
the same day. We focused our work on pairs of APCs, one of which 
contained a service that required an expensive device. See 68 FR 47979 
for a complete description of the data development. We undertook this 
activity to see if creating larger classification groups of this type 
might increase the number of multiple procedure claims that we could 
use to set payment rates for these services. We also thought that the 
analysis might yield useful information regarding the appropriateness 
of the multiple procedure reduction for combinations of services that 
include at least one APC with an expensive device, that are commonly 
performed on the same date. In many cases, we found that the 
combination APC medians closely approximated the median that results 
under the current policy (that is, the sum of single medians for each 
APC, reducing the median for the lower cost procedure by 50 percent). 
In other cases, the data revealed combination APC median costs that 
were considerably higher or lower than under our current policy.
    We concluded in the proposed rule that the results of the study 
provided no compelling reason to change our payment policy. We asked 
for comment on all aspects of the methodology, analysis, and payment 
options. We also asked for discussion of how we could use more multiple 
procedure claims were we not to create combination APCs and for an 
explanation of why external data should be used in lieu of our single 
or multiple procedure claims data to set median costs for APCs with 
large device costs. However, we did not propose to create combination 
APCs or to make payment based on the combination APC medians for 2004.
    We received only a few comments on the combination APC methodology 
and these were in the context of why we should not apply multiple 
procedure reductions to specific combinations of APCs. See the 
discussion of multiple procedure reduction in V.D.2 for a summary of 
these comments and our responses.

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 used the same 
basic methodology that we described in the April 7, 2000 final rule. 
That is, we recalibrated the weights based on claims and cost report 
data for outpatient services. We used 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 127 million final 
action claims for hospital outpatient department services furnished on 
or after April 1, 2002 and before January 1, 2003. We eliminated 2.6 
million claims for bill types other than OPPS bill types and claims for 
services furnished in Maryland, Guam, and the Virgin Islands. We 
matched the remaining claims that were paid under the OPPS to the most 
recent cost report filed by the individual hospitals represented in our 
claims data. We were left with about 75 million claims for which we 
could identify cost report data. The APC relative weights 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 used claims for the period beginning April 1, 2002 through and 
including December 31, 2002 as the basis 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.
    Comment: Some commenters supported our use of claims for this 9-
month period for setting the weights for

[[Page 63417]]

the 2004 OPPS. Other commenters wanted us to use external data in lieu 
of claims data for specified APCs because they believed that the 
payments that result from the median costs developed using claims data 
were inadequate. Other commenters objected to the use of 2002 claims 
data because they stated that 2002 costs would not be an appropriate 
proxy for the relative costs of drugs, biologicals, and 
radiopharmaceuticals in 2004 and they urged us to use hospital 
acquisition costs instead of claims data.
    Response: We used 2002 claims data for services furnished from 
April 1, 2002 through December 31, 2002 as the basis for the relative 
weights used to create payment amounts for the 2004 OPPS. Our 
established policy is to use the most recent claims data available. For 
the August 12, 2003 proposed rule and this final rule, those data are 
for services in the last 3 quarters of 2002. These data are used to 
calculate median costs upon which to base our relative weights. The 
OPPS seeks and uses relative costs to create weights that are used to 
distribute a fixed amount of Medicare payment for OPPS services 
appropriately among hospitals. Therefore, the accuracy of the 
relativity is more important than whether the median costs derived from 
the claims data accurately reflect the costs of the services. See 
section III.B for our discussion of the use of external data.
2. Treatment of ``Multiple Procedure'' Claims
    Since the inception of the OPPS, 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 OPPS 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 and complex procedures, particularly those commonly performed 
in combination with other procedures.
    We agree that it is desirable to use the data from as many claims 
as possible to recalibrate the relative payment weights, including 
those with multiple procedures. For CY 2003, we identified a number of 
multiple-procedure claims that could be treated as single-procedure 
claims, enabling us to greatly increase the number of claims used to 
develop the APC payment weights. However, there remain several inherent 
features of multiple procedure claims that prevent 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).
    To enable us to use more claims in the creation of median costs 
upon which our payment weights and rates are based, we proposed several 
changes to how we use claims data for the CY 2004 OPPS. Specifically, 
we proposed to expand the number of HCPCS codes that we ``ignore'' for 
the purpose of creating pseudo single claims 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 
proposed where possible, to attribute the charges to major, separately 
payable HCPCS codes based on the codes' dates of service. We also 
considered creating combination APCs for procedures that have a 
significant device component. Our complete discussion of the use of 
data to set the weights for CY 2004 OPPS follows in section III.B of 
this preamble.

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 only 
one remaining separately paid, major HCPCS code on the claim. Ignoring 
these codes enabled us to attribute the costs of packaged HCPCS codes 
and packaged revenue centers to the remaining separately paid, major 
HCPCS codes and, thereby, create a useable psuedo single claim. We did 
this because we believed 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 once the 
ignored codes were bypassed.
    For CY 2004 OPPS, we proposed to expand the list of HCPCS codes to 
be ignored for purposes of creating pseudo-single claims. On claims 
that contain other separately payable HCPCS, we proposed to bypass the 
HCPCS codes in the APCs identified in Table 6. As with the previously 
ignored HCPCS codes 93005, 71010, and 71020, we believe that there are 
additional codes that are highly unlikely to have charges that are 
found in packaged HCPCS or in packaged revenue centers. Therefore, we 
believe that they also can be ignored for the purpose of creating 
pseudo-single claims from the remaining charges on the claim. We 
solicited comments on the proposed methodology to create pseudo-single 
claims, on the list of codes that we proposed to ignore (Table 6), and 
whether there are other low-cost services that we could ignore using 
this methodology. We also requested comments on whether we should use 
the charges for the codes in the APCs in Table 6 to create pseudo 
singles for these codes from these claims.

Use of Dates of Service To Create Single Claims

    For CY 2004, we used 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 could 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 could not use this approach because 
there was no way to tell to which major payable HCPCS code the charges 
from the packaged HCPCS or packaged revenue center belonged. Moreover, 
where the hospital did not provide dates for all packaged revenue 
centers, we could not attribute charges based on the date of service.

Use of Single Procedure Claims

    Comment: Some commenters objected to the use of single procedure 
claims as the basis for setting weights for all APCs. The commenters 
are concerned that even with the changes we made to use more claims for 
2004 OPPS, some of the APCs had medians based on less than 10 percent 
of their true claims volume. They believe that this methodology results 
in the use of claims only for simple, low-cost cases from small, 
relatively non-busy centers with low levels of technological complexity 
and inappropriately low costs and charges. They urged us to use 
external data, whether proprietary or not, in place of the claims-
derived medians when the medians would otherwise be based on a small 
number of claims.
    Some commenters urged us to ignore codes for procedures performed 
on the same day as procedures of interest to them and to package all 
revenue center charges and charges for packaged HCPCS codes into the 
code for which they were seeking a median. Some commenters gave us 
relatively elaborate strategies for creating pseduo-single claims out 
of multiple procedure claims for particular services or groups of 
services that were of interest to them. Some of these related to 
special packaging for chemotherapy services and nuclear medicine 
services. The commenters urged us to model our data for the 2005 OPPS 
according to the specifications they provided.

[[Page 63418]]

    Response: We would certainly prefer to use all claims in the 
setting of weights for APCs, if it were possible to do so validly. 
However, we continue to be plagued by our inability to allocate revenue 
center charges when there are multiple major procedure codes for 
services performed on the same day. We are unable to determine how to 
accurately split some costs (for example, recovery room time) among the 
major procedures. We have received no comments that offer alternatives 
that would enable us to do so with confidence.
    We did not accept the service-specific strategies for acquiring 
more single claims that were submitted in comments because none of them 
could be generalized to the entire claims population in such a way that 
we could be sure that they would not distort the relativity of all 
services. We set weights for hundreds of APCs in this system and we 
think it is important that the same rules governing creation of pseudo 
single claims from multiple procedure claims be applied across all 
services so that packaging occurs uniformly and the relativity of 
services is maintained. It is a practical impossibility to have 
different strategies for creating pseudo singles for each category of 
services.
    We did not use the line items that were ignored in the calculation 
of medians for the APC into which they would fall because we lacked 
confidence that they would accurately represent the full cost of the 
service. We asked for comments on this in the proposed rule. Based on 
the comments that indicate that the data for these line items should be 
used in median setting, we expect to use these line items for median 
setting for the 2005 proposed rule.

APCs to be Ignored To Create More Single Claims

    Comment: Commenters supported the expansion of the list of APCs 
that we ignored to create single procedure claims from multiple 
procedure claims to enable us to use more claims data in weight 
setting. A commenter asked that we confirm that the line items that 
were ignored to create pseudo-single claims (See Table 6) are used in 
the weight setting process. A commenter asked that we implement the 
combination APC approach as a way of using more claims data for 
multiple procedure claims. One commenter asked that we add evaluation 
and management codes to the list of codes ignored for purposes of 
creating pseudo-singles. Other commenters provided lists of additional 
codes that could be ignored to create more pseudo-single claims.
    Commenters also supported the use of dates of service on lines with 
revenue code charges where they could be used to attribute charges to 
HCPCS codes for weight setting. Some commenters advised that we should 
use the date of service aggregation at the beginning of the pseudo-
single claim creation to achieve the best effects. Some commenters 
asked that we require all hospitals to use dates of service on all 
lines (but not before July 1, 2004), even where only revenue codes are 
on the lines, so that more claims could be used in future years.
    Several commenters asked that we eliminate the requirement for 
series bills for certain services if we require a date of service for 
each line because the claim will grow in size as charges for multiple 
dates of service that are now combined on a single line with no date of 
service will now have to be split into multiple lines to show the date 
of service. The commenters fear that the increase in the lines on the 
claim may result in errors on the claim and there may be cashflow 
problems if more claims are returned to the provider. The commenters 
indicated that delays in payment for series bills covering 30 days of 
service are significant.
    Response: For the 2004 OPPS, we did make progress in using more 
claims by looking to the dates on revenue center charges, where they 
exist, to assign them to a single major procedure on the same date. We 
applied the date of service criteria before we ignored APCs to create 
single claims. Moreover, we were able to create more single procedure 
claims by ignoring procedures for which we thought no revenue center 
charges or packaged HCPCS charges would be appropriately assigned. We 
appreciate the information provided in comments and hope that the 
public will continue to furnish us with an expanded list of codes that 
they believe can be considered ``stand alone'' codes, which we could 
properly ignore in creating pseudo single claims from claims containing 
multiple major procedures. We did not add evaluation and management 
service codes to the list because we believe that drugs and supplies 
are often used during such services and that it would not be correct to 
assume that all of the supply and drug charges on the claim were for 
items and services used with the procedure that also is billed also on 
the same claim. We would like to further explore the issue of which 
claims to ignore for pseudo single creation with the APC Panel in its 
winter meeting and to seek the Panel's views on the specific code to be 
added to the list of codes to be ignored for this purpose.
    While we did not apply the combination APC approach, we expect to 
continue to explore whether this would, upon further refinement, have 
value in establishing correct weights for procedures performed in 
combination with one another. We hope to improve both of these 
processes next year and to develop other methods of using multiple 
procedure claims.
    We did not use the line items for the HCPCS codes we ignored in the 
calculation of medians for those HCPCS codes. We asked for public 
comment on the issue. In view of the public comments supporting the 
concept of ignoring certain codes for creation of pseudo singles and 
supporting the validity of using these line items in the median setting 
for these codes, we will propose to use them for median setting for the 
2005 proposed rule.
    Our requirement for series bills creates efficiencies in claims 
processing that enable us to provide better provider service. In view 
of the decision to not implement the drug administration option, which 
would have required coding of all drugs, and seemed to be the impetus 
for the comment, we do not expect to revise our series bill policy.

B. Description of Our Calculation of 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 287 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, 206 hospitals had claims data.
    [sbull] We eliminated from our data claims for critical access 
hospitals that are not

[[Page 63419]]

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 56 hospitals whose total operating CCR deviated from the geometric 
mean by more than three standard deviations.
    [sbull] We excluded from our data approximately 3.11 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 remaining claims that we had matched with 
a cost report into the following three distinct groups: (1) Single-
procedure claims; (2) multiple-procedure claims; and (3) claims on 
which we could not identify at least one OPPS covered service. Single-
procedure claims are those that include only one HCPCS code (other than 
laboratory and incidentals such as packaged drugs and venipuncture) 
that could be grouped to an APC. Multiple-procedure claims include more 
than one HCPCS code that could be mapped to an APC. Dividing the claims 
yielded approximately 24.43 million single-procedure claims and 16.86 
million multiple-procedure claims.
    We converted 9.833 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 6. These are services with payment amounts 
below $50 (under the 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 6) 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 6. If only one HCPCS code remained, we 
treated the claim as a single-procedure claim.

                                        Table 6.--APCS That Were Ignored To Create Pseudo Single Procedure Claims
--------------------------------------------------------------------------------------------------------------------------------------------------------
                APC                                                   APC Description                                           Status indicator
--------------------------------------------------------------------------------------------------------------------------------------------------------
0001...............................  Level I Photochemotherapy.......................................................  S
0060...............................  Manipulation Therapy............................................................  S
0077...............................  Level I Pulmonary Treatment.....................................................  S
0099...............................  Electrocardiograms..............................................................  S
0215...............................  Level I Nerve and Muscle Tests..................................................  S
0215...............................  Level I Nerve and Muscle Tests..................................................  S
0230...............................  Level I Eye Tests & Treatments..................................................  S
0260...............................  Level I Plain Film Except Teeth.................................................  X
0262...............................  Plain Film of Teeth.............................................................  X
0271...............................  Mammography.....................................................................  S
0341...............................  Skin Tests and Miscellaneous Red Blood Cell Tests...............................  X
0342...............................  Level I Pathology...............................................................  X
0343...............................  Level II Pathology..............................................................  X
0344...............................  Level III Pathology.............................................................  X
0345...............................  Level I Transfusion Laboratory Procedures.......................................  X
0364...............................  Level I Audiometry..............................................................  X
0367...............................  Level I Pulmonary Test..........................................................  X
0669...............................  Digital Mammography.............................................................  S
0690...............................  Electronic Analysis of Pacemakers and other Cardiac Devices.....................  S
0706...............................  New Technology--Level I ($0-$50)................................................  S
--------------------------------------------------------------------------------------------------------------------------------------------------------

    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.
    [sbull] To calculate median costs for services within an APC, we 
used only single-procedure bills and those multiple-procedure bills 
that we converted into single claims. If a claim had a single code with 
a zero charge (that would have been considered a single-procedure 
claim), we did not use it. As we discussed in section III.A.2 of this 
final 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 7, 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

[[Page 63420]]

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 7.--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 Venous/Arterial Catheter.......  T
0039.................................  Implant Neurostim, One Array........................  S
0048.................................  Arthroplasty with Prosthesis........................  T
0080.................................  Diagnostic Cardiac Catheterization..................  T
0081.................................  Non-Coronary Angioplasty or Atherectomy.............  T
0082.................................  Coronary Atherectomy................................  T
0083.................................  Coronary Angioplasty and Percutaneous Valvuloplasty.  T
0085.................................  Level II Electrophysiologic Evaluation..............  T
0086.................................  Ablate Heart Dysrhythm Focus........................  T
0087.................................  Cardiac Electrophysiologic Recording/Mapping........  T
0089.................................  Insertion/Replacement of Permanent Pacemaker and      T
                                        Electrodes.
0090.................................  Insertion/Replacement of Pacemaker Pulse Generator..  T
0104.................................  Transcatheter Placement of Intracoronary Stents.....  T
0106.................................  Insertion/Replacement/Repair of Pacemaker and/or      T
                                        Electrodes.
0107.................................  Insertion of Cardioverter-Defibrillator.............  T
0108.................................  Insertion/Replacement/Repair of Cardioverter-         T
                                        Defibrillator Leads.
0115.................................  Cannula/Access Device Procedures....................  T
0119.................................  Implantation of Devices.............................  T
0122.................................  Level II Tube Changes and Repositioning.............  T
0167.................................  Level III Urethral Procedures.......................  T
0202.................................  Level VIII Female Reproductive Proc.................  T
0222.................................  Implantation of Neurological Device.................  T
0225.................................  Implantation of Neurostimulator Electrodes..........  S
0226.................................  Implantation of Drug Infusion Reservoir.............  T
0227.................................  Implantation of Drug Infusion Device................  T
0229.................................  Transcatheter Placement of Intravascular Shunts.....  T
0259.................................  Level VI ENT Procedures.............................  T
0313.................................  Brachytherapy.......................................  S
0384.................................  GI Procedures with Stents...........................  T
0385.................................  Level I Prosthetic Urological Procedures............  T
0386.................................  Level II Prosthetic Urological Procedures...........  T
0648.................................  Breast Reconstruction with Prosthesis...............  T
0652.................................  Insertion of Intraperitoneal Catheters..............  T
0653.................................  Vascular Reconstruction/Fistula Repair with Device..  T
0654.................................  Insertion/Replacement of a Permanent Dual Chamber     T
                                        Pacemaker.
0655.................................  Insertion/Replacement/Conversion of a Permanent Dual  T
                                        Chamber Pacemaker.
0670.................................  Intravenous and Intracardiac Ultrasound.............  S
0674.................................  Prostate Cryoablation...............................  T
0680.................................  Insertion of Patient Activated Event Recorders......  S
0681.................................  Knee Arthroplasty...................................  T
----------------------------------------------------------------------------------------------------------------

    [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 8 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 the 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. For 
2004 OPPS, we converted these categories to a single set of revenue 
codes (see Table 8) 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 8 
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 8.--Packaged Services by Revenue Code
------------------------------------------------------------------------
               Revenue code                          Description
------------------------------------------------------------------------
250.......................................  Pharmacy.
251.......................................  Generic.
252.......................................  Nongeneric.

[[Page 63421]]

 
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 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.
    [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 made an adjustment of 0.981635942 to the weights. The 
weights that we developed for 2004 OPPS, which incorporate the 
recalibration adjustments explained in this section, are listed in 
Addendum A and Addendum B.

Impact of Allocation of Equipment and Capital Costs

    Comment: Several commenters indicated that the weight setting 
methodology may have a disproportionately adverse effect on procedures 
performed in departments with higher medical equipment and capital 
costs such as radiology and nuclear medicine. The commenters indicated 
that the capital costs incurred by these departments are generally 
spread among all hospital departments on a square foot or other basis, 
rather than being specifically allocated to the departments that incur 
the costs involved. This would distort the cost to charge ratios for 
these departments, resulting in under-weighting of the APCs for the 
services they furnish. Commenters indicated that we recognized this in 
the preamble to the 2000 OPPS rule (65 FR 18485, April 7, 2002) but 
indicated that it did not have the data necessary to make the 
appropriate adjustment due to hospital reporting processes. The 
commenter indicated that it would be appropriate for us to re-evaluate 
mechanisms that could be used to ameliorate the distortion.

[[Page 63422]]

    Response: We recognize that the allocation of capital and equipment 
costs to revenue centers that do not use the equipment could distort 
cost to charge ratios for the revenue centers that use the equipment 
(and presumably whose charges reflect those costs). It is not clear how 
cost to charge ratios could be adjusted for such allocations. However, 
for the 2005 OPPS, we hope to explore the effect and impact of basing 
relative weights on relative hospital charges, rather than costs. If 
weights are based on relative charges, then presumably, the charges for 
services with high cost equipment and capital expenses would reflect 
those costs relative to other services without such costs.

Dates of Service on Revenue Code Lines

    Comment: Commenters supported requiring dates of service on lines 
with revenue code charges but asked that the requirement not be 
enforced until June 2004 to enable hospitals to have sufficient time to 
adjust their systems to provide this information.
    Response: Subsequent to the proposed rule, we learned that the X 
12N 837 standard transaction with which covered entities had to be in 
compliance on October 16, 2003, requires a date of service on each line 
item containing a charge.

Single Revenue Code List for Packaging

    Comment: One commenter supported the use of a single revenue code 
list for packaging costs into separately paid HCPCS codes. The 
commenter indicated that this change would result in more accurately 
attributing costs to services. Another commenter objected to our 
proposed changes for packaging revenue centers. This commenter is 
concerned that the use of a single set of revenue codes for packaging 
into the major procedure on a claim may inappropriately allocate 
charges not associated with the major service on the claim. For 
example, the commenter stated that revenue code 254 and revenue code 
255 should continue to map to a radiological APC, and charges in these 
revenue centers should not be assigned to a major non-radiological 
procedure.
    Response: We proposed to combine the multiple lists of revenue 
codes into one because there was significant overlap in them and our 
physicians believed that the risk of not picking up appropriate charges 
was greater than the risk of picking up charges that were not 
appropriate. In the case cited by the commenter, we are depending on 
hospital billing and our reliance on single procedure claims to 
preclude us from packaging a charge for a radiological service into a 
HCPCS code for a non-radiological service. We have never had a 
complaint that we have packaged more costs than were appropriate into a 
HCPCS code, although we frequently are told that we neglected to pick 
up all related charges. For the final rule, we retained the single set 
of revenue codes for packaging into separately payable major HCPCS 
codes.

Need for Stability in Relative Weights

    Comment: Commenters stated that significant changes in weights for 
services from year to year are difficult for hospitals because not all 
hospitals provide all services and if the APC rates fall for the 
particular service mix the hospital furnishes, this can mean 
significant shifts in total payment for outpatient services from 
Medicare from year to year. Commenters indicated that we should adjust 
medians derived from claims data to limit the amount of change that 
occurs from year to year. Commenters indicated that hospitals are 
limiting availability of services based on declining Medicare OPPS 
revenues and that once a service is curtailed or eliminated, it is not 
likely to be reintroduced again because the hospital will cease 
monitoring the costs of the device and equipment needed to offer the 
service once it is no longer provided in the hospital and, therefore, 
even if it would be cost effective to reintroduce the service, it is 
not likely to occur. Commenters indicated that the pattern of revenue 
changes is a factor in hospital decisions regarding whether to acquire 
state-of-the-art equipment. Therefore, reductions in payments for 
equipment-intense services discourage hospitals from acquiring the 
equipment necessary to provide state-of-the-art services to Medicare 
beneficiaries. Commenters also indicated that the cumulative effects of 
the reductions from 2002 payment rates, particularly for procedures to 
implant medical devices, have resulted in significant payment cuts for 
many of these procedures and will discourage acquisition of the items 
necessary to provide the highest quality care.
    A commenter stated that we should stabilize the APC rate when a 
device comes off of pass-through status. Several commenters stated that 
the proposed rates reverse the progress that was made in 2002 by using 
the manufacturer prices in the setting of medians for 2002. Commenters 
indicated that we should adjust the medians from claims data to ensure 
that no APC's median falls more than 5 percent compared to the medians 
used for payment in 2003. A commenter suggested that we adjust the 
medians whenever there is more than a 20 percent reduction from one 
year to the next. Another commenter indicated that all APCs that 
decline more than 10 percent compared to 2003 adjusted medians should 
be adjusted in the same way that we proposed to adjust medians for 
drugs, biologicals and radiopharmaceuticals and that these adjustments 
also should apply to brachytherapy sources.
    Another commenter asked that we let no median cost used in weight 
setting fall more than half the difference between the loss and 15 
percent because this methodology offers a buffer for hospitals to 
minimize annual changes. Another commenter indicated that we should 
freeze the 2003 payment rates, particularly for brachytherapy services 
and should educate providers to show all of the charges for all of the 
ancillary services on the claim so that they will be included in the 
development of relative weights for future years.
    Response: We are sympathetic with the concerns of hospitals that 
the OPPS should be sufficiently stable that hospitals would have the 
capacity to plan and budget for future years. We recognize that the 
early years of a payment system may result in shifts in payment across 
services. However, a prospective payment system is a system of 
averaging in which the payment to the hospital becomes an overall 
amount that the hospital has at its disposal to use in the way it finds 
to be most efficient and effective. The payments for individual 
services are the means by which the amount of money to be spent on OPPS 
is distributed among hospitals but the hospitals have the right to use 
that payment as they choose across all services they choose to furnish. 
The OPPS is a system that attempts to calibrate payments for a service 
or procedure to best approximate the costs that an efficient provider 
would incur in providing the service or procedure in order to give 
providers incentives for efficient procurement and service delivery.
    As we indicated in the proposed rule, for 2004, some of the same 
services had significant declines in median costs compared to the 2003 
adjusted median but not compared to the 2003 median before adjustment. 
We did not propose to adjust the 2004 medians for procedural APCs 
compared to the 2003 adjusted median. Instead, we indicated that we 
would consider using external data that could be made publicly 
available if we were convinced that the medians for 2004 would result 
in payment rates that were grossly aberrant in the context of the 
service.

[[Page 63423]]

    After reviewing the comments, and our final claims data for 2004, 
we decided that we would not adjust the medians for procedural APCs but 
that we would adjust medians for certain APCs for which we were given 
external data that could be made public because we were convinced that 
the medians from our claims data resulted in median costs that were 
grossly variant. We adjusted the medians for the following APCs using 
external data: APC 0107 (insertion of cardioverter-defibrilator), APC 
0108 (Insertion/replacement/repair of cardioverter defibrillator leads 
and insertion of pulse generator), APC 0222 (implantation of 
neurostimulator), APC 0039 (which was broken out of APC 0222) and APC 
0674 (prostate cryoablation). For each of these APCs we calculated an 
adjusted device portion of the median by taking one part of the device 
cost from our data and one part of the device cost supplied by external 
data. We added the adjusted device median to the nondevice median from 
our data to acquire the adjusted median. In the case of APC 0108, we 
used the external device cost data that was used to set the median for 
the 2003 OPPS because we received no outside data for the 2004 OPPS for 
this APC and because the proposed median of $28,685.30 set forth in the 
proposed rule was considerably higher than the final rule data median 
of $23,944.80, which resulted when additional claims were used to 
calculate the median cost. In other cases, we found that corrections in 
the APC assignment or splitting an APC into two APCs resulted in more 
accurate median costs.
    For 2004, we will adjust median costs for drugs, biologicals and 
radiopharmaceuticals as proposed for reasons discussed in section 
VI.B.3. We will freeze payments for blood and blood products at the 
2003 rates for reasons discussed in section VI.B.8. We will pay single 
indication orphan drugs at 88 percent AWP for reasons discussed in 
section VI.B.6.

Comparison of Procedural APC Medians for the 2004 OPPS to Adjusted 
Medians for 2003 OPPS

    Using the data available to us at the time we developed the 
proposed rule, we identified APCs that showed decreases in median cost 
of more than 10 percent compared to the adjusted medians on which their 
payments were based for 2003. We discussed specific APC medians to the 
extent that we understood the reason for the decreases or were 
particularly puzzled by the change. We requested comments on the 
medians and provided a set of criteria for external data that could be 
used to supplement the median costs derived from our claims data. The 
criteria we provided regarding the use of external data included a 
stipulation that the data must not be confidential because any data we 
use must be available to the public. We also provided a list of 
preferred (but not required) criteria that addressed our preferences 
for characteristics of the data. We indicated that to be of optimal 
use, the external data should represent a divergent group of hospitals 
by location and type, identify the number of devices billed to Medicare 
as well as rebates or reductions for bulk purchases, identify the HCPCS 
codes with which the devices would be used, identify the source of the 
data and include both charges and costs for each hospital by quarter 
for the last 3 quarters of 2002 (68 FR 47987). We did not propose to 
adjust the medians for procedural APCs in the manner that they were 
adjusted for the 2003 OPPS. For 2004 we did not apply a systematic 
adjustment to all medians that declined more than a specified 
percentage in comparison with the medians for 2003. Instead, as 
discussed previously, we adjusted the medians of 5 APCs based on 
external data where we thought it was necessary and we have split some 
APCs where we thought doing so would result in more accurate relative 
weights.

Use of External Data

    Comment: Some commenters opposed the use of external data on the 
basis that they believe that they will result in unfair imbalances in 
payment. They recognized that the application of cost-to-charge ratios 
will not result in amounts that are equal to full acquisition costs but 
they believe that as long as the same standard methodology is used 
across all services, the relative payments will be correct. They 
indicated that in a system of averaging, it is not necessary or even 
expected that each item and service will be paid at acquisition cost. 
They encouraged us to remain faithful to the averaging process inherent 
in a prospective payment system and not to rely on external data. Some 
commenters opposed use of external data and supported the requirement 
that they be publicly disclosable. Other commenters stated that we 
should use our claims data to set weights because they accurately 
reflect the relative hospital costs of providing outpatient services. 
However, these commenters were concerned with how different rates for 
some services in the 2004 proposed rule are from the rates for the same 
services in 2003.
    Some commenters said that we should use external data that are 
proprietary and maintain the confidentiality of such data. Several 
commenters indicated that the prices for medical devices are often 
covered by agreements that preclude the parties from disclosing the 
price of the device and that we should use the data to set prices, 
notwithstanding that they cannot be made available for inspection by 
the parties whose payments may be reduced by their use. Several 
commenters stated that we used external data that were proprietary for 
setting of 2002 weights, and for some 2003 weights and that we should 
do so again because data from manufacturer price lists and invoices 
more accurately reflect the costs attained by applying the cost-to-
charge ratios for hospital departments to the charges for the devices 
to get costs to package into the APC medians. These commenters stated 
that external data should be used more widely than data based on the 
criteria that were used for the 2003 OPPS for the use of external data 
(that is, that the device-cost portion of the APC exceeded 80 percent 
of the total APC cost for external data to be used). These commenters 
stated that external data should be used for all APCs that show 
significant reductions since the 2002 OPPS. In particular, they cited 
the APC Panel recommendation that outside data be used to set the 
median cost for APC 107.
    Some commenters had specific comments on the criteria we provided 
for use of external data. One commenter stated that its members did not 
have and could not easily acquire the data that would ensure that the 
data represent a diverse group of hospitals by location and type nor 
could they identify specific hospitals that used their devices. The 
commenter also stated that its members could not provide the 
information on discounts and rebates against their price lists that we 
requested. The commenter indicated that its members did not want to 
provide the HCPCS codes in which their products were used but instead, 
wanted us to require the typical applications that they feel are most 
appropriate. The commenters agreed that they could provide the source 
of the data. The commenters stated that its members could not provide 
data that corresponded with the same period of time being used to set 
the relative weights for all APCs.
    Response: In the proposed rule, we indicated that external data 
should cover services furnished during the last 3 quarters of 2002 (68 
FR 47987). We appreciate that manufacturers and wholesalers would not 
want to disclose negotiated prices for 2003 or 2004 for competitive 
reasons. However, we fail to

[[Page 63424]]

understand how they could be harmed by publicly disclosing prices that 
were applicable in 2002 but have now been obsolete for a year. 
Moreover, since upward adjustment of any median cost results in 
reduction of payments for all other items and services, we believe 
that, in a governmental payment program, the parties whose payments are 
reduced by the use of external data should be able to examine all 
elements of the payment system.
    We do not believe that widespread use of external data to set 
median costs for selected APCs is appropriate in a system that relies 
on relativity to establish payment amounts. We are sympathetic with the 
concerns of some commenters that widespread use of external data will 
result in payment inequities rather than appropriate payments to 
hospitals based on the relative weights of the services they furnish. 
However, we are also concerned about circumstances in which we are 
convinced that the payment amounts that would result from the medians 
from our data will discourage hospitals to provide access to needed 
care. Therefore, in the case of several APCs as discussed elsewhere, we 
used external data to adjust the medians. In general, however, we 
continue to have confidence in the integrity of our claims data with 
respect to the procedural APCs. For the future, we prefer to seek ways 
to refine the methodologies that we apply to our own data, such as the 
use of a greater percentage of claims to set the weights for certain 
APCs.
    Comment: Several commenters stated that we should work with them to 
set the methodology for the 2005 medians in view of the absence of 
device codes in the 2003 data and should pursue a study of the 
acquisition costs of devices in particular, so that there will be valid 
device related data for setting the 2005 OPPS.
    Response: We are always interested in hearing the proposals of 
outside parties with regard to our methodology for setting OPPS 
weights. We recognize the concern that the absence of device codes for 
2003 claims may lead to median costs that fail to fully incorporate the 
costs of the devices used in the applicable APCs and we are interested 
in all ideas for preventing this problem. Our proposed methodology will 
be presented in the proposed rule for the 2005 OPPS and will be open to 
public comment.

General Comments About Payment

    Comment: A commenter asked that we base the relative weights on the 
geometric mean that we use for trimming the data. The commenter 
indicated that the use of the geometric mean is the industry standard 
for both trimming aberrant data, as we use it, and also for calculating 
relative weights when costs are not distributed symmetrically. The 
commenter stated that the use of the geometric mean is particularly 
useful in circumstances that mirror those of OPPS: the first years of a 
new system and with low-volume high-cost services. The commenter noted 
that we agreed to move forward with analyses to look at the use of a 
mean versus median cost for weight setting in the November 1, 2002 
final rule published in the Federal Register, but believes that not 
much analysis is needed since the use of the geometric mean is an 
industry standard for setting relative weights.
    Response: We appreciate the thoughtful comments on this issue and 
other suggestions on how we might improve our rate setting methodology. 
We will continue to explore these options in 2004. Our efforts in 2003 
were limited to creating unscaled weights from the means used for the 
2003 OPPS and comparing them to the unscaled weights for medians for 
2003 OPPS. Our preliminary comparison revealed that there would be many 
swings in payments. Hence, for the 2004 OPPS, we continued our use of 
the median cost.
    In preparation for 2005 OPPS, we hope to calculate OPPS amounts 
using the mean costs, and also mean and median charges (to circumvent 
the effects of cost-to-charge ratios), and the 2004 OPPS conversion 
factor. This should give us a more complete view of the impact of 
revising our methodology in this way.

Charge Compression and Cost Finding

    Comment: A commenter indicated that the use of cost to charge 
ratios is consistent with the concept of averaging that underpins a 
prospective payment system and that the system should not seek to 
micro-cost individual items or services but rather should rely upon the 
hospital charging patterns irrespective of Medicare policy to base 
relativity. The commenter indicated that while some items have 
different markups than others, the use of a standardized methodology to 
establish relative weights for all services should result in 
appropriate relative payments. The commenter strongly objected to any 
additional burdens that would be imposed in order to fine tune the 
pass-through payment system or weights at the expense of all other APC 
payments. The commenter specifically objected to CMS overriding the 
claims data to alter the ratio for new technology devices because the 
commenter believes that such adjustments will make the OPPS unduly 
administratively complex and create unfair imbalances in payment.
    Other commenters opposed the use of cost-to-charge ratios applied 
to charges to acquire cost data. They indicated that in many cases, we 
had to use overall hospital cost-to-charge ratios that had no relevance 
to the costs of the services being determined and therefore resulted in 
invalid representations of median costs. They also indicated that both 
the departmental and the hospital specific cost-to-charge ratios were 
derived in part from costs that are commingled between inpatient and 
outpatient services and therefore are not necessarily representative of 
a ratio that could be applied to outpatient services alone, as we do. 
Some commenters indicated that we ignore studies that demonstrate that 
charges are compressed, with low-cost services being marked up more 
than high-cost services, thus resulting in systematic underpayment of 
high-cost items and diminishing beneficiary access to high-cost 
services. A commenter suggested that, for drugs, biologicals and 
radiopharmaceuticals, we set a minimum payment based on the Federal 
Supply Schedule price plus a percentage markup to ensure that payment 
for drugs, biologicals, and radiopharmaceuticals was sufficient to make 
them available to Medicare beneficiaries who need them.
    Several commenters indicated that the application of hospital 
specific cost-to-charge ratios at the department level where available, 
otherwise at the hospital level will always result in incorrect costs 
because hospitals do not have a consistent markup for all items and 
services within a department. They indicated that hospitals markup low-
cost items more than high-cost items and that therefore, the 
application of a cost-to-charge ratio, even at the department level, 
will never result in the hospital acquisition cost for an item. They 
indicated that there is no easy adjustment to correct for charge 
compression and they urge us to explore using external data, developing 
surveys or doing studies to acquire hospital cost data that can be used 
in place of the median costs acquired from claims data.
    Response: We recognize that the application of cost-to-charge 
ratios to charges for individual items as needed to develop median 
costs for APCs is imperfect. However, the only means at our disposal 
for determining costs from the charges on the claims was to calculate a 
cost-to-charge ratio using the cost report data that we believe is

[[Page 63425]]

applicable to the OPD (for example, excluding room and board). We 
acknowledge that this system for determining relative values is 
imperfect, but we believe that it continues to be preferable to total 
reliance for particular items on external data which could 
inappropriately inflate Medicare payments for those items to the 
detriment of general hospital services. As indicated above, we hope to 
explore use of mean costs, and mean and median charges in preparation 
for the 2005 OPPS to determine if such a change would result in better 
relative weights and less instability in OPPS payments for particular 
services from year to year. However for 2004, we based relative weights 
on median costs derived through the application of a cost-to-charge 
ratio to the charges for the services.

General Concerns About Decreases

    Comment: We received many comments objecting to proposed decreases 
in the proposed payment rates for specific services. These commenters 
indicated that the service has become more expensive rather than less 
expensive over the year, or indicated that the payment for the service 
declined for 2003 and should not decline for 2004. In some cases, the 
comments indicated that the payment should remain at the 2003 rate so 
that hospitals will not consider discontinuing the service.
    Response: The OPPS is a relative payment system based upon the 
relative median costs of services. We calculate the costs of services 
by applying a cost to charge ratio to the charges for the services and 
then packaging the costs together for major HCPCS codes. We then 
calculate the median of the array of costs across all claims for HCPCS 
codes in an APC. There are many factors that can affect whether the 
cost of services rises or falls from one year to the next. In general, 
for the 2004 OPPS, about half the APC median costs increased and about 
half decreased compared to the 2003 median costs. In most cases, the 
changes were modest and such changes from year to year are to be 
expected as hospitals find ways to reduce costs for some services and 
incur higher costs for others. Because we do not expect the mix of 
services furnished in hospitals to vary hugely from year to year across 
the universe of hospitals, we do not expect that the changes in 
relative costs to create enormous impacts either.

Disparity in Payments for Overhead Costs for the Same Service

    Comment: A commenter indicated that OPPS provides disparate payment 
for the overhead costs associated with services that are furnished both 
in physician offices and in hospital outpatient departments. As an 
example, the commenter indicated that CMS attributes $25.36 in 
physician practice expense to CPT code 99213 (office or outpatient mid 
level evaluation and management service for an established patient) but 
pays a hospital $54.46 (the amount set forth in the proposed rule) for 
the overhead for the same service and indicated that for other services 
the OPPS payment is as much as 4 times the amount paid to physicians 
for practice expense for the same service. The commenter asked that CMS 
establish payment equity for the same service furnished in these 
respective settings.
    Response: The method for calculating payment for physicians' 
practice expenses under the Medicare physician fee schedule is 
established by law, as is the method we use for the outpatient setting. 
The application of the different methodologies results in different 
payment amounts in the two settings.
    Comments and responses on payment amounts for specific APCs are 
included in section II.B.

Source of Data for Weight Setting

    Comment: One commenter stated that we should conduct a study to 
establish a source for cost data other than claims data on which to 
base APC weights. Another commenter strongly objected to use of survey 
data because the commenter did not believe that it could ever fully 
capture all hospital costs for services and that therefore, the survey 
data would be used only for items and would have to be integrated with 
claims data for services. The commenter did not believe that the two 
could be integrated in a way that would properly reflect the relative 
costs.
    Response: We believe that relative weights should generally be 
based on claims data because, notwithstanding the weaknesses, claims 
data are the most complete and accurate source of information about all 
services furnished by all providers paid under OPPS. We believe that it 
would be unreasonably expensive to acquire survey data that would be 
representative of the entire population of Medicare hospitals and all 
OPPS services furnished in them. We do not support the idea of using 
only selected hospitals and/or selected services because we think data 
from a limited survey would not be representative of the whole 
population of Medicare hospitals and services and would not be accurate 
to reflect relative costs of all services.

Incomplete Hospital Bills

    Comment: Commenters indicated that when OPPS was implemented, 
hospitals no longer had a payment incentive to ensure that all charges 
were shown on the claim because there was no longer a direct 
relationship between the amount of charges on the claim and the interim 
payment they would receive for services. Therefore they ceased to 
complete the claim as fully as when the charges were directly related 
to the Medicare interim payment. Several commenters indicated that in 
some cases, hospitals went as far as to remove items from the 
chargemaster so that a charge was no longer created when an item or 
service was used, particularly if the item or service were from a 
department other than the department billing the CPT code. A commenter 
said that in many cases, hospitals ceased to bill all charges for 
services if the completion of the claim with all charges would delay 
the submission of the claim to Medicare and therefore delay the 
Medicare payment to the hospital. Commenters indicated that hospitals 
did this particularly for services like brachytherapy in which the 
services were furnished from multiple departments of the hospital and 
the claim could be delayed significantly to accumulate all charges. 
Commenters indicated that the absence of all charges for services could 
result in poor data and instability in median costs from year to year, 
particularly when we use only single procedure claims.
    Response: We encourage hospitals to report all charges for all 
services on claims for Medicare payment so that the data on which 
relative weights are set will fully reflect the relative costs of all 
services. However, where all charges are not included on the claim but 
the costs exist in the cost centers, the cost-to-charge ratios would 
increase and, to some extent, offset the effect of the absence of 
charges. Hence, while we would prefer that hospitals bill all charges 
for the services they furnish, where they do not do so, it does not 
necessarily mean that the costs derived from applying the hospital's 
cost-to-charge ratio to charges would result in improper relative 
weights for the services.

C. Discussion of Relative Weights for Specific Procedural APCs

New APC for Antepartum Care
    We proposed rule to split APC 0199, Obstetrical Care Service, into 
two APCs.

[[Page 63426]]

For this final rule, new APC 0700, Antepartum Care Service, was created 
and 59412 (external cephalic version) was assigned to it. The two 
remaining HCPCS code 59409 (vaginal delivery only) and 59612 (vaginal 
delivery only, after previous cesarean delivery) will remain in APC 
0199, Obstetrical Care Service. We received no comments about this APC 
and will finalize our proposal.

Implantation of Neurostimulators and Implantation of Neurostimulator 
Leads (APCs 0222 and 225)

    Comment: Commenters encouraged us to use a ``dampening'' approach 
to increase the median costs for these APCs and to use external data to 
set the payment weights for APCs 0222 and 0225. Commenters indicated 
that the proposed payment amounts do not cover the cost of the device, 
much less the hospital services to furnish it. Commenters indicated 
that our policy of calculating median weights based on single claims or 
pseudo single claims disadvantages these services by resulting in the 
use of only the simplest and lowest cost services. A commenter 
indicated that these services have had relative weights that were too 
low since the inception of OPPS and that the cumulative effect of 
multiple years of payment reductions will cause hospitals to cease to 
provide these services to Medicare beneficiaries. A commenter suggested 
that we split these APCs to reflect the different resources used in 
implanting one device versus another device in the same APC. A 
commenter also asked that we establish a separate APC for the 
NeuroCybernetic Prosthesis System.
    Response: We also are concerned that the median costs for these 
APCs appear to be so low relative to other OPPS median costs. Both of 
these APCs are ones for which we require that selected C codes be on 
the claims that are used in calculation of the median to increase the 
likelihood that we are using correctly coded claims for these services. 
We recognize that the need to use single procedure claims and the need 
to further select claims that appear to be correctly coded reduce the 
number of claims used in median calculation. However, if we did not 
require that selected C codes were on the claims used, the median costs 
would be even lower than those calculated. Hence, using more single 
procedure claims would, in this case, result in even lower median 
costs.
    For 2004, we have made changes to both of these APCs. In the case 
of APC 0222, we removed HCPCS code 61885 from APC 0222 and we placed it 
in its own APC 0039 because the APC Panel recommended that its status 
indicator be changed from a ``T'' to an ``S'' in order to not apply the 
multiple procedure reduction when two devices are implanted, as is 
often the case. Moreover, for both APC 0222 and APC 0039, we accepted 
external data for the device cost and used one part external data and 
one part claims data for the device portion of the APC's median cost to 
which we added the nondevice portion of the median cost. This increased 
the median cost for APC 0222 from a final data median of $11,050.90 to 
an adjusted median cost of $13,383.79. This increased the median cost 
for APC 0039 from a final data median cost of $10,741.66 to an adjusted 
median cost of $13,555.80. We believe that this more accurately 
reflects the relative cost of these services to other OPPS services.
    In the case of APC 0225, we split the APC into two APCs, (APC 0225) 
and (APC 0040). APC 0225 contains CPT codes 63655, 64553, 64573, 64580 
and 64577 and for this final rule, has a median cost of $11,873.72. APC 
0040 contains CPT codes 64560, 64555, 63650, 64561, 64575, 64581, and 
64565 and, for this final rule, has a median cost of $3,002.98. Both 
APCs have a status indicator ``S'' (to which multiple procedure 
discounts do not apply).
    We believe that these changes will result in more appropriate 
relative weights for these services in relation to other OPPS services.
Brachytherapy Issues

High Dose Rate Brachytherapy (APC 0313)

    Comment: Commenters objected to the proposed payment amounts for 
this APC and indicated that the costs of the procedure could not be 
fully included in it. Commenters indicated that they did not believe 
that hospitals were billing for both the needles and the catheters. 
These commenters recommended that we use only claims that contain the 
primary procedure code, the HDR Iridium source code, and codes for 
catheters and needles. A commenter indicated that the direct costs for 
the practice expense in physician offices for the codes in this APC 
average $1,130.16 and that it is inconceivable to the commenter that 
hospital costs could be any less. The commenter believes that the 
faulty data are attributable to hospital billing errors and urged us to 
educate hospitals regarding how to bill the service properly. A 
commenter asked us to issue a program instruction requiring hospitals 
to report both the cost of the HDR source and the needles or catheters 
needed to administer the treatment by date of service to facilitate 
setting of a correct median cost. The commenter is concerned that the 
actual cost of brachytherapy needles and catheters has not been 
captured and is not incorporated into any of the related APCs. 
Commenters also indicated that the discussion of the APC in the August 
12, 2003 proposed rule was confusing and did not fit the services 
furnished in this APC.
    Response: Upon receipt of comments and after listening to the 
concerns of outside groups during the comment period, we explored the 
circumstances surrounding the development of the median cost for the 
APC that resulted in the weights and payments in the August 12, 2003 
proposed rule. We found that, while the APC was on the list of APCs for 
which claims were required to contain C codes and although the criteria 
required that there be both a brachytherapy source (C1717) and either 
needles (C1715) or catheters (C1728), no claims that met all of those 
criteria were found among the single procedure claims for that APC. 
Therefore, the system defaulted to using all single procedure claims, 
for which there were no sources or needles/catheters on the claim. 
Hence, APC 0313 was erroneously included in Table 7 as an APC for which 
C codes were required. Moreover, our discussion of the median for the 
APC was in error to say that there had been sources packaged into the 
payment for 2002 and that this accounted for the reduction in proposed 
payment for 2003.
    For the final rule, we acquired more single procedure claims but 
again, none of the single procedure claims contained both sources and 
needles or catheters. We then revised our criteria to require only that 
the claims must contain sources (C1717). This gave us 27 single 
procedure claims that we used to acquire a median cost of $936.52, a 
significant increase over the median for all claims of $795.83.
    In the course of discussions regarding this APC, some parties 
suggested that we ignore other procedure codes, such as dosimetry 
codes, that are typically found on claims for these services because 
the commenters believe that no charges billed under packaged revenue 
codes or packaged HCPCS should be allocated to those other procedures. 
We plan to explore the expansion of the codes we ignore for selection 
of single procedure claims for the 2005 OPPS. However, we did not 
believe we had sufficient information or data to make such a change for 
the final rule for 2004. We again note that it is important for

[[Page 63427]]

hospitals to include charges for all services they furnish on the claim 
so that we can better ensure that the relative weights are based on the 
most accurate data possible.

Low Dose Rate Brachytherapy (APCs 312 and 651)

    Comment: We received several comments regarding payment for low 
dose, non-prostate brachytherapy (APCs 312 and 651). Commenters cited 
the proposed reduction in payment for APC 0312 and expressed concern 
that our methodology that excludes a number of multiple procedure bills 
results in our use of data from atypical encounters such as those in 
small centers with minimal technological complexity and inappropriate 
costs and charges. Commenters indicated that typically other services 
would be furnished on the same day and that the presence of these 
services on the claim would likely result in the claim not being used. 
Commenters indicated that the resources used for the services in these 
APCs are highly variable depending on the part of the body being 
treated and the nature of the equipment involved. They indicated that 
some hospitals ceased billing charges for all of the services furnished 
when OPPS was implemented because showing the charges on the claim 
would no longer result in more payment but showing all charges on the 
claim was costly, burdensome, and slowed billing. Commenters indicated 
that we should educate providers in the correct way to bill for the 
catheters, needles, and sources used for this service and that in the 
absence of acceptable median costs, we should adjust the medians to 
result in reasonable payments for the service. Commenters indicated 
that we should select only claims that contain device costs and ignore 
claims that do not contain such costs, setting the median cost on the 
subset of selected claims.
    Response: We used the medians from our final data to set the 
relative weights on which the payments will be based for 2004. We were 
not convinced by comments that the data did not reflect a median cost 
that was appropriate relative to the costs of other OPPS services. We 
recognize that our methodology excludes a large number of claims 
because there were multiple procedures on the claim and as we indicated 
in the discussion of multiple procedure claims, we are continuing to 
work on ways to use more claims data. We will closely examine expanding 
the list of CPT and HCPCS codes that could be ignored to create pseudo 
single claims for use in calculating median costs to set relative 
weights. For future years, we will consider whether to impose criteria 
for correctly coded claims, such as requiring that the claims contain 
either any C code or specified C codes for brachytherapy sources and 
needles or catheters that are necessary to insert the sources. We were 
not able to do this for the 2004 OPPS. For the 2005 OPPS, we will use 
the claims data from 2003, for which there is no coding of 
brachytherapy needles or catheters, although there is coding of sources 
that can be used to select correctly coded claims.
    As we previously indicated, for the 2004 OPPS, we will pay for 
prostate brachytherapy using the CPT codes and the HCPCS codes for 
brachytherapy sources used. We expect that the majority of the CPT 
codes billed will be 77778 (APC 0651) and 55859 (APC 0163) and that the 
HCPCS codes billed will be C1718 (brachytherapy source, iodine 125) or 
C1720 (brachy source, palladium 103). When we calculate the total 
median cost on which the payment to the hospital for the services 
involved in prostate brachytherapy will be based, we determine that 
paying under APC 0651 and APC 0163 with separate payment for the 
sources (APC 1718 or APC 1720) will result in more payment than would 
be the case under the packaged payment we proposed. For example, if we 
assume that 100 sources are implanted during a prostate brachytherapy 
procedure, we would expect the hospital to bill 77778, 55859, and 100 
units of either C1718 or C1720. The sum of the applicable medians will 
be $6,486.54 if using iodine sources and $7,261.54 if using palladium 
sources. This is a considerable increase over the payments in 2003, 
which were $5,154.34 with iodine sources and $5,998.24 with palladium 
sources. We believe that this circumstance will be the predominant use 
of APC 0651 and that the total median for the service will result in 
appropriate relative weights on which to set the payments.
    APC 0312 was billed just over 850 times for the 9 months of data 
used in the final rule. Of the five CPT codes in this APC, four have 
median costs for the CPT code of less than $400 and one code, 77776, 
Interstitial radiation source application, simple has a median of 
$2,218.18. However, that code does not meet the test of being 
significant, which we define as having a frequency greater than 1,000 
or a frequency lower than 99 and a percentage of larger than or equal 
to 2 percent. Therefore, we have not moved it from the APC.

Separate Payment for All Brachytherapy Sources

    Comment: Commenters indicated that we should provide separate 
payment for all brachytherapy sources but that the current payment 
structure and amounts are inadequate. Commenters indicated that we 
should create two new permanent separate brachytherapy source APCs for 
high activity iodine 125 and high activity palladium 103 sources that 
should be paid on a per source, per patient basis in addition to the 
procedure code. Commenters indicated that the proposed rates for iodine 
125 and palladium 103 sources do not capture the costs of loose low 
dose seeds, much less the costs of high activity sources, which 
typically cost in excess of $150 per source.
    Response: For 2004, we will pay separately for implantable 
brachytherapy sources based on the median costs from our claims data. 
We were not convinced by comments that the relative weights that will 
result from these median costs are inappropriate.

Prostate Brachytherapy

    Comment: Commenters indicated that the creation of the new G codes 
(G0256 and G0261) for prostate brachytherapy imposes an unneeded burden 
on hospitals and that it conflict with the reporting of the service by 
other payers. Additionally, commenters stated that the use of the codes 
will preclude us from capturing the costs of the service in the future. 
The commenters encouraged us to eliminate the G codes and pay using the 
CPT codes for the procedures and the HCPCS codes for the sources on a 
per source, per case basis. They indicated that this would allow us to 
capture the true costs of the procedures to set rates in the future and 
that this approach is consistent with the APC Panel recommendation to 
us. A commenter requested that we eliminate APC 0649 (Prostate 
Brachytherapy Palladium Seeds) and APC 0684 (Prostate Brachytherapy 
Iodine Seeds) and reinstate the previous policy that allowed hospitals 
to bill the prostate brachytherapy procedures with two separate APCs; 
one for urology CPT code 55859 and one for the radiation oncology CPT 
code 77778. The commenter stated that this elimination would be 
consistent with our decision to pay for the sources on an individual 
basis. The commenter believed that creation of the G codes has caused 
unnecessary confusion for hospitals. The procedure is now described 
with a single G code; however, only one revenue center can be selected, 
causing confusion since these APCs have both a

[[Page 63428]]

urology CPT code as well as a radiation oncology CPT code. The 
commenter requested that we eliminate these two APC groups and 
institute a system that would allow the two procedures to be reported 
in separate APC groups.
    Response: We agree and have deleted the alphanumeric HCPCS codes 
for packaged prostate brachytherapy and will pay using CPT codes for 
the procedures and the HCPCS codes for the sources. We have deleted the 
G codes (G0256 and G0261) and APCs 0649 and 0684; and for 2004, we will 
pay prostate brachytherapy procedures under APCs 0163 and 0651. 
Brachytherapy sources used for prostate brachytherapy will be paid on a 
per source basis using APCs 1718 (iodine) and 1720 (palladium).

Cryoablation of the Prostate (APC 0674)

    Comment: Commenters indicated that the proposed payment was too low 
to pay for both the hospital services and the cost of the probes used 
in the procedure. They indicated that 92 percent of the procedures use 
6 or more probes (64 percent use 6 probes and 28 percent use more than 
6 probes). They indicated that a kit of 6 probes costs $5,000 and asked 
that we set a payment amount no less than the minimum cost a hospital 
incurs to provide the service, which they stated is $6,750. Commenters 
indicated that charges for this new technology were not properly 
reported by hospitals and that therefore the data do not properly 
reflect the costs of the service.
    Response: We recognize that with the device being paid as a pass-
through for the first time effective April 1, 2001, it is likely that 
there are irregularities in the claims data regarding the number of 
units of the device that have probably led to a median cost that is not 
representative of the relative cost of the procedure with the device 
packaged. Therefore, for 2004, we used one part of the acquisition cost 
of 6 probes ($5,000 for 6 probes which are used in 64 percent of the 
procedures) and one part of the device cost from our claims data to 
create an adjusted device cost median to which we added the nondevice 
cost from our claims data to acquire an adjusted median of $6,915.08 on 
which we based the relative weight for the 2004 OPPS. This compares 
favorably to the median of $5,925.41 on which the August 12, 2003 
proposed rule was based and also compares favorably to the final rule 
data median of $6,283.49 on which the payment weights would have been 
based had we not used external data to adjust the device portion of the 
median.

Payment for Cesium-131

    A new brachytherapy source, Cesium-131, came to our attention 
during the latter part of this year, through the pass-through device 
application process. We reached a decision on this application after 
publication of the August 12, 2003 proposed rule. We determined that 
this source did not meet our criteria for creation of a new pass-
through category for devices. However, we believe that separate payment 
for a substantially equivalent new brachytherapy source is warranted, 
since we pay separately for other sources. The indications presented to 
us for Cesium-131 were substantially the same as those for Palladium-
103 and Iodine-125. As such, the reasons for separate payment of 
brachytherapy sources, for example, variation in the number of seeds or 
other source forms make packaging into a clinical APC an undesirable 
option. Therefore, we have decided to create a separate APC so that the 
costs of this new source may be tracked like those of other 
brachytherapy sources. The payment rate for this source is $44.67 per 
seed. This payment rate is close to the reported price of the Cesium-
131 seed and equal to our payment rate based on claims for Palladium-
103, a source that is used for similar clinical indications.

Cardiopulmonary Resuscitation

    Comment: A commenter indicated that a 28 percent drop in payment 
for this service is unwarranted because of the number of people and the 
level of training needed when this service is furnished.
    Response: We were not convinced that the relative weight that would 
result from the use of the median cost for this APC would be 
inappropriate in relation to other OPPS services. Therefore, we will 
use the median cost from the final rule data to set the weight for this 
APC.

Computer Aided Detection for Diagnostic Mammography

    Comment: A commenter expressed concern about our proposal to 
reassign Computer-Aided Detection for Diagnostic Mammography from a New 
Technology APC to APC 0410. The commenter stated that the proposed 
reassignment is premature and would result in a reduced payment rate 
that would be approximately half of the payment rate for the technical 
component of procedures performed in other settings. The commenter 
recommended that we retain this procedure in New Technology APC 1501 
until we have greater claims experience.
    Response: The alphanumeric HCPCS code for this service (G0236) is 
being replaced by a CPT code for the same service for 2004 (CPT code 
76082). We found over 43,000 claims for this service in the 2002 data 
on which we are basing the 2004 relative weights. We believe that this 
volume of services is sufficient to justify setting a relative weight 
based on cost information rather than keeping the service in a new 
technology APC. Moreover, the practice expense portion of payment for 
this service is not relevant to the setting of relative weights for 
OPPS services, in which the relativity is established within the 
context of services paid under OPPS and not with regard to the practice 
expense for services under the Medicare physician fee schedule.

Orthopedic Fracture Fixation Procedures

    Comment: Commenters stated that APCs 0043, 0046, 0047, 0048, 0049, 
and 0050 are not clinically similar and they violate the 2 times rule. 
They asked that we separate out the more costly procedures that involve 
fracture fixation devices because they involve additional time, 
resources, and significant costs of fixation devices. They recommended 
that we either create two new APCs with corresponding HCPCS codes for 
upper (at a payment of approximately $2,000) and lower fracture 
fixation devices (at a payment of approximately $3,000) or create two 
code modifiers (for upper and lower fixation devices) and multiple new 
APCs.
    Response: For the 2004 OPPS, services that require an external 
fixation device will continue to be paid in APCs that also provide 
payment for fractures that do not require external fixation devices. 
While we are sympathetic to the commenters' concerns, we are not able 
to identify CPT codes that always require use of an external fixation 
device or the extent to which such devices are required for other 
codes. Nor did the information we received from the commenters provide 
a convincing breakdown of the differences in costs for procedures using 
external fixation devices. To create new APCs or new APC relative 
weights to provide additional payment for external fixation devices 
where such APCs would also contain procedures that do not routinely 
require use of an external fixation device, would result in overpayment 
of those procedures. Moreover, since most services in these APCs do not 
require an external fixation device, it may be appropriate to continue 
to pay for them in these APCs to encourage hospitals to use them only 
when required. Furthermore, we would be reluctant to

[[Page 63429]]

impose an additional burden on hospitals by establishing ``G'' codes or 
modifiers to use in reporting procedures with or without external 
fixation devices. However, as we state elsewhere, we would support 
interested specialty societies' decisions to request the CPT to 
consider this coding issue.

APC 0680 Reveal ILR

    Comment: A commenter indicated that the proposed payment rate is 
about 95 percent of the hospital acquisition cost of the device, 
leaving the hospital at an immediate loss if it implants this device. 
The commenter indicated that it is the only manufacturer of the device 
and therefore the only source of acquisition cost for the device. They 
indicated that in 2002, the cost was $3,495 and recommended that we re-
evaluate and re-price the APC to provide sufficient payment that 
beneficiaries will have access to the device when needed. They 
indicated that the predominant site of service is in the hospital 
outpatient department and that if payment is below hospital cost, 
beneficiary access will eventually be limited.
    Response: The final rule data for APC 0680 reveals a median cost of 
$3,691.15 for this APC, on which the relative weights for 2004 are 
based. We were not convinced by comments that this median cost would 
result in a relative weight that would be inappropriate relative to the 
payments for other services under OPPS.

Fractional Flow Reserve (FFR)

    Comment: A commenter indicated that fractional flow reserve (CPT 
codes 93571, Intravascular doppler velocity and/or pressure derived 
coronary flow reserve measurement * * * during coronary angiography, 
initial vessel and 93572, each additional vessel) should be paid 
separately in addition to the procedure with which they are performed, 
rather than being packaged into the payment for the primary procedure. 
The commenter indicated that FFR should be paid separately because it 
is an expensive service with higher device and equipment costs and 
takes more time and staff than if it is not used. They also indicated 
that we pay separately for Intravascular ultrasound (IVUS) which is 
also deployed via guidewires. They stated that the principal difference 
is that IVUS describes the anatomy of the vessels while FFR describes 
the blood flow through the vessels. They indicated that it is 
inequitable to treat them differently. Payment for IVUS but not FFR 
creates inappropriate financial incentives for hospitals in determining 
which procedures to provide.
    Response: Currently, where FFR is provided, the costs for it are 
packaged with the principal service to which FFR is an addition, which 
we expect to be coronary angiography. If we were to pay separately for 
this service, we would need to remove the costs for this service from 
the cost for services with which it was packaged (that is, coronary 
arteriography), which would reduce the medians on which the payments 
for those services are based. This would reduce the median and 
therefore the payment for coronary angiography. We are concerned with 
the circumstances under which this service would be appropriately paid 
under Medicare and will consider development of a national coverage 
decision regarding when it is medically necessary to treat illness or 
injury. After such a coverage decision is made, we will reconsider 
whether it is appropriate to pay separately for the service.

Cataract Surgery With IOL Implantation (APC 0246)

    Comment: A manufacturer of intraocular lenses was concerned that on 
claims for the procedures in APC 246, the median charge of claims for 
which no charge is reported using revenue code 276 (Intraocular lens) 
is one-third lower than the median charge of claims where a charge is 
reported using revenue code 276. The commenter believes that when 
charges are not listed in revenue center 0276, they are omitted from 
the claim altogether, rather than being placed in a different revenue 
center. The commenter recommended that we adopt a policy of using only 
claims for APC 0246 that report charges for revenue code 276, which 
would be consistent with our proposal to calculate relative weights for 
certain device-related APCs using only claims that included a separate 
and correctly coded charge for a device.
    Response: For the 2004 OPPS, payment for cataract surgery with IOL 
insertion is based on the median cost for the procedure from the final 
data. A review of the 2002 claims for procedures in APC 246, which 
includes CPT code 66984, one of the highest volume outpatient surgical 
procedures paid under the OPPS, indicates that the vast majority are 
billed with revenue code 276. Long-standing instructions require 
hospitals to report the IOL charge under revenue code 276 when billing 
for a procedure in APC 246.
    In our implementing instructions for the 2004 OPPS update, we will 
remind hospitals and the contractors who process OPPS claims that, in 
order to receive payment for a procedure in APC 246, hospitals are 
required to report the associated IOL charge under revenue code 276. We 
will also consider for the 2005 OPPS update the commenter's 
recommendation that we use only claims with revenue code 276 to 
recalibrate the relative payment weight for APC 246. Our data are 
extremely robust for this APC (with a frequency of nearly 520,000), and 
they indicate that the preponderance of the claims used to establish 
the 2004 median does include revenue code 276.

Transcatheter Placement of Intracoronary Drug-Eluting Stent Procedures 
(APC 0656)

    Comment: One commenter supported our recognition of the new drug-
eluting stent technology through the creation of two ``G'' codes (G0290 
and G0291) and their placement in new APC 0656. However, the commenter 
questioned how we calculated the proposed payment rate for 2004. The 
commenter stated that some patients classically considered at higher 
risk for percutaneous interventions, including diabetics and patients 
with multi-vessel disease, are being referred for drug-eluting stent 
procedures. The commenter stated that the clinical disposition of these 
patients makes them more complex and more resource-intensive than the 
average patient. The commenter further noted that, while the reporting 
of a second main coronary vessel procedure would result in a second, 
reduced APC payment, that our payment for the single vessel should be 
based on an average of 1.7 stents per vessel. Finally, the commenter 
recommended that we add APC 0656 to the list of APCs for which a device 
was required to be on the claim for weight setting.
    Response: For the 2004 OPPS, we will continue to base the payment 
for transcatheter placement of intracoronary drug eluting stents on the 
median for APC 0104, transcatheter placement of intracoronary stents. 
We increased the median for APC 0104 ($4,765.05) by $1,200 to acquire 
the median we used for APC 0656. We are using the same adjustment 
amount used for a single stent in the inpatient prospective payment 
system. We received no comments that are sufficiently compelling to 
convince us that more than one stent per vessel typically will be used 
when this service is furnished in the outpatient department or that the 
adjustment amount of $1,200 per stent is inappropriate. We will 
consider including this on the agenda for the next APC Panel meeting.

[[Page 63430]]

    With respect to the comment that we should add APC 0656 to the list 
of APCs for which a device was required to be on the claim for weight 
setting, we believe it would be inappropriate to do so for the 2004 
OPPS. This is because the drug-eluting stent was not approved by the 
FDA until 2003, and, therefore, it did not appear in the 2002 data. 
Moreover, since there are no device codes for coronary stents for use 
on claims in 2003, the 2003 data will not contain the device codes that 
would be needed to create a subset of stent device claims to use for 
the 2005 OPPS. However, in view of the reinstitution of device coding 
for 2004, we will consider this comment in our work to develop the 2006 
OPPS. Moreover, as we indicated above, we based the payment for APC 
0656 on the median for APC 0104, which was calculated from claims that 
contained C codes for stents.

Cardioverter Defibrillator (APC 0107)

    Comment: Commenters indicated that the proposed payment for this 
APC was too low to pay for the device, much less the cost of the 
services to implant it. They indicated that the cost of the device in 
2002 varied between $19,160 and $21,410 among major group purchasers, 
considerably more than the proposed payment of $15,773.28. They asked 
that we use the external data to set the device portion of the hospital 
cost.
    Response: We reviewed the data for this APC and considered the 
comments of the APC Panel at its August 2003 meeting on the August 12, 
2003 proposed rule. We were convinced that the median for this device 
is too low to be appropriate relative to other median costs. We used 
external data that had been presented to the APC Panel to calculate a 
mean external acquisition cost and used one part external cost to one 
part median cost from our claims data to acquire an adjusted cost for 
the device. We then added the nondevice median from our claims data to 
the adjusted device acquisition cost to acquire an adjusted median that 
we used to set the relative weight for this APC. Effective for October 
1, 2003, we established codes to be used for reporting the services 
assigned to APCs 107 and 108. Specifically, CPT code 33240 (Insertion 
of cardioverter defibrillator) is no longer recognized as a valid code 
for OPPS. Instead, hospitals now report either G0297 (Insertion of 
single chamber pacing cardioverter defibrillator pulse generator) or 
G0298 (Insertion of dual chamber pacing cardioverter defibrillator 
pulse generator). Also effective for October 1, 2003, CPT code 33249 
(Insertion/replacement/repair of cardioverter defibrillator and 
insertion of pulse generator) is no longer recognized as a valid code 
for OPPS. Instead, hospitals will report either G0299 (Insertion or 
repositioning of electrode lead for single chamber pacing cardioverter 
defibrillator and insertion of pulse generator) or G0300 (Insertion or 
repositioning of electrode lead for dual chamber pacing cardioverter 
defibrillator and insertion of pulse generator). These codes were 
created to capture differential costs related to single and dual 
chamber cardioverter defibrillators. Claims containing the CPT codes we 
no longer recognize for OPPS (CPT codes 33240 and 33249) are being 
returned to providers to be coded correctly and resubmitted.

Insertion of Pacemaker Dual Chamber (APC 0655) and Insertion of 
Pacemaker Single Chamber (APC 0089)

    Comment: A commenter indicated that the proposed payment rates for 
these APCs are only slightly more than the lowest median hospital 
acquisition cost of the device leaving a hospital little or no payment 
for the services to implant it. They asked that we re-evaluate and 
price these APCs at a level that pays the full cost of the device and 
services.
    Response: We carefully reviewed the data for these APCs. We were 
not convinced that there was a need to adjust the median for either of 
these APCs. The median cost for APC 0655 is about 12 percent higher 
than the adjusted median on which the 2003 payment weights were based 
(2003 adjusted median of $7,298.52 versus the final rule median of 
$8,225.23). The median cost for APC 0089 is slightly higher than the 
adjusted median on which the 2003 weights were based (2003 adjusted 
median of $6,686.16 versus the final rule median of $6,754.63). The 
comment was not convincing that these median costs were inappropriate 
in relation to the other median costs that will be used to set the 
relative weights. Moreover, since median costs for both APCs rose above 
the amounts achieved by upward adjustments for these APCs in 2003, we 
believe that the medians are appropriately relative to the costs for 
other services that will be used to set the relative weights.

Insertion of Pacemaker, Dual Chamber Generator Only (APC 0654)

    Comment: A commenter indicated that the proposed payment rate is 
about 95 percent of the hospital acquisition cost of the device, 
leaving the hospital at an immediate loss if it implants this device. 
They asked that we re-evaluate and price these APCs at a level that 
pays the full cost of the device and services.
    Response: The median cost for this APC is about 19 percent higher 
than the adjusted median on which the 2003 payment weight was based 
(2003 adjusted median of $5,456.63 versus the final rule median of 
$6,495.61). We saw no reason to further adjust the median on which the 
relative weights for 2004 are based. The comment was not convincing 
that these median costs were inappropriate in relation to the other 
median costs that will be used to set the relative weights. Moreover, 
since the median cost for the APC rose above the amounts achieved by 
upward adjustments for the APC in 2003, we believe that the median is 
appropriately relative to the costs for other services that will be 
used to set the relative weights.

INTEGRA Wound Products and Other Wound Products

    Comment: We received a comment concerning INTEGRA Dermal 
Regeneration Template and INTEGRA Bilayer Wound Matrix in which the 
commenter stated that there is a payment disparity between the INTEGRA 
products and APLIGRAF, DERMAGRAFT and TRANSCYTE, which are eligible for 
separate payment as biologicals. The commenter noted that hospitals 
that use APLIGRAF, DERMAGRAFT, and TRANSCYTE receive an extra payment 
in the form of a pass-through or other separately paid APC payment in 
addition to the APC payment for the skin repair procedures (APC 0025), 
while users of the aforementioned INTEGRA products receive only the 
regular payment associated with skin repair CPT codes. The commenter 
stated that this payment differentiation provides a financial incentive 
to hospitals to use the other skin replacement products, and places 
INTEGRA at a competitive disadvantage. The commenter recommended that 
we create a product-specific APC for INTEGRA to provide comparable 
payment for ``this class of products.'' Alternatively, the commenter 
recommended that we establish a single APC that includes the cost of 
all or most skin replacement technologies. The manufacturer noted that 
hospitals using INTEGRA would receive only $340.41 under our proposed 
rate for APC 0025, while total payments for APC 0025 plus the product-
specific codes for APLIGRAF, DERMAGRAFT, and TRANSCYTE would be between 
$770.86 and $1,072.86.
    Response: TRANSCYTE was approved for transitional pass-through

[[Page 63431]]

payment as a biological as of July 1, 2003; DERMAGRAFT continues in 
pass-through status through 2004; and APLIGRAF is a former pass-through 
biological proposed to be paid separately as non-pass-through 
biological, that is, status indicator ``K.'' Since no party has yet 
applied for transitional pass-through payment for INTEGRA along with 
relevant documentation in order to evaluate Integra as a biological for 
pass-through payment, we have not been able to evaluate pass-through 
payment status as a biological for this product. We are sympathetic to 
the commenter's concern, and we find merit in the recommendation to 
group a class of skin replacement products into the same APC. However, 
we do not believe that we have sufficient information at present upon 
which to determine the appropriate payment rate for such an APC. 
Furthermore, we would want to allow the public an opportunity to 
provide input on such a proposal. Therefore, we will consider the 
recommendation of a common APC for skin repair using new skin 
replacement technologies for 2005. We will also consider referring this 
issue for consideration by the APC Panel at its next meeting. 
Meanwhile, we invite public comment on the concept of grouping payment 
for skin repair procedures using new skin repair technologies such as 
INTEGRA, DERMAGRAFT, and APLIGRAF into a common APC.

Stereotactic Radiosurgery

    Comment: A commenter urged that we continue to consider 
stereotactic radiosurgery (SRS) to be a radiation procedure and that we 
not reopen the revenue code of surgery for SRS, stating that a 
radiation oncologist is a critical component to the delivery of SRS. 
The commenter expressed concern for unintended consequences that may 
result from unbundling of services associated with this procedure.
    Response: We appreciate the commenter's concern for accurately 
capturing the costs of stereotactic radiosurgery. As a matter of 
policy, however, we do not generally mandate the reporting of services 
under specific revenue centers but leave that decision up to the 
hospitals.
    Comment: We received several comments regarding stereotactic 
radiosurgery (SRS). Commenters were concerned that the current G code 
descriptors do not appropriately recognize the differences among the 
various forms of SRS. Commenters explained that there are two basic 
methods in which SRS can be delivered to patients, linear accelerator-
based treatment (often referred to as ``Linac'') and multi-source 
photon-based treatment (often referred to as Cobalt 60). Advances in 
technology have further distinguished these treatment modalities. 
Linear accelerator-based treatment can be performed using various types 
of SRS systems, two of which include gantry-based systems and image-
guided robotic SRS systems. Commenters stated that the existing G codes 
do not accurately describe the unique differences among these services 
and therefore do not accurately capture the costs involved in providing 
these services.
    For example, several commenters expressed concern regarding the 
limitation imposed by the code descriptor for HCPCS code G0242, which 
restricts its use to planning for Cobalt 60-based treatment. While some 
commenters stated that planning costs for linear accelerator-based 
treatment and Cobalt 60-based treatment are identical, other commenters 
asserted that planning costs for these services differ significantly.
    Commenters recommended the following options to resolve the issue:
    (1) Create another G code to distinguish between linear 
accelerator-based SRS and Cobalt 60-based SRS, which would be 
consistent with the two G codes (G0173 for linear accelerator-based and 
G0243 for Cobalt 60-based) for SRS treatment delivery; or
    (2) Modify the descriptor for HCPCS code G0242 to describe 
treatment planning for both linear accelerator-based and Cobalt 60-
based SRS treatments. For clarification purposes, the current G codes 
for SRS treatment delivery services are as follows:
    G codes for linear accelerator-based SRS treatment delivery:
    HCPCS code G0173--Stereotactic radiosurgery, complete course of 
therapy in one session.
    HCPCS code G0251--Linear accelerator-based stereotactic 
radiosurgery, delivery including collimator changes and custom 
plugging, fractionated treatment, all lesions, per session, maximum 5 
sessions per course of treatment.
    G code for Cobalt 60-based SRS treatment delivery:
    HCPCS code G0243--Multi-source photon stereotactic radiosurgery, 
delivery including collimator changes and custom plugging, complete 
course of treatment, all lesions. The current G code for Cobalt 60-
based SRS treatment planning is as follows:
    HCPCS code G0242--Multi-source photon stereotactic radiosurgery 
(Cobalt 60 multi-source converging beams) plan, including dose volume 
histograms for target and critical structure tolerances, plan 
optimization performed for highly conformal distributions, plan 
positional accuracy and dose verification, all lesions treated, per 
course of treatment.
    Response: We agree with commenters that the current description for 
HCPCS code G0242 is limited to the planning of Cobalt 60-based SRS 
treatment and does not account for the planning of linear accelerator-
based SRS treatment. To be consistent with the two G codes we created 
for treatment delivery, we will create a new G code (G0338) to 
distinguish linear accelerator-based SRS treatment planning from Cobalt 
60-based SRS treatment planning. We will place G0338 in APC 1516 at a 
payment rate of $1,450. The new G code for linear accelerator-based SRS 
treatment planning will be as follows:
    HCPCS code G0338--Linear-accelerator-based stereotactic 
radiosurgery plan, including dose volume histograms for target and 
critical structure tolerances, plan optimization performed for highly 
conformal distributions, plan positional accuracy and dose 
verification, all lesions treated, per course of treatment.
    Comment: Several commenters expressed concern that our current code 
descriptors for HCPCS codes G0173 and G0251 do not distinguish between 
the various types of linear accelerator-based SRS treatment. Currently, 
image-guided robotic linear accelerator-based SRS systems are grouped 
with other forms of linear accelerator-based SRS systems using HCPCS 
codes G0173 and G0251. Commenters requested that we modify the code 
descriptors to distinguish image-guided robotic systems from other 
forms of linear accelerator-based SRS systems to account for the wide 
cost variation in delivering these services.
    Response: We agree with commenters that the descriptors for HCPCS 
codes G0173 and G0251 do not distinguish image-guided robotic SRS 
systems from other forms of linear accelerator-based SRS systems to 
account for the cost variation of delivering these services. To more 
accurately capture the true costs of these services, we will create two 
new G codes (G0339 and G0340) to describe complete and fractionated 
image-guided robotic linear accelerator-based SRS treatment. Please see 
response to below comment for code descriptors.
    Comment: Commenters urged that we modify the code descriptor for 
the delivery of image-guided robotic SRS to include both complete and 
fractionated courses of therapy in one code, resulting in the same 
payment amount for both types of therapy. Commenters explained

[[Page 63432]]

that the per-session costs of delivering image-guided robotic linear 
accelerator-based SRS are the same, regardless of whether the patient's 
disease requires one treatment or multiple treatments.
    Response: Our claims data do not support the assertion that the 
per-session costs of delivering image-guided robotic linear 
accelerator-based SRS is equal to the costs of delivering a complete 
course of image-guided robotic linear accelerator-based SRS treatment. 
However, we acknowledge the possibility that claims data for G0173 and 
G0251 may include both image-guided robotic linear accelerator-based 
SRS treatments as well as other forms of linear accelerator-based SRS 
treatments and, as a result, the median cost may not accurately reflect 
the true costs of delivering image-guided robotic linear accelerator-
based SRS therapy. As stated in our response to the above comment, we 
will create two new G codes (G0339 and G0340) to distinguish complete 
and fractionated image-guided robotic linear accelerator-based SRS 
treatment from other forms of complete and fractionated linear 
accelerator-based SRS treatment. We will place HCPCS code G0339 
(complete session) in APC 1528 at a payment rate of $5250. The APC 
placement of HCPCS code G0340 is discussed below.
    While we recognize the costs to provide multi-session image-guided 
robotic SRS therapy may be greater than the current payment rate for 
HCPCS code G0251, we received no convincing cost data supporting 
commenters' claims that the costs of performing each additional session 
subsequent to the first session of a fractionated treatment is 
equivalent to the costs of performing a complete session. Rather, we 
believe that certain economies of scale are realized when performing 
each additional session subsequent to the first session of a 
fractionated treatment. That is, based on our understanding of the 
therapy, we do not believe that the same exact amount of hospital 
resources would be utilized for each subsequent session.
    Statements provided by various interested parties indicate that the 
costs of providing each session of a fractionated treatment range from 
$2700 to $9000. However, we received no convincing data to substantiate 
these statements. We have estimated that approximately 75 percent of 
the costs of a complete session would be required to provide each 
additional session subsequent to the first session of a fractionated 
treatment. Therefore, we will place HCPCS code G0340 in new technology 
APC 1525, which covers procedures ranging from $3500 to $4000 in 
payment and which pays $3750. This new technology APC range pays 
approximately seventy-five percent of the payment for HCPCS code G0339. 
We will modify the descriptor for HCPCS code 0340 to describe 
additional sessions (second through fifth sessions) subsequent to the 
first session of a fractionated treatment. In addition, we will expand 
the descriptor for a complete session (HCPCS code G0339) to include the 
first session of a multi-session treatment. To further clarify, when 
providers perform multi-session image-guided robotic SRS therapy, they 
should bill using HCPCS code G0339 for the first session. For each 
additional session subsequent to the first session, providers should 
bill using only HCPCS code G0340 up to a maximum of five sessions.
    Although we received no clinical data to substantiate the use of a 
single session versus multiple fractionations up to five sessions, a 
few commenters stated that a maximum of five sessions may be utilized 
to treat certain conditions; therefore, we will continue to pay for the 
delivery of multi-session therapy (HCPCS code G0340) up to a maximum of 
five sessions per course of treatment. When additional data is 
submitted, we may reconsider this payment decision.
    As described above, we will create the following new G codes to 
identify image-guided robotic linear accelerator-based SRS treatment 
delivery:
    HCPCS code G0339--Image-guided robotic linear accelerator-based 
stereotactic radiosurgery, complete course of therapy in one session, 
or first session of fractionated treatment.
    HCPCS code G0340--Image-guided robotic linear accelerator-based 
stereotactic radiosurgery, delivery including collimator changes and 
custom plugging, fractionated treatment, all lesions, per session, 
second through fifth sessions, maximum five sessions per course of 
treatment.

SIRTeX Medical (RE: SIR-Spheres Brachytherapy Source)

    Comment: The manufacturer of a brachytherapy source to treat liver 
cancer commented that our proposed payment of $8,870.88 for APC 2616 
was inadequate to pay for its product, which it reported costs $14,000 
per treatment dose. This commenter stated that there are only two 
products that would fit this APC, which is for Yttrium-90 brachytherapy 
source. Moreover, this party claimed that there were significant 
clinical differences between its product and another Yttrium-90 source, 
and that these differences necessitated the price differential between 
the two products. The commenter requested establishment of a separate 
alpha-numeric HCPCS code for its product, in order to account for the 
cost differences between the two Yttrium-90 products and to set more 
equitable payment rates for the two products.
    Response: We appreciate the concerns of the commenter. We would 
first note that payment to APC 2616 has increased to $9,615.50 per dose 
compared to the 2003 payment of $6,485.37. The information provided in 
the comment did not convince us that the payment rate resulting from 
the 2002 claims data is inadequate to pay hospitals for the Yttrium-90 
products. We are uncertain whether or not there are other Yttrium-90 
sources in addition to the two discussed in this comment that would 
need to be considered in any analysis of the relative costs of the 
products. Therefore, until we have additional data, we believe that 
code C2616 and APC 2616 adequately describes and pays for Yttrium-90 
brachytherapy sources.

Low Osmolar Contrast Media

    Comment: A radiology specialty society expressed disappointment 
because we did not address payment for low osmolar contrast media 
(LOCM) in the proposed rule. The commenter believes that the 
variability in usage and Medicare's restricted coverage of LOCM warrant 
payment in a separate APC in the 2004 final rule. The commenter 
recommends that we increase the relative weights of APCs that include 
codes that involve the use of LOCM agents to reflect the additional 
costs of these agents if we do not establish a separate APC to pay for 
LOCM.
    Response: We issued a program memorandum on November 22, 2002 
(Transmittal A-02-120, Change Request 2185) in which we removed all 
requirements differentiating payment between high osmolar contrast 
material and LOCM as well as restrictions that would limit payment for 
LOCM only to patients with specific diagnoses. In that program 
memorandum, we instructed our contractors to discontinue any edits that 
would prohibit payment for LOCM if specific diagnoses were not 
reflected on the claim, effective for services furnished on or after 
January 1, 2003. We further directed contractors to instruct hospitals 
to include charges for LOCM in the charge for the diagnostic procedure 
or, if LOCM is billed as a separate charge, to use revenue code 254 or 
255 as appropriate. These instructions applied only to hospitals 
subject to the OPPS.
    We disagree with the commenter's recommendation that a separate APC

[[Page 63433]]

should be established to bill for LOCM for several reasons. Prior to 
issuance of Transmittal A-02-120, covered LOCM costs would have been 
reflected either in an appropriate revenue code or within the 
hospital's charge for a diagnostic procedure or in a charge with an 
appropriate HCPCS code (A4644, A4645, or A4646). To the extent that 
hospitals submitted covered charges for LOCM in 2002, those costs are 
packaged into the cost of the procedure with which the LOCM was used. 
We expect that claims for services involving the use of LOCM furnished 
during CY 2003 will reflect even more fully costs associated with LOCM 
in light of the instructions that were issued in Transmittal A-02-120. 
These costs will be reflected in the 2005 update of the OPPS. Finally, 
without verifiable information that demonstrates the actual market-
based price that a broadly based national sample of hospitals are 
routinely required to pay in order to procure LOCM, we have no data 
upon which to base a determination that a separate APC for LOCM would 
be appropriate.

Prosthetic Urology

    Comment: Several commenters supported the proposed restructuring of 
the prosthetic urology procedures into APCs 385 and 386. However, the 
commenters urged us to consider further refinements to increase the 
payment rates for these APCs. The commenters expressed concern about 
the use of a single departmental cost-to-charge ratio for devices and 
recommended for calendar year 2005 that we implement edits in our 
development of median costs to benchmark cost data for device 
procedures so that charges for expensive devices are not reduced below 
a designated point. The commenters also stated that hospitals charged 
for only one component of a prosthetic urology device for multi-
component prosthetic urology devices. The commenters believe this 
resulted in under-reporting of charges for the entire procedure. The 
commenters recommended that we use external data to adjust the level of 
payment for multi-component devices and exclude claims with device 
costs less than $5,000 from the rate-setting database. Commenters 
stated that hospitals in the States of California, Colorado, Florida, 
Illinois, North Dakota, New York, and Oklahoma have closed their 
prosthetic urology programs because Medicare OPPS payments are too low.
    Response: APCs 385 and 386 were created by splitting APC 0182 into 
two APCs for higher cost and lower cost devices (penile prostheses and 
urinary sphincters). The payment for these procedures in 2003 is 
$4,975.96. As a result of splitting former APC 0182 into two APCs, the 
payment amount for 2004 is $3,663.93 for APC 0385 and $6,342.07 for APC 
0386. This is a relatively small reduction for APC 0385 with the lower 
cost devices and a very significant increase for APC 0386, with the 
higher cost devices. Moreover, as discussed in more detail elsewhere, 
we decided to change the status indicator for these APCs from ``T'' to 
an ``S'' so that the multiple procedure reduction will not apply to 
them (or other procedures with a ``T'' status indicator) on the same 
day. These changes together result in significantly more payment for 
these services in 2004 than in 2003. Therefore, we did not use external 
data to further adjust the median cost on which the payment was based.

Intensity Modulation Radiation Therapy

    Comment: Commenters urged that we withdraw our proposal to move 
intensity modulation radiation therapy (IMRT) treatment planning (CPT 
code 77301) from new technology APC 1510 (previously APC 0712 in 2003) 
to APC 0413 and IMRT treatment delivery (CPT code 77418) from new 
technology APC 1506 (previously APC 0710 in 2003) to APC 0412. 
Commenters indicated that the payments proposed for APCs 0412 and 0413 
are too low to adequately compensate hospitals for the costs of the 
services. One commenter further explained that part of the problem 
behind the low median cost may be that, according to CMS PM A-02-26, 
hospitals are precluded from billing for all of the services involved 
in this treatment. The commenter indicated that hospitals should be 
able to bill and be paid for the simulations (CPT codes 77280-77295), 
dosimetry calculations (CPT code 77300), an isodose plan (CPT codes 
77305-77315), special teletherapy port plan (CPT code 77321), 
continuing medical physics (CPT code 77336) and special medical physics 
(CPT code 77370). Commenters requested that CPT codes 77301 and 77418 
be retained in their current new technology APCs (APCs 1510 and 1506, 
respectively) for another year to provide additional time for provider 
education about the proper coding of these services and to enable the 
data to mature.
    Response: We agree with commenters that the payment rate for APC 
0413 does not adequately cover the costs of providing IMRT treatment 
planning (CPT code 77301). As noted by one commenter, PM A-02-26 
instructs that services identified by CPT codes 77280 through 77295, 
77300, and 77305 through 77321, 77336, and 77370 are included in the 
APC payment for IMRT and SR planning. The low median for CPT code 77301 
appears to be a result of miscoding. Therefore, we will retain CPT code 
77301 in new technology APC 1510 to allow additional time for provider 
education and to enable the data to mature. We believe, however, that 
the significant volume of single claims (93 percent of total claims) 
used to set the payment rate for IMRT treatment delivery (CPT code 
77418) accurately reflects the costs hospitals are reporting for this 
service. Based on this robust claims data, we will move CPT 77418 from 
new technology APC 1506 (previously APC 0710 in 2003) to APC 0412 (IMRT 
Treatment Delivery).
    Comment: One commenter requested that we allow the use of existing 
IMRT CPT codes 77301 and 77418 for compensator-based IMRT technology in 
the hospital outpatient setting. The commenter states that Medicare 
beneficiaries may be denied access to compensator-based IMRT as a 
result of inadequate payment for this service.
    Response: We do not prohibit the use of existing IMRT CPT codes 
77301 and 77418 to be billed for compensator-based IMRT technology in 
the hospital outpatient setting. Rather, we believe the confusion may 
pertain to billing instructions for CPT codes 77301 and 77334 billed on 
the same day. CMS PM A-02-26 instructs that ``payment for IMRT and SR 
planning does not include payment for services described by CPT codes 
77332 through 77334. When provided, these services should be billed in 
addition to the IMRT and SR planning codes 77301 and G0242.'' Providers 
billing for both CPT codes 77301 (IMRT treatment planning) and 77334 
(design and construction of complex treatment devices) on the same day 
should append a 59 modifier to receive accurate payment.
Proton Beam Therapy
    Comment: Several commenters indicated that proton beam therapy, 
intermediate and complex should be moved from APC 0650 to a new 
technology APC (as it appears in Addendum B). However, commenters 
stated that these two codes should not be placed in the same APC due to 
a significant difference in resource utilization. We received several 
other comments supporting our proposal to maintain simple proton beam 
therapy (CPT codes 77520 and 77522) in APC 0664 and intermediate and 
complex proton beam therapies (CPT codes 77523 and 77525, respectively) 
in APC 1511 (previously APC 0712 in 2003).
    Response: We agree with commenters that codes for simple proton 
beam

[[Page 63434]]

radiation therapy (CPT codes 77520 and 77522) should be placed in a 
different APC than codes for intermediary (CPT code 77523) and complex 
(CPT code 77525) radiation therapy. As we stated in the correction 
notice of February 10, 2003 (68 FR 6636), we also agree with commenters 
that it would be inappropriate to return codes for simple proton beam 
therapy to a new technology APC due to having sufficient claims data to 
integrate these codes into the OPPS. We continue to believe that the 
placement of these codes in APC 0664 is appropriate based on having 
used 98 percent of total claims for simple proton beam therapy to set 
the 2004 median for APC 0664. Therefore, CPT codes 77520 and 77522 will 
remain in APC 0664.
    The placement of intermediate (CPT code 77523) and complex (CPT 
code 77525) proton beam therapies in APC 650 in the November 1, 2002 
final rule (67 FR 66718) for the 2003 OPPS was an error that was 
corrected in the correction notice of February 10, 2003 (68 FR 6636). 
We clarified in the correction notice that these CPT codes were placed 
in new technology APC 0712 for CY 2003 because they lacked sufficient 
cost data to confidently move these codes out of a new technology APC. 
We continue to lack sufficient cost data to move these codes into a 
clinical APC; therefore, we will crosswalk CPT codes 77523 and 77525 
from new technology APC 0712 to the corresponding new technology APC 
1511 for CY 2004. Once sufficient data is available, we will be able to 
determine whether intermediate and complex proton beam therapies should 
be placed in the same APC.

FDG PET Procedures

    Comment: Several commenters commended us for our proposed rates for 
FDG PET procedures. They were pleased that the proposed 2004 rates for 
the FDG PET procedure and the radiopharmaceutical when combined are 
nearly identical to the rates for the combined procedure and 
radiopharmaceutical for 2003. Commenters stated that the retention of 
FDG PET procedures in a new technology APC will allow providers an 
additional year to improve their reporting practices, while providing 
us with another year of more accurate claims data.
    Response: We agree with commenters that the retention of FDG PET 
procedures in a new technology APC for an additional year will allow 
providers a reasonable amount of time to improve their reporting 
practices, while providing us with another year of claims experience. 
Therefore, we will retain FDG PET procedures in new technology APC 
1516.
    Comment: One commenter expressed concern that HCPCS code G0296 did 
not appear in Addendum B of the August 12, 2003 proposed rule. The 
commenter urged us to place this new code in APC 1516 with other FDG 
PET procedures.
    Response: We thank the commenter for bringing to our attention the 
absence of HCPCS code G0296 from addendum B of the proposed rule. We 
agree with the commenter's recommendation to place this code in the 
same APC as other FDG PET procedures. Therefore, we will place HCPCS 
code G0296 in new technology APC 1516.
    Comment: One commenter recommended the establishment of a revenue 
code dedicated solely to PET procedures.
    Response: Revenue codes exist for hospital accounting purposes and, 
in general we do not require that particular services be billed with 
particular revenue codes. We are not convinced that adding specific 
requirements for revenue coding or expanding the revenue codes to 
acquire more specific information will result in better data or that 
the end result would be cost effective in terms of its potential effect 
on hospital operations.

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, Pub. L. 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), Pub. L. 106-554, enacted December 21, 2000).
    Transitional pass-through payments are also required for certain 
``new'' medical devices, drugs, and biological agents that were not 
being paid for as a hospital outpatient service as of December 31, 1996 
and whose cost is ``not insignificant'' in relation to the OPPS payment 
for the procedures or services associated with the new device, drug, or 
biological. Under the statute, transitional pass-through payments 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 current device category codes can be found 
below, in Table 10.
    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 for transitional pass-through payment. 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.

[[Page 63435]]

    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.

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 proposed 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.
    In the August 12, 2003 proposed rule, we described in the detail 
the methodology we used to make an estimate of pass-through spending in 
2004 (68 FR 47992). In general, we specified that after using the 
respective methodologies described in the proposed rule, 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 would be required.
    Table 9 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 
specified in the proposed rule that we were uncertain whether estimated 
pass-through spending in 2004 would exceed $456 million (2.0 percent of 
total estimated OPPS spending) because we had not yet completed the 
estimate of pass-through spending for a number of drugs and devices. In 
particular, we did 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 invited comments on the methodology we 
proposed and the estimates for utilization that appeared in Table 12 of 
the August 12, 2003 proposed rule. We received several comments on this 
proposal, which are summarized below along with our responses.

                               Table 9.--Estimate of Pass-Through Spending in 2004
----------------------------------------------------------------------------------------------------------------
                                                                    2004 pass-                         2004
                                                                      through     2004 estimated    anticipated
         HCPC                APC             Drug biological          payment       utilization    pass-through
                                                                      portion                        payments
----------------------------------------------------------------------------------------------------------------
                                          Existing Pass-through
                                            Drugs/biologicals
J0583................  9111             Injectin Bivalrudin, per           $0.40      $5,278,000      $2,111,200
                                         1 mg.
C9112................  9112             Injection, Perflutren              37.44          67,000       2,508,480
                                         lipid microsphere, per
                                         2 ml.
C9113................  9113             Injection, Pantoprazole             6.34          20,000         126,800
                                         sodium, per vial.
J1335................  9116             Injection, Ertapenum                6.00          14,400          86,400
                                         sodium, per 500 mg.
J2505................  9119             Injection,                        708.00         110,344      78,123,329
                                         Pegfilgrastim, per 6 mg
                                         single dose vial.
J9395................  9120             Injection, Fluvestrant,            22.13         274,156       6,067,072
                                         per 25 mg.
C9121................  9121             Injection, Argatroban,              4.13          50,000         206,500
                                         per 5 mg.
C9200................  9200             Orcel, per 36 cm2.......          286.80           1,000         286,800
C9123................  9123             Transcyte, per 247 sq cm          194.76             100          19,476
C9203................  9203             Injection Perflexane               36.00          82,400       2,966,400
                                         lipid microspheres, per
                                         10 ml vial.
J2324................  9114             Injection, Nesiritide,             38.30          60,000       2,298,000
                                         per 0.5 mg vial.
J3315................  9122             Injection, Triptorelin            100.70         307,440      30,959,208
                                         pamoate, per 3.75 mg.
J3487................  9115             Injection, Zoledronic              54.93         539,000      29,607,270
                                         acid, per 1 mg.
J3486................  9204             Injectionm Ziprasidone              5.25         234,286       1,230,000
                                         mesylate, per 10 mg.
C9205................  9205             Injection, Oxaliplatin,            23.86         280,756       6,698,845
                                         per 5 mg.
C9208................  9208             Injection, IV,                     31.27         194,533       6,083,040
                                         Agalsidase beta, per 1
                                         mg.
C9201................  9201             Dermagraft, per 37.5              145.92           9,264       1,351,803
                                         square centimeters.
C9209................  9209             Injection, IV,                    162.72           2,612         425,092
                                         Laronidase, per 2.9 mg.
                                           Pass-through Drugs/
                                          Biologicals Effective
                                               January 2004
C9207................  9207             Injection, IV,                    262.66         102,680      26,970,000
                                         Bortezomib, per 3.5 mg.
C9210................  9210             Injection, IV,                     77.76          37,500       2,916,000
                                         Palonosetron HCI, per
                                         0.25 mg (250
                                         micrograms).
C9211................  9211             Injection, alefacept,             168.00          13,775       2,314,200
                                         for intravenous use,
                                         per 7.5 mg.
C9212................  9212             Injection, alefacept,             119.40          27,550       3,289,470
                                         for intramuscular use,
                                         per 7.5 mg.
                                          Existing Pass-through
                                                 Devices
C1783................  1783             Ocular implant, aqueous   ..............             324         160,250
                                         drainage assist device.
C1814................  1814             Retinal tamponade         ..............          35,173      13,675,262
                                         device, silicone oil.
C1884................  1884             Embolization Protective   ..............          25,000      38,601,544
                                         System.
C1888................  1888             Catheter, ablation, non-  ..............             215         129,731
                                         cardiac, endovascular
                                         (implantable).

[[Page 63436]]

 
C1900................  1900             Lead, left ventricular    ..............           2,095       2,819,912
                                         coronary venous system.
C2614................  2614             Probe, percutaneous       ..............             901       1,752,445
                                         lumbar discectomy.
C2632................  2632             Brachytherapy solution,   ..............             225       1,890,000
                                         iodine--125, per mCi.
C1818................  1818             Integrated                ..............               4          27,800
                                         keratoprosthesis.
                                          Pass-through Devices
                                          Effective January 2004
C1819................  1819             Tissue localization-      ..............           9,858       1,823,730
                                         excision dev.
                                         Other Items Expected To                  ..............  ..............
                                          Be Determined Eligible
                                                 for 2004
                                        Spending for future       ..............  ..............      22,466,959
                                         approved drugs.
                                        Spending for future       ..............  ..............      12,791,197
                                         approved devices.
                                        Total Spending for Pass-  ..............  ..............     302,784,216
                                         through Drugs/
                                         biologicals, and
                                         devices 2004.
----------------------------------------------------------------------------------------------------------------

    Comment: Several commenters objected to the methods used to project 
pass-through drug spending, especially those techniques used to 
estimate future products that are first eligible for pass-through 
payments beginning in April 2004 or later in the year. They are 
concerned that pass-through expenditures in 2004 will exceed the 
statutory cap and cause us to impose a pro rata reduction. Several 
hospital associations propose that we limit the funds allocated for the 
pass-through pool to one percent and use the remaining 1.0 percent to 
fund all other APCs. They suggest that we over-estimate pass-through 
spending, which results in the reduction of payment rates for other 
critical care services.
    Response: Section 1833(t)(6)(E)(i) of the Act requires that the 
Secretary estimate the total pass-through payments to be made for the 
forthcoming year (which allows us to determine the amount of the 
conversion factor for the forthcoming year) and to the extent the 
estimate exceeds the statutory limit, reduce the amount of each pass-
through payment. For 2004, the statutory limit is 2.0 percent of total 
estimated program payments. In the August 12, 2003 proposed rule, we 
provided our best estimate at that time of pass-through payments for 
the drugs and devices for which we expected to make pass-through 
payments in 2004, and we explained our methodology for determining the 
estimate for the final rule. We provided a list of the devices and 
drugs we either knew would be paid under pass-through next year or 
which we believed may be paid as pass-through items in 2004.
    We finalized our estimate of 2004 pass-through spending and, for 
the reasons discussed below, we have determined that no pro rata 
reduction will be required in 2004. As discussed below the estimate 
falls under the statutory limit of 2.0 percent. Therefore, the 
conversion factor has been increased correspondingly from the proposed 
rule by 0.7 percent.

Pass-Through Devices Effective January 2004

    Comment: One commenter recommended that we not impose a pro rata 
reduction on pass-through devices if the estimated pass-through 
expenditures increase appreciably. A device manufacturers' association 
was concerned that new drugs will take an increasing share of the pass-
through pool. They suggested that the shift to more pass-through 
spending on drugs will increase under the easier qualifications for 
drug pass-through payments and encouraged us to reconsider the issue to 
determine how to ensure that devices maintain an ``adequate'' share of 
the pass-through pool.
    Response: Section 1833(t)(6)(E)(iii) of the Act requires a 
prospective uniform reduction (pro rata) of the amount of each of the 
transitional pass-through payments made in that year, if it is expected 
that pass-through payments will exceed the cap set for OPPS pass-
through expenditures. Therefore, if any pro rata reduction applies, we 
are required to apply it to pass-through devices as well as drugs and 
biological agents. For 2004, we do not expect the total payments for 
pass-through drugs and devices to exceed the statutory limit. 
Therefore, as discussed elsewhere, we will not impose a pro rata 
adjustment on any pass-through items in 2004.

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 proposed 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 10, 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. The device 
category expiration dates are listed in Table 10. We proposed 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 more than 2\1/2\ years as of 
December 31, 2003, and we proposed that they would not be eligible for 
pass-through payments effective January 1, 2004. The two categories we 
proposed for expiration are C1765 and C2618, as indicated in Table 10. 
Each category includes devices for which pass-through payment was first 
made under OPPS in 2000 or 2001.
    A comprehensive list of all currently effective pass-through device 
categories is displayed in Table 10. Also displayed

[[Page 63437]]

are the dates the devices described by the category were populated and 
their respective expiration dates. For devices continuing on pass-
through status after 2003, expiration dates were set forth in the 
August 12, proposed rule and are finalized here. Newly added code C1819 
is first announced in this final rule and is given a December 31, 2005 
expiration date.
    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 continued 
to be paid in 2003) is found in the November 1, 2002 final rule (67 FR 
66761 through 66763).

     Table 10.--List of Current Pass--Through Device Categories With
                            Expiration Dates
------------------------------------------------------------------------
                      Category long                           Expiration
   HCPCS codes         descriptor        Date(s)  populated      date
------------------------------------------------------------------------
C1765...........  Adhesion Barrier....  10/1/00-3/31/01; 7/1/   12/31/03
                                         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.
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.
C1819...........  Tissue localization   1/1/04..............    12/31/05
                   excision device.
------------------------------------------------------------------------

    We received several comments on this proposal, which are summarized 
below along with our responses.
    Comment: A few parties provided comments on our criteria for 
eligibility for a new device category for pass-through payment as 
published in the November 1, 2002 Federal Register (67 FR 66781).
    Response: We made no proposal to modify our criteria for 
establishment of a new category for transitional pass-through payment, 
so the criteria were not subject to comment in this rulemaking period. 
However, we will take note of these comments as considerations in our 
ongoing evaluation of the new device category process.

New Technology Treatment for New Devices for Brachytherapy Catheters 
and Needles

    Comment: A commenter asked that we consider pass-through payment or 
new technology payment for new devices of brachytherapy catheters and 
needles when they are approved by FDA for new indications and treatment 
protocols.
    Response: We have a process for applying for pass-through new 
technology APC status. See http://www.cms.hhs.gov for instructions. If 
a provider or other party believes that an item or service meets the 
criteria for pass-through or new technology status, the interested 
party should submit an application, and we will then make a judgement 
based on the individual circumstances described in the application.

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 clinical APCs with which the devices were billed in 2001. 
There were very few exceptions to the policy (for example, 
brachytherapy sources for other than prostate brachytherapy), and we 
proposed to make no changes. Therefore, we proposed that payment for 
the devices that populate C1765 and C2618, which we proposed would 
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.
    The methodology that we proposed to use to package expiring 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 of the proposed rule, we proposed 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 proposed 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 proposed would no longer be 
eligible for pass-through payment in 2004 into the HCPCS codes with 
which the devices were billed.
    We received several comments on this proposal, which are summarized 
below along with our responses.
    Comment: A commenter supported packaging the cost of expiring pass-
through codes C2618 and CC1765 into the payment for the procedure in 
which they are used because they believe that packaging minimizes 
payment incentive to use these devices over other appropriate devices. 
The commenter urged CMS to release the crosswalk it will use to assign 
pass-through device costs to specific APCs so that they can confirm the 
appropriateness of the assignment.
    Response: There is no such crosswalk. Devices and packaged drugs 
(that is, those with a per day median cost of $50 or less) are packaged 
into the HCPCS code on the single procedure claim (natural single or 
pseudo single) with which they are billed. The packaging is controlled 
solely by what the hospital bills on the claim. To determine what drugs 
and devices were packaged into an APC, one would need to undertake an 
extensive analysis of all single and pseudo single claims used in 
weight setting. The only time that judgment was used to attribute a 
device to an APC was not for purposes of packaging charges into APCs 
but rather was in the setting of median costs for 5 APCs in which 
external data on acquisition costs was used in a one to one proportion

[[Page 63438]]

with claims data to set the device cost for an APC as discussed above.

C. Reinstitution of C Codes for Expired Device Categories

    Comment: Some commenters strongly objected to reinstatement of the 
C codes for devices because of the burden that it would impose on 
hospitals without a corresponding benefit in immediate payment. They 
indicated that charges for devices are included in the revenue code 
charges for the services furnished and that using C codes will increase 
administrative costs significantly without any benefit to patient care 
or hospital revenues. They indicated that hospital staffs would not be 
able to differentiate between devices that should be reported and those 
that should not. One commenter said that widespread confusion over what 
device to code and what device to not code is the reason that the 
claims for services that require pass-through devices often do not show 
codes for the devices. The commenter indicates that most hospitals 
could not comply with this requirement by January 1, 2004 in any case 
because of extensive changes to chargemasters that would be needed. 
Moreover, given that many hospitals did not comply even when the use of 
the code would have resulted in separate payment is a strong indication 
that they would be unlikely to comply when no additional payment will 
result from coding devices. Commenters indicated that reintroducing C 
codes for devices will result in continuation of improper coding and 
will lead to a false sense of confidence in the data for procedures 
that require devices. A commenter said that if CMS decided to 
reintroduce C codes for devices, CMS should reinstate the same C codes 
that were used for device coding in 2002 because it would minimize 
confusion.
    Other commenters said that CMS should reinstate the C codes for 
reporting of devices so that CMS and others can ensure that only 
correctly coded claims are used to set medians for APCs into which 
device costs are packaged. They said that coding for devices is needed 
so that CMS can be assured that the costs of the devices are packaged 
into the costs for the procedure when the medians for the procedure are 
set. They urged us to continue to use the presence of an appropriate 
device code as a criterion for claims used to set medians for devices.
    Response: For 2004, we are reactivating the C codes for device 
categories as they existed on December 31, 2002. The use of the code is 
not required and will not be enforced. However, hospitals should 
understand that providing complete and accurate information on the 
claims about the services that were furnished and the charges for those 
services is fundamental to our establishment of relative weights on 
which the payment for their services is based.
    Comment: Commenters that supported the reinstitution of C codes for 
devices said that CMS should continue to restrict the claims used for 
APCs with a device to claims that contain the charges for the devices 
used in the APC. In particular, a commenter said that the median for 
APC 0246 (Cataract removal with intraocular lens) should be based only 
on claims that contain charges under revenue center 0276 and that 
claims for APC 0246 that do not contain charges in revenue center 0276 
should not be used to set the median. In the case of this APC, the 
commenter asked that we adopt the 2004 proposed payment at a minimum. 
Other commenters opposed the reinstitution of C codes for devices, 
which would preclude us from restricting claims used to set weights for 
device APCs to claims containing such codes.
    Response: We restricted the claims used to set the medians for the 
APCs contained in Table 7 to claims for which there was a line item 
containing a device category code that was in use for services 
furnished on April 1, 2002 through and including December 31, 2002. We 
believed that restricting the claims used to set median costs to those 
that met this criterion resulted in median costs that more accurately 
reflected relative costs of these services. Moreover, for the APCs in 
Table 7 we required that the claim not only contain a device code that 
was valid during the period specified but we also required that the 
claim must have a particular device code or combination of device 
codes.
    For APC 0313 (high dose rate brachytherapy), we attempted to 
require both brachytherapy sources HDR Iridium 192 (C1717) and either a 
catheter (C1728) or needle (C1715) but we found that no single 
procedure claims met those criteria. Hence, the median for APC 0313 
that appeared in the 2003 OPPS final rule was the median for claims 
that did not meet the specified criteria and it was mistakenly included 
in Table 10 in the NPRM. For this final rule, we again began by 
applying the criteria including source and needle or catheter codes, 
but still no claims met the criteria. Therefore, we sought only single 
procedure claims that contained brachytherapy sources. We found 27 
single procedure claims that met the revised criteria and we used the 
median cost of $936.52 that resulted from those claims.

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

1. Reducing Transitional Pass-Through Payments To Offset Costs Packaged 
Into APC Groups
    In the November 30, 2001 final rule, we explained the methodology 
we used to estimate the portion of each APC rate that could reasonably 
be attributed to the cost of associated devices that are eligible for 
pass-through payments (66 FR 59904). 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 final APC rates, 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

[[Page 63439]]

and proposed to modify our policy for applying offsets. Specifically, 
we proposed to apply an offset to a new device category only when we 
can determine that an APC contains costs associated with the device. We 
specified in the proposed rule that we would continue our existing 
methodology for determining the offset amount, described above. 
However, we solicited comments for alternative methodologies for 
determining the offset amounts that potentially could be applied to the 
payment amounts for new device categories.
    We added that we could 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 proposed to 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 
final rule for further discussion.
    We proposed 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 categories are packaged into the existing APCs. For the 
categories existing as of publication of the proposed rule, we 
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 
proposed 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 proposed, if any offsets apply, for new 
categories, to announce the offsets in a transmittal that announces the 
information regarding the new category.
    We received several comments on the proposal, which are summarized 
below along with our responses.
    Comment: Device manufacturers and associations generally supported 
our proposal to modify our policy in applying offsets to only those 
device categories where we can determine that an APC contains costs 
associated with the device category. One commenter also recommended 
that we not apply offsets to those categories that do not replace 
current devices found in the APC costs.
    Response: We will apply an offset to a new device category only 
when we are able to determine that an APC contains costs associated 
with the new device. We will also continue our existing methodology for 
determining any offset amount, if we find that device costs associated 
with a new device category are packaged into the APCs. We will include 
information about any applicable offset in the transmittal we issue to 
announce information regarding the new category.
    We also will publish the device percentages related to APCs on our 
web site. We believe this information is useful to the public even if 
we do not use the information to apply any particular offset to new 
device categories, because we use this information to apply the tests 
of ``not insignificant cost'' to a proposed new device category 
application. A transitional pass-through device category must have an 
average cost that is not insignificant in relation to the OPD fee 
schedule amount, according to section 1833(t)(6)(A)(iv)(II) of the Act.
2. Multiple Procedure Reduction for Devices
    In our discussion in the proposed rule of recommendations of the 
Advisory Panel, we noted that the Panel asked us to analyze our data to 
determine if we may be underpaying for devices when the multiple 
procedure policy is applied (68 FR 47976). We made no proposal to 
change our policy regarding the multiple procedure reduction for 
device-related APCs, but we did receive a number of comments on the 
topic.
    Comment: Commenters stated that we should change the status 
indicator (SI) from ``T'' to ``S'' for APCs with packaged device costs 
so that the multiple procedure discount will not adversely affect the 
payment for APCs that contain high cost devices. One commenter 
indicated that no APC for which the device percentage is 50 percent or 
more should be subjected to a multiple procedure reduction because any 
such reduction would reduce the Medicare payment below the hospital's 
cost for the device. The commenter offered to work with us to develop a 
list of device percentages of APC payments that would not be subject to 
the multiple procedure reduction. Another commenter suggested that we 
create a modifier that could be used to override the multiple procedure 
reduction for certain codes with SI ``T''. Some commenters said that 
any code that is not subject to the multiple procedure modifier under 
the Medicare physician fee schedule should be subjected to a multiple 
procedure modifier under OPPS.
    Response: We are concerned that the application of the multiple 
procedure reduction has been a recurring theme among commenters with 
regard to APCs that contain significant device costs. We continue to 
believe that for most cases, including many cases with devices, the 
payment reductions for the second and subsequent payments are 
appropriate. This is particularly true given that there must be two 
procedures with SI=T for the reduction to occur. Hence, if a device 
procedure is performed with a non-device procedure, the non-device 
procedure will not be reduced if the device procedure has an SI=S, even 
if the non-device procedure is less costly because it was done at the 
same time as the device intense procedure. We are reluctant to change 
the SIs for device procedures because of the increase that will occur 
for non-device procedures. The shift in median costs will be picked up 
in the scaling of relative weights for budget neutrality and will 
result in some reduction for all services, shifting payment to 
procedures and away from other services types (for example, E&M, 
diagnostic tests).
    Decisions regarding the application of the multiple procedure SIs 
are made independently for the Medicare physician fee schedule and the 
OPPS. The physician fee schedule decision is heavily dependent upon the 
work performed by the physician and the OPPS decision is made only with 
regard to the resources the hospital supplies for the service to be 
performed. There is no reason to believe that a decision to reduce or 
not reduce for multiple procedures in one system would necessarily 
justify that same decision in the other system.
    For 2004 OPPS we have not changed the policy. However, as we did 
for 2003 OPPS, we have changed the SI for certain APCs for which we 
were convinced that the application of the multiple procedure reduction 
would result in inappropriate payment. For 2005, we hope to analyze the 
effects of a more systematic approach to determining when we should 
apply the

[[Page 63440]]

multiple procedure reduction to APCs with high device costs. We hope to 
develop these possible approaches and discuss them with the APC Panel 
at its winter meeting.

Prosthetic Urology (APCs 0385 and 0386)

    Comment: Commenters said that APCs 0385 and 0386 should be changed 
from SI=S to SI=T and that the APC Panel agreed and recommended these 
changes in its August 22, 2003 meeting. The commenters indicated that 
when a penile prosthesis and a urinary sphincter are both implanted at 
the same time, while there is some cost efficiency (for example, OR 
time, recovery room time, drugs, supplies), the cost of the prostheses 
are such a large part of the cost of the APC that the reduction of the 
second APC by 50 percent results in less than cost being paid.
    Response: For the 2004 OPPS, we have changed the SI for these APCs 
from T to S, so that when both the prosthesis and sphincter are 
implanted on the same date, the multiple procedure reduction will not 
apply to the second device. These APCs each contain a combination of 
penile prostheses and sphincters. Our data analysis shows that it is 
not a rare occurrence for both to be implanted on the same day and that 
each APC has a device percentage in excess of 60 percent. For these 
reasons, we have changed the SI for these APCs to ``S'' for 2004.

Electrophysiology APCs (APCs 0085, 0086 and 0087)

    Comment: Commenters said that APCs 0085, 0086, and 0087 should not 
be subject to the multiple procedure reduction because the devices used 
in these procedures are not less costly when the second procedure is 
done on the same day. Commenters said that these procedures have become 
so advanced that they now are commonly done on the same day and that 
the multiple procedure reduction significantly reduces the payments 
below what they were paid when they were done on subsequent days. A 
commenter suggested that we should create a combination APC for APCs 
0085, 0086 and 0087 or for APCs 0085 and 0086 since these are often 
performed on the same day and the commenter believes that the multiple 
procedure reduction improperly reduces payment for them.
    Response: We have not changed the SI for these APCs because we do 
not believe that such a change is warranted. Although devices are 
integral to these APCs, the device portion of the median is not very 
significant. Each has a device percent lower than 35 percent (APC 0085 
= 25.61 percent, APC 0086=34.77 percent, APC 0087= 30 percent). 
Moreover, we believe that there is efficiency in performing these 
procedures on the same day in the outpatient setting, which is why 
hospital practice has changed. Therefore, we are retaining these 
procedures as SI=T for 2004.

Implantation or Revision of Pain Management Catheter; Implantation of 
Drug Infusion Device (APCs 0223 and 0227)

    Comment: A commenter indicated that the same rationale that applies 
to implantation of neurostimulators (discussed immediately preceding) 
applies to APCs 0223 and 0227 and that therefore, the multiple 
procedure reduction should not apply.
    Response: We are not convinced by the comment that it would be 
appropriate to change the SI for APCs 0223 and 0227 from ``T'' to 
``S''. We believe that there are economies of scale that cause these 
procedures to allow for appropriate payment when they are performed 
with other procedures.

Left Ventricular Leads (APCs 0105, 1547 and 1550)

    Comment: A commenter indicated that placement of a Left ventricular 
lead (CPT code 33224, 33225, and 33226, APCs 0105, 1547 and 1550 
respectively) should not be subjected to the multiple procedure 
reduction.
    Response: We have reviewed the codes contained in these APCs and we 
are not convinced that it would be appropriate to change the SI for 
these APCs.

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

A. Pass-Through Drugs and Biologicals

    In the proposed rule, we expressed concern about the extent to 
which Medicare pays more for pass-through 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. We proposed 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 proposed to 
make those changes on a prospective payment basis through our regular 
OPPS Transmittal process and PRICER quarterly updates. We further 
proposed 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.
    We stated that 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 proposed to use 95 percent of the AWP 
listed in the most recent quarterly update of the Single Drug Pricer 
(SDP). If a drug with pass-through status is not included in the SDP, 
we proposed to forward to the SDP contractor the AWP information 
submitted as part of the pass-through application for calculation of an 
allowed payment amount.
    Because the January SDP would not be available in time, we proposed 
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 proposed 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.
    Comment: A national hospital association supported our proposal to 
use the SDP to determine the payment amount for pass-through drugs and 
biologicals. However, the same commenter expressed concern about not 
having accurate 2004 information on AWP until after the 2004 OPPS is 
implemented, which would make it impossible to predict pass-through 
spending and not give hospitals enough time to update their billing 
systems. The commenter also opposed our proposal to update the AWP for 
pass-through drugs on a quarterly basis because it would result in 
increased confusion and burden on hospitals to make quarterly price 
changes and could result in CMS having to make quarterly adjustments to 
the pass-through pool to recalculate the relative payment weights for 
all APCs.
    A provider expressed reservations about the impact of the AWP rule, 
which could precipitate a shift in care from physicians' offices to 
hospitals. This commenter recommended that we determine pass-through 
payment

[[Page 63441]]

amounts using market applications by drug manufacturers and acquisition 
data solicited from the hospital industry through group purchasing 
organizations and individual hospitals and systems. The same commenter 
encouraged us to delay changes in pass-through payments pending an 
assessment of the impact of the AWP rule on physician practices.
    Response: We wish to clarify how our use of the SDP to price pass-
through drugs will affect the OPPS in 2004. The payment rates for pass-
through drugs and biologicals that are shown in Addendum B are based on 
the April 1, 2003 SDP, which was the update that was available when we 
recalibrated the relative payment weights for this final rule. We also 
used these payment rates as the basis for estimating pass-through 
spending in 2004, which is discussed in section IV of this preamble.
    We have carefully considered the commenter's concern about the 
confusion that could result if we were to revise the payment amounts 
for pass-through drugs and biologicals by installing prices from the 
January 2004 update of the SDP in the OPPS PRICER for implementation 
beginning January 1, 2004. We agree with the commenter that, because of 
the timing, this proposal could create operational problems both for 
providers and for our claims processing systems. Therefore, we will 
retain the payment amounts published in this final rule as the payment 
amounts for pass-through drugs effective January 1, 2004.
    Further, to keep quarterly changes to a minimum, we have decided 
not to implement at this time our proposal to update the AWP for pass-
through drugs paid under the OPPS on a quarterly basis in accordance 
with quarterly SDP updates.
    At this time, we are not implementing the AWP rule. Therefore, we 
are not making final the OPPS changes we proposed that would have 
resulted from the AWP rule.
    Comment: Several commenters were concerned about the delay in 
processing pass-through applications and assigning c-codes for new 
drugs and biologicals. Commenters believed that the lack of immediate 
payment under OPPS for new FDA-approved drugs and biologicals may drive 
hospitals to discontinue providing innovative life-saving therapies to 
Medicare beneficiaries until pass-through payments are established. 
Another commenter suggested that CMS create and regularly update a 
central on-line listing of all current codes for pass-through drugs, 
biologicals, and devices. The Web site should also list all pass-
through drug and device applications under review, and their status in 
the review process.
    Response: We understand the concerns expressed by commenters about 
the impact of the time gap from FDA approval to our c-code assignment 
and payment for new pass-through items; however, our position on this 
issue remains the same as that described in the November 1, 2002 final 
rule (67 FR 66780-81).

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.
    Comment: Several trade associations and manufacturers urged CMS to 
revise its policy that radiopharmaceuticals are not drugs. They 
emphasized that radiopharmaceuticals go through the same FDA approval 
process as drugs, are approved for inclusion in the United States 
Pharmacopoeia Drug Indication, and have historically been considered 
drugs under OPPS. They indicated that Congress is considering a 
legislative clarification that under OPPS radiopharmaceuticals will 
continue to be treated and paid as drugs.
    Response: We appreciate the comments on this issue. We do not 
intend, by our designation of radiopharmaceuticals for purposes of 
determining which items are eligible for pass-through status, to imply 
that radiopharmaceuticals are not considered drugs under the Food, 
Drug, and Cosmetic Act or that they are not subject to the same FDA 
approval process as those items that we have designated as drugs. 
However, we will continue to consider radiopharmaceuticals as neither a 
drug nor biological. Our reasons were set forth in the November 1, 2002 
final rule (67 FR 66757). In that rule, we stated that a careful 
reading of the statutory language in section 1861(t)(1) convinces us 
that inclusion of an item in, for example, the USPDI, does not 
necessarily mean that the item is a drug or biological. Inclusion in 
such a reference (or approval by a hospital committee) is a necessary 
condition for us to call a product a drug or biological, but it is not 
enough. CMS must make its own determination that a product is a drug or 
biological for OPPS purposes under its governing statutes, and this 
determination is different from and does not affect FDA's determination 
that a product is a drug or biological under the Food, Drug, and 
Cosmetic Act.
    While we have determined that radiopharmaceuticals are not drugs 
under the OPPS, we have chosen to establish separate payment for 
radiopharmaceuticals under the same packaging threshold policy that we 
apply to drugs and biologicals. We have also determined that we will 
apply the same adjustments to the median costs for radiopharmaceuticals 
that will apply to non-pass-through, separately paid drugs and 
biologicals.

Payment for New Radionucliide Therapy for Certain Forms of Non-Hodgkins 
Lymphoma

    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 proposed to make payment for Zevalin (ibritumomab tiuxetan) 
separately from payment for the procedures with which Zevalin 
(ibritumomab tiuxetan) is used.
    We proposed 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 proposed to place HCPCS A9522 in

[[Page 63442]]

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 portion of the payment is attributed to labor-related costs.
    Because we proposed that payment for G0273 and G0274 no longer 
include payment for Zevalin, we also proposed 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.
    Zevalin (ibritumomab tiuxetan) is a radioimmunotherapy that is used 
to treat patients with certain forms of non-Hodgkin's lymphoma (NHL). 
Medicare began payment under the OPPS for Zevalin services furnished on 
or after October 1, 2002.
    On June 27, 2003, the FDA approved the manufacture and sale of 
Bexxar (tositumomab and Iodine I 131 tositumomab), which is another 
radioimmunotherapy used to treat patients with certain forms of non-
Hodgkin's lymphoma. Both Zevalin and Bexxar are therapeutic regimens 
administered in two separate steps: The first step is diagnostic to 
determine radiopharmaceutical biodistribution of radiolabeled 
antibodies; the second step is the therapeutic administration of 
targeted radiolabeled antibodies.
    On September 8, 2003, we issued a One Time Notification 
(Transmittal 1, Change Request 2914) to implement payment for Bexxar 
effective for services furnished on or after July 1, 2003. We 
instructed hospitals to bill for Bexxar using HCPCS codes G0273 (Pretx 
planning, non-Hodgkins), G0274 (Radiopharm tx, non-Hodgkins), and G3001 
(Administration and supply of tositumomab, 450mg). Publication 
deadlines precluded our being able to address payment for Bexxar in the 
August 12, 2003 proposed rule.
    Comment: A major hospital association, a nuclear medicine specialty 
organization, several providers that treat cancer patients, and two 
radiopharmaceutical manufacturers submitted comments regarding the 
changes we proposed to the coding and payment for Zevalin (ibritumomab 
tiuxetan) under the 2004 OPPS. The commenters agree with our proposal 
to separate payment for Zevalin from the payment for the procedure and 
to pay for Zevalin using HCPCS codes A9522 and A9523, which would not 
be subject to a wage index adjustment. One commenter noted that the 
HCPCS descriptors for A9522 and A9523 define the unit of service as 
``per millicurie,'' but that the payment we proposed for these two 
codes appeared to be a total payment amount rather than a per 
millicurie rate. Several commenters recommended that the code 
descriptors for A9522 and A9523 be revised to read ``per dose'' rather 
than ``per millicurie.''
    Response: We appreciate the commenters'' support of our proposal to 
pay for Zevalin separately from its administration. We also agree with 
the commenter who suggested that the payment rate proposed for A9522 
and A9523 was incorrectly shown as a total payment amount rather than a 
per millicure rate, and we have made certain that the final payment 
amounts implemented in the 2004 update are consistent with the code 
descriptor for the service. We further agree with the recommendation of 
commenters that the HCPCS descriptors for Indium 111 ibritumomab 
tiuxetan and Yttrium 90 ibritumomab tiuxetan would be less confusing if 
expressed in terms of dose rather than millicuries. However, the 
descriptors for A9522 and A9523 were established by the HCPCS National 
Panel through the process described on our Web site at http://www.cms.hhs.gov/medicare/hcpcs/, and such a descriptor change could not 
be applied for in time for January 1, 2004 implementation of the OPPS. 
Therefore, we are establishing two temporary C-codes for hospitals to 
use to bill under the OPPS for Indium 111 ibritumomab tiuxetan and 
Yttrium 90 ibritumomab tiuxetan, for services furnished beginning 
January 1, 2004, as follows:
    C1082, Supply of radiopharmaceutical diagnostic imaging agent, 
indium-111 ibritumomab tiuxetan, per dose
    C1083, Supply of radiopharmaceutical therapeutic imaging agent, 
Yttrium 90 ibritumomab tiuxetan, per dose
    Comment: One commenter recommended that we create separate codes 
that parallel A9522 and A9523 to bill for Bexxar (tositumomab and I-131 
tositumomab).
    Response: We are establishing two temporary C-codes for hospitals 
to use to bill under the OPPS for I-131 tositumomab for services 
furnished beginning January 1, 2004, as follows:
    C1080, Supply of radiopharmaceutical diagnostic imaging agent, I-
131 tositumomab, per dose
    C1081, Supply of radiopharmaceutical therapeutic imaging agent, I-
131 tositumomab, per dose
    Comment: Several commenters recommended that we discontinue use of 
HCPCS codes G0273 and G0274 to describe the administration of Zevalin 
and that, instead, we instruct hospitals to report new CPT code 78804, 
Radiopharmaceutical localization of tumor or distribution of 
radiopharmaceutical agent(s); whole body, requiring two or more days 
imaging, and new CPT code 79403, Radiopharmaceutical therapy, 
radiolabeled monoclonal antibody by intravenous infusion. One commenter 
expressed concern about our proposal to assign G0273 for pre-treatment 
planning and administration of the diagnostic dose to APC 0406, Tumor/
Infection Imaging because the payment rate proposed for APC 0406 
($258.10) is inadequate to pay for the cost of the scans required to 
measure the distribution of the radiopharmaceutical agent. The same 
commenter agreed with our proposal to assign G0274 for administration 
of the therapeutic dose to APC 0408, with a proposed payment rate of 
$217.16.
    Response: We agree with the commenters' recommendations that we 
replace HCPCS codes G0273 and G0274 with CPT codes 78804 and 79403, 
respectively. We will direct our contractors to instruct hospitals to 
use CPT code 78804 to report administration of the diagnostic dose of 
ibritumomab tiuxetan and I-131 tositumomab and to report CPT code 79403 
to report administration of the therapeutic dose of ibritumomab 
tiuxetan and I-131 tositumomab. We also agree with the concern of 
commenters that the payment amount for APC 0406 in the final rule is 
insufficient for administration of the diagnostic radiolabeled 
antibodies plus the imaging required to determine radiopharmaceutical 
localization of tumor(s) and distribution of the radiopharmaceutical 
agent. Therefore, we are assigning CPT code 78804 to New Technology APC 
1508, which has a payment rate of $650. After we have had an 
opportunity to collect claims data that indicate hospital costs for 
this procedure, we will re-evaluate its APC assignment. Further, there 
are several additional expenses associated with these innovative 
radioimmunotherapies used to treat patients with certain forms of non-
Hodgkin's lymphoma, which we discuss below. We are therefore assigning 
CPT code 70403 to New Technology APC 1507, until we have collected 
sufficient data to confirm the appropriate clinical APC for this 
service.
    Comment: Several commenters expressed concern that our proposed 
payment for Zevalin ($2,084.55 for the diagnostic dose of indium and 
$18,066.09 for the therapeutic dose of

[[Page 63443]]

yttrium) would be approximately $2,000 less than what it costs a 
hospital to purchase Zevalin from a nuclear pharmacy, thereby 
jeopardizing beneficiary access to this therapy. One commenter 
submitted information from a nuclear pharmacy attesting that it has 
dispensed 2,068 patient-specific doses of Zevalin nationwide (1,071 
Indium doses and 997 Yttrium doses) and that its current charges are 
$2,260 per dose of Indium-111 Zevalin and $19,565 per dose of Yttrium-
90 Zevalin. The commenter stated that this represents nearly 80 percent 
of all Zevalin doses dispensed between product launch in April 2002 
through June 30, 2003.
    Another commenter expressed concern about the adverse impact that 
the proposed reduction in payments for Zevalin could have on payment 
for Bexxar in 2004. The commenter urged us not to base payment for 
Bexxar on what we proposed for Zevalin but, rather, on hospital 
acquisition costs for Bexxar, which approximate the wholesale 
acquisition cost (WAC) of $2,250 for the diagnostic dose and $19,500 
for the therapeutic dose.
    Response: Although we established a code to enable hospitals to 
bill for and receive separate payment for Zevalin effective October 1, 
2002, hospitals could only report this code through December 31, 2002. 
(Effective January 1, 2003, we combined payment for Zevalin with its 
administration, using HCPCS codes G0273 and G0274.) Our 2002 claims 
data are insufficient to allow us to calculate a median cost for 
Zevalin. Because Bexxar was approved by the FDA in June 2003, it was 
not billed at all in 2002. Therefore, we cannot determine payment rates 
for either radiopharmaceutical based on the standard methodology that 
we use to calculate the other APC relative payment weights and rates. 
In instances where we lack adequate data upon which to base a payment 
rate, we have relied wholly or in part on external data as the basis 
for rate setting. For example, in the absence of claims data, we use 
data submitted in applications for new technology status to enable us 
to assign a service to an appropriate new technology APC. Elsewhere in 
this final rule, we discuss how we are using external data to set 2004 
payment rates for certain other services and procedures.
    We received information consistent with our request for verifiable 
data (68 FR 47998) that indicates the payment amounts we proposed for 
A9522 and A9523 in the proposed rule do not reflect the price for 
Zevalin that is widely available to the hospital market.
    Therefore, we are making final the following payments, effective 
for services furnished on or after January 1, 2004:
    For HCPCS code C1080 (APC 1080) the payment is $2,260;
    For HCPCS code C1081 (APC 1081) the payment is $19,565; For HCPCS 
code C1082 (APC 9118) the payment is $2,260;
    For HCPCS code C1083 (APC 9117) the payment is $19,565.
    Comment: One commenter expressed concern about the inadequacy of 
the 2003 payment rate ($2,159) that we established for HCPCS code 
G3001, Administration and supply of tositumomab, 450mg. The commenter 
noted that the WAC for unlabeled tositumomab is $2,125, and that a 
payment amount of $2,159 is not sufficient to pay hospitals for both 
the acquisition of unlabeled tositumomab and its administration. The 
commenter was also concerned that packaging the unlabeled antibody 
tositumomab with its administration and assigning it to an APC that is 
subject to wage adjustment would result in large payment differences 
across the country. The commenter noted that the unlabeled antibody 
rituximab, which is used with Zevalin therapy, is a separately payable 
drug and therefore not subject to wage index adjustments. The commenter 
recommended that we either increase the payment rate for G3001 and 
exempt it from wage adjustment or that we create a new code for 
unlabeled tositumomab, assign a payment rate that reflects its 
acquisition cost, and pay separately for its administration using HCPCS 
code Q0084.
    Response: After carefully reviewing the commenter's concerns, we 
have assigned HCPCS code G3001 to New Technology APC 1522, which has a 
payment rate of $2,250. Unlabeled tositumomab is not approved as either 
a drug or a radiopharmaceutical, but is a supply that is required as 
part of the Bexxar treatment regimen. Therefore, we do not agree with 
the commenter's recommendation that we assign a separate new code to 
unlabeled tositumomab. Moreover, administration of unlabeled 
tositumomab is a complete service that qualifies it for assignment to a 
New Technology APC. We believe that the increased payment resulting 
from assignment of G3001 to New Technology APC 1522 will be sufficient 
to enable hospitals to acquire and administer unlabeled tositumomab, 
notwithstanding application of a wage adjustment.
    Comment: One commenter recommended that we modify the payment 
amounts for the existing codes used to bill for Bexxar or that we 
establish new codes to recognize the costs of patient evaluation, 
education, and clearance for radiation safety purposes as well as the 
costs of compounding Bexxar by radiopharmacies. The same commenter 
suggested that, as an alternative to establishing a new code for the 
costs associated with the procedures required for patient safety and 
education when Bexxar is used, we allow hospitals to report an 
appropriate Evaluation and Management code for patient evaluation, 
education, and clearance when receiving diagnostic or therapeutic 
services involving radioisotopes.
    Response: We disagree with the commenter's recommendation that an 
additional code is needed to pay for radiopharmacy compounding costs or 
that an allowance of $1,000 should be added to the payment for the both 
diagnostic and therapeutic doses of Bexxar to offset these costs. We 
believe that the rates we are implementing in this final rule, as 
discussed above, provide sufficient payment for radiopharmacy 
compounding or delivery costs that hospitals may incur when using 
Bexxar or Zevalin. We have carefully considered the commenter's 
recommendation that hospitals be allowed to bill an appropriate 
evaluation and management code for patient evaluation, education, and 
clearance following procedures involving radioisotopes. We recognize 
that special requirements may have to be met before releasing a patient 
following exposure to a high dose of radiation. We would expect the 
patient's physician to provide, and bill for separately with 
appropriate documentation, a significant portion of the preparation and 
education needed by a patient being treated with Zevalin or Bexxar. 
However, to the extent that qualified hospital staff are required to 
provide additional face-to-face patient education and instructions 
before the patient's release following radioimmunotherapy, the hospital 
may bill an appropriate evaluation and management code as long as the 
medical record documents that the services are medically necessary and 
that they constitute a distinct, separately identifiable evaluation and 
management service that is consistent with the hospital's criteria for 
that service.

Drugs and Biologicals for Which 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

[[Page 63444]]

than 2 years nor any longer than 3 years. The drugs and biologicals 
that are due to expire on December 31, 2003 meet that criterion. Table 
11 lists the drugs and biologicals for which pass-through status will 
expire on December 31, 2003.

             Table 11.--List of Drugs and Biologicals for Which Pass-Through Status Expires CY 2004
----------------------------------------------------------------------------------------------------------------
                                                                                                   Pass-through
      HCPCS          APC                   Long descriptor                       Trade name         expiration
                                                                                                       date
----------------------------------------------------------------------------------------------------------------
C9202............    9202  Injection, suspension of microspheres of human  Optison (single              12-31-03
                            serum albumin with octafluoropropane, per 3ml.  source).
J0587............    9018  Injection, Botulinum toxin, type B, per 100     Myobloc (single              12-31-03
                            units.                                          source).
J0637............    9019  Injection, Caspofungin acetate, 5 mg..........  Cancidas (single             12-31-03
                                                                            source).
J7517............    9015  Mycophenolate mofetil, oral per 250 mg........  CellCept (single             12-31-03
                                                                            source).
J9010............    9110  Injection, Alemtuzumab, per 10 mg.............  Campath (single              12-31-03
                                                                            source).
J9017............    9012  Injection, Arsenic trioxide, per 1 mg.........  Trisenox (single             12-31-03
                                                                            source).
J9219............    7051  Implant, Leuprolide acetate, per 65 mg implant  Viadur (single               12-31-03
                                                                            source).
----------------------------------------------------------------------------------------------------------------

    Comment: A commenter requested that we maintain transitional pass-
through status for this biological through calendar year 2004. The 
commenter indicated that Dermagraft was approved as a pass-through 
device effective October 1, 2000 through March 31, 2001, by which time 
CMS had concluded that Dermagraft should be classified as a biological 
for payment purposes. Dermagraft later re-qualified for pass-through 
status as a biological effective April 1, 2002. The commenter stated 
that CMS should not count the time Dermagraft was on the pass-through 
list as a device to determine whether this product received a minimum 
of 2 years under pass-through status.
    Response: We agree with the commenter and will retain Dermagraft in 
pass-through status through December 2004.
    Comment: The manufacturer of an ultrasound contrast agent, Optison 
(APC 9202, C9202), expressed concern about our decision to retire their 
product from pass-through status on December 31, 2003. The manufacturer 
indicated that two of Optison's competitors, Definity (C9112) and 
Imagent (C9203) will remain pass-throughs in 2004 and receive higher 
payments, while payment for Optison will be based on median cost 
calculated from hospital claims data. The commenter was concerned about 
differential OPPS payments to hospitals for clinically similar products 
and recommended that we should either allow all of these agents to 
remain on pass-through status until December 31, 2004, or remove them 
and use claims data to establish a uniform payment rate for 2004.
    Response: As stated above, section 1833(t)(6)(C)(i) of the Act 
specifies that transitional pass-through payments for drugs and 
biologicals must be made for at least for 2 years but not more than 3 
years. Pass-through payment for Optison was established on April 1, 
2001, while Definity and Imagent received pass-through status on April 
1, 2002 and April 1, 2003, respectively. Since hospitals have been 
billing for and receiving pass-through payments for Optison for at 
least 2 years, we have the statutory authority to remove this item from 
pass-through status. Since pass-through payments for Definity and 
Imagent have not exceeded the minimum 2-year period yet, these products 
will retain their special status in 2004. In the absence of verifiable 
external data, the 2004 payment rate for Optison was calculated using 
hospital claims data from April through December 2002 and was eligible 
for dampening.
2. 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. For 2004, we proposed 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. In the proposed rule, 
we set forth the methodology we used to calculate the median cost per 
day for drugs, biologicals, and radiopharmaceuticals (68 FR 47996-
47997).
    We proposed 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. For 2004, we proposed that:
    [sbull] Currently packaged drugs and radiopharmaceuticals with 
median costs per day at or above $150 would receive separate payment in 
2004.
    [sbull] Currently separately payable drugs and radiopharmaceuticals 
with median costs per day 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 requested comments on the methodology we used to determine the 
median cost per day, on the threshold we proposed 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. We 
also requested comments on alternatives to packaging.
    We received many comments on our proposals, which are summarized 
below along with our responses.
    Comment: We received many comments from patient advocates, 
individual clinicians, physician and nursing professional associations, 
individual hospitals, and manufacturers and their representatives that 
expressed significant concerns over our proposal to continue the 2003 
policy under which we package the cost of most drugs, biologicals and 
radiopharmaceuticals that cost $150 or less. We also received several 
comments from major provider groups in support of the packaging 
proposal and recommending a higher threshold. One such organization 
recommends that we study this issue further to develop a more 
appropriate long-term solution.
    Commenters who disagreed with the proposal to package drugs, 
biologicals and radiopharmaceuticals costing $150 or less believe that 
the proposed rates for the drug administration codes do not adequately 
address the costs of hospitals to administer these drugs. Several 
commenters conducted their own analyses of this issue in conjunction

[[Page 63445]]

with the proposals for drug administration discussed elsewhere in this 
final rule. For many of these commenters, the issues of packaging, drug 
payment rates and our discussion of drug administration in the proposed 
rule were intertwined. Some commenters that disagreed with our $150 
packaging threshold asserted that most visits involve delivery of drugs 
that had been designated as packaged and that overpayment for visits 
with no packaged drugs is small compared to the overall underpayment of 
both packaged and separately payable drugs. Particular concern was 
expressed about the packaging of cancer chemotherapy drugs. One 
commenter stated that the dosages may vary significantly, and where 
given in high doses the cost for a single drug alone may exceed the 
total packaged payment. Also, commenters stated that several packaged 
drugs are often administered during a single infusion, and where the 
cost of a single packaged drug may be less than $150 the cost of 
multiple packaged drugs is often greater than $150.
    Several commenters indicated that the methodology and cost data we 
used to calculate the median cost per day for drugs and 
radiopharmaceuticals were based on incorrectly coded claims where the 
wrong number of units were reported and a very limited number of single 
claims were captured which failed to portray the hospitals' charges 
appropriately. Therefore, certain high cost items fell below the $150 
threshold.
    Commenters expressed concern about patient access to effective but 
lower cost drugs and the disincentive we may create by paying 
separately for those over $150 per day. One organization stated that 
cancer centers have reported that they have taken or are considering 
steps to restrict patient access to those drugs that we have packaged. 
One hospital estimated that it would lose approximately $490 per visit 
for a patient receiving chemotherapy due to the $150 packaging rule and 
the proposed reductions in payments for certain drugs. While some 
commenters expressed general concerns about packaging the costs of any 
drugs, biologicals or radiopharmaceuticals, other commenters 
recommended that we apply a $50 threshold in lieu of the proposed $150 
threshold in determining which items to pay for separately. Some of the 
commenters recommending a $50 threshold cited statutory changes under 
consideration by Congress that would mandate a $50 threshold.
    Response: For 2004, we have established a $50 median cost per day 
threshold in determining whether drugs, biologicals and 
radiopharmaceuticals will be packaged. Those items that fall below the 
threshold will be packaged into the costs of the service or procedure 
with which they are billed; those items with median costs above the 
threshold will be paid for separately in 2004.
    We analyzed our data in determining our final drug administration 
coding and payment policy, as discussed elsewhere in this final rule, 
and reviewed the median costs of all APCs under both a $150 and a $50 
packaging rule. We concluded that there was not a sufficient difference 
in the median costs under those two scenarios, resulting in inadequate 
payment when drugs, biologicals and radiopharmaceuticals costing 
between $50 and $150 would be used by the hospital. Therefore, we agree 
with the majority of commenters that, for 2004, the appropriate 
threshold should be $50.
    We also recognize, as several commenters did, that packaging 
creates incentives for hospital efficiencies and will continue to apply 
that concept to devices, most supplies and equipment associated with a 
procedural APC, and low cost drugs. However, we are convinced that 
under our current methodology for establishing relative weights, that 
packaging drugs, biologicals and radiopharmaceuticals costing in excess 
of the $50 threshold per patient per day would not provide adequate 
payment in 2004 and could adversely affect beneficiary access to 
important therapies. Nevertheless, our final decision for 2004 does not 
mean that a change in our methodology for establishing relative weights 
in the future could not cause us to revisit our packaging policy in the 
future. Since we have lowered the packaging threshold from $150 to $50, 
we will not adopt the proposal to provide an exception to the packaging 
rule for drugs and radiopharmaceuticals whose payment status would 
change from 2003 to 2004 as a result of using newer 2002 data.
    However, we note several exceptions to our policy of packaging 
drugs, biologicals and radiopharmaceuticals for which the median per 
day cost is less than the $50 threshold. As discussed elsewhere in this 
final rule, we will allow separate payment under the OPPS for all blood 
and blood products and for single indication orphan drugs. We will also 
allow separate payment for hepatitis B vaccine under the OPPS. While 
the median per day costs for several hepatitis B vaccine codes fell 
below the $50 threshold using the final rule data, we believe that 
continued separate payment for these codes is warranted given the 
special, separate benefit category established by Congress. Separate 
payment for influenza and pneumococcal vaccines will continue to be 
made outside of the OPPS on a reasonable cost basis.
3. Payment for Drugs, Biologicals, and Radiopharmaceuticals That Are 
Not Packaged
    In order to establish payment rates for separately payable drugs 
and radiopharmaceuticals for the 2004 OPPS, we first determined median 
cost for each drug and radiopharmaceutical per unit. 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.
    We solicited comments concerning the reasons for the fluctuations 
in median costs from 2003 to 2004. We stated our interest 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 charges) 
that we use for setting payment rates.
    In the proposed rule, we discussed in detail several options we 
considered to address the fluctuations in median costs for separately 
payable drugs and radiopharmaceuticals (68 FR 47997-47998). The option 
that we proposed for 2004 was 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 proposed 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 proposed to establish their 
payment rates using the median costs derived from the 2002 claims data. 
We stated that, based on more complete claims data we expected to have 
for the final rule and on the comments from the public, we would re-
evaluate the appropriateness of adjusting median costs for drugs for 
which median costs would decline in 2004.

[[Page 63446]]

    We also proposed a separate payment policy for drugs, biologicals, 
and radiopharmaceuticals for which generic alternatives have been 
approved by the Food and Drug Administration (FDA) between October 2001 
and December 2002.
    We solicited comment on both our proposed methodology and payment 
rates for separately payable drugs and radiopharmaceuticals for 2004. 
We requested that commenters who disagree with the proposed rate for a 
drug or radiopharmaceutical submit verifiable information to support 
their opinions that the proposed rate is inaccurate and does not 
reflect the price that is widely available to the hospital market.
    We received a number of comments on our payment methodology options 
for separately payable drugs, biologicals, and radiopharmaceuticals. 
Those comments are summarized below along with our responses.
    Comment: We received a number of comments noting disagreement with 
the proposed payment rates for separately paid drugs, biologicals and 
radiopharmaceuticals overall. Many of these comments were included in 
the comments on our packaging proposal, summarized above, and expressed 
some of the same concerns, such as restrictions to patient access, 
particularly to cancer chemotherapy drugs. One hospital commenting on 
the proposed rates stated that, as with most hospitals, they 
continually attempt to leverage buying power to reduce the costs of 
drugs but, like most hospitals, have been unable to do so for certain 
drugs. Commenters asked that we critically review the data used to 
establish the payment rates including consideration of the charge 
compression issue. Commenters stated that the proposed payments would 
not cover the direct acquisition costs of certain items.
    A number of commenters objecting to our proposed payment rates 
stated that the hospital data that we use to calculate those rates are 
flawed and that the methodology we employ to convert hospital claims 
data to relative weights is problematic. Commenters attributed these 
concerns to issues such as hospital billing practices that result in 
inaccurate reporting of units or charges, HCPCS coding changes, and the 
use of cost-to-charge ratios across all products regardless of whether 
an item is high or low cost.
    We received numerous comments on alternatives to our proposed 
policies for separately payable drugs and radiopharmaceuticals. One 
commenter suggested that we pay the amount of the hospital's 
acquisition cost plus an additional 25 percent to pay for costs of 
receiving, processing and storing the items. Other comments suggested 
that we limit the decreases for all separately paid drugs to a 
reduction of 10 percent in the payment rates, as we proposed for blood 
and blood products, instead of our proposed policy of limiting 
reductions in median costs for those separately paid items with median 
costs with reductions greater than 15 percent. Another suggestion was 
that we establish a payment rate floor for a product that could be 
raised if a manufacturer submitted information demonstrating that the 
rate should be higher than the floor.
    Several commenters indicated that we should use only claims that 
have the appropriate administration or procedure code and the HCPCS 
code for a particular drug or radiopharmaceutical when determining the 
median cost for that drug or radiopharmaceutical. One commenter 
recommended that we pay for drugs and biologicals at 95% AWP to 
standardize payments for drugs and biologicals across different 
practice settings. Another commenter requested that we establish 
payment floors that are equal to those in the pending Congressional 
Medicare legislation (for example, certain sole source drugs would be 
paid at least 88 percent of AWP in 2004); whereas another drug 
manufacturer recommended that we use the Federal Supply Schedule price 
plus a certain percentage (for example, 12.5 percent) as an absolute 
minimum payment amount for drugs and radiopharmaceuticals.
    In addition to the comments regarding our proposed payment rates 
for drugs, biologicals and radiopharmaceuticals overall, we received 
comments concerning the proposed rate for specific items. For a few of 
those items, we received external cost data that met the preferred 
criteria we set forth in our proposed rule (for example, non-
proprietary data that demonstrates actual, market-based prices at which 
a broadly-based national sample of hospitals were able to procure the 
item). Several commenters suggested that we substitute external data on 
hospital acquisition cost for median costs calculated from our claims 
data when determining the payment rate for drugs and 
radiopharmaceuticals for which we have received such data. Others 
recommended that we use external data to benchmark payment for drugs 
and radiopharmaceuticals and make appropriate adjustments to the 
proposed 2004 payment levels. Even though most commenters supported the 
use of external data in place of hospital claims data, a national 
hospital association expressed concern about the use of external data 
in OPPS. The commenter indicated that if external data is used for rate 
setting in 2004, then we may have to continue to collect data on 
acquisition cost for future years to be able to continue to adjust the 
weights. Instead, the commenter was supportive of using claims data to 
set payment rates without the use of external data and urged us to 
remain committed to the averaging process inherent in the prospective 
payment system.
    Response: We have decided to adopt the general principle proposed 
in our August 12, 2003 proposed rule limiting the reduction in median 
costs to one-fourth of the difference between the value derived from 
our claims data and a 15 percent reduction. For example, a drug whose 
median cost decreased by 35 percent from the median cost used to 
establish the separate payment rate for 2003 would be 15 percent + (\1/
4\ times 35-15) percent, or 20 percent. However, we will not apply this 
methodology to the medians of those drugs, biologicals and 
radiopharmaceuticals that are packaged in 2003 but for which we will 
allow separate payment in 2004. Payment for drugs, biologicals and 
radiopharmaceuticals that emerge from packaged status in 2004 because 
their median per day costs are greater than $50 per day will be based 
on the unadjusted median cost derived from our April-December 2002 
claims data. Since these items are packaged in 2003, we did not 
calculate any adjusted medians on which to base their payments on for 
2003. Thus, we are unable to determine the extent to which their median 
costs fluctuate from 2003 to 2004.
    As discussed in our proposed rule and elsewhere in this final rule, 
we used a more complete set of claims for the April-December 2002 
claims period and the most recently submitted cost report data to 
calculate median costs for all currently separately paid drugs, 
biologicals and radiopharmaceuticals. Our analysis of the later and 
more complete data revealed that a number of these items continued to 
experience a decline of more than 15% in median cost. We again 
considered several options to address the fluctuations in medians, 
which for some items would result in wide fluctuations in payments to 
hospitals. One option was to do nothing to adjust for the fluctuations; 
another option was to apply a more modest give-back (for example, 50 
percent instead of 75 percent, after allowing for the 15 percent 
reduction.) We also considered the comments we received on drug 
payments in general and for specific items.

[[Page 63447]]

    We did not adopt the options that would allow no adjustments for 
items separately paid in 2003 where the costs declined because we were 
convinced by the many commenters on this topic that such fluctuations 
create problems for the hospitals. We were also convinced by the 
commenters that a less generous give-back, such as 50 percent, would 
not adequately address the very real concerns about patient access to 
some of these drugs, particularly for cancer chemotherapy. We believe 
that, for the majority of items paid separately in 2003 for which the 
more recent hospital data indicates a reduction in excess of 15 
percent, the adjustment methodology we proposed and that we are 
adopting for this final rule provides an adequate buffer for the 
hospitals against dramatic fluctuations in payment amounts while at the 
same time not significantly affecting the budget neutrality scalar 
applied to the relative weights for all services.
    We believe that either the use of our unadjusted medians or, where 
applicable, a median adjusted to limit reductions greater than 15 
percent methodology, will not adversely impact beneficiary access. 
However, we were convinced by the external data meeting our preferred 
criteria and the related comments that we received for several items, 
the payment rates resulting from our data alone could provide a 
disincentive for hospitals to provide these particular therapies. 
Therefore, we have determined that we will use this credible and 
relevant external data to establish a median cost for the following 
items listed in table 15. For these items, as with the few device-
related APCs for which we are considering external data, we have 
calculated an adjusted median cost by blending the median cost derived 
from our dampening methodology with the cost data from the external 
sources on a one-to-one ratio.

            Table 12.--List of Drugs, Biologicals, and Radiopharmaceuticals for Which Blended Data Were Used to Determine 2004 Payment Rates
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                   2004 adjusted         External       2004 1:1 Blended
              APC                     HCPCS                      Short descriptor                   median cost      acquisition cost     median cost
--------------------------------------------------------------------------------------------------------------------------------------------------------
0909..........................  J1825............  Interferon beta-1a..........................            $159.16            $231.25            $195.21
9022..........................  Q3025............  IM inj interferon beta-1a...................              53.05              77.08              65.07
0902..........................  J0585............  Botulinum toxin a...........................               2.86               3.92               3.39
7000..........................  J0207............  Amifostine..................................             241.95             369.49             305.72
1624..........................  Q3007............  Sodium phosphate p32........................              49.18             100.00              74.59
1625..........................  Q3008............  Indium 111-in pentetreotide.................             400.41             550.00             475.21
1305..........................  C1305............  Apligraf....................................             659.55           1,077.57             868.56
--------------------------------------------------------------------------------------------------------------------------------------------------------

    We note that we also received external data for other items, which 
we did not use for rate setting. In those cases, we determined the data 
was not reliable because the data did not meet the preferred criteria 
set forth in the August 12, 2003 proposed rule.
    Comment: One commenter raised a concern about our proposal to limit 
reductions in the median costs of non-pass-through drugs and 
biologicals to one-fourth of the difference between the actual decline 
and 15% less than the 2003 adjusted median. While expressing support 
for an initiative that reduces significant fluctuation in APC payment 
rates from one year to the next, the commenter expressed uncertainty 
about the size of the reduction limitation and suggested that CMS 
consider a less generous dampening approach since the budget-neutral 
dampening would negatively affect other APCs.
    Response: While we believe that a general limitation on reductions 
in payments for certain drugs and biologicals is warranted for reasons 
discussed elsewhere in this final rule, we also recognize the 
commenter's concerns about the effect that such a policy would have on 
other APCs. We have decided to address the commenter's concern by 
placing an upper limit on adjustments to the median costs used to 
calculate the 2004 payment rates. We believe that it is reasonable to 
place such an upper limit on the dampening so that the resulting 
adjusted median is no greater than 95 percent of AWP or the 2004 
unadjusted median. We reviewed the drugs, biologicals, and 
radiopharmaceuticals whose median costs decreased by more than 15 
percent from 2003 to 2004. We then compared the adjusted median (after 
dampening) to 95 percent of AWP for each of the items. In cases where 
95 percent of AWP was higher than the adjusted median, we capped the 
adjusted median at a value that was the higher of 95 percent of AWP or 
the 2004 unadjusted median. The 95 percent of AWPs for these drugs and 
radiopharmaceuticals were calculated using AWP values from the Redbook 
that were effective as of April 1, 2003. We reviewed the drugs, 
biologicals, and radiopharmaceuticals whose median costs decreased by 
more than 15 percent from 2003 to 2004. We then compared the adjusted 
median (after dampening) to 95 percent of AWP for each of the items. In 
cases where 95 percent of AWP was higher than the adjusted median, we 
capped the adjusted median at a value that was the higher of 95 percent 
of the AWP or the 2004 unadjusted median. The drugs, biologicals, and 
radiopharmaceuticals affected by this policy are listed in the table 
below.

               Table 13.--Items Whose 2004 Adjusted Medians are Capped at the Higher of 95 Percent of AWP or Their 2004 Unadjusted Median
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                   2004 adjusted                        2004 unadjusted
                      APC                                         Description                          median            95% AWP             median
--------------------------------------------------------------------------------------------------------------------------------------------------------
1095..........................................  Technetium TC 99m depreotide...................            $216.26             $40.00             $17.18
0820..........................................  Daunorubicin...................................              89.80              78.14              65.81
0961..........................................  Albumin (human), 5%, 50 ml.....................              41.86              15.31              16.15
0963..........................................  Albumin (human), 5%, 250 ml....................             204.03              58.00              62.83
0964..........................................  Albumin (human), 25%, 20 ml....................              46.10              15.31              21.86
0965..........................................  Albumin (human), 25%, 50 ml....................             114.36              30.63              51.12
--------------------------------------------------------------------------------------------------------------------------------------------------------


[[Page 63448]]

4. Payment for Drug Administration
    In order to facilitate accurate payments for drugs and drug 
administration, we considered whether to make several changes in our 
current payment policy with regard to payment for Q0081, Q0083, Q0084, 
and Q0085.
    We proposed 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).
    In the proposed rule, we presented data that showed that paying 
based on a median cost for the APC for each of the four current 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 proposed rule we discussed our data analysis in detail. 
We also discussed four alternatives to the current codes and APC 
payments in detail (68 FR 47999-48003). In summary, the 4 alternatives 
presented were:
    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 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. We solicited comments on each of the options in the proposed 
rule.
    For 2004 OPPS we will continue the use of Q0081, Q0083 and Q0084 to 
pay for drug administration, for both packaged drugs and separately 
paid drugs. These drug administration codes will continue to describe 
the administration of drugs per visit. As recommended by the APC Panel, 
we will cease to make payment under OPPS for Q0085 and will instead 
permit the services described by Q0085 to be billed using both Q0083 
and Q0084. We believe that this will result in appropriate payment for 
drug administration because for 2004 OPPS we will pay separately for 
drugs for which the per day median cost is in excess of $50 per day.
    Comment: Commenters stated that appropriate payment for drug 
administration is very important but the options provided for making 
changes would be extremely burdensome and cannot be done for 2004, if 
ever. They indicated that the risk of incorrect coding and the adverse 
consequences of incorrect coding for options 2, 3 or 4 are severe and 
that the payment changes do not justify the change in codes or policy. 
Commenters indicated that options 2-4 would increase operational costs 
that would eliminate any benefit from higher payments; decrease 
accuracy of coding for drug administration; increase improper payments 
due to decreased accuracy of coding; increase inaccuracies in claims 
data due to decreased accuracy of coding. The commenters indicated that 
they believe that there were many errors in the addenda (Addenda L, M, 
N, O, P, and Q) in the proposed rule that would be used for option 4 
and that it would be virtually impossible to create mutually exclusive 
lists of drugs as would be required to implement option 4.
    Commenters indicated that they believed the options as presented in 
the NPRM would violate the HIPAA requirements that the same service be 
coded the same way for all payers. They urged CMS to eliminate the Q 
codes for drug administration and in favor of use of the CPT codes to 
code drugs administration. Commenters asked that CMS engage the APC 
Panel in a discussion of the best way to code drug administration.
    One of the commenters indicated that its analysis showed that 
options 2, 3 or 4 have considerable financial risk for Medicare. 
Specifically, the commenter indicated that its analysis revealed that 
option 2 would result in additional payments of $107.1 million for 
2004. A commenter asked that CMS create a task force to study the most 
appropriate methodology for payment for drug administration and for 
setting payment rates. A commenter supported option 4, which would 
continue the current coding and map the combination of a drug 
administration code and drug codes to the appropriate APC. One 
commenter suggested that we continue the current coding for drug 
administration, set payment rates at the packaged drug rate for the APC 
but offset the payment by the difference if no appropriate drug is 
billed for the same date of service. The commenter indicated that this 
would simplify the coding and the payment for drug administration and 
should result in greater accuracy of payment. A commenter supported 
options 2 or 3 as the most accurate for payment of drugs furnished in 
the emergency department.
    Response: For the reasons discussed earlier in this section, for 
2004, CMS will continue use of Q0081, Q0083 and Q0084. Q0085 will not 
be recognized as a valid OPPS code for 2004. Instead, when a hospital 
furnishes chemotherapy infusion and chemotherapy via another route, the 
hospital will bill and be paid for both Q0083 and Q0084. Coding for 
drug administration is discussed in greater detail below in the context 
of other comments.
    As discussed in elsewhere in this final rule, for 2004, CMS will 
pay separately for all drugs, biologicals and radiopharmaceuticals that 
have a per day median cost in excess of $50. Therefore, only drugs, 
biologicals and radiopharmaceuticals that have a per day median cost of 
$50 or less will be packaged into the payment for the services. 
Therefore, the payment for drug administration codes Q0081, Q0083 and 
Q0084 will be based on the median costs for drug administration with 
only drugs having a median per day cost of $50 or less packaged into 
the cost of the administration code. We believe that separate payment 
for drugs with a median cost in excess of $50 will result in the drug 
administration codes being paid more accurately and will result in more 
equitable payment for both the drugs and their administration.

[[Page 63449]]

Edits To Ensure Correct Billing for Drugs

    Comment: A commenter asked that CMS create a series of edits in the 
OCE that would facilitate the collection of better data on drug costs 
and drug administration. Specifically, the commenter wants the OCE to 
edit out claims where a drug administration code is billed with no drug 
code on the claim; where a chemotherapy drug administration code is 
billed with a revenue code 25X and no specific HCPS code; and where 
multiple units of a drug administration code are billed on the same 
line.
    Response: We will consider what edits may be appropriate for 
inclusion in the OCE with regard to drug administration to facilitate 
collection of better data. However, we are concerned that edits of the 
type requested by the commenter may both impose greater billing burden 
on hospitals and create complexities that could delay claims 
processing.

Discounting of Non-Chemotherapy Administration

    Comment: Commenters indicated that no multiple procedure reduction 
should be applied to Q0081 (infusion of drugs other than chemotherapy) 
or its successor codes under any of the options. They indicated that 
payment is already too low to cover the cost of the infusion and that 
reducing it further when there are more costly procedures on the claim 
will only further under pay the service.
    Response: We have retained the status indicator of ``T'' for Q0081. 
This status indicator means that the code will be reduced by 50 percent 
if it is the lower priced service on the same claim with another 
procedure with the status indicator ``T''. In most cases, we expect 
that this reduction would occur when there is a separate procedure 
performed on the same day as the infusion and that there will be 
significant efficiencies in administering an infusion. If the infusion 
is performed by itself or with a visit, or with a service with status 
code ``S'', the multiple procedure reduction will not apply.

Payment for Drug Administration on a Per Day Versus a Per Visit Basis

    Comment: Commenters indicated that it would be incorrect to revise 
the definition of the drug administration codes to be per day instead 
of per visit, as they are currently defined. They referred to many 
cases in which it is necessary for a patient to have more than one 
administration of non-chemotherapy drugs in a day and that hospitals 
should be able to bill multiple units of the applicable code when that 
occurs. They noted that the APC Panel supported this view with regard 
to Q0081, infusion of non-chemotherapy drugs. They asked that CMS 
provide explicit instructions regarding billing for drug administration 
and ensure that fiscal intermediaries are bound to comply with the 
national instructions. One commenter asked that CMS create modifiers or 
specific HCPCS codes to reflect administration of multiple chemotherapy 
agents during a single session and that CMS permit payment for more 
than one chemotherapy administration on the same day of service, with a 
new modifier to reflect truly separate administrations.
    Response: We acknowledge the commenters' concerns about our 
proposal to change the drug administration codes from a per visit basis 
to a per day basis and have not revised the definition of the drug 
administration codes from per day to per visit.

CPT Codes for Drug Administration

    Comment: Many commenters suggested that CMS should delete the HCPCS 
alphanumeric codes for drug administration and should use existing CPT 
codes. They indicated that the APC Panel supports this change and that 
it would be less burdensome for providers than using the HCPCS 
alphanumeric codes. One commenter presented a crosswalk that could be 
used to pay under the current drug administration APCs while permitting 
hospitals to bill using CPT codes. A commenter indicated that hospitals 
already maintain start and stop times for infusion therapies and that, 
therefore, the use of CPT codes for infusion would not be more 
burdensome than the current HCPCS codes.
    Response: For the reasons discussed earlier in this section, for 
2004 OPPS, administration of infusion of non-chemotherapy drugs, 
infusion of chemotherapy drugs and administration of chemotherapy by 
other than infusion, will continue to be billed and paid based on 
Q0081, Q0083 and Q0084. However, we take seriously the requests of the 
commenters and the APC Panel that we should use the CPT codes to pay 
for drug administration. We will seriously consider the crosswalk 
submitted and will discuss it with the APC Panel at its winter meeting. 
We also will pursue a means by which the existing data from 2003 
hospital claims, which exist only for the Q codes, which are per visit, 
can be used to pay for services billed under the CPT infusion codes, 
which are on a per hour basis.

Elimination of Q0085 Chemotherapy Administration by Both Infusion and 
Other Technique

    Comment: Several commenters supported elimination of Q0085 and the 
continued use of Q0083 and Q0084 in place of Q0085.
    Response: As indicated above, we will no longer recognize Q0085 for 
payment of drug administration services for 2004. The code could not be 
deleted from HCPCS because the 2004 HCPCS was complete before the NPRM 
comment period closed. Instead, hospitals will bill and be paid for 
both Q0083 and Q0084 when they furnish chemotherapy by both infusion 
and another route.

Charge Compression Reduction Through Revenue Code Requirements and 
Expansion of Revenue Codes

    Comment: A commenter indicated that CMS could reduce charge 
compression effects by requiring hospitals to do detailed coding of 
drugs using the most specific categories of revenue codes. The 
commenter indicated that CMS would also need to create additional 
revenue codes to collect more specific information. The commenter 
indicated that collection of drug charge information at such detailed 
levels would both reduce charge compression and give CMS more 
information when determining which drugs to package to specific drug 
administration services.
    Response: CMS will not require that specific revenue codes be used 
for drugs and will not ask the National Uniform Billing Committee to 
create additional revenue codes to collect more specific information. 
Revenue codes exist for hospital accounting purposes and, in general 
CMS does not require that particular services be billed with particular 
revenue codes. We are not convinced that adding specific requirements 
for revenue coding or expanding the revenue codes to acquire more 
specific information will result in better data or that the end result 
would be cost effective in terms of its potential effect on hospital 
operations. We believe that such requests to the NUBC should be 
generated by the provider community if it believes such changes would 
be in their overall best interest.

Request for Clarification of Instructions

    Comment: Commenters said that CMS needs to develop and issue clear 
national instructions on how drug administration in the OPD should be 
billed and to ensure that fiscal intermediaries all comply uniformly 
with the instructions. They said that in the absence of national 
instructions,

[[Page 63450]]

fiscal intermediary medical directors have developed and enforced local 
medical review policies that vary considerably from one another, 
resulting in very different interpretations of how services should be 
billed and of the amount of payment for the same set of circumstances. 
They specifically recommend that we address issues including how often 
drug administration codes can be billed in a day, billing for piggyback 
infusions, how to bill units of service, billing for pain control pump 
services, double infusions, and use of chemotherapy administration 
codes for patients with non-cancer diagnoses. The commenter also asked 
for clarification of the use of 90782 (IM injection) and 90784 (IVP 
injection) when used for sedation before surgery, Q0081 when used to 
keep a vein open, and Q0083 with regard to whether it should be billed 
each time a chemotherapy drug is administered. A commenter also asked 
that CMS clarify whether HCCPS codes Q0081, Q0083, Q0084 and Q0085, CPT 
codes 90783, 90784 and 90788 may be billed more than once per visit. 
The commenter indicated that CMS previously said that CPT codes 90782-
90788 may be billed separately for each injection and asked if this is 
a change to CMS policy in this regard.
    Response: CMS will develop program instructions regarding how the 
drug administration codes should be used. We will attempt to address 
the specific questions identified in the comments in the course of 
developing those instructions. When the instructions are issued, they 
will be binding on all Medicare fiscal intermediaries under their 
contract with CMS. In the absence of national instructions, Medicare 
fiscal intermediaries have authority to develop local medical review 
policies governing billing, coverage and payment.
    With regard to the issue of how often in a day Q0081, Q0083 and 
Q0084 may be billed, each of these codes is to be used to report all 
services in a single visit, regardless of the number of drugs 
administered during that visit. Therefore, if two chemotherapy drugs 
are administered by intravenous injection and 3 chemotherapy drugs are 
administered by infusion, the hospital would bill 1 unit of Q0083 and 1 
unit of Q0084. A second unit of either code would only be billed if the 
patient left the OPD after completion of the first administration and 
then returned later for a separate encounter for administration of 
another chemotherapy drug. If the patient leaves the OPD and returns 
later in the day suffering from dehydration and requires infusion of 
fluids and infusion of antiemetics, the hospital would bill Q0081 for 
those services. If the patient returns later in the same day for 
another infusion of one or more chemotherapy drugs that could not be 
administered at the earlier infusion for medical reasons, the hospital 
may bill 2 units of Q0084.
    CPT codes 90782-90788 each represent an injection and as such, one 
unit of the code may be billed each time there is a separate injection 
that meets the definition of the code.
    As indicated above, drugs for which the median cost per day is 
greater than $50 are paid separately and are not packaged into the 
payment for the drug administration codes with which they are billed. 
See Addendum B for the 2004 OPPS payment amount for separately paid 
drugs, which are indicated with both payment amounts and status 
indicator ``K.''

Proposed Payment Rates for Drug Administration

    Comment: Commenters indicated that the proposed payment rates for 
drug administration are too low to adequately compensate hospitals for 
the costs of packaged drugs. They indicated that there is some 
confusion over the resultant decrease in drug administration medians 
after low cost drugs ($50-$150) were packaged into the drug 
administration codes. The expectation was that the addition of the drug 
costs would result in increases. Moreover, they stated that the payment 
rates for drug administration services that include drugs that cost $50 
to $150 per day, are so low that none of the rates are adequate to 
cover cases for which multiple drugs of $100 each are administered.
    A commenter who is particularly concerned with immunosuppressive 
drugs that are needed by beneficiaries following organ transplants, 
indicated that in 2000, Congress directed the Secretary of HHS to 
prepare a report to Congress containing recommendations regarding a 
cost effective way of providing coverage for immunosuppressive drugs to 
promote the objectives of improving health outcomes by decreasing 
transplant rejection rates attributable to failure to comply with 
immunosuppressive drug therapy and to achieve Medicare cost savings by 
preventing the need for secondary transplants and other care related to 
post transplant complications (Pub. L. 106-113). The commenter believes 
that packaging transplant drugs into the payment for drug 
administration and the proposal of such a low amount of payment defeats 
Congress's stated intention in this case and will decrease beneficiary 
access to immunosuppressive drug therapy following transplant surgery.
    Response: We believe that making separate payment for both the 
procedure and drugs for which there is a median per day cost in excess 
of $50, will result in appropriate payment for the procedure with which 
the drug is billed. In the case of the HCPCS codes for administration 
of drugs per visit (Q0081, Q0083 and Q0084), compared to the proposed 
payments published in the NPRM, payments for the procedures do not 
decline by much when calculated without packaged drugs that have 
medians of $50 to $150. Therefore, we believe that total payments will 
be more appropriate for these drugs in 2004.
    With respect to post-transplant immunosuppressive drugs, we would 
note that take-home supplies of such drugs are billed to the Durable 
Medical Equipment Regional Carriers and paid for separately outside of 
the OPPS. To the extent that such drugs fall below the $50 median cost 
per day, we expect the frequency of administration in the hospital 
outpatient setting to be low.

Coding for Drugs

    Comment: A trade association representing drug manufacturers 
supported our proposal to require hospitals to report individual codes 
for all drugs, including those that are packaged, on the grounds that 
it would improve the quality of our data. Most commenters representing 
hospitals and hospital associations opposed the proposal. They 
indicated that the operational impact on hospitals would be 
significant, if we were to implement such a requirement. It would take 
a year or more to update chargemasters and train staff, and many more 
codes would have to be established for drugs that are administered but 
not identified in the current HCPCS. Hospitals and hospital groups did 
not support detailed reporting of routine, low cost drugs and supplies 
that are currently reported only using a packaged revenue code. A 
commenter stated that if CMS were to choose to require drug and/or 
device coding, CMS should give hospitals at least a year to prepare to 
implement the requirement and work with hospitals to identify all drugs 
and devices that would require codes, develop HCPCS codes with dosage 
descriptions that match the administered or purchased dose, assign HCPS 
to all administered drugs, clarify reporting of self-administered drugs 
and drugs considered integral to a procedure under OPPS, and identify 
applicable drugs and devices in hospital

[[Page 63451]]

chargemasters. Commenters indicated that the use of ``unclassified 
drugs'' and ``unclassified biologicals'' would increase if hospitals 
are required to bill all drugs and that such a requirement would result 
in less reliable data for CMS at great cost to hospitals, with no 
measurable benefit. Some commenters indicated that the use of 
unclassified codes would create significantly more work for hospital 
staff and Medicare contractors. One commenter was concerned that this 
requirement would force hospitals to contort internal ordering and 
billing systems in order to match HCPCS codes to unrelated packaged 
dosage amounts, thereby significantly increasing the potential for 
error in the administration of drugs and putting patient safety at 
risk.
    Response: Because we are not implementing any of the new drug 
administration coding requirements that we proposed, the need for more 
detailed drug coding is removed. Therefore, we are not requiring 
hospitals to report with a HCPCS code every drug that is administered 
to a patient. However, in order to receive payment for a drug for which 
a separate payment is provided, hospitals will have to continue to bill 
for the drug using revenue code 636, ``Drugs requiring detail coding,'' 
and report the appropriate HCPCS code for the drug. Drugs for which 
separate payment is allowed are designated by status indicator ``K'' in 
Addendum B. Hospitals should continue to bill for packaged drugs, which 
are assigned status indicator ``N,'' using any of the drug revenue 
codes that are packaged revenue codes under the OPPS: 250, 251, 252, 
254, 255, 257, 258, 259, 631, 632, or 633. Hospitals are not required 
to use HCPCS codes when billing for packaged drugs, unless revenue code 
636 is used. Although we are not requiring hospitals to report HCPCS 
codes for packaged drugs, it is essential that hospitals continue to 
bill charges for packaged drugs by including the charge for packaged 
drugs in the charge for the procedure or service with which the drug is 
used, or as a separate drug charge (whether or not it is separately 
payable). Reporting charges for packaged drugs is critical because 
packaged drug costs are used for calculating outlier payments and are 
also identified when we calculate hospital costs for the procedures and 
services with which the drugs are used in the course of the annual OPPS 
updates.
    Comment: Several commenters recommended that CMS establish a unique 
revenue code for radiopharmaceuticals that hospitals would be required 
to use when reporting all radiopharmaceuticals, whether packaged or 
separately payable. They indicated that establishing a unique revenue 
code would assist CMS in tracking costs for the radiopharmaceuticals 
and contribute to more accurate cost data collection.
    Response: We do not establish revenue codes. Rather, the National 
Uniform Billing Committee (NUBC) receives and considers such requests 
from multiple sources, including providers and other members of the 
public. While we continue to examine cost-to-charge and cost 
compression issues, we will consider whether such an approach would 
assist CMS in refining our methods of establishing relative weights. We 
would also note that the commenters and other interested parties may 
also request that the NUBC consider the creation of new revenue codes.
    Comment: Several commenters expressed concern about the frequent 
coding changes implemented for radiopharmaceuticals over the past two 
years. They recommended that CMS revise the HCPCS coding descriptors 
for products that do not currently have ``per dose'' or ``per study'' 
descriptors to reflect the products as they are administered to the 
patient. They emphasized that creating these new descriptors and 
corresponding payment rates will improve data collection and help to 
ensure equitable payment to hospitals.
    Response: We recognize the concerns expressed by these commenters. 
However, we are striving to achieve stability in descriptor changes, 
and we believe that in changing descriptors to ``per dose'', we will 
lose specificity with respect to the data we will receive from 
hospitals. We are not convinced that there is a programmatic need to 
change the radiopharmaceutical code descriptors to ``per dose'' and 
that our claims data are problematic for setting payment rates for 
these products; however, we will continue to work with industry 
representatives to ensure that the current HCPCS descriptors are 
appropriate and review this issue in the future, if needed. 
Furthermore, we stress the importance of proper coding by providers so 
that we can get accurate data for future rate setting.
    Comment: One drug manufacturer urged CMS to advise hospitals that 
it is appropriate for them to set charges for drugs submitted to 
Medicare for OPPS services so that the charges reflect actual product 
costs when charges are multiplied by hospital and cost-center-specific 
ratios of cost-to-charges. The commenter also requested CMS to not rely 
on data obtained in the absence of such advice. A comment from a 
national hospital organization, however, advised CMS to permit 
hospitals to continue to establish their charge structures and mark-up 
policies separate and apart from CMS's payment policies. The commenter 
indicated that only in this manner would prospective payments 
appropriately reflect general trends in charges and mark-ups across all 
hospitals.
    Response: We do not regulate what hospitals charge for hospital 
services and will not advise hospitals regarding how to determine the 
charge for an item or service. Hospital charges have fundamental uses 
and the use of charges to determine relative costs for OPPS should not 
be the determining factor in how a hospital sets its charge for any 
item or service. The OPPS is a system based upon the relative costs of 
services and these costs are developed by applying the hospital's most 
recent cost to charge ratio to the charges of the hospital for the 
item. While we recognize that the system is imperfect, we believe that 
on average, it results in appropriate relative weights. However we 
recognize that on occasion, this is not true and therefore, as 
discussed elsewhere, we have used external data where we believe that 
the median derived from claims data does not appropriately reflect the 
relative cost of the item or service.
    Comment: One commenter requested that we change the status 
indicator for HCPCS code J7599 (Immunosuppressive drug, not otherwise 
classified) from ``E'' to ``N'' so that new immunosuppresives can be 
identified on claims forms as a separate line item until a unique pass-
through ``C'' code can be assigned to the product.
    Response: We agree that the status indicator for J7599 should be 
``N'' and have made that change for CY 2004. As for other new drugs and 
biologicals, interested parties may submit an application for pass-
through status for new immunosuppressives.

Coding for Drugs Billed as Supplies

    Comment: Commenters said that CMS significantly complicated the 
issue of billing for drugs when it indicated that drugs that are an 
integral part of the procedure should be billed as supplies (revenue 
code 270) rather than as pharmaceuticals (revenue code 250).
    Response: We did not issue instructions to require that drugs that 
are an integral part of a surgical procedure be billed using revenue 
code 270 (supplies) rather than revenue code 250 (pharmaceuticals). 
Rather, we instructed hospitals to report drugs that are treated as 
supplies because they are

[[Page 63452]]

an integral part of a procedure or treatment under the revenue code 
associated with the cost center under which the hospital accumulates 
the costs for the drugs. (See section XXIV.D of Transmittal A-02-129, 
issued on January 3, 2003.)
    In general, supplies that are an integral component of a procedure 
or treatment are not reported with a HCPCS code. The charges for such 
supplies are typically reflected either in the charges on the line for 
the HCPCS for the procedure or on another line with a revenue code that 
will result in the charges being assigned to the same cost center to 
which the cost of those services are assigned in the cost report.

Correct Coding Initiative Edits

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 proposed 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.
    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 proposed to adopt the following methodology to price 
the affected drugs, biologicals, and radiopharmaceuticals under the 
OPPS.
    We proposed to identify items approved for generic availability by 
the FDA during the 6 months before the first day of the claims period 
we 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 
proposed to base our payment rate on 43 percent of the AWP for the 
drug, biological, or radiopharmaceutical.
    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 proposed 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 solicited comments on this proposed method of calculating 
payment for drugs, biologicals, and radiopharmaceuticals for which 
generic alternatives have recently been approved. Specifically, we were 
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.
    We received many comments on our proposal regarding generic drugs 
and radiopharmaceuticals, which are summarized below along with our 
responses.
    Comment: One commenter applauded CMS's efforts to lower payment for 
generic products to an amount more closely aligned with hospital 
acquisition cost. However, the commenter indicated that payment for 
generic cancer products would continue to be excessive and contribute 
to an environment where hospitals may offer treatments using less 
effective chemotherapy products. Alternatively, comments from a 
national hospital association and numerous manufacturers stated that 
the presence of generic alternatives in the market does not necessarily 
result in cost savings for hospitals. They indicated that established 
multi-year contracts may prevent providers from switching immediately 
to generic alternatives. As a result, providers would not realize any 
cost savings from buying the generic products until the conclusion of 
their existing contract, which in some cases may be a few years after 
the generics are available in the market. Commenters also indicated 
that it is quite common for shortages of generic equivalents to occur 
when they first appear in the market. Thus, there is no guarantee that 
sufficient quantities of generic alternatives will be available in the 
marketplace for all providers to purchase them. Furthermore, adoption 
of generic drugs by hospitals is also affected by whether the providers 
determine they are safe to use in comparison to the brand name 
products. One commenter recommended that CMS continue to use its 2002 
claims data to set the payment rated for these drugs.
    Response: We appreciate these insightful comments and agree with 
the commenters that the time it takes for hospitals to realize cost 
savings (or price decreases) from purchasing generic products is longer 
than we initially expected because of the various reasons described by 
the commenters. Further research on this issue also shows that cost 
savings due to competition between generic and name brand drugs can 
vary. One reason is that in some cases regulations allow the first 
generic marketed to compete with a name brand drug to have a period of 
exclusivity during which time no other generics may come on the market. 
This period of exclusivity may mean that cost savings during this 
period of exclusivity are less than cost savings that occur once more 
than one generic is put on the market. For 2004, we believe that 
calculating payment rates for generics according to the methodology 
discussed above would not sufficiently take into consideration the true 
costs incurred by hospitals for purchasing generic products. Therefore, 
we believe that it is appropriate to calculate the payment rates for 
generics according to the same methodology used for other separately 
payable drugs and radiopharmaceuticals.
6. Orphan Drugs
    In the proposed rule we stated that we no longer believe that 
paying for orphan drugs at reasonable cost, outside of OPPS is 
appropriate, and we proposed the following payment policy:
    [sbull] We proposed to continue using the same criteria to identify 
single indication orphan drugs (67 FR 66772).
    [sbull] We proposed to discontinue retrospective cost payments and 
to make prospective payments under the OPPS for those identified single 
indication orphan drugs.
    [sbull] We proposed 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 proposed to make separate payment for the single 
indication orphan drugs and place them in APCs.
    The 11 single indication orphan drugs that would be affected by our 
proposal are: (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); J2355 
Injection, oprelvekin, 5 mg; J3240 Injection, thyrotropin alpha, 0.9 
mg;

[[Page 63453]]

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 solicited comments on these proposals and requested that 
commenters submit information meeting the same criteria as comments for 
other drugs (as discussed above). We received numerous comments, all of 
which were in opposition to our proposals regarding payment for orphan 
drugs.
    Comment: Every commenter who commented on the changes we proposed 
regarding payments for single indication orphan drugs opposed our 
proposal to discontinue payment for orphan drugs on a reasonable cost 
basis and to instead use the same methodology to set payment amounts 
for the single indication orphan drugs that we use to set rates for 
other drugs. Commenters stated that doing so would create serious 
access problems for patients who rely on an orphan drug for treatment 
of a rare disease because hospitals would no longer be able to afford 
to treat them. A number of commenters were particularly concerned by 
the decreased payment rate proposed for alpha-1-proteinase inhibitor. 
Some pointed out that the data we used to calculate payments for orphan 
drugs are especially flawed because of the low volume, high cost 
characteristics of orphan drugs, complicated by errors in the way 
hospitals bill for drugs generally. Recommendations from commenters 
included: applying the dampening rule to limit decreases to 10% of 
reasonable cost payments in 2003; establishing a payment floor; and, 
continuing to pay for orphan drugs on a reasonable cost basis.
    Response: We carefully reviewed commenters' concerns about the 
impact our proposal would have on patient access to orphan drugs. We do 
not dispute that orphan drugs used solely to treat an orphan condition 
are generally expensive and, by definition, are rarely used. We also 
recognize that coding changes may have resulted in questionable billing 
data. However, we believe that it is important to balance these 
concerns with maintaining a consistent payment system for hospital 
outpatient department services overall, and to limit to the maximum 
possible extent payment for services or items outside the OPPS. We also 
discussed in the August 12 proposed rule our concerns about the 
increased number of drugs that meet our criteria for special payment 
status as single indication orphan drugs and the resulting increase in 
the number of hospital outpatient services that would be paid outside 
the OPPS were we to continue to pay for these drugs on a reasonable 
cost basis. It was in light of these factors that we proposed to 
discontinue payment for single indication orphan drugs on a reasonable 
cost basis outside the OPPS and to use our claims data as the basis for 
setting payment rates for those drugs that we have identified as 
meeting our criteria for special payment status as single indication 
orphan drugs. We also proposed to pay separately for the single 
indication orphan drugs and to assign each of them to an APC.
    Having weighed the concerns raised by commenters and our concerns 
about the increasing number of outpatient services that would be paid 
outside the OPPS were we to continue the current policy of paying for 
single indication orphan drugs on a reasonable cost basis, we have 
decided that beneficiaries, hospitals, and the Medicare program will be 
best served over the long term by our making payment for the single 
indication orphan drugs under the OPPS at 88 percent of the AWP. We 
arrived at 88 percent based on our analysis of claims data, and our 
intent that payment be sufficient to ensure that all beneficiaries have 
access to needed drugs. Among the 11 orphan drugs, the highest median 
cost in the claims data was approximately 78 percent of the AWP. After 
considering comments we received on the proposed rule, we were 
concerned that merely adopting the existing highest percentage of the 
AWP may not ensure that a sufficient payment amount is established in 
all cases prospectively. We therefore have provided for an additional 
margin of ten percentage points to account for possible future 
increases, and ensure sufficient payment. This results in the 
percentage of 88 percent that we have adopted in this final rule.
    However, we received information consistent with our request for 
verifiable data (68 FR 47998) that indicates the payment amounts we 
proposed for alpha-1 proteinase inhibitor, for imiglucerase, and for 
alglucerase do not reflect the price at which these drugs are widely 
available to the hospital market. This information, combined with the 
concerns expressed by commenters generally that the payment amounts we 
proposed for the 11 drugs that meet our criteria for special payment as 
single indication orphan drugs are too low and may threaten beneficiary 
access to the drugs, have persuaded us to make final one modification 
to the method we proposed for setting payment rates for drugs that are 
paid as single indication orphan drugs under the OPPS. That is, rather 
than using claims data to calculate payment rates for single indication 
orphan drugs that meet our criteria for special payment under the OPPS, 
we are setting payment for all but two of these drugs at 88 percent of 
their AWP as established in the April 1, 2003 single drug pricer (SDP). 
As discussed above, we received information about the widely available 
market price for imiglucerase and alglucerase, and, based on that 
information, we have priced these two drugs at 94 percent of their AWP.
    We believe that this policy is a reasonable compromise. It enables 
us to set a prospective payment amount under the OPPS for qualified 
single indication orphan drugs. But, by increasing payment levels for 
these low volume drugs, we minimize the risk of compromising 
beneficiary access to treatment for life-threatening, rare diseases.
    Therefore, we have set payment rates for single indication orphan 
drugs in accordance with the following policy, effective January 1, 
2004:
    [sbull] We are using the same criteria that we implemented in CY 
2003 to identify single indication orphan drugs used solely for an 
orphan condition for special payment under the OPPS;
    [sbull] We are discontinuing payment on a reasonable cost basis for 
single indication orphan drugs furnished in the outpatient department 
of hospital that is subject to the OPPS;
    [sbull] We are making separate payment for single indication orphan 
drugs and assigning them to APCs;
    [sbull] We are setting payment under the 2004 OPPS for single 
indication orphan drugs at 88 percent of the AWP listed for these drugs 
in the April 1, 2003 single drug pricer unless we are presented with 
verifiable information that shows that our payment rate does not 
reflect the price that is widely available to the hospital market.
    Comment: Several commenters objected to our special treatment for 
only 11 orphan drugs, rather than including all of the drugs that the 
FDA designates as having orphan status. A few commenters recommended 
that we set the criteria for special treatment based on claims volume 
instead of our current criteria. That is, CMS would set a criterion for 
``high volume'' drugs based on a threshold of 30,000 or more claims per 
year. Then, any FDA-designated orphan drug with less than the threshold 
volume of claims would be subject to special payment under the OPPS as 
an orphan drug.
    Response: Using the statutory authority at section 1833(t)(1)(B)(i) 
of

[[Page 63454]]

the Act, which gives the Secretary broad authority to designate covered 
OPD services under the OPPS, we have established criteria which 
distinguish these 11 drugs from other drugs designated as orphan drugs 
by the FDA under the Orphan Drug Act. Our determination under this 
authority to provide special payment for a subset of FDA-designated 
orphan drugs does not affect FDA's classification of drugs under the 
Orphan Drug Act. Because these 11 drugs have a low volume of patient 
use, lack other indications, and have no other source of payment, we 
allow special treatment of them so beneficiaries can continue to have 
access to them. Because these 11 drugs are used solely to treat an 
orphan condition that affects a relatively low number of beneficiaries, 
hospitals receive payment for a low volume of cases by definition, and 
the cost of the drug is not spread across other uses. We are concerned 
that if we were to adopt the commenter's recommendation that we qualify 
all FDA-designated orphan drugs under a particular volume threshold for 
special payment under the OPPS, we could be expanding this special 
payment provision, which is meant to target the small number of orphan 
drugs that are used solely to treat rare diseases, to drugs that are 
used for other conditions and indications, for which hospitals would 
also be receiving payment. Therefore, we are not adding a volume 
threshold to our criteria for identifying orphan drugs that receive 
special payment under the OPPS in 2004.
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 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 were paid 
at reasonable cost for these vaccines in 2003. We are aware that access 
concerns continue to exist for these vaccines; therefore, we proposed 
to continue paying for influenza and pneumococcal pneumonia vaccines 
under reasonable cost methodology.
    We received no comments regarding our payment proposal for 
vaccines, and finalize our proposal in this rule.
8. Blood and Blood Products
    Since the OPPS was first implemented in August 2000, separate 
payment has been made for blood and blood products in APCs rather than 
packaging them into payment for the procedures with which they were 
administered. We proposed to continue to pay separately for 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.
    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 determined 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 proposed a 10 percent limit to decreases in payment 
rates for blood and blood products from 2003 to 2004.
    We solicited comment on this proposal, especially from hospitals. 
Specifically, we solicited comments that include verifiable information 
about the widely available acquisition cost of commonly used blood and 
blood products.
    We received several comments on this proposal, which are summarized 
below along with our responses.
    Comment: Several hospital groups supported the recommendation made 
by the APC Panel at its August 22, 2003 meeting and urged us to 
consider freezing 2004 payment rates for blood and blood products at 
the 2003 levels. A few commenters recommended that CMS use data 
provided by suppliers of blood and blood products to help set payment 
rates for 2004. Two commenters stated that major blood organizations 
are prepared to share the data for verification with CMS. Another 
commenter recommended that CMS base payments on either reasonable cost 
or external data.
    Response: After carefully reviewing the concerns expressed by 
commenters and analyzing the further reductions in payment that would 
result from using our 2002 claims data, even with the 10 percent limit 
on payment decreases that we proposed, we are convinced that our 
payments would be considerably lower than what it costs hospitals to 
acquire blood and blood products. Further, we are mindful of the 
increasing number of tests required to ensure the safety of the 
nation's blood supply, which is adding to the cost of processing blood 
and blood products. Therefore, in order to ensure that our 
beneficiaries have uninterrupted access to safe blood and blood 
products, we agree with the recommendation of commenters and the APC 
Panel that we freeze payments for blood and blood products in 2004 at 
2003 payment levels rather than implement our proposal to limit payment 
decreases to 10 percent. This will enable us to undertake further study 
of the issues raised by commenters and by presenters at the August APC 
Panel meeting, without putting beneficiary access to blood and blood 
products at risk. Therefore, effective for services furnished on or 
after January 1, 2004, the payment rates for blood and blood products 
will not change from their 2003 levels.
    Comment: One commenter was concerned that while autologous blood 
and directed donor blood do not have separate CPT codes, hospitals' 
costs to obtain them are different. Hospitals can only report charges 
for the autologous blood unit if the patient receives it; otherwise, 
hospitals must absorb the cost of the autologous donation. The same 
commenter also suggested that CMS research the issue of whether 
providing blood to patients with special needs would increase hospital 
costs. The commenter stated that hospitals do not receive additional 
payment when conducting national searches to meet special blood needs. 
Another commenter was concerned that drugs and biologicals were 
dampened to a

[[Page 63455]]

lesser extent than blood and blood products. The commenter requested 
that CMS discontinue the differential dampening and apply the dampening 
rule equally.
    Response: The commenter's concerns about rules governing payment 
for autologous blood and the costs associated with procuring blood for 
patients with special needs fall outside the scope of our proposed 
rule. These questions require further analysis and study, which we 
cannot undertake in time for implementation of the 2004 update of the 
OPPS. However, as we examine the current policies that affect payment 
for blood and blood products under the OPPS, we will consider both of 
the commenter's concerns.
    As for the comment regarding adoption of a uniform dampening policy 
for both separately payable drugs as well as blood and blood products, 
this concern is no longer an issue because of our decision to freeze 
payment rates for blood and blood products at their 2003 levels for 
2004.
    Comment: Several commenters requested that CMS provide and promote 
guidance on correct coding and billing for blood and blood products to 
hospitals and other providers.
    Response: We acknowledge the need for comprehensive billing and 
coding guidelines for hospitals and other providers. This is an area we 
expect to address in the near future.
9. Intravenous Immune Globulin
    In the proposed rule, we discussed public comments suggesting that 
we reclassify intravenous immune globulin (IVIG) as a blood and blood 
product. We stated that after a review of claims data, we believe that 
payment for these products is appropriate using the methodology we 
proposed to implement for other drugs and biologicals. Therefore, we 
proposed to continue to classify IVIG as a biologic. We solicited 
comments on this proposal.
    We received several comments on this proposal, which are summarized 
below along with our responses.
    Comment: Several trade associations, manufacturers, patient 
organizations and individual commenters urged CMS to classify 
intravenous immune globulin (IVIG) under the ``blood and blood product 
category.'' They indicated that IVIG is derived from plasma 
fractionation similar to other products categorized as a blood and 
blood product by CMS; and, furthermore, IVIG falls within the FDA's 
definition of ``blood and blood product.'' Some of the commenters 
expressed concern about the potential negative impact on patient access 
as a result of our proposed payment policy. Another commenter requested 
that we consider all plasma-derived products and their recombinant 
analogs as blood products.
    Response: We appreciate these comments. However, we continue to 
believe that IVIG and other plasma-derived therapies and their 
recombinant analogs are comparable to other drugs and biologicals, and 
they do not have the same access concerns as other blood and blood 
products. Our policy regarding IVIG and plasma therapies were described 
in the November 1, 2002 final rule (67 FR 66774). For 2004, IVIG will 
be a separately payable item, and its payment rate will be based on 
approximately 26,500 claims for approximately 1.5 million services. As 
mentioned in the August 12, 2003 proposed rule (68 FR 48005), analysis 
of the claims data indicated that hospital costs and billing practices 
for IVIG have been consistent over the past two years. Therefore, we 
believe that the 2002 claims data contain a sufficiently robust set of 
claims for IVIG on which to base the payment rate for this item using 
the methodology that will be used for other separately payable non-
pass-through drugs, biologicals, and radiopharmaceuticals.
10. 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 proposed 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 
proposed to assign P9011 to APC 0957 (Platelet concentrate) with a 
payment rate of $37.30. We invited comments on this proposed change in 
the status indicator and payment amount for P9011.
    We received a few comments on this proposal, which are summarized 
below along with our responses.
    Comment: Commenters pointed out that there was a typographical 
error in the proposed rule in which we referred to the split unit of 
blood as P9010 rather than P9011.
    Response: We agree this was an error and have corrected it in this 
preamble and are making final our proposal to assign P9011 to APC 0957 
(platelet concentrate).
11. Other Issues
    We proposed 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. 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.
    We have continued to gather information regarding an appropriate 
conversion ratio by reviewing recent published studies and data from 
alternative sources. In the proposed rule, we stated that 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 
proposed to continue with the current policy regarding payment for 
Procrit and Aranesp, including the current conversion ratio. We 
solicited comments on this issue and we stated that 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.
    We received several comments on this proposal, which are summarized 
below along with our responses.
    Comment: We received several comments concerning payment under the 
OPPS for erythropoietin and an erythropoietin-like product. 
Specifically, the comments pertained to payment for 
AranespTM (marketed by Amgen) and Procrit TM 
(marketed by Ortho Biotech) under the OPPS and the decision we made for 
2003 with respect to an appropriate conversion ratio to ensure that 
these products, which use the same biological mechanism to produce the 
same results, are paid at the same rate .
    Response: Erythropoietin, a protein produced by the kidney, 
stimulates the bone marrow to produce red blood cells. In severe kidney 
disease, the kidney is not able to produce normal amounts of 
erythropoietin and this leads to the anemia. Additionally, certain 
chemotherapeutic agents used in the treatment of some cancers suppress 
the bone marrow and cause anemia. Treatment with exogenous 
erythropoietin can increase red blood

[[Page 63456]]

cell production in these patients and thus treat their anemia.
    In the late 1980's, scientists used recombinant DNA technology to 
produce an erythropoietin-like protein called epoetin alfa. Epoetin 
alfa has exactly the same amino acid structure as the erythropoietin 
humans produce naturally and, when given to patients with anemia, 
stimulates red blood cell production.
    Two commercial epoetin-alfa products are currently marketed in the 
United States: EpogenTM (marketed by Amgen) and Procrit 
TM (marketed by Ortho Biotech). These products are exactly 
the same but are marketed under two different trade names. Both 
EpogenTM and Procrit TM are approved by the FDA 
for marketing for the following conditions: (1) Treatment of anemia 
related to chronic renal failure (including patients on and not on 
dialysis), (2) treatment of Zidovudine-related anemia in HIV patients, 
(3) treatment of anemia in cancer patients on chemotherapy, and (4) 
treatment of anemia related to allogenic blood transfusions in surgery 
patients. Both products are given either intravenously or 
subcutaneously up to three times a week.
    Amgen developed a new erythropoietin-like product, darbepoetin 
alfa, which it markets as AranespTM. Also produced by 
recombinant DNA technology, darbepoetin alfa differs from epoetin alfa 
by the addition of two carbohydrate chains. The addition of these two 
carbohydrate chains affects the biologic half-life of the compound. 
This change, in turn, affects how often the biological can be 
administered, which yields a decreased dosing schedule for darbepoetin 
alfa by comparison to epoetin alfa. Amgen has received FDA approval to 
market AranespTM for treatment of anemia related to chronic 
renal failure (including patients on and not on dialysis) and for 
treatment of chemotherapy-related anemia in cancer patients.
    Because darbepoetin alfa has two additional carbohydrate side-
chains, it is not structurally identical to epoetin alfa. However, the 
two products use the same biological mechanism to produce the same 
clinical results--stimulation of the bone marrow to produce red blood 
cells.
    These biologicals are dosed in different units. Epoetin alfa is 
dosed in Units per kilogram (U/kg) of patient weight and darbepoetin 
alfa in micrograms per kilogram (mcg/kg). The difference in dosing 
metric is due to changes in the accepted convention at the time of each 
product's development. At the time epoetin alfa was developed, 
biologicals (such as those developed through recombinant DNA) were 
typically dosed in International Units (IU or Units for short), a 
measure of the product's biologic activity. They were not dosed by 
weight (for example, micrograms) because of a concern that weight might 
not accurately reflect their standard biologic activity. The biologic 
activity of such products can now be accurately predicted by weight, 
however, and manufacturers have begun specifying the doses of such 
biologicals by weight. No standard formula exists for converting 
amounts of a biologic dosed in Units to amounts of a drug dosed by 
weight.
    In the clinical management of individual patients, CMS recognizes 
that no precise method of converting an epoetin alfa dose to a 
darbepoetin alfa dose has yet been established for any of the approved 
clinical uses. There are general guidelines for conversion and 
clinicians modify the dose based on the patient's hematopoietic 
response after the start of treatment with the new biological. For the 
purpose of developing a payment policy, however, it is feasible to 
establish a method of converting the dose of each of these drugs to the 
other. This payment methodology is intended to reflect average dosing 
requirements for the entire Medicare target population, and is not 
intended to serve as a guide for dosing individual patients.
    As part of the process to define and further refine a payment 
conversion ratio between these biologicals, CMS held a series of 
meetings with representatives from both Amgen and Ortho Biotech. Both 
companies provided substantial new data, both published and 
unpublished. We also reviewed the Food and Drug Administration labeling 
for each product (EpogenTM, ProcritTM, and AranespTM), hired an 
independent contractor to review the available clinical evidence, and 
performed an internal review of this evidence as well. CMS took into 
consideration both published and unpublished studies as well as 
abstracts, conference reports, clinical guidelines, marketing material, 
and other reports and materials provided by Amgen and Ortho Biotech.
    As noted in the OPPS final rule for 2003, CMS was interested in 
having a ``head-to-head'' comparison of epoetin alfa to darbepoetin 
alfa either in patients with chronic kidney disease or in cancer 
patients with chemotherapy-induced anemia, and in which appropriate 
outcome measures were used. Because no head-to-head study has yet been 
completed, CMS also considered clinical studies that either compared 
both products to each other or that linked the dose of a particular 
product with an appropriate health outcome measure. For the 2003 OPPS, 
we held a series of meetings with both Amgen and Ortho Biotech. We 
examined the written and published information provided by both 
companies, reviewed the FDA labeling for each product, hired an 
independent contractor to review available clinical evidence and 
performed an internal review of the evidence as well. In our review, we 
placed the greatest emphasis on published, high quality clinical 
studies and looked for the best possible estimates based on an 
evaluation of the dosing of each product that, on average, produced the 
same clinical response. Based on our own review of the evidence, our 
consultation with the independent contractor who also reviewed the 
evidence, and our discussions with each company, we established a 
conversion ratio for purposes of payment in 2003 of 260 International 
Units of epoetin alfa to one microgram of darbepoetin alfa (260:1).
    Since publication of the OPPS final rule for 2003, we have 
continued to review and refine our analysis of the appropriate 
conversion ratio between these biologicals. In order to facilitate 
analysis of the non-peer reviewed materials submitted by Amgen and 
Ortho Biotech, we initiated a process in July 2003, in which each 
company shared with CMS, our contractor, and each other, a detailed 
description of the methods used in each of their unpublished clinical 
studies. Each company was then asked to submit to us their comments as 
well as the responses to questions raised by the other company's 
review. Finally, based on our analysis of this information, CMS 
submitted questions to each company to clarify their views. The final 
payment conversion ratio is based on our analysis of the information 
submitted during the process described above, as well as claims 
analysis, and other publicly available information.
    Chemotherapy-induced anemia: The articles submitted by the 
manufacturers regarding treatment of chemotherapy-induced anemia (CIA) 
were all observational, retrospective, cohort studies. Several of these 
studies were conducted with a high degree of attention to minimizing 
avoidable bias and maximizing data integrity. Observational studies 
are, however, unavoidably subject to patient selection bias since study 
subjects are not randomly assigned to the groups being compared. It is 
not possible to eliminate the possibility that the choice of

[[Page 63457]]

erythropoetic agent was somehow systematically linked to 
characteristics of the patients treated. Similarities or differences in 
clinical response may reflect either baseline patient characteristics 
or the effects of the therapy being studied.
    Another major limitation of observational studies is that the 
researcher typically has no control over the manner in which the 
intervention under study has been delivered. In this instance, an 
additional difficulty with using observational studies to assess the 
equivalence of dosages of epoetin alfa and darbepoetin alfa in 
chemotherapy-induced anemia in cancer patients is that the response to 
these drugs may be disease-driven, dosage-driven, or both (depending 
for example, among other factors, on the individual cancer patient's 
level of endogenous erythropoietin). A large range of dosages of both 
epoetin alfa and darbepoetin alfa may show similar effects in any given 
patient and higher than necessary dosages may not be reflected in 
greater elevations of hemoglobin. More generally, the populations in 
the reported studies may show different results due to differences in 
demographics, health status, types of cancer, and cancer treatments.
    Beyond these methodological concerns, the question of what 
constitutes the best indicator of drug effect remains unsettled. 
Studies in the literature have used one or more of the following end-
points to analyze the effects of erythropoietic drugs:

1. Hemoglobin response--an increase from baseline of 2 g/dL 
(usually in the absence of transfusion in the preceding 28 days)
2. Hematopoietic response--Hemoglobin increase of 2g/dL from 
baseline or a hemoglobin 12g/dL
3. Mean change in hemoglobin `` the mean increase in hemoglobin from 
baseline (usually in the absence of transfusion in the preceding 28 
days)
4. Transfusions of red blood cells `` the number (percent) of patients 
requiring transfusion measured at various time intervals.
    Studies submitted by one of the manufacturers proposed additional 
measures such as ``early hemoglobin response'' (the hemoglobin rise 
from baseline at 4 or 5 weeks) and the ``area under the curve'' defined 
by hemoglobin increases from baseline. The FDA has not used these 
measures as criteria for registration (i.e., market approval) and they 
do not appear to be regularly used in the peer reviewed literature of 
erythropoietic drugs and their use either in kidney disease or in 
oncology. Therefore, their clinical significance is unclear at this 
time. They do, however, raise the question of how hemoglobin response 
patterns affect symptoms that matter most to patients. Both companies 
are conducting additional clinical studies to address further the 
potential importance of front-loaded regimens that provide high initial 
doses of erythropoietic drugs in order to stimulate a more rapid 
clinical response.
    During the process of exchanging and critiquing study methods, 
Amgen and Ortho-Biotech each raised significant methodological concerns 
about the study designs used to obtain new data. In addition to the 
overall concern about the observational methodology and selection of 
the outcome chosen for purposes of comparison, the following concerns 
were raised:

--the use of survival curves to analyze clinical data in this context
--the possible effect of patient functional status on erythropoietic 
response
--the technique for calculating mean values for drug dosages 
(arithmetic vs geometric means)
--the strategy for deciding how to handle data from patients who 
received transfusions
--the significance of an early rise in hemoglobin, and/or the 
significance of measures of hemoglobin response over the entire 12-16 
week treatment interval

    Each company provided extensive and compelling discussions of these 
and other issues, highlighting the fact that conclusions regarding the 
relative potency of these products are inherently limited by the nature 
and quality of the clinical data that currently exist. Despite the 
limitations of the available studies, CMS believes that it has 
sufficient data to establish a reasonable conversion ratio for payment 
purposes.
    Amgen submitted several observational studies, including one 
community-based study and three medication use evaluations (MUE). While 
interim results from two of these studies have been published in peer-
reviewed journals, final results have not yet been subjected to full 
peer review. In one study (Vadhan-Raj, 2003), patients were started on 
darbepoetin at 3 mcg/kg every other week (QOW). The patients received 
up to 8 doses (16 weeks). The patients had hemoglobin (Hgb) responses 
comparable to that seen with epoetin 40,000-60,000 IU per week. The 
protocol allowed a dose increase and 43 percent of participants had 
their darbepoetin dose increased to 5 mcg/kg/QOW per the protocol. 
Virtually all of the Amgen studies produced results that suggested a 
conversion ratio of 400:1.
    Ortho Biotech submitted early unpublished results from a 
multicenter head-to-head trial of 40,000 IU of epoetin weekly compared 
to 200 mcg of darbepoetin every other week. The primary end-point is 
the change in Hgb from baseline at week 5, and initial results show 
significantly greater increase in Hgb for patients treated with 
epoetin. Ortho Biotech also submitted data from several retrospective 
analyses of medical charts and electronic medial records, totaling 
several thousand patients. None of these studies have yet been peer-
reviewed or published. All of the Ortho-sponsored studies provide 
results suggesting that the appropriate conversion ratio is 260:1 or 
less.
    In the observational studies that directly compare Aranesp and 
Procrit for the treatment of CIA, and report total dose per patient per 
episode of both epoetin and darbepoetin, the ratio of mean total doses 
is 341:1 and the ratio of median total doses is 352:1. However, 
selection bias may affect the validity of these studies. CMS therefore 
believes that the above-mentioned ratios may still overestimate, at 
least modestly, the potency of darbepoetin alfa relative to epoetin 
alfa. An analysis of Medicare claims data from 2002 and 2003 determined 
that the ratio of utilization of Procrit to Aranesp in Medicare 
patients was 330:1 (units:mcg).
    As noted above, a conversion ratio between the dosages of these two 
products is not meant to guide what should be done for individual 
patients in clinical practice. In addition, by using a conversion ratio 
CMS is not attempting to establish a lower or upper limit on the amount 
of either biological a physician can prescribe to a patient. CMS 
expects that physicians will continue to prescribe these biologicals 
based on their own clinical judgment of the needs of individual 
patients.
    Based on our own review of the evidence, our consultation with the 
independent contactor who also reviewed the evidence, and our 
discussions with Amgen and Ortho Biotech, CMS concludes that an 
appropriate conversion ratio for the purposes of a payment policy is 
330 International Units of epoetin alfa to one microgram of darbepoetin 
alfa (330:1) for the purpose of treating chemotherapy-induced anemia.
    Chronic Kidney Disease without dialysis: It is well established 
that as a patient progresses through the stages of chronic kidney 
disease (CKD), erythropoietin levels decline and anemia tends to 
develop. Furthermore,

[[Page 63458]]

CKD patients are a very heterogeneous population, and it is likely that 
they will need varying doses of erythropoietic drugs as their CKD 
progresses to ESRD. At the present time there are no head-to-head 
randomized controlled clinical trials that look at erythropoietic drug 
needs across the spectrum of CKD.
    Amgen presented studies that examined the effect of darbepoetin on 
hemoglobin in this population. Two studies showed a dose conversion 
ratio (DCR) range between 215-330. These were observational studies 
similarly affected by the methodological weaknesses of this study 
design previously discussed for chemotherapy-induced anemia. A third 
study submitted by Amgen showed a DCR of 168:1 and is the only study 
that prospectively looked at darbepoetin and epoetin.
    We estimate that no more than 10 percent of the Medicare patients 
who receive darbepoetin in the hospital outpatient setting receive it 
solely because of CKD. As a result, at this time, we believe that it 
could be confusing and burdensome for hospitals as well as the Medicare 
claims processing systems to use different HCPCS codes assigned to 
different APCs in order to distinguish and pay different amounts for 
darbepoetin used by patients with CIA from darbepoetin used by patients 
with CKD. Therefore, given the heterogeneity of the population, the 
general paucity of scientific evidence on CKD, the estimated low 
incidence of CKD-only indications in the OPPS population, and the 
potential burden on providers of requiring different codes for 
different indications, we are not establishing a different payment rate 
for darbepoetin for CKD at this time. However, CMS invites the 
submission of peer reviewed clinical data to further illuminate the 
issue. Therefore, we are going to use a 330:1 conversion ratio for CKD 
also and, therefore, a single APC payment rate for darbepoetin alfa, in 
2004.

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 the proposed rule. We also proposed 
to use the final FY 2004 hospital inpatient wage index to calculate the 
final CY 2004 payment rates and coinsurance amounts for OPPS. 
Therefore, we have used the corrected final FY 2004 hospital inpatient 
wage index to make wage adjustments in determining the final payments 
rates set forth in this final rule. The corrected final FY 2004 
hospital inpatient wage index published as Tables 4A, 4B, and 4C in the 
October 6, 2003 Federal Register (68 FR 57732 through 57758) is 
reprinted in this final 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 used the corrected final FY 2004 
hospital inpatient wage index to calculate the payment rates and 
coinsurance amounts published in this final rule to implement the OPPS 
for CY 2004. We note however, that from time to time, there are mid-
year corrections to these wage indices and that our contractors will 
adopt and implement the mid-year changes for OPPS in the same manner 
that they make mid-year changes for inpatient hospital prospective 
payment.
    We received several comments on how we apply the wage index in 
setting rates.
    Comment: Commenters stated that we should exempt the device portion 
of the median cost from wage adjustment. They indicated that the wage 
index reflects the variation in wages and that applying it to 60 
percent of an APC payment where part of that payment is for devices, to 
which the wage index is not applicable, results in inappropriately low 
payments in rural areas and discourages the expansion of state of the 
art technologies to rural hospitals. A commenter indicated that we 
should work with the commenter to calculate and publish a list of the 
device percentages for each APC and that the wage index adjustment 
should not be applied to that portion of the APC.
    Response: To apply the wage index only to the non-device portion of 
the APC payment will mean a significant revision to the methodology 
used to calculate the relative weights and the conversion factor as 
well as changes to the system that applies the wage index on individual 
claims. When we calculate median costs, we divide 60 percent of the 
cost by the wage index for the hospital to neutralize the cost for the 
effects of the wage index. In addition, when we determine the 
conversion factor, we calculate a wage adjustment scalar to adjust for 
any increase or decrease that may occur to total payments from changes 
in the wage index. Moreover, it cannot be assumed that not applying the 
wage index to the device portion of the APC payment will result in 
increased payment for APCs that require devices. In localities that 
have high wage indices, this change could result in reductions in 
payments for device APCs. For example, if the wage index is 1.5 and the 
national APC payment is $10,000, the wage index applied to 60 percent 
of the APC increases the payment to the high wage index hospital to 
$13,000. If the wage index is 0.9, the wage index applied to 60 percent 
of the APC decreases the payment to the hospital to $9,400. However, if 
the wage index is applied only to 20 percent of the APC payment because 
80 percent of the cost of the APC is for the device, the hospital in 
the high wage index area will now get $11,000 (a $2,000 loss) and the 
hospital in the low wage index area will now get $9,800 (a $400 gain).
    Also, because the wage index is used to neutralize costs derived 
from charges and is a factor in the conversion factor, the $10,000 
payment in the example may change. To gauge the full impact of such a 
change, we would have to undertake significant statistical analysis. We 
will continue to apply the wage index to 60 percent of the APC for 
2004. However, we recognize the need to reassess whether this 
percentage is correct in view of the packaging of high cost devices 
into APCs and will make every effort to do a reassessment for 2005 OPPS 
proposed rule. If we determine that a change to the percentage might be 
appropriate, we will propose it in the 2005 OPPS NPRM.

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. Therefore, we proposed 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; situations in which reclassification of HCPCS codes from 
an existing APC to another APC results in a change in the APC payment; 
and situations in which newly created APCs are comprised of HCPCS codes 
from existing APCs.

[[Page 63459]]

    As we stated in the August 12, 2003 proposed rule, 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 unadjusted coinsurance amount for an APC group lower 
than 20 percent or greater than 50 percent of the payment rate.
    We proposed 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 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 percentage 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 percentage of the codes being added to the reconfigured 
APC.
    We stated in the proposed rule that 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. We received no comments from the public on our proposal for 
the calculation of beneficiary copayment amounts.
    The unadjusted copayment amounts for services payable under the 
OPPS effective January 1, 2004 are shown in Addendum A and Addendum B.

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 was 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 proposed 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 proposed market basket 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, 
resulted in a proposed conversion factor for 2004 of $54.289.
    For purposes of updating the CY 2003 conversion factor to determine 
a final conversion factor for CY 2004 we applied an update factor based 
on the final hospital inpatient market basket increase for FY 2004 of 
3.4 percent, as published in the final rule for IPPS on August 1, 2003. 
We further adjusted the conversion factor by applying a budget 
neutrality factor of 1.001 for wage index changes based on final FY 
2004 hospital inpatient PPS wage index values as published in a 
correction notice to the IPPS final rule on October 6, 2003. In 
addition, for CY 2004, estimated pass-through payments have decreased 
to 1.3 percent of total OPPS payments, down from 2.3 percent in CY 
2003. The conversion factor was further adjusted by the difference in 
estimated pass-through payments of 1.0 percent.
    The increase factor of 3.4 percent for 2004, the required wage 
index budget neutrality adjustment of slightly more than 1.001 and the 
1.0 percent adjustment to the pass-through estimate, result in a final 
conversion factor for 2004 of $54.561.
    We received several comments concerning the conversion factor 
update for 2004, which are summarized below.
    Comment: Several commenters stated that the OPPS has been 
underfunded since its inception. One commenter stated that the OPPS 
conversion factor has increased by less than the full market basket 
increase and urged that we work with Congress to enact an annual 
outpatient update for 2005 that corrects for the funding gap. Other 
commenters, noting the preliminary estimate of pass-through spending in 
our proposed rule of August 12 of 1.0 percent of total OPPS payments, 
strongly urged us to return the remaining 1.0 percent to the conversion 
factor to help fund all other APCs.
    Response: As described elsewhere in this final rule, we have 
completed our estimate of pass-through spending for 2004. By statute, 
we are authorized to spend only 2.0 percent of total estimated OPPS 
payments on pass-through spending for 2004. According to the best 
information available to us at this time, we estimate the total pass-
through spending to be 1.3 percent of total OPPS spending for 2004. For 
2003, we estimated the total pass-through spending to be 2.3 percent of 
total. Thus, we have returned the additional 1.0 percent to the 
conversion factor.

[[Page 63460]]

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

A. 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 would calculate outlier 
payments based on each individual OPPS service. We revised the 
aggregate method that we had used to calculate outlier payments and 
began to determine outliers on a service-by-service basis.
    As explained in the April 7, 2000 final rule (65 FR 18498), we set 
a target for outlier payments at 2.0 percent of total payments. For 
purposes of simulating payments to calculate outlier thresholds, we 
proposed to continue to set the target for outlier payments at 2.0 
percent. 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 proposed to establish two separate outlier thresholds, one 
for community mental health centers (CMHCs) and one for hospitals. For 
CY 2004, we proposed 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 proposed 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 proposed 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. In this final 
rule, we are setting the target amount for outlier payments at 2.6 
times the APC payment for hospitals and 3.65 times the APC payment for 
CMHCs. For 2004, the hospital outlier threshold is met when costs of 
furnishing a service or procedure exceed 2.6 times the APC payment 
amount and the outlier payment percentage is 50 percent of the amount 
of costs in excess of the threshold. Similarly, for CMHCs the threshold 
is met when costs of furnishing a service or procedure exceed 3.65 
times the APC payment amount and the outlier payment percentage is 50 
percent of the amount of costs in excess of the threshold.
    We received several comments concerning our proposal to establish 
two separate outlier pools, one for hospitals and another for CMHCs, 
and to determine eligibility for outlier payments by applying an 
outlier threshold of 2.75 times the APC payment for hospitals and 11.75 
times the APC payment for CMHCs. The comments we received concerning 
that proposal are summarized in section XI E.3 along with our 
responses. Comments we received pertaining to other aspects of our 
proposal for outlier payments are summarized below:
    Comment: One hospital association contended that outpatient 
services that qualify for outlier payments should receive 80 percent of 
their costs above the threshold, rather than the proposed level of 50 
percent. The association stated that an increased payment level would 
help to ameliorate the level of losses incurred by hospitals, such as 
teaching hospitals, that provide complex outpatient services and would 
make OPPS policy consistent with the policy under the IPPS. The 
association also pointed out that because we apply an outlier threshold 
that is a multiple of the APC payment, rather than a fixed dollar 
amount, hospitals that provide certain costlier services must absorb 
significantly more costs before even qualifying for outlier payments, 
making it even more important to increase the outlier payment 
percentage. The association recognized that increasing the payment 
percentage would require additional funds and recommended that we 
seriously consider increasing the outlier payment pool from its current 
level of 2.0 percent of total OPPS payments to 3.0 percent, the maximum 
allowed by law for 2004 and beyond.
    Response: Although we acknowledge the importance of outlier 
payments to providers, those payments are intended to ensure that the 
Medicare program shares, to some extent, in the extraordinarily high 
costs a provider may incur in caring for specific patients in unusual 
circumstances. Outlier payments are not intended to be paid on a 
routine or regular basis for treating the majority of Medicare 
beneficiaries. The APC payments are developed to be reasonable and 
adequate payment for all but the most extraordinary cases. At this 
time, we do not believe that it would be appropriate to shift 
additional funds from APC payments in order to increase the outlier 
payment percentage. Increasing the outlier pool would result in reduced 
payments for the majority of services providers furnish in order to 
make increased payments for the rare, extraordinarily high cost cases a 
provider may treat.
    Comment: A hospital association commented that we have furnished 
very little data on actual outlier payments under the OPPS, so 
hospitals have no way of knowing whether actual payments were higher or 
lower than estimated outlier payments and are unable to comment on the 
proper outlier threshold for OPPS. The association pointed out that we 
have historically furnished data on actual outlier payments in the IPPS 
rule and recommended that we furnish data on OPPS outlier payments so 
that hospitals may be able to make informed comments on the proper 
threshold.
    Response: Based on hospital and CMHC claims submitted for the 
period April 1, 2002 through December 31, 2002, outlier payments for 
that period amounted to 1.78 percent of total OPPS payments. The 
outlier target we were trying to achieve for that period was 1.5 
percent of total OPPS payments. Outlier payments to hospitals alone 
amounted to 1.54 percent of total OPPS payments to hospitals, while 
outlier payments to CMHCs amounted to 49.8 percent of their total OPPS 
payments.

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

[[Page 63461]]

under the transitional corridor provisions of the statute.
    Since small rural hospitals may not be able to achieve the same 
level of operating efficiencies as larger rural hospitals and urban 
hospitals, we were concerned that the possible decrease in payments to 
these hospitals resulting from the elimination of the transitional 
corridor payments could 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. In light of these concerns, we 
stated in the August 12, 2003 proposed rule that 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. In the August 12, 2003 proposed rule, we 
invited comments on whether we should provide an adjustment, such as 
the one described above, for small rural hospitals.
    We received a few comments regarding the elimination of 
transitional corridor payments, which are summarized below along with 
our responses.
    Comment: Two commenters stated that the loss of transitional 
corridor payments would dramatically affect revenues for rural 
hospitals; therefore, they supported increased payments to rural 
hospitals for clinic and emergency room visits. One hospital 
association recommended that we provide appropriate payment protections 
for small rural hospitals that provide emergency services to safeguard 
them from any adverse consequences stemming from the elimination of 
transitional corridor payments and to avoid life-threatening 
consequences by protecting beneficiaries' timely access to emergency 
services. Two additional commenters contended that our proposal would 
be inadequate and that to avoid curtailing services to Medicare 
beneficiaries relief is needed for small rural hospitals, sole 
community hospitals, and rural referral centers. They recommended that 
we continue transitional corridor payments using the authority we have 
to make adjustments under section 1833(t)(2)(E) of the Act. One 
commenter stated that our proposal failed to address other outpatient 
services that will be underpaid and suggested that transitional 
corridor payments be continued for a year while a more broad based 
payment methodology is developed for small rural hospitals. Another 
commenter recommended a rural APC add-on adjustment for all APCs paid 
to rural hospitals to acknowledge that these hospitals cannot achieve 
the same level of operating efficiencies as larger rural and urban 
hospitals. Another commenter argued that termination of transitional 
corridor payments was detrimental to all hospitals and recommended 
retaining transitional corridor payments for all hospitals.
    One commenter opposed shifting payments from larger hospitals in 
order to increase payments to small rural hospitals. The commenter 
stated that all hospitals, regardless of size and location, struggle 
with gaining operating efficiencies under the OPPS. One hospital 
association indicated that transitional corridor payments have been a 
critical source of financial support for many teaching hospitals and 
payments to these hospitals deserve further analyses by us, which would 
likely result in the conclusion that a teaching hospital adjustment is 
warranted. Several hospital associations expressed concern about our 
proposal to create differential payment rates between urban and rural 
hospitals for clinic and emergency room visits, and one questioned our 
legal authority to pay differently for the same service. One of the 
associations added that as a preferred alternative, it is urging the 
Congress to allocate additional resources to extend the transitional 
corridor and hold harmless provisions to all providers as well as 
urging the Congress to increase payments for clinic and emergency room 
visits for all hospitals. Another of the hospital associations stated 
that it does not support a budget neutral, redistributive adjustment 
through regulation, but is instead urging the Congress to allocate 
additional resources to assist rural hospitals by increasing payment 
rates for clinic and emergency room visits for all hospitals.
    The Medicare Payment Advisory Commission (MedPAC) commented that 
the August 12, 2003 proposed rule failed to provide a rationale for 
proposing increased payments for emergency room and clinic visits as a 
means of supporting small rural hospitals and recognized that only 
limited cost report data are available to assess the performance of 
small rural hospitals under the OPPS. MedPAC stated that we should 
consider other regulatory options to ensure access to care for rural 
beneficiaries, such as a low-volume adjustment and pointed out that any 
payment adjustment should be accompanied by an analysis of how small 
rural hospitals have fared under the OPPS, the impact of any payment 
adjustment, and the impact of other policies that affect rural 
hospitals such as conversion to critical access status. MedPAC also 
stated that legislative remedies could include extending the hold 
harmless policy or providing a transition from hold harmless status.
    Response: Although we expressed concerns in the August 12, 2003 
proposed rule that the sunsetting of transitional corridor payments 
might significantly impact small rural hospitals and we invited 
comments about whether we should provide for some type of adjustment to 
payments for these hospitals, we did not receive a large number of 
comments and the comments we did receive are mixed on the issue. 
Although some commenters called for an extension of hold harmless 
transitional corridor payments for small rural hospitals, we do not 
believe that is a viable option because any adjustment we would make 
under the authority of section 1833(t) of the Act would have to be made 
on a budget neutral basis and would result in decreased APC payments 
for all providers. Because we did not receive a strong response in 
favor of increased visit payments to small rural hospitals or 
compelling evidence that clearly supported the position that an 
adjustment for small rural hospitals is necessary to ensure access to 
hospital outpatient services in areas served by small rural hospitals, 
we will not adopt a payment adjustment for small rural hospitals. We 
will continue to seek information related to specific situations that 
demonstrate that access to care is a problem for Medicare 
beneficiaries.

XI. Other Policy Decisions and 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).

[[Page 63462]]

    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 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.

Outcome of January 2002 APC Panel Meeting

    During its January 2002 meeting, the APC Panel made several 
recommendations regarding coding for evaluation and management 
services. 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. 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.
    On their own initiative, the AHA and the AHIMA convened an 
independent expert panel of individuals from various organizations to 
develop code descriptions and guidelines for hospital emergency 
department and clinic visits and to 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 APC600, GXXX6 to APC 601, GXXX7 to APC 602, and 
GXXX8 to APC 620. These crosswalks and code descriptions are listed in 
Table 14 below.

                        Table 14.--Crosswalks of 2003 HCPCS Codes to the Proposed G Codes
----------------------------------------------------------------------------------------------------------------
                                                                 2003     2004 Proposed G               Payment
      2003 HCPCS description         2004 G code description    HCPCS          codes           APC       amount
----------------------------------------------------------------------------------------------------------------
Emergency department visit........  Level 1 Emergency Visit.      99281              GXXX1       0610     $74.70
                                                                  99282
Emergency department visit........  Level 2 Emergency Visit.      99283              GXXX2       0611     130.77
Emergency department visit........  Level 3 Emergency Visit.      99284              GXXX3       0612     226.30
                                                                  99285
Critical care.....................  Level 4 Critical Care         99291              GXXX4       0620     491.01
                                     provided in the              99292
                                     emergency department.
Office/outpatient visit, new......  Level 1 Clinic Visit....      99201              GXXX5       0600      50.62
                                                                  99202
Office/outpatient visit, new......  Level 2 Clinic Visit....      99203              GXXX6       0601      53.56
Office/outpatient visit, new......  Level 3 Clinic Visit....      99204              GXXX7       0602      82.07
                                                                  99205
Office/outpatient visit,            Level 1 Clinic Visit....      99211              GXXX5       0600      50.62
 established.                                                     99212
Office/outpatient visit,            Level 2 Clinic Visit....      99213              GXXX6       0601      53.56
 established.
Office/outpatient visit,            Level 3 Clinic Visit....      99214              GXXX7       0602      82.07
 established.                                                     99215
Office consultation...............  Level 1 Clinic Visit....      99241              GXXX5       0600      50.62
                                                                  99242
Office consultation...............  Level 2 Clinic Visit....      99243              GXXX6       0601      53.56
Office consultation...............  Level 3 Clinic Visit....      99244              GXXX7       0602      82.07
                                                                  99245

[[Page 63463]]

 
Critical care.....................  Level 4 Critical Care         99291              GXXX8       0620     491.01
                                     provided in the clinic.      99292
----------------------------------------------------------------------------------------------------------------

    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 proposed 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 proposed 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 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 adoption and implementation of any coding changes or 
coding guidelines, ample time will be provided for the public to 
comment on our proposal and, following announcement of any final 
decisions, for the education of clinicians and coders and for hospitals 
to make the necessary changes in their systems to accommodate the codes 
and guidelines. In the proposed rule, we requested comments on the 
amount of time hospitals believe would be adequate to implement these 
new codes and guidelines. We stated that 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.
    We received comments on our proposal, which are summarized below 
with our responses.
    Comment: Several physician societies objected to the creation of 
new G codes to replace existing CPT codes for facility coding of 
emergency and clinic visits. These commenters stated that new G codes 
for these services would add an unnecessary layer of complexity and 
confusion to the system, and that the existing CPT codes adequately and 
appropriately describe the services provided in the emergency and 
clinic settings. One physician society supported the creation of new G 
codes for facility coding of emergency and clinic visits, agreeing that 
CPT codes fail to accurately describe facility resources used to 
provide E/M services, but expressed concern that payers or auditors 
might refer to crosswalks made in establishing facility E/M code levels 
to determine appropriate level of coding for physician E/M services. 
This commenter urged CMS to clarify that the levels of visits for 
facility E/M services should not be used by payers or auditors to 
verify that physicians have billed for the appropriate level of visit.
    Several commenters, including a hospital association and 
federation, commended CMS for proposing new G codes for facility coding 
of emergency and clinic visits, stating that existing CPT codes for E/M 
services correspond to different levels of physician effort and fail to 
adequately describe non-physician resources. These commenters stated 
that the proposed new G codes would appropriately capture facility 
resources, minimize confusion relative to physician versus facility E/M 
services, and adequately meet hospitals' need to comply with HIPAA 
regulations.
    Response: We agree with those commenters who believe that CPT codes 
for E/M services describe different levels of physician effort, and 
therefore, fail to accurately describe facility resources used to 
provide E/M services. In the November 1, 2002 final rule (67 FR 66718), 
we explained that the development of new HCPCS codes for facility 
visits was necessary to address potential HIPAA compliance issues. We 
also agree with comments that the

[[Page 63464]]

proposed new G codes would appropriately capture facility resources and 
minimize confusion relative to physician versus facility E/M services. 
Therefore, we will continue to develop coding guidelines for facility 
E/M codes that are clear, facilitate accurate payment, are useful for 
compliance purposes and audits, and comply with HIPAA. For 
clarification purposes, levels of visits for facility E/M services 
should not be used by payers or auditors to verify that physicians have 
billed for the appropriate level of visit.
    Comment: We received a number of comments regarding our proposal of 
three levels of care (plus critical care) for clinic and emergency 
department visits. Several commenters stated that variation in cost per 
visit warrants five levels of service mapping to five separate APCs to 
maintain reasonable steps in payment as treatment costs increase. These 
commenters expressed concern that the agency will no longer have the 
ability to collect cost data for the five levels of emergency and 
clinic visits currently described by CPT codes, and that an averaging 
of charges over only three levels of service will result in adverse 
effects (that is, overpayments and underpayments) at the low and high 
end of visit codes. Furthermore, these commenters stated that private 
payers require a five tiered system and may not recognize the new G 
codes for payment. In contrast, we received several comments supporting 
our proposal of three levels of care (plus critical care) for clinic 
and emergency department visits. These commenters stated that three 
levels would help reduce the coding complexity and would be a more 
appropriate and accurate mechanism for reporting emergency and clinic 
visits.
    Response: We appreciate the commenters' concerns while at the same 
time recognizing merits in the independent expert panel's 
recommendation to create three levels of care (plus critical care) for 
clinic and emergency visits. Given the level of interest in this issue 
and the importance to Medicare and to hospitals of establishing the 
appropriate codes and payment levels for these services, we will 
continue to study the issue. Prior to implementation of new facility E/
M codes we will carefully consider all commenters' concerns related to 
variation in visit costs and recognition of a three tiered system by 
private payers. We will also consider placing this issue on the agenda 
for the 2004 APC Panel meeting.
    Comment: Several physician societies expressed concern about 
potential discrepancies in payment for the same services furnished in 
clinic and emergency departments versus physician offices. One 
commenter stated that the proposal lacked physician input. While 
acknowledging statutory requirements that dictate the structure of the 
payment system for non-physician resources required to support 
physician services and the payment system for outpatient facility 
resources, commenters stated that we should avoid adopting policies 
that further increase the inequity in Medicare's payment systems. These 
commenters urged us to establish payment equity for the same services 
furnished in these respective settings.
    Response: As stated elsewhere, the statute contains different 
provisions for how payments are established under the physician fee 
schedule and how payments are established under the OPPS. With respect 
to the absence of physician input on the proposal, we welcome comments 
from all interested parties as we continue to develop our policy.
    Comment: We received numerous and detailed comments in reference to 
the model guidelines proposed by the independent expert panel convened 
by the American Hospital Association (AHA) and the American Health 
Information Management Association (AHIMA).
    Response: We are appreciative of the detailed comments we received 
in reference to the model guidelines proposed by the independent expert 
panel convened by the AHA and AHIMA. While we will carefully consider 
these comments in our continued review of the independent panel's 
proposed guidelines, we will not be responding to such comments in this 
rule since CMS did not propose these coding guidelines in the August 
12, 2003 proposed rule.
    Comment: Several commenters supported our decision to delay 
implementation of new E/M codes for clinic and emergency department 
visits until we have established defined and uniform coding guidelines.
    Response: To minimize confusion, we continue to believe that a 
national set of defined coding guidelines must be established and 
implemented in conjunction with any new E/M codes for clinic and 
emergency department visits.
    Comment: Several commenters encouraged CMS to make any proposed 
guidelines for billing hospital emergency room and clinic visits 
publicly available with opportunity to comment as soon as they are 
complete.
    Response: We plan to make any coding guidelines that we are 
considering 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 listserve. As stated elsewhere, we will provide ample opportunity 
for the public to comment on the proposal.
    Comment: Several commenters requested that CMS provide adequate 
time for the education of clinicians and coders and for hospitals to 
make the necessary changes in their systems to accommodate new 
evaluation and management (E/M) codes and guidelines. While two 
commenters requested a minimum notice of three months prior to 
implementation, the majority of commenters requested a minimum notice 
of between six and twelve months prior to implementation of facility 
evaluation and management codes and guidelines.
    Response: We will continue to be considerate of the time necessary 
to educate clinicians and coders and for hospitals to modify their 
systems to accommodate new codes and guidelines. Based on comments 
received, we will provide a minimum notice of between six and twelve 
months prior to implementation of facility evaluation and management 
codes and guidelines. We do not expect to implement these new codes and 
guidelines any earlier than January 2005.

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 an 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 status 
indicator (SI) assignments for APCs in Addendum A, HCPCS codes in 
Addendum B, definitions of the status indicators in Addendum D1, and 
definitions of code condition indicators in Addendum D2.
    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

[[Page 63465]]

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 a system of payment status indicators with specific 
meanings.
    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.
    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.
    In the August 12, 2003 proposed rule, we listed the OPPS status 
indicators and described how we proposed to use them in the 2004 OPPS. 
We also solicited comments on the appropriateness of the status 
indicator that we proposed to assign to each APC in Addendum A and each 
HCPCS code in Addendum B. Because the assignment of a status indicator 
designates how a particular outpatient service will be paid, either 
under the OPPS or under another payment system, or why payment is not 
made for a code, the comments that we received regarding the status 
indicator assigned to a particular APC or HCPCS code are discussed 
elsewhere in this final rule, within the context of the payment policy 
or rule that affect how payment is determined for the APC or HCPCS 
code.
    Since publication of the August 12 proposed rule, we have been 
preparing specifications for the January 1, 2004 outpatient code editor 
(OCE) and PRICER, which are pivotal in determining how hospital claims 
for outpatient services are processed and paid. In the course of 
discussions with the contractors and systems maintainers with whom we 
work to ensure that claims are processed appropriately and in 
accordance with the policies and changes that we are implementing in 
this final OPPS rule for 2004, several issues related to status 
indicator definitions and claims processing edits and dispositions have 
arisen. As a result of these discussions, we have determined that 
claims would be processed more accurately if we established two 
additional payment status indicators to designate with greater 
specificity the appropriate disposition of certain codes for which 
payment is not made under the OPPS. Therefore, we are adding two status 
indicators, status indicator ``B'' and status indicator ``Y,'' to 
Addendum D1, which lists all of the status indicators established as 
part of the OPPS and describes what they signify. We have also revised 
and refined the status indicator definitions and clarified the 
explanation of what each status indicator means. None of these changes 
affect how services are paid under the OPPS. Rather, the changes are 
intended to clarify how the status indicators relate to existing 
payment policy and rules and to assist hospitals and our contractors in 
determining the disposition of individual HCPCS codes when they are 
billed to Medicare.
    In 2004, we are adding a new Status Indicator ``Y'' to designate 
codes for non-implantable Durable Medical Equipment (DME) to assist 
hospitals in identifying codes that they must bill directly to the 
Durable Medical Equipment Regional Carrier (DMERC) rather than to the 
fiscal intermediary. Codes assigned Status Indicator ``Y'' are listed 
in Addendum B.
    Historically, we have used Status Indicator ``E'' to identify 
certain HCPCS codes that are recognized by Medicare but that are not 
payable under the OPPS when they are submitted on an outpatient 
hospital Part B bill type (bill type 12x, 13x, or 14x). Beginning with 
implementation of the 2004 final rule, we are assigning Status 
Indicator ``B'' to HCPCS codes that are not payable under OPPS when 
submitted on an outpatient hospital Part B bill type (12x, 13x, and 
14x), but that may be payable by intermediaries to other provider types 
when submitted on an appropriate bill type, such as bill type 75x 
submitted by a CORF. In some cases, another code may be submitted by 
hospitals on an outpatient hospital Part B bill type (12x, 13x, and 
14x) to receive payment for a service or code that is assigned status 
indicator ``B'' in Addendum B. Because we did not include these status 
indicator changes in the August 12, 2003 proposed rule, we invite 
comments on their addition to Addendum D1, and on the revised 
definitions and explanations that we included in Addendum D1.
    Addendum D2 shows the indicators that we use to designate codes 
that are new in 2004 for which comments may be submitted as well as 
codes that are deleted in 2004 either with or without a grace period.

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 the proposed rule, we 
did not propose anything new with regard to observation services, nor 
did we seek public comment on observation issues. We stated that we 
would update by Program Memorandum any changes in the list of ICD-9-CM 
codes required for payment of HCPCS code G0244 resulting from the 
October 1 annual update of ICD-9-CM. We also stated in the proposed 
rule that we would include any changes in the 2004 final OPPS rule and 
allow the public an opportunity to comment.
    We have had an opportunity to review the October 1, 2003 update of 
the ICD-9-CM and we have determined that there are not changes that 
affect the list of diagnosis codes required for payment of HCPCS code 
G0244. Therefore, we are not implementing any changes in the way we pay 
for observation services under the 2004 OPPS.

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 be provided only in the inpatient setting and 
that, therefore, should be payable only when provided in that setting.
    Section 1833(t)(1)(B)(i) of the Act gives the Secretary broad 
authority to determine the services to be covered and paid for under 
the OPPS. In the April 7, 2000 final rule, we identified procedures 
that are typically provided only in an inpatient setting and, 
therefore, would not be paid by Medicare under the OPPS (65 FR 18455). 
These procedures comprise what is referred to as the ``inpatient 
list.'' The inpatient list specifies those services that are only paid 
when provided in an inpatient setting. These are services that require 
inpatient care because of the nature of the procedure, the need for at 
least 24 hours of post-operative recovery time or monitoring before the 
patient can be safely discharged, or the underlying physical condition 
of the patient. As we

[[Page 63466]]

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 in the 
proposed rule, we did not propose to make any of the procedures that 
are currently on the inpatient list in Addendum E payable under the 
OPPS in 2004. We solicited comments on whether any procedures in 
Addendum E should be paid under the OPPS. We asked 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 solicited 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 indicated in the proposed rule that we 
would propose either to assign a CPT code to an APC for payment under 
the OPPS or, if the comments did not provide sufficient information and 
data to enable us to make a decision, to present the comments to the 
APC Panel at its 2004 meeting.
    Procedures on the inpatient list can be found in Addendum E. CPT 
codes that are new in 2004 and that we believe are appropriately 
assigned status indicator ``C'' to designate that they are on the 
inpatient list can be found in Addendum B with condition code ``NI''. 
We invite comment on assignment of these codes to the inpatient list.
    We received a few comments regarding the inpatient list, which are 
summarized below with our responses.
    Comment: A group of providers representing 18 health care systems 
around the country requested that CMS clarify the intent of the 
inpatient list. The commenter expressed concern that some independent 
medical review criteria appear to equate codes with APC payments as 
procedures that CMS has determined must be outpatient services both 
because they are payable under the OPPS and because they are not 
included on the inpatient list. The commenter is concerned that 
hospitals will interpret these criteria to mean that any procedure or 
service not on the inpatient list must be furnished on an outpatient 
basis, regardless of the needs of the patient.
    Response: We wish to clarify that assignment of an APC payment to a 
service or procedure does not mean that Medicare covers the service or 
procedure or that it may only be payable when furnished in an 
outpatient setting. In the November 1, 2002 final rule (67 FR 66739) as 
well as the April 7, 2000 and the November 30, 2001 final rules, we 
explain in detail our rationale for the inpatient list. Assignment of 
an APC payment to a service or procedure does not prohibit hospitals 
from providing these services on an inpatient basis when it is 
reasonable and necessary to admit the patient based on the patient's 
medical condition.
    Comment: The same commenter repeated objections that have been 
submitted in comments to OPPS rules in prior years, that it is unfair 
to deny payment to hospitals for procedures on the inpatient list, but 
to pay physicians when they perform procedures on the inpatient list in 
a hospital outpatient setting. The commenter asserts that physicians 
are not responsive to hospital efforts to educate them regarding 
Medicare payment for procedures on the inpatient list performed on a 
patient who has not been admitted as an inpatient because the location 
that the physician chooses to perform a procedure has no impact on 
Medicare payment for the physician's professional services. Moreover, 
the commenter asserts that physicians disagree with assignment of 
procedures to the inpatient list because new technology or surgical 
advances allow the procedure to be appropriately performed on an 
outpatient basis. The commenter urged us to release the inpatient list 
as part of the physician's fee schedule in order to align hospital and 
physician incentives.
    Response: In the November 1, 2002 final rule (67 FR 66740) we 
responded to similar comments regarding hospitals' concerns about 
physicians being paid for procedures on the inpatient list that are 
performed on an outpatient basis even though payment is denied to 
hospitals for those procedures. As we state above, the basis for the 
inpatient list is rooted in section 1833(t)(1)(B)(i) of the Act, which 
gives the Secretary broad authority to determine the services to be 
covered and paid for under the OPPS. The authority in this section of 
the Act does not extend to services that are covered and paid for under 
the Medicare physician fee schedule, which is a separate benefit and 
payment system. However, we believe that as hospitals and physicians 
continue to gain experience and become more knowledgeable about how 
Medicare pays for services under the OPPS, problems associated with the 
existence of the inpatient list will continue to diminish.
    Moreover, we welcome at any time recommendations from hospitals 
and/or physicians regarding procedures currently on the inpatient list 
that are being safely and appropriately performed on an outpatient 
basis. Requests for review of a code or group of codes on the inpatient 
list should be sent to the Director, Division of Outpatient Care, 
Centers for Medicare & Medicaid Services, Mailstop C4-05-17, 7500 
Security Boulevard, Baltimore, MD 21244-1850. Such requests should 
include supporting information and data to demonstrate that the code 
meets the five criteria for payment under the OPPS that are listed 
above, and that are also discussed in the November 1, 2002 final rule 
(67 FR 66739). In addition, we ask that evidence be submitted, 
including operative reports of actual cases and peer-reviewed medical 
literature, to demonstrate that the procedure is being performed on an 
outpatient basis in a safe and appropriate manner in a variety of 
different types of hospitals.
    Comment: The same commenter recommended that we change our policy 
for OPPS payment of inpatient services when the patient is transferred 
to another hospital. They state that the current requirement creates 
unnecessary administrative burden when a hospital, in order to receive 
payment, must admit a patient simply to stabilize them prior to 
transfer. The commenter

[[Page 63467]]

recommended that, when procedures on the inpatient list are provided to 
patients in order to stabilize the patient immediately prior to 
transfer, we ignore the payment status indicator of ``C'' assigned to 
the procedure on a claim and allow the claim to be paid under the OPPS.
    Response: Procedures on the inpatient list performed on patients 
whose status is that of outpatient are not payable under the OPPS. 
However, we recognize that there are occasions when a procedure on the 
inpatient list may have to be performed to resuscitate or stabilize a 
patient with an emergent, life-threatening condition whose status is 
that of an outpatient. We also recognize that, once stabilized, such a 
patient may subsequently require transfer to another facility in order 
to receive appropriate care. As we explain in the November 1, 2002 
final rule (67 FR 66798), when a physician performs a procedure on the 
inpatient list to resuscitate or stabilize a patient with an emergent, 
life-threatening condition whose status is that of an outpatient, we 
expect the physician to order that the patient be admitted following 
the procedure for the purpose of receiving inpatient hospital services 
and occupying an inpatient hospital bed. Or, the physician may order 
that the patient be admitted and then determine that the patient should 
be transferred to another provider. In the latter instance, Medicare 
allows payment for services furnished to a patient who is transferred 
to another provider. However, in order for the discharging hospital to 
receive payment in cases where it is determined that appropriate care 
for the patient necessitates transfer to another provider, long-
standing Medicare rules provide that the patient has to have been 
admitted to the discharging hospital. Further, as we discuss in the 
November 1, 2002 final rule, it is important that the particular 
circumstances necessitating performance of a procedure on the inpatient 
list when the patient's status is that of an outpatient be thoroughly 
documented in the medical record. For these reasons, we disagree with 
and are not implementing the commenter's recommendation that we modify 
the outpatient code editor (OCE) to allow payment under the OPPS for 
services furnished to resuscitate or stabilize an outpatient with an 
emergent, life-threatening condition who is transferred to another 
facility following a procedure on the inpatient list.
    Comment: One hospital requested that we remove CPT 37182, Insertion 
of transvenous intrahepatic protosystemic shunts(s) (TIPS), from the 
inpatient list. One health system requested that we remove CPT 20660, 
Application of cranial tongs, caliper, or stereotactic frame, including 
removal (separate procedure) and CPT 49061, Drainage of retroperitoneal 
abscess; percutaneous, from the inpatient list.
    Response: Our medical officers reviewed these recommendations and 
determined that these codes do not meet the criteria for removing a 
procedure from the inpatient list and assignment to an APC. We would 
expect patients whose medical condition requires these procedures to be 
admitted as inpatients in order to have these procedures performed. Our 
data indicate that these procedures are performed predominantly in the 
inpatient setting. Therefore, in the absence of evidence demonstrating 
that these procedures are being performed on an outpatient basis in a 
safe and appropriate manner in a variety of different types of 
hospitals and that the criteria for removing a procedure from the 
inpatient list are met, we are retaining these codes on the inpatient 
list.
    Comment: A provider group requested that we change the status 
indicator of the following codes from ``N'' to ``C,'' because these are 
add-on codes for procedures already on the inpatient list: CPT 61316, 
Incision and subcutaneous placement of cranial bone graft; CPT 61517, 
Implantation of brain intracavitary chemotherapy agent; CPT 62148, 
Incision and retrieval of subcutaneous cranial bone graft for 
cranioplasty; and, CPT 62160, Neuroendoscopy, intracranial, for 
placement or replacement of ventricular catheter and attachment to 
shunt system or external drainage.
    Response: We thank the commenter for bringing these codes to our 
attention and we agree that the status indicator for these codes should 
be changed from ``N'' to ``C.''

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 SI ``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 SI ``C'' and modifier -CA, is currently made under APC 0977.
    We reviewed this policy and determined that assigning payment for 
these services to APC 0977, 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 proposed 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 SI ``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 
0375 instead of APC 0977 for services furnished on the same date of 
service that a procedure with SI ``C'' and modifier -CA is billed. We 
proposed at the outset to set the payment rate for APC 0375 in the 
amount of $1,150, which is the payment amount for the newly structured 
New Technology APC that would replace APC 0977. 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. In the proposed 
rule, we invited comments on these proposed changes.
    Comment: One commenter was concerned with the methodology for 
calculation of APC 375, Ancillary Outpatient Services when Patient 
Expires. The commenter stated that items such as pass-through devices 
and drugs and packaged items reported without HCPCS should be included 
in the calculation.
    Response: It is conceivable that a pass-through drug or device 
could be furnished to a patient during the same encounter when a 
procedure billed with modifier -CA is performed. If that were the case, 
we would expect the hospital to include these services on the claim 
submitted for the encounter. Although

[[Page 63468]]

we would not pay separately for the pass-through items, we agree with 
the commenter that we should consider taking these costs into account 
when evaluating how best to establish the payment rate for APC 375 in 
future updates of the OPPS. We also agree that charges reported with a 
revenue code but without a HCPCS code should be considered as well.

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 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.
    Effective January 1, 2003, the PHP APC amount was $240.03, of which 
$48.17 is the beneficiary's coinsurance. In the proposed rule, we 
described the methodology we followed in developing the 2003 PHP 
payment rate.
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 that was used to compute the CY 2003 PHP median cost per 
day. However, when we applied the methodology to the CMHC claims, the 
CMHC median cost per day was determined to be significantly higher than 
the median cost per day for hospital outpatient departments to provide 
the same benefit. In addition, the difference in median costs per day 
was significantly larger than last year.
    As a result, we proposed a per diem rate for PHP services furnished 
during CY 2004 based solely on hospital PHP data. The proposed PHP APC 
0033 amount, after scaling, was determined to be $208.95, of which 
$41.69 is the beneficiary's coinsurance.
    However, a Program Memorandum issued on January 17, 2003, directed 
the FIs to recalculate hospital and CMHC cost-to-charge ratios. We 
anticipated receipt of the updated ratios this summer, and indicated 
that if the updated cost-to-charge ratios resulted in a more reasonable 
median per diem rate, we would use the CMHC data in developing the 
final rate for CY 2004.
    We received 42 public comments in response to this proposal. A 
summary of the comments is provided below along with our responses.
    Comment: In general, the commenters expressed concern that a 
reduction in the PHP rate of this magnitude would lead to the closure 
of many PHPs and that limited access to this crucial service would 
result in more costly inpatient hospital care as the ony alternative. A 
hospital association commented that basing the rate on only hospital 
data is inconsistent with other prospective payment systems and 
recommended that we find an alternative method to secure reliable CMHC 
data. CMHCs commented that their costs are higher than hospitals', with 
most in the $300 to $400 range. One commenter provided summary 
information on the average per day costs for seven CMHCs. Although the 
average per day cost for these seven providers was $390, the costs for 
individual providers ranged from $216 to $725. Unfortunately, the 
commenter did not provide a breakdown of these costs. Another commenter 
indicated that a per day rate of $300 to $350 was more appropriate than 
our proposed amount.
    Another commenter stated that our inability to process the data 
timely does not constitute an appropriate basis for excluding all CMHC 
data from the per diem calculations. The commenters suggested 
alternatives such as including prior years' CMHC data trended forward 
based on medical inflation or maintaining the CY 2003 payment rate for 
PHP services furnished in CY 2004. One commenter questioned why the 
median cost per day for hospitals was reported as $225 but the proposed 
rate was reduced to $208.95.
    Response: As we stated in the August 12, 2003 proposed rule, we 
intended to review the PHP data using the updated cost-to-charge ratios 
to compute the final CY 2004 PHP APC. As expected, the updated ratios 
reduced the median cost per day for CMHCs. The revised medians are $440 
for CMHCs and $206 for hospitals. Combining these files results in a 
median per diem PHP cost of $303. As with all APCs in the OPPS, the 
median cost for each APC is scaled to be relative to a mid-level office 
visit and the conversion factor is applied. The resulting APC amount 
for CY 2004 is $286.82 of which $57.36 is the beneficiary's 
coinsurance.
    Comment: With respect to the methodology used to establish the PHP 
APC amount, commenters expressed concern that data from settled cost 
reports fails to include costs reversed on appeal and that there are 
inherent problems in using claims data from a different time period 
like available cost-to-charge ratios on settled cost reports.
    Response: We used the best available data in computing the APCs. 
The January 17, 2003 Program Memorandum directed FIs to update the 
cost-to-charge ratios on an ongoing basis whenever a more recent full 
year cost report is available. In this way, we hope to minimize the 
time lag between the cost-to-charge ratios and claims data.
    Comment: One commenter provided links to certain data files that 
were used to establish the APC rates. Since APC 0033 and certain HCPCS 
codes that are only paid under OPPS when they are furnished as part of 
a PHP were not included in these data files, the commenter believed 
that the data used to establish the PHP APC amount is incomplete.
    Response: These data files are provided so that interested parties 
can study the costs associated with the HCPCS codes that comprise each 
APC and other analyses. We are required to include the HCPCS codes 
within each APC that are similar in resource use. This is not the case 
with the PHP APC (0033) in which the day of care is the unit that 
defines the structure and scheduling of PHPs and the composition of the 
PHP APC consists of the cost of all services provided each day. 
Although we require that each PHP day include a psychotherapy service, 
we do not specify the specific mix of other services provided and have 
focused our analysis on the cost per day rather than the cost of each 
service furnished within the day. As a result, we will add APC 0033 to 
the file that displays the APC median costs, but not the PHP data that 
show medians by HCPCS codes. We will continue to analyze the PHP data 
and will reconsider this position in the future.
    Comment: One commenter related that administrative costs for CMHCs 
continue to be a major impediment to operating PHPs for Medicare 
beneficiaries. Medicare does not cover transportation to and from 
programs and does not cover meals. Almost all programs offer 
transportation because in

[[Page 63469]]

most cases Medicare beneficiaries with serious mental illnesses would 
not be able to access these programs without the transportation. They 
also commented about the current Medicare bad debt policy, which is 
beyond the scope of the August 12, 2003 proposed rule.
    Response: The services that are covered as part of a PHP are 
specified in section 1861(ff) of the Act. Meals and transportation are 
specifically excluded under section 1861(ff)(2)(I) of the Act.
    Comment: Several commenters summed the median cost figures for 
various combinations of HCPCS codes 90853 (group psychotherapy), 90818 
(individual psychotherapy, 45-50 minutes), and 90847 (family 
psychotherapy, with patient present) and concluded that the per diem 
amount is considerably less than the combined cost of these services.
    Response: We believe that the figures cited by the commenters were 
taken from a file that shows the median cost for single bills, for 
example, where group psychotherapy was the only service furnished. We 
do not believe that this is an appropriate comparison. These amounts 
are provided to enable the public to identify the median cost of 
services before scaling. It is important to note that these services 
are not PHP services, but rather single outpatient therapeutic 
sessions. As stated earlier, we used data from PHP programs (both 
hospitals and CMHCs) to determine the median cost of a day of PHP. PHP 
is a program of services where savings can be realized by hospitals and 
CMHCs over delivering individual psychotherapy services.
    Comment: Several commenters compared the proposed per diem amount 
to the cost of the minimum services mandated by us or by the local 
medical review policies (LMRP) used by their FIs.
    Response: We have not specified the specific daily components of a 
PHP. However, there is an edit in our claims processing system to 
identify claims that do not have at least three services, with at least 
one psychotherapy service (individual, group, or family therapy) for 
each day of PHP care. We have implemented this edit to ensure that PHPs 
meet the statutory requirement that they be intensive treatment 
programs provided in lieu of inpatient psychiatric hospital services. 
Claims with fewer than three services per day undergo medical review by 
the FIs to ensure that the patient is receiving intensive treatment. 
There may be legitimate reasons for a day on a claim to have fewer 
services, for example, where the patient leaves the program early to 
receive medical care. Medical review of these claims verifies that the 
patient requires and is receiving a PHP level of care.
    Comment: The commenters also questioned our requirement that 
psychotherapy services be conducted by a Master's level practitioner. 
One commenter questioned how a hospital could comply with the three 
services per day requirement when licensed clinical social worker (CSW) 
services are bundled into the per diem payment.
    Response: We do not require that a Master's prepared practitioner 
furnish psychotherapy services in a PHP. However, in accordance with 
section 1861(ff)(2)(A) of the Act, we require that practitioners who 
furnish psychotherapy services are authorized to do so by their States, 
through licensure, certification, or other official State processes. 
When a service is furnished by a practitioner who is not authorized by 
the State to furnish psychotherapy services, the service would not be 
recognized as a PHP service.
    With respect to billing by CSWs, the professional component of 
services furnished by CSWs to PHP patients is bundled into the per diem 
payment amount and no billing to the Part B carrier is permitted. The 
rationale for this policy was explained in the interim final regulation 
with comment period we published on February 11, 1994 (59 FR 6570).
    The OPPS is intended to pay PHP providers for the resources 
associated with sponsoring a PHP, for example, building maintenance, 
utilities, and support staff, including the cost of CSWs. Thus, where a 
PHP provider utilizes CSWs for psychotherapy services to PHP patients, 
payment for the professional costs of the CSW is made through the OPPS 
per diem payment. However, if a PHP utilizes psychiatrists, clinical 
psychologists, nurse practitioners, physician assistants, or clinical 
nurse specialists to furnish therapeutic services to PHP patients, the 
physician or practitioner may bill the Part B carrier for payment under 
the physician fee schedule for their professional services. When this 
occurs, the PHP provider may bill the FI under the OPPS for the 
facility resources associated with the psychotherapy service.
    We note that a physician or any of the practitioners specified in 
42 CFR 410.43(b) (including CSWs) may bill the Part B carrier for their 
professional services furnished to hospital outpatients who are not in 
a PHP. In this case, the hospital would bill the FI under the OPPS for 
the facility resources associated with the service furnished.
    Comment: Several commenters suggested alternative methodologies for 
paying PHP providers, such as linking per diem and outlier payments to 
the units of service furnished each day or paying providers the average 
of all PHP costs plus 40 percent, subject to final settlement based on 
the provider's cost.
    Response: We plan further analysis of the PHP data and may propose 
changes to the payment methodology for CY 2005. We note that OPPS is a 
prospective system and a methodology with interim payments subject to 
cost settlement would not be allowable under the statute.
    Comment: One commenter believes the sample used to determine the 
rates is skewed and represents a subset of the provider community that 
provides PHP services.
    Response: We do not agree that the sample is skewed. All facilities 
that submit claims for PHP services have been included in the 
development of the final rate.
3. Outlier Payments for PHPs
    In a related matter, the use of historical 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.
    In the August 12, 2003 proposed rule, we stated that given the 
difference in PHP charges between hospitals and CMHCs, we did not 
believe it was appropriate to make outlier payments to CMHCs using the 
outlier percentage target amount and threshold established for 
hospitals. Therefore, we proposed 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. Since CMHCs were projected 
to receive 0.36 percent of total OPPS payments in CY 2004, excluding 
outlier payments, we proposed 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 proposed to set the threshold 
for CY 2004 at 11.75 times the PHP APC payment amount. We proposed to 
apply the same outlier payment percentage that applies to hospitals. 
Therefore, for CY 2004, we

[[Page 63470]]

proposed to pay 50 percent of CMHC and hospital per diem costs over the 
threshold.
    Comment: Several commenters representing CMHCs suggested that in 
developing our proposed outlier policy, we made generalizations and 
overreacted to a few aberrant providers. Also, these commenters believe 
the per diem amount is insufficient and that outlier payments would 
provide the additional amounts they needed to stay in business until 
more representative data could be obtained and analyzed.
    Response: Based on our analysis of PHP claims data, nearly half of 
the CMHCs billing for PHP services in 2002 received outlier payments. 
The total dollar amount of outlier payments received by these CMHCs was 
nearly equal to the total amount all CMHCs received in per diem 
payments. Of those CMHCs that received outlier payments, 56 percent 
received an average of more than $200 per day in outlier payments, 30 
percent received more than $300 per day in outlier payments, 21 percent 
received more than $400 per day in outlier payments, and 11 percent 
received more than $500 per day in outlier payments.
    The outlier policy is intended to compensate providers for treating 
exceptionally resource-intensive patients. Outlier payments were never 
intended to be made for all patients and used as a supplement to the 
per diem payment amount. Our analysis showed that the CMHC average 
charge per day increased by 31 percent from CY 2001 to CY 2002. We do 
not believe this increase in charges correlates to an equivalent 
increase in CMHC costs. Rather, our analysis indicates that the 
increase in charges was made in order to qualify for outlier payments 
to cover CMHC operating expenses, not for patients who are 
exceptionally resource-intensive. We are concerned that if CMHCs 
continue this pattern of escalating charges, CMHCs will receive a 
disproportionate share of outlier payments compared to non-CMHCs that 
do not artificially inflate their charges, thereby limiting outlier 
money for truly deserving cases.
    Comment: Although one commenter supported our proposed outlier 
policy, most commenters, including major hospital associations, did not 
believe it was sound policy to create separate outlier thresholds based 
on site of service.
    Response: Applying the updated cost-to-charge ratios reduced the 
CMHC charges to better reflect their costs. We are concerned, however, 
that the impact of updated cost-to-charge ratios may be mitigated by 
future increases in charges. We proposed an outlier policy in 
consideration of the charges on the claims, the cost report data 
available, and the payments made to CMHCs. Our analysis indicates that 
CMHCs have dramatically increased their charges between CY 2001 and CY 
2002. Between CYs 2001 to 2002, CMHC average per diem charges increased 
by 31 percent. We believe that in most cases, these increases in 
charges were not related to a corresponding increase in costs, but 
rather were designed to enhance outlier payments. We believe the data 
may indicate a pattern of artificially inflated charges by CMHCs that 
needs to be addressed. Although we agree that establishing site of 
service differences is not generally the preferred approach, we 
continue to believe that establishing two separate outlier percentages 
is the most appropriate way to address the problem to account for the 
disparity between hospital and CMHC PHP per diem charges.
    For these reasons, for CY 2004, we are establishing a separate CMHC 
threshold. The threshold is based on the proportion of total OPPS 
payments CMHCs are estimated to receive in CY 2004. As stated earlier 
in this section, our analysis indicated that CMHCs were projected to 
receive 0.36 percent of total OPPS payments in CY 2004, excluding 
outlier payments. Therefore, we proposed 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 proposed to set the threshold 
for CY 2004 at 11.75 times the PHP APC payment amount. We have updated 
our simulations using the final CY 2004 PHP per diem rate. CMHCs are 
now projected to receive approximately 0.5 percent of estimated total 
OPPS payments in CY 2004, excluding outlier payments. We have 
calculated the CMHC outlier threshold to achieve that level of payment. 
The resulting threshold for CY 2004 is 3.65 percent times the APC 0033 
payment amount. We will apply the same outlier payment percentage that 
applies to hospitals. Therefore, for CY 2004, we will pay 50 percent of 
the difference between CMHC per diem costs and the CMHC outlier 
threshold amount. We intend to analyze whether a separate CMHC outlier 
threshold will continue to be appropriate in future updates.

XII. General Data, Billing, and Coding Issues

    We received a number of general comments about OPPS data and 
related issues to which we respond below. Not all coding questions are 
addressed, however. We do not believe that the final rule is the 
appropriate venue in which to address specific inquiries about billing.

OPPS Data

    Comment: A commenter indicated that it was difficult to model the 
August 12, 2003 proposed rule after its release and urged us to provide 
timely responses to questions about data, data files, and the specifics 
of the methodology used to generate relative weights, either by having 
data meetings or by clarifying the language in the final rule and 
median cost files. The commenter asked that we create a web-site to 
post responses to questions on data so that the information will be 
available for all to use. The commenter also asked that a number of 
data elements be added to the median cost file and the limited data set 
of claims that is available for public purchase.
    Response: We have tried to respond to questions on data related 
issues on a flow basis. However, staff limitations and the need to 
develop the final rule greatly restrict the amount of time that our 
staff can devote to replying to these questions. Moreover, creation and 
maintenance of a web-site to post answers to questions from a few 
people with special interests is not a good use of our limited staff 
resources. We would encourage interested parties who have suggestions 
for improving our data file clarity to contact us with those specifics.

Creation of a National Outpatient Coding Governing Body

    Comment: A commenter indicated that we should create an outpatient 
coding governing body that would educate providers regarding the 
correct use of codes, maintain a web-site on which all guidance on 
coding would be maintained, and oversee the Medicare fiscal 
intermediary interpretation of codes to ensure national uniformity 
across fiscal intermediaries.
    Response: The HCPCS codes most often used for payment under OPPS 
are CPT codes, which are created and owned by the American Medical 
Association (AMA). Providers should look to the many resources 
available from the AMA for education regarding the correct use of CPT 
codes. The alphanumeric HCPCS codes are created and owned by us but 
they form a very limited portion of the services payable under OPPS 
and, as providers have frequently asked, we attempt to eliminate 
alphanumeric codes whenever possible and to work with the AMA to create 
CPT codes for use in both the physician fee schedule and the OPPS.

[[Page 63471]]

We attempt to provide coding guidance on alphanumeric codes, which are 
usually created only when there is a coverage or payment decision and 
when there is no CPT code that describes the service being covered or 
paid. However, providers must look to the AMA for education and support 
in the use of the CPT codes that form the bulk of OPPS.
    Comment: We received one comment requesting that we publish updated 
addenda each quarter.
    Response: The addenda that are published annually online are an 
official public record that cannot be changed without going through the 
Federal Register. We provide the Addenda in Excel format for the 
convenience of users since it is difficult to manipulate data in pdf 
format.
    We also received a number of comments that were not relevant to the 
proposals made in the August 12, 2003 proposed rule. The commenters 
requested specific coding changes and requested clarification or 
guidance regarding certain billing requirements. Although we will 
provide answers to the questions raised, the final rule is not the 
appropriate venue for that guidance. We will consider the requests and 
suggestions provided, and will continue our ongoing efforts to 
formulate and publish billing instructions. Similarly, we will consult 
with our clinical experts regarding the suggestions made regarding 
coding of outpatient department procedures and other services.

Revenue Code Edits

    Comment: A commenter asked whether we permit fiscal intermediaries 
to impose CPT to revenue code edits. The commenter believes that CMS 
has said that providers may choose the revenue code that applies to the 
item or service being billed but that some fiscal intermediaries have 
imposed revenue code to CPT edits that prevent hospitals from billing 
the service under the revenue code that they believe is appropriate and 
that cause unnecessary and unfair payment denials.
    Response: We have issued some instructions that require that 
specific revenue codes be billed with certain HCPCS codes, such as 
specific revenues codes that must be used when billing for devices that 
qualify for pass-through payments. Where explicit instructions have not 
been issued, we instructed intermediaries to advise hospitals to report 
charges under the revenue code that will result in the charges being 
assigned to the same cost center to which the cost of those services 
are assigned in the cost report. However, we have not explicitly 
prohibited intermediaries from installing the revenue code to HCPCS 
code edits, so it is possible that certain edits are applied by some 
intermediaries and not others. The commenter did not provide examples 
of the edits that are causing what the commenter considers to be 
unnecessary and unfair payment denials.

New CPT Venous Access Codes

    Comment: A commenter indicated that CPT had revised its venous 
access codes and encouraged us to use external information to determine 
hospital acquisition costs for devices used in these procedures.
    Response: We carefully reviewed the new CPT codes for insertion of 
venous access devices and we assigned the new CPT codes to APCs based 
on our clinicians' view of the relative amount of hospital resources 
that the services, as described by the new codes, would use. We note 
that the new CPT codes represent longstanding services, albeit with new 
code descriptions and code numbers. Since these are new CPT codes 
(albeit for existing services), the APC and status indicator 
assignments are interim and subject to comment.

New ``NI'' Drug Codes

    There are several new HCPCS codes for drugs, biologicals, and 
radiopharmaceuticals that are new for 2004. Since these codes were not 
subject to public comment in the August 12, 2003 proposed rule, they 
have been assigned to code condition ``NI'' and are subject to public 
comments following the publication of this rule. Some of these new 
codes for drugs and radiopharmaceuticals are replacements for codes for 
which we have hospital cost data. In these cases, we cross-walked the 
data for the expired codes to the new codes to determine their 
packaging status and payment rates. For codes that did not have a 
predecessor, we had no means to determine associated hospital costs; 
therefore, we assigned the codes to packaged status for 2004. We 
reinforce the importance of billing for packaged codes with appropriate 
charges so that we can collect cost data on these codes to use for 
future rate setting. We invite comments on the status indicators that 
have been assigned to these codes. Commenters who would like us to 
consider their cost data for these codes may submit verifiable external 
information according to the criteria set forth in the August 12, 2003 
proposed rule.

Status Indicator Changes for Services Currently Packaged

    Comment: A commenter asked us to pay separately for the following 
services for which payment is currently packaged into payment for other 
services. Commenters asked that we change the SI for CPT code 36540, 
collection of blood from an implanted access device, to a payable SI 
because otherwise hospitals would be forced to bill an E&M code when 
this is the only service provided. Commenters asked that we change the 
SI for 36600, withdrawal of arterial blood, from an ``N'' to a ``T'' 
since it requires more effort and risk than a simple venipuncture 
(which is paid separately under the clinical laboratory fee schedule). 
Commenters asked that we change the SI for 90471 and 90472, vaccine 
administration and each subsequent administration, from N to X since 
patients may present only to receive the vaccine because otherwise 
hospitals must bill an E&M to receive any payment. Commenters asked 
that we change the SI for CPT codes 94760, 94761, and 94762, Pulse 
oximetry, multiple and continuous, from ``N'' to ``X'' because these 
may be the only services the patient receives and, in the case of CPT 
code 94762, the service continues for a long period of time. Commenters 
also asked that we change the SI for the following services from ``N'' 
to ``C'' since they are add-ons to services that are inpatient only: 
61316, 61517, 62148, and 62160.
    Response: We will carefully consider the status indicator changes 
for the currently packaged services for which the commenter wants 
separate payment for 2005 OPPS. The commenters did not provide enough 
information or empirical evidence to convince us of the need for these 
changes and so we would like to have the opportunity to receive input 
about this from the APC Panel. We have revised the SI for the following 
codes from ``N'' to a ``C'' in recognition that if there are charges 
for these codes which are add-ons to inpatient only procedures, they 
are billing errors and should not be packaged into the median costs for 
other procedures on the claim that can be paid in the outpatient 
department: 61316, 61517, 62148, and 62160.

XIII. Provisions of the Final Rule With Comment Period for 2004

A. Changes Required By Statute

    We made the following changes to implement statutory requirements:
    [sbull] Added APCs, deleted APCs, and modified the composition of 
some existing APCs.

[[Page 63472]]

    [sbull] Recalibrated the relative payment weights of the APCs.
    [sbull] Updated the conversion factor and the wage index.
    [sbull] Revised the APC payment amounts to reflect the APC 
reclassifications, the recalibration of payment weights, and the other 
required updates and adjustments.
    [sbull] Ceased 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] Ceased transitional outpatient payments (TOPS payments) for 
all hospitals paid under OPPS except for cancer hospitals and 
children's hospitals.

B. Additional Changes

    We made the following additional changes to the OPPS:
    [sbull] Adjusted payment to moderate the effects of decreased 
median costs for non-pass-through drugs, biologicals, and 
radiopharmaceuticals.
    [sbull] Changed status indicators for HCPCS codes.
    [sbull] Listed midyear and proposed HCPCS codes that are paid under 
OPPS.
    [sbull] Allocated a portion of the outlier percentage target amount 
to CMHCs and created a separate threshold for outlier payments for 
partial hospitalization services.
    [sbull] Created methodology and payment rates for separately 
payable drugs and radiopharmaceuticals for 2004.
    [sbull] Changed the status indicator and payment amount for P901 by 
assigning it to APC 0957 (Platelet concentrate) with a payment rate of 
$37.30.

C. Major Changes From the Proposed Rule

    [sbull] We will apply a $50 threshold in lieu of the proposed $150 
threshold in determining which drugs to pay for separately.
    [sbull] We will set payment for all except two orphan drugs that 
meet our criteria for special payment under the OPPS at 88 percent of 
their AWP as established in the April 2003 single drug pricer (SDP). 
Based on widely available market prices for two orphan drugs, we will 
set the payment for these two orphan drugs at 94 percent of their AWP.
    [sbull] We will set payment rates for 2004 for blood and blood 
products at 2003 payment rates.

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 final 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 Federal Register documents, we are not able to acknowledge 
or respond to them individually. We will consider all comments we 
receive by the date and time specified in the DATES section of this 
preamble, and, if we proceed with a subsequent document, we will 
respond to comments in the preamble to that document.

XVI. Regulatory Impact Analysis

A. General

    We have examined the impacts of this final rule as required by 
Executive Order 12866 (September 1993, Regulatory Planning and Review), 
the Regulatory Flexibility Act (RFA) (September 16, 1980, Pub. L. 96-
354), section 1102(b) of the Social Security Act, the Unfunded Mandates 
Reform Act of 1995 (Pub. L. 104-4), and Executive Order 13132.
    Executive Order 12866 (as amended by Executive Order 13258, which 
merely reassigns responsibility of duties) directs agencies to assess 
all costs and benefits of available regulatory alternatives and, if 
regulation is necessary, to select regulatory approaches that maximize 
net benefits (including potential economic, environmental, public 
health and safety effects, distributive impacts, and equity). A 
regulatory impact analysis (RIA) must be prepared for major rules with 
economically significant effects ($100 million or more in any 1 year).
    We estimate the effects of the provisions that will be implemented 
by this final rule will result in expenditures exceeding $100 million 
in any 1 year. We estimate the total increase (from changes in the 
final rule as well as enrollment, utilization, and case mix changes) in 
expenditures under the OPPS for CY 2004 compared to CY 2003 to be 
approximately $0.607 billion. Therefore, this final rule is an 
economically significant rule under Executive Order 12866, and a major 
rule under 5 U.S.C. 804(2).
    The RFA requires agencies to determine whether a rule will have a 
significant economic impact on a substantial number of small entities. 
For purposes of the RFA, small entities include small businesses, 
nonprofit organizations, and government agencies. Most hospitals and 
most other providers and suppliers are small entities, either by 
nonprofit status or by having revenues of $6 million to $29 million in 
any 1 year (see 65 FR 69432).
    For purposes of the RFA, we have determined that approximately 37 
percent of hospitals will be considered small entities according to the 
Small Business Administration (SBA) size standards. We do not have data 
available to calculate the percentages of entities in the 
pharmaceutical preparation manufacturing, biological products, or 
medical instrument industries that will 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

[[Page 63473]]

beds (or New England County Metropolitan Area (NECMA)). Section 601(g) 
of the Social Security Amendments of 1983 (Pub. L. 98-21) designated 
hospitals in certain New England counties as belonging to the adjacent 
NECMA. Thus, for purposes of the OPPS, we classify these hospitals as 
urban hospitals. We believe that the changes in this final rule will 
affect both a substantial number of rural hospitals as well as other 
classes of hospitals and that the effects on some may be significant. 
Therefore, we conclude that this final rule will 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 final rule will not 
mandate any requirements for State, local, or tribal governments. This 
final rule will 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 final rule that imposes 
substantial direct costs on State and local governments, preempts State 
law, or otherwise has Federalism implications.
    We have examined this final rule in accordance with Executive Order 
13132, Federalism, and have determined that it will not have an impact 
on the rights, roles, and responsibilities of State, local or tribal 
governments. The impact analysis (see Table 15) shows that payments to 
governmental hospitals (including State, local, and tribal governmental 
hospitals) will increase by 4.9 percent under the final rule.

B. Changes in This Final Rule

    We are making several changes to the OPPS that are required by the 
statute. We are required under section 1833(t)(3)(C)(ii) of the Act to 
update annually the conversion factor used to determine the APC payment 
rates. We are also required under section 1833(t)(9)(A) of the Act to 
revise, not less often than annually, the wage index and other 
adjustments. In addition, we must review the clinical integrity of 
payment groups and weights at least annually. Accordingly, in this 
final rule, we are updating the conversion factor and the wage index 
adjustment for hospital outpatient services furnished beginning January 
1, 2004 as we discuss in sections IX and VII, respectively, of this 
final rule. We are also revising the relative APC payment weights based 
on claims data from April 1, 2002 through December 31, 2002. Finally, 
we are removing two devices and eight drugs and biological agents from 
pass-through payment status. Alternatives to the changes we proposed 
and why we did not accept them are discussed throughout this final 
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 final rule, the change to the conversion factor as 
provided by statute will increase total OPPS payments by 4.5 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) will not increase OPPS payments because the OPPS is budget 
neutral. However, the wage index and APC weight changes will change the 
distribution of payments within the budget neutral system as shown in 
Table 15 and described in more detail in this section. The overall 4.5 
percent increase does not take into account the expiration of 
transitional corridor payments or the end of the hold harmless 
provisions for small rural hospitals.

A. Alternatives Considered

    Alternatives to the changes we are making and the reasons that we 
have chosen the options we have are discussed throughout this final 
rule. Some of the major issues discussed in this rule and the sections 
in which they are discussed follow:

------------------------------------------------------------------------
                   Issue                          Preamble section
------------------------------------------------------------------------
Drug packaging threshold..................  VI.B.2.
Drug administration.......................  VI.B.4.
Adjustment of median costs................  II.B.
Outlier policy............................  X.A.
Device coding.............................  V.C.
Payment adjustment for small rural          X.B.
 hospitals.
Payment for orphan drugs, generic drugs     VI.B.
 and blood.
APC changes...............................  II.A and III.C.
------------------------------------------------------------------------

Conclusion
    It is clear that the changes in this final rule will affect both a 
substantial number of rural hospitals as well as other classes of 
hospitals, and the effects on some may be significant. Therefore, the 
discussion below, in combination with the rest of this final rule, 
constitutes a regulatory impact analysis.
    The OPPS rates for CY 2004 will have, overall, a positive effect 
for every category of hospital. These changes in the OPPS for 2004 will 
result in an overall 4.5 percent increase in Medicare payments to 
hospitals, exclusive of outlier and transitional pass-through payments. 
We also noted that both the overall 4.5 percent increase and the 
percent changes to individual classes of hospitals depicted in Table 15 
are exclusive of any impacts to those hospitals that would result from 
the expiration of the transitional corridor payments or the end of the 
hold harmless provision for small rural hospitals. 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. We also note that both the overall 4.5 percent increase and 
the percent changes to individual classes of hospitals depicted in 
Table 15 are exclusive of any impacts to those hospitals that would 
result from the expiration of the transitional corridor payments or the 
end of the hold harmless provision for small rural hospitals. The 
impact of the wage and recalibration changes does vary somewhat by 
hospital group. Estimates of these impacts are displayed on Table 15.
    The overall projected increase in payments for urban hospitals is 
slightly lower (4.3 percent) than the average increase for all 
hospitals (4.5 percent) while the increase for rural hospitals is 
slightly greater (4.9 percent) than the average increase. Again, as 
noted above, these numbers do not include the effect of the expiration 
of the transitional hold harmless payments to small rural hospitals. 
The introduction of a new wage index combined with changes to the APC 
structure will result in small distributional changes for all 
categories of hospitals. Rural hospitals will gain 0.2 percent from the 
wage index change and another 0.2 percent as a result of APC changes. 
Large urban hospitals will lose 0.2 percent from the APC change, 
whereas ``other'' urban hospitals show an increase of 0.1 percent from 
the APC changes. A discussion of the distribution of outlier payments 
that we project under this final rule can be found under section XV.E 
below. Table 16 presents the outlier distribution that we expect to see 
under this final rule.

[[Page 63474]]

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 do not make adjustments for future changes in variables 
such as service volume, service mix, or number of encounters.

D. Estimated Impacts of This Final Rule on Hospitals

    The OPPS is a budget neutral payment system under which the 
increase to the total payments made under OPPS is limited by the 
increase to the conversion factor set under the methodology in the 
statute. The impact tables show the redistribution of hospital payments 
among providers as a result of a new wage index and APC structure. In 
some cases, under this final rule, hospitals will receive more total 
payment than in 2003 while in other cases they will receive less total 
payment than they received in 2003. The impact of this final rule will 
depend on a number of factors, most significant of which are the mix of 
services furnished by a hospital (for example, how the APCs for the 
hospital's most frequently furnished services will change) and the 
impact of the wage index changes on the hospital.
    Column 4 in Table 15 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 final 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 final 2004 OPPS rates that is summarized in Table 15. For 
that reason, the total number of hospitals included in Table 15 (4,378) 
is lower than in previous years. CAHs are excluded from the OPPS.
    To a very limited extent, wage index changes favor rural hospital 
categories. Large urban hospitals with greater than 500 beds show the 
largest percent decrease (-3.0) attributable to wage index changes. 
Rural hospitals show modest increases of 0.2 percent for most bed sizes 
but show the largest gains for categories with fewer than 50 beds or 
150 to 199 beds where the wage index change results in a 0.4 percent 
increase. Rural hospitals located in Puerto Rico show the largest 
negative impact (-2.5 percent) due to changes in the wage index. 
Hospitals located in the Middle Atlantic region also experience a large 
negative impact -0.6 percent 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 (-0.8 percent). Conversely, urban hospitals 
with greater than 199 beds show a decrease attributed to APC 
recalibration. Urban hospitals in excess of 500 beds show a 0.5 percent 
decrease 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 between 5,000 and 20,999 are projected to 
experience increases larger than 5.0 percent. Urban hospitals that 
provide low-volume services show similar rates of increases (5.0 
percent). Conversely, urban and rural hospitals providing more than 
21,000 services are projected to experience a rate of increase in the 
4.0 to 4.7 percent range.
    Major teaching hospitals are projected to experience a smaller 
increase in payments (3.7 percent) than the aggregate for all hospitals 
(4.5 percent) due to negative impacts from both the wage index (-0.4 
percent) and APC recalibration (-0.4 percent). Hospitals with less 
intensive teaching programs are projected to experience an overall 
increase (4.5 percent) that is equal to the average for all hospitals. 
There is little difference in impact among hospitals that serve low-
income patients where increases in payments range from 4.3 to 4.7 
percent higher than in 2003.
    Psychiatric hospitals and long term care facilities show the 
largest increase in payment rates among all categories of hospital 
providers. Psychiatric hospitals show an increase of 18.2 percent as a 
result of an increase in payment rates for partial hospitalization 
programs and for other services such as psychotherapy. Also, payments 
made to psychiatric facilities represent a small portion of total 
spending for OPPS, approximately 60.6 million dollars for 2004. Long-
term care facilities show a growth rate of 7.5 percent over payments 
made in 2003. We believe this is the result of a policy change that 
removes payments made for therapy services from the physician fee 
schedule to the hospital outpatient prospective payment system. 
Payments made for long-term care account for a small amount of OPPS 
payments, approximately 14.5 million for 2004.

             Table 15.--Impact of Change for CY 2004 Hospital Outpatient Prospective Payment System
    [Percent change in total payments to hospital (program and beneficiary); does not include hold harmless,
                            corridor, outlier or transitional pass-through payments]
----------------------------------------------------------------------------------------------------------------
                                                               Number of
                                                               hospitals     New Wage   APC changes  All CY 2004
                                                                  (1)       index (2)       (3)      changes (4)
----------------------------------------------------------------------------------------------------------------
ALL HOSPITALS...............................................        4,378            0            0          4.5
NON-TEFRA HOSPITALS.........................................        3,854            0         -0.1          4.4
URBAN HOSPS.................................................        2,383         -0.1         -0.1          4.3
LARGE URBAN (GT 1 MILL.)....................................        1,377            0         -0.2          4.2
OTHER URBAN (LE 1 MILL.)....................................        1,006         -0.1          0.1          4.4
RURAL HOSPS.................................................        1,471          0.2          0.2          4.9
BEDS (URBAN)
    0-99 BEDS...............................................          538          0.1          0.6          5.2
    100-199 BEDS............................................          878         -0.1          0.3          4.8
    200-299 BEDS............................................          454         -0.1         -0.1          4.3
    300-499 BEDS............................................          363          0.1         -0.4          4.2
    500 + BEDS..............................................          150         -0.3         -0.5          3.7
BEDS (RURAL)
    0-49 BEDS...............................................          699          0.4          0.6          5.6

[[Page 63475]]

 
    50-99 BEDS..............................................          454          0.2          0.6          5.3
    100-149 BEDS............................................          190          0.2            0          4.7
    150-199 BEDS............................................           66          0.4          0.1          4.9
    200 + BEDS..............................................           62          0.1         -0.8          3.7
VOLUME (URBAN)
    LT 5,000 Lines..........................................          186          0.1            1          5.6
    5,000-10,999 Lines......................................          350            0          0.9          5.4
    11,000-20,999 Lines.....................................          499         -0.1          0.7          5.1
    21,000-42,999 Lines.....................................          720          0.1          0.1          4.6
    GT 42,999 Lines.........................................          628         -0.1         -0.4            4
VOLUME (RURAL)
    LT 5,000 Lines..........................................          364          0.3            0          4.8
    5,000-10,999 Lines......................................          466          0.3          0.5          5.3
    11,000-20,999 Lines.....................................          346          0.2          0.7          5.4
    21,000-42,999 Lines.....................................          234          0.3            0          4.7
    GT 42,999 Lines.........................................           61          0.1         -0.4          4.2
REGION (URBAN)
    NEW ENGLAND.............................................          128         -0.3         -0.3          3.9
    MIDDLE ATLANTIC.........................................          369         -0.6         -0.5          3.4
    SOUTH ATLANTIC..........................................          353            0            0          4.5
    EAST NORTH CENT.........................................          400         -0.2         -0.2            4
    EAST SOUTH CENT.........................................          149          0.3          0.2            5
    WEST NORTH CENT.........................................          163          0.2          0.5          5.1
    WEST SOUTH CENT.........................................          295          0.1          0.1          4.7
    MOUNTAIN................................................          122          0.8            0          5.3
    PACIFIC.................................................          364          0.3         -0.2          4.6
    PUERTO RICO.............................................           40            0          4.8          9.5
REGION (RURAL)
    NEW ENGLAND.............................................           36          0.4          1.7          6.7
    MIDDLE ATLANTIC.........................................           65         -0.6          0.9          4.9
    SOUTH ATLANTIC..........................................          216          0.1            0          4.6
    EAST NORTH CENT.........................................          193          0.2            0          4.7
    EAST SOUTH CENT.........................................          227          0.2         -0.2          4.5
    WEST NORTH CENT.........................................          247          0.8          0.5          5.8
    WEST SOUTH CENT.........................................          269          0.4          0.2          5.2
    MOUNTAIN................................................          123          0.2         -0.1          4.6
    PACIFIC.................................................           90          0.4         -0.9          3.9
    PUERTO RICO.............................................            5         -2.5          0.3          2.2
TEACHING STATUS
    NON-TEACHING............................................        2,805          0.1          0.1          4.7
    MINOR...................................................          761          0.1         -0.1          4.5
    MAJOR...................................................          288         -0.4         -0.4          3.7
DSH PATIENT (PERCENT)
    0.......................................................           10            3          3.8         11.6
    GT 0-0.10...............................................          897            0         -0.2          4.3
    0.10-0.16...............................................          837         -0.1            0          4.4
    0.16-0.23...............................................          787          0.1         -0.2          4.3
    0.23-0.35...............................................          744            0          0.1          4.5
    GE 0.35.................................................          579         -0.1          0.2          4.7
URBAN IME/DSH
    IME & DSH...............................................          965         -0.1         -0.2          4.1
    IME/NO DSH..............................................            1         -0.1          8.5         13.3
    NO IME/DSH..............................................        1,409            0          0.1          4.6
    NO IME/NO DSH...........................................            8            3          3.7         11.6
RURAL HOSP. TYPES
    NO SPECIAL STATUS.......................................          469          0.1          0.2          4.9
    RRC.....................................................          161          0.3         -0.5          4.3
    SCH/EACH................................................          489          0.3          0.5          5.4
    MDH.....................................................          250          0.3          1.6          6.5
    SCH AND RRC.............................................           75          0.1         -0.3          4.3
TYPE OF OWNERSHIP
    VOLUNTARY...............................................        2,370         -0.1         -0.2          4.2
    PROPRIETARY.............................................          696          0.2          0.5          5.2
    GOVERNMENT..............................................          788          0.2          0.3          4.9
SPECIALTY HOSPITALS
    EYE AND EAR.............................................           13         -0.6          1.8          5.7
    CANCER..................................................           11            0         -1.2          3.2
TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES)
    REHAB...................................................          155          0.5         -1.1          3.9

[[Page 63476]]

 
    PSYCH...................................................          175          0.8         12.2         18.2
    LTC.....................................................          150          1.6          1.2          7.5
    CHILDREN................................................           44            0          0.5         4.9
----------------------------------------------------------------------------------------------------------------
 1. Some data necessary to classify hospitals by category were missing; thus, the total number of hospitals in
  each category may not equal the national total.
 2. This column shows the impact of updating the wage index used to calculate payment by applying the FY 2004
  hospital inpatient wage index after geographic reclassification by the Medicare Geographic Classification
  Review Board. The appropriate hospital inpatient wage index appears in a correction notice published in the
  Federal Register on October 6, 2003 68FR 57732.
 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 CY 2003 to CY 2004, 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.
 5. Volume is expressed in terms of the number of lines that appear on a claim.

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. Table 16 below 
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 
will be paid under the OPPS in 2004, that approximately 95 percent of 
hospitals will receive outlier payments. For the majority of provider 
groups, the table shows outlier payments as a percent of total payments 
in the 1.5 to 3.5 percent range. Two categories, Rehabilitation and 
Children's hospitals are the exception with outlier to total payment 
ratios of 6.7 and 11.9 percent respectively. We would point out that 
these hospital types represent a small number of providers with a low 
volume of services. 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 16.--Distribution of Outlier Payments for CY 2004 Hospital Outpatient Prospective Payment
----------------------------------------------------------------------------------------------------------------
                                                                                                       Outlier
                                                                                         Number of   payments as
                                                               Number of    Percent of   hospitals    a percent
                                                               hospitals      total         with       of total
                                                                            hospitals     outliers     payments
                                                                                                      (percent)
----------------------------------------------------------------------------------------------------------------
ALL HOSPITALS...............................................        4,378          100        4,144          2.0
NON-TEFRA HOSPITALS.........................................        3,854           88        3,841          2.0
URBAN HOSPS.................................................        2,383         54.4        2,372          2.1
LARGE URBAN (GT 1 MILL.)....................................        1,377         31.4        1,371          2.3
OTHER URBAN (LE 1 MILL.)....................................        1,006           23        1,001          1.8
RURAL HOSPS.................................................        1,471         33.6        1,469          1.7
BEDS (URBAN)
    0-99 BEDS...............................................          538         12.2          529          2.5
    100-199 BEDS............................................          878           20          877          1.8
    200-299 BEDS............................................          454         10.4          453          1.9
    300-499 BEDS............................................          363          8.2          363          2.1
    500 + BEDS..............................................          150          3.4          150          2.6
BEDS (RURAL)
    0-49 BEDS...............................................          699           16          698          2.3
    50-99 BEDS..............................................          454         10.4          453          1.9
    100-149 BEDS............................................          190          4.4          190          1.4
    150-199 BEDS............................................           66          1.6           66          1.7
    200 + BEDS..............................................           62          1.4           62          1.4
VOLUME (URBAN)
    LT 5,000................................................          186          4.2          175          3.2
    5,000-10,999............................................          350            8          350          3.0
    11,000-20,999...........................................          499         11.4          499          2.1
    21,000-42,999...........................................          720         16.4          720          2.0
    GT 42,999...............................................          628         14.4          628          2.1
VOLUME (RURAL)
    LT 5,000................................................          364          8.4          362          3.1
    5,000-10,999............................................          466         10.6          466          2.2
    11,000-20,999...........................................          346            8          346          1.8
    21,000-42,999...........................................          234          5.4          234          1.5
    GT 42,999...............................................           61          1.4           61          1.5
REGION (URBAN)
    NEW ENGLAND.............................................          128            3          127          1.8

[[Page 63477]]

 
    MIDDLE ATLANTIC.........................................          369          8.4          369          3.1
    SOUTH ATLANTIC..........................................          353            8          353          1.9
    EAST NORTH CENT.........................................          400          9.2          396          1.9
    EAST SOUTH CENT.........................................          149          3.4          148          1.4
    WEST NORTH CENT.........................................          163          3.8          163          1.6
    WEST SOUTH CENT.........................................          295          6.8          295          2.4
    MOUNTAIN................................................          122          2.8          120          1.9
    PACIFIC.................................................          364          8.4          361          2.0
    PUERTO RICO.............................................           40            1           40          0.6
REGION (RURAL)
    NEW ENGLAND.............................................           36          0.8           36          2.2
    MIDDLE ATLANTIC.........................................           65          1.4           65          1.6
    SOUTH ATLANTIC..........................................          216            5          215          1.6
    EAST NORTH CENT.........................................          193          4.4          193          1.6
    EAST SOUTH CENT.........................................          227          5.2          227          1.2
    WEST NORTH CENT.........................................          247          5.6          246          1.8
    WEST SOUTH CENT.........................................          269          6.2          269          1.8
    MOUNTAIN................................................          123          2.8          123          2.8
    PACIFIC.................................................           90            2           90          2.4
    PUERTO RICO.............................................            5          0.2            5          1.0
TEACHING STATUS
    NON-TEACHING............................................        2,805           64        2,793          1.8
    MINOR...................................................          761         17.4          760          1.7
    MAJOR...................................................          288          6.6          288          3.0
DSH PATIENT (PERCENT)
    0.......................................................           10          0.2            8          3.5
    GT 0-0.10...............................................          897         20.4          892          1.9
    0.10-0.16...............................................          837         19.2          837          1.8
    0.16-0.23...............................................          787           18          787          1.7
    0.23-0.35...............................................          744           17          741          2.3
    GE 0.35.................................................          579         13.2          576          2.9
URBAN IME/DSH
    IME & DSH...............................................          965           22          965          2.3
    IME/NO DSH..............................................            1            0            0          0.0
    NO IME/DSH..............................................        1,409         32.2        1,400          1.8
    NO IME/NO DSH...........................................            8          0.2            7          3.5
RURAL HOSP. TYPES
    NO SPECIAL STATUS.......................................          469         10.8          467          1.8
    RRC.....................................................          161          3.6          161          1.4
    SCH/EACH................................................          489         11.2          489          2.1
    MDH.....................................................          250          5.8          250          2.0
    SCH AND RRC.............................................           75          1.8           75          1.5
TYPE OF OWNERSHIP
    VOLUNTARY...............................................        2,370         54.2        2,366          1.9
    PROPRIETARY.............................................          696         15.8          689          2.0
    GOVERNMENT..............................................          788           18          786          2.5
SPECIALTY HOSPITALS
    EYE AND EAR.............................................           13          0.2           13          2.7
    CANCER..................................................           11          0.2           11          3.9
TEFRA HOSPITALS (NOT INCLUDED ON OTHER LINES)
    REHAB...................................................          155          3.6          103          6.7
    PSYCH...................................................          175            4           59          0.5
    LTC.....................................................          150          3.4           98          2.5
    CHILDREN................................................           44            1           43         11.9
----------------------------------------------------------------------------------------------------------------

F. Estimated Impacts of This Final Rule on Beneficiaries

    For services for which the beneficiary pays a coinsurance of 20 
percent of the payment rate, the beneficiary share of payment will 
increase for services for which OPPS payments will rise and will 
decrease for services for which OPPS payments will fall. For example, 
for a mid-level office visit (APC 0601), the minimum unadjusted co-
payment in 2003 was $10.11; under this final rule, the minimum 
unadjusted co-payment for APC 601 will be $10.71 because the OPPS 
payment for the service will increase under this final rule. For some 
services (those services for which a national unadjusted co-payment 
amount is shown in Addendum B) the beneficiary co-payment is frozen 
based on historic data and will not change, and will therefore present 
no potential impact on beneficiaries.

[[Page 63478]]

    However, in all cases, the statute limits beneficiary liability for 
co-payment for a service to the inpatient hospital deductible for the 
applicable year. This amount is $876 for 2004. In general, the impact 
of this final rule on beneficiaries will vary based on the service the 
beneficiary receives and whether the co-payment 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.


(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)
    Dated: October 27, 2003.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
    Approved: October 29, 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...................     0.4237       $23.12         $7.09         $4.62
                   Photochemotherapy.
0002............  Level I Fine Needle   T...................     0.8083       $44.10  ............         $8.82
                   Biopsy/Aspiration.
0003............  Bone Marrow Biopsy/   T...................     2.3229      $126.74  ............        $25.35
                   Aspiration.
0004............  Level I Needle        T...................     1.5882       $86.65        $22.36        $17.33
                   Biopsy/ Aspiration
                   Except Bone Marrow.
0005............  Level II Needle       T...................     3.2698      $178.40        $71.59        $35.68
                   Biopsy/Aspiration
                   Except Bone Marrow.
0006............  Level I Incision &    T...................     1.6527       $90.17        $23.26        $18.03
                   Drainage.
0007............  Level II Incision &   T...................    11.8633      $647.27  ............       $129.45
                   Drainage.
0008............  Level III Incision    T...................    19.4831    $1,063.02  ............       $212.60
                   and Drainage.
0009............  Nail Procedures.....  T...................     0.6652       $36.29         $8.34         $7.26
0010............  Level I Destruction   T...................     0.6480       $35.36        $10.08         $7.07
                   of Lesion.
0011............  Level II Destruction  T...................     2.2217      $121.22        $27.88        $24.24
                   of Lesion.
0012............  Level I Debridement   T...................     0.7694       $41.98        $11.18         $8.40
                   & Destruction.
0013............  Level II Debridement  T...................     1.1272       $61.50        $14.20        $12.30
                   & Destruction.
0015............  Level III             T...................     1.5968       $87.12        $20.35        $17.42
                   Debridement &
                   Destruction.
0016............  Level IV Debridement  T...................     2.5724      $140.35        $57.31        $28.07
                   & Destruction.
0017............  Level VI Debridement  T...................    16.3697      $893.15       $227.84       $178.63
                   & Destruction.
0018............  Biopsy of Skin/       T...................     0.9178       $50.08        $16.04        $10.02
                   Puncture of Lesion.
0019............  Level I Excision/     T...................     3.9493      $215.48        $71.87        $43.10
                   Biopsy.
0020............  Level II Excision/    T...................     7.0842      $386.52       $113.25        $77.30
                   Biopsy.
0021............  Level III Excision/   T...................    14.3594      $783.46       $219.48       $156.69
                   Biopsy.
0022............  Level IV Excision/    T...................    18.7932    $1,025.38       $354.45       $205.08
                   Biopsy.
0023............  Exploration           T...................     2.8141      $153.54        $40.37        $30.71
                   Penetrating Wound.
0024............  Level I Skin Repair.  T...................     1.6850       $91.94        $33.10        $18.39
0025............  Level II Skin Repair  T...................     5.1912      $283.24       $107.00        $56.65
0027............  Level IV Skin Repair  T...................    15.8990      $867.47       $329.72       $173.49
0028............  Level I Breast        T...................    17.6584      $963.46       $303.74       $192.69
                   Surgery.
0029............  Level II Breast       T...................    30.1167    $1,643.20       $632.64       $328.64
                   Surgery.
0030............  Level III Breast      T...................    37.3083    $2,035.58       $763.55       $407.12
                   Surgery.
0032............  Insertion of Central  T...................    11.4907      $626.94  ............       $125.39
                   Venous/Arterial
                   Catheter.
0033............  Partial               P...................     5.2569      $286.82  ............        $57.36
                   Hospitalization.
0035............  Placement of          T...................     0.1691        $9.23         $2.79         $1.85
                   Arterial or Central
                   Venous Catheter.
0036............  Level II Fine Needle  T...................     1.5170       $82.77  ............        $16.55
                   Biopsy/Aspiration.
0037............  Level III Needle      T...................     9.8921      $539.72       $237.45       $107.94
                   Biopsy/Aspiration
                   Except Bone Marrow.
0039............  Implantation of       S...................   235.1866   $12,832.02  ............     $2,566.40
                   Neurostimulator.
0040............  Level II              S...................    52.1002    $2,842.64  ............       $568.53
                   Implantation of
                   Neurostimulator
                   Electrodes.
0041............  Level I Arthroscopy.  T...................    27.3819    $1,493.98  ............       $298.80
0042............  Level II Arthroscopy  T...................    43.0808    $2,350.53       $804.74       $470.11
0043............  Closed Treatment      T...................     1.9074      $104.07  ............        $20.81
                   Fracture Finger/Toe/
                   Trunk.
0045............  Bone/Joint            T...................    13.5889      $741.42       $268.47       $148.28
                   Manipulation Under
                   Anesthesia.
0046............  Open/Percutaneous     T...................    32.5581    $1,776.40       $535.76       $355.28
                   Treatment Fracture
                   or Dislocation.
0047............  Arthroplasty without  T...................    29.9582    $1,634.55       $537.03       $326.91
                   Prosthesis.
0048............  Arthroplasty with     T...................    51.4609    $2,807.76       $695.60       $561.55
                   Prosthesis.
0049............  Level I               T...................    19.6046    $1,069.65  ............       $213.93
                   Musculoskeletal
                   Procedures Except
                   Hand and Foot.
0050............  Level II              T...................    24.8651    $1,356.66  ............       $271.33
                   Musculoskeletal
                   Procedures Except
                   Hand and Foot.
0051............  Level III             T...................    34.5144    $1,883.14  ............       $376.63
                   Musculoskeletal
                   Procedures Except
                   Hand and Foot.
0052............  Level IV              T...................    42.7126    $2,330.44  ............       $466.09
                   Musculoskeletal
                   Procedures Except
                   Hand and Foot.
0053............  Level I Hand          T...................    14.8831      $812.04       $253.49       $162.41
                   Musculoskeletal
                   Procedures.
0054............  Level II Hand         T...................    24.2456    $1,322.86  ............       $264.57
                   Musculoskeletal
                   Procedures.
0055............  Level I Foot          T...................    18.7205    $1,021.41       $355.34       $204.28
                   Musculoskeletal
                   Procedures.
0056............  Level II Foot         T...................    25.3930    $1,385.47       $405.81       $277.09
                   Musculoskeletal
                   Procedures.
0057............  Bunion Procedures...  T...................    25.5035    $1,391.50       $475.91       $278.30
0058............  Level I Strapping     S...................     1.0931       $59.64  ............        $11.93
                   and Cast
                   Application.
0060............  Manipulation Therapy  S...................     0.2788       $15.21  ............         $3.04
0068............  CPAP Initiation.....  S...................     1.0807       $58.96        $29.48        $11.79
0069............  Thoracoscopy........  T...................    28.9392    $1,578.95       $591.64       $315.79
0070............  Thoracentesis/Lavage  T...................     3.0717      $167.60  ............        $33.52
                   Procedures.
0071............  Level I Endoscopy     T...................     0.8799       $48.01        $12.89         $9.60
                   Upper Airway.

[[Page 63479]]

 
0072............  Level II Endoscopy    T...................     1.7613       $96.10        $26.68        $19.22
                   Upper Airway.
0073............  Level III Endoscopy   T...................     3.4541      $188.46        $73.38        $37.69
                   Upper Airway.
0074............  Level IV Endoscopy    T...................    13.9480      $761.02       $295.70       $152.20
                   Upper Airway.
0075............  Level V Endoscopy     T...................    20.3815    $1,112.04       $445.92       $222.41
                   Upper Airway.
0076............  Level I Endoscopy     T...................     9.2346      $503.85       $189.82       $100.77
                   Lower Airway.
0077............  Level I Pulmonary     S...................     0.2837       $15.48         $7.74         $3.10
                   Treatment.
0078............  Level II Pulmonary    S...................     0.7917       $43.20        $14.55         $8.64
                   Treatment.
0079............  Ventilation           S...................     2.1494      $117.27  ............        $23.45
                   Initiation and
                   Management.
0080............  Diagnostic Cardiac    T...................    36.0160    $1,965.07       $838.92       $393.01
                   Catheterization.
0081............  Non-Coronary          T...................    35.0285    $1,911.19  ............       $382.24
                   Angioplasty or
                   Atherectomy.
0082............  Coronary Atherectomy  T...................   110.2196    $6,013.69     $1,293.59     $1,202.74
0083............  Coronary Angioplasty  T...................    59.2047    $3,230.27  ............       $646.05
                   and Percutaneous
                   Valvuloplasty.
0084............  Level I               S...................    10.5226      $574.12  ............       $114.82
                   Electrophysiologic
                   Evaluation.
0085............  Level II              T...................    35.4126    $1,932.15       $426.25       $386.43
                   Electrophysiologic
                   Evaluation.
0086............  Ablate Heart          T...................    44.9389    $2,451.91       $833.33       $490.38
                   Dysrhythm Focus.
0087............  Cardiac               T...................    39.8161    $2,172.41  ............       $434.48
                   Electrophysiologic
                   Recording/Mapping.
0088............  Thrombectomy........  T...................    34.6942    $1,892.95       $655.22       $378.59
0089............  Insertion/            T...................   117.1896    $6,393.98     $1,722.59     $1,278.80
                   Replacement of
                   Permanent Pacemaker
                   and Electrodes.
0090............  Insertion/            T...................    96.8284    $5,283.05     $1,651.45     $1,056.61
                   Replacement of
                   Pacemaker Pulse
                   Generator.
0091............  Level II Vascular     T...................    28.8326    $1,573.14       $348.23       $314.63
                   Ligation.
0092............  Level I Vascular      T...................    25.0959    $1,369.26       $505.37       $273.85
                   Ligation.
0093............  Vascular              T...................    21.3104    $1,162.72       $277.34       $232.54
                   Reconstruction/
                   Fistula Repair
                   without Device.
0094............  Level I               S...................     2.6345      $143.74        $48.58        $28.75
                   Resuscitation and
                   Cardioversion.
0095............  Cardiac               S...................     0.5994       $32.70        $16.35         $6.54
                   Rehabilitation.
0096............  Non-Invasive          S...................     1.7176       $93.71        $46.85        $18.74
                   Vascular Studies.
0097............  Cardiac and           X...................     1.0635       $58.03        $23.80        $11.61
                   Ambulatory Blood
                   Pressure Monitoring.
0098............  Injection of          T...................     1.0729       $58.54        $14.06        $11.71
                   Sclerosing Solution.
0099............  Electrocardiograms..  S...................     0.3703       $20.20  ............         $4.04
0100............  Cardiac Stress Tests  X...................     1.5862       $86.54        $41.44        $17.31
0101............  Tilt Table            S...................     4.4040      $240.29       $105.27        $48.06
                   Evaluation.
0103............  Miscellaneous         T...................    11.6202      $634.01       $223.63       $126.80
                   Vascular Procedures.
0104............  Transcatheter         T...................    82.6713    $4,510.63  ............       $902.13
                   Placement of
                   Intracoronary
                   Stents.
0105............  Revision/Removal of   T...................    19.1898    $1,047.01       $370.40       $209.40
                   Pacemakers, AICD,
                   or Vascular.
0106............  Insertion/            T...................    58.9719    $3,217.57  ............       $643.51
                   Replacement/Repair
                   of Pacemaker and/or
                   Electrodes.
0107............  Insertion of          T...................   337.1304   $18,394.17     $3,699.14     $3,678.83
                   Cardioverter-
                   Defibrillator.
0108............  Insertion/            T...................   433.2998   $23,641.27  ............     $4,728.25
                   Replacement/Repair
                   of Cardioverter-
                   Defibrillator Leads.
0109............  Removal of Implanted  T...................     7.4705      $407.60       $131.49        $81.52
                   Devices.
0110............  Transfusion.........  S...................     3.6718      $200.34  ............        $40.07
0111............  Blood Product         S...................    13.1719      $718.67       $200.18       $143.73
                   Exchange.
0112............  Apheresis,            S...................    37.5832    $2,050.58       $612.47       $410.12
                   Photopheresis, and
                   Plasmapheresis.
0113............  Excision Lymphatic    T...................    19.9322    $1,087.52  ............       $217.50
                   System.
0114............  Thyroid/              T...................    37.5963    $2,051.29       $485.91       $410.26
                   Lymphadenectomy
                   Procedures.
0115............  Cannula/Access        T...................    25.6437    $1,399.15       $459.35       $279.83
                   Device Procedures.
0116............  Chemotherapy          S...................     0.7996       $43.63  ............         $8.73
                   Administration by
                   Other Technique
                   Except Infusion.
0117............  Chemotherapy          S...................     3.0360      $165.65        $42.54        $33.13
                   Administration by
                   Infusion Only.
0119............  Implantation of       T...................   134.7194    $7,350.43  ............     $1,470.09
                   Infusion Pump.
0120............  Infusion Therapy      T...................     1.9114      $104.29        $28.21        $20.86
                   Except Chemotherapy.
0121............  Level I Tube changes  T...................     2.1189      $115.61        $43.80        $23.12
                   and Repositioning.
0122............  Level II Tube         T...................     8.8621      $483.53        $99.16        $96.71
                   changes and
                   Repositioning.
0123............  Bone Marrow           S...................     5.2882      $288.53  ............        $57.71
                   Harvesting and Bone
                   Marrow/Stem Cell
                   Transplant.
0124............  Revision of           T...................    23.8050    $1,298.82  ............       $259.76
                   Implanted Infusion
                   Pump.
0125............  Refilling of          T...................     2.1606      $117.88  ............        $23.58
                   Infusion Pump.
0130............  Level I Laparoscopy.  T...................    32.7724    $1,788.09       $659.53       $357.62
0131............  Level II Laparoscopy  T...................    40.8064    $2,226.44     $1,001.89       $445.29
0132............  Level III             T...................    57.2045    $3,121.13     $1,239.22       $624.23
                   Laparoscopy.
0140............  Esophageal Dilation   T...................     6.4525      $352.05       $107.24        $70.41
                   without Endoscopy.
0141............  Upper GI Procedures.  T...................     7.8206      $426.70       $143.38        $85.34
0142............  Small Intestine       T...................     8.7959      $479.91       $152.78        $95.98
                   Endoscopy.
0143............  Lower GI Endoscopy..  T...................     8.2957      $452.62       $186.06        $90.52
0146............  Level I               T...................     3.9826      $217.29        $64.40        $43.46
                   Sigmoidoscopy.
0147............  Level II              T...................     7.6808      $419.07  ............        $83.81
                   Sigmoidoscopy.
0148............  Level I Anal/Rectal   T...................     3.8320      $209.08        $63.38        $41.82
                   Procedure.
0149............  Level III Anal/       T...................    17.1425      $935.31       $293.06       $187.06
                   Rectal Procedure.
0150............  Level IV Anal/Rectal  T...................    22.1919    $1,210.81       $437.12       $242.16
                   Procedure.

[[Page 63480]]

 
0151............  Endoscopic            T...................    17.9462      $979.16       $245.46       $195.83
                   Retrograde
                   Cholangio-
                   Pancreatography
                   (ERCP).
0152............  Percutaneous          T...................     9.1474      $499.09       $125.28        $99.82
                   Abdominal and
                   Biliary Procedures.
0153............  Peritoneal and        T...................    20.8723    $1,138.81       $410.87       $227.76
                   Abdominal
                   Procedures.
0154............  Hernia/Hydrocele      T...................    26.9636    $1,471.16       $464.85       $294.23
                   Procedures.
0155............  Level II Anal/Rectal  T...................    10.0809      $550.02       $188.89       $110.00
                   Procedure.
0156............  Level II Urinary and  T...................     2.4747      $135.02        $40.52        $27.00
                   Anal Procedures.
0157............  Colorectal Cancer     S...................     2.5693      $140.18  ............        $28.04
                   Screening: Barium
                   Enema.
0158............  Colorectal Cancer     T...................     7.4244      $405.08  ............       $101.27
                   Screening:
                   Colonoscopy.
0159............  Colorectal Cancer     S...................     2.7823      $151.81  ............        $37.95
                   Screening: Flexible
                   Sigmoidoscopy.
0160............  Level I               T...................     6.8801      $375.39       $105.06        $75.08
                   Cystourethroscopy
                   and other
                   Genitourinary
                   Procedures.
0161............  Level II              T...................    16.8407      $918.85       $249.36       $183.77
                   Cystourethroscopy
                   and other
                   Genitourinary
                   Procedures.
0162............  Level III             T...................    21.9098    $1,195.42  ............       $239.08
                   Cystourethroscopy
                   and other
                   Genitourinary
                   Procedures.
0163............  Level IV              T...................    33.8805    $1,848.55  ............       $369.71
                   Cystourethroscopy
                   and other
                   Genitourinary
                   Procedures.
0164............  Level I Urinary and   T...................     1.2021       $65.59        $17.59        $13.12
                   Anal Procedures.
0165............  Level III Urinary     T...................    14.6838      $801.16  ............       $160.23
                   and Anal Procedures.
0166............  Level I Urethral      T...................    16.7918      $916.18       $218.73       $183.24
                   Procedures.
0167............  Level III Urethral    T...................    30.0186    $1,637.84       $555.84       $327.57
                   Procedures.
0168............  Level II Urethral     T...................    30.0147    $1,637.63       $405.60       $327.53
                   Procedures.
0169............  Lithotripsy.........  T...................    45.1150    $2,461.52     $1,115.69       $492.30
0170............  Dialysis............  S...................     5.9678      $325.61  ............        $65.12
0180............  Circumcision........  T...................    18.6176    $1,015.79       $304.87       $203.16
0181............  Penile Procedures...  T...................    29.4217    $1,605.28       $621.82       $321.06
0183............  Testes/Epididymis     T...................    21.6724    $1,182.47  ............       $236.49
                   Procedures.
0184............  Prostate Biopsy.....  T...................     3.8995      $212.76        $96.27        $42.55
0187............  Miscellaneous         X...................     4.4288      $241.64        $90.71        $48.33
                   Placement/
                   Repositioning.
0188............  Level II Female       T...................     1.1365       $62.01  ............        $12.40
                   Reproductive Proc.
0189............  Level III Female      T...................     1.4232       $77.65        $18.09        $15.53
                   Reproductive Proc.
0190............  Level I Hysteroscopy  T...................    19.6922    $1,074.43       $424.28       $214.89
0191............  Level I Female        T...................     0.1853       $10.11         $2.93         $2.02
                   Reproductive Proc.
0192............  Level IV Female       T...................     2.7121      $147.97        $39.11        $29.59
                   Reproductive Proc.
0193............  Level V Female        T...................    15.0453      $820.89       $171.13       $164.18
                   Reproductive Proc.
0194............  Level VIII Female     T...................    18.4286    $1,005.48       $397.84       $201.10
                   Reproductive Proc.
0195............  Level IX Female       T...................    25.6950    $1,401.94       $483.80       $280.39
                   Reproductive Proc.
0196............  Dilation and          T...................    16.1219      $879.63       $338.23       $175.93
                   Curettage.
0197............  Infertility           T...................     4.8280      $263.42  ............        $52.68
                   Procedures.
0198............  Pregnancy and         T...................     1.3578       $74.08        $32.19        $14.82
                   Neonatal Care
                   Procedures.
0199............  Obstetrical Care      T...................    17.2831      $942.98  ............       $188.60
                   Service.
0200............  Level VII Female      T...................    17.9920      $981.66       $307.83       $196.33
                   Reproductive Proc.
0201............  Level VI Female       T...................    16.8660      $920.23       $329.65       $184.05
                   Reproductive Proc.
0202............  Level X Female        T...................    38.9821    $2,126.90     $1,042.18       $425.38
                   Reproductive Proc.
0203............  Level IV Nerve        T...................    11.5969      $632.74       $276.76       $126.55
                   Injections.
0204............  Level I Nerve         T...................     2.1711      $118.46        $40.13        $23.69
                   Injections.
0206............  Level II Nerve        T...................     5.2875      $288.49        $75.55        $57.70
                   Injections.
0207............  Level III Nerve       T...................     6.4554      $352.21       $123.69        $70.44
                   Injections.
0208............  Laminotomies and      T...................    40.2830    $2,197.88  ............       $439.58
                   Laminectomies.
0209............  Extended EEG Studies  S...................    11.5435      $629.82       $280.58       $125.96
                   and Sleep Studies,
                   Level II.
0212............  Nervous System        T...................     2.9739      $162.26        $74.67        $32.45
                   Injections.
0213............  Extended EEG Studies  S...................     2.9055      $158.53        $65.74        $31.71
                   and Sleep Studies,
                   Level I.
0214............  Electroencephalogram  S...................     2.2176      $120.99        $58.12        $24.20
0215............  Level I Nerve and     S...................     0.6457       $35.23        $15.76         $7.05
                   Muscle Tests.
0216............  Level III Nerve and   S...................     2.8535      $155.69        $67.98        $31.14
                   Muscle Tests.
0218............  Level II Nerve and    S...................     1.1404       $62.22  ............        $12.44
                   Muscle Tests.
0220............  Level I Nerve         T...................    16.5554      $903.28  ............       $180.66
                   Procedures.
0221............  Level II Nerve        T...................    24.8875    $1,357.89       $463.62       $271.58
                   Procedures.
0222............  Implantation of       T...................   232.2024   $12,669.20  ............     $2,533.84
                   Neurological Device.
0223............  Implantation or       T...................    26.7610    $1,460.11  ............       $292.02
                   Revision of Pain
                   Management Catheter.
0224............  Implantation of       T...................    34.1770    $1,864.73       $453.41       $372.95
                   Reservoir/Pump/
                   Shunt.
0225............  Level I               S...................   206.0034   $11,239.75  ............     $2,247.95
                   Implementation of
                   Neurostimulator
                   Electrodes.
0226............  Implantation of Drug  T...................   136.2989    $7,436.60  ............     $1,487.32
                   Infusion Reservoir.
0227............  Implantation of Drug  T...................   160.8363    $8,775.39  ............     $1,755.08
                   Infusion Device.
0228............  Creation of Lumbar    T...................    52.2880    $2,852.89       $639.03       $570.58
                   Subarachnoid Shunt.
0229............  Transcatherter        T...................    61.9895    $3,382.21       $771.23       $676.44
                   Placement of
                   Intravascular
                   Shunts.
0230............  Level I Eye Tests &   S...................     0.7619       $41.57        $14.97         $8.31
                   Treatments.
0231............  Level III Eye Tests   S...................     2.1883      $119.40        $50.94        $23.88
                   & Treatments.

[[Page 63481]]

 
0232............  Level I Anterior      T...................     4.9206      $268.47       $103.17        $53.69
                   Segment Eye
                   Procedures.
0233............  Level II Anterior     T...................    14.4205      $786.80       $266.33       $157.36
                   Segment Eye
                   Procedures.
0234............  Level III Anterior    T...................    21.4631    $1,171.05       $511.31       $234.21
                   Segment Eye
                   Procedures.
0235............  Level I Posterior     T...................     5.0749      $276.89        $72.04        $55.38
                   Segment Eye
                   Procedures.
0236............  Level II Posterior    T...................    18.6701    $1,018.66  ............       $203.73
                   Segment Eye
                   Procedures.
0237............  Level III Posterior   T...................    34.1784    $1,864.81       $818.54       $372.96
                   Segment Eye
                   Procedures.
0238............  Level I Repair and    T...................     3.1954      $174.34        $58.96        $34.87
                   Plastic Eye
                   Procedures.
0239............  Level II Repair and   T...................     6.1331      $334.63  ............        $66.93
                   Plastic Eye
                   Procedures.
0240............  Level III Repair and  T...................    17.4535      $952.28       $315.31       $190.46
                   Plastic Eye
                   Procedures.
0241............  Level IV Repair and   T...................    22.1969    $1,211.09       $384.47       $242.22
                   Plastic Eye
                   Procedures.
0242............  Level V Repair and    T...................    29.4294    $1,605.70       $597.36       $321.14
                   Plastic Eye
                   Procedures.
0243............  Strabismus/Muscle     T...................    21.7323    $1,185.74       $431.39       $237.15
                   Procedures.
0244............  Corneal Transplant..  T...................    37.6284    $2,053.04       $803.26       $410.61
0245............  Level I Cataract      T...................    12.2973      $670.95       $222.22       $134.19
                   Procedures without
                   IOL Insert.
0246............  Cataract Procedures   T...................    22.9755    $1,253.57       $495.96       $250.71
                   with IOL Insert.
0247............  Laser Eye Procedures  T...................     4.9482      $269.98       $104.31        $54.00
                   Except Retinal.
0248............  Laser Retinal         T...................     4.8223      $263.11        $95.08        $52.62
                   Procedures.
0249............  Level II Cataract     T...................    27.7406    $1,513.55       $524.67       $302.71
                   Procedures without
                   IOL Insert.
0250............  Nasal Cauterization/  T...................     1.4697       $80.19        $28.07        $16.04
                   Packing.
0251............  Level I ENT           T...................     1.7880       $97.56  ............        $19.51
                   Procedures.
0252............  Level II ENT          T...................     6.4469      $351.75       $113.41        $70.35
                   Procedures.
0253............  Level III ENT         T...................    15.2249      $830.69       $282.29       $166.14
                   Procedures.
0254............  Level IV ENT          T...................    21.8901    $1,194.35       $321.35       $238.87
                   Procedures.
0256............  Level V ENT           T...................    35.1548    $1,918.08  ............       $383.62
                   Procedures.
0258............  Tonsil and Adenoid    T...................    20.6265    $1,125.40       $437.25       $225.08
                   Procedures.
0259............  Level VI ENT          T...................   392.8622   $21,434.95     $9,394.83     $4,286.99
                   Procedures.
0260............  Level I Plain Film    X...................     0.7802       $42.57        $21.28         $8.51
                   Except Teeth.
0261............  Level II Plain Film   X...................     1.3176       $71.89  ............        $14.38
                   Except Teeth
                   Including Bone
                   Density Measurement.
0262............  Plain Film of Teeth.  X...................     0.7540       $41.14         $9.82         $8.23
0263............  Level I               X...................     2.1883      $119.40        $43.58        $23.88
                   Miscellaneous
                   Radiology
                   Procedures.
0264............  Level II              X...................     3.0287      $165.25        $79.41        $33.05
                   Miscellaneous
                   Radiology
                   Procedures.
0265............  Level I Diagnostic    S...................     1.0289       $56.14        $28.07        $11.23
                   Ultrasound Except
                   Vascular.
0266............  Level II Diagnostic   S...................     1.6117       $87.94        $43.97        $17.59
                   Ultrasound Except
                   Vascular.
0267............  Level III Diagnostic  S...................     2.4586      $134.14        $65.52        $26.83
                   Ultrasound Except
                   Vascular.
0268............  Ultrasound Guidance   S...................     1.3081       $71.37  ............        $14.27
                   Procedures.
0269............  Level III             S...................     3.2309      $176.28        $87.24        $35.26
                   Echocardiogram
                   Except
                   Transesophageal.
0270............  Transesophageal       S...................     5.8546      $319.43       $146.79        $63.89
                   Echocardiogram.
0271............  Mammography.........  S...................     0.6499       $35.46        $16.80         $7.09
0272............  Level I Fluoroscopy.  X...................     1.4166       $77.29        $38.36        $15.46
0274............  Myelography.........  S...................     3.5931      $196.04        $93.63        $39.21
0275............  Arthrography........  S...................     3.2775      $178.82        $69.09        $35.76
0276............  Level I Digestive     S...................     1.5906       $86.78        $41.72        $17.36
                   Radiology.
0277............  Level II Digestive    S...................     2.4444      $133.37        $60.47        $26.67
                   Radiology.
0278............  Diagnostic Urography  S...................     2.7012      $147.38        $66.07        $29.48
0279............  Level II Angiography  S...................    10.7073      $584.20       $174.57       $116.84
                   and Venography
                   except Extremity.
0280............  Level III             S...................    19.1015    $1,042.20       $353.85       $208.44
                   Angiography and
                   Venography except
                   Extremity.
0281............  Venography of         S...................     6.6031      $360.27       $115.16        $72.05
                   Extremity.
0282............  Miscellaneous         S...................     1.6834       $91.85        $44.51        $18.37
                   Computerized Axial
                   Tomography.
0283............  Computerized Axial    S...................     4.6543      $253.94       $126.27        $50.79
                   Tomography with
                   Contrast Material.
0284............  Magnetic Resonance    S...................     7.1165      $388.28       $194.13        $77.66
                   Imaging and
                   Magnetic Resonance
                   Angiography with
                   Contras.
0285............  Myocardial Positron   S...................    14.1508      $772.08       $334.45       $154.42
                   Emission Tomography
                   (PET).
0287............  Complex Venography..  S...................     6.4923      $354.23       $111.33        $70.85
0288............  Bone Density:Axial    S...................     1.2726       $69.43  ............        $13.89
                   Skeleton.
0289............  Needle Localization   X...................     3.4900      $190.42        $44.80        $38.08
                   for Breast Biopsy.
0296............  Level I Therapeutic   S...................     2.8635      $156.24        $69.20        $31.25
                   Radiologic
                   Procedures.
0297............  Level II Therapeutic  S...................     7.7145      $420.91       $172.51        $84.18
                   Radiologic
                   Procedures.
0299............  Miscellaneous         S...................     5.7618      $314.37  ............        $62.87
                   Radiation Treatment.
0300............  Level I Radiation     S...................     1.4912       $81.36  ............        $16.27
                   Therapy.
0301............  Level II Radiation    S...................     2.1340      $116.43  ............        $23.29
                   Therapy.
0302............  Level III Radiation   S...................     6.3268      $345.20       $130.77        $69.04
                   Therapy.
0303............  Treatment Device      X...................     2.8835      $157.33        $66.95        $31.47
                   Construction.
0304............  Level I Therapeutic   X...................     1.6742       $91.35        $41.52        $18.27
                   Radiation Treatment
                   Preparation.
0305............  Level II Therapeutic  X...................     3.6767      $200.60        $91.38        $40.12
                   Radiation Treatment
                   Preparation.
0310............  Level III             X...................    13.7165      $748.39       $325.27       $149.68
                   Therapeutic
                   Radiation Treatment
                   Preparation.
0312............  Radioelement          S...................     3.6637      $199.90  ............        $39.98
                   Applications.
0313............  Brachytherapy.......  S...................    16.2481      $886.51  ............       $177.30
0314............  Hyperthermic          S...................     4.6041      $251.20       $101.77        $50.24
                   Therapies.

[[Page 63482]]

 
0320............  Electroconvulsive     S...................     5.3785      $293.46        $80.06        $58.69
                   Therapy.
0321............  Biofeedback and       S...................     1.2387       $67.58        $21.78        $13.52
                   Other Training.
0322............  Brief Individual      S...................     1.2802       $69.85  ............        $13.97
                   Psychotherapy.
0323............  Extended Individual   S...................     1.8689      $101.97        $21.26        $20.39
                   Psychotherapy.
0324............  Family Psychotherapy  S...................     2.4473      $133.53  ............        $26.71
0325............  Group Psychotherapy.  S...................     1.4865       $81.10        $18.27        $16.22
0330............  Dental Procedures...  S...................     0.5745       $31.35  ............         $6.27
0332............  Computerized Axial    S...................     3.3936      $185.16        $91.27        $37.03
                   Tomography and
                   Computerized
                   Angiography without
                   Contras.
0333............  Computerized Axial    S...................     5.4241      $295.94       $146.98        $59.19
                   Tomography and
                   Computerized Angio
                   w/o Contrast
                   Material.
0335............  Magnetic Resonance    S...................     6.3499      $346.46       $151.46        $69.29
                   Imaging,
                   Miscellaneous.
0336............  Magnetic Resonance    S...................     6.3897      $348.63       $174.31        $69.73
                   Imaging and
                   Magnetic Resonance
                   Angiography without
                   Cont.
0337............  MRI and Magnetic      S...................     9.2075      $502.37       $240.77       $100.47
                   Resonance
                   Angiography without
                   Contrast Material
                   followed.
0339............  Observation.........  S...................     3.8356      $209.27  ............        $41.85
0340............  Minor Ancillary       X...................     0.6314       $34.45  ............         $6.89
                   Procedures.
0341............  Skin Tests..........  X...................     0.1365        $7.45         $3.03         $1.49
0342............  Level I Pathology...  X...................     0.2162       $11.80         $5.88         $2.36
0343............  Level II Pathology..  X...................     0.4617       $25.19        $12.55         $5.04
0344............  Level III Pathology.  X...................     0.6291       $34.32        $17.16         $6.86
0345............  Level I Transfusion   X...................     0.2550       $13.91         $3.10         $2.78
                   Laboratory
                   Procedures.
0346............  Level II Transfusion  X...................     0.3866       $21.09         $5.32         $4.22
                   Laboratory
                   Procedures.
0347............  Level III             X...................     0.9610       $52.43        $13.20        $10.49
                   Transfusion
                   Laboratory
                   Procedures.
0348............  Fertility Laboratory  X...................     0.8194       $44.71  ............         $8.94
                   Procedures.
0352............  Level I Injections..  X...................     0.1230        $6.71  ............         $1.34
0353............  Level II Allergy      X...................     0.3982       $21.73  ............         $4.35
                   Injections.
0355............  Level III             K...................     0.2749       $15.00  ............         $3.00
                   Immunizations.
0356............  Level IV              K...................     0.7698       $42.00  ............         $8.40
                   Immunizations.
0359............  Level II Injections.  X...................     0.8000       $43.65  ............         $8.73
0360............  Level I Alimentary    X...................     1.7313       $94.46        $42.45        $18.89
                   Tests.
0361............  Level II Alimentary   X...................     3.5510      $193.75        $83.23        $38.75
                   Tests.
0362............  Level III             X...................     2.6984      $147.23  ............        $29.45
                   Otorhinolaryngologi
                   c Function Tests.
0363............  Level I               X...................     0.8641       $47.15        $17.44         $9.43
                   Otorhinolaryngologi
                   c Function Tests.
0364............  Level I Audiometry..  X...................     0.4459       $24.33         $9.06         $4.87
0365............  Level II Audiometry.  X...................     1.2132       $66.19        $18.95        $13.24
0367............  Level I Pulmonary     X...................     0.5887       $32.12        $15.16         $6.42
                   Test.
0368............  Level II Pulmonary    X...................     0.9319       $50.85        $25.42        $10.17
                   Tests.
0369............  Level III Pulmonary   X...................     2.4984      $136.32        $44.18        $27.26
                   Tests.
0370............  Allergy Tests.......  X...................     0.9185       $50.11        $11.58        $10.02
0371............  Level I Allergy       X...................     0.4105       $22.40  ............         $4.48
                   Injections.
0372............  Therapeutic           X...................     0.5607       $30.59        $10.09         $6.12
                   Phlebotomy.
0373............  Neuropsychological    X...................     2.0899      $114.03  ............        $22.81
                   Testing.
0374............  Monitoring            X...................     1.1252       $61.39  ............        $12.28
                   Psychiatric Drugs.
0375............  Ancillary Outpatient  T...................  .........    $1,150.00  ............       $230.00
                   Services When
                   Patient Expires.
0376............  Level II Cardiac      S...................     4.4510      $242.85       $121.42        $48.57
                   Imaging.
0377............  Level III Cardiac     S...................     6.8830      $375.54       $187.76        $75.11
                   Imaging.
0378............  Level II Pulmonary    S...................     5.4852      $299.28       $149.63        $59.86
                   Imaging.
0379............  Injection adenosine   K...................     0.2078       $11.34  ............         $2.27
                   6 MG.
0380............  Dipyridamole          K...................     0.2525       $13.78  ............         $2.76
                   injection.
0384............  GI Procedures with    T...................    20.6602    $1,127.24       $244.83       $225.45
                   Stents.
0385............  Level I Prosthetic    S...................    67.1530    $3,663.93  ............       $732.79
                   Urological
                   Procedures.
0386............  Level II Prosthetic   S...................   116.2382    $6,342.07  ............     $1,268.41
                   Urological
                   Procedures.
0387............  Level II              T...................    28.1480    $1,535.78       $655.55       $307.16
                   Hysteroscopy.
0388............  Discography.........  S...................    11.6347      $634.80       $303.19       $126.96
0389............  Non-imaging Nuclear   S...................     1.6328       $89.09        $44.54        $17.82
                   Medicine.
0390............  Level I Endocrine     S...................     2.7907      $152.26        $76.13        $30.45
                   Imaging.
0391............  Level II Endocrine    S...................     3.1956      $174.36        $87.18        $34.87
                   Imaging.
0393............  Red Cell/Plasma       S...................     4.4354      $242.00       $121.00        $48.40
                   Studies.
0394............  Hepatobiliary         S...................     4.3714      $238.51       $119.25        $47.70
                   Imaging.
0395............  GI Tract Imaging....  S...................     3.9536      $215.71       $107.85        $43.14
0396............  Bone Imaging........  S...................     4.1883      $228.52       $114.26        $45.70
0397............  Vascular Imaging....  S...................     2.2183      $121.03        $60.51        $24.21
0398............  Level I Cardiac       S...................     4.5091      $246.02       $123.01        $49.20
                   Imaging.
0399............  Nuclear Medicine Add- S...................     1.5273       $83.33        $41.66        $16.67
                   on Imaging.
0400............  Hematopoietic         S...................     3.8242      $208.65       $104.32        $41.73
                   Imaging.
0401............  Level I Pulmonary     S...................     3.3736      $184.07        $92.03        $36.81
                   Imaging.
0402............  Brain Imaging.......  S...................     5.4063      $294.97       $147.48        $58.99

[[Page 63483]]

 
0403............  CSF Imaging.........  S...................     3.8402      $209.53       $104.76        $41.91
0404............  Renal and             S...................     3.7303      $203.53       $101.76        $40.71
                   Genitourinary
                   Studies Level I.
0405............  Renal and             S...................     4.3432      $236.97       $118.48        $47.39
                   Genitourinary
                   Studies Level II.
0406............  Tumor/Infection       S...................     4.3955      $239.82       $119.91  $47.96 W
0407............  Radionuclide Therapy  S...................     3.5841      $195.55        $97.77        $39.11
0409............  Red Blood Cell Tests  X...................     0.1390        $7.58         $2.32         $1.52
0410............  Mammogram Add On....  S...................     0.1523        $8.31  ............         $1.66
0411............  Respiratory           S...................     0.4367       $23.83  ............         $4.77
                   Procedures.
0412............  IMRT Treatment        S...................     5.3904      $294.11  ............        $58.82
                   Delivery.
0413............  IMRT Treatment Plan.  S...................     7.4469      $406.31  ............        $81.26
0415............  Level II Endoscopy    T...................    20.7348    $1,131.31       $459.92       $226.26
                   Lower Airway.
0600............  Low Level Clinic      V...................     0.9278       $50.62  ............        $10.12
                   Visits.
0601............  Mid Level Clinic      V...................     0.9816       $53.56  ............        $10.71
                   Visits.
0602............  High Level Clinic     V...................     1.5041       $82.07  ............        $16.41
                   Visits.
0610............  Low Level Emergency   V...................     1.3691       $74.70        $19.57        $14.94
                   Visits.
0611............  Mid Level Emergency   V...................     2.3967      $130.77        $36.16        $26.15
                   Visits.
0612............  High Level Emergency  V...................     4.1476      $226.30        $54.12        $45.26
                   Visits.
0620............  Critical Care.......  S...................     8.9992      $491.01       $142.30        $98.20
0648............  Breast                T...................    54.0165    $2,947.19  ............       $589.44
                   Reconstruction with
                   Prosthesis.
0651............  Complex Interstitial  S...................    10.2314      $558.24  ............       $111.65
                   Radiation Source
                   Application.
0652............  Insertion of          T...................    27.0364    $1,475.13  ............       $295.03
                   Intraperitoneal
                   Catheters.
0653............  Vascular              T...................    30.0334    $1,638.65  ............       $327.73
                   Reconstruction/
                   Fistula Repair with
                   Device.
0654............  Insertion/            T...................   112.6957    $6,148.79  ............     $1,229.76
                   Replacement of a
                   permanent dual
                   chamber pacemaker.
0655............  Insertion/            T...................   142.7039    $7,786.07  ............     $1,557.21
                   Replacement/
                   Conversion of a
                   permanent dual
                   chamber pacemaker.
0656............  Transcatheter         T...................   103.4907    $5,646.56  ............     $1,129.31
                   Placement of
                   Intracoronary Drug-
                   Eluting Stents.
0657............  Placement of Tissue   S...................     1.5102       $82.40  ............        $16.48
                   Clips.
0658............  Percutaneous Breast   T...................     5.5779      $304.34  ............        $60.87
                   Biopsies.
0659............  Hyperbaric Oxygen...  S...................     3.0228      $164.93  ............        $32.99
0660............  Level II              X...................     1.7353       $94.68        $30.66        $18.94
                   Otorhinolaryngologi
                   c Function Tests.
0661............  Level IV Pathology..  X...................     3.2576      $177.74        $88.87        $35.55
0662............  CT Angiography......  S...................     5.8775      $320.68       $156.47        $64.14
0664............  Proton Beam           S...................     9.7295      $530.85  ............       $106.17
                   Radiation Therapy.
0665............  Bone                  S...................     0.7257       $39.59  ............         $7.92
                   Density:Appendicula
                   rSkeleton.
0668............  Level I Angiography   S...................    10.2660      $560.12       $237.76       $112.02
                   and Venography
                   except Extremity.
0669............  Digital Mammography.  S...................     0.9009       $49.15  ............         $9.83
0670............  Intravenous and       S...................    27.4483    $1,497.61       $542.37       $299.52
                   Intracardiac
                   Ultrasound.
0671............  Level II              S...................     1.6384       $89.39        $44.69        $17.88
                   Echocardiogram
                   Except
                   Transesophageal.
0672............  Level IV Posterior    T...................    38.9476    $2,125.02       $988.43       $425.00
                   Segment Procedures.
0673............  Level IV Anterior     T...................    26.8390    $1,464.36       $649.56       $292.87
                   Segment Eye
                   Procedures.
0674............  Prostate              T...................   119.9733    $6,545.86  ............     $1,309.17
                   Cryoablation.
0675............  Prostatic             T...................    49.3452    $2,692.32  ............       $538.46
                   Thermotherapy.
0676............  Level II              T...................     2.7315      $149.03        $40.30        $29.81
                   Transcatheter
                   Thrombolysis.
0677............  Level I               T...................     2.1805      $118.97  ............        $23.79
                   Transcatheter
                   Thrombolysis.
0678............  External              T...................     2.0659      $112.72  ............        $22.54
                   Counterpulsation.
0679............  Level II              S...................     5.4887      $299.47        $95.30        $59.89
                   Resuscitation and
                   Cardioversion.
0680............  Insertion of Patient  S...................    62.8252    $3,427.81  ............       $685.56
                   Activated Event
                   Recorders.
0681............  Knee Arthroplasty...  T...................    98.1613    $5,355.78     $2,131.36     $1,071.16
0682............  Level V Debridement   T...................     8.0790      $440.80       $174.57        $88.16
                   & Destruction.
0683............  Level II              S...................     1.5489       $84.51        $30.42        $16.90
                   Photochemotherapy.
0685............  Level III Needle      T...................     4.8100      $262.44       $115.47        $52.49
                   Biopsy/Aspiration
                   Except Bone Marrow.
0686............  Level III Skin        T...................     7.9247      $432.38       $198.89        $86.48
                   Repair.
0687............  Revision/Removal of   T...................    20.4416    $1,115.31       $513.05       $223.06
                   Neurostimulator
                   Electrodes.
0688............  Revision/Removal of   T...................    46.7347    $2,549.89     $1,249.45       $509.98
                   Neurostimulator
                   Pulse Generator
                   Receiver.
0689............  Electronic Analysis   S...................     0.5533       $30.19  ............         $6.04
                   of Cardioverter-
                   defibrillators.
0690............  Electronic Analysis   S...................     0.4074       $22.23        $10.63         $4.45
                   of Pacemakers and
                   other Cardiac
                   Devices.
0691............  Electronic Analysis   S...................     2.8066      $153.13        $76.56        $30.63
                   of Programmable
                   Shunts/Pumps.
0692............  Electronic Analysis   S...................     1.1057       $60.33        $30.16        $12.07
                   of Neurostimulator
                   Pulse Generators.
0693............  Level II Breast       T...................    39.0111    $2,128.48       $798.17       $425.70
                   Reconstruction.
0694............  Mohs Surgery........  T...................     2.9752      $162.33        $64.93        $32.47
0695............  Level VII             T...................    19.1849    $1,046.75       $266.59       $209.35
                   Debridement &
                   Destruction.
0697............  Level I               S...................     1.4415       $78.65        $39.32        $15.73
                   Echocardiogram
                   Except
                   Transesophageal.
0698............  Level II Eye Tests &  S...................     0.9599       $52.37        $18.72        $10.47
                   Treatments.
0699............  Level IV Eye Tests &  T...................     2.2303      $121.69        $47.46        $24.34
                   Treatments.
0700............  Antepartum            T...................     2.4306      $132.62        $37.13        $26.52
                   Manipulation.

[[Page 63484]]

 
0701............  SR 89 chloride, per   K...................     7.3835      $402.85  ............        $80.57
                   mCi.
0702............  SM 153 lexidronam,    K...................    16.0268      $874.44  ............       $174.89
                   50 mCi.
0704............  IN 111 Satumomab      K...................     2.2811      $124.46  ............        $24.89
                   pendetide per dose.
0705............  Technetium TC99M      K...................     1.0642       $58.06  ............        $11.61
                   tetrofosmin.
0726............  Dexrazoxane hcl       K...................     2.0616      $112.48  ............        $22.50
                   injection, 250 mg.
0728............  Filgrastim 300 mcg    K...................     2.2631      $123.48  ............        $24.70
                   injection.
0730............  Pamidronate disodium  K...................     3.1949      $174.32  ............        $34.86
                   , 30 mg.
0731............  Sargramostim          K...................     0.2991       $16.32  ............         $3.26
                   injection.
0732............  Mesna injection 200   K...................     0.5211       $28.43  ............         $5.69
                   mg.
0733............  Non esrd epoetin      K...................     0.1802        $9.83  ............         $1.97
                   alpha inj, 1000 u.
0734............  Injection,            K...................  .........        $3.24  ............         $0.65
                   darbepoetin alfa
                   (for non-ESRD), per
                   1 mcg.
0763............  Dolasetron mesylate   K...................     0.7514       $41.00  ............         $8.20
                   oral.
0764............  Granisetron HCl       K...................     0.1044        $5.70  ............         $1.14
                   injection.
0765............  Granisetron HCl 1 mg  K...................     0.6322       $34.49  ............         $6.90
                   oral.
0800............  Leuprolide acetate,   K...................     3.3525      $182.92  ............        $36.58
                   3.75 mg.
0802............  Etoposide oral 50 mg  K...................     0.5016       $27.37  ............         $5.47
0807............  Aldesleukin/single    K...................  .........      $680.35  ............       $136.07
                   use vial.
0809............  Bcg live              K...................     1.9015      $103.75  ............        $20.75
                   intravesical vac.
0810............  Goserelin acetate     K...................     5.2265      $285.16  ............        $57.03
                   implant 3.6 mg.
0811............  Carboplatin           K...................     1.5849       $86.47  ............        $17.29
                   injection 50 mg.
0813............  Cisplatin 10 mg       K...................     0.3985       $21.74  ............         $4.35
                   injection.
0814............  Asparaginase          K...................     0.2957       $16.13  ............         $3.23
                   injection.
0815............  Cyclophosphamide 100  K...................     0.0868        $4.74  ............         $0.95
                   MG inj.
0816............  Cyclophosphamide      K...................     0.0825        $4.50  ............         $0.90
                   lyophilized.
0817............  Cytarabine hcl 100    K...................     0.0930        $5.07  ............         $1.01
                   MG inj.
0819............  Dacarbazine 100 mg    K...................     0.0974        $5.31  ............         $1.06
                   inj.
0820............  Daunorubicin 10 mg..  K...................     1.3557       $73.97  ............        $14.79
0821............  Daunorubicin citrate  K...................     2.9976      $163.55  ............        $32.71
                   liposom 10 mg.
0823............  Docetaxel, 20 mg....  K...................     4.0499      $220.97  ............        $44.19
0824............  Etoposide 10 MG inj.  K...................     0.0836        $4.56  ............         $0.91
0827............  Floxuridine           K...................     2.0928      $114.19  ............        $22.84
                   injection 500 mg.
0828............  Gemcitabine HCL 200   K...................     1.4742       $80.43  ............        $16.09
                   mg.
0830............  Irinotecan injection  K...................     1.8428      $100.55  ............        $20.11
                   20 mg.
0831............  Ifosfomide injection  K...................     1.9435      $106.04  ............        $21.21
                   1 gm.
0832............  Idarubicin hcl        K...................     3.2663      $178.21  ............        $35.64
                   injection 5 mg.
0834............  Interferon alfa-2a    K...................     0.3777       $20.61  ............         $4.12
                   inj.
0836............  Interferon alfa-2b    K...................     0.2003       $10.93  ............         $2.19
                   inj recombinant, 1
                   million.
0838............  Interferon gamma 1-b  K...................  .........      $180.15  ............        $36.03
                   inj, 3 million u.
0840............  Melphalan hydrochl    K...................     4.6719      $254.90  ............        $50.98
                   50 mg.
0842............  Fludarabine           K...................     3.7708      $205.74  ............        $41.15
                   phosphate inj 50 mg.
0844............  Pentostatin           K...................    17.7045      $965.98  ............       $193.20
                   injection, 10 mg.
0847............  Doxorubic hcl 10 MG   K...................     0.1212        $6.61  ............         $1.32
                   vl chemo.
0849............  Rituximab, 100 mg...  K...................     5.6158      $306.40  ............        $61.28
0850............  Streptozocin          K...................     1.1948       $65.19  ............        $13.04
                   injection, 1 gm.
0851............  Thiotepa injection..  K...................     1.0984       $59.93  ............        $11.99
0852............  Topotecan, 4 mg.....  K...................     7.9435      $433.41  ............        $86.68
0855............  Vinorelbine           K...................     1.1874       $64.79  ............        $12.96
                   tartrate, 10 mg.
0856............  Porfimer sodium, 75   K...................    29.2205    $1,594.30  ............       $318.86
                   mg.
0857............  Bleomycin sulfate     K...................     2.9427      $160.56  ............        $32.11
                   injection 15 u.
0858............  Cladribine, 1mg.....  K...................     0.6931       $37.82  ............         $7.56
0860............  Plicamycin            K...................     0.2826       $15.42  ............         $3.08
                   (mithramycin) inj.
0861............  Leuprolide acetate    K...................     0.7991       $43.60  ............         $8.72
                   injection 1 mg.
0862............  Mitomycin 5 mg inj..  K...................     0.9719       $53.03  ............        $10.61
0863............  Paclitaxel            K...................     2.0553      $112.14  ............        $22.43
                   injection, 30 mg.
0864............  Mitoxantrone hcl, 5   K...................     3.1832      $173.68  ............        $34.74
                   mg.
0865............  Interferon alfa-n3    K...................     1.4598       $79.65  ............        $15.93
                   inj, human
                   leukocyte derived,
                   2.
0884............  Rho d immune          K...................     0.1863       $10.16  ............         $2.03
                   globulin inj, 1
                   dose pkg.
0888............  Cyclosporine oral     K...................     0.0470        $2.56  ............         $0.51
                   100 mg.
0890............  Lymphocyte immune     K...................     2.3439      $127.89  ............        $25.58
                   globulin 250 mg.
0891............  Tacrolimus oral per   K...................     0.0246        $1.34  ............         $0.27
                   1 mg.
0900............  Alglucerase           K...................  .........       $37.13  ............         $7.43
                   injection, per 10 u.
0901............  Alpha 1 proteinase    K...................  .........        $3.43  ............         $0.69
                   inhibitor, 10 mg.
0902............  Botulinum toxin a,    K...................     0.0588        $3.21  ............         $0.64
                   per unit.
0903............  Cytomegalovirus imm   K...................     5.3368      $291.18  ............        $58.24
                   IV/vial.
0905............  Immune globulin, 1g.  K...................     0.8057       $43.96  ............         $8.79
0906............  RSV-ivig, 50 mg.....  K...................     0.8910       $48.61  ............         $9.72
0907............  Ganciclovir sodium    K...................     0.5918       $32.29  ............         $6.46
                   injection.
0909............  Interferon beta-1a,   K...................     3.3868      $184.79  ............        $36.96
                   33 mcg.
0910............  Interferon beta-1b /  K...................     1.8421      $100.51  ............        $20.10
                   0.25 mg.

[[Page 63485]]

 
0911............  Streptokinase per     K...................     1.5733       $85.84  ............        $17.17
                   250,000 iu.
0913............  Ganciclovir long act  K...................     1.5861       $86.54  ............        $17.31
                   implant.
0916............  Imiglucerase          K...................  .........        $3.71  ............         $0.74
                   injection/unit.
0917............  Adenosine injection.  K...................     1.0393       $56.71  ............        $11.34
0925............  Factor viii per iu..  K...................  .........        $0.51  ............         $0.10
0926............  Factor VIII           K...................  .........        $1.52  ............         $0.30
                   (porcine) per iu.
0927............  Factor viii           K...................  .........        $1.01  ............         $0.20
                   recombinant per iu.
0928............  Factor ix complex     K...................  .........        $0.51  ............         $0.10
                   per iu.
0929............  Anti-inhibitor per    K...................  .........        $1.01  ............         $0.20
                   iu.
0931............  Factor IX non-        K...................  .........        $0.51  ............         $0.10
                   recombinant, per iu.
0932............  Factor IX             K...................  .........        $1.01  ............         $0.20
                   recombinant, per iu.
0949............  Plasma, Pooled        K...................  .........      $124.31  ............        $24.86
                   Multiple Donor,
                   Solvent/Detergent T.
0950............  Blood (Whole) For     K...................  .........       $87.93  ............        $17.59
                   Transfusion.
0952............  Cryoprecipitate.....  K...................  .........       $29.31  ............         $5.86
0954............  RBC leukocytes        K...................  .........      $119.26  ............        $23.85
                   reduced.
0955............  Plasma, Fresh Frozen  K...................  .........       $95.00  ............        $19.00
0956............  Plasma Protein        K...................  .........       $92.98  ............        $18.60
                   Fraction.
0957............  Platelet Concentrate  K...................  .........       $41.44  ............         $8.29
0958............  Platelet Rich Plasma  K...................  .........       $53.56  ............        $10.71
0959............  Red Blood Cells.....  K...................  .........       $86.41  ............        $17.28
0960............  Washed Red Blood      K...................  .........      $160.69  ............        $32.14
                   Cells.
0961............  Infusion, Albumin     K...................     0.2802       $15.29  ............         $3.06
                   (Human) 5%, 50 ml.
0963............  Albumin (human), 5%,  K...................     1.0901       $59.48  ............        $11.90
                   250 ml.
0964............  Albumin (human),      K...................     0.3741       $20.41  ............         $4.08
                   25%, 20 ml.
0965............  Albumin (human),      K...................     0.8869       $48.39  ............         $9.68
                   25%, 50ml.
0966............  Plasmaprotein         K...................  .........      $464.90  ............        $92.98
                   fract,5%,250ml.
1009............  Cryoprecip reduced    K...................  .........       $37.39  ............         $7.48
                   plasma.
1010............  Blood, L/R, CMV-neg.  K...................  .........      $121.78  ............        $24.36
1011............  Platelets, HLA-m, L/  K...................  .........      $499.77  ............        $99.95
                   R, unit.
1013............  Platelet              K...................  .........       $49.52  ............         $9.90
                   concentrate, L/R,
                   unit.
1016............  Blood, L/R, froz/     K...................  .........      $301.68  ............        $60.34
                   deglycerol/washed.
1017............  Platelets, aph/pher,  K...................  .........      $393.15  ............        $78.63
                   L/R, CMV-neg, unit.
1018............  Blood, L/R,           K...................  .........      $132.40  ............        $26.48
                   irradiated.
1019............  Platelets, aph/pher,  K...................  .........      $406.28  ............        $81.26
                   L/R, irradiated,
                   unit.
1020............  Pit, pher,L/          K...................  .........      $495.22  ............        $99.04
                   R,CMV,irrad.
1021............  RBC, frz/deg/wsh, L/  K...................  .........      $336.04  ............        $67.21
                   R, irrad.
1022............  RBC, L/R, CMV neg,    K...................  .........      $201.12  ............        $40.22
                   irrad.
1045............  Iobenguane sulfate I- K...................     3.0392      $165.82  ............        $33.16
                   131per 0.5 mCi.
1064............  I-131 sodium iodide   K...................     0.1004        $5.48  ............         $1.10
                   capsule.
1065............  I-131 sodium iodide   K...................     0.1189        $6.49  ............         $1.30
                   solution.
1079............  CO 57/58 per 0.5 uCi  K...................     1.2556       $68.51  ............        $13.70
1080............  I-131 tositumomab,    K...................  .........    $2,260.00  ............       $452.00
                   dx.
1081............  I-131 tositumomab,    K...................  .........   $19,565.00  ............     $3,913.00
                   tx.
1084............  Denileukin diftitox,  K...................  .........    $1,232.88  ............       $246.58
                   300 MCG.
1086............  Temozolomide,oral 5   K...................     0.0690        $3.76  ............         $0.75
                   mg.
1089............  Cyanocobalamin        K...................     1.0460       $57.07  ............        $11.41
                   cobalt co57.
1091............  IN 111 Oxyquinoline,  K...................     4.1151      $224.52  ............        $44.90
                   per .5 mCi.
1092............  IN 111 Pentetate,     K...................     3.9855      $217.45  ............        $43.49
                   per 0.5 mCi.
1095............  Technetium TC 99M     K...................     0.6940       $37.87  ............         $7.57
                   Depreotide.
1096............  TC 99M Exametazime,   K...................     3.8609      $210.65  ............        $42.13
                   per dose.
1122............  TC 99M arcitumomab,   K...................     9.8014      $534.77  ............       $106.95
                   per vial.
1166............  Cytarabine liposome.  K...................     5.1134      $278.99  ............        $55.80
1167............  Epirubicin hcl, 2 mg  K...................     0.3744       $20.43  ............         $4.09
1178............  Busulfan IV, 6 mg...  K...................     5.4930      $299.70  ............        $59.94
1200............  TC 99M Sodium         K...................     0.5550       $30.28  ............         $6.06
                   Glucoheptonat.
1201............  TC 99M SUCCIMER, PER  K...................     1.4706       $80.24  ............        $16.05
                   Vial.
1203............  Verteporfin for       K...................    16.4439      $897.20  ............       $179.44
                   injection.
1207............  Octreotide            K...................     1.2049       $65.74  ............        $13.15
                   injection, depot.
1305............  Apligraf............  K...................    15.0691      $822.19  ............       $164.44
1409............  Factor viia           K...................  .........    $1,083.93  ............       $216.79
                   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).

[[Page 63486]]

 
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-Level  S...................  .........    $1,250.00  ............       $250.00
                   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 XVII ($1500-
                   $1600).
1518............  New Technology--      S...................  .........    $1,650.00  ............       $330.00
                   Level XVIII ($1600-
                   $1700).
1519............  New Technology--      S...................  .........    $1,750.00  ............       $350.00
                   Level IXX ($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 XXI ($1900-
                   $2000).
1522............  New Technology--      S...................  .........    $2,250.00  ............       $450.00
                   Level XXII ($2000-
                   $2500).
1523............  New Technology--      S...................  .........    $2,750.00  ............       $550.00
                   Level XXIII ($2500-
                   $3000).
1524............  New Technology--      S...................  .........    $3,250.00  ............       $650.00
                   Level XIV ($3000-
                   $3500).
1525............  New Technology--      S...................  .........    $3,750.00  ............       $750.00
                   Level XXV ($3500-
                   $4000).
1526............  New Technology--      S...................  .........    $4,250.00  ............       $850.00
                   Level XXVI ($4000-
                   $4500).
1527............  New Technology--      S...................  .........    $4,750.00  ............       $950.00
                   Level XXVII ($4500-
                   $5000).
1528............  New Technology--      S...................  .........    $5,250.00  ............     $1,050.00
                   Level XXVIII ($5000-
                   $5500).
1529............  New Technology--      S...................  .........    $5,750.00  ............     $1,150.00
                   Level XXIX ($5500-
                   $6000).
1530............  New Technology--      S...................  .........    $6,250.00  ............     $1,250.00
                   Level XXX ($6000-
                   $6500).
1531............  New Technology--      S...................  .........    $6,750.00  ............     $1,350.00
                   Level XXXI ($6500-
                   $7000).
1532............  New Technology--      S...................  .........    $7,250.00  ............     $1,450.00
                   Level XXXII ($7000-
                   $7500).
1533............  New Technology--      S...................  .........    $7,750.00  ............     $1,550.00
                   Level XXXIII ($7500-
                   $8000).
1534............  New Technology--      S...................  .........    $8,250.00  ............     $1,650.00
                   Level XXXIV ($8000-
                   $8500).
1535............  New Technology--      S...................  .........    $8,750.00  ............     $1,750.00
                   Level XXXV ($8500-
                   $9000).
1536............  New Technology--      S...................  .........    $9,250.00  ............     $1,850.00
                   Level XXXVI ($9000-
                   $9500).
1537............  New Technology--      S...................  .........    $9,750.00  ............     $1,950.00
                   Level XXXVII ($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-Level  T...................  .........    $1,250.00  ............       $250.00
                   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 XVII ($1500-
                   $1600).
1555............  New Technology--      T...................  .........    $1,650.00  ............       $330.00
                   Level XVIII ($1600-
                   $1700).
1556............  New Technology--      T...................  .........    $1,750.00  ............       $350.00
                   Level XIX ($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 XXI ($1900-
                   $2000).
1559............  New Technology--      T...................  .........    $2,250.00  ............       $450.00
                   Level XXII ($2000-
                   $2500).
1560............  New Technology--      T...................  .........    $2,750.00  ............       $550.00
                   Level XXIII ($2500-
                   $3000).
1561............  New Technology--      T...................  .........    $3,250.00  ............       $650.00
                   Level XXIV ($3000-
                   $3500).
1562............  New Technology--      T...................  .........    $3,750.00  ............       $750.00
                   Level XXV ($3500-
                   $4000).
1563............  New Technology--      T...................  .........    $4,250.00  ............       $850.00
                   Level XXVI ($4000-
                   $4500).
1564............  New Technology--      T...................  .........    $4,750.00  ............       $950.00
                   Level XXVII ($4500-
                   $5000).
1565............  New Technology--      T...................  .........    $5,250.00  ............     $1,050.00
                   Level XXVIII ($5000-
                   $5500).
1566............  New Technology--      T...................  .........    $5,750.00  ............     $1,150.00
                   Level XXIX ($5500-
                   $6000).
1567............  New Technology--      T...................  .........    $6,250.00  ............     $1,250.00
                   Level XXX ($6000-
                   $6500).
1568............  New Technology--      T...................  .........    $6,750.00  ............     $1,350.00
                   Level XXXI ($6500-
                   $7000).
1569............  New Technology--      T...................  .........    $7,250.00  ............     $1,450.00
                   Level XXXII ($7000-
                   $7500).
1570............  New Technology--      T...................  .........    $7,750.00  ............     $1,550.00
                   Level XXXIII ($7500-
                   $8000).
1571............  New Technology--      T...................  .........    $8,250.00  ............     $1,650.00
                   Level XXXIV ($8000-
                   $8500).
1572............  New Technology--      T...................  .........    $8,750.00  ............     $1,750.00
                   Level XXXV ($8500-
                   $9000).
1573............  New Technology--      T...................  .........    $9,250.00  ............     $1,850.00
                   Level XXXVI ($9000-
                   $9500).
1574............  New Technology--      T...................  .........    $9,750.00  ............     $1,950.00
                   Level XXXVII ($9500-
                   $10000).
1600............  Technetium TC 99m     K...................     1.1782       $64.28  ............        $12.86
                   sestamibi.
1603............  Thallous chloride TL  K...................     0.3645       $19.89  ............         $3.98
                   201/mci.
1604............  IN 111 capromab       K...................    12.6045      $687.71  ............       $137.54
                   pendetide, per dose.
1605............  Abciximab injection,  K...................     5.3048      $289.44  ............        $57.89
                   10 mg.

[[Page 63487]]

 
1606............  Anistreplase, 30 u..  K...................    27.7939    $1,516.46  ............       $303.29
1607............  Eptifibatide          K...................     0.1465        $7.99  ............         $1.60
                   injection, 5mg.
1608............  Etanercept injection  K...................     1.8762      $102.37  ............        $20.47
1609............  Rho(D) immune         K...................     0.1789        $9.76  ............         $1.95
                   globulin h, sd, 100
                   iu.
1611............  Hylan G-F 20          K...................     2.2628      $123.46  ............        $24.69
                   injection, 16 mg.
1612............  Daclizumab,           K...................  .........      $393.78  ............        $78.76
                   parenteral, 25 mg.
1613............  Trastuzumab, 10 mg..  K...................     0.7434       $40.56  ............         $8.11
1614............  Valrubicin, 200 mg..  K...................     8.4635      $461.78  ............        $92.36
1615............  Basiliximab, 20 mg..  K...................  .........    $1,425.06  ............       $285.01
1618............  Vonwillebrandfactrcm  K...................  .........        $1.01  ............         $0.20
                   plx, per iu.
1619............  Gallium ga 67.......  K...................     0.2056       $11.22  ............         $2.24
1620............  Technetium tc99m      K...................     3.3666      $183.69  ............        $36.74
                   bicisate.
1622............  Technetium tc99m      K...................     0.3782       $20.63  ............         $4.13
                   mertiatide.
1624............  Sodium phosphate p32  K...................     1.2941       $70.61  ............        $14.12
1625............  Indium 111-in         K...................     8.2447      $449.84  ............        $89.97
                   pentetreotide.
1628............  Chromic phosphate     K...................     1.8057       $98.52  ............        $19.70
                   p32.
1716............  Brachytx source,      K...................     1.3811       $75.35  ............        $15.07
                   Gold 198.
1718............  Brachytx source,      K...................     0.6843       $37.34  ............         $7.47
                   Iodine 125.
1719............  Brachytx source,Non-  K...................     0.3187       $17.39  ............         $3.48
                   HDR Ir-192.
1720............  Brachytx source,      K...................     0.8187       $44.67  ............         $8.93
                   Palladium 103.
1775............  FDG, per dose (4-40   K...................     5.9471      $324.48  ............        $64.90
                   mCi/ml).
1783............  Ocular implant,       H...................  .........  ...........  ............         $0.00
                   aqueous drain
                   device.
1814............  Retinal Tamp,         H...................  .........  ...........  ............         $-.00
                   silicone oil.
1818............  Integrated            H...................  .........  ...........  ............         $0.00
                   keratoprosthesis.
1819............  Tissue localization-  H...................  .........  ...........  ............         $0.00
                   excision dev.
1884............  Embolization Protect  H...................  .........  ...........  ............         $0.00
                   syst.
1888............  Catheter, ablation,   H...................  .........  ...........  ............         $0.00
                   non-cardiac,
                   endovascular
                   (implantable).
1900............  Lead coronary venous  H...................  .........  ...........  ............         $0.00
2614............  Probe, percutaneous   H...................  .........  ...........  ............         $0.00
                   lumbar disc.
2616............  Brachytx source,      K...................   176.2339    $9,615.50  ............     $1,923.10
                   Yttrium-90.
2632............  Brachytx sol, I-125,  H...................  .........  ...........  ............         $0.00
                   per mCi.
2633............  Brachytx source,      K...................     0.8187       $44.67  ............         $8.93
                   Cesium-131.
7000............  Amifostine, 500 mg..  K...................     5.3041      $289.40  ............        $57.88
7007............  Inj milrinone         K...................     0.2129       $11.62  ............         $2.32
                   lactate, per 5 mg.
7011............  Oprelvekin            K...................  .........      $248.16  ............        $49.63
                   injection, 5 mg.
7015............  Busulfan, oral, 2 mg  K...................     0.0288        $1.57  ............         $0.31
7019............  Aprotinin, 10,000     K...................     0.0215        $1.17  ............         $0.23
                   kiu.
7024............  Corticorelin ovine    K...................     4.1221      $224.91  ............        $44.98
                   triflutat.
7025............  Digoxin immune FAB    K...................     4.9694      $271.14  ............        $54.23
                   (ovine).
7026............  Ethanolamine oleate   K...................     0.5099       $27.82  ............         $5.56
                   100 mg.
7027............  Fomepizole, 15mg....  K...................     0.1325        $7.23  ............         $1.45
7028............  Fosphenytoin, 50 mg.  K...................     0.0895        $4.88  ............         $0.98
7030............  Hemin, per 1 mg.....  K...................     0.0118        $0.64  ............         $0.13
7031............  Octreotide acetate    K...................     0.0264        $1.44  ............         $0.29
                   injection.
7034............  Somatropin injection  K...................     0.7547       $41.18  ............         $8.24
7035............  Teniposide, 50 mg...  K...................     2.5185      $137.41  ............        $27.48
7036............  Urokinase 250,000 iu  K...................     3.7855      $206.54  ............        $41.31
                   inj.
7037............  Urofollitropin, 75    K...................     1.1634       $63.48  ............        $12.70
                   iu.
7038............  Muromonab-CD3, 5 mg.  K...................     5.8803      $320.84  ............        $64.17
7040............  Pentastarch 10%       K...................     0.4838       $26.40  ............         $5.28
                   solution.
7041............  Tirofiban             K...................      4.176      $227.85  ............        $45.57
                   hydrochloride 12.5
                   mg.
7042............  Capecitabine, oral,   K...................     0.0302        $1.65  ............         $0.33
                   150 mg.
7043............  Infliximab injection  K...................     0.7122       $38.86  ............         $7.77
                   10 mg.
7045............  Trimetrexate          K...................     1.1246       $61.36  ............        $12.27
                   glucoronate.
7046............  Doxorubicin hcl       K...................     4.6982      $256.34  ............        $51.27
                   liposome inj 10 mg.
7048............  Alteplase             K...................     0.2856       $15.58  ............         $3.12
                   recombinant.
7049............  Filgrastim 480 mcg    K...................     3.2251      $175.96  ............        $35.19
                   injection.
7051............  Leuprolide acetate    K...................    67.2039    $3,666.71  ............       $733.34
                   implant, 65 mg.
7316............  Sodium hyaluronate    K...................     2.5436      $138.78  ............        $27.76
                   injection.
9001............  Linezolid injection.  K...................     0.2771       $15.12  ............         $3.02
9002............  Tenecteplase, 50mg/   K...................    23.7669    $1,296.75  ............       $259.35
                   vial.
9003............  Palivizumab, per      K...................     6.3077      $344.15  ............        $68.83
                   50mg.
9004............  Gemtuzumab            K...................  .........    $2,022.90  ............       $404.58
                   ozogamicin inj,5mg.
9005............  Reteplase injection.  K...................    10.4165      $568.33  ............       $113.67
9006............  Tacrolimus injection  K...................     0.1048        $5.72  ............         $1.14
9008............  Baclofen Refill Kit-  K...................     0.1264        $6.90  ............         $1.38
                   500mcg.
9009............  Baclofen refill kit-- K...................     0.7499       $40.92  ............         $8.18
                   per 2000 mcg.
9010............  Baclofen refill kit-- K...................     0.7739       $42.22  ............         $8.44
                   per 4000 mcg.
9012............  Arsenic Trioxide....  K...................     0.4933       $26.91  ............         $5.38

[[Page 63488]]

 
9013............  Co 57 cobaltous       K...................     1.0386       $56.67  ............        $11.33
                   chloride.
9015............  Mycophenolate         K...................     0.0374        $2.04  ............         $0.41
                   mofetil oral 250 mg.
9018............  Botulinum toxin B,    K...................     0.1279        $6.98  ............         $1.40
                   per 100 u.
9019............  Caspofungin acetate,  K...................     0.5432       $29.64  ............         $5.93
                   5 mg.
9020............  Sirolimus tablet, 1   K...................     0.0529        $2.89  ............         $0.58
                   mg.
9021............  Immune globulin 10    K...................     0.0080        $0.44  ............         $0.09
                   mg.
9022............  IM inj interferon     K...................     1.1290       $61.60  ............        $12.32
                   beta 1-a.
9023............  Rho d immune          K...................     0.0310        $1.69  ............         $0.34
                   globulin 50 mcg.
9024............  Amphotericin B,       K...................     0.3823       $20.86  ............         $4.17
                   lipid formulation.
9025............  Radiopharms Used to   K...................     2.6372      $143.89  ............        $28.78
                   Image Perfusion of
                   Heart.
9100............  Iodinated I-          K...................     0.0066        $0.36  ............         $0.07
                   131albumin, per 5
                   uci.
9104............  Anti-thymocycte       K...................     2.9978      $163.56  ............        $32.71
                   globulin rabbit.
9105............  Hep B imm glob, per   K...................     1.3074       $71.33  ............        $14.27
                   1 ml.
9108............  Thyrotropin alfa,     K...................  .........      $572.00  ............       $114.40
                   per 1.1 mg.
9109............  Tirofliban hcl, per   K...................     2.1737      $118.60  ............        $23.72
                   6.25 mg.
9110............  Alemtuzumab, per 10   K...................     7.7873      $424.88  ............        $84.98
                   mg.
9111............  Inj, bivalirudin,     G...................  .........        $1.60  ............         $0.24
                   per 250 mg vial.
9112............  Perflutren lipid      G...................  .........      $148.20  ............        $22.15
                   micro, per 2ml.
9113............  Inj, pantoprazole     G...................  .........       $25.08  ............         $3.75
                   sodium, vial.
9114............  Nesiritide, per 0.5   G...................  .........      $151.62  ............        $22.66
                   mg vial.
9115............  Inj, zoledronic       G...................  .........      $217.43  ............        $32.50
                   acid, per 1 mg.
9116............  Inj, Ertapenem        G...................  .........       $23.74  ............         $3.55
                   sodium, per 1 gm
                   vial.
9117............  Yttrium 90            K...................  .........   $19,565.00  ............     $3,913.00
                   ibritumomab
                   tiuxetan.
9118............  In-111 ibritumomab    K...................  .........    $2,260.00  ............       $452.00
                   tiuxetan.
9119............  Pegfilgrastim, per 1  G...................  .........    $2,802.50  ............       $418.90
                   mg.
9120............  Inj, Fulvestrant,     G...................  .........       $87.58  ............        $13.09
                   per 50 mg.
9121............  Inj, Argatroban, per  G...................  .........       $16.35  ............         $2.44
                   5 mg.
9122............  Inj, Triptorelin      G...................  .........      $398.62  ............        $59.58
                   pamoate, per 3.75
                   mg.
9123............  Transcyte, per 247    G...................  .........      $770.93  ............       $115.23
                   sq cm.
9200............  Orcel, per 36 cm2...  G...................  .........    $1,135.25  ............       $169.69
9201............  Dermagraft, per 37.5  G...................  .........      $577.60  ............        $86.34
                   sq cm.
9202............  Octafluoropropane...  K...................     2.1737      $118.60  ............        $23.72
9203............  Perflexane lipid      G...................  .........      $142.50  ............        $21.30
                   micro.
9204............  Ziprasidone mesylate  G...................  .........       $20.79  ............         $3.11
9205............  Oxaliplatin.........  G...................  .........       $94.46  ............        $14.12
9207............  Injection,            G...................  .........    $1,039.68  ............       $155.40
                   bortezomib.
9208............  Injection,            G...................  .........      $123.78  ............        $18.50
                   agalsidase beta.
9209............  Injection,            G...................  .........      $644.10  ............        $96.28
                   laronidase.
9210............  Injection,            G...................  .........      $307.80  ............        $46.01
                   palonosetron HCL.
9211............  Inj, alefacept, IV..  G...................  .........      $665.00  ............        $99.40
9212............  Inj, alefacept, IM..  G...................  .........      $472.63  ............        $70.65
9217............  Leuprolide acetate    K...................     5.7252      $312.37  ............        $62.47
                   suspnsion, 7.5 mg.
9500............  Platelets,            K...................  .........       $74.79  ............        $14.96
                   irradiated.
9501............  Platelets, pheresis.  K...................  .........      $408.81  ............        $81.76
9502............  Platelet pheresis     K...................  .........      $443.68  ............        $88.74
                   irradiated.
9503............  Fresh frozen plasma,  K...................  .........       $69.74  ............        $13.95
                   ea unit.
9504............  RBC deglycerolized..  K...................  .........      $183.44  ............        $36.69
9505............  RBC irradiated......  K...................  .........      $108.65  ............        $21.73
9506............  Granulocytes,         K...................  .........    $1,248.66  ............       $249.73
                   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 63488]]



                                  Addendum B.--Payment Status by HCPCS Code and Related Information Calender Year 2004
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                                                                  National     Minimum
      CPT/HCPCS           Status indicator         Condition            Description          APC        Relative     Payment     unadjusted   unadjusted
                                                                                                         weight        rate      copayment    copayment
--------------------------------------------------------------------------------------------------------------------------------------------------------
0001F................  E....................  NI.................  Blood pressure,       ...........  ...........  ...........  ...........  ...........
                                                                    measured.
0001T................  C....................  ...................  Endovas repr abdo ao  ...........  ...........  ...........  ...........  ...........
                                                                    aneurys.
0002F................  E....................  NI.................  Tobacco use,          ...........  ...........  ...........  ...........  ...........
                                                                    smoking, assess.
0002T................  C....................  DG.................  Endovas repr abdo ao  ...........  ...........  ...........  ...........  ...........
                                                                    aneurys.
0003F................  E....................  NI.................  Tobacco use, non-     ...........  ...........  ...........  ...........  ...........
                                                                    smoking.
0003T................  S....................  ...................  Cervicography.......         1501  ...........       $25.00  ...........        $5.00
0004F................  E....................  NI.................  Tobacco use txmnt     ...........  ...........  ...........  ...........  ...........
                                                                    counseling.
0005F................  E....................  NI.................  Tobacco use txmnt,    ...........  ...........  ...........  ...........  ...........
                                                                    pharmacol.
0005T................  C....................  ...................  Perc cath stent/      ...........  ...........  ...........  ...........  ...........
                                                                    brain cv art.

[[Page 63489]]

 
0006F................  E....................  NI.................  Statin therapy,       ...........  ...........  ...........  ...........  ...........
                                                                    prescribed.
0006T................  C....................  ...................  Perc cath stent/      ...........  ...........  ...........  ...........  ...........
                                                                    brain cv art.
0007F................  E....................  NI.................  Beta-blocker thx      ...........  ...........  ...........  ...........  ...........
                                                                    prescribed.
0007T................  C....................  ...................  Perc cath stent/      ...........  ...........  ...........  ...........  ...........
                                                                    brain cv art.
0008F................  E....................  NI.................  Ace inhibitor thx     ...........  ...........  ...........  ...........  ...........
                                                                    prescribed.
0008T................  E....................  ...................  Upper gi endoscopy w/ ...........  ...........  ...........  ...........  ...........
                                                                    suture.
0009F................  E....................  NI.................  Assess anginal        ...........  ...........  ...........  ...........  ...........
                                                                    symptom/level.
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  ...........  ...........  ...........  ...........  ...........
0010F................  E....................  NI.................  Assess anginal        ...........  ...........  ...........  ...........  ...........
                                                                    symptom/level.
0010T................  A....................  ...................  Tb test, gamma        ...........  ...........  ...........  ...........  ...........
                                                                    interferon.
0011F................  E....................  NI.................  Oral antiplat thx     ...........  ...........  ...........  ...........  ...........
                                                                    prescribed.
00120................  N....................  ...................  Anesth, ear surgery.  ...........  ...........  ...........  ...........  ...........
00124................  N....................  ...................  Anesth, ear exam....  ...........  ...........  ...........  ...........  ...........
00126................  N....................  ...................  Anesth, tympanotomy.  ...........  ...........  ...........  ...........  ...........
0012T................  T....................  ...................  Osteochondral knee           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    autograft.
0013T................  T....................  ...................  Osteochondral knee           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    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      27.3819    $1,493.98  ...........      $298.80
                                                                    knee.
00160................  N....................  ...................  Anesth, nose/sinus    ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
00162................  N....................  ...................  Anesth, nose/sinus    ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
00164................  N....................  ...................  Anesth, biopsy of     ...........  ...........  ...........  ...........  ...........
                                                                    nose.
0016T................  T....................  ...................  Thermotx choroid             0235       5.0749      $276.89       $72.04       $55.38
                                                                    vasc lesion.
00170................  N....................  ...................  Anesth, procedure on  ...........  ...........  ...........  ...........  ...........
                                                                    mouth.
00172................  N....................  ...................  Anesth, cleft palate  ...........  ...........  ...........  ...........  ...........
                                                                    repair.
00174................  C....................  ...................  Anesth, pharyngeal    ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
00176................  C....................  ...................  Anesth, pharyngeal    ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
0017T................  E....................  ...................  Photocoagulat         ...........  ...........  ...........  ...........  ...........
                                                                    macular drusen.
0018T................  S....................  ...................  Transcranial                 0215       0.6457       $35.23       $15.76        $7.05
                                                                    magnetic 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.
0025T................  S....................  DG.................  Ultrasonic                   0230       0.7619       $41.57       $14.97        $8.31
                                                                    pachymetry.
0026T................  A....................  ...................  Measure remnant       ...........  ...........  ...........  ...........  ...........
                                                                    lipoproteins.
0027T................  T....................  ...................  Endoscopic epidural          1547  ...........      $850.00  ...........      $170.00
                                                                    lysis.
0028T................  N....................  ...................  Dexa body             ...........  ...........  ...........  ...........  ...........
                                                                    composition study.
0029T................  A....................  ...................  Magnetic tx for       ...........  ...........  ...........  ...........  ...........
                                                                    incontinence.
00300................  N....................  ...................  Anesth, head/neck/    ...........  ...........  ...........  ...........  ...........
                                                                    ptrunk.
0030T................  A....................  ...................  Antiprothrombin       ...........  ...........  ...........  ...........  ...........
                                                                    antibody.
0031T................  N....................  ...................  Speculoscopy........  ...........  ...........  ...........  ...........  ...........
00320................  N....................  ...................  Anesth, neck organ,   ...........  ...........  ...........  ...........  ...........
                                                                    1 & over.
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.

[[Page 63490]]

 
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.
0045T................  N....................  NI.................  Whole body            ...........  ...........  ...........  ...........  ...........
                                                                    photography.
0046T................  T....................  NI.................  Cath lavage, mammary         0018       0.9178       $50.08       $16.04       $10.02
                                                                    duct(s).
00470................  N....................  ...................  Anesth, removal of    ...........  ...........  ...........  ...........  ...........
                                                                    rib.
00472................  N....................  ...................  Anesth, chest wall    ...........  ...........  ...........  ...........  ...........
                                                                    repair.
00474................  C....................  ...................  Anesth, surgery of    ...........  ...........  ...........  ...........  ...........
                                                                    rib(s).
0047T................  T....................  NI.................  Cath lavage, mammary         0018       0.9178       $50.08       $16.04       $10.02
                                                                    duct(s).
0048T................  C....................  NI.................  Implant ventricular   ...........  ...........  ...........  ...........  ...........
                                                                    device.
0049T................  C....................  NI.................  External circulation  ...........  ...........  ...........  ...........  ...........
                                                                    assist.
00500................  N....................  ...................  Anesth, esophageal    ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
0050T................  C....................  NI.................  Removal circulation   ...........  ...........  ...........  ...........  ...........
                                                                    assist.
0051T................  C....................  NI.................  Implant total heart   ...........  ...........  ...........  ...........  ...........
                                                                    system.
00520................  N....................  ...................  Anesth, chest         ...........  ...........  ...........  ...........  ...........
                                                                    procedure.
00522................  N....................  ...................  Anesth, chest lining  ...........  ...........  ...........  ...........  ...........
                                                                    biopsy.
00524................  C....................  ...................  Anesth, chest         ...........  ...........  ...........  ...........  ...........
                                                                    drainage.
00528................  N....................  ...................  Anesth, chest         ...........  ...........  ...........  ...........  ...........
                                                                    partition view.
00529................  N....................  NI.................  Anesth, chest         ...........  ...........  ...........  ...........  ...........
                                                                    partition view.
0052T................  C....................  NI.................  Replace component     ...........  ...........  ...........  ...........  ...........
                                                                    heart syst.
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.
0053T................  C....................  NI.................  Replace component     ...........  ...........  ...........  ...........  ...........
                                                                    heart syst.
00540................  C....................  ...................  Anesth, chest         ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
00541................  N....................  ...................  Anesth, one lung      ...........  ...........  ...........  ...........  ...........
                                                                    ventilation.
00542................  C....................  ...................  Anesth, release of    ...........  ...........  ...........  ...........  ...........
                                                                    lung.
00544................  C....................  DG.................  Anesth, chest lining  ...........  ...........  ...........  ...........  ...........
                                                                    removal.
00546................  C....................  DG.................  Anesth, lung,chest    ...........  ...........  ...........  ...........  ...........
                                                                    wall surg.
00548................  N....................  DG.................  Anesth,               ...........  ...........  ...........  ...........  ...........
                                                                    trachea,bronchi
                                                                    surg.
0054T................  E....................  NI.................  Bone surgery using    ...........  ...........  ...........  ...........  ...........
                                                                    computer.
00550................  N....................  DG.................  Anesth, sternal       ...........  ...........  ...........  ...........  ...........
                                                                    debridement.
0055T................  E....................  NI.................  Bone surgery using    ...........  ...........  ...........  ...........  ...........
                                                                    computer.
00560................  C....................  DG.................  Anesth, open heart    ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
00562................  C....................  DG.................  Anesth, open heart    ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
00563................  N....................  DG.................  Anesth, heart proc w/ ...........  ...........  ...........  ...........  ...........
                                                                    pump.
00566................  N....................  DG.................  Anesth, cabg w/o      ...........  ...........  ...........  ...........  ...........
                                                                    pump.
0056T................  E....................  NI.................  Bone surgery using    ...........  ...........  ...........  ...........  ...........
                                                                    computer.
0057T................  E....................  NI.................  Uppr gi scope w/      ...........  ...........  ...........  ...........  ...........
                                                                    thrml txmnt.
00580................  C....................  ...................  Anesth, heart/lung    ...........  ...........  ...........  ...........  ...........
                                                                    transplnt.
0058T................  X....................  NI.................  Cryopreservation,            0348       0.8194       $44.71  ...........        $8.94
                                                                    ovary tiss.
0059T................  X....................  NI.................  Cryopreservation,            0348       0.8194       $44.71  ...........        $8.94
                                                                    oocyte.
00600................  N....................  ...................  Anesth, spine, cord   ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
00604................  C....................  ...................  Anesth, sitting       ...........  ...........  ...........  ...........  ...........
                                                                    procedure.
0060T................  E....................  NI.................  Electrical impedance  ...........  ...........  ...........  ...........  ...........
                                                                    scan.
0061T................  E....................  NI.................  Destruction of        ...........  ...........  ...........  ...........  ...........
                                                                    tumor, breast.
00620................  N....................  ...................  Anesth, spine, cord   ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
00622................  C....................  ...................  Anesth, removal of    ...........  ...........  ...........  ...........  ...........
                                                                    nerves.
00630................  N....................  ...................  Anesth, spine, cord   ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
00632................  C....................  ...................  Anesth, removal of    ...........  ...........  ...........  ...........  ...........
                                                                    nerves.
00634................  C....................  ...................  Anesth for            ...........  ...........  ...........  ...........  ...........
                                                                    chemonucleolysis.
00635................  N....................  ...................  Anesth, lumbar        ...........  ...........  ...........  ...........  ...........
                                                                    puncture.
00640................  N....................  ...................  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.

[[Page 63491]]

 
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.
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.
01173................  N....................  NI.................  Anesth, fx repair,    ...........  ...........  ...........  ...........  ...........
                                                                    pelvis.
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.

[[Page 63492]]

 
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, dx 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/ft      ...........  ...........  ...........  ...........  ...........
                                                                    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....................  ...................  Anes dx shoulder      ...........  ...........  ...........  ...........  ...........
                                                                    arthroscopy.
01630................  N....................  ...................  Anesth, surgery of    ...........  ...........  ...........  ...........  ...........
                                                                    shoulder.
01632................  C....................  ...................  Anesth, surgery of    ...........  ...........  ...........  ...........  ...........
                                                                    shoulder.
01634................  C....................  ...................  Anesth, shoulder      ...........  ...........  ...........  ...........  ...........
                                                                    joint amput.
01636................  C....................  ...................  Anesth, forequarter   ...........  ...........  ...........  ...........  ...........
                                                                    amput.
01638................  C....................  ...................  Anesth, shoulder      ...........  ...........  ...........  ...........  ...........
                                                                    replacement.
01650................  N....................  ...................  Anesth, shoulder      ...........  ...........  ...........  ...........  ...........
                                                                    artery surg.
01652................  C....................  ...................  Anesth, shoulder      ...........  ...........  ...........  ...........  ...........
                                                                    vessel surg.
01654................  C....................  ...................  Anesth, shoulder      ...........  ...........  ...........  ...........  ...........
                                                                    vessel surg.
01656................  C....................  ...................  Anesth, arm-leg       ...........  ...........  ...........  ...........  ...........
                                                                    vessel surg.
01670................  N....................  ...................  Anesth, shoulder      ...........  ...........  ...........  ...........  ...........
                                                                    vein surg.
01680................  N....................  ...................  Anesth, shoulder      ...........  ...........  ...........  ...........  ...........
                                                                    casting.
01682................  N....................  ...................  Anesth, airplane      ...........  ...........  ...........  ...........  ...........
                                                                    cast.
01710................  N....................  ...................  Anesth, elbow area    ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
01712................  N....................  ...................  Anesth, uppr arm      ...........  ...........  ...........  ...........  ...........
                                                                    tendon surg.
01714................  N....................  ...................  Anesth, uppr arm      ...........  ...........  ...........  ...........  ...........
                                                                    tendon surg.
01716................  N....................  ...................  Anesth, biceps        ...........  ...........  ...........  ...........  ...........
                                                                    tendon repair.
01730................  N....................  ...................  Anesth, uppr arm      ...........  ...........  ...........  ...........  ...........
                                                                    procedure.
01732................  N....................  ...................  Anesth, dx 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.

[[Page 63493]]

 
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.
01958................  N....................  NI.................  Anesth, antepartum    ...........  ...........  ...........  ...........  ...........
                                                                    manipul.
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....................  ...................  Hosp manage cont      ...........  ...........  ...........  ...........  ...........
                                                                    drug admin.
01999................  N....................  ...................  Unlisted anesth       ...........  ...........  ...........  ...........  ...........
                                                                    procedure.
10021................  T....................  ...................  Fna w/o image.......         0002       0.8083       $44.10  ...........        $8.82
10022................  T....................  ...................  Fna w/image.........         0036       1.5170       $82.77  ...........       $16.55
10040................  T....................  ...................  Acne surgery........         0010       0.6480       $35.36       $10.08        $7.07
10060................  T....................  ...................  Drainage of skin             0006       1.6527       $90.17       $23.26       $18.03
                                                                    abscess.
10061................  T....................  ...................  Drainage of skin             0006       1.6527       $90.17       $23.26       $18.03
                                                                    abscess.
10080................  T....................  ...................  Drainage of                  0006       1.6527       $90.17       $23.26       $18.03
                                                                    pilonidal cyst.
10081................  T....................  ...................  Drainage of                  0007      11.8633      $647.27  ...........      $129.45
                                                                    pilonidal cyst.
10120................  T....................  ...................  Remove foreign body.         0006       1.6527       $90.17       $23.26       $18.03
10121................  T....................  ...................  Remove foreign body.         0021      14.3594      $783.46      $219.48      $156.69
10140................  T....................  ...................  Drainage of hematoma/        0007      11.8633      $647.27  ...........      $129.45
                                                                    fluid.
10160................  T....................  ...................  Puncture drainage of         0018       0.9178       $50.08       $16.04       $10.02
                                                                    lesion.
10180................  T....................  ...................  Complex drainage,            0007      11.8633      $647.27  ...........      $129.45
                                                                    wound.
11000................  T....................  ...................  Debride infected             0015       1.5968       $87.12       $20.35       $17.42
                                                                    skin.
11001................  T....................  ...................  Debride infected             0012       0.7694       $41.98       $11.18        $8.40
                                                                    skin add-on.
11010................  T....................  ...................  Debride skin, fx....         0019       3.9493      $215.48       $71.87       $43.10
11011................  T....................  ...................  Debride skin/muscle,         0019       3.9493      $215.48       $71.87       $43.10
                                                                    fx.
11012................  T....................  ...................  Debride skin/muscle/         0019       3.9493      $215.48       $71.87       $43.10
                                                                    bone, fx.
11040................  T....................  ...................  Debride skin,                0015       1.5968       $87.12       $20.35       $17.42
                                                                    partial.
11041................  T....................  ...................  Debride skin, full..         0015       1.5968       $87.12       $20.35       $17.42
11042................  T....................  ...................  Debride skin/tissue.         0016       2.5724      $140.35       $57.31       $28.07
11043................  T....................  ...................  Debride tissue/              0016       2.5724      $140.35       $57.31       $28.07
                                                                    muscle.
11044................  T....................  ...................  Debride tissue/              0682       8.0790      $440.80      $174.57       $88.16
                                                                    muscle/bone.
11055................  T....................  ...................  Trim skin lesion....         0012       0.7694       $41.98       $11.18        $8.40
11056................  T....................  ...................  Trim skin lesions, 2         0012       0.7694       $41.98       $11.18        $8.40
                                                                    to 4.
11057................  T....................  ...................  Trim skin lesions,           0013       1.1272       $61.50       $14.20       $12.30
                                                                    over 4.
11100................  T....................  ...................  Biopsy, skin lesion.         0018       0.9178       $50.08       $16.04       $10.02
11101................  T....................  ...................  Biopsy, skin add-on.         0018       0.9178       $50.08       $16.04       $10.02
11200................  T....................  ...................  Removal of skin tags         0013       1.1272       $61.50       $14.20       $12.30
11201................  T....................  ...................  Remove skin tags add-        0015       1.5968       $87.12       $20.35       $17.42
                                                                    on.
11300................  T....................  ...................  Shave skin lesion...         0012       0.7694       $41.98       $11.18        $8.40
11301................  T....................  ...................  Shave skin lesion...         0012       0.7694       $41.98       $11.18        $8.40
11302................  T....................  ...................  Shave skin lesion...         0012       0.7694       $41.98       $11.18        $8.40
11303................  T....................  ...................  Shave skin lesion...         0015       1.5968       $87.12       $20.35       $17.42
11305................  T....................  ...................  Shave skin lesion...         0013       1.1272       $61.50       $14.20       $12.30
11306................  T....................  ...................  Shave skin lesion...         0013       1.1272       $61.50       $14.20       $12.30
11307................  T....................  ...................  Shave skin lesion...         0013       1.1272       $61.50       $14.20       $12.30
11308................  T....................  ...................  Shave skin lesion...         0013       1.1272       $61.50       $14.20       $12.30
11310................  T....................  ...................  Shave skin lesion...         0013       1.1272       $61.50       $14.20       $12.30
11311................  T....................  ...................  Shave skin lesion...         0013       1.1272       $61.50       $14.20       $12.30
11312................  T....................  ...................  Shave skin lesion...         0013       1.1272       $61.50       $14.20       $12.30
11313................  T....................  ...................  Shave skin lesion...         0016       2.5724      $140.35       $57.31       $28.07
11400................  T....................  ...................  Removal of skin              0019       3.9493      $215.48       $71.87       $43.10
                                                                    lesion.
11401................  T....................  ...................  Removal of skin              0019       3.9493      $215.48       $71.87       $43.10
                                                                    lesion.
11402................  T....................  ...................  Removal of skin              0019       3.9493      $215.48       $71.87       $43.10
                                                                    lesion.
11403................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.

[[Page 63494]]

 
11404................  T....................  ...................  Removal of skin              0021      14.3594      $783.46      $219.48      $156.69
                                                                    lesion.
11406................  T....................  ...................  Removal of skin              0021      14.3594      $783.46      $219.48      $156.69
                                                                    lesion.
11420................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11421................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11422................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11423................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11424................  T....................  ...................  Removal of skin              0021      14.3594      $783.46      $219.48      $156.69
                                                                    lesion.
11426................  T....................  ...................  Removal of skin              0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
11440................  T....................  ...................  Removal of skin              0019       3.9493      $215.48       $71.87       $43.10
                                                                    lesion.
11441................  T....................  ...................  Removal of skin              0019       3.9493      $215.48       $71.87       $43.10
                                                                    lesion.
11442................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11443................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11444................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11446................  T....................  ...................  Removal of skin              0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
11450................  T....................  ...................  Removal, sweat gland         0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
11451................  T....................  ...................  Removal, sweat gland         0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
11462................  T....................  ...................  Removal, sweat gland         0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
11463................  T....................  ...................  Removal, sweat gland         0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
11470................  T....................  ...................  Removal, sweat gland         0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
11471................  T....................  ...................  Removal, sweat gland         0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
11600................  T....................  ...................  Removal of skin              0019       3.9493      $215.48       $71.87       $43.10
                                                                    lesion.
11601................  T....................  ...................  Removal of skin              0019       3.9493      $215.48       $71.87       $43.10
                                                                    lesion.
11602................  T....................  ...................  Removal of skin              0019       3.9493      $215.48       $71.87       $43.10
                                                                    lesion.
11603................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11604................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11606................  T....................  ...................  Removal of skin              0021      14.3594      $783.46      $219.48      $156.69
                                                                    lesion.
11620................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11621................  T....................  ...................  Removal of skin              0019       3.9493      $215.48       $71.87       $43.10
                                                                    lesion.
11622................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11623................  T....................  ...................  Removal of skin              0021      14.3594      $783.46      $219.48      $156.69
                                                                    lesion.
11624................  T....................  ...................  Removal of skin              0021      14.3594      $783.46      $219.48      $156.69
                                                                    lesion.
11626................  T....................  ...................  Removal of skin              0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
11640................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11641................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11642................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11643................  T....................  ...................  Removal of skin              0020       7.0842      $386.52      $113.25       $77.30
                                                                    lesion.
11644................  T....................  ...................  Removal of skin              0021      14.3594      $783.46      $219.48      $156.69
                                                                    lesion.
11646................  T....................  ...................  Removal of skin              0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
11719................  T....................  ...................  Trim nail(s)........         0009       0.6652       $36.29        $8.34        $7.26
11720................  T....................  ...................  Debride nail, 1-5...         0009       0.6652       $36.29        $8.34        $7.26
11721................  T....................  ...................  Debride nail, 6 or           0009       0.6652       $36.29        $8.34        $7.26
                                                                    more.
11730................  T....................  ...................  Removal of nail              0013       1.1272       $61.50       $14.20       $12.30
                                                                    plate.
11732................  T....................  ...................  Remove nail plate,           0012       0.7694       $41.98       $11.18        $8.40
                                                                    add-on.
11740................  T....................  ...................  Drain blood from             0009       0.6652       $36.29        $8.34        $7.26
                                                                    under nail.
11750................  T....................  ...................  Removal of nail bed.         0019       3.9493      $215.48       $71.87       $43.10
11752................  T....................  ...................  Remove nail bed/             0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    finger tip.
11755................  T....................  ...................  Biopsy, nail unit...         0019       3.9493      $215.48       $71.87       $43.10
11760................  T....................  ...................  Repair of nail bed..         0024       1.6850       $91.94       $33.10       $18.39
11762................  T....................  ...................  Reconstruction of            0024       1.6850       $91.94       $33.10       $18.39
                                                                    nail bed.
11765................  T....................  ...................  Excision of nail             0015       1.5968       $87.12       $20.35       $17.42
                                                                    fold, toe.
11770................  T....................  ...................  Removal of pilonidal         0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
11771................  T....................  ...................  Removal of pilonidal         0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
11772................  T....................  ...................  Removal of pilonidal         0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
11900................  T....................  ...................  Injection into skin          0012       0.7694       $41.98       $11.18        $8.40
                                                                    lesions.
11901................  T....................  ...................  Added skin lesions           0012       0.7694       $41.98       $11.18        $8.40
                                                                    injection.
11920................  T....................  ...................  Correct skin color           0024       1.6850       $91.94       $33.10       $18.39
                                                                    defects.
11921................  T....................  ...................  Correct skin color           0024       1.6850       $91.94       $33.10       $18.39
                                                                    defects.
11922................  T....................  ...................  Correct skin color           0024       1.6850       $91.94       $33.10       $18.39
                                                                    defects.
11950................  T....................  ...................  Therapy for contour          0024       1.6850       $91.94       $33.10       $18.39
                                                                    defects.
11951................  T....................  ...................  Therapy for contour          0024       1.6850       $91.94       $33.10       $18.39
                                                                    defects.
11952................  T....................  ...................  Therapy for contour          0024       1.6850       $91.94       $33.10       $18.39
                                                                    defects.
11954................  T....................  ...................  Therapy for contour          0024       1.6850       $91.94       $33.10       $18.39
                                                                    defects.
11960................  T....................  ...................  Insert tissue                0027      15.8990      $867.47      $329.72      $173.49
                                                                    expander(s).
11970................  T....................  ...................  Replace tissue               0027      15.8990      $867.47      $329.72      $173.49
                                                                    expander.
11971................  T....................  ...................  Remove tissue                0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    expander(s).
11975................  E....................  ...................  Insert contraceptive  ...........  ...........  ...........  ...........  ...........
                                                                    cap.
11976................  T....................  ...................  Removal of                   0019       3.9493      $215.48       $71.87       $43.10
                                                                    contraceptive cap.
11977................  E....................  ...................  Removal/reinsert      ...........  ...........  ...........  ...........  ...........
                                                                    contra cap.
11980................  X....................  ...................  Implant hormone              0340       0.6314       $34.45  ...........        $6.89
                                                                    pellet(s).
11981................  X....................  ...................  Insert drug implant          0340       0.6314       $34.45  ...........        $6.89
                                                                    device.
11982................  X....................  ...................  Remove drug implant          0340       0.6314       $34.45  ...........        $6.89
                                                                    device.
11983................  X....................  ...................  Remove/insert drug           0340       0.6314       $34.45  ...........        $6.89
                                                                    implant.
12001................  T....................  ...................  Repair superficial           0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12002................  T....................  ...................  Repair superficial           0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12004................  T....................  ...................  Repair superficial           0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).

[[Page 63495]]

 
12005................  T....................  ...................  Repair superficial           0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12006................  T....................  ...................  Repair superficial           0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12007................  T....................  ...................  Repair superficial           0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12011................  T....................  ...................  Repair superficial           0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12013................  T....................  ...................  Repair superficial           0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12014................  T....................  ...................  Repair superficial           0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12015................  T....................  ...................  Repair superficial           0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12016................  T....................  ...................  Repair superficial           0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12017................  T....................  ...................  Repair superficial           0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12018................  T....................  ...................  Repair superficial           0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12020................  T....................  ...................  Closure of split             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound.
12021................  T....................  ...................  Closure of split             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound.
12031................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12032................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12034................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12035................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12036................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12037................  T....................  ...................  Layer closure of             0025       5.1912      $283.24      $107.00       $56.65
                                                                    wound(s).
12041................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12042................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12044................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12045................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12046................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12047................  T....................  ...................  Layer closure of             0025       5.1912      $283.24      $107.00       $56.65
                                                                    wound(s).
12051................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12052................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12053................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12054................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12055................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12056................  T....................  ...................  Layer closure of             0024       1.6850       $91.94       $33.10       $18.39
                                                                    wound(s).
12057................  T....................  ...................  Layer closure of             0025       5.1912      $283.24      $107.00       $56.65
                                                                    wound(s).
13100................  T....................  ...................  Repair of wound or           0025       5.1912      $283.24      $107.00       $56.65
                                                                    lesion.
13101................  T....................  ...................  Repair of wound or           0025       5.1912      $283.24      $107.00       $56.65
                                                                    lesion.
13102................  T....................  ...................  Repair wound/lesion          0024       1.6850       $91.94       $33.10       $18.39
                                                                    add-on.
13120................  T....................  ...................  Repair of wound or           0024       1.6850       $91.94       $33.10       $18.39
                                                                    lesion.
13121................  T....................  ...................  Repair of wound or           0024       1.6850       $91.94       $33.10       $18.39
                                                                    lesion.
13122................  T....................  ...................  Repair wound/lesion          0024       1.6850       $91.94       $33.10       $18.39
                                                                    add-on.
13131................  T....................  ...................  Repair of wound or           0024       1.6850       $91.94       $33.10       $18.39
                                                                    lesion.
13132................  T....................  ...................  Repair of wound or           0024       1.6850       $91.94       $33.10       $18.39
                                                                    lesion.
13133................  T....................  ...................  Repair wound/lesion          0024       1.6850       $91.94       $33.10       $18.39
                                                                    add-on.
13150................  T....................  ...................  Repair of wound or           0025       5.1912      $283.24      $107.00       $56.65
                                                                    lesion.
13151................  T....................  ...................  Repair of wound or           0024       1.6850       $91.94       $33.10       $18.39
                                                                    lesion.
13152................  T....................  ...................  Repair of wound or           0025       5.1912      $283.24      $107.00       $56.65
                                                                    lesion.
13153................  T....................  ...................  Repair wound/lesion          0024       1.6850       $91.94       $33.10       $18.39
                                                                    add-on.
13160................  T....................  ...................  Late closure of              0027      15.8990      $867.47      $329.72      $173.49
                                                                    wound.
14000................  T....................  ...................  Skin tissue                  0027      15.8990      $867.47      $329.72      $173.49
                                                                    rearrangement.
14001................  T....................  ...................  Skin tissue                  0027      15.8990      $867.47      $329.72      $173.49
                                                                    rearrangement.
14020................  T....................  ...................  Skin tissue                  0027      15.8990      $867.47      $329.72      $173.49
                                                                    rearrangement.
14021................  T....................  ...................  Skin tissue                  0027      15.8990      $867.47      $329.72      $173.49
                                                                    rearrangement.
14040................  T....................  ...................  Skin tissue                  0027      15.8990      $867.47      $329.72      $173.49
                                                                    rearrangement.
14041................  T....................  ...................  Skin tissue                  0027      15.8990      $867.47      $329.72      $173.49
                                                                    rearrangement.
14060................  T....................  ...................  Skin tissue                  0027      15.8990      $867.47      $329.72      $173.49
                                                                    rearrangement.
14061................  T....................  ...................  Skin tissue                  0027      15.8990      $867.47      $329.72      $173.49
                                                                    rearrangement.
14300................  T....................  ...................  Skin tissue                  0027      15.8990      $867.47      $329.72      $173.49
                                                                    rearrangement.
14350................  T....................  ...................  Skin tissue                  0027      15.8990      $867.47      $329.72      $173.49
                                                                    rearrangement.
15000................  T....................  ...................  Skin graft..........         0025       5.1912      $283.24      $107.00       $56.65
15001................  T....................  ...................  Skin graft add-on...         0025       5.1912      $283.24      $107.00       $56.65
15050................  T....................  ...................  Skin pinch graft....         0025       5.1912      $283.24      $107.00       $56.65
15100................  T....................  ...................  Skin split graft....         0027      15.8990      $867.47      $329.72      $173.49
15101................  T....................  ...................  Skin split graft add-        0027      15.8990      $867.47      $329.72      $173.49
                                                                    on.
15120................  T....................  ...................  Skin split graft....         0027      15.8990      $867.47      $329.72      $173.49
15121................  T....................  ...................  Skin split graft add-        0027      15.8990      $867.47      $329.72      $173.49
                                                                    on.
15200................  T....................  ...................  Skin full graft.....         0027      15.8990      $867.47      $329.72      $173.49
15201................  T....................  ...................  Skin full graft add-         0025       5.1912      $283.24      $107.00       $56.65
                                                                    on.
15220................  T....................  ...................  Skin full graft.....         0027      15.8990      $867.47      $329.72      $173.49
15221................  T....................  ...................  Skin full graft add-         0025       5.1912      $283.24      $107.00       $56.65
                                                                    on.
15240................  T....................  ...................  Skin full graft.....         0027      15.8990      $867.47      $329.72      $173.49
15241................  T....................  ...................  Skin full graft add-         0025       5.1912      $283.24      $107.00       $56.65
                                                                    on.
15260................  T....................  ...................  Skin full graft.....         0027      15.8990      $867.47      $329.72      $173.49
15261................  T....................  ...................  Skin full graft add-         0025       5.1912      $283.24      $107.00       $56.65
                                                                    on.
15342................  T....................  ...................  Cultured skin graft,         0024       1.6850       $91.94       $33.10       $18.39
                                                                    25 cm.
15343................  T....................  ...................  Culture skn graft            0024       1.6850       $91.94       $33.10       $18.39
                                                                    addl 25 cm.
15350................  T....................  ...................  Skin homograft......         0686       7.9247      $432.38      $198.89       $86.48
15351................  T....................  ...................  Skin homograft add-          0027      15.8990      $867.47      $329.72      $173.49
                                                                    on.
15400................  T....................  ...................  Skin heterograft....         0025       5.1912      $283.24      $107.00       $56.65

[[Page 63496]]

 
15401................  T....................  ...................  Skin heterograft add-        0025       5.1912      $283.24      $107.00       $56.65
                                                                    on.
15570................  T....................  ...................  Form skin pedicle            0027      15.8990      $867.47      $329.72      $173.49
                                                                    flap.
15572................  T....................  ...................  Form skin pedicle            0027      15.8990      $867.47      $329.72      $173.49
                                                                    flap.
15574................  T....................  ...................  Form skin pedicle            0027      15.8990      $867.47      $329.72      $173.49
                                                                    flap.
15576................  T....................  ...................  Form skin pedicle            0027      15.8990      $867.47      $329.72      $173.49
                                                                    flap.
15600................  T....................  ...................  Skin graft..........         0027      15.8990      $867.47      $329.72      $173.49
15610................  T....................  ...................  Skin graft..........         0027      15.8990      $867.47      $329.72      $173.49
15620................  T....................  ...................  Skin graft..........         0027      15.8990      $867.47      $329.72      $173.49
15630................  T....................  ...................  Skin graft..........         0027      15.8990      $867.47      $329.72      $173.49
15650................  T....................  ...................  Transfer skin                0027      15.8990      $867.47      $329.72      $173.49
                                                                    pedicle flap.
15732................  T....................  ...................  Muscle-skin graft,           0027      15.8990      $867.47      $329.72      $173.49
                                                                    head/neck.
15734................  T....................  ...................  Muscle-skin graft,           0027      15.8990      $867.47      $329.72      $173.49
                                                                    trunk.
15736................  T....................  ...................  Muscle-skin graft,           0027      15.8990      $867.47      $329.72      $173.49
                                                                    arm.
15738................  T....................  ...................  Muscle-skin graft,           0027      15.8990      $867.47      $329.72      $173.49
                                                                    leg.
15740................  T....................  ...................  Island pedicle flap          0027      15.8990      $867.47      $329.72      $173.49
                                                                    graft.
15750................  T....................  ...................  Neurovascular                0027      15.8990      $867.47      $329.72      $173.49
                                                                    pedicle 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      15.8990      $867.47      $329.72      $173.49
15770................  T....................  ...................  Derma-fat-fascia             0027      15.8990      $867.47      $329.72      $173.49
                                                                    graft.
15775................  T....................  ...................  Hair transplant              0025       5.1912      $283.24      $107.00       $56.65
                                                                    punch grafts.
15776................  T....................  ...................  Hair transplant              0025       5.1912      $283.24      $107.00       $56.65
                                                                    punch grafts.
15780................  T....................  ...................  Abrasion treatment           0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    of skin.
15781................  T....................  ...................  Abrasion treatment           0019       3.9493      $215.48       $71.87       $43.10
                                                                    of skin.
15782................  T....................  ...................  Dressing change not          0019       3.9493      $215.48       $71.87       $43.10
                                                                    for burn.
15783................  T....................  ...................  Abrasion treatment           0016       2.5724      $140.35       $57.31       $28.07
                                                                    of skin.
15786................  T....................  ...................  Abrasion, lesion,            0012       0.7694       $41.98       $11.18        $8.40
                                                                    single.
15787................  T....................  ...................  Abrasion, lesions,           0013       1.1272       $61.50       $14.20       $12.30
                                                                    add-on.
15788................  T....................  ...................  Chemical peel, face,         0012       0.7694       $41.98       $11.18        $8.40
                                                                    epiderm.
15789................  T....................  ...................  Chemical peel, face,         0015       1.5968       $87.12       $20.35       $17.42
                                                                    dermal.
15792................  T....................  ...................  Chemical peel,               0012       0.7694       $41.98       $11.18        $8.40
                                                                    nonfacial.
15793................  T....................  ...................  Chemical peel,               0012       0.7694       $41.98       $11.18        $8.40
                                                                    nonfacial.
15810................  T....................  ...................  Salabrasion.........         0016       2.5724      $140.35       $57.31       $28.07
15811................  T....................  ...................  Salabrasion.........         0016       2.5724      $140.35       $57.31       $28.07
15819................  T....................  ...................  Plastic surgery,             0025       5.1912      $283.24      $107.00       $56.65
                                                                    neck.
15820................  T....................  ...................  Revision of lower            0027      15.8990      $867.47      $329.72      $173.49
                                                                    eyelid.
15821................  T....................  ...................  Revision of lower            0027      15.8990      $867.47      $329.72      $173.49
                                                                    eyelid.
15822................  T....................  ...................  Revision of upper            0027      15.8990      $867.47      $329.72      $173.49
                                                                    eyelid.
15823................  T....................  ...................  Revision of upper            0027      15.8990      $867.47      $329.72      $173.49
                                                                    eyelid.
15824................  T....................  ...................  Removal of forehead          0027      15.8990      $867.47      $329.72      $173.49
                                                                    wrinkles.
15825................  T....................  ...................  Removal of neck              0027      15.8990      $867.47      $329.72      $173.49
                                                                    wrinkles.
15826................  T....................  ...................  Removal of brow              0027      15.8990      $867.47      $329.72      $173.49
                                                                    wrinkles.
15828................  T....................  ...................  Removal of face              0027      15.8990      $867.47      $329.72      $173.49
                                                                    wrinkles.
15829................  T....................  ...................  Removal of skin              0027      15.8990      $867.47      $329.72      $173.49
                                                                    wrinkles.
15831................  T....................  ...................  Excise excessive             0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    skin tissue.
15832................  T....................  ...................  Excise excessive             0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    skin tissue.
15833................  T....................  ...................  Excise excessive             0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    skin tissue.
15834................  T....................  ...................  Excise excessive             0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    skin tissue.
15835................  T....................  ...................  Excise excessive             0025       5.1912      $283.24      $107.00       $56.65
                                                                    skin tissue.
15836................  T....................  ...................  Excise excessive             0021      14.3594      $783.46      $219.48      $156.69
                                                                    skin tissue.
15837................  T....................  ...................  Excise excessive             0021      14.3594      $783.46      $219.48      $156.69
                                                                    skin tissue.
15838................  T....................  ...................  Excise excessive             0021      14.3594      $783.46      $219.48      $156.69
                                                                    skin tissue.
15839................  T....................  ...................  Excise excessive             0021      14.3594      $783.46      $219.48      $156.69
                                                                    skin tissue.
15840................  T....................  ...................  Graft for face nerve         0027      15.8990      $867.47      $329.72      $173.49
                                                                    palsy.
15841................  T....................  ...................  Graft for face nerve         0027      15.8990      $867.47      $329.72      $173.49
                                                                    palsy.
15842................  T....................  ...................  Flap for face nerve          0027      15.8990      $867.47      $329.72      $173.49
                                                                    palsy.
15845................  T....................  ...................  Skin and muscle              0027      15.8990      $867.47      $329.72      $173.49
                                                                    repair, face.
15850................  T....................  ...................  Removal of sutures..         0016       2.5724      $140.35       $57.31       $28.07
15851................  T....................  ...................  Removal of sutures..         0016       2.5724      $140.35       $57.31       $28.07
15852................  X....................  ...................  Dressing change,not          0340       0.6314       $34.45  ...........        $6.89
                                                                    for burn.
15860................  S....................  ...................  Test for blood flow          1501  ...........       $25.00  ...........        $5.00
                                                                    in graft.
15876................  T....................  ...................  Suction assisted             0027      15.8990      $867.47      $329.72      $173.49
                                                                    lipectomy.
15877................  T....................  ...................  Suction assisted             0027      15.8990      $867.47      $329.72      $173.49
                                                                    lipectomy.
15878................  T....................  ...................  Suction assisted             0027      15.8990      $867.47      $329.72      $173.49
                                                                    lipectomy.
15879................  T....................  ...................  Suction assisted             0027      15.8990      $867.47      $329.72      $173.49
                                                                    lipectomy.
15920................  T....................  ...................  Removal of tail bone         0019       3.9493      $215.48       $71.87       $43.10
                                                                    ulcer.
15922................  T....................  ...................  Removal of tail bone         0027      15.8990      $867.47      $329.72      $173.49
                                                                    ulcer.
15931................  T....................  ...................  Remove sacrum                0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    pressure sore.
15933................  T....................  ...................  Remove sacrum                0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    pressure sore.
15934................  T....................  ...................  Remove sacrum                0027      15.8990      $867.47      $329.72      $173.49
                                                                    pressure sore.
15935................  T....................  ...................  Remove sacrum                0027      15.8990      $867.47      $329.72      $173.49
                                                                    pressure sore.
15936................  T....................  ...................  Remove sacrum                0027      15.8990      $867.47      $329.72      $173.49
                                                                    pressure sore.
15937................  T....................  ...................  Remove sacrum                0027      15.8990      $867.47      $329.72      $173.49
                                                                    pressure sore.
15940................  T....................  ...................  Remove hip pressure          0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    sore.

[[Page 63497]]

 
15941................  T....................  ...................  Remove hip pressure          0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    sore.
15944................  T....................  ...................  Remove hip pressure          0027      15.8990      $867.47      $329.72      $173.49
                                                                    sore.
15945................  T....................  ...................  Remove hip pressure          0027      15.8990      $867.47      $329.72      $173.49
                                                                    sore.
15946................  T....................  ...................  Remove hip pressure          0027      15.8990      $867.47      $329.72      $173.49
                                                                    sore.
15950................  T....................  ...................  Remove thigh                 0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    pressure sore.
15951................  T....................  ...................  Remove thigh                 0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    pressure sore.
15952................  T....................  ...................  Remove thigh                 0027      15.8990      $867.47      $329.72      $173.49
                                                                    pressure sore.
15953................  T....................  ...................  Remove thigh                 0027      15.8990      $867.47      $329.72      $173.49
                                                                    pressure sore.
15956................  T....................  ...................  Remove thigh                 0027      15.8990      $867.47      $329.72      $173.49
                                                                    pressure sore.
15958................  T....................  ...................  Remove thigh                 0027      15.8990      $867.47      $329.72      $173.49
                                                                    pressure sore.
15999................  T....................  ...................  Removal of pressure          0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    sore.
16000................  T....................  ...................  Initial treatment of         0012       0.7694       $41.98       $11.18        $8.40
                                                                    burn(s).
16010................  T....................  ...................  Treatment of burn(s)         0016       2.5724      $140.35       $57.31       $28.07
16015................  T....................  ...................  Treatment of burn(s)         0017      16.3697      $893.15      $227.84      $178.63
16020................  T....................  ...................  Treatment of burn(s)         0013       1.1272       $61.50       $14.20       $12.30
16025................  T....................  ...................  Treatment of burn(s)         0012       0.7694       $41.98       $11.18        $8.40
16030................  T....................  ...................  Treatment of burn(s)         0015       1.5968       $87.12       $20.35       $17.42
16035................  C....................  ...................  Incision of burn      ...........  ...........  ...........  ...........  ...........
                                                                    scab, initi.
16036................  C....................  ...................  Escharotomy; add'l    ...........  ...........  ...........  ...........  ...........
                                                                    incision.
17000................  T....................  ...................  Destroy benign/              0010       0.6480       $35.36       $10.08        $7.07
                                                                    premlg lesion.
17003................  T....................  ...................  Destroy lesions, 2-          0010       0.6480       $35.36       $10.08        $7.07
                                                                    14.
17004................  T....................  ...................  Destroy lesions, 15          0011       2.2217      $121.22       $27.88       $24.24
                                                                    or more.
17106................  T....................  ...................  Destruction of skin          0011       2.2217      $121.22       $27.88       $24.24
                                                                    lesions.
17107................  T....................  ...................  Destruction of skin          0011       2.2217      $121.22       $27.88       $24.24
                                                                    lesions.
17108................  T....................  ...................  Destruction of skin          0011       2.2217      $121.22       $27.88       $24.24
                                                                    lesions.
17110................  T....................  ...................  Destruct lesion, 1-          0010       0.6480       $35.36       $10.08        $7.07
                                                                    14.
17111................  T....................  ...................  Destruct lesion, 15          0010       0.6480       $35.36       $10.08        $7.07
                                                                    or more.
17250................  T....................  ...................  Chemical cautery,            0013       1.1272       $61.50       $14.20       $12.30
                                                                    tissue.
17260................  T....................  ...................  Destruction of skin          0015       1.5968       $87.12       $20.35       $17.42
                                                                    lesions.
17261................  T....................  ...................  Destruction of skin          0015       1.5968       $87.12       $20.35       $17.42
                                                                    lesions.
17262................  T....................  ...................  Destruction of skin          0015       1.5968       $87.12       $20.35       $17.42
                                                                    lesions.
17263................  T....................  ...................  Destruction of skin          0015       1.5968       $87.12       $20.35       $17.42
                                                                    lesions.
17264................  T....................  ...................  Destruction of skin          0015       1.5968       $87.12       $20.35       $17.42
                                                                    lesions.
17266................  T....................  ...................  Destruction of skin          0016       2.5724      $140.35       $57.31       $28.07
                                                                    lesions.
17270................  T....................  ...................  Destruction of skin          0015       1.5968       $87.12       $20.35       $17.42
                                                                    lesions.
17271................  T....................  ...................  Destruction of skin          0013       1.1272       $61.50       $14.20       $12.30
                                                                    lesions.
17272................  T....................  ...................  Destruction of skin          0015       1.5968       $87.12       $20.35       $17.42
                                                                    lesions.
17273................  T....................  ...................  Destruction of skin          0015       1.5968       $87.12       $20.35       $17.42
                                                                    lesions.
17274................  T....................  ...................  Destruction of skin          0016       2.5724      $140.35       $57.31       $28.07
                                                                    lesions.
17276................  T....................  ...................  Destruction of skin          0016       2.5724      $140.35       $57.31       $28.07
                                                                    lesions.
17280................  T....................  ...................  Destruction of skin          0015       1.5968       $87.12       $20.35       $17.42
                                                                    lesions.
17281................  T....................  ...................  Destruction of skin          0015       1.5968       $87.12       $20.35       $17.42
                                                                    lesions.
17282................  T....................  ...................  Destruction of skin          0015       1.5968       $87.12       $20.35       $17.42
                                                                    lesions.
17283................  T....................  ...................  Destruction of skin          0015       1.5968       $87.12       $20.35       $17.42
                                                                    lesions.
17284................  T....................  ...................  Destruction of skin          0016       2.5724      $140.35       $57.31       $28.07
                                                                    lesions.
17286................  T....................  ...................  Destruction of skin          0015       1.5968       $87.12       $20.35       $17.42
                                                                    lesions.
17304................  T....................  ...................  Chemosurgery of skin         0694       2.9752      $162.33       $64.93       $32.47
                                                                    lesion.
17305................  T....................  ...................  2 stage mohs, up to          0694       2.9752      $162.33       $64.93       $32.47
                                                                    5 spec.
17306................  T....................  ...................  3 stage mohs, up to          0694       2.9752      $162.33       $64.93       $32.47
                                                                    5 spec.
17307................  T....................  ...................  Mohs addl stage up           0694       2.9752      $162.33       $64.93       $32.47
                                                                    to 5 spec.
17310................  T....................  ...................  Extensive skin               0694       2.9752      $162.33       $64.93       $32.47
                                                                    chemosurgery.
17340................  T....................  ...................  Cryotherapy of skin.         0012       0.7694       $41.98       $11.18        $8.40
17360................  T....................  ...................  Skin peel therapy...         0012       0.7694       $41.98       $11.18        $8.40
17380................  T....................  ...................  Hair removal by              0012       0.7694       $41.98       $11.18        $8.40
                                                                    electrolysis.
17999................  T....................  ...................  Skin tissue                  0006       1.6527       $90.17       $23.26       $18.03
                                                                    procedure.
19000................  T....................  ...................  Drainage of breast           0004       1.5882       $86.65       $22.36       $17.33
                                                                    lesion.
19001................  T....................  ...................  Drain breast lesion          0004       1.5882       $86.65       $22.36       $17.33
                                                                    add-on.
19020................  T....................  ...................  Incision of breast           0007      11.8633      $647.27  ...........      $129.45
                                                                    lesion.
19030................  N....................  ...................  Injection for breast  ...........  ...........  ...........  ...........  ...........
                                                                    x-ray.
19100................  T....................  ...................  Bx breast percut w/o         0005       3.2698      $178.40       $71.59       $35.68
                                                                    image.
19101................  T....................  ...................  Biopsy of breast,            0028      17.6584      $963.46      $303.74      $192.69
                                                                    open.
19102................  T....................  ...................  Bx breast percut w/          0005       3.2698      $178.40       $71.59       $35.68
                                                                    image.
19103................  T....................  ...................  Bx breast percut w/          0658       5.5779      $304.34  ...........       $60.87
                                                                    device.
19110................  T....................  ...................  nipple exploration..         0028      17.6584      $963.46      $303.74      $192.69
19112................  T....................  ...................  Excise breast duct           0028      17.6584      $963.46      $303.74      $192.69
                                                                    fistula.
19120................  T....................  ...................  Removal of breast            0028      17.6584      $963.46      $303.74      $192.69
                                                                    lesion.
19125................  T....................  ...................  Excision, breast             0028      17.6584      $963.46      $303.74      $192.69
                                                                    lesion.
19126................  T....................  ...................  Excision, addl               0028      17.6584      $963.46      $303.74      $192.69
                                                                    breast lesion.
19140................  T....................  ...................  Removal of breast            0028      17.6584      $963.46      $303.74      $192.69
                                                                    tissue.
19160................  T....................  ...................  Removal of breast            0028      17.6584      $963.46      $303.74      $192.69
                                                                    tissue.
19162................  T....................  ...................  Remove breast                0693      39.0111    $2,128.48      $798.17      $425.70
                                                                    tissue, nodes.
19180................  T....................  ...................  Removal of breast...         0029      30.1167    $1,643.20      $632.64      $328.64
19182................  T....................  ...................  Removal of breast...         0029      30.1167    $1,643.20      $632.64      $328.64
19200................  C....................  ...................  Removal of breast...  ...........  ...........  ...........  ...........  ...........
19220................  C....................  ...................  Removal of breast...  ...........  ...........  ...........  ...........  ...........

[[Page 63498]]

 
19240................  T....................  ...................  Removal of breast...         0030      37.3083    $2,035.58      $763.55      $407.12
19260................  T....................  ...................  Removal of chest             0021      14.3594      $783.46      $219.48      $156.69
                                                                    wall 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       1.5102       $82.40  ...........       $16.48
                                                                    percut.
19316................  T....................  ...................  Suspension of breast         0029      30.1167    $1,643.20      $632.64      $328.64
19318................  T....................  ...................  Reduction of large           0693      39.0111    $2,128.48      $798.17      $425.70
                                                                    breast.
19324................  T....................  ...................  Enlarge breast......         0693      39.0111    $2,128.48      $798.17      $425.70
19325................  T....................  ...................  Enlarge breast with          0648      54.0165    $2,947.19  ...........      $589.44
                                                                    implant.
19328................  T....................  ...................  Removal of breast            0029      30.1167    $1,643.20      $632.64      $328.64
                                                                    implant.
19330................  T....................  ...................  Removal of implant           0029      30.1167    $1,643.20      $632.64      $328.64
                                                                    material.
19340................  T....................  ...................  Immediate breast             0030      37.3083    $2,035.58      $763.55      $407.12
                                                                    prosthesis.
19342................  T....................  ...................  Delayed breast               0648      54.0165    $2,947.19  ...........      $589.44
                                                                    prosthesis.
19350................  T....................  ...................  Breast                       0028      17.6584      $963.46      $303.74      $192.69
                                                                    reconstruction.
19355................  T....................  ...................  Correct inverted             0029      30.1167    $1,643.20      $632.64      $328.64
                                                                    nipple(s).
19357................  T....................  ...................  Breast                       0648      54.0165    $2,947.19  ...........      $589.44
                                                                    reconstruction.
19361................  C....................  ...................  Breast                ...........  ...........  ...........  ...........  ...........
                                                                    reconstruction.
19364................  C....................  ...................  Breast                ...........  ...........  ...........  ...........  ...........
                                                                    reconstruction.
19366................  T....................  ...................  Breast                       0029      30.1167    $1,643.20      $632.64      $328.64
                                                                    reconstruction.
19367................  C....................  ...................  Breast                ...........  ...........  ...........  ...........  ...........
                                                                    reconstruction.
19368................  C....................  ...................  Breast                ...........  ...........  ...........  ...........  ...........
                                                                    reconstruction.
19369................  C....................  ...................  Breast                ...........  ...........  ...........  ...........  ...........
                                                                    reconstruction.
19370................  T....................  ...................  Surgery of breast            0029      30.1167    $1,643.20      $632.64      $328.64
                                                                    capsule.
19371................  T....................  ...................  Removal of breast            0029      30.1167    $1,643.20      $632.64      $328.64
                                                                    capsule.
19380................  T....................  ...................  Revise breast                0030      37.3083    $2,035.58      $763.55      $407.12
                                                                    reconstruction.
19396................  T....................  ...................  Design custom breast         0029      30.1167    $1,643.20      $632.64      $328.64
                                                                    implant.
19499................  T....................  ...................  Breast surgery               0028      17.6584      $963.46      $303.74      $192.69
                                                                    procedure.
20000................  T....................  ...................  Incision of abscess.         0006       1.6527       $90.17       $23.26       $18.03
20005................  T....................  ...................  Incision of deep             0049      19.6046    $1,069.65  ...........      $213.93
                                                                    abscess.
20100................  T....................  ...................  Explore wound, neck.         0023       2.8141      $153.54       $40.37       $30.71
20101................  T....................  ...................  Explore wound, chest         0027      15.8990      $867.47      $329.72      $173.49
20102................  T....................  ...................  Explore wound,               0027      15.8990      $867.47      $329.72      $173.49
                                                                    abdomen.
20103................  T....................  ...................  Explore wound,               0023       2.8141      $153.54       $40.37       $30.71
                                                                    extremity.
20150................  T....................  ...................  Excise epiphyseal            0051      34.5144    $1,883.14  ...........      $376.63
                                                                    bar.
20200................  T....................  ...................  Muscle biopsy.......         0021      14.3594      $783.46      $219.48      $156.69
20205................  T....................  ...................  Deep muscle biopsy..         0021      14.3594      $783.46      $219.48      $156.69
20206................  T....................  ...................  Needle biopsy,               0005       3.2698      $178.40       $71.59       $35.68
                                                                    muscle.
20220................  T....................  ...................  Bone biopsy, trocar/         0019       3.9493      $215.48       $71.87       $43.10
                                                                    needle.
20225................  T....................  ...................  Bone biopsy, trocar/         0020       7.0842      $386.52      $113.25       $77.30
                                                                    needle.
20240................  T....................  ...................  Bone biopsy,                 0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    excisional.
20245................  T....................  ...................  Bone biopsy,                 0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    excisional.
20250................  T....................  ...................  Open bone biopsy....         0049      19.6046    $1,069.65  ...........      $213.93
20251................  T....................  ...................  Open bone biopsy....         0049      19.6046    $1,069.65  ...........      $213.93
20500................  T....................  ...................  Injection of sinus           0251       1.7880       $97.56  ...........       $19.51
                                                                    tract.
20501................  N....................  ...................  Inject sinus tract    ...........  ...........  ...........  ...........  ...........
                                                                    for x-ray.
20520................  T....................  ...................  Removal of foreign           0019       3.9493      $215.48       $71.87       $43.10
                                                                    body.
20525................  T....................  ...................  Removal of foreign           0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    body.
20526................  T....................  ...................  Ther injection, carp         0204       2.1711      $118.46       $40.13       $23.69
                                                                    tunnel.
20550................  T....................  ...................  Inject tendon/               0204       2.1711      $118.46       $40.13       $23.69
                                                                    ligament/cyst.
20551................  T....................  ...................  Inj tendon origin/           0204       2.1711      $118.46       $40.13       $23.69
                                                                    insertion.
20552................  T....................  ...................  Inj trigger point, 1/        0204       2.1711      $118.46       $40.13       $23.69
                                                                    2 muscl.
20553................  T....................  ...................  Inject trigger               0204       2.1711      $118.46       $40.13       $23.69
                                                                    points, 
                                                                    3.
20600................  T....................  ...................  Drain/inject, joint/         0204       2.1711      $118.46       $40.13       $23.69
                                                                    bursa.
20605................  T....................  ...................  Drain/inject, joint/         0204       2.1711      $118.46       $40.13       $23.69
                                                                    bursa.
20610................  T....................  ...................  Drain/inject, joint/         0204       2.1711      $118.46       $40.13       $23.69
                                                                    bursa.
20612................  T....................  ...................  Aspirate/inj                 0204       2.1711      $118.46       $40.13       $23.69
                                                                    ganglion cyst.
20615................  T....................  ...................  Treatment of bone            0004       1.5882       $86.65       $22.36       $17.33
                                                                    cyst.
20650................  T....................  ...................  Insert and remove            0049      19.6046    $1,069.65  ...........      $213.93
                                                                    bone 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       0.6314       $34.45  ...........        $6.89
                                                                    device.
20670................  T....................  ...................  Removal of support           0021      14.3594      $783.46      $219.48      $156.69
                                                                    implant.
20680................  T....................  ...................  Removal of support           0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    implant.
20690................  T....................  ...................  Apply bone fixation          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    device.
20692................  T....................  ...................  Apply bone fixation          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    device.
20693................  T....................  ...................  Adjust bone fixation         0049      19.6046    $1,069.65  ...........      $213.93
                                                                    device.
20694................  T....................  ...................  Remove bone fixation         0049      19.6046    $1,069.65  ...........      $213.93
                                                                    device.
20802................  C....................  ...................  Replantation, arm,    ...........  ...........  ...........  ...........  ...........
                                                                    complete.
20805................  C....................  ...................  Replant forearm,      ...........  ...........  ...........  ...........  ...........
                                                                    complete.
20808................  C....................  ...................  Replantation hand,    ...........  ...........  ...........  ...........  ...........
                                                                    complete.

[[Page 63499]]

 
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      24.8651    $1,356.66  ...........      $271.33
                                                                    graft.
20902................  T....................  ...................  Removal of bone for          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    graft.
20910................  T....................  ...................  Remove cartilage for         0027      15.8990      $867.47      $329.72      $173.49
                                                                    graft.
20912................  T....................  ...................  Remove cartilage for         0027      15.8990      $867.47      $329.72      $173.49
                                                                    graft.
20920................  T....................  ...................  Removal of fascia            0027      15.8990      $867.47      $329.72      $173.49
                                                                    for graft.
20922................  T....................  ...................  Removal of fascia            0027      15.8990      $867.47      $329.72      $173.49
                                                                    for graft.
20924................  T....................  ...................  Removal of tendon            0050      24.8651    $1,356.66  ...........      $271.33
                                                                    for graft.
20926................  T....................  ...................  Removal of tissue            0027      15.8990      $867.47      $329.72      $173.49
                                                                    for 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,              0006       1.6527       $90.17       $23.26       $18.03
                                                                    muscle.
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      19.6046    $1,069.65  ...........      $213.93
                                                                    stimulation.
20979................  A....................  ...................  Us bone stimulation.  ...........  ...........  ...........  ...........  ...........
20982................  T....................  NI.................  Ablate, bone                 1557  ...........    $1,850.00  ...........      $370.00
                                                                    tumor(s) perq.
20999................  T....................  ...................  Musculoskeletal              0049      19.6046    $1,069.65  ...........      $213.93
                                                                    surgery.
21010................  T....................  ...................  Incision of jaw              0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    joint.
21015................  T....................  ...................  Resection of facial          0253      15.2249      $830.69      $282.29      $166.14
                                                                    tumor.
21025................  T....................  ...................  Excision of bone,            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    lower jaw.
21026................  T....................  ...................  Excision of facial           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    bone(s).
21029................  T....................  ...................  Contour of face bone         0256      35.1548    $1,918.08  ...........      $383.62
                                                                    lesion.
21030................  T....................  ...................  Removal of face bone         0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    lesion.
21031................  T....................  ...................  Remove exostosis,            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    mandible.
21032................  T....................  ...................  Remove exostosis,            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    maxilla.
21034................  T....................  ...................  Removal of face bone         0256      35.1548    $1,918.08  ...........      $383.62
                                                                    lesion.
21040................  T....................  ...................  Removal of jaw bone          0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    lesion.
21044................  T....................  ...................  Removal of jaw bone          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    lesion.
21045................  C....................  ...................  Extensive jaw         ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
21046................  T....................  ...................  Remove mandible cyst         0256      35.1548    $1,918.08  ...........      $383.62
                                                                    complex.
21047................  T....................  ...................  Excise lwr jaw cyst          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    w/repair.
21048................  T....................  ...................  Remove maxilla cyst          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    complex.
21049................  T....................  ...................  Excis uppr jaw cyst          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    w/repair.
21050................  T....................  ...................  Removal of jaw joint         0256      35.1548    $1,918.08  ...........      $383.62
21060................  T....................  ...................  Remove jaw joint             0256      35.1548    $1,918.08  ...........      $383.62
                                                                    cartilage.
21070................  T....................  ...................  Remove coronoid              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    process.
21076................  T....................  ...................  Prepare face/oral            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    prosthesis.
21077................  T....................  ...................  Prepare face/oral            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    prosthesis.
21079................  T....................  ...................  Prepare face/oral            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    prosthesis.
21080................  T....................  ...................  Prepare face/oral            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    prosthesis.
21081................  T....................  ...................  Prepare face/oral            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    prosthesis.
21082................  T....................  ...................  Prepare face/oral            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    prosthesis.
21083................  T....................  ...................  Prepare face/oral            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    prosthesis.
21084................  T....................  ...................  Prepare face/oral            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    prosthesis.
21085................  T....................  ...................  Prepare face/oral            0253      15.2249      $830.69      $282.29      $166.14
                                                                    prosthesis.
21086................  T....................  ...................  Prepare face/oral            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    prosthesis.
21087................  T....................  ...................  Prepare face/oral            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    prosthesis.
21088................  T....................  ...................  Prepare face/oral            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    prosthesis.
21089................  T....................  ...................  Prepare face/oral            0253      15.2249      $830.69      $282.29      $166.14
                                                                    prosthesis.
21100................  T....................  ...................  Maxillofacial                0256      35.1548    $1,918.08  ...........      $383.62
                                                                    fixation.
21110................  T....................  ...................  Interdental fixation         0252       6.4469      $351.75      $113.41       $70.35
21116................  N....................  ...................  Injection, jaw joint  ...........  ...........  ...........  ...........  ...........
                                                                    x-ray.
21120................  T....................  ...................  Reconstruction of            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    chin.
21121................  T....................  ...................  Reconstruction of            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    chin.
21122................  T....................  ...................  Reconstruction of            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    chin.
21123................  T....................  ...................  Reconstruction of            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    chin.
21125................  T....................  ...................  Augmentation, lower          0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    jaw bone.
21127................  T....................  ...................  Augmentation, lower          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    jaw bone.
21137................  T....................  ...................  Reduction of                 0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    forehead.
21138................  T....................  ...................  Reduction of                 0256      35.1548    $1,918.08  ...........      $383.62
                                                                    forehead.

[[Page 63500]]

 
21139................  T....................  ...................  Reduction of                 0256      35.1548    $1,918.08  ...........      $383.62
                                                                    forehead.
21141................  C....................  ...................  Reconstruct midface,  ...........  ...........  ...........  ...........  ...........
                                                                    lefort.
21142................  C....................  ...................  Reconstruct midface,  ...........  ...........  ...........  ...........  ...........
                                                                    lefort.
21143................  C....................  ...................  Reconstruct midface,  ...........  ...........  ...........  ...........  ...........
                                                                    lefort.
21145................  C....................  ...................  Reconstruct midface,  ...........  ...........  ...........  ...........  ...........
                                                                    lefort.
21146................  C....................  ...................  Reconstruct midface,  ...........  ...........  ...........  ...........  ...........
                                                                    lefort.
21147................  C....................  ...................  Reconstruct midface,  ...........  ...........  ...........  ...........  ...........
                                                                    lefort.
21150................  C....................  ...................  Reconstruct midface,  ...........  ...........  ...........  ...........  ...........
                                                                    lefort.
21151................  C....................  ...................  Reconstruct midface,  ...........  ...........  ...........  ...........  ...........
                                                                    lefort.
21154................  C....................  ...................  Reconstruct midface,  ...........  ...........  ...........  ...........  ...........
                                                                    lefort.
21155................  C....................  ...................  Reconstruct midface,  ...........  ...........  ...........  ...........  ...........
                                                                    lefort.
21159................  C....................  ...................  Reconstruct midface,  ...........  ...........  ...........  ...........  ...........
                                                                    lefort.
21160................  C....................  ...................  Reconstruct midface,  ...........  ...........  ...........  ...........  ...........
                                                                    lefort.
21172................  C....................  ...................  Reconstruct orbit/    ...........  ...........  ...........  ...........  ...........
                                                                    forehead.
21175................  C....................  ...................  Reconstruct orbit/    ...........  ...........  ...........  ...........  ...........
                                                                    forehead.
21179................  C....................  ...................  Reconstruct entire    ...........  ...........  ...........  ...........  ...........
                                                                    forehead.
21180................  C....................  ...................  Reconstruct entire    ...........  ...........  ...........  ...........  ...........
                                                                    forehead.
21181................  T....................  ...................  Contour cranial bone         0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    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      35.1548    $1,918.08  ...........      $383.62
                                                                    segment.
21199................  T....................  ...................  Reconstr lwr jaw w/          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    advance.
21206................  T....................  ...................  Reconstruct upper            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    jaw bone.
21208................  T....................  ...................  Augmentation of              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    facial bones.
21209................  T....................  ...................  Reduction of facial          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    bones.
21210................  T....................  ...................  Face bone graft.....         0256      35.1548    $1,918.08  ...........      $383.62
21215................  T....................  ...................  Lower jaw bone graft         0256      35.1548    $1,918.08  ...........      $383.62
21230................  T....................  ...................  Rib cartilage graft.         0256      35.1548    $1,918.08  ...........      $383.62
21235................  T....................  ...................  Ear cartilage graft.         0254      21.8901    $1,194.35      $321.35      $238.87
21240................  T....................  ...................  Reconstruction of            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    jaw joint.
21242................  T....................  ...................  Reconstruction of            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    jaw joint.
21243................  T....................  ...................  Reconstruction of            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    jaw joint.
21244................  T....................  ...................  Reconstruction of            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    lower jaw.
21245................  T....................  ...................  Reconstruction of            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    jaw.
21246................  T....................  ...................  Reconstruction of            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    jaw.
21247................  C....................  ...................  Reconstruct lower     ...........  ...........  ...........  ...........  ...........
                                                                    jaw bone.
21248................  T....................  ...................  Reconstruction of            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    jaw.
21249................  T....................  ...................  Reconstruction of            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    jaw.
21255................  C....................  ...................  Reconstruct lower     ...........  ...........  ...........  ...........  ...........
                                                                    jaw bone.
21256................  C....................  ...................  Reconstruction of     ...........  ...........  ...........  ...........  ...........
                                                                    orbit.
21260................  T....................  ...................  Revise eye sockets..         0256      35.1548    $1,918.08  ...........      $383.62
21261................  T....................  ...................  Revise eye sockets..         0256      35.1548    $1,918.08  ...........      $383.62
21263................  T....................  ...................  Revise eye sockets..         0256      35.1548    $1,918.08  ...........      $383.62
21267................  T....................  ...................  Revise eye sockets..         0256      35.1548    $1,918.08  ...........      $383.62
21268................  C....................  ...................  Revise eye sockets..  ...........  ...........  ...........  ...........  ...........
21270................  T....................  ...................  Augmentation, cheek          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    bone.
21275................  T....................  ...................  Revision,                    0256      35.1548    $1,918.08  ...........      $383.62
                                                                    orbitofacial bones.
21280................  T....................  ...................  Revision of eyelid..         0256      35.1548    $1,918.08  ...........      $383.62
21282................  T....................  ...................  Revision of eyelid..         0253      15.2249      $830.69      $282.29      $166.14
21295................  T....................  ...................  Revision of jaw              0252       6.4469      $351.75      $113.41       $70.35
                                                                    muscle/bone.
21296................  T....................  ...................  Revision of jaw              0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    muscle/bone.
21299................  T....................  ...................  Cranio/maxillofacial         0253      15.2249      $830.69      $282.29      $166.14
                                                                    surgery.
21300................  T....................  ...................  Treatment of skull           0253      15.2249      $830.69      $282.29      $166.14
                                                                    fracture.
21310................  X....................  ...................  Treatment of nose            0340       0.6314       $34.45  ...........        $6.89
                                                                    fracture.
21315................  X....................  ...................  Treatment of nose            0340       0.6314       $34.45  ...........        $6.89
                                                                    fracture.
21320................  X....................  ...................  Treatment of nose            0340       0.6314       $34.45  ...........        $6.89
                                                                    fracture.
21325................  T....................  ...................  Treatment of nose            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    fracture.
21330................  T....................  ...................  Treatment of nose            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    fracture.
21335................  T....................  ...................  Treatment of nose            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    fracture.
21336................  T....................  ...................  Treat nasal septal           0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
21337................  T....................  ...................  Treat nasal septal           0253      15.2249      $830.69      $282.29      $166.14
                                                                    fracture.
21338................  T....................  ...................  Treat nasoethmoid            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    fracture.
21339................  T....................  ...................  Treat nasoethmoid            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    fracture.
21340................  T....................  ...................  Treatment of nose            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    fracture.
21343................  C....................  ...................  Treatment of sinus    ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
21344................  C....................  ...................  Treatment of sinus    ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
21345................  T....................  ...................  Treat nose/jaw               0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    fracture.
21346................  C....................  ...................  Treat nose/jaw        ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
21347................  C....................  ...................  Treat nose/jaw        ...........  ...........  ...........  ...........  ...........
                                                                    fracture.

[[Page 63501]]

 
21348................  C....................  ...................  Treat nose/jaw        ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
21355................  T....................  ...................  Treat cheek bone             0256      35.1548    $1,918.08  ...........      $383.62
                                                                    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      35.1548    $1,918.08  ...........      $383.62
                                                                    fracture.
21395................  C....................  ...................  Treat eye socket      ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
21400................  T....................  ...................  Treat eye socket             0252       6.4469      $351.75      $113.41       $70.35
                                                                    fracture.
21401................  T....................  ...................  Treat eye socket             0253      15.2249      $830.69      $282.29      $166.14
                                                                    fracture.
21406................  T....................  ...................  Treat eye socket             0256      35.1548    $1,918.08  ...........      $383.62
                                                                    fracture.
21407................  T....................  ...................  Treat eye socket             0256      35.1548    $1,918.08  ...........      $383.62
                                                                    fracture.
21408................  C....................  ...................  Treat eye socket      ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
21421................  T....................  ...................  Treat mouth roof             0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    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      21.8901    $1,194.35      $321.35      $238.87
                                                                    fracture.
21445................  T....................  ...................  Treat dental ridge           0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    fracture.
21450................  T....................  ...................  Treat lower jaw              0251       1.7880       $97.56  ...........       $19.51
                                                                    fracture.
21451................  T....................  ...................  Treat lower jaw              0252       6.4469      $351.75      $113.41       $70.35
                                                                    fracture.
21452................  T....................  ...................  Treat lower jaw              0253      15.2249      $830.69      $282.29      $166.14
                                                                    fracture.
21453................  T....................  ...................  Treat lower jaw              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    fracture.
21454................  T....................  ...................  Treat lower jaw              0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    fracture.
21461................  T....................  ...................  Treat lower jaw              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    fracture.
21462................  T....................  ...................  Treat lower jaw              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    fracture.
21465................  T....................  ...................  Treat lower jaw              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    fracture.
21470................  T....................  ...................  Treat lower jaw              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    fracture.
21480................  T....................  ...................  Reset dislocated jaw         0251       1.7880       $97.56  ...........       $19.51
21485................  T....................  ...................  Reset dislocated jaw         0253      15.2249      $830.69      $282.29      $166.14
21490................  T....................  ...................  Repair dislocated            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    jaw.
21493................  T....................  ...................  Treat hyoid bone             0252       6.4469      $351.75      $113.41       $70.35
                                                                    fracture.
21494................  T....................  ...................  Treat hyoid bone             0252       6.4469      $351.75      $113.41       $70.35
                                                                    fracture.
21495................  C....................  ...................  Treat hyoid bone      ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
21497................  T....................  ...................  Interdental wiring..         0253      15.2249      $830.69      $282.29      $166.14
21499................  T....................  ...................  Head surgery                 0253      15.2249      $830.69      $282.29      $166.14
                                                                    procedure.
21501................  T....................  ...................  Drain neck/chest             0008      19.4831    $1,063.02  ...........      $212.60
                                                                    lesion.
21502................  T....................  ...................  Drain chest lesion..         0049      19.6046    $1,069.65  ...........      $213.93
21510................  C....................  ...................  Drainage of bone      ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
21550................  T....................  ...................  Biopsy of neck/chest         0021      14.3594      $783.46      $219.48      $156.69
21555................  T....................  ...................  Remove lesion, neck/         0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    chest.
21556................  T....................  ...................  Remove lesion, neck/         0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    chest.
21557................  C....................  ...................  Remove tumor, neck/   ...........  ...........  ...........  ...........  ...........
                                                                    chest.
21600................  T....................  ...................  Partial removal of           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    rib.
21610................  T....................  ...................  Partial removal of           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    rib.
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.
21685................  T....................  NI.................  Hyoid myotomy &              0252       6.4469      $351.75      $113.41       $70.35
                                                                    suspension.
21700................  T....................  ...................  Revision of neck             0049      19.6046    $1,069.65  ...........      $213.93
                                                                    muscle.
21705................  C....................  ...................  Revision of neck      ...........  ...........  ...........  ...........  ...........
                                                                    muscle/rib.
21720................  T....................  ...................  Revision of neck             0049      19.6046    $1,069.65  ...........      $213.93
                                                                    muscle.
21725................  T....................  ...................  Revision of neck             0006       1.6527       $90.17       $23.26       $18.03
                                                                    muscle.
21740................  C....................  ...................  Reconstruction of     ...........  ...........  ...........  ...........  ...........
                                                                    sternum.
21742................  T....................  ...................  Repair stern/nuss w/         0051      34.5144    $1,883.14  ...........      $376.63
                                                                    o scope.
21743................  T....................  ...................  Repair sternum/nuss          0051      34.5144    $1,883.14  ...........      $376.63
                                                                    w/scope.
21750................  C....................  ...................  Repair of sternum     ...........  ...........  ...........  ...........  ...........
                                                                    separation.
21800................  T....................  ...................  Treatment of rib             0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
21805................  T....................  ...................  Treatment of rib             0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
21810................  C....................  ...................  Treatment of rib      ...........  ...........  ...........  ...........  ...........
                                                                    fracture(s).
21820................  T....................  ...................  Treat sternum                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
21825................  C....................  ...................  Treat sternum         ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
21899................  T....................  ...................  Neck/chest surgery           0252       6.4469      $351.75      $113.41       $70.35
                                                                    procedure.
21920................  T....................  ...................  Biopsy soft tissue           0020       7.0842      $386.52      $113.25       $77.30
                                                                    of back.
21925................  T....................  ...................  Biopsy soft tissue           0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    of back.

[[Page 63502]]

 
21930................  T....................  ...................  Remove lesion, back          0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    or flank.
21935................  T....................  ...................  Remove tumor, back..         0022      18.7932    $1,025.38      $354.45      $205.08
22100................  T....................  ...................  Remove part of neck          0208      40.2830    $2,197.88  ...........      $439.58
                                                                    vertebra.
22101................  T....................  ...................  Remove part, thorax          0208      40.2830    $2,197.88  ...........      $439.58
                                                                    vertebra.
22102................  T....................  ...................  Remove part, lumbar          0208      40.2830    $2,197.88  ...........      $439.58
                                                                    vertebra.
22103................  T....................  ...................  Remove extra spine           0208      40.2830    $2,197.88  ...........      $439.58
                                                                    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       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
22310................  T....................  ...................  Treat spine fracture         0043       1.9074      $104.07  ...........       $20.81
22315................  T....................  ...................  Treat spine fracture         0043       1.9074      $104.07  ...........       $20.81
22318................  C....................  ...................  Treat odontoid fx w/  ...........  ...........  ...........  ...........  ...........
                                                                    o graft.
22319................  C....................  ...................  Treat odontoid fx w/  ...........  ...........  ...........  ...........  ...........
                                                                    graft.
22325................  C....................  ...................  Treat spine fracture  ...........  ...........  ...........  ...........  ...........
22326................  C....................  ...................  Treat neck spine      ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
22327................  C....................  ...................  Treat thorax spine    ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
22328................  C....................  ...................  Treat each add spine  ...........  ...........  ...........  ...........  ...........
                                                                    fx.
22505................  T....................  ...................  Manipulation of              0045      13.5889      $741.42      $268.47      $148.28
                                                                    spine.
22520................  T....................  ...................  Percut                       0050      24.8651    $1,356.66  ...........      $271.33
                                                                    vertebroplasty thor.
22521................  T....................  ...................  Percut                       0050      24.8651    $1,356.66  ...........      $271.33
                                                                    vertebroplasty lumb.
22522................  T....................  ...................  Percut                       0050      24.8651    $1,356.66  ...........      $271.33
                                                                    vertebroplasty
                                                                    add'l.
22532................  C....................  NI.................  Lat thorax spine      ...........  ...........  ...........  ...........  ...........
                                                                    fusion.
22533................  C....................  NI.................  Lat lumbar spine      ...........  ...........  ...........  ...........  ...........
                                                                    fusion.
22534................  C....................  NI.................  Lat thor/lumb, add'l  ...........  ...........  ...........  ...........  ...........
                                                                    seg.
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      40.2830    $2,197.88  ...........      $439.58
22614................  T....................  ...................  Spine fusion, extra          0208      40.2830    $2,197.88  ...........      $439.58
                                                                    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                0043       1.9074      $104.07  ...........       $20.81
                                                                    procedure.
22900................  T....................  ...................  Remove abdominal             0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    wall lesion.
22999................  T....................  ...................  Abdomen surgery              0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    procedure.
23000................  T....................  ...................  Removal of calcium           0021      14.3594      $783.46      $219.48      $156.69
                                                                    deposits.
23020................  T....................  ...................  Release shoulder             0051      34.5144    $1,883.14  ...........      $376.63
                                                                    joint.

[[Page 63503]]

 
23030................  T....................  ...................  Drain shoulder               0008      19.4831    $1,063.02  ...........      $212.60
                                                                    lesion.
23031................  T....................  ...................  Drain shoulder bursa         0008      19.4831    $1,063.02  ...........      $212.60
23035................  T....................  ...................  Drain shoulder bone          0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lesion.
23040................  T....................  ...................  Exploratory shoulder         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    surgery.
23044................  T....................  ...................  Exploratory shoulder         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    surgery.
23065................  T....................  ...................  Biopsy shoulder              0021      14.3594      $783.46      $219.48      $156.69
                                                                    tissues.
23066................  T....................  ...................  Biopsy shoulder              0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    tissues.
23075................  T....................  ...................  Removal of shoulder          0021      14.3594      $783.46      $219.48      $156.69
                                                                    lesion.
23076................  T....................  ...................  Removal of shoulder          0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
23077................  T....................  ...................  Remove tumor of              0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    shoulder.
23100................  T....................  ...................  Biopsy of shoulder           0049      19.6046    $1,069.65  ...........      $213.93
                                                                    joint.
23101................  T....................  ...................  Shoulder joint               0050      24.8651    $1,356.66  ...........      $271.33
                                                                    surgery.
23105................  T....................  ...................  Remove shoulder              0050      24.8651    $1,356.66  ...........      $271.33
                                                                    joint lining.
23106................  T....................  ...................  Incision of                  0050      24.8651    $1,356.66  ...........      $271.33
                                                                    collarbone joint.
23107................  T....................  ...................  Explore treat                0050      24.8651    $1,356.66  ...........      $271.33
                                                                    shoulder joint.
23120................  T....................  ...................  Partial removal,             0051      34.5144    $1,883.14  ...........      $376.63
                                                                    collar bone.
23125................  T....................  ...................  Removal of collar            0051      34.5144    $1,883.14  ...........      $376.63
                                                                    bone.
23130................  T....................  ...................  Remove shoulder              0051      34.5144    $1,883.14  ...........      $376.63
                                                                    bone, part.
23140................  T....................  ...................  Removal of bone              0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lesion.
23145................  T....................  ...................  Removal of bone              0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
23146................  T....................  ...................  Removal of bone              0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
23150................  T....................  ...................  Removal of humerus           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
23155................  T....................  ...................  Removal of humerus           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
23156................  T....................  ...................  Removal of humerus           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
23170................  T....................  ...................  Remove collar bone           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
23172................  T....................  ...................  Remove shoulder              0050      24.8651    $1,356.66  ...........      $271.33
                                                                    blade lesion.
23174................  T....................  ...................  Remove humerus               0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
23180................  T....................  ...................  Remove collar bone           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
23182................  T....................  ...................  Remove shoulder              0050      24.8651    $1,356.66  ...........      $271.33
                                                                    blade lesion.
23184................  T....................  ...................  Remove humerus               0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
23190................  T....................  ...................  Partial removal of           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    scapula.
23195................  T....................  ...................  Removal of head of           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    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              0020       7.0842      $386.52      $113.25       $77.30
                                                                    foreign body.
23331................  T....................  ...................  Remove shoulder              0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    foreign body.
23332................  C....................  ...................  Remove shoulder       ...........  ...........  ...........  ...........  ...........
                                                                    foreign body.
23350................  N....................  ...................  Injection for         ...........  ...........  ...........  ...........  ...........
                                                                    shoulder x-ray.
23395................  T....................  ...................  Muscle                       0051      34.5144    $1,883.14  ...........      $376.63
                                                                    transfer,shoulder/
                                                                    arm.
23397................  T....................  ...................  Muscle transfers....         0052      42.7126    $2,330.44  ...........      $466.09
23400................  T....................  ...................  Fixation of shoulder         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    blade.
23405................  T....................  ...................  Incision of tendon &         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    muscle.
23406................  T....................  ...................  Incise tendon(s) &           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    muscle(s).
23410................  T....................  ...................  Repair of tendon(s).         0052      42.7126    $2,330.44  ...........      $466.09
23412................  T....................  ...................  Repair rotator cuff,         0052      42.7126    $2,330.44  ...........      $466.09
                                                                    chronic.
23415................  T....................  ...................  Release of shoulder          0051      34.5144    $1,883.14  ...........      $376.63
                                                                    ligament.
23420................  T....................  ...................  Repair of shoulder..         0052      42.7126    $2,330.44  ...........      $466.09
23430................  T....................  ...................  Repair biceps tendon         0052      42.7126    $2,330.44  ...........      $466.09
23440................  T....................  ...................  Remove/transplant            0052      42.7126    $2,330.44  ...........      $466.09
                                                                    tendon.
23450................  T....................  ...................  Repair shoulder              0052      42.7126    $2,330.44  ...........      $466.09
                                                                    capsule.
23455................  T....................  ...................  Repair shoulder              0052      42.7126    $2,330.44  ...........      $466.09
                                                                    capsule.
23460................  T....................  ...................  Repair shoulder              0052      42.7126    $2,330.44  ...........      $466.09
                                                                    capsule.
23462................  T....................  ...................  Repair shoulder              0052      42.7126    $2,330.44  ...........      $466.09
                                                                    capsule.
23465................  T....................  ...................  Repair shoulder              0052      42.7126    $2,330.44  ...........      $466.09
                                                                    capsule.
23466................  T....................  ...................  Repair shoulder              0052      42.7126    $2,330.44  ...........      $466.09
                                                                    capsule.
23470................  T....................  ...................  Reconstruct shoulder         0048      51.4609    $2,807.76      $695.60      $561.55
                                                                    joint.
23472................  C....................  ...................  Reconstruct shoulder  ...........  ...........  ...........  ...........  ...........
                                                                    joint.
23480................  T....................  ...................  Revision of collar           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    bone.
23485................  T....................  ...................  Revision of collar           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    bone.
23490................  T....................  ...................  Reinforce clavicle..         0051      34.5144    $1,883.14  ...........      $376.63
23491................  T....................  ...................  Reinforce shoulder           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    bones.
23500................  T....................  ...................  Treat clavicle               0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
23505................  T....................  ...................  Treat clavicle               0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
23515................  T....................  ...................  Treat clavicle               0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
23520................  T....................  ...................  Treat clavicle               0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
23525................  T....................  ...................  Treat clavicle               0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
23530................  T....................  ...................  Treat clavicle               0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
23532................  T....................  ...................  Treat clavicle               0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
23540................  T....................  ...................  Treat clavicle               0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
23545................  T....................  ...................  Treat clavicle               0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
23550................  T....................  ...................  Treat clavicle               0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
23552................  T....................  ...................  Treat clavicle               0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.

[[Page 63504]]

 
23570................  T....................  ...................  Treat shoulder blade         0043       1.9074      $104.07  ...........       $20.81
                                                                    fx.
23575................  T....................  ...................  Treat shoulder blade         0043       1.9074      $104.07  ...........       $20.81
                                                                    fx.
23585................  T....................  ...................  Treat scapula                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
23600................  T....................  ...................  Treat humerus                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
23605................  T....................  ...................  Treat humerus                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
23615................  T....................  ...................  Treat humerus                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
23616................  T....................  ...................  Treat humerus                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
23620................  T....................  ...................  Treat humerus                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
23625................  T....................  ...................  Treat humerus                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
23630................  T....................  ...................  Treat humerus                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
23650................  T....................  ...................  Treat shoulder               0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
23655................  T....................  ...................  Treat shoulder               0045      13.5889      $741.42      $268.47      $148.28
                                                                    dislocation.
23660................  T....................  ...................  Treat shoulder               0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
23665................  T....................  ...................  Treat dislocation/           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
23670................  T....................  ...................  Treat dislocation/           0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
23675................  T....................  ...................  Treat dislocation/           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
23680................  T....................  ...................  Treat dislocation/           0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
23700................  T....................  ...................  Fixation of shoulder         0045      13.5889      $741.42      $268.47      $148.28
23800................  T....................  ...................  Fusion of shoulder           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    joint.
23802................  T....................  ...................  Fusion of shoulder           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    joint.
23900................  C....................  ...................  Amputation of arm &   ...........  ...........  ...........  ...........  ...........
                                                                    girdle.
23920................  C....................  ...................  Amputation at         ...........  ...........  ...........  ...........  ...........
                                                                    shoulder joint.
23921................  T....................  ...................  Amputation follow-up         0025       5.1912      $283.24      $107.00       $56.65
                                                                    surgery.
23929................  T....................  ...................  Shoulder surgery             0043       1.9074      $104.07  ...........       $20.81
                                                                    procedure.
23930................  T....................  ...................  Drainage of arm              0008      19.4831    $1,063.02  ...........      $212.60
                                                                    lesion.
23931................  T....................  ...................  Drainage of arm              0007      11.8633      $647.27  ...........      $129.45
                                                                    bursa.
23935................  T....................  ...................  Drain arm/elbow bone         0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lesion.
24000................  T....................  ...................  Exploratory elbow            0050      24.8651    $1,356.66  ...........      $271.33
                                                                    surgery.
24006................  T....................  ...................  Release elbow joint.         0050      24.8651    $1,356.66  ...........      $271.33
24065................  T....................  ...................  Biopsy arm/elbow             0021      14.3594      $783.46      $219.48      $156.69
                                                                    soft tissue.
24066................  T....................  ...................  Biopsy arm/elbow             0021      14.3594      $783.46      $219.48      $156.69
                                                                    soft tissue.
24075................  T....................  ...................  Remove arm/elbow             0021      14.3594      $783.46      $219.48      $156.69
                                                                    lesion.
24076................  T....................  ...................  Remove arm/elbow             0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
24077................  T....................  ...................  Remove tumor of arm/         0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    elbow.
24100................  T....................  ...................  Biopsy elbow joint           0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lining.
24101................  T....................  ...................  Explore/treat elbow          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    joint.
24102................  T....................  ...................  Remove elbow joint           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lining.
24105................  T....................  ...................  Removal of elbow             0049      19.6046    $1,069.65  ...........      $213.93
                                                                    bursa.
24110................  T....................  ...................  Remove humerus               0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lesion.
24115................  T....................  ...................  Remove/graft bone            0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
24116................  T....................  ...................  Remove/graft bone            0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
24120................  T....................  ...................  Remove elbow lesion.         0049      19.6046    $1,069.65  ...........      $213.93
24125................  T....................  ...................  Remove/graft bone            0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
24126................  T....................  ...................  Remove/graft bone            0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
24130................  T....................  ...................  Removal of head of           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    radius.
24134................  T....................  ...................  Removal of arm bone          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
24136................  T....................  ...................  Remove radius bone           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
24138................  T....................  ...................  Remove elbow bone            0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
24140................  T....................  ...................  Partial removal of           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    arm bone.
24145................  T....................  ...................  Partial removal of           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    radius.
24147................  T....................  ...................  Partial removal of           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    elbow.
24149................  C....................  ...................  Radical resection of  ...........  ...........  ...........  ...........  ...........
                                                                    elbow.
24150................  T....................  ...................  Extensive humerus            0052      42.7126    $2,330.44  ...........      $466.09
                                                                    surgery.
24151................  T....................  ...................  Extensive humerus            0052      42.7126    $2,330.44  ...........      $466.09
                                                                    surgery.
24152................  T....................  ...................  Extensive radius             0052      42.7126    $2,330.44  ...........      $466.09
                                                                    surgery.
24153................  T....................  ...................  Extensive radius             0052      42.7126    $2,330.44  ...........      $466.09
                                                                    surgery.
24155................  T....................  ...................  Removal of elbow             0051      34.5144    $1,883.14  ...........      $376.63
                                                                    joint.
24160................  T....................  ...................  Remove elbow joint           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    implant.
24164................  T....................  ...................  Remove radius head           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    implant.
24200................  T....................  ...................  Removal of arm               0019       3.9493      $215.48       $71.87       $43.10
                                                                    foreign body.
24201................  T....................  ...................  Removal of arm               0021      14.3594      $783.46      $219.48      $156.69
                                                                    foreign body.
24220................  N....................  ...................  Injection for elbow   ...........  ...........  ...........  ...........  ...........
                                                                    x-ray.
24300................  T....................  ...................  Manipulate elbow w/          0045      13.5889      $741.42      $268.47      $148.28
                                                                    anesth.
24301................  T....................  ...................  Muscle/tendon                0050      24.8651    $1,356.66  ...........      $271.33
                                                                    transfer.
24305................  T....................  ...................  Arm tendon                   0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lengthening.
24310................  T....................  ...................  Revision of arm              0049      19.6046    $1,069.65  ...........      $213.93
                                                                    tendon.
24320................  T....................  ...................  Repair of arm tendon         0051      34.5144    $1,883.14  ...........      $376.63
24330................  T....................  ...................  Revision of arm              0051      34.5144    $1,883.14  ...........      $376.63
                                                                    muscles.
24331................  T....................  ...................  Revision of arm              0051      34.5144    $1,883.14  ...........      $376.63
                                                                    muscles.
24332................  T....................  ...................  Tenolysis, triceps..         0049      19.6046    $1,069.65  ...........      $213.93
24340................  T....................  ...................  Repair of biceps             0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tendon.
24341................  T....................  ...................  Repair arm tendon/           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    muscle.
24342................  T....................  ...................  Repair of ruptured           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tendon.
24343................  T....................  ...................  Repr elbow lat               0050      24.8651    $1,356.66  ...........      $271.33
                                                                    ligmnt w/tiss.
24344................  T....................  ...................  Reconstruct elbow            0051      34.5144    $1,883.14  ...........      $376.63
                                                                    lat ligmnt.

[[Page 63505]]

 
24345................  T....................  ...................  Repr elbw med ligmnt         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    w/tissu.
24346................  T....................  ...................  Reconstruct elbow            0051      34.5144    $1,883.14  ...........      $376.63
                                                                    med ligmnt.
24350................  T....................  ...................  Repair of tennis             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    elbow.
24351................  T....................  ...................  Repair of tennis             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    elbow.
24352................  T....................  ...................  Repair of tennis             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    elbow.
24354................  T....................  ...................  Repair of tennis             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    elbow.
24356................  T....................  ...................  Revision of tennis           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    elbow.
24360................  T....................  ...................  Reconstruct elbow            0047      29.9582    $1,634.55      $537.03      $326.91
                                                                    joint.
24361................  T....................  ...................  Reconstruct elbow            0048      51.4609    $2,807.76      $695.60      $561.55
                                                                    joint.
24362................  T....................  ...................  Reconstruct elbow            0048      51.4609    $2,807.76      $695.60      $561.55
                                                                    joint.
24363................  T....................  ...................  Replace elbow joint.         0048      51.4609    $2,807.76      $695.60      $561.55
24365................  T....................  ...................  Reconstruct head of          0047      29.9582    $1,634.55      $537.03      $326.91
                                                                    radius.
24366................  T....................  ...................  Reconstruct head of          0048      51.4609    $2,807.76      $695.60      $561.55
                                                                    radius.
24400................  T....................  ...................  Revision of humerus.         0050      24.8651    $1,356.66  ...........      $271.33
24410................  T....................  ...................  Revision of humerus.         0050      24.8651    $1,356.66  ...........      $271.33
24420................  T....................  ...................  Revision of humerus.         0051      34.5144    $1,883.14  ...........      $376.63
24430................  T....................  ...................  Repair of humerus...         0051      34.5144    $1,883.14  ...........      $376.63
24435................  T....................  ...................  Repair humerus with          0051      34.5144    $1,883.14  ...........      $376.63
                                                                    graft.
24470................  T....................  ...................  Revision of elbow            0051      34.5144    $1,883.14  ...........      $376.63
                                                                    joint.
24495................  T....................  ...................  Decompression of             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    forearm.
24498................  T....................  ...................  Reinforce humerus...         0051      34.5144    $1,883.14  ...........      $376.63
24500................  T....................  ...................  Treat humerus                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
24505................  T....................  ...................  Treat humerus                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
24515................  T....................  ...................  Treat humerus                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
24516................  T....................  ...................  Treat humerus                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
24530................  T....................  ...................  Treat humerus                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
24535................  T....................  ...................  Treat humerus                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
24538................  T....................  ...................  Treat humerus                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
24545................  T....................  ...................  Treat humerus                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
24546................  T....................  ...................  Treat humerus                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
24560................  T....................  ...................  Treat humerus                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
24565................  T....................  ...................  Treat humerus                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
24566................  T....................  ...................  Treat humerus                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
24575................  T....................  ...................  Treat humerus                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
24576................  T....................  ...................  Treat humerus                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
24577................  T....................  ...................  Treat humerus                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
24579................  T....................  ...................  Treat humerus                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
24582................  T....................  ...................  Treat humerus                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
24586................  T....................  ...................  Treat elbow fracture         0046      32.5581    $1,776.40      $535.76      $355.28
24587................  T....................  ...................  Treat elbow fracture         0046      32.5581    $1,776.40      $535.76      $355.28
24600................  T....................  ...................  Treat elbow                  0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
24605................  T....................  ...................  Treat elbow                  0045      13.5889      $741.42      $268.47      $148.28
                                                                    dislocation.
24615................  T....................  ...................  Treat elbow                  0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
24620................  T....................  ...................  Treat elbow fracture         0043       1.9074      $104.07  ...........       $20.81
24635................  T....................  ...................  Treat elbow fracture         0046      32.5581    $1,776.40      $535.76      $355.28
24640................  T....................  ...................  Treat elbow                  0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
24650................  T....................  ...................  Treat radius                 0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
24655................  T....................  ...................  Treat radius                 0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
24665................  T....................  ...................  Treat radius                 0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
24666................  T....................  ...................  Treat radius                 0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
24670................  T....................  ...................  Treat ulnar fracture         0043       1.9074      $104.07  ...........       $20.81
24675................  T....................  ...................  Treat ulnar fracture         0043       1.9074      $104.07  ...........       $20.81
24685................  T....................  ...................  Treat ulnar fracture         0046      32.5581    $1,776.40      $535.76      $355.28
24800................  T....................  ...................  Fusion of elbow              0051      34.5144    $1,883.14  ...........      $376.63
                                                                    joint.
24802................  T....................  ...................  Fusion/graft of              0051      34.5144    $1,883.14  ...........      $376.63
                                                                    elbow joint.
24900................  C....................  ...................  Amputation of upper   ...........  ...........  ...........  ...........  ...........
                                                                    arm.
24920................  C....................  ...................  Amputation of upper   ...........  ...........  ...........  ...........  ...........
                                                                    arm.
24925................  T....................  ...................  Amputation follow-up         0049      19.6046    $1,069.65  ...........      $213.93
                                                                    surgery.
24930................  C....................  ...................  Amputation follow-up  ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
24931................  C....................  ...................  Amputate upper arm &  ...........  ...........  ...........  ...........  ...........
                                                                    implant.
24935................  T....................  ...................  Revision of                  0052      42.7126    $2,330.44  ...........      $466.09
                                                                    amputation.
24940................  C....................  ...................  Revision of upper     ...........  ...........  ...........  ...........  ...........
                                                                    arm.
24999................  T....................  ...................  Upper arm/elbow              0043       1.9074      $104.07  ...........       $20.81
                                                                    surgery.
25000................  T....................  ...................  Incision of tendon           0049      19.6046    $1,069.65  ...........      $213.93
                                                                    sheath.
25001................  T....................  ...................  Incise flexor carpi          0049      19.6046    $1,069.65  ...........      $213.93
                                                                    radialis.
25020................  T....................  ...................  Decompress forearm 1         0049      19.6046    $1,069.65  ...........      $213.93
                                                                    space.
25023................  T....................  ...................  Decompress forearm 1         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    space.
25024................  T....................  ...................  Decompress forearm 2         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    spaces.
25025................  T....................  ...................  Decompress forearm 2         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    spaces.
25028................  T....................  ...................  Drainage of forearm          0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lesion.
25031................  T....................  ...................  Drainage of forearm          0049      19.6046    $1,069.65  ...........      $213.93
                                                                    bursa.
25035................  T....................  ...................  Treat forearm bone           0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lesion.
25040................  T....................  ...................  Explore/treat wrist          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    joint.
25065................  T....................  ...................  Biopsy forearm soft          0021      14.3594      $783.46      $219.48      $156.69
                                                                    tissues.
25066................  T....................  ...................  Biopsy forearm soft          0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    tissues.

[[Page 63506]]

 
25075................  T....................  ...................  Removel forearm              0021      14.3594      $783.46      $219.48      $156.69
                                                                    lesion subcu.
25076................  T....................  ...................  Removel forearm              0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion deep.
25077................  T....................  ...................  Remove tumor,                0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    forearm/wrist.
25085................  T....................  ...................  Incision of wrist            0049      19.6046    $1,069.65  ...........      $213.93
                                                                    capsule.
25100................  T....................  ...................  Biopsy of wrist              0049      19.6046    $1,069.65  ...........      $213.93
                                                                    joint.
25101................  T....................  ...................  Explore/treat wrist          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    joint.
25105................  T....................  ...................  Remove wrist joint           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lining.
25107................  T....................  ...................  Remove wrist joint           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    cartilage.
25110................  T....................  ...................  Remove wrist tendon          0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lesion.
25111................  T....................  ...................  Remove wrist tendon          0053      14.8831      $812.04      $253.49      $162.41
                                                                    lesion.
25112................  T....................  ...................  Reremove wrist               0053      14.8831      $812.04      $253.49      $162.41
                                                                    tendon lesion.
25115................  T....................  ...................  Remove wrist/forearm         0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lesion.
25116................  T....................  ...................  Remove wrist/forearm         0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lesion.
25118................  T....................  ...................  Excise wrist tendon          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    sheath.
25119................  T....................  ...................  Partial removal of           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    ulna.
25120................  T....................  ...................  Removal of forearm           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
25125................  T....................  ...................  Remove/graft forearm         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
25126................  T....................  ...................  Remove/graft forearm         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
25130................  T....................  ...................  Removal of wrist             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
25135................  T....................  ...................  Remove & graft wrist         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
25136................  T....................  ...................  Remove & graft wrist         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
25145................  T....................  ...................  Remove forearm bone          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
25150................  T....................  ...................  Partial removal of           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    ulna.
25151................  T....................  ...................  Partial removal of           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    radius.
25170................  T....................  ...................  Extensive forearm            0052      42.7126    $2,330.44  ...........      $466.09
                                                                    surgery.
25210................  T....................  ...................  Removal of wrist             0054      24.2456    $1,322.86  ...........      $264.57
                                                                    bone.
25215................  T....................  ...................  Removal of wrist             0054      24.2456    $1,322.86  ...........      $264.57
                                                                    bones.
25230................  T....................  ...................  Partial removal of           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    radius.
25240................  T....................  ...................  Partial removal of           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    ulna.
25246................  N....................  ...................  Injection for wrist   ...........  ...........  ...........  ...........  ...........
                                                                    x-ray.
25248................  T....................  ...................  Remove forearm               0049      19.6046    $1,069.65  ...........      $213.93
                                                                    foreign body.
25250................  T....................  ...................  Removal of wrist             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    prosthesis.
25251................  T....................  ...................  Removal of wrist             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    prosthesis.
25259................  T....................  ...................  Manipulate wrist w/          0043       1.9074      $104.07  ...........       $20.81
                                                                    anesthes.
25260................  T....................  ...................  Repair forearm               0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon/muscle.
25263................  T....................  ...................  Repair forearm               0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon/muscle.
25265................  T....................  ...................  Repair forearm               0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon/muscle.
25270................  T....................  ...................  Repair forearm               0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon/muscle.
25272................  T....................  ...................  Repair forearm               0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon/muscle.
25274................  T....................  ...................  Repair forearm               0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon/muscle.
25275................  T....................  ...................  Repair forearm               0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon sheath.
25280................  T....................  ...................  Revise wrist/forearm         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon.
25290................  T....................  ...................  Incise wrist/forearm         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon.
25295................  T....................  ...................  Release wrist/               0049      19.6046    $1,069.65  ...........      $213.93
                                                                    forearm tendon.
25300................  T....................  ...................  Fusion of tendons at         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    wrist.
25301................  T....................  ...................  Fusion of tendons at         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    wrist.
25310................  T....................  ...................  Transplant forearm           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tendon.
25312................  T....................  ...................  Transplant forearm           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tendon.
25315................  T....................  ...................  Revise palsy hand            0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tendon(s).
25316................  T....................  ...................  Revise palsy hand            0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tendon(s).
25320................  T....................  ...................  Repair/revise wrist          0051      34.5144    $1,883.14  ...........      $376.63
                                                                    joint.
25332................  T....................  ...................  Revise wrist joint..         0047      29.9582    $1,634.55      $537.03      $326.91
25335................  T....................  ...................  Realignment of hand.         0051      34.5144    $1,883.14  ...........      $376.63
25337................  T....................  ...................  Reconstruct ulna/            0051      34.5144    $1,883.14  ...........      $376.63
                                                                    radioulnar.
25350................  T....................  ...................  Revision of radius..         0051      34.5144    $1,883.14  ...........      $376.63
25355................  T....................  ...................  Revision of radius..         0051      34.5144    $1,883.14  ...........      $376.63
25360................  T....................  ...................  Revision of ulna....         0050      24.8651    $1,356.66  ...........      $271.33
25365................  T....................  ...................  Revise radius & ulna         0050      24.8651    $1,356.66  ...........      $271.33
25370................  T....................  ...................  Revise radius or             0051      34.5144    $1,883.14  ...........      $376.63
                                                                    ulna.
25375................  T....................  ...................  Revise radius & ulna         0051      34.5144    $1,883.14  ...........      $376.63
25390................  T....................  ...................  Shorten radius or            0050      24.8651    $1,356.66  ...........      $271.33
                                                                    ulna.
25391................  T....................  ...................  Lengthen radius or           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    ulna.
25392................  T....................  ...................  Shorten radius &             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    ulna.
25393................  T....................  ...................  Lengthen radius &            0051      34.5144    $1,883.14  ...........      $376.63
                                                                    ulna.
25394................  T....................  ...................  Repair carpal bone,          0053      14.8831      $812.04      $253.49      $162.41
                                                                    shorten.
25400................  T....................  ...................  Repair radius or             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    ulna.
25405................  T....................  ...................  Repair/graft radius          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    or ulna.
25415................  T....................  ...................  Repair radius & ulna         0050      24.8651    $1,356.66  ...........      $271.33
25420................  T....................  ...................  Repair/graft radius          0051      34.5144    $1,883.14  ...........      $376.63
                                                                    & ulna.
25425................  T....................  ...................  Repair/graft radius          0051      34.5144    $1,883.14  ...........      $376.63
                                                                    or ulna.
25426................  T....................  ...................  Repair/graft radius          0051      34.5144    $1,883.14  ...........      $376.63
                                                                    & ulna.
25430................  T....................  ...................  Vasc graft into              0054      24.2456    $1,322.86  ...........      $264.57
                                                                    carpal bone.
25431................  T....................  ...................  Repair nonunion              0054      24.2456    $1,322.86  ...........      $264.57
                                                                    carpal bone.
25440................  T....................  ...................  Repair/graft wrist           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    bone.
25441................  T....................  ...................  Reconstruct wrist            0048      51.4609    $2,807.76      $695.60      $561.55
                                                                    joint.

[[Page 63507]]

 
25442................  T....................  ...................  Reconstruct wrist            0048      51.4609    $2,807.76      $695.60      $561.55
                                                                    joint.
25443................  T....................  ...................  Reconstruct wrist            0048      51.4609    $2,807.76      $695.60      $561.55
                                                                    joint.
25444................  T....................  ...................  Reconstruct wrist            0048      51.4609    $2,807.76      $695.60      $561.55
                                                                    joint.
25445................  T....................  ...................  Reconstruct wrist            0048      51.4609    $2,807.76      $695.60      $561.55
                                                                    joint.
25446................  T....................  ...................  Wrist replacement...         0048      51.4609    $2,807.76      $695.60      $561.55
25447................  T....................  ...................  Repair wrist                 0047      29.9582    $1,634.55      $537.03      $326.91
                                                                    joint(s).
25449................  T....................  ...................  Remove wrist joint           0047      29.9582    $1,634.55      $537.03      $326.91
                                                                    implant.
25450................  T....................  ...................  Revision of wrist            0051      34.5144    $1,883.14  ...........      $376.63
                                                                    joint.
25455................  T....................  ...................  Revision of wrist            0051      34.5144    $1,883.14  ...........      $376.63
                                                                    joint.
25490................  T....................  ...................  Reinforce radius....         0051      34.5144    $1,883.14  ...........      $376.63
25491................  T....................  ...................  Reinforce ulna......         0051      34.5144    $1,883.14  ...........      $376.63
25492................  T....................  ...................  Reinforce radius and         0051      34.5144    $1,883.14  ...........      $376.63
                                                                    ulna.
25500................  T....................  ...................  Treat fracture of            0043       1.9074      $104.07  ...........       $20.81
                                                                    radius.
25505................  T....................  ...................  Treat fracture of            0043       1.9074      $104.07  ...........       $20.81
                                                                    radius.
25515................  T....................  ...................  Treat fracture of            0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    radius.
25520................  T....................  ...................  Treat fracture of            0043       1.9074      $104.07  ...........       $20.81
                                                                    radius.
25525................  T....................  ...................  Treat fracture of            0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    radius.
25526................  T....................  ...................  Treat fracture of            0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    radius.
25530................  T....................  ...................  Treat fracture of            0043       1.9074      $104.07  ...........       $20.81
                                                                    ulna.
25535................  T....................  ...................  Treat fracture of            0043       1.9074      $104.07  ...........       $20.81
                                                                    ulna.
25545................  T....................  ...................  Treat fracture of            0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    ulna.
25560................  T....................  ...................  Treat fracture               0043       1.9074      $104.07  ...........       $20.81
                                                                    radius & ulna.
25565................  T....................  ...................  Treat fracture               0043       1.9074      $104.07  ...........       $20.81
                                                                    radius & ulna.
25574................  T....................  ...................  Treat fracture               0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    radius & ulna.
25575................  T....................  ...................  Treat fracture               0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    radius/ulna.
25600................  T....................  ...................  Treat fracture               0043       1.9074      $104.07  ...........       $20.81
                                                                    radius/ulna.
25605................  T....................  ...................  Treat fracture               0043       1.9074      $104.07  ...........       $20.81
                                                                    radius/ulna.
25611................  T....................  ...................  Treat fracture               0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    radius/ulna.
25620................  T....................  ...................  Treat fracture               0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    radius/ulna.
25622................  T....................  ...................  Treat wrist bone             0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
25624................  T....................  ...................  Treat wrist bone             0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
25628................  T....................  ...................  Treat wrist bone             0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
25630................  T....................  ...................  Treat wrist bone             0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
25635................  T....................  ...................  Treat wrist bone             0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
25645................  T....................  ...................  Treat wrist bone             0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
25650................  T....................  ...................  Treat wrist bone             0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
25651................  T....................  ...................  Pin ulnar styloid            0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
25652................  T....................  ...................  Treat fracture ulnar         0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    styloid.
25660................  T....................  ...................  Treat wrist                  0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
25670................  T....................  ...................  Treat wrist                  0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
25671................  T....................  ...................  Pin radioulnar               0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
25675................  T....................  ...................  Treat wrist                  0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
25676................  T....................  ...................  Treat wrist                  0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
25680................  T....................  ...................  Treat wrist fracture         0043       1.9074      $104.07  ...........       $20.81
25685................  T....................  ...................  Treat wrist fracture         0046      32.5581    $1,776.40      $535.76      $355.28
25690................  T....................  ...................  Treat wrist                  0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
25695................  T....................  ...................  Treat wrist                  0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
25800................  T....................  ...................  Fusion of wrist              0051      34.5144    $1,883.14  ...........      $376.63
                                                                    joint.
25805................  T....................  ...................  Fusion/graft of              0051      34.5144    $1,883.14  ...........      $376.63
                                                                    wrist joint.
25810................  T....................  ...................  Fusion/graft of              0051      34.5144    $1,883.14  ...........      $376.63
                                                                    wrist joint.
25820................  T....................  ...................  Fusion of hand bones         0053      14.8831      $812.04      $253.49      $162.41
25825................  T....................  ...................  Fuse hand bones with         0054      24.2456    $1,322.86  ...........      $264.57
                                                                    graft.
25830................  T....................  ...................  Fusion, radioulnar           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    jnt/ulna.
25900................  C....................  ...................  Amputation of         ...........  ...........  ...........  ...........  ...........
                                                                    forearm.
25905................  C....................  ...................  Amputation of         ...........  ...........  ...........  ...........  ...........
                                                                    forearm.
25907................  T....................  ...................  Amputation follow-up         0049      19.6046    $1,069.65  ...........      $213.93
                                                                    surgery.
25909................  C....................  ...................  Amputation follow-up  ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
25915................  C....................  ...................  Amputation of         ...........  ...........  ...........  ...........  ...........
                                                                    forearm.
25920................  C....................  ...................  Amputate hand at      ...........  ...........  ...........  ...........  ...........
                                                                    wrist.
25922................  T....................  ...................  Amputate hand at             0049      19.6046    $1,069.65  ...........      $213.93
                                                                    wrist.
25924................  C....................  ...................  Amputation follow-up  ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
25927................  C....................  ...................  Amputation of hand..  ...........  ...........  ...........  ...........  ...........
25929................  T....................  ...................  Amputation follow-up         0027      15.8990      $867.47      $329.72      $173.49
                                                                    surgery.
25931................  C....................  ...................  Amputation follow-up  ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
25999................  T....................  ...................  Forearm or wrist             0043       1.9074      $104.07  ...........       $20.81
                                                                    surgery.
26010................  T....................  ...................  Drainage of finger           0006       1.6527       $90.17       $23.26       $18.03
                                                                    abscess.
26011................  T....................  ...................  Drainage of finger           0007      11.8633      $647.27  ...........      $129.45
                                                                    abscess.
26020................  T....................  ...................  Drain hand tendon            0053      14.8831      $812.04      $253.49      $162.41
                                                                    sheath.
26025................  T....................  ...................  Drainage of palm             0053      14.8831      $812.04      $253.49      $162.41
                                                                    bursa.
26030................  T....................  ...................  Drainage of palm             0053      14.8831      $812.04      $253.49      $162.41
                                                                    bursa(s).
26034................  T....................  ...................  Treat hand bone              0053      14.8831      $812.04      $253.49      $162.41
                                                                    lesion.
26035................  T....................  ...................  Decompress fingers/          0053      14.8831      $812.04      $253.49      $162.41
                                                                    hand.
26037................  T....................  ...................  Decompress fingers/          0053      14.8831      $812.04      $253.49      $162.41
                                                                    hand.
26040................  T....................  ...................  Release palm                 0054      24.2456    $1,322.86  ...........      $264.57
                                                                    contracture.
26045................  T....................  ...................  Release palm                 0054      24.2456    $1,322.86  ...........      $264.57
                                                                    contracture.

[[Page 63508]]

 
26055................  T....................  ...................  Incise finger tendon         0053      14.8831      $812.04      $253.49      $162.41
                                                                    sheath.
26060................  T....................  ...................  Incision of finger           0053      14.8831      $812.04      $253.49      $162.41
                                                                    tendon.
26070................  T....................  ...................  Explore/treat hand           0053      14.8831      $812.04      $253.49      $162.41
                                                                    joint.
26075................  T....................  ...................  Explore/treat finger         0053      14.8831      $812.04      $253.49      $162.41
                                                                    joint.
26080................  T....................  ...................  Explore/treat finger         0053      14.8831      $812.04      $253.49      $162.41
                                                                    joint.
26100................  T....................  ...................  Biopsy hand joint            0053      14.8831      $812.04      $253.49      $162.41
                                                                    lining.
26105................  T....................  ...................  Biopsy finger joint          0053      14.8831      $812.04      $253.49      $162.41
                                                                    lining.
26110................  T....................  ...................  Biopsy finger joint          0053      14.8831      $812.04      $253.49      $162.41
                                                                    lining.
26115................  T....................  ...................  Removel hand lesion          0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    subcut.
26116................  T....................  ...................  Removel hand lesion,         0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    deep.
26117................  T....................  ...................  Remove tumor, hand/          0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    finger.
26121................  T....................  ...................  Release palm                 0054      24.2456    $1,322.86  ...........      $264.57
                                                                    contracture.
26123................  T....................  ...................  Release palm                 0054      24.2456    $1,322.86  ...........      $264.57
                                                                    contracture.
26125................  T....................  ...................  Release palm                 0054      24.2456    $1,322.86  ...........      $264.57
                                                                    contracture.
26130................  T....................  ...................  Remove wrist joint           0053      14.8831      $812.04      $253.49      $162.41
                                                                    lining.
26135................  T....................  ...................  Revise finger joint,         0054      24.2456    $1,322.86  ...........      $264.57
                                                                    each.
26140................  T....................  ...................  Revise finger joint,         0053      14.8831      $812.04      $253.49      $162.41
                                                                    each.
26145................  T....................  ...................  Tendon excision,             0053      14.8831      $812.04      $253.49      $162.41
                                                                    palm/finger.
26160................  T....................  ...................  Remove tendon sheath         0053      14.8831      $812.04      $253.49      $162.41
                                                                    lesion.
26170................  T....................  ...................  Removal of palm              0053      14.8831      $812.04      $253.49      $162.41
                                                                    tendon, each.
26180................  T....................  ...................  Removal of finger            0053      14.8831      $812.04      $253.49      $162.41
                                                                    tendon.
26185................  T....................  ...................  Remove finger bone..         0053      14.8831      $812.04      $253.49      $162.41
26200................  T....................  ...................  Remove hand bone             0053      14.8831      $812.04      $253.49      $162.41
                                                                    lesion.
26205................  T....................  ...................  Remove/graft bone            0054      24.2456    $1,322.86  ...........      $264.57
                                                                    lesion.
26210................  T....................  ...................  Removal of finger            0053      14.8831      $812.04      $253.49      $162.41
                                                                    lesion.
26215................  T....................  ...................  Remove/graft finger          0053      14.8831      $812.04      $253.49      $162.41
                                                                    lesion.
26230................  T....................  ...................  Partial removal of           0053      14.8831      $812.04      $253.49      $162.41
                                                                    hand bone.
26235................  T....................  ...................  Partial removal,             0053      14.8831      $812.04      $253.49      $162.41
                                                                    finger bone.
26236................  T....................  ...................  Partial removal,             0053      14.8831      $812.04      $253.49      $162.41
                                                                    finger bone.
26250................  T....................  ...................  Extensive hand               0053      14.8831      $812.04      $253.49      $162.41
                                                                    surgery.
26255................  T....................  ...................  Extensive hand               0054      24.2456    $1,322.86  ...........      $264.57
                                                                    surgery.
26260................  T....................  ...................  Extensive finger             0053      14.8831      $812.04      $253.49      $162.41
                                                                    surgery.
26261................  T....................  ...................  Extensive finger             0053      14.8831      $812.04      $253.49      $162.41
                                                                    surgery.
26262................  T....................  ...................  Partial removal of           0053      14.8831      $812.04      $253.49      $162.41
                                                                    finger.
26320................  T....................  ...................  Removal of implant           0021      14.3594      $783.46      $219.48      $156.69
                                                                    from hand.
26340................  T....................  ...................  Manipulate finger w/         0043       1.9074      $104.07  ...........       $20.81
                                                                    anesth.
26350................  T....................  ...................  Repair finger/hand           0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26352................  T....................  ...................  Repair/graft hand            0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26356................  T....................  ...................  Repair finger/hand           0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26357................  T....................  ...................  Repair finger/hand           0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26358................  T....................  ...................  Repair/graft hand            0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26370................  T....................  ...................  Repair finger/hand           0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26372................  T....................  ...................  Repair/graft hand            0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26373................  T....................  ...................  Repair finger/hand           0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26390................  T....................  ...................  Revise hand/finger           0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26392................  T....................  ...................  Repair/graft hand            0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26410................  T....................  ...................  Repair hand tendon..         0053      14.8831      $812.04      $253.49      $162.41
26412................  T....................  ...................  Repair/graft hand            0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26415................  T....................  ...................  Excision, hand/              0054      24.2456    $1,322.86  ...........      $264.57
                                                                    finger tendon.
26416................  T....................  ...................  Graft hand or finger         0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26418................  T....................  ...................  Repair finger tendon         0053      14.8831      $812.04      $253.49      $162.41
26420................  T....................  ...................  Repair/graft finger          0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26426................  T....................  ...................  Repair finger/hand           0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26428................  T....................  ...................  Repair/graft finger          0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26432................  T....................  ...................  Repair finger tendon         0053      14.8831      $812.04      $253.49      $162.41
26433................  T....................  ...................  Repair finger tendon         0053      14.8831      $812.04      $253.49      $162.41
26434................  T....................  ...................  Repair/graft finger          0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26437................  T....................  ...................  Realignment of               0053      14.8831      $812.04      $253.49      $162.41
                                                                    tendons.
26440................  T....................  ...................  Release palm/finger          0053      14.8831      $812.04      $253.49      $162.41
                                                                    tendon.
26442................  T....................  ...................  Release palm &               0054      24.2456    $1,322.86  ...........      $264.57
                                                                    finger tendon.
26445................  T....................  ...................  Release hand/finger          0053      14.8831      $812.04      $253.49      $162.41
                                                                    tendon.
26449................  T....................  ...................  Release forearm/hand         0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26450................  T....................  ...................  Incision of palm             0053      14.8831      $812.04      $253.49      $162.41
                                                                    tendon.
26455................  T....................  ...................  Incision of finger           0053      14.8831      $812.04      $253.49      $162.41
                                                                    tendon.
26460................  T....................  ...................  Incise hand/finger           0053      14.8831      $812.04      $253.49      $162.41
                                                                    tendon.
26471................  T....................  ...................  Fusion of finger             0053      14.8831      $812.04      $253.49      $162.41
                                                                    tendons.
26474................  T....................  ...................  Fusion of finger             0053      14.8831      $812.04      $253.49      $162.41
                                                                    tendons.
26476................  T....................  ...................  Tendon lengthening..         0053      14.8831      $812.04      $253.49      $162.41
26477................  T....................  ...................  Tendon shortening...         0053      14.8831      $812.04      $253.49      $162.41
26478................  T....................  ...................  Lengthening of hand          0053      14.8831      $812.04      $253.49      $162.41
                                                                    tendon.
26479................  T....................  ...................  Shortening of hand           0053      14.8831      $812.04      $253.49      $162.41
                                                                    tendon.
26480................  T....................  ...................  Transplant hand              0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26483................  T....................  ...................  Transplant/graft             0054      24.2456    $1,322.86  ...........      $264.57
                                                                    hand tendon.
26485................  T....................  ...................  Transplant palm              0054      24.2456    $1,322.86  ...........      $264.57
                                                                    tendon.
26489................  T....................  ...................  Transplant/graft             0054      24.2456    $1,322.86  ...........      $264.57
                                                                    palm tendon.

[[Page 63509]]

 
26490................  T....................  ...................  Revise thumb tendon.         0054      24.2456    $1,322.86  ...........      $264.57
26492................  T....................  ...................  Tendon transfer with         0054      24.2456    $1,322.86  ...........      $264.57
                                                                    graft.
26494................  T....................  ...................  Hand tendon/muscle           0054      24.2456    $1,322.86  ...........      $264.57
                                                                    transfer.
26496................  T....................  ...................  Revise thumb tendon.         0054      24.2456    $1,322.86  ...........      $264.57
26497................  T....................  ...................  Finger tendon                0054      24.2456    $1,322.86  ...........      $264.57
                                                                    transfer.
26498................  T....................  ...................  Finger tendon                0054      24.2456    $1,322.86  ...........      $264.57
                                                                    transfer.
26499................  T....................  ...................  Revision of finger..         0054      24.2456    $1,322.86  ...........      $264.57
26500................  T....................  ...................  Hand tendon                  0053      14.8831      $812.04      $253.49      $162.41
                                                                    reconstruction.
26502................  T....................  ...................  Hand tendon                  0054      24.2456    $1,322.86  ...........      $264.57
                                                                    reconstruction.
26504................  T....................  ...................  Hand tendon                  0054      24.2456    $1,322.86  ...........      $264.57
                                                                    reconstruction.
26508................  T....................  ...................  Release thumb                0053      14.8831      $812.04      $253.49      $162.41
                                                                    contracture.
26510................  T....................  ...................  Thumb tendon                 0054      24.2456    $1,322.86  ...........      $264.57
                                                                    transfer.
26516................  T....................  ...................  Fusion of knuckle            0054      24.2456    $1,322.86  ...........      $264.57
                                                                    joint.
26517................  T....................  ...................  Fusion of knuckle            0054      24.2456    $1,322.86  ...........      $264.57
                                                                    joints.
26518................  T....................  ...................  Fusion of knuckle            0054      24.2456    $1,322.86  ...........      $264.57
                                                                    joints.
26520................  T....................  ...................  Release knuckle              0053      14.8831      $812.04      $253.49      $162.41
                                                                    contracture.
26525................  T....................  ...................  Release finger               0053      14.8831      $812.04      $253.49      $162.41
                                                                    contracture.
26530................  T....................  ...................  Revise knuckle joint         0047      29.9582    $1,634.55      $537.03      $326.91
26531................  T....................  ...................  Revise knuckle with          0048      51.4609    $2,807.76      $695.60      $561.55
                                                                    implant.
26535................  T....................  ...................  Revise finger joint.         0047      29.9582    $1,634.55      $537.03      $326.91
26536................  T....................  ...................  Revise/implant               0048      51.4609    $2,807.76      $695.60      $561.55
                                                                    finger joint.
26540................  T....................  ...................  Repair hand joint...         0053      14.8831      $812.04      $253.49      $162.41
26541................  T....................  ...................  Repair hand joint            0054      24.2456    $1,322.86  ...........      $264.57
                                                                    with graft.
26542................  T....................  ...................  Repair hand joint            0053      14.8831      $812.04      $253.49      $162.41
                                                                    with graft.
26545................  T....................  ...................  Reconstruct finger           0054      24.2456    $1,322.86  ...........      $264.57
                                                                    joint.
26546................  T....................  ...................  Repair nonunion hand         0054      24.2456    $1,322.86  ...........      $264.57
26548................  T....................  ...................  Reconstruct finger           0054      24.2456    $1,322.86  ...........      $264.57
                                                                    joint.
26550................  T....................  ...................  Construct thumb              0054      24.2456    $1,322.86  ...........      $264.57
                                                                    replacement.
26551................  C....................  ...................  Great toe-hand        ...........  ...........  ...........  ...........  ...........
                                                                    transfer.
26553................  C....................  ...................  Single transfer, toe- ...........  ...........  ...........  ...........  ...........
                                                                    hand.
26554................  C....................  ...................  Double transfer, toe- ...........  ...........  ...........  ...........  ...........
                                                                    hand.
26555................  T....................  ...................  Positional change of         0054      24.2456    $1,322.86  ...........      $264.57
                                                                    finger.
26556................  C....................  ...................  Toe joint transfer..  ...........  ...........  ...........  ...........  ...........
26560................  T....................  ...................  Repair of web finger         0053      14.8831      $812.04      $253.49      $162.41
26561................  T....................  ...................  Repair of web finger         0054      24.2456    $1,322.86  ...........      $264.57
26562................  T....................  ...................  Repair of web finger         0054      24.2456    $1,322.86  ...........      $264.57
26565................  T....................  ...................  Correct metacarpal           0054      24.2456    $1,322.86  ...........      $264.57
                                                                    flaw.
26567................  T....................  ...................  Correct finger               0054      24.2456    $1,322.86  ...........      $264.57
                                                                    deformity.
26568................  T....................  ...................  Lengthen metacarpal/         0054      24.2456    $1,322.86  ...........      $264.57
                                                                    finger.
26580................  T....................  ...................  Repair hand                  0054      24.2456    $1,322.86  ...........      $264.57
                                                                    deformity.
26587................  T....................  ...................  Reconstruct extra            0053      14.8831      $812.04      $253.49      $162.41
                                                                    finger.
26590................  T....................  ...................  Repair finger                0054      24.2456    $1,322.86  ...........      $264.57
                                                                    deformity.
26591................  T....................  ...................  Repair muscles of            0054      24.2456    $1,322.86  ...........      $264.57
                                                                    hand.
26593................  T....................  ...................  Release muscles of           0053      14.8831      $812.04      $253.49      $162.41
                                                                    hand.
26596................  T....................  ...................  Excision                     0054      24.2456    $1,322.86  ...........      $264.57
                                                                    constricting tissue.
26600................  T....................  ...................  Treat metacarpal             0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
26605................  T....................  ...................  Treat metacarpal             0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
26607................  T....................  ...................  Treat metacarpal             0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
26608................  T....................  ...................  Treat metacarpal             0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
26615................  T....................  ...................  Treat metacarpal             0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
26641................  T....................  ...................  Treat thumb                  0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
26645................  T....................  ...................  Treat thumb fracture         0043       1.9074      $104.07  ...........       $20.81
26650................  T....................  ...................  Treat thumb fracture         0046      32.5581    $1,776.40      $535.76      $355.28
26665................  T....................  ...................  Treat thumb fracture         0046      32.5581    $1,776.40      $535.76      $355.28
26670................  T....................  ...................  Treat hand                   0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
26675................  T....................  ...................  Treat hand                   0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
26676................  T....................  ...................  Pin hand dislocation         0046      32.5581    $1,776.40      $535.76      $355.28
26685................  T....................  ...................  Treat hand                   0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
26686................  T....................  ...................  Treat hand                   0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
26700................  T....................  ...................  Treat knuckle                0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
26705................  T....................  ...................  Treat knuckle                0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
26706................  T....................  ...................  Pin knuckle                  0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
26715................  T....................  ...................  Treat knuckle                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
26720................  T....................  ...................  Treat finger                 0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture, each.
26725................  T....................  ...................  Treat finger                 0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture, each.
26727................  T....................  ...................  Treat finger                 0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture, each.
26735................  T....................  ...................  Treat finger                 0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture, each.
26740................  T....................  ...................  Treat finger                 0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture, each.
26742................  T....................  ...................  Treat finger                 0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture, each.
26746................  T....................  ...................  Treat finger                 0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture, each.
26750................  T....................  ...................  Treat finger                 0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture, each.
26755................  T....................  ...................  Treat finger                 0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture, each.
26756................  T....................  ...................  Pin finger fracture,         0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    each.
26765................  T....................  ...................  Treat finger                 0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture, each.
26770................  T....................  ...................  Treat finger                 0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.

[[Page 63510]]

 
26775................  T....................  ...................  Treat finger                 0045      13.5889      $741.42      $268.47      $148.28
                                                                    dislocation.
26776................  T....................  ...................  Pin finger                   0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
26785................  T....................  ...................  Treat finger                 0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
26820................  T....................  ...................  Thumb fusion with            0054      24.2456    $1,322.86  ...........      $264.57
                                                                    graft.
26841................  T....................  ...................  Fusion of thumb.....         0054      24.2456    $1,322.86  ...........      $264.57
26842................  T....................  ...................  Thumb fusion with            0054      24.2456    $1,322.86  ...........      $264.57
                                                                    graft.
26843................  T....................  ...................  Fusion of hand joint         0054      24.2456    $1,322.86  ...........      $264.57
26844................  T....................  ...................  Fusion/graft of hand         0054      24.2456    $1,322.86  ...........      $264.57
                                                                    joint.
26850................  T....................  ...................  Fusion of knuckle...         0054      24.2456    $1,322.86  ...........      $264.57
26852................  T....................  ...................  Fusion of knuckle            0054      24.2456    $1,322.86  ...........      $264.57
                                                                    with graft.
26860................  T....................  ...................  Fusion of finger             0054      24.2456    $1,322.86  ...........      $264.57
                                                                    joint.
26861................  T....................  ...................  Fusion of finger             0054      24.2456    $1,322.86  ...........      $264.57
                                                                    jnt, add-on.
26862................  T....................  ...................  Fusion/graft of              0054      24.2456    $1,322.86  ...........      $264.57
                                                                    finger joint.
26863................  T....................  ...................  Fuse/graft added             0054      24.2456    $1,322.86  ...........      $264.57
                                                                    joint.
26910................  T....................  ...................  Amputate metacarpal          0054      24.2456    $1,322.86  ...........      $264.57
                                                                    bone.
26951................  T....................  ...................  Amputation of finger/        0053      14.8831      $812.04      $253.49      $162.41
                                                                    thumb.
26952................  T....................  ...................  Amputation of finger/        0053      14.8831      $812.04      $253.49      $162.41
                                                                    thumb.
26989................  T....................  ...................  Hand/finger surgery.         0043       1.9074      $104.07  ...........       $20.81
26990................  T....................  ...................  Drainage of pelvis           0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lesion.
26991................  T....................  ...................  Drainage of pelvis           0049      19.6046    $1,069.65  ...........      $213.93
                                                                    bursa.
26992................  C....................  ...................  Drainage of bone      ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
27000................  T....................  ...................  Incision of hip              0049      19.6046    $1,069.65  ...........      $213.93
                                                                    tendon.
27001................  T....................  ...................  Incision of hip              0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon.
27003................  T....................  ...................  Incision of hip              0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon.
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      34.5144    $1,883.14  ...........      $376.63
                                                                    joint.
27035................  T....................  ...................  Denervation of hip           0052      42.7126    $2,330.44  ...........      $466.09
                                                                    joint.
27036................  C....................  ...................  Excision of hip       ...........  ...........  ...........  ...........  ...........
                                                                    joint/muscle.
27040................  T....................  ...................  Biopsy of soft               0020       7.0842      $386.52      $113.25       $77.30
                                                                    tissues.
27041................  T....................  ...................  Biopsy of soft               0019       3.9493      $215.48       $71.87       $43.10
                                                                    tissues.
27047................  T....................  ...................  Remove hip/pelvis            0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
27048................  T....................  ...................  Remove hip/pelvis            0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
27049................  T....................  ...................  Remove tumor, hip/           0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    pelvis.
27050................  T....................  ...................  Biopsy of sacroiliac         0049      19.6046    $1,069.65  ...........      $213.93
                                                                    joint.
27052................  T....................  ...................  Biopsy of hip joint.         0049      19.6046    $1,069.65  ...........      $213.93
27054................  C....................  ...................  Removal of hip joint  ...........  ...........  ...........  ...........  ...........
                                                                    lining.
27060................  T....................  ...................  Removal of ischial           0049      19.6046    $1,069.65  ...........      $213.93
                                                                    bursa.
27062................  T....................  ...................  Remove femur lesion/         0049      19.6046    $1,069.65  ...........      $213.93
                                                                    bursa.
27065................  T....................  ...................  Removal of hip bone          0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lesion.
27066................  T....................  ...................  Removal of hip bone          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lesion.
27067................  T....................  ...................  Remove/graft hip             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    bone 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      24.8651    $1,356.66  ...........      $271.33
27086................  T....................  ...................  Remove hip foreign           0020       7.0842      $386.52      $113.25       $77.30
                                                                    body.
27087................  T....................  ...................  Remove hip foreign           0049      19.6046    $1,069.65  ...........      $213.93
                                                                    body.
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................  B....................  ...................  Inject sacroiliac     ...........  ...........  ...........  ...........  ...........
                                                                    joint.
27097................  T....................  ...................  Revision of hip              0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon.
27098................  T....................  ...................  Transfer tendon to           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    pelvis.
27100................  T....................  ...................  Transfer of                  0051      34.5144    $1,883.14  ...........      $376.63
                                                                    abdominal muscle.
27105................  T....................  ...................  Transfer of spinal           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    muscle.
27110................  T....................  ...................  Transfer of                  0051      34.5144    $1,883.14  ...........      $376.63
                                                                    iliopsoas muscle.
27111................  T....................  ...................  Transfer of                  0051      34.5144    $1,883.14  ...........      $376.63
                                                                    iliopsoas 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  ...........  ...........  ...........  ...........  ...........

[[Page 63511]]

 
27147................  C....................  ...................  Revision of hip bone  ...........  ...........  ...........  ...........  ...........
27151................  C....................  ...................  Incision of hip       ...........  ...........  ...........  ...........  ...........
                                                                    bones.
27156................  C....................  ...................  Revision of hip       ...........  ...........  ...........  ...........  ...........
                                                                    bones.
27158................  C....................  ...................  Revision of pelvis..  ...........  ...........  ...........  ...........  ...........
27161................  C....................  ...................  Incision of neck of   ...........  ...........  ...........  ...........  ...........
                                                                    femur.
27165................  C....................  ...................  Incision/fixation of  ...........  ...........  ...........  ...........  ...........
                                                                    femur.
27170................  C....................  ...................  Repair/graft femur    ...........  ...........  ...........  ...........  ...........
                                                                    head/neck.
27175................  C....................  ...................  Treat slipped         ...........  ...........  ...........  ...........  ...........
                                                                    epiphysis.
27176................  C....................  ...................  Treat slipped         ...........  ...........  ...........  ...........  ...........
                                                                    epiphysis.
27177................  C....................  ...................  Treat slipped         ...........  ...........  ...........  ...........  ...........
                                                                    epiphysis.
27178................  C....................  ...................  Treat slipped         ...........  ...........  ...........  ...........  ...........
                                                                    epiphysis.
27179................  C....................  ...................  Revise head/neck of   ...........  ...........  ...........  ...........  ...........
                                                                    femur.
27181................  C....................  ...................  Treat slipped         ...........  ...........  ...........  ...........  ...........
                                                                    epiphysis.
27185................  C....................  ...................  Revision of femur     ...........  ...........  ...........  ...........  ...........
                                                                    epiphysis.
27187................  C....................  ...................  Reinforce hip bones.  ...........  ...........  ...........  ...........  ...........
27193................  T....................  ...................  Treat pelvic ring            0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27194................  T....................  ...................  Treat pelvic ring            0045      13.5889      $741.42      $268.47      $148.28
                                                                    fracture.
27200................  T....................  ...................  Treat tail bone              0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27202................  T....................  ...................  Treat tail bone              0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27215................  C....................  ...................  Treat pelvic          ...........  ...........  ...........  ...........  ...........
                                                                    fracture(s).
27216................  T....................  ...................  Treat pelvic ring            0050      24.8651    $1,356.66  ...........      $271.33
                                                                    fracture.
27217................  C....................  ...................  Treat pelvic ring     ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
27218................  C....................  ...................  Treat pelvic ring     ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
27220................  T....................  ...................  Treat hip socket             0043       1.9074      $104.07  ...........       $20.81
                                                                    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       1.9074      $104.07  ...........       $20.81
27232................  C....................  ...................  Treat thigh fracture  ...........  ...........  ...........  ...........  ...........
27235................  T....................  ...................  Treat thigh fracture         0050      24.8651    $1,356.66  ...........      $271.33
27236................  C....................  ...................  Treat thigh fracture  ...........  ...........  ...........  ...........  ...........
27238................  T....................  ...................  Treat thigh fracture         0043       1.9074      $104.07  ...........       $20.81
27240................  C....................  ...................  Treat thigh fracture  ...........  ...........  ...........  ...........  ...........
27244................  C....................  ...................  Treat thigh fracture  ...........  ...........  ...........  ...........  ...........
27245................  C....................  ...................  Treat thigh fracture  ...........  ...........  ...........  ...........  ...........
27246................  T....................  ...................  Treat thigh fracture         0043       1.9074      $104.07  ...........       $20.81
27248................  C....................  ...................  Treat thigh fracture  ...........  ...........  ...........  ...........  ...........
27250................  T....................  ...................  Treat hip                    0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
27252................  T....................  ...................  Treat hip                    0045      13.5889      $741.42      $268.47      $148.28
                                                                    dislocation.
27253................  C....................  ...................  Treat hip             ...........  ...........  ...........  ...........  ...........
                                                                    dislocation.
27254................  C....................  ...................  Treat hip             ...........  ...........  ...........  ...........  ...........
                                                                    dislocation.
27256................  T....................  ...................  Treat hip                    0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
27257................  T....................  ...................  Treat hip                    0045      13.5889      $741.42      $268.47      $148.28
                                                                    dislocation.
27258................  C....................  ...................  Treat hip             ...........  ...........  ...........  ...........  ...........
                                                                    dislocation.
27259................  C....................  ...................  Treat hip             ...........  ...........  ...........  ...........  ...........
                                                                    dislocation.
27265................  T....................  ...................  Treat hip                    0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
27266................  T....................  ...................  Treat hip                    0045      13.5889      $741.42      $268.47      $148.28
                                                                    dislocation.
27275................  T....................  ...................  Manipulation of hip          0045      13.5889      $741.42      $268.47      $148.28
                                                                    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       1.9074      $104.07  ...........       $20.81
                                                                    surgery.
27301................  T....................  ...................  Drain thigh/knee             0008      19.4831    $1,063.02  ...........      $212.60
                                                                    lesion.
27303................  C....................  ...................  Drainage of bone      ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
27305................  T....................  ...................  Incise thigh tendon          0049      19.6046    $1,069.65  ...........      $213.93
                                                                    & fascia.
27306................  T....................  ...................  Incision of thigh            0049      19.6046    $1,069.65  ...........      $213.93
                                                                    tendon.
27307................  T....................  ...................  Incision of thigh            0049      19.6046    $1,069.65  ...........      $213.93
                                                                    tendons.
27310................  T....................  ...................  Exploration of knee          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    joint.
27315................  T....................  ...................  Partial removal,             0220      16.5554      $903.28  ...........      $180.66
                                                                    thigh nerve.
27320................  T....................  ...................  Partial removal,             0220      16.5554      $903.28  ...........      $180.66
                                                                    thigh nerve.
27323................  T....................  ...................  Biopsy, thigh soft           0021      14.3594      $783.46      $219.48      $156.69
                                                                    tissues.
27324................  T....................  ...................  Biopsy, thigh soft           0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    tissues.
27327................  T....................  ...................  Removal of thigh             0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
27328................  T....................  ...................  Removal of thigh             0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
27329................  T....................  ...................  Remove tumor, thigh/         0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    knee.
27330................  T....................  ...................  Biopsy, knee joint           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lining.
27331................  T....................  ...................  Explore/treat knee           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    joint.
27332................  T....................  ...................  Removal of knee              0050      24.8651    $1,356.66  ...........      $271.33
                                                                    cartilage.
27333................  T....................  ...................  Removal of knee              0050      24.8651    $1,356.66  ...........      $271.33
                                                                    cartilage.
27334................  T....................  ...................  Remove knee joint            0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lining.
27335................  T....................  ...................  Remove knee joint            0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lining.

[[Page 63512]]

 
27340................  T....................  ...................  Removal of kneecap           0049      19.6046    $1,069.65  ...........      $213.93
                                                                    bursa.
27345................  T....................  ...................  Removal of knee cyst         0049      19.6046    $1,069.65  ...........      $213.93
27347................  T....................  ...................  Remove knee cyst....         0049      19.6046    $1,069.65  ...........      $213.93
27350................  T....................  ...................  Removal of kneecap..         0050      24.8651    $1,356.66  ...........      $271.33
27355................  T....................  ...................  Remove femur lesion.         0050      24.8651    $1,356.66  ...........      $271.33
27356................  T....................  ...................  Remove femur lesion/         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    graft.
27357................  T....................  ...................  Remove femur lesion/         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    graft.
27358................  T....................  ...................  Remove femur lesion/         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    fixation.
27360................  T....................  ...................  Partial removal, leg         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    bone(s).
27365................  C....................  ...................  Extensive leg         ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
27370................  N....................  ...................  Injection for knee x- ...........  ...........  ...........  ...........  ...........
                                                                    ray.
27372................  T....................  ...................  Removal of foreign           0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    body.
27380................  T....................  ...................  Repair of kneecap            0049      19.6046    $1,069.65  ...........      $213.93
                                                                    tendon.
27381................  T....................  ...................  Repair/graft kneecap         0049      19.6046    $1,069.65  ...........      $213.93
                                                                    tendon.
27385................  T....................  ...................  Repair of thigh              0049      19.6046    $1,069.65  ...........      $213.93
                                                                    muscle.
27386................  T....................  ...................  Repair/graft of              0049      19.6046    $1,069.65  ...........      $213.93
                                                                    thigh muscle.
27390................  T....................  ...................  Incision of thigh            0049      19.6046    $1,069.65  ...........      $213.93
                                                                    tendon.
27391................  T....................  ...................  Incision of thigh            0049      19.6046    $1,069.65  ...........      $213.93
                                                                    tendons.
27392................  T....................  ...................  Incision of thigh            0049      19.6046    $1,069.65  ...........      $213.93
                                                                    tendons.
27393................  T....................  ...................  Lengthening of thigh         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon.
27394................  T....................  ...................  Lengthening of thigh         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendons.
27395................  T....................  ...................  Lengthening of thigh         0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tendons.
27396................  T....................  ...................  Transplant of thigh          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon.
27397................  T....................  ...................  Transplants of thigh         0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tendons.
27400................  T....................  ...................  Revise thigh muscles/        0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tendons.
27403................  T....................  ...................  Repair of knee               0050      24.8651    $1,356.66  ...........      $271.33
                                                                    cartilage.
27405................  T....................  ...................  Repair of knee               0051      34.5144    $1,883.14  ...........      $376.63
                                                                    ligament.
27407................  T....................  ...................  Repair of knee               0051      34.5144    $1,883.14  ...........      $376.63
                                                                    ligament.
27409................  T....................  ...................  Repair of knee               0051      34.5144    $1,883.14  ...........      $376.63
                                                                    ligaments.
27418................  T....................  ...................  Repair degenerated           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    kneecap.
27420................  T....................  ...................  Revision of unstable         0051      34.5144    $1,883.14  ...........      $376.63
                                                                    kneecap.
27422................  T....................  ...................  Revision of unstable         0051      34.5144    $1,883.14  ...........      $376.63
                                                                    kneecap.
27424................  T....................  ...................  Revision/removal of          0051      34.5144    $1,883.14  ...........      $376.63
                                                                    kneecap.
27425................  T....................  ...................  Lateral retinacular          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    release.
27427................  T....................  ...................  Reconstruction, knee         0052      42.7126    $2,330.44  ...........      $466.09
27428................  T....................  ...................  Reconstruction, knee         0052      42.7126    $2,330.44  ...........      $466.09
27429................  T....................  ...................  Reconstruction, knee         0052      42.7126    $2,330.44  ...........      $466.09
27430................  T....................  ...................  Revision of thigh            0051      34.5144    $1,883.14  ...........      $376.63
                                                                    muscles.
27435................  T....................  ...................  Incision of knee             0051      34.5144    $1,883.14  ...........      $376.63
                                                                    joint.
27437................  T....................  ...................  Revise kneecap......         0047      29.9582    $1,634.55      $537.03      $326.91
27438................  T....................  ...................  Revise kneecap with          0048      51.4609    $2,807.76      $695.60      $561.55
                                                                    implant.
27440................  T....................  ...................  Revision of knee             0047      29.9582    $1,634.55      $537.03      $326.91
                                                                    joint.
27441................  T....................  ...................  Revision of knee             0047      29.9582    $1,634.55      $537.03      $326.91
                                                                    joint.
27442................  T....................  ...................  Revision of knee             0047      29.9582    $1,634.55      $537.03      $326.91
                                                                    joint.
27443................  T....................  ...................  Revision of knee             0047      29.9582    $1,634.55      $537.03      $326.91
                                                                    joint.
27445................  C....................  ...................  Revision of knee      ...........  ...........  ...........  ...........  ...........
                                                                    joint.
27446................  T....................  ...................  Revision of knee             0681      98.1613    $5,355.78    $2,131.36    $1,071.16
                                                                    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.....  ...........  ...........  ...........  ...........  ...........
27496................  T....................  ...................  Decompression of             0049      19.6046    $1,069.65  ...........      $213.93
                                                                    thigh/knee.
27497................  T....................  ...................  Decompression of             0049      19.6046    $1,069.65  ...........      $213.93
                                                                    thigh/knee.
27498................  T....................  ...................  Decompression of             0049      19.6046    $1,069.65  ...........      $213.93
                                                                    thigh/knee.
27499................  T....................  ...................  Decompression of             0049      19.6046    $1,069.65  ...........      $213.93
                                                                    thigh/knee.
27500................  T....................  ...................  Treatment of thigh           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27501................  T....................  ...................  Treatment of thigh           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27502................  T....................  ...................  Treatment of thigh           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27503................  T....................  ...................  Treatment of thigh           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27506................  C....................  ...................  Treatment of thigh    ...........  ...........  ...........  ...........  ...........
                                                                    fracture.

[[Page 63513]]

 
27507................  C....................  ...................  Treatment of thigh    ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
27508................  T....................  ...................  Treatment of thigh           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27509................  T....................  ...................  Treatment of thigh           0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27510................  T....................  ...................  Treatment of thigh           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27511................  C....................  ...................  Treatment of thigh    ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
27513................  C....................  ...................  Treatment of thigh    ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
27514................  C....................  ...................  Treatment of thigh    ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
27516................  T....................  ...................  Treat thigh fx               0043       1.9074      $104.07  ...........       $20.81
                                                                    growth plate.
27517................  T....................  ...................  Treat thigh fx               0043       1.9074      $104.07  ...........       $20.81
                                                                    growth plate.
27519................  C....................  ...................  Treat thigh fx        ...........  ...........  ...........  ...........  ...........
                                                                    growth plate.
27520................  T....................  ...................  Treat kneecap                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27524................  T....................  ...................  Treat kneecap                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27530................  T....................  ...................  Treat knee fracture.         0043       1.9074      $104.07  ...........       $20.81
27532................  T....................  ...................  Treat knee fracture.         0043       1.9074      $104.07  ...........       $20.81
27535................  C....................  ...................  Treat knee fracture.  ...........  ...........  ...........  ...........  ...........
27536................  C....................  ...................  Treat knee fracture.  ...........  ...........  ...........  ...........  ...........
27538................  T....................  ...................  Treat knee                   0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture(s).
27540................  C....................  ...................  Treat knee fracture.  ...........  ...........  ...........  ...........  ...........
27550................  T....................  ...................  Treat knee                   0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
27552................  T....................  ...................  Treat knee                   0045      13.5889      $741.42      $268.47      $148.28
                                                                    dislocation.
27556................  C....................  ...................  Treat knee            ...........  ...........  ...........  ...........  ...........
                                                                    dislocation.
27557................  C....................  ...................  Treat knee            ...........  ...........  ...........  ...........  ...........
                                                                    dislocation.
27558................  C....................  ...................  Treat knee            ...........  ...........  ...........  ...........  ...........
                                                                    dislocation.
27560................  T....................  ...................  Treat kneecap                0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
27562................  T....................  ...................  Treat kneecap                0045      13.5889      $741.42      $268.47      $148.28
                                                                    dislocation.
27566................  T....................  ...................  Treat kneecap                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
27570................  T....................  ...................  Fixation of knee             0045      13.5889      $741.42      $268.47      $148.28
                                                                    joint.
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      19.6046    $1,069.65  ...........      $213.93
                                                                    surgery.
27596................  C....................  ...................  Amputation follow-up  ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
27598................  C....................  ...................  Amputate lower leg    ...........  ...........  ...........  ...........  ...........
                                                                    at knee.
27599................  T....................  ...................  Leg surgery                  0043       1.9074      $104.07  ...........       $20.81
                                                                    procedure.
27600................  T....................  ...................  Decompression of             0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lower leg.
27601................  T....................  ...................  Decompression of             0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lower leg.
27602................  T....................  ...................  Decompression of             0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lower leg.
27603................  T....................  ...................  Drain lower leg              0007      11.8633      $647.27  ...........      $129.45
                                                                    lesion.
27604................  T....................  ...................  Drain lower leg              0049      19.6046    $1,069.65  ...........      $213.93
                                                                    bursa.
27605................  T....................  ...................  Incision of achilles         0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    tendon.
27606................  T....................  ...................  Incision of achilles         0049      19.6046    $1,069.65  ...........      $213.93
                                                                    tendon.
27607................  T....................  ...................  Treat lower leg bone         0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lesion.
27610................  T....................  ...................  Explore/treat ankle          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    joint.
27612................  T....................  ...................  Exploration of ankle         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    joint.
27613................  T....................  ...................  Biopsy lower leg             0020       7.0842      $386.52      $113.25       $77.30
                                                                    soft tissue.
27614................  T....................  ...................  Biopsy lower leg             0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    soft tissue.
27615................  T....................  ...................  Remove tumor, lower          0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    leg.
27618................  T....................  ...................  Remove lower leg             0021      14.3594      $783.46      $219.48      $156.69
                                                                    lesion.
27619................  T....................  ...................  Remove lower leg             0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    lesion.
27620................  T....................  ...................  Explore/treat ankle          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    joint.
27625................  T....................  ...................  Remove ankle joint           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lining.
27626................  T....................  ...................  Remove ankle joint           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    lining.
27630................  T....................  ...................  Removal of tendon            0049      19.6046    $1,069.65  ...........      $213.93
                                                                    lesion.
27635................  T....................  ...................  Remove lower leg             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    bone lesion.
27637................  T....................  ...................  Remove/graft leg             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    bone lesion.
27638................  T....................  ...................  Remove/graft leg             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    bone lesion.
27640................  T....................  ...................  Partial removal of           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tibia.
27641................  T....................  ...................  Partial removal of           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    fibula.
27645................  C....................  ...................  Extensive lower leg   ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
27646................  C....................  ...................  Extensive lower leg   ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
27647................  T....................  ...................  Extensive ankle/heel         0051      34.5144    $1,883.14  ...........      $376.63
                                                                    surgery.
27648................  N....................  ...................  Injection for ankle   ...........  ...........  ...........  ...........  ...........
                                                                    x-ray.
27650................  T....................  ...................  Repair achilles              0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tendon.
27652................  T....................  ...................  Repair/graft                 0051      34.5144    $1,883.14  ...........      $376.63
                                                                    achilles tendon.
27654................  T....................  ...................  Repair of achilles           0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tendon.
27656................  T....................  ...................  Repair leg fascia            0049      19.6046    $1,069.65  ...........      $213.93
                                                                    defect.
27658................  T....................  ...................  Repair of leg                0049      19.6046    $1,069.65  ...........      $213.93
                                                                    tendon, each.
27659................  T....................  ...................  Repair of leg                0049      19.6046    $1,069.65  ...........      $213.93
                                                                    tendon, each.
27664................  T....................  ...................  Repair of leg                0049      19.6046    $1,069.65  ...........      $213.93
                                                                    tendon, each.
27665................  T....................  ...................  Repair of leg                0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon, each.
27675................  T....................  ...................  Repair lower leg             0049      19.6046    $1,069.65  ...........      $213.93
                                                                    tendons.
27676................  T....................  ...................  Repair lower leg             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendons.
27680................  T....................  ...................  Release of lower leg         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon.
27681................  T....................  ...................  Release of lower leg         0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendons.

[[Page 63514]]

 
27685................  T....................  ...................  Revision of lower            0050      24.8651    $1,356.66  ...........      $271.33
                                                                    leg tendon.
27686................  T....................  ...................  Revise lower leg             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendons.
27687................  T....................  ...................  Revision of calf             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    tendon.
27690................  T....................  ...................  Revise lower leg             0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tendon.
27691................  T....................  ...................  Revise lower leg             0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tendon.
27692................  T....................  ...................  Revise additional            0051      34.5144    $1,883.14  ...........      $376.63
                                                                    leg tendon.
27695................  T....................  ...................  Repair of ankle              0050      24.8651    $1,356.66  ...........      $271.33
                                                                    ligament.
27696................  T....................  ...................  Repair of ankle              0050      24.8651    $1,356.66  ...........      $271.33
                                                                    ligaments.
27698................  T....................  ...................  Repair of ankle              0050      24.8651    $1,356.66  ...........      $271.33
                                                                    ligament.
27700................  T....................  ...................  Revision of ankle            0047      29.9582    $1,634.55      $537.03      $326.91
                                                                    joint.
27702................  C....................  ...................  Reconstruct ankle     ...........  ...........  ...........  ...........  ...........
                                                                    joint.
27703................  C....................  ...................  Reconstruction,       ...........  ...........  ...........  ...........  ...........
                                                                    ankle joint.
27704................  T....................  ...................  Removal of ankle             0049      19.6046    $1,069.65  ...........      $213.93
                                                                    implant.
27705................  T....................  ...................  Incision of tibia...         0051      34.5144    $1,883.14  ...........      $376.63
27707................  T....................  ...................  Incision of fibula..         0049      19.6046    $1,069.65  ...........      $213.93
27709................  T....................  ...................  Incision of tibia &          0050      24.8651    $1,356.66  ...........      $271.33
                                                                    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      24.8651    $1,356.66  ...........      $271.33
                                                                    epiphysis.
27732................  T....................  ...................  Repair of fibula             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    epiphysis.
27734................  T....................  ...................  Repair lower leg             0050      24.8651    $1,356.66  ...........      $271.33
                                                                    epiphyses.
27740................  T....................  ...................  Repair of leg                0050      24.8651    $1,356.66  ...........      $271.33
                                                                    epiphyses.
27742................  T....................  ...................  Repair of leg                0051      34.5144    $1,883.14  ...........      $376.63
                                                                    epiphyses.
27745................  T....................  ...................  Reinforce tibia.....         0051      34.5144    $1,883.14  ...........      $376.63
27750................  T....................  ...................  Treatment of tibia           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27752................  T....................  ...................  Treatment of tibia           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27756................  T....................  ...................  Treatment of tibia           0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27758................  T....................  ...................  Treatment of tibia           0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27759................  T....................  ...................  Treatment of tibia           0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27760................  T....................  ...................  Treatment of ankle           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27762................  T....................  ...................  Treatment of ankle           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27766................  T....................  ...................  Treatment of ankle           0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27780................  T....................  ...................  Treatment of fibula          0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27781................  T....................  ...................  Treatment of fibula          0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27784................  T....................  ...................  Treatment of fibula          0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27786................  T....................  ...................  Treatment of ankle           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27788................  T....................  ...................  Treatment of ankle           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27792................  T....................  ...................  Treatment of ankle           0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27808................  T....................  ...................  Treatment of ankle           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27810................  T....................  ...................  Treatment of ankle           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27814................  T....................  ...................  Treatment of ankle           0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27816................  T....................  ...................  Treatment of ankle           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27818................  T....................  ...................  Treatment of ankle           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27822................  T....................  ...................  Treatment of ankle           0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27823................  T....................  ...................  Treatment of ankle           0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27824................  T....................  ...................  Treat lower leg              0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27825................  T....................  ...................  Treat lower leg              0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
27826................  T....................  ...................  Treat lower leg              0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27827................  T....................  ...................  Treat lower leg              0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27828................  T....................  ...................  Treat lower leg              0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
27829................  T....................  ...................  Treat lower leg              0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    joint.
27830................  T....................  ...................  Treat lower leg              0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
27831................  T....................  ...................  Treat lower leg              0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
27832................  T....................  ...................  Treat lower leg              0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
27840................  T....................  ...................  Treat ankle                  0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
27842................  T....................  ...................  Treat ankle                  0045      13.5889      $741.42      $268.47      $148.28
                                                                    dislocation.
27846................  T....................  ...................  Treat ankle                  0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
27848................  T....................  ...................  Treat ankle                  0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
27860................  T....................  ...................  Fixation of ankle            0045      13.5889      $741.42      $268.47      $148.28
                                                                    joint.
27870................  T....................  ...................  Fusion of ankle              0051      34.5144    $1,883.14  ...........      $376.63
                                                                    joint.
27871................  T....................  ...................  Fusion of                    0051      34.5144    $1,883.14  ...........      $376.63
                                                                    tibiofibular 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      19.6046    $1,069.65  ...........      $213.93
                                                                    surgery.
27886................  C....................  ...................  Amputation follow-up  ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
27888................  C....................  ...................  Amputation of foot    ...........  ...........  ...........  ...........  ...........
                                                                    at ankle.
27889................  T....................  ...................  Amputation of foot           0050      24.8651    $1,356.66  ...........      $271.33
                                                                    at ankle.
27892................  T....................  ...................  Decompression of leg         0049      19.6046    $1,069.65  ...........      $213.93
27893................  T....................  ...................  Decompression of leg         0049      19.6046    $1,069.65  ...........      $213.93

[[Page 63515]]

 
27894................  T....................  ...................  Decompression of leg         0049      19.6046    $1,069.65  ...........      $213.93
27899................  T....................  ...................  Leg/ankle surgery            0043       1.9074      $104.07  ...........       $20.81
                                                                    procedure.
28001................  T....................  ...................  Drainage of bursa of         0007      11.8633      $647.27  ...........      $129.45
                                                                    foot.
28002................  T....................  ...................  Treatment of foot            0049      19.6046    $1,069.65  ...........      $213.93
                                                                    infection.
28003................  T....................  ...................  Treatment of foot            0049      19.6046    $1,069.65  ...........      $213.93
                                                                    infection.
28005................  T....................  ...................  Treat foot bone              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    lesion.
28008................  T....................  ...................  Incision of foot             0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    fascia.
28010................  T....................  ...................  Incision of toe              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    tendon.
28011................  T....................  ...................  Incision of toe              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    tendons.
28020................  T....................  ...................  Exploration of foot          0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    joint.
28022................  T....................  ...................  Exploration of foot          0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    joint.
28024................  T....................  ...................  Exploration of toe           0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    joint.
28030................  T....................  ...................  Removal of foot              0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
28035................  T....................  ...................  Decompression of             0220      16.5554      $903.28  ...........      $180.66
                                                                    tibia nerve.
28043................  T....................  ...................  Excision of foot             0021      14.3594      $783.46      $219.48      $156.69
                                                                    lesion.
28045................  T....................  ...................  Excision of foot             0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    lesion.
28046................  T....................  ...................  Resection of tumor,          0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    foot.
28050................  T....................  ...................  Biopsy of foot joint         0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    lining.
28052................  T....................  ...................  Biopsy of foot joint         0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    lining.
28054................  T....................  ...................  Biopsy of toe joint          0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    lining.
28060................  T....................  ...................  Partial removal,             0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    foot fascia.
28062................  T....................  ...................  Removal of foot              0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    fascia.
28070................  T....................  ...................  Removal of foot              0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    joint lining.
28072................  T....................  ...................  Removal of foot              0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    joint lining.
28080................  T....................  ...................  Removal of foot              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    lesion.
28086................  T....................  ...................  Excise foot tendon           0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    sheath.
28088................  T....................  ...................  Excise foot tendon           0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    sheath.
28090................  T....................  ...................  Removal of foot              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    lesion.
28092................  T....................  ...................  Removal of toe               0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    lesions.
28100................  T....................  ...................  Removal of ankle/            0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    heel lesion.
28102................  T....................  ...................  Remove/graft foot            0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    lesion.
28103................  T....................  ...................  Remove/graft foot            0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    lesion.
28104................  T....................  ...................  Removal of foot              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    lesion.
28106................  T....................  ...................  Remove/graft foot            0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    lesion.
28107................  T....................  ...................  Remove/graft foot            0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    lesion.
28108................  T....................  ...................  Removal of toe               0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    lesions.
28110................  T....................  ...................  Part removal of              0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    metatarsal.
28111................  T....................  ...................  Part removal of              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    metatarsal.
28112................  T....................  ...................  Part removal of              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    metatarsal.
28113................  T....................  ...................  Part removal of              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    metatarsal.
28114................  T....................  ...................  Removal of                   0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    metatarsal heads.
28116................  T....................  ...................  Revision of foot....         0055      18.7205    $1,021.41      $355.34      $204.28
28118................  T....................  ...................  Removal of heel bone         0055      18.7205    $1,021.41      $355.34      $204.28
28119................  T....................  ...................  Removal of heel spur         0055      18.7205    $1,021.41      $355.34      $204.28
28120................  T....................  ...................  Part removal of              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    ankle/heel.
28122................  T....................  ...................  Partial removal of           0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    foot bone.
28124................  T....................  ...................  Partial removal of           0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    toe.
28126................  T....................  ...................  Partial removal of           0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    toe.
28130................  T....................  ...................  Removal of ankle             0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    bone.
28140................  T....................  ...................  Removal of                   0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    metatarsal.
28150................  T....................  ...................  Removal of toe......         0055      18.7205    $1,021.41      $355.34      $204.28
28153................  T....................  ...................  Partial removal of           0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    toe.
28160................  T....................  ...................  Partial removal of           0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    toe.
28171................  T....................  ...................  Extensive foot               0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    surgery.
28173................  T....................  ...................  Extensive foot               0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    surgery.
28175................  T....................  ...................  Extensive foot               0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    surgery.
28190................  T....................  ...................  Removal of foot              0019       3.9493      $215.48       $71.87       $43.10
                                                                    foreign body.
28192................  T....................  ...................  Removal of foot              0021      14.3594      $783.46      $219.48      $156.69
                                                                    foreign body.
28193................  T....................  ...................  Removal of foot              0020       7.0842      $386.52      $113.25       $77.30
                                                                    foreign body.
28200................  T....................  ...................  Repair of foot               0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    tendon.
28202................  T....................  ...................  Repair/graft of foot         0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    tendon.
28208................  T....................  ...................  Repair of foot               0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    tendon.
28210................  T....................  ...................  Repair/graft of foot         0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    tendon.
28220................  T....................  ...................  Release of foot              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    tendon.
28222................  T....................  ...................  Release of foot              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    tendons.
28225................  T....................  ...................  Release of foot              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    tendon.
28226................  T....................  ...................  Release of foot              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    tendons.
28230................  T....................  ...................  Incision of foot             0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    tendon(s).
28232................  T....................  ...................  Incision of toe              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    tendon.
28234................  T....................  ...................  Incision of foot             0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    tendon.
28238................  T....................  ...................  Revision of foot             0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    tendon.
28240................  T....................  ...................  Release of big toe..         0055      18.7205    $1,021.41      $355.34      $204.28
28250................  T....................  ...................  Revision of foot             0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    fascia.
28260................  T....................  ...................  Release of midfoot           0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    joint.
28261................  T....................  ...................  Revision of foot             0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    tendon.

[[Page 63516]]

 
28262................  T....................  ...................  Revision of foot and         0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    ankle.
28264................  T....................  ...................  Release of midfoot           0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    joint.
28270................  T....................  ...................  Release of foot              0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    contracture.
28272................  T....................  ...................  Release of toe               0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    joint, each.
28280................  T....................  ...................  Fusion of toes......         0055      18.7205    $1,021.41      $355.34      $204.28
28285................  T....................  ...................  Repair of hammertoe.         0055      18.7205    $1,021.41      $355.34      $204.28
28286................  T....................  ...................  Repair of hammertoe.         0055      18.7205    $1,021.41      $355.34      $204.28
28288................  T....................  ...................  Partial removal of           0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    foot bone.
28289................  T....................  ...................  Repair hallux                0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    rigidus.
28290................  T....................  ...................  Correction of bunion         0056      25.3930    $1,385.47      $405.81      $277.09
28292................  T....................  ...................  Correction of bunion         0057      25.5035    $1,391.50      $475.91      $278.30
28293................  T....................  ...................  Correction of bunion         0057      25.5035    $1,391.50      $475.91      $278.30
28294................  T....................  ...................  Correction of bunion         0056      25.3930    $1,385.47      $405.81      $277.09
28296................  T....................  ...................  Correction of bunion         0056      25.3930    $1,385.47      $405.81      $277.09
28297................  T....................  ...................  Correction of bunion         0057      25.5035    $1,391.50      $475.91      $278.30
28298................  T....................  ...................  Correction of bunion         0056      25.3930    $1,385.47      $405.81      $277.09
28299................  T....................  ...................  Correction of bunion         0057      25.5035    $1,391.50      $475.91      $278.30
28300................  T....................  ...................  Incision of heel             0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    bone.
28302................  T....................  ...................  Incision of ankle            0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    bone.
28304................  T....................  ...................  Incision of midfoot          0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    bones.
28305................  T....................  ...................  Incise/graft midfoot         0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    bones.
28306................  T....................  ...................  Incision of                  0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    metatarsal.
28307................  T....................  ...................  Incision of                  0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    metatarsal.
28308................  T....................  ...................  Incision of                  0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    metatarsal.
28309................  T....................  ...................  Incision of                  0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    metatarsals.
28310................  T....................  ...................  Revision of big toe.         0055      18.7205    $1,021.41      $355.34      $204.28
28312................  T....................  ...................  Revision of toe.....         0055      18.7205    $1,021.41      $355.34      $204.28
28313................  T....................  ...................  Repair deformity of          0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    toe.
28315................  T....................  ...................  Removal of sesamoid          0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    bone.
28320................  T....................  ...................  Repair of foot bones         0056      25.3930    $1,385.47      $405.81      $277.09
28322................  T....................  ...................  Repair of                    0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    metatarsals.
28340................  T....................  ...................  Resect enlarged toe          0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    tissue.
28341................  T....................  ...................  Resect enlarged toe.         0055      18.7205    $1,021.41      $355.34      $204.28
28344................  T....................  ...................  Repair extra toe(s).         0056      25.3930    $1,385.47      $405.81      $277.09
28345................  T....................  ...................  Repair webbed toe(s)         0056      25.3930    $1,385.47      $405.81      $277.09
28360................  T....................  ...................  Reconstruct cleft            0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    foot.
28400................  T....................  ...................  Treatment of heel            0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
28405................  T....................  ...................  Treatment of heel            0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
28406................  T....................  ...................  Treatment of heel            0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
28415................  T....................  ...................  Treat heel fracture.         0046      32.5581    $1,776.40      $535.76      $355.28
28420................  T....................  ...................  Treat/graft heel             0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
28430................  T....................  ...................  Treatment of ankle           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
28435................  T....................  ...................  Treatment of ankle           0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
28436................  T....................  ...................  Treatment of ankle           0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
28445................  T....................  ...................  Treat ankle fracture         0046      32.5581    $1,776.40      $535.76      $355.28
28450................  T....................  ...................  Treat midfoot                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture, each.
28455................  T....................  ...................  Treat midfoot                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture, each.
28456................  T....................  ...................  Treat midfoot                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
28465................  T....................  ...................  Treat midfoot                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture, each.
28470................  T....................  ...................  Treat metatarsal             0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
28475................  T....................  ...................  Treat metatarsal             0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
28476................  T....................  ...................  Treat metatarsal             0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
28485................  T....................  ...................  Treat metatarsal             0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
28490................  T....................  ...................  Treat big toe                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
28495................  T....................  ...................  Treat big toe                0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
28496................  T....................  ...................  Treat big toe                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
28505................  T....................  ...................  Treat big toe                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
28510................  T....................  ...................  Treatment of toe             0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
28515................  T....................  ...................  Treatment of toe             0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
28525................  T....................  ...................  Treat toe fracture..         0046      32.5581    $1,776.40      $535.76      $355.28
28530................  T....................  ...................  Treat sesamoid bone          0043       1.9074      $104.07  ...........       $20.81
                                                                    fracture.
28531................  T....................  ...................  Treat sesamoid bone          0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    fracture.
28540................  T....................  ...................  Treat foot                   0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
28545................  T....................  ...................  Treat foot                   0045      13.5889      $741.42      $268.47      $148.28
                                                                    dislocation.
28546................  T....................  ...................  Treat foot                   0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
28555................  T....................  ...................  Repair foot                  0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
28570................  T....................  ...................  Treat foot                   0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
28575................  T....................  ...................  Treat foot                   0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
28576................  T....................  ...................  Treat foot                   0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
28585................  T....................  ...................  Repair foot                  0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
28600................  T....................  ...................  Treat foot                   0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
28605................  T....................  ...................  Treat foot                   0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
28606................  T....................  ...................  Treat foot                   0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
28615................  T....................  ...................  Repair foot                  0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
28630................  T....................  ...................  Treat toe                    0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.

[[Page 63517]]

 
28635................  T....................  ...................  Treat toe                    0045      13.5889      $741.42      $268.47      $148.28
                                                                    dislocation.
28636................  T....................  ...................  Treat toe                    0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
28645................  T....................  ...................  Repair toe                   0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
28660................  T....................  ...................  Treat toe                    0043       1.9074      $104.07  ...........       $20.81
                                                                    dislocation.
28665................  T....................  ...................  Treat toe                    0045      13.5889      $741.42      $268.47      $148.28
                                                                    dislocation.
28666................  T....................  ...................  Treat toe                    0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
28675................  T....................  ...................  Repair of toe                0046      32.5581    $1,776.40      $535.76      $355.28
                                                                    dislocation.
28705................  T....................  ...................  Fusion of foot bones         0056      25.3930    $1,385.47      $405.81      $277.09
28715................  T....................  ...................  Fusion of foot bones         0056      25.3930    $1,385.47      $405.81      $277.09
28725................  T....................  ...................  Fusion of foot bones         0056      25.3930    $1,385.47      $405.81      $277.09
28730................  T....................  ...................  Fusion of foot bones         0056      25.3930    $1,385.47      $405.81      $277.09
28735................  T....................  ...................  Fusion of foot bones         0056      25.3930    $1,385.47      $405.81      $277.09
28737................  T....................  ...................  Revision of foot             0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    bones.
28740................  T....................  ...................  Fusion of foot bones         0056      25.3930    $1,385.47      $405.81      $277.09
28750................  T....................  ...................  Fusion of big toe            0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    joint.
28755................  T....................  ...................  Fusion of big toe            0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    joint.
28760................  T....................  ...................  Fusion of big toe            0056      25.3930    $1,385.47      $405.81      $277.09
                                                                    joint.
28800................  C....................  ...................  Amputation of         ...........  ...........  ...........  ...........  ...........
                                                                    midfoot.
28805................  C....................  ...................  Amputation thru       ...........  ...........  ...........  ...........  ...........
                                                                    metatarsal.
28810................  T....................  ...................  Amputation toe &             0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    metatarsal.
28820................  T....................  ...................  Amputation of toe...         0055      18.7205    $1,021.41      $355.34      $204.28
28825................  T....................  ...................  Partial amputation           0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    of toe.
28899................  T....................  ...................  Foot/toes surgery            0043       1.9074      $104.07  ...........       $20.81
                                                                    procedure.
29000................  S....................  ...................  Application of body          0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29010................  S....................  ...................  Application of body          0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29015................  S....................  ...................  Application of body          0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29020................  S....................  ...................  Application of body          0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29025................  S....................  ...................  Application of body          0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29035................  S....................  ...................  Application of body          0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29040................  S....................  ...................  Application of body          0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29044................  S....................  ...................  Application of body          0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29046................  S....................  ...................  Application of body          0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29049................  S....................  ...................  Application of               0058       1.0931       $59.64  ...........       $11.93
                                                                    figure eight.
29055................  S....................  ...................  Application of               0058       1.0931       $59.64  ...........       $11.93
                                                                    shoulder cast.
29058................  S....................  ...................  Application of               0058       1.0931       $59.64  ...........       $11.93
                                                                    shoulder cast.
29065................  S....................  ...................  Application of long          0058       1.0931       $59.64  ...........       $11.93
                                                                    arm cast.
29075................  S....................  ...................  Application of               0058       1.0931       $59.64  ...........       $11.93
                                                                    forearm cast.
29085................  S....................  ...................  Apply hand/wrist             0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29086................  S....................  ...................  Apply finger cast...         0058       1.0931       $59.64  ...........       $11.93
29105................  S....................  ...................  Apply long arm               0058       1.0931       $59.64  ...........       $11.93
                                                                    splint.
29125................  S....................  ...................  Apply forearm splint         0058       1.0931       $59.64  ...........       $11.93
29126................  S....................  ...................  Apply forearm splint         0058       1.0931       $59.64  ...........       $11.93
29130................  S....................  ...................  Application of               0058       1.0931       $59.64  ...........       $11.93
                                                                    finger splint.
29131................  S....................  ...................  Application of               0058       1.0931       $59.64  ...........       $11.93
                                                                    finger splint.
29200................  S....................  ...................  Strapping of chest..         0058       1.0931       $59.64  ...........       $11.93
29220................  S....................  ...................  Strapping of low             0058       1.0931       $59.64  ...........       $11.93
                                                                    back.
29240................  S....................  ...................  Strapping of                 0058       1.0931       $59.64  ...........       $11.93
                                                                    shoulder.
29260................  S....................  ...................  Strapping of elbow           0058       1.0931       $59.64  ...........       $11.93
                                                                    or wrist.
29280................  S....................  ...................  Strapping of hand or         0058       1.0931       $59.64  ...........       $11.93
                                                                    finger.
29305................  S....................  ...................  Application of hip           0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29325................  S....................  ...................  Application of hip           0058       1.0931       $59.64  ...........       $11.93
                                                                    casts.
29345................  S....................  ...................  Application of long          0058       1.0931       $59.64  ...........       $11.93
                                                                    leg cast.
29355................  S....................  ...................  Application of long          0058       1.0931       $59.64  ...........       $11.93
                                                                    leg cast.
29358................  S....................  ...................  Apply long leg cast          0058       1.0931       $59.64  ...........       $11.93
                                                                    brace.
29365................  S....................  ...................  Application of long          0058       1.0931       $59.64  ...........       $11.93
                                                                    leg cast.
29405................  S....................  ...................  Apply short leg cast         0058       1.0931       $59.64  ...........       $11.93
29425................  S....................  ...................  Apply short leg cast         0058       1.0931       $59.64  ...........       $11.93
29435................  S....................  ...................  Apply short leg cast         0058       1.0931       $59.64  ...........       $11.93
29440................  S....................  ...................  Addition of walker           0058       1.0931       $59.64  ...........       $11.93
                                                                    to cast.
29445................  S....................  ...................  Apply rigid leg cast         0058       1.0931       $59.64  ...........       $11.93
29450................  S....................  ...................  Application of leg           0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29505................  S....................  ...................  Application, long            0058       1.0931       $59.64  ...........       $11.93
                                                                    leg splint.
29515................  S....................  ...................  Application lower            0058       1.0931       $59.64  ...........       $11.93
                                                                    leg splint.
29520................  S....................  ...................  Strapping of hip....         0058       1.0931       $59.64  ...........       $11.93
29530................  S....................  ...................  Strapping of knee...         0058       1.0931       $59.64  ...........       $11.93
29540................  S....................  ...................  Strapping of ankle..         0058       1.0931       $59.64  ...........       $11.93
29550................  S....................  ...................  Strapping of toes...         0058       1.0931       $59.64  ...........       $11.93
29580................  S....................  ...................  Application of paste         0058       1.0931       $59.64  ...........       $11.93
                                                                    boot.
29590................  S....................  ...................  Application of foot          0058       1.0931       $59.64  ...........       $11.93
                                                                    splint.
29700................  S....................  ...................  Removal/revision of          0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29705................  S....................  ...................  Removal/revision of          0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29710................  S....................  ...................  Removal/revision of          0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29715................  S....................  ...................  Removal/revision of          0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29720................  S....................  ...................  Repair of body cast.         0058       1.0931       $59.64  ...........       $11.93
29730................  S....................  ...................  Windowing of cast...         0058       1.0931       $59.64  ...........       $11.93

[[Page 63518]]

 
29740................  S....................  ...................  Wedging of cast.....         0058       1.0931       $59.64  ...........       $11.93
29750................  S....................  ...................  Wedging of clubfoot          0058       1.0931       $59.64  ...........       $11.93
                                                                    cast.
29799................  S....................  ...................  Casting/strapping            0058       1.0931       $59.64  ...........       $11.93
                                                                    procedure.
29800................  T....................  ...................  Jaw arthroscopy/             0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29804................  T....................  ...................  Jaw arthroscopy/             0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29805................  T....................  ...................  Shoulder                     0041      27.3819    $1,493.98  ...........      $298.80
                                                                    arthroscopy, dx.
29806................  T....................  ...................  Shoulder arthroscopy/        0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29807................  T....................  ...................  Shoulder arthroscopy/        0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29819................  T....................  ...................  Shoulder arthroscopy/        0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29820................  T....................  ...................  Shoulder arthroscopy/        0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29821................  T....................  ...................  Shoulder arthroscopy/        0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29822................  T....................  ...................  Shoulder arthroscopy/        0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29823................  T....................  ...................  Shoulder arthroscopy/        0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29824................  T....................  ...................  Shoulder arthroscopy/        0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29825................  T....................  ...................  Shoulder arthroscopy/        0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29826................  T....................  ...................  Shoulder arthroscopy/        0042      43.0808    $2,350.53      $804.74      $470.11
                                                                    surgery.
29827................  T....................  ...................  Arthroscop rotator           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    cuff repr.
29830................  T....................  ...................  Elbow arthroscopy...         0041      27.3819    $1,493.98  ...........      $298.80
29834................  T....................  ...................  Elbow arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29835................  T....................  ...................  Elbow arthroscopy/           0042      43.0808    $2,350.53      $804.74      $470.11
                                                                    surgery.
29836................  T....................  ...................  Elbow arthroscopy/           0042      43.0808    $2,350.53      $804.74      $470.11
                                                                    surgery.
29837................  T....................  ...................  Elbow arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29838................  T....................  ...................  Elbow arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29840................  T....................  ...................  Wrist arthroscopy...         0041      27.3819    $1,493.98  ...........      $298.80
29843................  T....................  ...................  Wrist arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29844................  T....................  ...................  Wrist arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29845................  T....................  ...................  Wrist arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29846................  T....................  ...................  Wrist arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29847................  T....................  ...................  Wrist arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29848................  T....................  ...................  Wrist endoscopy/             0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29850................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29851................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29855................  T....................  ...................  Tibial arthroscopy/          0042      43.0808    $2,350.53      $804.74      $470.11
                                                                    surgery.
29856................  T....................  ...................  Tibial arthroscopy/          0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29860................  T....................  ...................  Hip arthroscopy, dx.         0041      27.3819    $1,493.98  ...........      $298.80
29861................  T....................  ...................  Hip arthroscopy/             0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29862................  T....................  ...................  Hip arthroscopy/             0042      43.0808    $2,350.53      $804.74      $470.11
                                                                    surgery.
29863................  T....................  ...................  Hip arthroscopy/             0042      43.0808    $2,350.53      $804.74      $470.11
                                                                    surgery.
29870................  T....................  ...................  Knee arthroscopy, dx         0041      27.3819    $1,493.98  ...........      $298.80
29871................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    drainage.
29873................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29874................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29875................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29876................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29877................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29879................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29880................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29881................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29882................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29883................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29884................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29885................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29886................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29887................  T....................  ...................  Knee arthroscopy/            0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29888................  T....................  ...................  Knee arthroscopy/            0042      43.0808    $2,350.53      $804.74      $470.11
                                                                    surgery.
29889................  T....................  ...................  Knee arthroscopy/            0042      43.0808    $2,350.53      $804.74      $470.11
                                                                    surgery.
29891................  T....................  ...................  Ankle arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29892................  T....................  ...................  Ankle arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29893................  T....................  ...................  Scope, plantar               0055      18.7205    $1,021.41      $355.34      $204.28
                                                                    fasciotomy.
29894................  T....................  ...................  Ankle arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29895................  T....................  ...................  Ankle arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29897................  T....................  ...................  Ankle arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29898................  T....................  ...................  Ankle arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29899................  T....................  ...................  Ankle arthroscopy/           0041      27.3819    $1,493.98  ...........      $298.80
                                                                    surgery.
29900................  T....................  ...................  Mcp joint                    0053      14.8831      $812.04      $253.49      $162.41
                                                                    arthroscopy, dx.
29901................  T....................  ...................  Mcp joint                    0053      14.8831      $812.04      $253.49      $162.41
                                                                    arthroscopy, surg.
29902................  T....................  ...................  Mcp joint                    0053      14.8831      $812.04      $253.49      $162.41
                                                                    arthroscopy, surg.
29999................  T....................  ...................  Arthroscopy of joint         0041      27.3819    $1,493.98  ...........      $298.80
30000................  T....................  ...................  Drainage of nose             0251       1.7880       $97.56  ...........       $19.51
                                                                    lesion.
30020................  T....................  ...................  Drainage of nose             0251       1.7880       $97.56  ...........       $19.51
                                                                    lesion.
30100................  T....................  ...................  Intranasal biopsy...         0252       6.4469      $351.75      $113.41       $70.35
30110................  T....................  ...................  Removal of nose              0253      15.2249      $830.69      $282.29      $166.14
                                                                    polyp(s).
30115................  T....................  ...................  Removal of nose              0253      15.2249      $830.69      $282.29      $166.14
                                                                    polyp(s).
30117................  T....................  ...................  Removal of                   0253      15.2249      $830.69      $282.29      $166.14
                                                                    intranasal lesion.
30118................  T....................  ...................  Removal of                   0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    intranasal lesion.

[[Page 63519]]

 
30120................  T....................  ...................  Revision of nose....         0253      15.2249      $830.69      $282.29      $166.14
30124................  T....................  ...................  Removal of nose              0252       6.4469      $351.75      $113.41       $70.35
                                                                    lesion.
30125................  T....................  ...................  Removal of nose              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    lesion.
30130................  T....................  ...................  Removal of turbinate         0253      15.2249      $830.69      $282.29      $166.14
                                                                    bones.
30140................  T....................  ...................  Removal of turbinate         0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    bones.
30150................  T....................  ...................  Partial removal of           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    nose.
30160................  T....................  ...................  Removal of nose.....         0256      35.1548    $1,918.08  ...........      $383.62
30200................  T....................  ...................  Injection treatment          0253      15.2249      $830.69      $282.29      $166.14
                                                                    of nose.
30210................  T....................  ...................  Nasal sinus therapy.         0252       6.4469      $351.75      $113.41       $70.35
30220................  T....................  ...................  Insert nasal septal          0252       6.4469      $351.75      $113.41       $70.35
                                                                    button.
30300................  X....................  ...................  Remove nasal foreign         0340       0.6314       $34.45  ...........        $6.89
                                                                    body.
30310................  T....................  ...................  Remove nasal foreign         0253      15.2249      $830.69      $282.29      $166.14
                                                                    body.
30320................  T....................  ...................  Remove nasal foreign         0253      15.2249      $830.69      $282.29      $166.14
                                                                    body.
30400................  T....................  ...................  Reconstruction of            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    nose.
30410................  T....................  ...................  Reconstruction of            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    nose.
30420................  T....................  ...................  Reconstruction of            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    nose.
30430................  T....................  ...................  Revision of nose....         0254      21.8901    $1,194.35      $321.35      $238.87
30435................  T....................  ...................  Revision of nose....         0256      35.1548    $1,918.08  ...........      $383.62
30450................  T....................  ...................  Revision of nose....         0256      35.1548    $1,918.08  ...........      $383.62
30460................  T....................  ...................  Revision of nose....         0256      35.1548    $1,918.08  ...........      $383.62
30462................  T....................  ...................  Revision of nose....         0256      35.1548    $1,918.08  ...........      $383.62
30465................  T....................  ...................  Repair nasal                 0256      35.1548    $1,918.08  ...........      $383.62
                                                                    stenosis.
30520................  T....................  ...................  Repair of nasal              0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    septum.
30540................  T....................  ...................  Repair nasal defect.         0256      35.1548    $1,918.08  ...........      $383.62
30545................  T....................  ...................  Repair nasal defect.         0256      35.1548    $1,918.08  ...........      $383.62
30560................  T....................  ...................  Release of nasal             0251       1.7880       $97.56  ...........       $19.51
                                                                    adhesions.
30580................  T....................  ...................  Repair upper jaw             0256      35.1548    $1,918.08  ...........      $383.62
                                                                    fistula.
30600................  T....................  ...................  Repair mouth/nose            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    fistula.
30620................  T....................  ...................  Intranasal                   0256      35.1548    $1,918.08  ...........      $383.62
                                                                    reconstruction.
30630................  T....................  ...................  Repair nasal septum          0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    defect.
30801................  T....................  ...................  Cauterization, inner         0252       6.4469      $351.75      $113.41       $70.35
                                                                    nose.
30802................  T....................  ...................  Cauterization, inner         0253      15.2249      $830.69      $282.29      $166.14
                                                                    nose.
30901................  T....................  ...................  Control of nosebleed         0250       1.4697       $80.19       $28.07       $16.04
30903................  T....................  ...................  Control of nosebleed         0250       1.4697       $80.19       $28.07       $16.04
30905................  T....................  ...................  Control of nosebleed         0250       1.4697       $80.19       $28.07       $16.04
30906................  T....................  ...................  Repeat control of            0250       1.4697       $80.19       $28.07       $16.04
                                                                    nosebleed.
30915................  T....................  ...................  Ligation, nasal              0091      28.8326    $1,573.14      $348.23      $314.63
                                                                    sinus artery.
30920................  T....................  ...................  Ligation, upper jaw          0092      25.0959    $1,369.26      $505.37      $273.85
                                                                    artery.
30930................  T....................  ...................  Therapy, fracture of         0253      15.2249      $830.69      $282.29      $166.14
                                                                    nose.
30999................  T....................  ...................  Nasal surgery                0251       1.7880       $97.56  ...........       $19.51
                                                                    procedure.
31000................  T....................  ...................  Irrigation,                  0251       1.7880       $97.56  ...........       $19.51
                                                                    maxillary sinus.
31002................  T....................  ...................  Irrigation, sphenoid         0252       6.4469      $351.75      $113.41       $70.35
                                                                    sinus.
31020................  T....................  ...................  Exploration,                 0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    maxillary sinus.
31030................  T....................  ...................  Exploration,                 0256      35.1548    $1,918.08  ...........      $383.62
                                                                    maxillary sinus.
31032................  T....................  ...................  Explore sinus,               0256      35.1548    $1,918.08  ...........      $383.62
                                                                    remove polyps.
31040................  T....................  ...................  Exploration behind           0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    upper jaw.
31050................  T....................  ...................  Exploration,                 0256      35.1548    $1,918.08  ...........      $383.62
                                                                    sphenoid sinus.
31051................  T....................  ...................  Sphenoid sinus               0256      35.1548    $1,918.08  ...........      $383.62
                                                                    surgery.
31070................  T....................  ...................  Exploration of               0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    frontal sinus.
31075................  T....................  ...................  Exploration of               0256      35.1548    $1,918.08  ...........      $383.62
                                                                    frontal sinus.
31080................  T....................  ...................  Removal of frontal           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    sinus.
31081................  T....................  ...................  Removal of frontal           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    sinus.
31084................  T....................  ...................  Removal of frontal           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    sinus.
31085................  T....................  ...................  Removal of frontal           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    sinus.
31086................  T....................  ...................  Removal of frontal           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    sinus.
31087................  T....................  ...................  Removal of frontal           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    sinus.
31090................  T....................  ...................  Exploration of               0256      35.1548    $1,918.08  ...........      $383.62
                                                                    sinuses.
31200................  T....................  ...................  Removal of ethmoid           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    sinus.
31201................  T....................  ...................  Removal of ethmoid           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    sinus.
31205................  T....................  ...................  Removal of ethmoid           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    sinus.
31225................  C....................  ...................  Removal of upper jaw  ...........  ...........  ...........  ...........  ...........
31230................  C....................  ...................  Removal of upper jaw  ...........  ...........  ...........  ...........  ...........
31231................  T....................  ...................  Nasal endoscopy, dx.         0071       0.8799       $48.01       $12.89        $9.60
31233................  T....................  ...................  Nasal/sinus                  0072       1.7613       $96.10       $26.68       $19.22
                                                                    endoscopy, dx.
31235................  T....................  ...................  Nasal/sinus                  0074      13.9480      $761.02      $295.70      $152.20
                                                                    endoscopy, dx.
31237................  T....................  ...................  Nasal/sinus                  0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    endoscopy, surg.
31238................  T....................  ...................  Nasal/sinus                  0074      13.9480      $761.02      $295.70      $152.20
                                                                    endoscopy, surg.
31239................  T....................  ...................  Nasal/sinus                  0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    endoscopy, surg.
31240................  T....................  ...................  Nasal/sinus                  0074      13.9480      $761.02      $295.70      $152.20
                                                                    endoscopy, surg.
31254................  T....................  ...................  Revision of ethmoid          0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    sinus.
31255................  T....................  ...................  Removal of ethmoid           0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    sinus.
31256................  T....................  ...................  Exploration                  0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    maxillary sinus.
31267................  T....................  ...................  Endoscopy, maxillary         0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    sinus.
31276................  T....................  ...................  Sinus endoscopy,             0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    surgical.
31287................  T....................  ...................  Nasal/sinus                  0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    endoscopy, surg.

[[Page 63520]]

 
31288................  T....................  ...................  Nasal/sinus                  0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    endoscopy, 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                0252       6.4469      $351.75      $113.41       $70.35
                                                                    procedure.
31300................  T....................  ...................  Removal of larynx            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    lesion.
31320................  T....................  ...................  Diagnostic incision,         0256      35.1548    $1,918.08  ...........      $383.62
                                                                    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      35.1548    $1,918.08  ...........      $383.62
31420................  T....................  ...................  Removal of                   0256      35.1548    $1,918.08  ...........      $383.62
                                                                    epiglottis.
31500................  S....................  ...................  Insert emergency             0094       2.6345      $143.74       $48.58       $28.75
                                                                    airway.
31502................  T....................  ...................  Change of windpipe           0121       2.1189      $115.61       $43.80       $23.12
                                                                    airway.
31505................  T....................  ...................  Diagnostic                   0071       0.8799       $48.01       $12.89        $9.60
                                                                    laryngoscopy.
31510................  T....................  ...................  Laryngoscopy with            0074      13.9480      $761.02      $295.70      $152.20
                                                                    biopsy.
31511................  T....................  ...................  Remove foreign body,         0072       1.7613       $96.10       $26.68       $19.22
                                                                    larynx.
31512................  T....................  ...................  Removal of larynx            0074      13.9480      $761.02      $295.70      $152.20
                                                                    lesion.
31513................  T....................  ...................  Injection into vocal         0072       1.7613       $96.10       $26.68       $19.22
                                                                    cord.
31515................  T....................  ...................  Laryngoscopy for             0074      13.9480      $761.02      $295.70      $152.20
                                                                    aspiration.
31520................  T....................  ...................  Diagnostic                   0072       1.7613       $96.10       $26.68       $19.22
                                                                    laryngoscopy.
31525................  T....................  ...................  Diagnostic                   0074      13.9480      $761.02      $295.70      $152.20
                                                                    laryngoscopy.
31526................  T....................  ...................  Diagnostic                   0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    laryngoscopy.
31527................  T....................  ...................  Laryngoscopy for             0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    treatment.
31528................  T....................  ...................  Laryngoscopy and             0074      13.9480      $761.02      $295.70      $152.20
                                                                    dilation.
31529................  T....................  ...................  Laryngoscopy and             0074      13.9480      $761.02      $295.70      $152.20
                                                                    dilation.
31530................  T....................  ...................  Operative                    0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    laryngoscopy.
31531................  T....................  ...................  Operative                    0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    laryngoscopy.
31535................  T....................  ...................  Operative                    0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    laryngoscopy.
31536................  T....................  ...................  Operative                    0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    laryngoscopy.
31540................  T....................  ...................  Operative                    0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    laryngoscopy.
31541................  T....................  ...................  Operative                    0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    laryngoscopy.
31560................  T....................  ...................  Operative                    0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    laryngoscopy.
31561................  T....................  ...................  Operative                    0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    laryngoscopy.
31570................  T....................  ...................  Laryngoscopy with            0074      13.9480      $761.02      $295.70      $152.20
                                                                    injection.
31571................  T....................  ...................  Laryngoscopy with            0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    injection.
31575................  T....................  ...................  Diagnostic                   0072       1.7613       $96.10       $26.68       $19.22
                                                                    laryngoscopy.
31576................  T....................  ...................  Laryngoscopy with            0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    biopsy.
31577................  T....................  ...................  Remove foreign body,         0073       3.4541      $188.46       $73.38       $37.69
                                                                    larynx.
31578................  T....................  ...................  Removal of larynx            0075      20.3815    $1,112.04      $445.92      $222.41
                                                                    lesion.
31579................  T....................  ...................  Diagnostic                   0073       3.4541      $188.46       $73.38       $37.69
                                                                    laryngoscopy.
31580................  T....................  ...................  Revision of larynx..         0256      35.1548    $1,918.08  ...........      $383.62
31582................  T....................  ...................  Revision of larynx..         0256      35.1548    $1,918.08  ...........      $383.62
31584................  C....................  ...................  Treat larynx          ...........  ...........  ...........  ...........  ...........
                                                                    fracture.
31585................  T....................  ...................  Treat larynx                 0253      15.2249      $830.69      $282.29      $166.14
                                                                    fracture.
31586................  T....................  ...................  Treat larynx                 0256      35.1548    $1,918.08  ...........      $383.62
                                                                    fracture.
31587................  C....................  ...................  Revision of larynx..  ...........  ...........  ...........  ...........  ...........
31588................  T....................  ...................  Revision of larynx..         0256      35.1548    $1,918.08  ...........      $383.62
31590................  T....................  ...................  Reinnervate larynx..         0256      35.1548    $1,918.08  ...........      $383.62
31595................  T....................  ...................  Larynx nerve surgery         0256      35.1548    $1,918.08  ...........      $383.62
31599................  T....................  ...................  Larynx surgery               0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    procedure.
31600................  T....................  ...................  Incision of windpipe         0254      21.8901    $1,194.35      $321.35      $238.87
31601................  T....................  ...................  Incision of windpipe         0254      21.8901    $1,194.35      $321.35      $238.87
31603................  T....................  ...................  Incision of windpipe         0252       6.4469      $351.75      $113.41       $70.35
31605................  T....................  ...................  Incision of windpipe         0253      15.2249      $830.69      $282.29      $166.14
31610................  T....................  ...................  Incision of windpipe         0254      21.8901    $1,194.35      $321.35      $238.87
31611................  T....................  ...................  Surgery/speech               0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    prosthesis.
31612................  T....................  ...................  Puncture/clear               0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    windpipe.
31613................  T....................  ...................  Repair windpipe              0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    opening.
31614................  T....................  ...................  Repair windpipe              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    opening.
31615................  T....................  ...................  Visualization of             0076       9.2346      $503.85      $189.82      $100.77
                                                                    windpipe.
31622................  T....................  ...................  Dx bronchoscope/wash         0076       9.2346      $503.85      $189.82      $100.77
31623................  T....................  ...................  Dx bronchoscope/             0076       9.2346      $503.85      $189.82      $100.77
                                                                    brush.
31624................  T....................  ...................  Dx bronchoscope/             0076       9.2346      $503.85      $189.82      $100.77
                                                                    lavage.
31625................  T....................  ...................  Bronchoscopy w/              0076       9.2346      $503.85      $189.82      $100.77
                                                                    biopsy(s).
31628................  T....................  ...................  Bronchoscopy/lung            0076       9.2346      $503.85      $189.82      $100.77
                                                                    bx, each.

[[Page 63521]]

 
31629................  T....................  ...................  Bronchoscopy/needle          0076       9.2346      $503.85      $189.82      $100.77
                                                                    bx, each.
31630................  T....................  ...................  Bronchoscopy dilate/         0415      20.7348    $1,131.31      $459.92      $226.26
                                                                    fx repr.
31631................  T....................  ...................  Bronchoscopy, dilate         0415      20.7348    $1,131.31      $459.92      $226.26
                                                                    w/stent.
31632................  T....................  NI.................  Bronchoscopy/lung            0076       9.2346      $503.85      $189.82      $100.77
                                                                    bx, add'l.
31633................  T....................  NI.................  Bronchoscopy/needle          0076       9.2346      $503.85      $189.82      $100.77
                                                                    bx add'l.
31635................  T....................  ...................  Bronchoscopy w/fb            0076       9.2346      $503.85      $189.82      $100.77
                                                                    removal.
31640................  T....................  ...................  Bronchoscopy w/tumor         0415      20.7348    $1,131.31      $459.92      $226.26
                                                                    excise.
31641................  T....................  ...................  Bronchoscopy, treat          0415      20.7348    $1,131.31      $459.92      $226.26
                                                                    blockage.
31643................  T....................  ...................  Diag bronchoscope/           0076       9.2346      $503.85      $189.82      $100.77
                                                                    catheter.
31645................  T....................  ...................  Bronchoscopy, clear          0076       9.2346      $503.85      $189.82      $100.77
                                                                    airways.
31646................  T....................  ...................  Bronchoscopy,                0076       9.2346      $503.85      $189.82      $100.77
                                                                    reclear airway.
31656................  T....................  ...................  Bronchoscopy, inj            0076       9.2346      $503.85      $189.82      $100.77
                                                                    for x-ray.
31700................  T....................  ...................  Insertion of airway          0072       1.7613       $96.10       $26.68       $19.22
                                                                    catheter.
31708................  N....................  ...................  Instill airway        ...........  ...........  ...........  ...........  ...........
                                                                    contrast dye.
31710................  N....................  ...................  Insertion of airway   ...........  ...........  ...........  ...........  ...........
                                                                    catheter.
31715................  N....................  ...................  Injection for         ...........  ...........  ...........  ...........  ...........
                                                                    bronchus x-ray.
31717................  T....................  ...................  Bronchial brush              0073       3.4541      $188.46       $73.38       $37.69
                                                                    biopsy.
31720................  T....................  ...................  Clearance of airways         0071       0.8799       $48.01       $12.89        $9.60
31725................  C....................  ...................  Clearance of airways  ...........  ...........  ...........  ...........  ...........
31730................  T....................  ...................  Intro, windpipe wire/        0073       3.4541      $188.46       $73.38       $37.69
                                                                    tube.
31750................  T....................  ...................  Repair of windpipe..         0256      35.1548    $1,918.08  ...........      $383.62
31755................  T....................  ...................  Repair of windpipe..         0256      35.1548    $1,918.08  ...........      $383.62
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              0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    lesion.
31786................  C....................  ...................  Remove windpipe       ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
31800................  C....................  ...................  Repair of windpipe    ...........  ...........  ...........  ...........  ...........
                                                                    injury.
31805................  C....................  ...................  Repair of windpipe    ...........  ...........  ...........  ...........  ...........
                                                                    injury.
31820................  T....................  ...................  Closure of windpipe          0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
31825................  T....................  ...................  Repair of windpipe           0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    defect.
31830................  T....................  ...................  Revise windpipe scar         0254      21.8901    $1,194.35      $321.35      $238.87
31899................  T....................  ...................  Airways surgical             0076       9.2346      $503.85      $189.82      $100.77
                                                                    procedure.
32000................  T....................  ...................  Drainage of chest...         0070       3.0717      $167.60  ...........       $33.52
32002................  T....................  ...................  Treatment of                 0070       3.0717      $167.60  ...........       $33.52
                                                                    collapsed lung.
32005................  T....................  ...................  Treat lung lining            0070       3.0717      $167.60  ...........       $33.52
                                                                    chemically.
32020................  T....................  ...................  Insertion of chest           0070       3.0717      $167.60  ...........       $33.52
                                                                    tube.
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       3.0717      $167.60  ...........       $33.52
                                                                    lesion.
32215................  C....................  ...................  Treat chest lining..  ...........  ...........  ...........  ...........  ...........
32220................  C....................  ...................  Release of lung.....  ...........  ...........  ...........  ...........  ...........
32225................  C....................  ...................  Partial release of    ...........  ...........  ...........  ...........  ...........
                                                                    lung.
32310................  C....................  ...................  Removal of chest      ...........  ...........  ...........  ...........  ...........
                                                                    lining.
32320................  C....................  ...................  Free/remove chest     ...........  ...........  ...........  ...........  ...........
                                                                    lining.
32400................  T....................  ...................  Needle biopsy chest          0005       3.2698      $178.40       $71.59       $35.68
                                                                    lining.
32402................  C....................  ...................  Open biopsy chest     ...........  ...........  ...........  ...........  ...........
                                                                    lining.
32405................  T....................  ...................  Biopsy, lung or              0685       4.8100      $262.44      $115.47       $52.49
                                                                    mediastinum.
32420................  T....................  ...................  Puncture/clear lung.         0070       3.0717      $167.60  ...........       $33.52
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.

[[Page 63522]]

 
32522................  C....................  ...................  Remove lung & revise  ...........  ...........  ...........  ...........  ...........
                                                                    chest.
32525................  C....................  ...................  Remove lung & revise  ...........  ...........  ...........  ...........  ...........
                                                                    chest.
32540................  C....................  ...................  Removal of lung       ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
32601................  T....................  ...................  Thoracoscopy,                0069      28.9392    $1,578.95      $591.64      $315.79
                                                                    diagnostic.
32602................  T....................  ...................  Thoracoscopy,                0069      28.9392    $1,578.95      $591.64      $315.79
                                                                    diagnostic.
32603................  T....................  ...................  Thoracoscopy,                0069      28.9392    $1,578.95      $591.64      $315.79
                                                                    diagnostic.
32604................  T....................  ...................  Thoracoscopy,                0069      28.9392    $1,578.95      $591.64      $315.79
                                                                    diagnostic.
32605................  T....................  ...................  Thoracoscopy,                0069      28.9392    $1,578.95      $591.64      $315.79
                                                                    diagnostic.
32606................  T....................  ...................  Thoracoscopy,                0069      28.9392    $1,578.95      $591.64      $315.79
                                                                    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       3.0717      $167.60  ...........       $33.52
                                                                    pneumothorax.
32997................  C....................  ...................  Total lung lavage...  ...........  ...........  ...........  ...........  ...........
32999................  T....................  ...................  Chest surgery                0070       3.0717      $167.60  ...........       $33.52
                                                                    procedure.
33010................  T....................  ...................  Drainage of heart            0070       3.0717      $167.60  ...........       $33.52
                                                                    sac.
33011................  T....................  ...................  Repeat drainage of           0070       3.0717      $167.60  ...........       $33.52
                                                                    heart sac.
33015................  C....................  ...................  Incision of heart     ...........  ...........  ...........  ...........  ...........
                                                                    sac.
33020................  C....................  ...................  Incision of heart     ...........  ...........  ...........  ...........  ...........
                                                                    sac.
33025................  C....................  ...................  Incision of heart     ...........  ...........  ...........  ...........  ...........
                                                                    sac.
33030................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    heart sac.
33031................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    heart sac.
33050................  C....................  ...................  Removal of heart sac  ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
33120................  C....................  ...................  Removal of heart      ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
33130................  C....................  ...................  Removal of heart      ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
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     117.1896    $6,393.98    $1,722.59    $1,278.80
                                                                    pacemaker.
33207................  T....................  ...................  Insertion of heart           0089     117.1896    $6,393.98    $1,722.59    $1,278.80
                                                                    pacemaker.
33208................  T....................  ...................  Insertion of heart           0655     142.7039    $7,786.07  ...........    $1,557.21
                                                                    pacemaker.
33210................  T....................  ...................  Insertion of heart           0106      58.9719    $3,217.57  ...........      $643.51
                                                                    electrode.
33211................  T....................  ...................  Insertion of heart           0106      58.9719    $3,217.57  ...........      $643.51
                                                                    electrode.
33212................  T....................  ...................  Insertion of pulse           0090      96.8284    $5,283.05    $1,651.45    $1,056.61
                                                                    generator.
33213................  T....................  ...................  Insertion of pulse           0654     112.6957    $6,148.79  ...........    $1,229.76
                                                                    generator.
33214................  T....................  ...................  Upgrade of pacemaker         0655     142.7039    $7,786.07  ...........    $1,557.21
                                                                    system.
33215................  T....................  ...................  Reposition pacing-           0105      19.1898    $1,047.01      $370.40      $209.40
                                                                    defib lead.
33216................  T....................  ...................  Revise eltrd pacing-         0106      58.9719    $3,217.57  ...........      $643.51
                                                                    defib.
33217................  T....................  ...................  Insert lead pace-            0106      58.9719    $3,217.57  ...........      $643.51
                                                                    defib, dual.
33218................  T....................  ...................  Repair lead pace-            0106      58.9719    $3,217.57  ...........      $643.51
                                                                    defib, one.
33220................  T....................  ...................  Repair lead pace-            0106      58.9719    $3,217.57  ...........      $643.51
                                                                    defib, dual.
33222................  T....................  ...................  Revise pocket,               0027      15.8990      $867.47      $329.72      $173.49
                                                                    pacemaker.
33223................  T....................  ...................  Revise pocket,               0027      15.8990      $867.47      $329.72      $173.49
                                                                    pacing-defib.
33224................  T....................  ...................  Insert pacing lead &         1547  ...........      $850.00  ...........      $170.00
                                                                    connect.
33225................  T....................  ...................  L ventric pacing             1550  ...........    $1,150.00  ...........      $230.00
                                                                    lead add-on.
33226................  T....................  ...................  Reposition l ventric         0105      19.1898    $1,047.01      $370.40      $209.40
                                                                    lead.
33233................  T....................  ...................  Removal of pacemaker         0105      19.1898    $1,047.01      $370.40      $209.40
                                                                    system.
33234................  T....................  ...................  Removal of pacemaker         0105      19.1898    $1,047.01      $370.40      $209.40
                                                                    system.

[[Page 63523]]

 
33235................  T....................  ...................  Removal pacemaker            0105      19.1898    $1,047.01      $370.40      $209.40
                                                                    electrode.
33236................  C....................  ...................  Remove electrode/     ...........  ...........  ...........  ...........  ...........
                                                                    thoracotomy.
33237................  C....................  ...................  Remove electrode/     ...........  ...........  ...........  ...........  ...........
                                                                    thoracotomy.
33238................  C....................  ...................  Remove electrode/     ...........  ...........  ...........  ...........  ...........
                                                                    thoracotomy.
33240................  B....................  ...................  Insert pulse          ...........  ...........  ...........  ...........  ...........
                                                                    generator.
33241................  T....................  ...................  Remove pulse                 0105      19.1898    $1,047.01      $370.40      $209.40
                                                                    generator.
33243................  C....................  ...................  Remove eltrd/         ...........  ...........  ...........  ...........  ...........
                                                                    thoracotomy.
33244................  T....................  ...................  Remove eltrd,                0105      19.1898    $1,047.01      $370.40      $209.40
                                                                    transven.
33245................  C....................  ...................  Insert epic eltrd     ...........  ...........  ...........  ...........  ...........
                                                                    pace-defib.
33246................  C....................  ...................  Insert epic eltrd/    ...........  ...........  ...........  ...........  ...........
                                                                    generator.
33249................  B....................  ...................  Eltrd/insert pace-    ...........  ...........  ...........  ...........  ...........
                                                                    defib.
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           0680      62.8252    $3,427.81  ...........      $685.56
                                                                    ht record.
33284................  T....................  ...................  Remove pat-active ht         0109       7.4705      $407.60      $131.49       $81.52
                                                                    record.
33300................  C....................  ...................  Repair of heart       ...........  ...........  ...........  ...........  ...........
                                                                    wound.
33305................  C....................  ...................  Repair of heart       ...........  ...........  ...........  ...........  ...........
                                                                    wound.
33310................  C....................  ...................  Exploratory heart     ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
33315................  C....................  ...................  Exploratory heart     ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
33320................  C....................  ...................  Repair major blood    ...........  ...........  ...........  ...........  ...........
                                                                    vessel(s).
33321................  C....................  ...................  Repair major vessel.  ...........  ...........  ...........  ...........  ...........
33322................  C....................  ...................  Repair major blood    ...........  ...........  ...........  ...........  ...........
                                                                    vessel(s).
33330................  C....................  ...................  Insert major vessel   ...........  ...........  ...........  ...........  ...........
                                                                    graft.
33332................  C....................  ...................  Insert major vessel   ...........  ...........  ...........  ...........  ...........
                                                                    graft.
33335................  C....................  ...................  Insert major vessel   ...........  ...........  ...........  ...........  ...........
                                                                    graft.
33400................  C....................  ...................  Repair of aortic      ...........  ...........  ...........  ...........  ...........
                                                                    valve.
33401................  C....................  ...................  Valvuloplasty, open.  ...........  ...........  ...........  ...........  ...........
33403................  C....................  ...................  Valvuloplasty, w/cp   ...........  ...........  ...........  ...........  ...........
                                                                    bypass.
33404................  C....................  ...................  Prepare heart-aorta   ...........  ...........  ...........  ...........  ...........
                                                                    conduit.
33405................  C....................  ...................  Replacement of        ...........  ...........  ...........  ...........  ...........
                                                                    aortic valve.
33406................  C....................  ...................  Replacement of        ...........  ...........  ...........  ...........  ...........
                                                                    aortic valve.
33410................  C....................  ...................  Replacement of        ...........  ...........  ...........  ...........  ...........
                                                                    aortic valve.
33411................  C....................  ...................  Replacement of        ...........  ...........  ...........  ...........  ...........
                                                                    aortic valve.
33412................  C....................  ...................  Replacement of        ...........  ...........  ...........  ...........  ...........
                                                                    aortic valve.
33413................  C....................  ...................  Replacement of        ...........  ...........  ...........  ...........  ...........
                                                                    aortic valve.
33414................  C....................  ...................  Repair of aortic      ...........  ...........  ...........  ...........  ...........
                                                                    valve.
33415................  C....................  ...................  Revision,             ...........  ...........  ...........  ...........  ...........
                                                                    subvalvular tissue.
33416................  C....................  ...................  Revise ventricle      ...........  ...........  ...........  ...........  ...........
                                                                    muscle.
33417................  C....................  ...................  Repair of aortic      ...........  ...........  ...........  ...........  ...........
                                                                    valve.
33420................  C....................  ...................  Revision of mitral    ...........  ...........  ...........  ...........  ...........
                                                                    valve.
33422................  C....................  ...................  Revision of mitral    ...........  ...........  ...........  ...........  ...........
                                                                    valve.
33425................  C....................  ...................  Repair of mitral      ...........  ...........  ...........  ...........  ...........
                                                                    valve.
33426................  C....................  ...................  Repair of mitral      ...........  ...........  ...........  ...........  ...........
                                                                    valve.
33427................  C....................  ...................  Repair of mitral      ...........  ...........  ...........  ...........  ...........
                                                                    valve.
33430................  C....................  ...................  Replacement of        ...........  ...........  ...........  ...........  ...........
                                                                    mitral valve.
33460................  C....................  ...................  Revision of           ...........  ...........  ...........  ...........  ...........
                                                                    tricuspid valve.
33463................  C....................  ...................  Valvuloplasty,        ...........  ...........  ...........  ...........  ...........
                                                                    tricuspid.
33464................  C....................  ...................  Valvuloplasty,        ...........  ...........  ...........  ...........  ...........
                                                                    tricuspid.
33465................  C....................  ...................  Replace tricuspid     ...........  ...........  ...........  ...........  ...........
                                                                    valve.
33468................  C....................  ...................  Revision of           ...........  ...........  ...........  ...........  ...........
                                                                    tricuspid valve.
33470................  C....................  ...................  Revision of           ...........  ...........  ...........  ...........  ...........
                                                                    pulmonary valve.
33471................  C....................  ...................  Valvotomy, pulmonary  ...........  ...........  ...........  ...........  ...........
                                                                    valve.
33472................  C....................  ...................  Revision of           ...........  ...........  ...........  ...........  ...........
                                                                    pulmonary valve.
33474................  C....................  ...................  Revision of           ...........  ...........  ...........  ...........  ...........
                                                                    pulmonary valve.
33475................  C....................  ...................  Replacement,          ...........  ...........  ...........  ...........  ...........
                                                                    pulmonary valve.
33476................  C....................  ...................  Revision of heart     ...........  ...........  ...........  ...........  ...........
                                                                    chamber.
33478................  C....................  ...................  Revision of heart     ...........  ...........  ...........  ...........  ...........
                                                                    chamber.
33496................  C....................  ...................  Repair, prosth valve  ...........  ...........  ...........  ...........  ...........
                                                                    clot.
33500................  C....................  ...................  Repair heart vessel   ...........  ...........  ...........  ...........  ...........
                                                                    fistula.
33501................  C....................  ...................  Repair heart vessel   ...........  ...........  ...........  ...........  ...........
                                                                    fistula.
33502................  C....................  ...................  Coronary artery       ...........  ...........  ...........  ...........  ...........
                                                                    correction.
33503................  C....................  ...................  Coronary artery       ...........  ...........  ...........  ...........  ...........
                                                                    graft.
33504................  C....................  ...................  Coronary artery       ...........  ...........  ...........  ...........  ...........
                                                                    graft.
33505................  C....................  ...................  Repair artery w/      ...........  ...........  ...........  ...........  ...........
                                                                    tunnel.
33506................  C....................  ...................  Repair artery,        ...........  ...........  ...........  ...........  ...........
                                                                    translocation.
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.

[[Page 63524]]

 
33518................  C....................  ...................  CABG, artery-vein,    ...........  ...........  ...........  ...........  ...........
                                                                    two.
33519................  C....................  ...................  CABG, artery-vein,    ...........  ...........  ...........  ...........  ...........
                                                                    three.
33521................  C....................  ...................  CABG, artery-vein,    ...........  ...........  ...........  ...........  ...........
                                                                    four.
33522................  C....................  ...................  CABG, artery-vein,    ...........  ...........  ...........  ...........  ...........
                                                                    five.
33523................  C....................  ...................  Cabg, art-vein, six   ...........  ...........  ...........  ...........  ...........
                                                                    or more.
33530................  C....................  ...................  Coronary artery,      ...........  ...........  ...........  ...........  ...........
                                                                    bypass/reop.
33533................  C....................  ...................  CABG, arterial,       ...........  ...........  ...........  ...........  ...........
                                                                    single.
33534................  C....................  ...................  CABG, arterial, two.  ...........  ...........  ...........  ...........  ...........
33535................  C....................  ...................  CABG, arterial,       ...........  ...........  ...........  ...........  ...........
                                                                    three.
33536................  C....................  ...................  Cabg, arterial, four  ...........  ...........  ...........  ...........  ...........
                                                                    or more.
33542................  C....................  ...................  Removal of heart      ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
33545................  C....................  ...................  Repair of heart       ...........  ...........  ...........  ...........  ...........
                                                                    damage.
33572................  C....................  ...................  Open coronary         ...........  ...........  ...........  ...........  ...........
                                                                    endarterectomy.
33600................  C....................  ...................  Closure of valve....  ...........  ...........  ...........  ...........  ...........
33602................  C....................  ...................  Closure of valve....  ...........  ...........  ...........  ...........  ...........
33606................  C....................  ...................  Anastomosis/artery-   ...........  ...........  ...........  ...........  ...........
                                                                    aorta.
33608................  C....................  ...................  Repair anomaly w/     ...........  ...........  ...........  ...........  ...........
                                                                    conduit.
33610................  C....................  ...................  Repair by             ...........  ...........  ...........  ...........  ...........
                                                                    enlargement.
33611................  C....................  ...................  Repair double         ...........  ...........  ...........  ...........  ...........
                                                                    ventricle.
33612................  C....................  ...................  Repair double         ...........  ...........  ...........  ...........  ...........
                                                                    ventricle.
33615................  C....................  ...................  Repair, modified      ...........  ...........  ...........  ...........  ...........
                                                                    fontan.
33617................  C....................  ...................  Repair single         ...........  ...........  ...........  ...........  ...........
                                                                    ventricle.
33619................  C....................  ...................  Repair single         ...........  ...........  ...........  ...........  ...........
                                                                    ventricle.
33641................  C....................  ...................  Repair heart septum   ...........  ...........  ...........  ...........  ...........
                                                                    defect.
33645................  C....................  ...................  Revision of heart     ...........  ...........  ...........  ...........  ...........
                                                                    veins.
33647................  C....................  ...................  Repair heart septum   ...........  ...........  ...........  ...........  ...........
                                                                    defects.
33660................  C....................  ...................  Repair of heart       ...........  ...........  ...........  ...........  ...........
                                                                    defects.
33665................  C....................  ...................  Repair of heart       ...........  ...........  ...........  ...........  ...........
                                                                    defects.
33670................  C....................  ...................  Repair of heart       ...........  ...........  ...........  ...........  ...........
                                                                    chambers.
33681................  C....................  ...................  Repair heart septum   ...........  ...........  ...........  ...........  ...........
                                                                    defect.
33684................  C....................  ...................  Repair heart septum   ...........  ...........  ...........  ...........  ...........
                                                                    defect.
33688................  C....................  ...................  Repair heart septum   ...........  ...........  ...........  ...........  ...........
                                                                    defect.
33690................  C....................  ...................  Reinforce pulmonary   ...........  ...........  ...........  ...........  ...........
                                                                    artery.
33692................  C....................  ...................  Repair of heart       ...........  ...........  ...........  ...........  ...........
                                                                    defects.
33694................  C....................  ...................  Repair of heart       ...........  ...........  ...........  ...........  ...........
                                                                    defects.
33697................  C....................  ...................  Repair of heart       ...........  ...........  ...........  ...........  ...........
                                                                    defects.
33702................  C....................  ...................  Repair of heart       ...........  ...........  ...........  ...........  ...........
                                                                    defects.
33710................  C....................  ...................  Repair of heart       ...........  ...........  ...........  ...........  ...........
                                                                    defects.
33720................  C....................  ...................  Repair of heart       ...........  ...........  ...........  ...........  ...........
                                                                    defect.
33722................  C....................  ...................  Repair of heart       ...........  ...........  ...........  ...........  ...........
                                                                    defect.
33730................  C....................  ...................  Repair heart-vein     ...........  ...........  ...........  ...........  ...........
                                                                    defect(s).
33732................  C....................  ...................  Repair heart-vein     ...........  ...........  ...........  ...........  ...........
                                                                    defect.
33735................  C....................  ...................  Revision of heart     ...........  ...........  ...........  ...........  ...........
                                                                    chamber.
33736................  C....................  ...................  Revision of heart     ...........  ...........  ...........  ...........  ...........
                                                                    chamber.
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  ...........  ...........  ...........  ...........  ...........

[[Page 63525]]

 
33853................  C....................  ...................  Repair septal defect  ...........  ...........  ...........  ...........  ...........
33860................  C....................  ...................  Ascending aortic      ...........  ...........  ...........  ...........  ...........
                                                                    graft.
33861................  C....................  ...................  Ascending aortic      ...........  ...........  ...........  ...........  ...........
                                                                    graft.
33863................  C....................  ...................  Ascending aortic      ...........  ...........  ...........  ...........  ...........
                                                                    graft.
33870................  C....................  ...................  Transverse aortic     ...........  ...........  ...........  ...........  ...........
                                                                    arch graft.
33875................  C....................  ...................  Thoracic aortic       ...........  ...........  ...........  ...........  ...........
                                                                    graft.
33877................  C....................  ...................  Thoracoabdominal      ...........  ...........  ...........  ...........  ...........
                                                                    graft.
33910................  C....................  ...................  Remove lung artery    ...........  ...........  ...........  ...........  ...........
                                                                    emboli.
33915................  C....................  ...................  Remove lung artery    ...........  ...........  ...........  ...........  ...........
                                                                    emboli.
33916................  C....................  ...................  Surgery of great      ...........  ...........  ...........  ...........  ...........
                                                                    vessel.
33917................  C....................  ...................  Repair pulmonary      ...........  ...........  ...........  ...........  ...........
                                                                    artery.
33918................  C....................  ...................  Repair pulmonary      ...........  ...........  ...........  ...........  ...........
                                                                    atresia.
33919................  C....................  ...................  Repair pulmonary      ...........  ...........  ...........  ...........  ...........
                                                                    atresia.
33920................  C....................  ...................  Repair pulmonary      ...........  ...........  ...........  ...........  ...........
                                                                    atresia.
33922................  C....................  ...................  Transect pulmonary    ...........  ...........  ...........  ...........  ...........
                                                                    artery.
33924................  C....................  ...................  Remove pulmonary      ...........  ...........  ...........  ...........  ...........
                                                                    shunt.
33930................  C....................  ...................  Removal of donor      ...........  ...........  ...........  ...........  ...........
                                                                    heart/lung.
33935................  C....................  ...................  Transplantation,      ...........  ...........  ...........  ...........  ...........
                                                                    heart/lung.
33940................  C....................  ...................  Removal of donor      ...........  ...........  ...........  ...........  ...........
                                                                    heart.
33945................  C....................  ...................  Transplantation of    ...........  ...........  ...........  ...........  ...........
                                                                    heart.
33960................  C....................  ...................  External circulation  ...........  ...........  ...........  ...........  ...........
                                                                    assist.
33961................  C....................  ...................  External circulation  ...........  ...........  ...........  ...........  ...........
                                                                    assist.
33967................  C....................  ...................  Insert ia percut      ...........  ...........  ...........  ...........  ...........
                                                                    device.
33968................  C....................  ...................  Remove aortic assist  ...........  ...........  ...........  ...........  ...........
                                                                    device.
33970................  C....................  ...................  Aortic circulation    ...........  ...........  ...........  ...........  ...........
                                                                    assist.
33971................  C....................  ...................  Aortic circulation    ...........  ...........  ...........  ...........  ...........
                                                                    assist.
33973................  C....................  ...................  Insert balloon        ...........  ...........  ...........  ...........  ...........
                                                                    device.
33974................  C....................  ...................  Remove intra-aortic   ...........  ...........  ...........  ...........  ...........
                                                                    balloon.
33975................  C....................  ...................  Implant ventricular   ...........  ...........  ...........  ...........  ...........
                                                                    device.
33976................  C....................  ...................  Implant ventricular   ...........  ...........  ...........  ...........  ...........
                                                                    device.
33977................  C....................  ...................  Remove ventricular    ...........  ...........  ...........  ...........  ...........
                                                                    device.
33978................  C....................  ...................  Remove ventricular    ...........  ...........  ...........  ...........  ...........
                                                                    device.
33979................  C....................  ...................  Insert                ...........  ...........  ...........  ...........  ...........
                                                                    intracorporeal
                                                                    device.
33980................  C....................  ...................  Remove                ...........  ...........  ...........  ...........  ...........
                                                                    intracorporeal
                                                                    device.
33999................  T....................  ...................  Cardiac surgery              0070       3.0717      $167.60  ...........       $33.52
                                                                    procedure.
34001................  C....................  ...................  Removal of artery     ...........  ...........  ...........  ...........  ...........
                                                                    clot.
34051................  C....................  ...................  Removal of artery     ...........  ...........  ...........  ...........  ...........
                                                                    clot.
34101................  T....................  ...................  Removal of artery            0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    clot.
34111................  T....................  ...................  Removal of arm               0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    artery clot.
34151................  C....................  ...................  Removal of artery     ...........  ...........  ...........  ...........  ...........
                                                                    clot.
34201................  T....................  ...................  Removal of artery            0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    clot.
34203................  T....................  ...................  Removal of leg               0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    artery clot.
34401................  C....................  ...................  Removal of vein clot  ...........  ...........  ...........  ...........  ...........
34421................  T....................  ...................  Removal of vein clot         0088      34.6942    $1,892.95      $655.22      $378.59
34451................  C....................  ...................  Removal of vein clot  ...........  ...........  ...........  ...........  ...........
34471................  T....................  ...................  Removal of vein clot         0088      34.6942    $1,892.95      $655.22      $378.59
34490................  T....................  ...................  Removal of vein clot         0088      34.6942    $1,892.95      $655.22      $378.59
34501................  T....................  ...................  Repair valve,                0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    femoral vein.
34502................  C....................  ...................  Reconstruct vena      ...........  ...........  ...........  ...........  ...........
                                                                    cava.
34510................  T....................  ...................  Transposition of             0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    vein valve.
34520................  T....................  ...................  Cross-over vein              0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    graft.
34530................  T....................  ...................  Leg vein fusion.....         0088      34.6942    $1,892.95      $655.22      $378.59
34800................  C....................  ...................  Endovasc abdo repair  ...........  ...........  ...........  ...........  ...........
                                                                    w/tube.
34802................  C....................  ...................  Endovasc abdo repr w/ ...........  ...........  ...........  ...........  ...........
                                                                    device.
34804................  C....................  ...................  Endovasc abdo repr w/ ...........  ...........  ...........  ...........  ...........
                                                                    device.
34805................  C....................  NI.................  Endovasc abdo repair  ...........  ...........  ...........  ...........  ...........
                                                                    w/pros.
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, add'l.
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             0653      30.0334    $1,638.65  ...........      $327.73
                                                                    artery.
35013................  C....................  ...................  Repair artery         ...........  ...........  ...........  ...........  ...........
                                                                    rupture, arm.
35021................  C....................  ...................  Repair defect of      ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35022................  C....................  ...................  Repair artery         ...........  ...........  ...........  ...........  ...........
                                                                    rupture, chest.

[[Page 63526]]

 
35045................  C....................  ...................  Repair defect of arm  ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35081................  C....................  ...................  Repair defect of      ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35082................  C....................  ...................  Repair artery         ...........  ...........  ...........  ...........  ...........
                                                                    rupture, aorta.
35091................  C....................  ...................  Repair defect of      ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35092................  C....................  ...................  Repair artery         ...........  ...........  ...........  ...........  ...........
                                                                    rupture, aorta.
35102................  C....................  ...................  Repair defect of      ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35103................  C....................  ...................  Repair artery         ...........  ...........  ...........  ...........  ...........
                                                                    rupture, groin.
35111................  C....................  ...................  Repair defect of      ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35112................  C....................  ...................  Repair artery         ...........  ...........  ...........  ...........  ...........
                                                                    rupture,spleen.
35121................  C....................  ...................  Repair defect of      ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35122................  C....................  ...................  Repair artery         ...........  ...........  ...........  ...........  ...........
                                                                    rupture, belly.
35131................  C....................  ...................  Repair defect of      ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35132................  C....................  ...................  Repair artery         ...........  ...........  ...........  ...........  ...........
                                                                    rupture, groin.
35141................  C....................  ...................  Repair defect of      ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35142................  C....................  ...................  Repair artery         ...........  ...........  ...........  ...........  ...........
                                                                    rupture, thigh.
35151................  C....................  ...................  Repair defect of      ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35152................  C....................  ...................  Repair artery         ...........  ...........  ...........  ...........  ...........
                                                                    rupture, knee.
35161................  C....................  ...................  Repair defect of      ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35162................  C....................  ...................  Repair artery         ...........  ...........  ...........  ...........  ...........
                                                                    rupture.
35180................  T....................  ...................  Repair blood vessel          0093      21.3104    $1,162.72      $277.34      $232.54
                                                                    lesion.
35182................  C....................  ...................  Repair blood vessel   ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
35184................  T....................  ...................  Repair blood vessel          0093      21.3104    $1,162.72      $277.34      $232.54
                                                                    lesion.
35188................  T....................  ...................  Repair blood vessel          0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    lesion.
35189................  C....................  ...................  Repair blood vessel   ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
35190................  T....................  ...................  Repair blood vessel          0093      21.3104    $1,162.72      $277.34      $232.54
                                                                    lesion.
35201................  T....................  ...................  Repair blood vessel          0093      21.3104    $1,162.72      $277.34      $232.54
                                                                    lesion.
35206................  T....................  ...................  Repair blood vessel          0093      21.3104    $1,162.72      $277.34      $232.54
                                                                    lesion.
35207................  T....................  ...................  Repair blood vessel          0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    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      21.3104    $1,162.72      $277.34      $232.54
                                                                    lesion.
35231................  T....................  ...................  Repair blood vessel          0093      21.3104    $1,162.72      $277.34      $232.54
                                                                    lesion.
35236................  T....................  ...................  Repair blood vessel          0093      21.3104    $1,162.72      $277.34      $232.54
                                                                    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      21.3104    $1,162.72      $277.34      $232.54
                                                                    lesion.
35261................  T....................  ...................  Repair blood vessel          0653      30.0334    $1,638.65  ...........      $327.73
                                                                    lesion.
35266................  T....................  ...................  Repair blood vessel          0653      30.0334    $1,638.65  ...........      $327.73
                                                                    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      30.0334    $1,638.65  ...........      $327.73
                                                                    lesion.
35301................  C....................  ...................  Rechanneling of       ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35311................  C....................  ...................  Rechanneling of       ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35321................  T....................  ...................  Rechanneling of              0093      21.3104    $1,162.72      $277.34      $232.54
                                                                    artery.
35331................  C....................  ...................  Rechanneling of       ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35341................  C....................  ...................  Rechanneling of       ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35351................  C....................  ...................  Rechanneling of       ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35355................  C....................  ...................  Rechanneling of       ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35361................  C....................  ...................  Rechanneling of       ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35363................  C....................  ...................  Rechanneling of       ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35371................  C....................  ...................  Rechanneling of       ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35372................  C....................  ...................  Rechanneling of       ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35381................  C....................  ...................  Rechanneling of       ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35390................  C....................  ...................  Reoperation, carotid  ...........  ...........  ...........  ...........  ...........
                                                                    add-on.
35400................  C....................  ...................  Angioscopy..........  ...........  ...........  ...........  ...........  ...........
35450................  C....................  ...................  Repair arterial       ...........  ...........  ...........  ...........  ...........
                                                                    blockage.
35452................  C....................  ...................  Repair arterial       ...........  ...........  ...........  ...........  ...........
                                                                    blockage.
35454................  C....................  ...................  Repair arterial       ...........  ...........  ...........  ...........  ...........
                                                                    blockage.
35456................  C....................  ...................  Repair arterial       ...........  ...........  ...........  ...........  ...........
                                                                    blockage.
35458................  T....................  ...................  Repair arterial              0081      35.0285    $1,911.19  ...........      $382.24
                                                                    blockage.
35459................  T....................  ...................  Repair arterial              0081      35.0285    $1,911.19  ...........      $382.24
                                                                    blockage.
35460................  T....................  ...................  Repair venous                0081      35.0285    $1,911.19  ...........      $382.24
                                                                    blockage.
35470................  T....................  ...................  Repair arterial              0081      35.0285    $1,911.19  ...........      $382.24
                                                                    blockage.
35471................  T....................  ...................  Repair arterial              0081      35.0285    $1,911.19  ...........      $382.24
                                                                    blockage.
35472................  T....................  ...................  Repair arterial              0081      35.0285    $1,911.19  ...........      $382.24
                                                                    blockage.
35473................  T....................  ...................  Repair arterial              0081      35.0285    $1,911.19  ...........      $382.24
                                                                    blockage.
35474................  T....................  ...................  Repair arterial              0081      35.0285    $1,911.19  ...........      $382.24
                                                                    blockage.
35475................  T....................  ...................  Repair arterial              0081      35.0285    $1,911.19  ...........      $382.24
                                                                    blockage.
35476................  T....................  ...................  Repair venous                0081      35.0285    $1,911.19  ...........      $382.24
                                                                    blockage.
35480................  C....................  ...................  Atherectomy, open...  ...........  ...........  ...........  ...........  ...........
35481................  C....................  ...................  Atherectomy, open...  ...........  ...........  ...........  ...........  ...........
35482................  C....................  ...................  Atherectomy, open...  ...........  ...........  ...........  ...........  ...........

[[Page 63527]]

 
35483................  C....................  ...................  Atherectomy, open...  ...........  ...........  ...........  ...........  ...........
35484................  T....................  ...................  Atherectomy, open...         0081      35.0285    $1,911.19  ...........      $382.24
35485................  T....................  ...................  Atherectomy, open...         0081      35.0285    $1,911.19  ...........      $382.24
35490................  T....................  ...................  Atherectomy,                 0081      35.0285    $1,911.19  ...........      $382.24
                                                                    percutaneous.
35491................  T....................  ...................  Atherectomy,                 0081      35.0285    $1,911.19  ...........      $382.24
                                                                    percutaneous.
35492................  T....................  ...................  Atherectomy,                 0081      35.0285    $1,911.19  ...........      $382.24
                                                                    percutaneous.
35493................  T....................  ...................  Atherectomy,                 0081      35.0285    $1,911.19  ...........      $382.24
                                                                    percutaneous.
35494................  T....................  ...................  Atherectomy,                 0081      35.0285    $1,911.19  ...........      $382.24
                                                                    percutaneous.
35495................  T....................  ...................  Atherectomy,                 0081      35.0285    $1,911.19  ...........      $382.24
                                                                    percutaneous.
35500................  T....................  ...................  Harvest vein for             0081      35.0285    $1,911.19  ...........      $382.24
                                                                    bypass.
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.  ...........  ...........  ...........  ...........  ...........
35510................  C....................  NI.................  Artery bypass graft.  ...........  ...........  ...........  ...........  ...........
35511................  C....................  ...................  Artery bypass graft.  ...........  ...........  ...........  ...........  ...........
35512................  C....................  NI.................  Artery bypass graft.  ...........  ...........  ...........  ...........  ...........
35515................  C....................  ...................  Artery bypass graft.  ...........  ...........  ...........  ...........  ...........
35516................  C....................  ...................  Artery bypass graft.  ...........  ...........  ...........  ...........  ...........
35518................  C....................  ...................  Artery bypass graft.  ...........  ...........  ...........  ...........  ...........
35521................  C....................  ...................  Artery bypass graft.  ...........  ...........  ...........  ...........  ...........
35522................  C....................  NI.................  Artery bypass graft.  ...........  ...........  ...........  ...........  ...........
35525................  C....................  NI.................  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.
35685................  T....................  ...................  Bypass graft patency/        0093      21.3104    $1,162.72      $277.34      $232.54
                                                                    patch.
35686................  T....................  ...................  Bypass graft/av fist         0093      21.3104    $1,162.72      $277.34      $232.54
                                                                    patency.
35691................  C....................  ...................  Arterial              ...........  ...........  ...........  ...........  ...........
                                                                    transposition.

[[Page 63528]]

 
35693................  C....................  ...................  Arterial              ...........  ...........  ...........  ...........  ...........
                                                                    transposition.
35694................  C....................  ...................  Arterial              ...........  ...........  ...........  ...........  ...........
                                                                    transposition.
35695................  C....................  ...................  Arterial              ...........  ...........  ...........  ...........  ...........
                                                                    transposition.
35697................  C....................  NI.................  Reimplant artery      ...........  ...........  ...........  ...........  ...........
                                                                    each.
35700................  C....................  ...................  Reoperation, bypass   ...........  ...........  ...........  ...........  ...........
                                                                    graft.
35701................  C....................  ...................  Exploration, carotid  ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35721................  C....................  ...................  Exploration, femoral  ...........  ...........  ...........  ...........  ...........
                                                                    artery.
35741................  C....................  ...................  Exploration           ...........  ...........  ...........  ...........  ...........
                                                                    popliteal artery.
35761................  T....................  ...................  Exploration of               0115      25.6437    $1,399.15      $459.35      $279.83
                                                                    artery/vein.
35800................  C....................  ...................  Explore neck vessels  ...........  ...........  ...........  ...........  ...........
35820................  C....................  ...................  Explore chest         ...........  ...........  ...........  ...........  ...........
                                                                    vessels.
35840................  C....................  ...................  Explore abdominal     ...........  ...........  ...........  ...........  ...........
                                                                    vessels.
35860................  T....................  ...................  Explore limb vessels         0093      21.3104    $1,162.72      $277.34      $232.54
35870................  C....................  ...................  Repair vessel graft   ...........  ...........  ...........  ...........  ...........
                                                                    defect.
35875................  T....................  ...................  Removal of clot in           0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    graft.
35876................  T....................  ...................  Removal of clot in           0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    graft.
35879................  T....................  ...................  Revise graft w/vein.         0088      34.6942    $1,892.95      $655.22      $378.59
35881................  T....................  ...................  Revise graft w/vein.         0088      34.6942    $1,892.95      $655.22      $378.59
35901................  C....................  ...................  Excision, graft,      ...........  ...........  ...........  ...........  ...........
                                                                    neck.
35903................  T....................  ...................  Excision, graft,             0115      25.6437    $1,399.15      $459.35      $279.83
                                                                    extremity.
35905................  C....................  ...................  Excision, graft,      ...........  ...........  ...........  ...........  ...........
                                                                    thorax.
35907................  C....................  ...................  Excision, graft,      ...........  ...........  ...........  ...........  ...........
                                                                    abdomen.
36000................  N....................  ...................  Place needle in vein  ...........  ...........  ...........  ...........  ...........
36002................  S....................  ...................  Pseudoaneurysm               0267       2.4586      $134.14       $65.52       $26.83
                                                                    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                 0119     134.7194    $7,350.43  ...........    $1,470.09
                                                                    infusion pump.
36261................  T....................  ...................  Revision of infusion         0124      23.8050    $1,298.82  ...........      $259.76
                                                                    pump.
36262................  T....................  ...................  Removal of infusion          0124      23.8050    $1,298.82  ...........      $259.76
                                                                    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          0035       0.1691        $9.23        $2.79        $1.85
                                                                    < 1 yr.
36425................  T....................  ...................  Vein access cutdown          0035       0.1691        $9.23        $2.79        $1.85
                                                                     1 yr.
36430................  S....................  ...................  Blood transfusion            0110       3.6718      $200.34  ...........       $40.07
                                                                    service.
36440................  S....................  ...................  Bl push transfuse, 2         0110       3.6718      $200.34  ...........       $40.07
                                                                    yr or <.
36450................  S....................  ...................  Bl exchange/                 0110       3.6718      $200.34  ...........       $40.07
                                                                    transfuse, nb.
36455................  S....................  ...................  Bl exchange/                 0110       3.6718      $200.34  ...........       $40.07
                                                                    transfuse non-nb.
36460................  S....................  ...................  Transfusion service,         0110       3.6718      $200.34  ...........       $40.07
                                                                    fetal.
36468................  T....................  ...................  Injection(s), spider         0098       1.0729       $58.54       $14.06       $11.71
                                                                    veins.
36469................  T....................  ...................  Injection(s), spider         0098       1.0729       $58.54       $14.06       $11.71
                                                                    veins.
36470................  T....................  ...................  Injection therapy of         0098       1.0729       $58.54       $14.06       $11.71
                                                                    vein.
36471................  T....................  ...................  Injection therapy of         0098       1.0729       $58.54       $14.06       $11.71
                                                                    veins.
36481................  N....................  ...................  Insertion of          ...........  ...........  ...........  ...........  ...........
                                                                    catheter, vein.
36488................  T....................  DG.................  Insertion of                 0032      11.4907      $626.94  ...........      $125.39
                                                                    catheter, vein.
36489................  T....................  DG.................  Insertion of                 0032      11.4907      $626.94  ...........      $125.39
                                                                    catheter, vein.
36490................  T....................  DG.................  Insertion of                 0032      11.4907      $626.94  ...........      $125.39
                                                                    catheter, vein.
36491................  T....................  DG.................  Insertion of                 0032      11.4907      $626.94  ...........      $125.39
                                                                    catheter, vein.
36493................  X....................  DG.................  Repositioning of cvc         0187       4.4288      $241.64       $90.71       $48.33
36500................  N....................  ...................  Insertion of          ...........  ...........  ...........  ...........  ...........
                                                                    catheter, vein.
36510................  C....................  ...................  Insertion of          ...........  ...........  ...........  ...........  ...........
                                                                    catheter, vein.
36511................  S....................  ...................  Apheresis wbc.......         0111      13.1719      $718.67      $200.18      $143.73

[[Page 63529]]

 
36512................  S....................  ...................  Apheresis rbc.......         0111      13.1719      $718.67      $200.18      $143.73
36513................  S....................  ...................  Apheresis platelets.         0111      13.1719      $718.67      $200.18      $143.73
36514................  S....................  ...................  Apheresis plasma....         0111      13.1719      $718.67      $200.18      $143.73
36515................  S....................  ...................  Apheresis, adsorp/           0112      37.5832    $2,050.58      $612.47      $410.12
                                                                    reinfuse.
36516................  S....................  ...................  Apheresis, selective         0112      37.5832    $2,050.58      $612.47      $410.12
36522................  S....................  ...................  Photopheresis.......         0112      37.5832    $2,050.58      $612.47      $410.12
36530................  T....................  DG.................  Insertion of                 0119     134.7194    $7,350.43  ...........    $1,470.09
                                                                    infusion pump.
36531................  T....................  DG.................  Revision of infusion         0124      23.8050    $1,298.82  ...........      $259.76
                                                                    pump.
36532................  T....................  DG.................  Removal of infusion          0109       7.4705      $407.60      $131.49       $81.52
                                                                    pump.
36533................  T....................  DG.................  Insertion of access          0115      25.6437    $1,399.15      $459.35      $279.83
                                                                    device.
36534................  T....................  DG.................  Revision of access           0109       7.4705      $407.60      $131.49       $81.52
                                                                    device.
36535................  T....................  DG.................  Removal of access            0109       7.4705      $407.60      $131.49       $81.52
                                                                    device.
36536................  T....................  DG.................  Remove cva device            1541  ...........      $250.00  ...........       $50.00
                                                                    obstruct.
36537................  T....................  DG.................  Remove cva lumen             1541  ...........      $250.00  ...........       $50.00
                                                                    obstruct.
36540................  N....................  ...................  Collect blood venous  ...........  ...........  ...........  ...........  ...........
                                                                    device.
36550................  T....................  ...................  Declot vascular              0677       2.1805      $118.97  ...........       $23.79
                                                                    device.
36555................  T....................  NI.................  Insert non-tunnel cv         0032      11.4907      $626.94  ...........      $125.39
                                                                    cath.
36556................  T....................  NI.................  Insert non-tunnel cv         0032      11.4907      $626.94  ...........      $125.39
                                                                    cath.
36557................  T....................  NI.................  Insert tunneled cv           0032      11.4907      $626.94  ...........      $125.39
                                                                    cath.
36558................  T....................  NI.................  Insert tunneled cv           0032      11.4907      $626.94  ...........      $125.39
                                                                    cath.
36560................  T....................  NI.................  Insert tunneled cv           0115      25.6437    $1,399.15      $459.35      $279.83
                                                                    cath.
36561................  T....................  NI.................  Insert tunneled cv           0115      25.6437    $1,399.15      $459.35      $279.83
                                                                    cath.
36563................  T....................  NI.................  Insert tunneled cv           0115      25.6437    $1,399.15      $459.35      $279.83
                                                                    cath.
36565................  T....................  NI.................  Insert tunneled cv           0115      25.6437    $1,399.15      $459.35      $279.83
                                                                    cath.
36566................  T....................  NI.................  Insert tunneled cv           1564  ...........    $4,750.00  ...........      $950.00
                                                                    cath.
36568................  T....................  NI.................  Insert tunneled cv           0032      11.4907      $626.94  ...........      $125.39
                                                                    cath.
36569................  T....................  NI.................  Insert tunneled cv           0032      11.4907      $626.94  ...........      $125.39
                                                                    cath.
36570................  T....................  NI.................  Insert tunneled cv           0032      11.4907      $626.94  ...........      $125.39
                                                                    cath.
36571................  T....................  NI.................  Insert tunneled cv           0032      11.4907      $626.94  ...........      $125.39
                                                                    cath.
36575................  X....................  NI.................  Repair tunneled cv           0187       4.4288      $241.64       $90.71       $48.33
                                                                    cath.
36576................  X....................  NI.................  Repair tunneled cv           0187       4.4288      $241.64       $90.71       $48.33
                                                                    cath.
36578................  X....................  NI.................  Replace tunneled cv          0187       4.4288      $241.64       $90.71       $48.33
                                                                    cath.
36580................  T....................  NI.................  Replace tunneled cv          0032      11.4907      $626.94  ...........      $125.39
                                                                    cath.
36581................  T....................  NI.................  Replace tunneled cv          0032      11.4907      $626.94  ...........      $125.39
                                                                    cath.
36582................  T....................  NI.................  Replace tunneled cv          0115      25.6437    $1,399.15      $459.35      $279.83
                                                                    cath.
36583................  T....................  NI.................  Replace tunneled cv          0115      25.6437    $1,399.15      $459.35      $279.83
                                                                    cath.
36584................  T....................  NI.................  Replace tunneled cv          0032      11.4907      $626.94  ...........      $125.39
                                                                    cath.
36585................  T....................  NI.................  Replace tunneled cv          0032      11.4907      $626.94  ...........      $125.39
                                                                    cath.
36589................  X....................  NI.................  Removal tunneled cv          0187       4.4288      $241.64       $90.71       $48.33
                                                                    cath.
36590................  T....................  NI.................  Removal tunneled cv          0109       7.4705      $407.60      $131.49       $81.52
                                                                    cath.
36595................  T....................  NI.................  Mech remov tunneled          1541  ...........      $250.00  ...........       $50.00
                                                                    cv cath.
36596................  T....................  NI.................  Mech remov tunneled          1541  ...........      $250.00  ...........       $50.00
                                                                    cv cath.
36597................  X....................  NI.................  Reposition venous            0187       4.4288      $241.64       $90.71       $48.33
                                                                    catheter.
36600................  N....................  ...................  Withdrawal of         ...........  ...........  ...........  ...........  ...........
                                                                    arterial blood.
36620................  N....................  ...................  Insertion catheter,   ...........  ...........  ...........  ...........  ...........
                                                                    artery.
36625................  N....................  ...................  Insertion catheter,   ...........  ...........  ...........  ...........  ...........
                                                                    artery.
36640................  T....................  ...................  Insertion catheter,          0032      11.4907      $626.94  ...........      $125.39
                                                                    artery.
36660................  C....................  ...................  Insertion catheter,   ...........  ...........  ...........  ...........  ...........
                                                                    artery.
36680................  T....................  ...................  Insert needle, bone          0120       1.9114      $104.29       $28.21       $20.86
                                                                    cavity.
36800................  T....................  ...................  Insertion of cannula         0115      25.6437    $1,399.15      $459.35      $279.83
36810................  T....................  ...................  Insertion of cannula         0115      25.6437    $1,399.15      $459.35      $279.83
36815................  T....................  ...................  Insertion of cannula         0115      25.6437    $1,399.15      $459.35      $279.83
36819................  T....................  ...................  Av fusion/uppr arm           0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    vein.
36820................  T....................  ...................  Av fusion/forearm            0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    vein.
36821................  T....................  ...................  Av fusion direct any         0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    site.
36822................  C....................  ...................  Insertion of          ...........  ...........  ...........  ...........  ...........
                                                                    cannula(s).
36823................  C....................  ...................  Insertion of          ...........  ...........  ...........  ...........  ...........
                                                                    cannula(s).
36825................  T....................  ...................  Artery-vein                  0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    autograft.
36830................  T....................  ...................  Artery-vein graft...         0088      34.6942    $1,892.95      $655.22      $378.59
36831................  T....................  ...................  Open thrombect av            0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    fistula.
36832................  T....................  ...................  Av fistula revision,         0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    open.
36833................  T....................  ...................  Av fistula revision.         0088      34.6942    $1,892.95      $655.22      $378.59
36834................  T....................  ...................  Repair A-V aneurysm.         0088      34.6942    $1,892.95      $655.22      $378.59
36835................  T....................  ...................  Artery to vein shunt         0115      25.6437    $1,399.15      $459.35      $279.83
36838................  T....................  NI.................  Dist revas ligation,         0088      34.6942    $1,892.95      $655.22      $378.59
                                                                    hemo.
36860................  T....................  ...................  External cannula             0103      11.6202      $634.01      $223.63      $126.80
                                                                    declotting.
36861................  T....................  ...................  Cannula declotting..         0115      25.6437    $1,399.15      $459.35      $279.83
36870................  T....................  ...................  Percut thrombect av          0653      30.0334    $1,638.65  ...........      $327.73
                                                                    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).

[[Page 63530]]

 
37195................  C....................  ...................  Thrombolytic          ...........  ...........  ...........  ...........  ...........
                                                                    therapy, stroke.
37200................  T....................  ...................  Transcatheter biopsy         0685       4.8100      $262.44      $115.47       $52.49
37201................  T....................  ...................  Transcatheter                0676       2.7315      $149.03       $40.30       $29.81
                                                                    therapy infuse.
37202................  T....................  ...................  Transcatheter                0677       2.1805      $118.97  ...........       $23.79
                                                                    therapy infuse.
37203................  T....................  ...................  Transcatheter                0103      11.6202      $634.01      $223.63      $126.80
                                                                    retrieval.
37204................  T....................  ...................  Transcatheter                0115      25.6437    $1,399.15      $459.35      $279.83
                                                                    occlusion.
37205................  T....................  ...................  Transcatheter stent.         0229      61.9895    $3,382.21      $771.23      $676.44
37206................  T....................  ...................  Transcatheter stent          0229      61.9895    $3,382.21      $771.23      $676.44
                                                                    add-on.
37207................  T....................  ...................  Transcatheter stent.         0229      61.9895    $3,382.21      $771.23      $676.44
37208................  T....................  ...................  Transcatheter stent          0229      61.9895    $3,382.21      $771.23      $676.44
                                                                    add-on.
37209................  T....................  ...................  Exchange arterial            0103      11.6202      $634.01      $223.63      $126.80
                                                                    catheter.
37250................  S....................  ...................  Iv us first vessel           0670      27.4483    $1,497.61      $542.37      $299.52
                                                                    add-on.
37251................  S....................  ...................  Iv us each add               0670      27.4483    $1,497.61      $542.37      $299.52
                                                                    vessel add-on.
37500................  T....................  ...................  Endoscopy ligate             0092      25.0959    $1,369.26      $505.37      $273.85
                                                                    perf veins.
37501................  T....................  ...................  Vascular endoscopy           0092      25.0959    $1,369.26      $505.37      $273.85
                                                                    procedure.
37565................  T....................  ...................  Ligation of neck             0093      21.3104    $1,162.72      $277.34      $232.54
                                                                    vein.
37600................  T....................  ...................  Ligation of neck             0093      21.3104    $1,162.72      $277.34      $232.54
                                                                    artery.
37605................  T....................  ...................  Ligation of neck             0091      28.8326    $1,573.14      $348.23      $314.63
                                                                    artery.
37606................  T....................  ...................  Ligation of neck             0091      28.8326    $1,573.14      $348.23      $314.63
                                                                    artery.
37607................  T....................  ...................  Ligation of a-v              0092      25.0959    $1,369.26      $505.37      $273.85
                                                                    fistula.
37609................  T....................  ...................  Temporal artery              0021      14.3594      $783.46      $219.48      $156.69
                                                                    procedure.
37615................  T....................  ...................  Ligation of neck             0091      28.8326    $1,573.14      $348.23      $314.63
                                                                    artery.
37616................  C....................  ...................  Ligation of chest     ...........  ...........  ...........  ...........  ...........
                                                                    artery.
37617................  C....................  ...................  Ligation of abdomen   ...........  ...........  ...........  ...........  ...........
                                                                    artery.
37618................  C....................  ...................  Ligation of           ...........  ...........  ...........  ...........  ...........
                                                                    extremity artery.
37620................  T....................  ...................  Revision of major            0091      28.8326    $1,573.14      $348.23      $314.63
                                                                    vein.
37650................  T....................  ...................  Revision of major            0091      28.8326    $1,573.14      $348.23      $314.63
                                                                    vein.
37660................  C....................  ...................  Revision of major     ...........  ...........  ...........  ...........  ...........
                                                                    vein.
37700................  T....................  ...................  Revise leg vein.....         0091      28.8326    $1,573.14      $348.23      $314.63
37720................  T....................  ...................  Removal of leg vein.         0092      25.0959    $1,369.26      $505.37      $273.85
37730................  T....................  ...................  Removal of leg veins         0092      25.0959    $1,369.26      $505.37      $273.85
37735................  T....................  ...................  Removal of leg veins/        0092      25.0959    $1,369.26      $505.37      $273.85
                                                                    lesion.
37760................  T....................  ...................  Revision of leg              0091      28.8326    $1,573.14      $348.23      $314.63
                                                                    veins.
37765................  T....................  NI.................  Phleb veins - extrem         0091      28.8326    $1,573.14      $348.23      $314.63
                                                                    - to 20.
37766................  T....................  NI.................  Phleb veins - extrem         0091      28.8326    $1,573.14      $348.23      $314.63
                                                                    20+.
37780................  T....................  ...................  Revision of leg vein         0091      28.8326    $1,573.14      $348.23      $314.63
37785................  T....................  ...................  Ligate/divide/excise         0091      28.8326    $1,573.14      $348.23      $314.63
                                                                    vein.
37788................  C....................  ...................  Revascularization,    ...........  ...........  ...........  ...........  ...........
                                                                    penis.
37790................  T....................  ...................  Penile venous                0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    occlusion.
37799................  T....................  ...................  Vascular surgery             0035       0.1691        $9.23        $2.79        $1.85
                                                                    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      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    splenectomy.
38129................  T....................  ...................  Laparoscope proc,            0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    spleen.
38200................  N....................  ...................  Injection for spleen  ...........  ...........  ...........  ...........  ...........
                                                                    x-ray.
38204................  E....................  ...................  Bl donor search       ...........  ...........  ...........  ...........  ...........
                                                                    management.
38205................  S....................  ...................  Harvest allogenic            0111      13.1719      $718.67      $200.18      $143.73
                                                                    stem cells.
38206................  S....................  ...................  Harvest auto stem            0111      13.1719      $718.67      $200.18      $143.73
                                                                    cells.
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                  0003       2.3229      $126.74  ...........       $25.35
                                                                    aspiration.
38221................  T....................  ...................  Bone marrow biopsy..         0003       2.3229      $126.74  ...........       $25.35
38230................  S....................  ...................  Bone marrow                  0123       5.2882      $288.53  ...........       $57.71
                                                                    collection.
38240................  S....................  ...................  Bone marrow/stem             0123       5.2882      $288.53  ...........       $57.71
                                                                    transplant.
38241................  S....................  ...................  Bone marrow/stem             0123       5.2882      $288.53  ...........       $57.71
                                                                    transplant.
38242................  S....................  ...................  Lymphocyte infuse            0111      13.1719      $718.67      $200.18      $143.73
                                                                    transplant.
38300................  T....................  ...................  Drainage, lymph node         0008      19.4831    $1,063.02  ...........      $212.60
                                                                    lesion.
38305................  T....................  ...................  Drainage, lymph node         0008      19.4831    $1,063.02  ...........      $212.60
                                                                    lesion.
38308................  T....................  ...................  Incision of lymph            0113      19.9322    $1,087.52  ...........      $217.50
                                                                    channels.
38380................  C....................  ...................  Thoracic duct         ...........  ...........  ...........  ...........  ...........
                                                                    procedure.
38381................  C....................  ...................  Thoracic duct         ...........  ...........  ...........  ...........  ...........
                                                                    procedure.
38382................  C....................  ...................  Thoracic duct         ...........  ...........  ...........  ...........  ...........
                                                                    procedure.
38500................  T....................  ...................  Biopsy/removal,              0113      19.9322    $1,087.52  ...........      $217.50
                                                                    lymph nodes.
38505................  T....................  ...................  Needle biopsy, lymph         0005       3.2698      $178.40       $71.59       $35.68
                                                                    nodes.
38510................  T....................  ...................  Biopsy/removal,              0113      19.9322    $1,087.52  ...........      $217.50
                                                                    lymph nodes.
38520................  T....................  ...................  Biopsy/removal,              0113      19.9322    $1,087.52  ...........      $217.50
                                                                    lymph nodes.

[[Page 63531]]

 
38525................  T....................  ...................  Biopsy/removal,              0113      19.9322    $1,087.52  ...........      $217.50
                                                                    lymph nodes.
38530................  T....................  ...................  Biopsy/removal,              0113      19.9322    $1,087.52  ...........      $217.50
                                                                    lymph nodes.
38542................  T....................  ...................  Explore deep                 0114      37.5963    $2,051.29      $485.91      $410.26
                                                                    node(s), neck.
38550................  T....................  ...................  Removal, neck/armpit         0113      19.9322    $1,087.52  ...........      $217.50
                                                                    lesion.
38555................  T....................  ...................  Removal, neck/armpit         0113      19.9322    $1,087.52  ...........      $217.50
                                                                    lesion.
38562................  C....................  ...................  Removal, pelvic       ...........  ...........  ...........  ...........  ...........
                                                                    lymph nodes.
38564................  C....................  ...................  Removal, abdomen      ...........  ...........  ...........  ...........  ...........
                                                                    lymph nodes.
38570................  T....................  ...................  Laparoscopy, lymph           0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    node biop.
38571................  T....................  ...................  Laparoscopy,                 0132      57.2045    $3,121.13    $1,239.22      $624.23
                                                                    lymphadenectomy.
38572................  T....................  ...................  Laparoscopy,                 0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    lymphadenectomy.
38589................  T....................  ...................  Laparoscope proc,            0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    lymphatic.
38700................  T....................  ...................  Removal of lymph             0113      19.9322    $1,087.52  ...........      $217.50
                                                                    nodes, neck.
38720................  T....................  ...................  Removal of lymph             0113      19.9322    $1,087.52  ...........      $217.50
                                                                    nodes, neck.
38724................  C....................  ...................  Removal of lymph      ...........  ...........  ...........  ...........  ...........
                                                                    nodes, neck.
38740................  T....................  ...................  Remove armpit lymph          0114      37.5963    $2,051.29      $485.91      $410.26
                                                                    nodes.
38745................  T....................  ...................  Remove armpit lymph          0114      37.5963    $2,051.29      $485.91      $410.26
                                                                    nodes.
38746................  C....................  ...................  Remove thoracic       ...........  ...........  ...........  ...........  ...........
                                                                    lymph nodes.
38747................  C....................  ...................  Remove abdominal      ...........  ...........  ...........  ...........  ...........
                                                                    lymph nodes.
38760................  T....................  ...................  Remove groin lymph           0113      19.9322    $1,087.52  ...........      $217.50
                                                                    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       3.6718      $200.34  ...........       $40.07
                                                                    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             0069      28.9392    $1,578.95      $591.64      $315.79
                                                                    chest.
39499................  C....................  ...................  Chest procedure.....  ...........  ...........  ...........  ...........  ...........
39501................  C....................  ...................  Repair diaphragm      ...........  ...........  ...........  ...........  ...........
                                                                    laceration.
39502................  C....................  ...................  Repair                ...........  ...........  ...........  ...........  ...........
                                                                    paraesophageal
                                                                    hernia.
39503................  C....................  ...................  Repair of diaphragm   ...........  ...........  ...........  ...........  ...........
                                                                    hernia.
39520................  C....................  ...................  Repair of diaphragm   ...........  ...........  ...........  ...........  ...........
                                                                    hernia.
39530................  C....................  ...................  Repair of diaphragm   ...........  ...........  ...........  ...........  ...........
                                                                    hernia.
39531................  C....................  ...................  Repair of diaphragm   ...........  ...........  ...........  ...........  ...........
                                                                    hernia.
39540................  C....................  ...................  Repair of diaphragm   ...........  ...........  ...........  ...........  ...........
                                                                    hernia.
39541................  C....................  ...................  Repair of diaphragm   ...........  ...........  ...........  ...........  ...........
                                                                    hernia.
39545................  C....................  ...................  Revision of           ...........  ...........  ...........  ...........  ...........
                                                                    diaphragm.
39560................  C....................  ...................  Resect diaphragm,     ...........  ...........  ...........  ...........  ...........
                                                                    simple.
39561................  C....................  ...................  Resect diaphragm,     ...........  ...........  ...........  ...........  ...........
                                                                    complex.
39599................  C....................  ...................  Diaphragm surgery     ...........  ...........  ...........  ...........  ...........
                                                                    procedure.
40490................  T....................  ...................  Biopsy of lip.......         0251       1.7880       $97.56  ...........       $19.51
40500................  T....................  ...................  Partial excision of          0253      15.2249      $830.69      $282.29      $166.14
                                                                    lip.
40510................  T....................  ...................  Partial excision of          0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    lip.
40520................  T....................  ...................  Partial excision of          0253      15.2249      $830.69      $282.29      $166.14
                                                                    lip.
40525................  T....................  ...................  Reconstruct lip with         0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    flap.
40527................  T....................  ...................  Reconstruct lip with         0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    flap.
40530................  T....................  ...................  Partial removal of           0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    lip.
40650................  T....................  ...................  Repair lip..........         0252       6.4469      $351.75      $113.41       $70.35
40652................  T....................  ...................  Repair lip..........         0252       6.4469      $351.75      $113.41       $70.35
40654................  T....................  ...................  Repair lip..........         0252       6.4469      $351.75      $113.41       $70.35
40700................  T....................  ...................  Repair cleft lip/            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    nasal.
40701................  T....................  ...................  Repair cleft lip/            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    nasal.
40702................  T....................  ...................  Repair cleft lip/            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    nasal.
40720................  T....................  ...................  Repair cleft lip/            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    nasal.
40761................  T....................  ...................  Repair cleft lip/            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    nasal.
40799................  T....................  ...................  Lip surgery                  0253      15.2249      $830.69      $282.29      $166.14
                                                                    procedure.
40800................  T....................  ...................  Drainage of mouth            0251       1.7880       $97.56  ...........       $19.51
                                                                    lesion.
40801................  T....................  ...................  Drainage of mouth            0252       6.4469      $351.75      $113.41       $70.35
                                                                    lesion.
40804................  X....................  ...................  Removal, foreign             0340       0.6314       $34.45  ...........        $6.89
                                                                    body, mouth.
40805................  T....................  ...................  Removal, foreign             0252       6.4469      $351.75      $113.41       $70.35
                                                                    body, mouth.
40806................  T....................  ...................  Incision of lip fold         0251       1.7880       $97.56  ...........       $19.51
40808................  T....................  ...................  Biopsy of mouth              0251       1.7880       $97.56  ...........       $19.51
                                                                    lesion.
40810................  T....................  ...................  Excision of mouth            0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
40812................  T....................  ...................  Excise/repair mouth          0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
40814................  T....................  ...................  Excise/repair mouth          0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
40816................  T....................  ...................  Excision of mouth            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    lesion.
40818................  T....................  ...................  Excise oral mucosa           0251       1.7880       $97.56  ...........       $19.51
                                                                    for graft.
40819................  T....................  ...................  Excise lip or cheek          0252       6.4469      $351.75      $113.41       $70.35
                                                                    fold.
40820................  T....................  ...................  Treatment of mouth           0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
40830................  T....................  ...................  Repair mouth                 0251       1.7880       $97.56  ...........       $19.51
                                                                    laceration.
40831................  T....................  ...................  Repair mouth                 0252       6.4469      $351.75      $113.41       $70.35
                                                                    laceration.

[[Page 63532]]

 
40840................  T....................  ...................  Reconstruction of            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    mouth.
40842................  T....................  ...................  Reconstruction of            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    mouth.
40843................  T....................  ...................  Reconstruction of            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    mouth.
40844................  T....................  ...................  Reconstruction of            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    mouth.
40845................  T....................  ...................  Reconstruction of            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    mouth.
40899................  T....................  ...................  Mouth surgery                0252       6.4469      $351.75      $113.41       $70.35
                                                                    procedure.
41000................  T....................  ...................  Drainage of mouth            0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
41005................  T....................  ...................  Drainage of mouth            0251       1.7880       $97.56  ...........       $19.51
                                                                    lesion.
41006................  T....................  ...................  Drainage of mouth            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    lesion.
41007................  T....................  ...................  Drainage of mouth            0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
41008................  T....................  ...................  Drainage of mouth            0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
41009................  T....................  ...................  Drainage of mouth            0251       1.7880       $97.56  ...........       $19.51
                                                                    lesion.
41010................  T....................  ...................  Incision of tongue           0253      15.2249      $830.69      $282.29      $166.14
                                                                    fold.
41015................  T....................  ...................  Drainage of mouth            0251       1.7880       $97.56  ...........       $19.51
                                                                    lesion.
41016................  T....................  ...................  Drainage of mouth            0252       6.4469      $351.75      $113.41       $70.35
                                                                    lesion.
41017................  T....................  ...................  Drainage of mouth            0252       6.4469      $351.75      $113.41       $70.35
                                                                    lesion.
41018................  T....................  ...................  Drainage of mouth            0252       6.4469      $351.75      $113.41       $70.35
                                                                    lesion.
41100................  T....................  ...................  Biopsy of tongue....         0252       6.4469      $351.75      $113.41       $70.35
41105................  T....................  ...................  Biopsy of tongue....         0253      15.2249      $830.69      $282.29      $166.14
41108................  T....................  ...................  Biopsy of floor of           0252       6.4469      $351.75      $113.41       $70.35
                                                                    mouth.
41110................  T....................  ...................  Excision of tongue           0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
41112................  T....................  ...................  Excision of tongue           0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
41113................  T....................  ...................  Excision of tongue           0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
41114................  T....................  ...................  Excision of tongue           0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    lesion.
41115................  T....................  ...................  Excision of tongue           0252       6.4469      $351.75      $113.41       $70.35
                                                                    fold.
41116................  T....................  ...................  Excision of mouth            0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
41120................  T....................  ...................  Partial removal of           0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    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       1.7880       $97.56  ...........       $19.51
                                                                    laceration.
41251................  T....................  ...................  Repair tongue                0251       1.7880       $97.56  ...........       $19.51
                                                                    laceration.
41252................  T....................  ...................  Repair tongue                0252       6.4469      $351.75      $113.41       $70.35
                                                                    laceration.
41500................  T....................  ...................  Fixation of tongue..         0254      21.8901    $1,194.35      $321.35      $238.87
41510................  T....................  ...................  Tongue to lip                0253      15.2249      $830.69      $282.29      $166.14
                                                                    surgery.
41520................  T....................  ...................  Reconstruction,              0252       6.4469      $351.75      $113.41       $70.35
                                                                    tongue fold.
41599................  T....................  ...................  Tongue and mouth             0251       1.7880       $97.56  ...........       $19.51
                                                                    surgery.
41800................  T....................  ...................  Drainage of gum              0251       1.7880       $97.56  ...........       $19.51
                                                                    lesion.
41805................  T....................  ...................  Removal foreign              0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    body, gum.
41806................  T....................  ...................  Removal foreign              0253      15.2249      $830.69      $282.29      $166.14
                                                                    body,jawbone.
41820................  T....................  ...................  Excision, gum, each          0252       6.4469      $351.75      $113.41       $70.35
                                                                    quadrant.
41821................  T....................  ...................  Excision of gum flap         0252       6.4469      $351.75      $113.41       $70.35
41822................  T....................  ...................  Excision of gum              0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
41823................  T....................  ...................  Excision of gum              0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    lesion.
41825................  T....................  ...................  Excision of gum              0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
41826................  T....................  ...................  Excision of gum              0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
41827................  T....................  ...................  Excision of gum              0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    lesion.
41828................  T....................  ...................  Excision of gum              0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
41830................  T....................  ...................  Removal of gum               0253      15.2249      $830.69      $282.29      $166.14
                                                                    tissue.
41850................  T....................  ...................  Treatment of gum             0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
41870................  T....................  ...................  Gum graft...........         0254      21.8901    $1,194.35      $321.35      $238.87
41872................  T....................  ...................  Repair gum..........         0253      15.2249      $830.69      $282.29      $166.14
41874................  T....................  ...................  Repair tooth socket.         0254      21.8901    $1,194.35      $321.35      $238.87
41899................  T....................  ...................  Dental surgery               0253      15.2249      $830.69      $282.29      $166.14
                                                                    procedure.
42000................  T....................  ...................  Drainage mouth roof          0251       1.7880       $97.56  ...........       $19.51
                                                                    lesion.
42100................  T....................  ...................  Biopsy roof of mouth         0252       6.4469      $351.75      $113.41       $70.35
42104................  T....................  ...................  Excision lesion,             0253      15.2249      $830.69      $282.29      $166.14
                                                                    mouth roof.
42106................  T....................  ...................  Excision lesion,             0253      15.2249      $830.69      $282.29      $166.14
                                                                    mouth roof.
42107................  T....................  ...................  Excision lesion,             0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    mouth roof.
42120................  T....................  ...................  Remove palate/lesion         0256      35.1548    $1,918.08  ...........      $383.62
42140................  T....................  ...................  Excision of uvula...         0252       6.4469      $351.75      $113.41       $70.35
42145................  T....................  ...................  Repair palate,               0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    pharynx/uvula.
42160................  T....................  ...................  Treatment mouth roof         0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
42180................  T....................  ...................  Repair palate.......         0251       1.7880       $97.56  ...........       $19.51
42182................  T....................  ...................  Repair palate.......         0256      35.1548    $1,918.08  ...........      $383.62
42200................  T....................  ...................  Reconstruct cleft            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    palate.
42205................  T....................  ...................  Reconstruct cleft            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    palate.
42210................  T....................  ...................  Reconstruct cleft            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    palate.
42215................  T....................  ...................  Reconstruct cleft            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    palate.
42220................  T....................  ...................  Reconstruct cleft            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    palate.
42225................  T....................  ...................  Reconstruct cleft            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    palate.

[[Page 63533]]

 
42226................  T....................  ...................  Lengthening of               0256      35.1548    $1,918.08  ...........      $383.62
                                                                    palate.
42227................  T....................  ...................  Lengthening of               0256      35.1548    $1,918.08  ...........      $383.62
                                                                    palate.
42235................  T....................  ...................  Repair palate.......         0253      15.2249      $830.69      $282.29      $166.14
42260................  T....................  ...................  Repair nose to lip           0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    fistula.
42280................  T....................  ...................  Preparation, palate          0251       1.7880       $97.56  ...........       $19.51
                                                                    mold.
42281................  T....................  ...................  Insertion, palate            0253      15.2249      $830.69      $282.29      $166.14
                                                                    prosthesis.
42299................  T....................  ...................  Palate/uvula surgery         0251       1.7880       $97.56  ...........       $19.51
42300................  T....................  ...................  Drainage of salivary         0253      15.2249      $830.69      $282.29      $166.14
                                                                    gland.
42305................  T....................  ...................  Drainage of salivary         0253      15.2249      $830.69      $282.29      $166.14
                                                                    gland.
42310................  T....................  ...................  Drainage of salivary         0251       1.7880       $97.56  ...........       $19.51
                                                                    gland.
42320................  T....................  ...................  Drainage of salivary         0251       1.7880       $97.56  ...........       $19.51
                                                                    gland.
42325................  T....................  ...................  Create salivary cyst         0251       1.7880       $97.56  ...........       $19.51
                                                                    drain.
42326................  T....................  ...................  Create salivary cyst         0252       6.4469      $351.75      $113.41       $70.35
                                                                    drain.
42330................  T....................  ...................  Removal of salivary          0253      15.2249      $830.69      $282.29      $166.14
                                                                    stone.
42335................  T....................  ...................  Removal of salivary          0253      15.2249      $830.69      $282.29      $166.14
                                                                    stone.
42340................  T....................  ...................  Removal of salivary          0253      15.2249      $830.69      $282.29      $166.14
                                                                    stone.
42400................  T....................  ...................  Biopsy of salivary           0005       3.2698      $178.40       $71.59       $35.68
                                                                    gland.
42405................  T....................  ...................  Biopsy of salivary           0253      15.2249      $830.69      $282.29      $166.14
                                                                    gland.
42408................  T....................  ...................  Excision of salivary         0253      15.2249      $830.69      $282.29      $166.14
                                                                    cyst.
42409................  T....................  ...................  Drainage of salivary         0253      15.2249      $830.69      $282.29      $166.14
                                                                    cyst.
42410................  T....................  ...................  Excise parotid gland/        0256      35.1548    $1,918.08  ...........      $383.62
                                                                    lesion.
42415................  T....................  ...................  Excise parotid gland/        0256      35.1548    $1,918.08  ...........      $383.62
                                                                    lesion.
42420................  T....................  ...................  Excise parotid gland/        0256      35.1548    $1,918.08  ...........      $383.62
                                                                    lesion.
42425................  T....................  ...................  Excise parotid gland/        0256      35.1548    $1,918.08  ...........      $383.62
                                                                    lesion.
42426................  C....................  ...................  Excise parotid gland/ ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
42440................  T....................  ...................  Excise submaxillary          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    gland.
42450................  T....................  ...................  Excise sublingual            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    gland.
42500................  T....................  ...................  Repair salivary duct         0254      21.8901    $1,194.35      $321.35      $238.87
42505................  T....................  ...................  Repair salivary duct         0256      35.1548    $1,918.08  ...........      $383.62
42507................  T....................  ...................  Parotid duct                 0256      35.1548    $1,918.08  ...........      $383.62
                                                                    diversion.
42508................  T....................  ...................  Parotid duct                 0256      35.1548    $1,918.08  ...........      $383.62
                                                                    diversion.
42509................  T....................  ...................  Parotid duct                 0256      35.1548    $1,918.08  ...........      $383.62
                                                                    diversion.
42510................  T....................  ...................  Parotid duct                 0256      35.1548    $1,918.08  ...........      $383.62
                                                                    diversion.
42550................  N....................  ...................  Injection for         ...........  ...........  ...........  ...........  ...........
                                                                    salivary x-ray.
42600................  T....................  ...................  Closure of salivary          0253      15.2249      $830.69      $282.29      $166.14
                                                                    fistula.
42650................  T....................  ...................  Dilation of salivary         0252       6.4469      $351.75      $113.41       $70.35
                                                                    duct.
42660................  T....................  ...................  Dilation of salivary         0251       1.7880       $97.56  ...........       $19.51
                                                                    duct.
42665................  T....................  ...................  Ligation of salivary         0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    duct.
42699................  T....................  ...................  Salivary surgery             0253      15.2249      $830.69      $282.29      $166.14
                                                                    procedure.
42700................  T....................  ...................  Drainage of tonsil           0251       1.7880       $97.56  ...........       $19.51
                                                                    abscess.
42720................  T....................  ...................  Drainage of throat           0253      15.2249      $830.69      $282.29      $166.14
                                                                    abscess.
42725................  T....................  ...................  Drainage of throat           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    abscess.
42800................  T....................  ...................  Biopsy of throat....         0253      15.2249      $830.69      $282.29      $166.14
42802................  T....................  ...................  Biopsy of throat....         0253      15.2249      $830.69      $282.29      $166.14
42804................  T....................  ...................  Biopsy of upper nose/        0253      15.2249      $830.69      $282.29      $166.14
                                                                    throat.
42806................  T....................  ...................  Biopsy of upper nose/        0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    throat.
42808................  T....................  ...................  Excise pharynx               0253      15.2249      $830.69      $282.29      $166.14
                                                                    lesion.
42809................  X....................  ...................  Remove pharynx               0340       0.6314       $34.45  ...........        $6.89
                                                                    foreign body.
42810................  T....................  ...................  Excision of neck             0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    cyst.
42815................  T....................  ...................  Excision of neck             0256      35.1548    $1,918.08  ...........      $383.62
                                                                    cyst.
42820................  T....................  ...................  Remove tonsils and           0258      20.6265    $1,125.40      $437.25      $225.08
                                                                    adenoids.
42821................  T....................  ...................  Remove tonsils and           0258      20.6265    $1,125.40      $437.25      $225.08
                                                                    adenoids.
42825................  T....................  ...................  Removal of tonsils..         0258      20.6265    $1,125.40      $437.25      $225.08
42826................  T....................  ...................  Removal of tonsils..         0258      20.6265    $1,125.40      $437.25      $225.08
42830................  T....................  ...................  Removal of adenoids.         0258      20.6265    $1,125.40      $437.25      $225.08
42831................  T....................  ...................  Removal of adenoids.         0258      20.6265    $1,125.40      $437.25      $225.08
42835................  T....................  ...................  Removal of adenoids.         0258      20.6265    $1,125.40      $437.25      $225.08
42836................  T....................  ...................  Removal of adenoids.         0258      20.6265    $1,125.40      $437.25      $225.08
42842................  T....................  ...................  Extensive surgery of         0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    throat.
42844................  T....................  ...................  Extensive surgery of         0256      35.1548    $1,918.08  ...........      $383.62
                                                                    throat.
42845................  C....................  ...................  Extensive surgery of  ...........  ...........  ...........  ...........  ...........
                                                                    throat.
42860................  T....................  ...................  Excision of tonsil           0258      20.6265    $1,125.40      $437.25      $225.08
                                                                    tags.
42870................  T....................  ...................  Excision of lingual          0258      20.6265    $1,125.40      $437.25      $225.08
                                                                    tonsil.
42890................  T....................  ...................  Partial removal of           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    pharynx.
42892................  T....................  ...................  Revision of                  0256      35.1548    $1,918.08  ...........      $383.62
                                                                    pharyngeal walls.
42894................  C....................  ...................  Revision of           ...........  ...........  ...........  ...........  ...........
                                                                    pharyngeal walls.
42900................  T....................  ...................  Repair throat wound.         0252       6.4469      $351.75      $113.41       $70.35
42950................  T....................  ...................  Reconstruction of            0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    throat.
42953................  C....................  ...................  Repair throat,        ...........  ...........  ...........  ...........  ...........
                                                                    esophagus.
42955................  T....................  ...................  Surgical opening of          0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    throat.
42960................  T....................  ...................  Control throat               0250       1.4697       $80.19       $28.07       $16.04
                                                                    bleeding.
42961................  C....................  ...................  Control throat        ...........  ...........  ...........  ...........  ...........
                                                                    bleeding.
42962................  T....................  ...................  Control throat               0256      35.1548    $1,918.08  ...........      $383.62
                                                                    bleeding.
42970................  T....................  ...................  Control nose/throat          0250       1.4697       $80.19       $28.07       $16.04
                                                                    bleeding.
42971................  C....................  ...................  Control nose/throat   ...........  ...........  ...........  ...........  ...........
                                                                    bleeding.

[[Page 63534]]

 
42972................  T....................  ...................  Control nose/throat          0253      15.2249      $830.69      $282.29      $166.14
                                                                    bleeding.
42999................  T....................  ...................  Throat surgery               0252       6.4469      $351.75      $113.41       $70.35
                                                                    procedure.
43020................  T....................  ...................  Incision of                  0252       6.4469      $351.75      $113.41       $70.35
                                                                    esophagus.
43030................  T....................  ...................  Throat muscle                0253      15.2249      $830.69      $282.29      $166.14
                                                                    surgery.
43045................  C....................  ...................  Incision of           ...........  ...........  ...........  ...........  ...........
                                                                    esophagus.
43100................  C....................  ...................  Excision of           ...........  ...........  ...........  ...........  ...........
                                                                    esophagus lesion.
43101................  C....................  ...................  Excision of           ...........  ...........  ...........  ...........  ...........
                                                                    esophagus lesion.
43107................  C....................  ...................  Removal of esophagus  ...........  ...........  ...........  ...........  ...........
43108................  C....................  ...................  Removal of esophagus  ...........  ...........  ...........  ...........  ...........
43112................  C....................  ...................  Removal of esophagus  ...........  ...........  ...........  ...........  ...........
43113................  C....................  ...................  Removal of esophagus  ...........  ...........  ...........  ...........  ...........
43116................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    esophagus.
43117................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    esophagus.
43118................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    esophagus.
43121................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    esophagus.
43122................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    esophagus.
43123................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    esophagus.
43124................  C....................  ...................  Removal of esophagus  ...........  ...........  ...........  ...........  ...........
43130................  T....................  ...................  Removal of esophagus         0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    pouch.
43135................  C....................  ...................  Removal of esophagus  ...........  ...........  ...........  ...........  ...........
                                                                    pouch.
43200................  T....................  ...................  Esophagus endoscopy.         0141       7.8206      $426.70      $143.38       $85.34
43201................  T....................  ...................  Esoph scope w/               0141       7.8206      $426.70      $143.38       $85.34
                                                                    submucous inj.
43202................  T....................  ...................  Esophagus endoscopy,         0141       7.8206      $426.70      $143.38       $85.34
                                                                    biopsy.
43204................  T....................  ...................  Esoph scope w/               0141       7.8206      $426.70      $143.38       $85.34
                                                                    sclerosis inj.
43205................  T....................  ...................  Esophagus endoscopy/         0141       7.8206      $426.70      $143.38       $85.34
                                                                    ligation.
43215................  T....................  ...................  Esophagus endoscopy.         0141       7.8206      $426.70      $143.38       $85.34
43216................  T....................  ...................  Esophagus endoscopy/         0141       7.8206      $426.70      $143.38       $85.34
                                                                    lesion.
43217................  T....................  ...................  Esophagus endoscopy.         0141       7.8206      $426.70      $143.38       $85.34
43219................  T....................  ...................  Esophagus endoscopy.         0384      20.6602    $1,127.24      $244.83      $225.45
43220................  T....................  ...................  Esoph endoscopy,             0141       7.8206      $426.70      $143.38       $85.34
                                                                    dilation.
43226................  T....................  ...................  Esoph endoscopy,             0141       7.8206      $426.70      $143.38       $85.34
                                                                    dilation.
43227................  T....................  ...................  Esoph endoscopy,             0141       7.8206      $426.70      $143.38       $85.34
                                                                    repair.
43228................  T....................  ...................  Esoph endoscopy,             0141       7.8206      $426.70      $143.38       $85.34
                                                                    ablation.
43231................  T....................  ...................  Esoph endoscopy w/us         0141       7.8206      $426.70      $143.38       $85.34
                                                                    exam.
43232................  T....................  ...................  Esoph endoscopy w/us         0141       7.8206      $426.70      $143.38       $85.34
                                                                    fn bx.
43234................  T....................  ...................  Upper GI endoscopy,          0141       7.8206      $426.70      $143.38       $85.34
                                                                    exam.
43235................  T....................  ...................  Uppr gi endoscopy,           0141       7.8206      $426.70      $143.38       $85.34
                                                                    diagnosis.
43236................  T....................  ...................  Uppr gi scope w/             0141       7.8206      $426.70      $143.38       $85.34
                                                                    submuc inj.
43237................  T....................  NI.................  Endoscopic us exam,          0141       7.8206      $426.70      $143.38       $85.34
                                                                    esoph.
43238................  T....................  NI.................  Uppr gi endoscopy w/         0141       7.8206      $426.70      $143.38       $85.34
                                                                    us fn bx.
43239................  T....................  ...................  Upper GI endoscopy,          0141       7.8206      $426.70      $143.38       $85.34
                                                                    biopsy.
43240................  T....................  ...................  Esoph endoscope w/           0141       7.8206      $426.70      $143.38       $85.34
                                                                    drain cyst.
43241................  T....................  ...................  Upper GI endoscopy           0141       7.8206      $426.70      $143.38       $85.34
                                                                    with tube.
43242................  T....................  ...................  Uppr gi endoscopy w/         0141       7.8206      $426.70      $143.38       $85.34
                                                                    us fn bx.
43243................  T....................  ...................  Upper gi endoscopy &         0141       7.8206      $426.70      $143.38       $85.34
                                                                    inject.
43244................  T....................  ...................  Upper GI endoscopy/          0141       7.8206      $426.70      $143.38       $85.34
                                                                    ligation.
43245................  T....................  ...................  Uppr gi scope dilate         0141       7.8206      $426.70      $143.38       $85.34
                                                                    strictr.
43246................  T....................  ...................  Place gastrostomy            0141       7.8206      $426.70      $143.38       $85.34
                                                                    tube.
43247................  T....................  ...................  Operative upper GI           0141       7.8206      $426.70      $143.38       $85.34
                                                                    endoscopy.
43248................  T....................  ...................  Uppr gi endoscopy/           0141       7.8206      $426.70      $143.38       $85.34
                                                                    guide wire.
43249................  T....................  ...................  Esoph endoscopy,             0141       7.8206      $426.70      $143.38       $85.34
                                                                    dilation.
43250................  T....................  ...................  Upper GI endoscopy/          0141       7.8206      $426.70      $143.38       $85.34
                                                                    tumor.
43251................  T....................  ...................  Operative upper GI           0141       7.8206      $426.70      $143.38       $85.34
                                                                    endoscopy.
43255................  T....................  ...................  Operative upper GI           0141       7.8206      $426.70      $143.38       $85.34
                                                                    endoscopy.
43256................  T....................  ...................  Uppr gi endoscopy w          0384      20.6602    $1,127.24      $244.83      $225.45
                                                                    stent.
43258................  T....................  ...................  Operative upper GI           0141       7.8206      $426.70      $143.38       $85.34
                                                                    endoscopy.
43259................  T....................  ...................  Endoscopic                   0141       7.8206      $426.70      $143.38       $85.34
                                                                    ultrasound exam.
43260................  T....................  ...................  Endo                         0151      17.9462      $979.16      $245.46      $195.83
                                                                    cholangiopancreatog
                                                                    raph.
43261................  T....................  ...................  Endo                         0151      17.9462      $979.16      $245.46      $195.83
                                                                    cholangiopancreatog
                                                                    raph.
43262................  T....................  ...................  Endo                         0151      17.9462      $979.16      $245.46      $195.83
                                                                    cholangiopancreatog
                                                                    raph.
43263................  T....................  ...................  Endo                         0151      17.9462      $979.16      $245.46      $195.83
                                                                    cholangiopancreatog
                                                                    raph.
43264................  T....................  ...................  Endo                         0151      17.9462      $979.16      $245.46      $195.83
                                                                    cholangiopancreatog
                                                                    raph.
43265................  T....................  ...................  Endo                         0151      17.9462      $979.16      $245.46      $195.83
                                                                    cholangiopancreatog
                                                                    raph.
43267................  T....................  ...................  Endo                         0151      17.9462      $979.16      $245.46      $195.83
                                                                    cholangiopancreatog
                                                                    raph.
43268................  T....................  ...................  Endo                         0384      20.6602    $1,127.24      $244.83      $225.45
                                                                    cholangiopancreatog
                                                                    raph.
43269................  T....................  ...................  Endo                         0384      20.6602    $1,127.24      $244.83      $225.45
                                                                    cholangiopancreatog
                                                                    raph.
43271................  T....................  ...................  Endo                         0151      17.9462      $979.16      $245.46      $195.83
                                                                    cholangiopancreatog
                                                                    raph.
43272................  T....................  ...................  Endo                         0151      17.9462      $979.16      $245.46      $195.83
                                                                    cholangiopancreatog
                                                                    raph.
43280................  T....................  ...................  Laparoscopy,                 0132      57.2045    $3,121.13    $1,239.22      $624.23
                                                                    fundoplasty.
43289................  T....................  ...................  Laparoscope proc,            0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    esoph.
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.

[[Page 63535]]

 
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       6.4525      $352.05      $107.24       $70.41
43453................  T....................  ...................  Dilate esophagus....         0140       6.4525      $352.05      $107.24       $70.41
43456................  T....................  ...................  Dilate esophagus....         0140       6.4525      $352.05      $107.24       $70.41
43458................  T....................  ...................  Dilate esophagus....         0140       6.4525      $352.05      $107.24       $70.41
43460................  C....................  ...................  Pressure treatment    ...........  ...........  ...........  ...........  ...........
                                                                    esophagus.
43496................  C....................  ...................  Free jejunum flap,    ...........  ...........  ...........  ...........  ...........
                                                                    microvasc.
43499................  T....................  ...................  Esophagus surgery            0141       7.8206      $426.70      $143.38       $85.34
                                                                    procedure.
43500................  C....................  ...................  Surgical opening of   ...........  ...........  ...........  ...........  ...........
                                                                    stomach.
43501................  C....................  ...................  Surgical repair of    ...........  ...........  ...........  ...........  ...........
                                                                    stomach.
43502................  C....................  ...................  Surgical repair of    ...........  ...........  ...........  ...........  ...........
                                                                    stomach.
43510................  C....................  ...................  Surgical opening of   ...........  ...........  ...........  ...........  ...........
                                                                    stomach.
43520................  C....................  ...................  Incision of pyloric   ...........  ...........  ...........  ...........  ...........
                                                                    muscle.
43600................  T....................  ...................  Biopsy of stomach...         0141       7.8206      $426.70      $143.38       $85.34
43605................  C....................  ...................  Biopsy of stomach...  ...........  ...........  ...........  ...........  ...........
43610................  C....................  ...................  Excision of stomach   ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
43611................  C....................  ...................  Excision of stomach   ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
43620................  C....................  ...................  Removal of stomach..  ...........  ...........  ...........  ...........  ...........
43621................  C....................  ...................  Removal of stomach..  ...........  ...........  ...........  ...........  ...........
43622................  C....................  ...................  Removal of stomach..  ...........  ...........  ...........  ...........  ...........
43631................  C....................  ...................  Removal of stomach,   ...........  ...........  ...........  ...........  ...........
                                                                    partial.
43632................  C....................  ...................  Removal of stomach,   ...........  ...........  ...........  ...........  ...........
                                                                    partial.
43633................  C....................  ...................  Removal of stomach,   ...........  ...........  ...........  ...........  ...........
                                                                    partial.
43634................  C....................  ...................  Removal of stomach,   ...........  ...........  ...........  ...........  ...........
                                                                    partial.
43635................  C....................  ...................  Removal of stomach,   ...........  ...........  ...........  ...........  ...........
                                                                    partial.
43638................  C....................  ...................  Removal of stomach,   ...........  ...........  ...........  ...........  ...........
                                                                    partial.
43639................  C....................  ...................  Removal of stomach,   ...........  ...........  ...........  ...........  ...........
                                                                    partial.
43640................  C....................  ...................  Vagotomy & pylorus    ...........  ...........  ...........  ...........  ...........
                                                                    repair.
43641................  C....................  ...................  Vagotomy & pylorus    ...........  ...........  ...........  ...........  ...........
                                                                    repair.
43651................  T....................  ...................  Laparoscopy, vagus           0132      57.2045    $3,121.13    $1,239.22      $624.23
                                                                    nerve.
43652................  T....................  ...................  Laparoscopy, vagus           0132      57.2045    $3,121.13    $1,239.22      $624.23
                                                                    nerve.
43653................  T....................  ...................  Laparoscopy,                 0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    gastrostomy.
43659................  T....................  ...................  Laparoscope proc,            0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    stom.
43750................  T....................  ...................  Place gastrostomy            0141       7.8206      $426.70      $143.38       $85.34
                                                                    tube.
43752................  T....................  ...................  Nasal/orogastric w/          0121       2.1189      $115.61       $43.80       $23.12
                                                                    stent.
43760................  T....................  ...................  Change gastrostomy           0121       2.1189      $115.61       $43.80       $23.12
                                                                    tube.
43761................  T....................  ...................  Reposition                   0121       2.1189      $115.61       $43.80       $23.12
                                                                    gastrostomy 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            0141       7.8206      $426.70      $143.38       $85.34
                                                                    tube.
43831................  T....................  ...................  Place gastrostomy            0141       7.8206      $426.70      $143.38       $85.34
                                                                    tube.
43832................  C....................  ...................  Place gastrostomy     ...........  ...........  ...........  ...........  ...........
                                                                    tube.
43840................  C....................  ...................  Repair of stomach     ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
43842................  C....................  ...................  Gastroplasty for      ...........  ...........  ...........  ...........  ...........
                                                                    obesity.
43843................  C....................  ...................  Gastroplasty for      ...........  ...........  ...........  ...........  ...........
                                                                    obesity.
43846................  C....................  ...................  Gastric bypass for    ...........  ...........  ...........  ...........  ...........
                                                                    obesity.
43847................  C....................  ...................  Gastric bypass for    ...........  ...........  ...........  ...........  ...........
                                                                    obesity.
43848................  C....................  ...................  Revision              ...........  ...........  ...........  ...........  ...........
                                                                    gastroplasty.
43850................  C....................  ...................  Revise stomach-bowel  ...........  ...........  ...........  ...........  ...........
                                                                    fusion.
43855................  C....................  ...................  Revise stomach-bowel  ...........  ...........  ...........  ...........  ...........
                                                                    fusion.
43860................  C....................  ...................  Revise stomach-bowel  ...........  ...........  ...........  ...........  ...........
                                                                    fusion.
43865................  C....................  ...................  Revise stomach-bowel  ...........  ...........  ...........  ...........  ...........
                                                                    fusion.
43870................  T....................  ...................  Repair stomach               0141       7.8206      $426.70      $143.38       $85.34
                                                                    opening.

[[Page 63536]]

 
43880................  C....................  ...................  Repair stomach-bowel  ...........  ...........  ...........  ...........  ...........
                                                                    fistula.
43999................  T....................  ...................  Stomach surgery              0141       7.8206      $426.70      $143.38       $85.34
                                                                    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       7.8206      $426.70      $143.38       $85.34
44110................  C....................  ...................  Excise intestine      ...........  ...........  ...........  ...........  ...........
                                                                    lesion(s).
44111................  C....................  ...................  Excision of bowel     ...........  ...........  ...........  ...........  ...........
                                                                    lesion(s).
44120................  C....................  ...................  Removal of small      ...........  ...........  ...........  ...........  ...........
                                                                    intestine.
44121................  C....................  ...................  Removal of small      ...........  ...........  ...........  ...........  ...........
                                                                    intestine.
44125................  C....................  ...................  Removal of small      ...........  ...........  ...........  ...........  ...........
                                                                    intestine.
44126................  C....................  ...................  Enterectomy w/o       ...........  ...........  ...........  ...........  ...........
                                                                    taper, cong.
44127................  C....................  ...................  Enterectomy w/taper,  ...........  ...........  ...........  ...........  ...........
                                                                    cong.
44128................  C....................  ...................  Enterectomy cong,     ...........  ...........  ...........  ...........  ...........
                                                                    add-on.
44130................  C....................  ...................  Bowel to bowel        ...........  ...........  ...........  ...........  ...........
                                                                    fusion.
44132................  C....................  ...................  Enterectomy, cadaver  ...........  ...........  ...........  ...........  ...........
                                                                    donor.
44133................  C....................  ...................  Enterectomy, live     ...........  ...........  ...........  ...........  ...........
                                                                    donor.
44135................  C....................  ...................  Intestine transplnt,  ...........  ...........  ...........  ...........  ...........
                                                                    cadaver.
44136................  C....................  ...................  Intestine             ...........  ...........  ...........  ...........  ...........
                                                                    transplant, live.
44139................  C....................  ...................  Mobilization of       ...........  ...........  ...........  ...........  ...........
                                                                    colon.
44140................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    colon.
44141................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    colon.
44143................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    colon.
44144................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    colon.
44145................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    colon.
44146................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    colon.
44147................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    colon.
44150................  C....................  ...................  Removal of colon....  ...........  ...........  ...........  ...........  ...........
44151................  C....................  ...................  Removal of colon/     ...........  ...........  ...........  ...........  ...........
                                                                    ileostomy.
44152................  C....................  ...................  Removal of colon/     ...........  ...........  ...........  ...........  ...........
                                                                    ileostomy.
44153................  C....................  ...................  Removal of colon/     ...........  ...........  ...........  ...........  ...........
                                                                    ileostomy.
44155................  C....................  ...................  Removal of colon/     ...........  ...........  ...........  ...........  ...........
                                                                    ileostomy.
44156................  C....................  ...................  Removal of colon/     ...........  ...........  ...........  ...........  ...........
                                                                    ileostomy.
44160................  C....................  ...................  Removal of colon....  ...........  ...........  ...........  ...........  ...........
44200................  T....................  ...................  Laparoscopy,                 0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    enterolysis.
44201................  T....................  ...................  Laparoscopy,                 0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    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      57.2045    $3,121.13    $1,239.22      $624.23
                                                                    stoma.
44207................  T....................  ...................  L colectomy/                 0132      57.2045    $3,121.13    $1,239.22      $624.23
                                                                    coloproctostomy.
44208................  T....................  ...................  L colectomy/                 0132      57.2045    $3,121.13    $1,239.22      $624.23
                                                                    coloproctostomy.
44210................  C....................  ...................  Laparo total          ...........  ...........  ...........  ...........  ...........
                                                                    proctocolectomy.
44211................  C....................  ...................  Laparo total          ...........  ...........  ...........  ...........  ...........
                                                                    proctocolectomy.
44212................  C....................  ...................  Laparo total          ...........  ...........  ...........  ...........  ...........
                                                                    proctocolectomy.
44238................  T....................  ...................  Laparoscope proc,            0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    intestine.
44239................  T....................  ...................  Laparoscope proc,            0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    rectum.
44300................  C....................  ...................  Open bowel to skin..  ...........  ...........  ...........  ...........  ...........
44310................  C....................  ...................  Ileostomy/            ...........  ...........  ...........  ...........  ...........
                                                                    jejunostomy.
44312................  T....................  ...................  Revision of                  0027      15.8990      $867.47      $329.72      $173.49
                                                                    ileostomy.
44314................  C....................  ...................  Revision of           ...........  ...........  ...........  ...........  ...........
                                                                    ileostomy.
44316................  C....................  ...................  Devise bowel pouch..  ...........  ...........  ...........  ...........  ...........
44320................  C....................  ...................  Colostomy...........  ...........  ...........  ...........  ...........  ...........
44322................  C....................  ...................  Colostomy with        ...........  ...........  ...........  ...........  ...........
                                                                    biopsies.
44340................  T....................  ...................  Revision of                  0027      15.8990      $867.47      $329.72      $173.49
                                                                    colostomy.
44345................  C....................  ...................  Revision of           ...........  ...........  ...........  ...........  ...........
                                                                    colostomy.
44346................  C....................  ...................  Revision of           ...........  ...........  ...........  ...........  ...........
                                                                    colostomy.
44360................  T....................  ...................  Small bowel                  0142       8.7959      $479.91      $152.78       $95.98
                                                                    endoscopy.
44361................  T....................  ...................  Small bowel                  0142       8.7959      $479.91      $152.78       $95.98
                                                                    endoscopy/biopsy.
44363................  T....................  ...................  Small bowel                  0142       8.7959      $479.91      $152.78       $95.98
                                                                    endoscopy.
44364................  T....................  ...................  Small bowel                  0142       8.7959      $479.91      $152.78       $95.98
                                                                    endoscopy.
44365................  T....................  ...................  Small bowel                  0142       8.7959      $479.91      $152.78       $95.98
                                                                    endoscopy.
44366................  T....................  ...................  Small bowel                  0142       8.7959      $479.91      $152.78       $95.98
                                                                    endoscopy.
44369................  T....................  ...................  Small bowel                  0142       8.7959      $479.91      $152.78       $95.98
                                                                    endoscopy.
44370................  T....................  ...................  Small bowel                  0384      20.6602    $1,127.24      $244.83      $225.45
                                                                    endoscopy/stent.
44372................  T....................  ...................  Small bowel                  0142       8.7959      $479.91      $152.78       $95.98
                                                                    endoscopy.
44373................  T....................  ...................  Small bowel                  0142       8.7959      $479.91      $152.78       $95.98
                                                                    endoscopy.
44376................  T....................  ...................  Small bowel                  0142       8.7959      $479.91      $152.78       $95.98
                                                                    endoscopy.
44377................  T....................  ...................  Small bowel                  0142       8.7959      $479.91      $152.78       $95.98
                                                                    endoscopy/biopsy.

[[Page 63537]]

 
44378................  T....................  ...................  Small bowel                  0142       8.7959      $479.91      $152.78       $95.98
                                                                    endoscopy.
44379................  T....................  ...................  S bowel endoscope w/         0384      20.6602    $1,127.24      $244.83      $225.45
                                                                    stent.
44380................  T....................  ...................  Small bowel                  0142       8.7959      $479.91      $152.78       $95.98
                                                                    endoscopy.
44382................  T....................  ...................  Small bowel                  0142       8.7959      $479.91      $152.78       $95.98
                                                                    endoscopy.
44383................  T....................  ...................  Ileoscopy w/stent...         0384      20.6602    $1,127.24      $244.83      $225.45
44385................  T....................  ...................  Endoscopy of bowel           0143       8.2957      $452.62      $186.06       $90.52
                                                                    pouch.
44386................  T....................  ...................  Endoscopy, bowel             0143       8.2957      $452.62      $186.06       $90.52
                                                                    pouch/biop.
44388................  T....................  ...................  Colonoscopy.........         0143       8.2957      $452.62      $186.06       $90.52
44389................  T....................  ...................  Colonoscopy with             0143       8.2957      $452.62      $186.06       $90.52
                                                                    biopsy.
44390................  T....................  ...................  Colonoscopy for              0143       8.2957      $452.62      $186.06       $90.52
                                                                    foreign body.
44391................  T....................  ...................  Colonoscopy for              0143       8.2957      $452.62      $186.06       $90.52
                                                                    bleeding.
44392................  T....................  ...................  Colonoscopy &                0143       8.2957      $452.62      $186.06       $90.52
                                                                    polypectomy.
44393................  T....................  ...................  Colonoscopy, lesion          0143       8.2957      $452.62      $186.06       $90.52
                                                                    removal.
44394................  T....................  ...................  Colonoscopy w/snare.         0143       8.2957      $452.62      $186.06       $90.52
44397................  T....................  ...................  Colonoscopy w/stent.         0384      20.6602    $1,127.24      $244.83      $225.45
44500................  T....................  ...................  Intro,                       0121       2.1189      $115.61       $43.80       $23.12
                                                                    gastrointestinal
                                                                    tube.
44602................  C....................  ...................  Suture, small         ...........  ...........  ...........  ...........  ...........
                                                                    intestine.
44603................  C....................  ...................  Suture, small         ...........  ...........  ...........  ...........  ...........
                                                                    intestine.
44604................  C....................  ...................  Suture, large         ...........  ...........  ...........  ...........  ...........
                                                                    intestine.
44605................  C....................  ...................  Repair of bowel       ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
44615................  C....................  ...................  Intestinal            ...........  ...........  ...........  ...........  ...........
                                                                    stricturoplasty.
44620................  C....................  ...................  Repair bowel opening  ...........  ...........  ...........  ...........  ...........
44625................  C....................  ...................  Repair bowel opening  ...........  ...........  ...........  ...........  ...........
44626................  C....................  ...................  Repair bowel opening  ...........  ...........  ...........  ...........  ...........
44640................  C....................  ...................  Repair bowel-skin     ...........  ...........  ...........  ...........  ...........
                                                                    fistula.
44650................  C....................  ...................  Repair bowel fistula  ...........  ...........  ...........  ...........  ...........
44660................  C....................  ...................  Repair bowel-bladder  ...........  ...........  ...........  ...........  ...........
                                                                    fistula.
44661................  C....................  ...................  Repair bowel-bladder  ...........  ...........  ...........  ...........  ...........
                                                                    fistula.
44680................  C....................  ...................  Surgical revision,    ...........  ...........  ...........  ...........  ...........
                                                                    intestine.
44700................  C....................  ...................  Suspend bowel w/      ...........  ...........  ...........  ...........  ...........
                                                                    prosthesis.
44701................  N....................  ...................  Intraop colon lavage  ...........  ...........  ...........  ...........  ...........
                                                                    add-on.
44799................  T....................  ...................  Unlisted procedure           0142       8.7959      $479.91      $152.78       $95.98
                                                                    intestine.
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      32.7724    $1,788.09      $659.53      $357.62
                                                                    appendectomy.
44979................  T....................  ...................  Laparoscope proc,            0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    app.
45000................  T....................  ...................  Drainage of pelvic           0148       3.8320      $209.08       $63.38       $41.82
                                                                    abscess.
45005................  T....................  ...................  Drainage of rectal           0148       3.8320      $209.08       $63.38       $41.82
                                                                    abscess.
45020................  T....................  ...................  Drainage of rectal           0148       3.8320      $209.08       $63.38       $41.82
                                                                    abscess.
45100................  T....................  ...................  Biopsy of rectum....         0149      17.1425      $935.31      $293.06      $187.06
45108................  T....................  ...................  Removal of anorectal         0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    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           0149      17.1425      $935.31      $293.06      $187.06
                                                                    stricture.
45160................  T....................  ...................  Excision of rectal           0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    lesion.
45170................  T....................  ...................  Excision of rectal           0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    lesion.
45190................  T....................  ...................  Destruction, rectal          0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    tumor.
45300................  T....................  ...................  Proctosigmoidoscopy          0146       3.9826      $217.29       $64.40       $43.46
                                                                    dx.
45303................  T....................  ...................  Proctosigmoidoscopy          0146       3.9826      $217.29       $64.40       $43.46
                                                                    dilate.
45305................  T....................  ...................  Proctosigmoidoscopy          0146       3.9826      $217.29       $64.40       $43.46
                                                                    w/bx.
45307................  T....................  ...................  Proctosigmoidoscopy          0146       3.9826      $217.29       $64.40       $43.46
                                                                    fb.
45308................  T....................  ...................  Proctosigmoidoscopy          0147       7.6808      $419.07  ...........       $83.81
                                                                    removal.
45309................  T....................  ...................  Proctosigmoidoscopy          0147       7.6808      $419.07  ...........       $83.81
                                                                    removal.
45315................  T....................  ...................  Proctosigmoidoscopy          0147       7.6808      $419.07  ...........       $83.81
                                                                    removal.
45317................  T....................  ...................  Proctosigmoidoscopy          0147       7.6808      $419.07  ...........       $83.81
                                                                    bleed.
45320................  T....................  ...................  Proctosigmoidoscopy          0147       7.6808      $419.07  ...........       $83.81
                                                                    ablate.

[[Page 63538]]

 
45321................  T....................  ...................  Proctosigmoidoscopy          0147       7.6808      $419.07  ...........       $83.81
                                                                    volvul.
45327................  T....................  ...................  Proctosigmoidoscopy          0384      20.6602    $1,127.24      $244.83      $225.45
                                                                    w/stent.
45330................  T....................  ...................  Diagnostic                   0146       3.9826      $217.29       $64.40       $43.46
                                                                    sigmoidoscopy.
45331................  T....................  ...................  Sigmoidoscopy and            0146       3.9826      $217.29       $64.40       $43.46
                                                                    biopsy.
45332................  T....................  ...................  Sigmoidoscopy w/fb           0146       3.9826      $217.29       $64.40       $43.46
                                                                    removal.
45333................  T....................  ...................  Sigmoidoscopy &              0147       7.6808      $419.07  ...........       $83.81
                                                                    polypectomy.
45334................  T....................  ...................  Sigmoidoscopy for            0147       7.6808      $419.07  ...........       $83.81
                                                                    bleeding.
45335................  T....................  ...................  Sigmoidoscopy w/             0147       7.6808      $419.07  ...........       $83.81
                                                                    submuc inj.
45337................  T....................  ...................  Sigmoidoscopy &              0147       7.6808      $419.07  ...........       $83.81
                                                                    decompress.
45338................  T....................  ...................  Sigmoidoscopy w/tumr         0147       7.6808      $419.07  ...........       $83.81
                                                                    remove.
45339................  T....................  ...................  Sigmoidoscopy w/             0147       7.6808      $419.07  ...........       $83.81
                                                                    ablate tumr.
45340................  T....................  ...................  Sig w/balloon                0147       7.6808      $419.07  ...........       $83.81
                                                                    dilation.
45341................  T....................  ...................  Sigmoidoscopy w/             0147       7.6808      $419.07  ...........       $83.81
                                                                    ultrasound.
45342................  T....................  ...................  Sigmoidoscopy w/us           0147       7.6808      $419.07  ...........       $83.81
                                                                    guide bx.
45345................  T....................  ...................  Sigmoidoscopy w/             0384      20.6602    $1,127.24      $244.83      $225.45
                                                                    stent.
45355................  T....................  ...................  Surgical colonoscopy         0143       8.2957      $452.62      $186.06       $90.52
45378................  T....................  ...................  Diagnostic                   0143       8.2957      $452.62      $186.06       $90.52
                                                                    colonoscopy.
45379................  T....................  ...................  Colonoscopy w/fb             0143       8.2957      $452.62      $186.06       $90.52
                                                                    removal.
45380................  T....................  ...................  Colonoscopy and              0143       8.2957      $452.62      $186.06       $90.52
                                                                    biopsy.
45381................  T....................  ...................  Colonoscopy,                 0143       8.2957      $452.62      $186.06       $90.52
                                                                    submucous inj.
45382................  T....................  ...................  Colonoscopy/control          0143       8.2957      $452.62      $186.06       $90.52
                                                                    bleeding.
45383................  T....................  ...................  Lesion removal               0143       8.2957      $452.62      $186.06       $90.52
                                                                    colonoscopy.
45384................  T....................  ...................  Lesion remove                0143       8.2957      $452.62      $186.06       $90.52
                                                                    colonoscopy.
45385................  T....................  ...................  Lesion removal               0143       8.2957      $452.62      $186.06       $90.52
                                                                    colonoscopy.
45386................  T....................  ...................  Colonoscopy dilate           0143       8.2957      $452.62      $186.06       $90.52
                                                                    stricture.
45387................  T....................  ...................  Colonoscopy w/stent.         0384      20.6602    $1,127.24      $244.83      $225.45
45500................  T....................  ...................  Repair of rectum....         0149      17.1425      $935.31      $293.06      $187.06
45505................  T....................  ...................  Repair of rectum....         0150      22.1919    $1,210.81      $437.12      $242.16
45520................  T....................  ...................  Treatment of rectal          0098       1.0729       $58.54       $14.06       $11.71
                                                                    prolapse.
45540................  C....................  ...................  Correct rectal        ...........  ...........  ...........  ...........  ...........
                                                                    prolapse.
45541................  C....................  ...................  Correct rectal        ...........  ...........  ...........  ...........  ...........
                                                                    prolapse.
45550................  C....................  ...................  Repair rectum/remove  ...........  ...........  ...........  ...........  ...........
                                                                    sigmoid.
45560................  T....................  ...................  Repair of rectocele.         0150      22.1919    $1,210.81      $437.12      $242.16
45562................  C....................  ...................  Exploration/repair    ...........  ...........  ...........  ...........  ...........
                                                                    of rectum.
45563................  C....................  ...................  Exploration/repair    ...........  ...........  ...........  ...........  ...........
                                                                    of rectum.
45800................  C....................  ...................  Repair rect/bladder   ...........  ...........  ...........  ...........  ...........
                                                                    fistula.
45805................  C....................  ...................  Repair fistula w/     ...........  ...........  ...........  ...........  ...........
                                                                    colostomy.
45820................  C....................  ...................  Repair rectourethral  ...........  ...........  ...........  ...........  ...........
                                                                    fistula.
45825................  C....................  ...................  Repair fistula w/     ...........  ...........  ...........  ...........  ...........
                                                                    colostomy.
45900................  T....................  ...................  Reduction of rectal          0148       3.8320      $209.08       $63.38       $41.82
                                                                    prolapse.
45905................  T....................  ...................  Dilation of anal             0149      17.1425      $935.31      $293.06      $187.06
                                                                    sphincter.
45910................  T....................  ...................  Dilation of rectal           0149      17.1425      $935.31      $293.06      $187.06
                                                                    narrowing.
45915................  T....................  ...................  Remove rectal                0148       3.8320      $209.08       $63.38       $41.82
                                                                    obstruction.
45999................  T....................  ...................  Rectum surgery               0148       3.8320      $209.08       $63.38       $41.82
                                                                    procedure.
46020................  T....................  ...................  Placement of seton..         0148       3.8320      $209.08       $63.38       $41.82
46030................  T....................  ...................  Removal of rectal            0148       3.8320      $209.08       $63.38       $41.82
                                                                    marker.
46040................  T....................  ...................  Incision of rectal           0149      17.1425      $935.31      $293.06      $187.06
                                                                    abscess.
46045................  T....................  ...................  Incision of rectal           0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    abscess.
46050................  T....................  ...................  Incision of anal             0148       3.8320      $209.08       $63.38       $41.82
                                                                    abscess.
46060................  T....................  ...................  Incision of rectal           0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    abscess.
46070................  T....................  ...................  Incision of anal             0155      10.0809      $550.02      $188.89      $110.00
                                                                    septum.
46080................  T....................  ...................  Incision of anal             0149      17.1425      $935.31      $293.06      $187.06
                                                                    sphincter.
46083................  T....................  ...................  Incise external              0148       3.8320      $209.08       $63.38       $41.82
                                                                    hemorrhoid.
46200................  T....................  ...................  Removal of anal              0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    fissure.
46210................  T....................  ...................  Removal of anal              0149      17.1425      $935.31      $293.06      $187.06
                                                                    crypt.
46211................  T....................  ...................  Removal of anal              0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    crypts.
46220................  T....................  ...................  Removal of anal tag.         0149      17.1425      $935.31      $293.06      $187.06
46221................  T....................  ...................  Ligation of                  0148       3.8320      $209.08       $63.38       $41.82
                                                                    hemorrhoid(s).
46230................  T....................  ...................  Removal of anal tags         0149      17.1425      $935.31      $293.06      $187.06
46250................  T....................  ...................  Hemorrhoidectomy....         0150      22.1919    $1,210.81      $437.12      $242.16
46255................  T....................  ...................  Hemorrhoidectomy....         0150      22.1919    $1,210.81      $437.12      $242.16
46257................  T....................  ...................  Remove hemorrhoids &         0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    fissure.
46258................  T....................  ...................  Remove hemorrhoids &         0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    fistula.
46260................  T....................  ...................  Hemorrhoidectomy....         0150      22.1919    $1,210.81      $437.12      $242.16
46261................  T....................  ...................  Remove hemorrhoids &         0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    fissure.
46262................  T....................  ...................  Remove hemorrhoids &         0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    fistula.
46270................  T....................  ...................  Removal of anal              0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    fistula.
46275................  T....................  ...................  Removal of anal              0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    fistula.
46280................  T....................  ...................  Removal of anal              0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    fistula.
46285................  T....................  ...................  Removal of anal              0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    fistula.
46288................  T....................  ...................  Repair anal fistula.         0150      22.1919    $1,210.81      $437.12      $242.16
46320................  T....................  ...................  Removal of                   0148       3.8320      $209.08       $63.38       $41.82
                                                                    hemorrhoid clot.
46500................  T....................  ...................  Injection into               0155      10.0809      $550.02      $188.89      $110.00
                                                                    hemorrhoid(s).
46600................  X....................  ...................  Diagnostic anoscopy.         0340       0.6314       $34.45  ...........        $6.89
46604................  T....................  ...................  Anoscopy and                 0147       7.6808      $419.07  ...........       $83.81
                                                                    dilation.

[[Page 63539]]

 
46606................  T....................  ...................  Anoscopy and biopsy.         0147       7.6808      $419.07  ...........       $83.81
46608................  T....................  ...................  Anoscopy, remove for         0147       7.6808      $419.07  ...........       $83.81
                                                                    body.
46610................  T....................  ...................  Anoscopy, remove             0147       7.6808      $419.07  ...........       $83.81
                                                                    lesion.
46611................  T....................  ...................  Anoscopy............         0147       7.6808      $419.07  ...........       $83.81
46612................  T....................  ...................  Anoscopy, remove             0147       7.6808      $419.07  ...........       $83.81
                                                                    lesions.
46614................  T....................  ...................  Anoscopy, control            0147       7.6808      $419.07  ...........       $83.81
                                                                    bleeding.
46615................  T....................  ...................  Anoscopy............         0147       7.6808      $419.07  ...........       $83.81
46700................  T....................  ...................  Repair of anal               0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    stricture.
46705................  C....................  ...................  Repair of anal        ...........  ...........  ...........  ...........  ...........
                                                                    stricture.
46706................  T....................  ...................  Repr of anal fistula         0148       3.8320      $209.08       $63.38       $41.82
                                                                    w/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      22.1919    $1,210.81      $437.12      $242.16
                                                                    sphincter.
46751................  C....................  ...................  Repair of anal        ...........  ...........  ...........  ...........  ...........
                                                                    sphincter.
46753................  T....................  ...................  Reconstruction of            0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    anus.
46754................  T....................  ...................  Removal of suture            0149      17.1425      $935.31      $293.06      $187.06
                                                                    from anus.
46760................  T....................  ...................  Repair of anal               0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    sphincter.
46761................  T....................  ...................  Repair of anal               0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    sphincter.
46762................  T....................  ...................  Implant artificial           0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    sphincter.
46900................  T....................  ...................  Destruction, anal            0016       2.5724      $140.35       $57.31       $28.07
                                                                    lesion(s).
46910................  T....................  ...................  Destruction, anal            0017      16.3697      $893.15      $227.84      $178.63
                                                                    lesion(s).
46916................  T....................  ...................  Cryosurgery, anal            0013       1.1272       $61.50       $14.20       $12.30
                                                                    lesion(s).
46917................  T....................  ...................  Laser surgery, anal          0695      19.1849    $1,046.75      $266.59      $209.35
                                                                    lesions.
46922................  T....................  ...................  Excision of anal             0695      19.1849    $1,046.75      $266.59      $209.35
                                                                    lesion(s).
46924................  T....................  ...................  Destruction, anal            0695      19.1849    $1,046.75      $266.59      $209.35
                                                                    lesion(s).
46934................  T....................  ...................  Destruction of               0155      10.0809      $550.02      $188.89      $110.00
                                                                    hemorrhoids.
46935................  T....................  ...................  Destruction of               0155      10.0809      $550.02      $188.89      $110.00
                                                                    hemorrhoids.
46936................  T....................  ...................  Destruction of               0149      17.1425      $935.31      $293.06      $187.06
                                                                    hemorrhoids.
46937................  T....................  ...................  Cryotherapy of               0149      17.1425      $935.31      $293.06      $187.06
                                                                    rectal lesion.
46938................  T....................  ...................  Cryotherapy of               0150      22.1919    $1,210.81      $437.12      $242.16
                                                                    rectal lesion.
46940................  T....................  ...................  Treatment of anal            0149      17.1425      $935.31      $293.06      $187.06
                                                                    fissure.
46942................  T....................  ...................  Treatment of anal            0148       3.8320      $209.08       $63.38       $41.82
                                                                    fissure.
46945................  T....................  ...................  Ligation of                  0155      10.0809      $550.02      $188.89      $110.00
                                                                    hemorrhoids.
46946................  T....................  ...................  Ligation of                  0155      10.0809      $550.02      $188.89      $110.00
                                                                    hemorrhoids.
46999................  T....................  ...................  Anus surgery                 0148       3.8320      $209.08       $63.38       $41.82
                                                                    procedure.
47000................  T....................  ...................  Needle biopsy of             0685       4.8100      $262.44      $115.47       $52.49
                                                                    liver.
47001................  N....................  ...................  Needle biopsy, liver  ...........  ...........  ...........  ...........  ...........
                                                                    add-on.
47010................  C....................  ...................  Open drainage, liver  ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
47011................  T....................  ...................  Percut drain, liver          0037       9.8921      $539.72      $237.45      $107.94
                                                                    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....................  DG.................  Partial removal,      ...........  ...........  ...........  ...........  ...........
                                                                    donor liver.
47135................  C....................  DG.................  Transplantation of    ...........  ...........  ...........  ...........  ...........
                                                                    liver.
47136................  C....................  DG.................  Transplantation of    ...........  ...........  ...........  ...........  ...........
                                                                    liver.
47140................  C....................  NI.................  Partial removal,      ...........  ...........  ...........  ...........  ...........
                                                                    donor liver.
47141................  C....................  NI.................  Partial removal,      ...........  ...........  ...........  ...........  ...........
                                                                    donor liver.
47142................  C....................  NI.................  Partial removal,      ...........  ...........  ...........  ...........  ...........
                                                                    donor liver.
47300................  C....................  DG.................  Surgery for liver     ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
47350................  C....................  DG.................  Repair liver wound..  ...........  ...........  ...........  ...........  ...........
47360................  C....................  ...................  Repair liver wound..  ...........  ...........  ...........  ...........  ...........
47361................  C....................  ...................  Repair liver wound..  ...........  ...........  ...........  ...........  ...........
47362................  C....................  ...................  Repair liver wound..  ...........  ...........  ...........  ...........  ...........
47370................  T....................  ...................  Laparo ablate liver          0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    tumor rf.
47371................  T....................  ...................  Laparo ablate liver          0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    cryosurg.
47379................  T....................  ...................  Laparoscope                  0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    procedure, liver.
47380................  C....................  ...................  Open ablate liver     ...........  ...........  ...........  ...........  ...........
                                                                    tumor rf.
47381................  C....................  ...................  Open ablate liver     ...........  ...........  ...........  ...........  ...........
                                                                    tumor cryo.
47382................  T....................  ...................  Percut ablate liver          1557  ...........    $1,850.00  ...........      $370.00
                                                                    rf.
47399................  T....................  ...................  Liver surgery                0037       9.8921      $539.72      $237.45      $107.94
                                                                    procedure.
47400................  C....................  ...................  Incision of liver     ...........  ...........  ...........  ...........  ...........
                                                                    duct.
47420................  C....................  ...................  Incision of bile      ...........  ...........  ...........  ...........  ...........
                                                                    duct.
47425................  C....................  ...................  Incision of bile      ...........  ...........  ...........  ...........  ...........
                                                                    duct.
47460................  C....................  ...................  Incise bile duct      ...........  ...........  ...........  ...........  ...........
                                                                    sphincter.

[[Page 63540]]

 
47480................  C....................  ...................  Incision of           ...........  ...........  ...........  ...........  ...........
                                                                    gallbladder.
47490................  T....................  ...................  Incision of                  0152       9.1474      $499.09      $125.28       $99.82
                                                                    gallbladder.
47500................  N....................  ...................  Injection for liver   ...........  ...........  ...........  ...........  ...........
                                                                    x-rays.
47505................  N....................  ...................  Injection for liver   ...........  ...........  ...........  ...........  ...........
                                                                    x-rays.
47510................  T....................  ...................  Insert catheter,             0152       9.1474      $499.09      $125.28       $99.82
                                                                    bile duct.
47511................  T....................  ...................  Insert bile duct             0152       9.1474      $499.09      $125.28       $99.82
                                                                    drain.
47525................  T....................  ...................  Change bile duct             0122       8.8621      $483.53       $99.16       $96.71
                                                                    catheter.
47530................  T....................  ...................  Revise/reinsert bile         0122       8.8621      $483.53       $99.16       $96.71
                                                                    tube.
47550................  C....................  ...................  Bile duct endoscopy   ...........  ...........  ...........  ...........  ...........
                                                                    add-on.
47552................  T....................  ...................  Biliary endoscopy            0152       9.1474      $499.09      $125.28       $99.82
                                                                    thru skin.
47553................  T....................  ...................  Biliary endoscopy            0152       9.1474      $499.09      $125.28       $99.82
                                                                    thru skin.
47554................  T....................  ...................  Biliary endoscopy            0152       9.1474      $499.09      $125.28       $99.82
                                                                    thru skin.
47555................  T....................  ...................  Biliary endoscopy            0152       9.1474      $499.09      $125.28       $99.82
                                                                    thru skin.
47556................  T....................  ...................  Biliary endoscopy            0152       9.1474      $499.09      $125.28       $99.82
                                                                    thru skin.
47560................  T....................  ...................  Laparoscopy w/               0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    cholangio.
47561................  T....................  ...................  Laparo w/cholangio/          0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    biopsy.
47562................  T....................  ...................  Laparoscopic                 0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    cholecystectomy.
47563................  T....................  ...................  Laparo                       0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    cholecystectomy/
                                                                    graph.
47564................  T....................  ...................  Laparo                       0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    cholecystectomy/
                                                                    explr.
47570................  C....................  ...................  Laparo                ...........  ...........  ...........  ...........  ...........
                                                                    cholecystoenterosto
                                                                    my.
47579................  T....................  ...................  Laparoscope proc,            0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    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             0152       9.1474      $499.09      $125.28       $99.82
                                                                    stone.
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       9.1474      $499.09      $125.28       $99.82
                                                                    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,               0685       4.8100      $262.44      $115.47       $52.49
                                                                    pancreas.
48120................  C....................  ...................  Removal of pancreas   ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
48140................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    pancreas.
48145................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    pancreas.
48146................  C....................  ...................  Pancreatectomy......  ...........  ...........  ...........  ...........  ...........
48148................  C....................  ...................  Removal of            ...........  ...........  ...........  ...........  ...........
                                                                    pancreatic duct.
48150................  C....................  ...................  Partial removal of    ...........  ...........  ...........  ...........  ...........
                                                                    pancreas.
48152................  C....................  ...................  Pancreatectomy......  ...........  ...........  ...........  ...........  ...........
48153................  C....................  ...................  Pancreatectomy......  ...........  ...........  ...........  ...........  ...........
48154................  C....................  ...................  Pancreatectomy......  ...........  ...........  ...........  ...........  ...........
48155................  C....................  ...................  Removal of pancreas.  ...........  ...........  ...........  ...........  ...........
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             0037       9.8921      $539.72      $237.45      $107.94
                                                                    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.

[[Page 63541]]

 
48999................  T....................  ...................  Pancreas surgery             0005       3.2698      $178.40       $71.59       $35.68
                                                                    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       3.0717      $167.60  ...........       $33.52
                                                                    cavity.
49081................  T....................  ...................  Removal of abdominal         0070       3.0717      $167.60  ...........       $33.52
                                                                    fluid.
49085................  T....................  ...................  Remove abdomen               0153      20.8723    $1,138.81      $410.87      $227.76
                                                                    foreign body.
49180................  T....................  ...................  Biopsy, abdominal            0685       4.8100      $262.44      $115.47       $52.49
                                                                    mass.
49200................  T....................  ...................  Removal of abdominal         0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    lesion.
49201................  C....................  ...................  Remove abdom lesion,  ...........  ...........  ...........  ...........  ...........
                                                                    complex.
49215................  C....................  ...................  Excise sacral spine   ...........  ...........  ...........  ...........  ...........
                                                                    tumor.
49220................  C....................  ...................  Multiple surgery,     ...........  ...........  ...........  ...........  ...........
                                                                    abdomen.
49250................  T....................  ...................  Excision of                  0153      20.8723    $1,138.81      $410.87      $227.76
                                                                    umbilicus.
49255................  C....................  ...................  Removal of omentum..  ...........  ...........  ...........  ...........  ...........
49320................  T....................  ...................  Diag laparo separate         0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    proc.
49321................  T....................  ...................  Laparoscopy, biopsy.         0130      32.7724    $1,788.09      $659.53      $357.62
49322................  T....................  ...................  Laparoscopy,                 0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    aspiration.
49323................  T....................  ...................  Laparo drain                 0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    lymphocele.
49329................  T....................  ...................  Laparo proc, abdm/           0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    per/oment.
49400................  N....................  ...................  Air injection into    ...........  ...........  ...........  ...........  ...........
                                                                    abdomen.
49419................  T....................  ...................  Insrt abdom cath for         0119     134.7194    $7,350.43  ...........    $1,470.09
                                                                    chemotx.
49420................  T....................  ...................  Insert abdom drain,          0652      27.0364    $1,475.13  ...........      $295.03
                                                                    temp.
49421................  T....................  ...................  Insert abdom drain,          0652      27.0364    $1,475.13  ...........      $295.03
                                                                    perm.
49422................  T....................  ...................  Remove perm cannula/         0105      19.1898    $1,047.01      $370.40      $209.40
                                                                    catheter.
49423................  T....................  ...................  Exchange drainage            0152       9.1474      $499.09      $125.28       $99.82
                                                                    catheter.
49424................  N....................  ...................  Assess cyst,          ...........  ...........  ...........  ...........  ...........
                                                                    contrast inject.
49425................  C....................  ...................  Insert abdomen-       ...........  ...........  ...........  ...........  ...........
                                                                    venous drain.
49426................  T....................  ...................  Revise abdomen-              0153      20.8723    $1,138.81      $410.87      $227.76
                                                                    venous shunt.
49427................  N....................  ...................  Injection, abdominal  ...........  ...........  ...........  ...........  ...........
                                                                    shunt.
49428................  C....................  ...................  Ligation of shunt...  ...........  ...........  ...........  ...........  ...........
49429................  T....................  ...................  Removal of shunt....         0105      19.1898    $1,047.01      $370.40      $209.40
49491................  T....................  ...................  Rpr hern preemie             0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    reduc.
49492................  T....................  ...................  Rpr ing hern premie,         0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    blocked.
49495................  T....................  ...................  Rpr ing hernia baby,         0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    reduc.
49496................  T....................  ...................  Rpr ing hernia baby,         0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    blocked.
49500................  T....................  ...................  Rpr ing hernia,              0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    init, reduce.
49501................  T....................  ...................  Rpr ing hernia, init         0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    blocked.
49505................  T....................  ...................  Prp i/hern init              0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    reduc5
                                                                    yr.
49507................  T....................  ...................  Prp i/hern init              0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    block5
                                                                    yr.
49520................  T....................  ...................  Rerepair ing hernia,         0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    reduce.
49521................  T....................  ...................  Rerepair ing hernia,         0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    blocked.
49525................  T....................  ...................  Repair ing hernia,           0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    sliding.
49540................  T....................  ...................  Repair lumbar hernia         0154      26.9636    $1,471.16      $464.85      $294.23
49550................  T....................  ...................  Rpr rem hernia,              0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    init, reduce.
49553................  T....................  ...................  Rpr fem hernia, init         0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    blocked.
49555................  T....................  ...................  Rerepair fem hernia,         0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    reduce.
49557................  T....................  ...................  Rerepair fem hernia,         0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    blocked.
49560................  T....................  ...................  Rpr ventral hern             0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    init, reduc.
49561................  T....................  ...................  Rpr ventral hern             0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    init, block.
49565................  T....................  ...................  Rerepair ventrl              0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    hern, reduce.
49566................  T....................  ...................  Rerepair ventrl              0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    hern, block.
49568................  T....................  ...................  Hernia repair w/mesh         0154      26.9636    $1,471.16      $464.85      $294.23
49570................  T....................  ...................  Rpr epigastric hern,         0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    reduce.
49572................  T....................  ...................  Rpr epigastric hern,         0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    blocked.
49580................  T....................  ...................  Rpr umbil hern,              0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    reduc < 5 yr.
49582................  T....................  ...................  Rpr umbil hern,              0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    block < 5 yr.
49585................  T....................  ...................  Rpr umbil hern,              0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    reduc  5
                                                                    yr.
49587................  T....................  ...................  Rpr umbil hern,              0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    block  5
                                                                    yr.
49590................  T....................  ...................  Repair spigilian             0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    hernia.
49600................  T....................  ...................  Repair umbilical             0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    lesion.
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      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    initial.
49651................  T....................  ...................  Laparo hernia repair         0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    recur.
49659................  T....................  ...................  Laparo proc, hernia          0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    repair.
49900................  C....................  ...................  Repair of abdominal   ...........  ...........  ...........  ...........  ...........
                                                                    wall.

[[Page 63542]]

 
49904................  C....................  ...................  Omental flap, extra-  ...........  ...........  ...........  ...........  ...........
                                                                    abdom.
49905................  C....................  ...................  Omental flap........  ...........  ...........  ...........  ...........  ...........
49906................  C....................  ...................  Free omental flap,    ...........  ...........  ...........  ...........  ...........
                                                                    microvasc.
49999................  T....................  ...................  Abdomen surgery              0153      20.8723    $1,138.81      $410.87      $227.76
                                                                    procedure.
50010................  C....................  ...................  Exploration of        ...........  ...........  ...........  ...........  ...........
                                                                    kidney.
50020................  C....................  ...................  Renal abscess, open   ...........  ...........  ...........  ...........  ...........
                                                                    drain.
50021................  T....................  ...................  Renal abscess,               0037       9.8921      $539.72      $237.45      $107.94
                                                                    percut drain.
50040................  C....................  ...................  Drainage of kidney..  ...........  ...........  ...........  ...........  ...........
50045................  C....................  ...................  Exploration of        ...........  ...........  ...........  ...........  ...........
                                                                    kidney.
50060................  C....................  ...................  Removal of kidney     ...........  ...........  ...........  ...........  ...........
                                                                    stone.
50065................  C....................  ...................  Incision of kidney..  ...........  ...........  ...........  ...........  ...........
50070................  C....................  ...................  Incision of kidney..  ...........  ...........  ...........  ...........  ...........
50075................  C....................  ...................  Removal of kidney     ...........  ...........  ...........  ...........  ...........
                                                                    stone.
50080................  T....................  ...................  Removal of kidney            0163      33.8805    $1,848.55  ...........      $369.71
                                                                    stone.
50081................  T....................  ...................  Removal of kidney            0163      33.8805    $1,848.55  ...........      $369.71
                                                                    stone.
50100................  C....................  ...................  Revise kidney blood   ...........  ...........  ...........  ...........  ...........
                                                                    vessels.
50120................  C....................  ...................  Exploration of        ...........  ...........  ...........  ...........  ...........
                                                                    kidney.
50125................  C....................  ...................  Explore and drain     ...........  ...........  ...........  ...........  ...........
                                                                    kidney.
50130................  C....................  ...................  Removal of kidney     ...........  ...........  ...........  ...........  ...........
                                                                    stone.
50135................  C....................  ...................  Exploration of        ...........  ...........  ...........  ...........  ...........
                                                                    kidney.
50200................  T....................  ...................  Biopsy of kidney....         0685       4.8100      $262.44      $115.47       $52.49
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       4.8100      $262.44      $115.47       $52.49
                                                                    lesion.
50392................  T....................  ...................  Insert kidney drain.         0161      16.8407      $918.85      $249.36      $183.77
50393................  T....................  ...................  Insert ureteral tube         0161      16.8407      $918.85      $249.36      $183.77
50394................  N....................  ...................  Injection for kidney  ...........  ...........  ...........  ...........  ...........
                                                                    x-ray.
50395................  T....................  ...................  Create passage to            0161      16.8407      $918.85      $249.36      $183.77
                                                                    kidney.
50396................  T....................  ...................  Measure kidney               0164       1.2021       $65.59       $17.59       $13.12
                                                                    pressure.
50398................  T....................  ...................  Change kidney tube..         0122       8.8621      $483.53       $99.16       $96.71
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      32.7724    $1,788.09      $659.53      $357.62
                                                                    cyst.
50542................  T....................  ...................  Laparo ablate renal          0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    mass.
50543................  T....................  ...................  Laparo partial               0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    nephrectomy.
50544................  T....................  ...................  Laparoscopy,                 0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    pyeloplasty.
50545................  C....................  ...................  Laparo radical        ...........  ...........  ...........  ...........  ...........
                                                                    nephrectomy.
50546................  C....................  ...................  Laparoscopic          ...........  ...........  ...........  ...........  ...........
                                                                    nephrectomy.
50547................  C....................  ...................  Laparo removal donor  ...........  ...........  ...........  ...........  ...........
                                                                    kidney.
50548................  C....................  ...................  Laparo remove w/      ...........  ...........  ...........  ...........  ...........
                                                                    ureter.
50549................  T....................  ...................  Laparoscope proc,            0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    renal.
50551................  T....................  ...................  Kidney endoscopy....         0160       6.8801      $375.39      $105.06       $75.08
50553................  T....................  ...................  Kidney endoscopy....         0161      16.8407      $918.85      $249.36      $183.77
50555................  T....................  ...................  Kidney endoscopy &           0160       6.8801      $375.39      $105.06       $75.08
                                                                    biopsy.
50557................  T....................  ...................  Kidney endoscopy &           0162      21.9098    $1,195.42  ...........      $239.08
                                                                    treatment.
50559................  T....................  ...................  Renal endoscopy/             0160       6.8801      $375.39      $105.06       $75.08
                                                                    radiotracer.
50561................  T....................  ...................  Kidney endoscopy &           0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
50562................  T....................  ...................  Renal scope w/tumor          0160       6.8801      $375.39      $105.06       $75.08
                                                                    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               0169      45.1150    $2,461.52    $1,115.69      $492.30
                                                                    kidney stone.

[[Page 63543]]

 
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               0164       1.2021       $65.59       $17.59       $13.12
                                                                    pressure.
50688................  T....................  ...................  Change of ureter             0122       8.8621      $483.53       $99.16       $96.71
                                                                    tube.
50690................  N....................  ...................  Injection for ureter  ...........  ...........  ...........  ...........  ...........
                                                                    x-ray.
50700................  C....................  ...................  Revision of ureter..  ...........  ...........  ...........  ...........  ...........
50715................  C....................  ...................  Release of ureter...  ...........  ...........  ...........  ...........  ...........
50722................  C....................  ...................  Release of ureter...  ...........  ...........  ...........  ...........  ...........
50725................  C....................  ...................  Release/revise        ...........  ...........  ...........  ...........  ...........
                                                                    ureter.
50727................  C....................  ...................  Revise ureter.......  ...........  ...........  ...........  ...........  ...........
50728................  C....................  ...................  Revise ureter.......  ...........  ...........  ...........  ...........  ...........
50740................  C....................  ...................  Fusion of ureter &    ...........  ...........  ...........  ...........  ...........
                                                                    kidney.
50750................  C....................  ...................  Fusion of ureter &    ...........  ...........  ...........  ...........  ...........
                                                                    kidney.
50760................  C....................  ...................  Fusion of ureters...  ...........  ...........  ...........  ...........  ...........
50770................  C....................  ...................  Splicing of ureters.  ...........  ...........  ...........  ...........  ...........
50780................  C....................  ...................  Reimplant ureter in   ...........  ...........  ...........  ...........  ...........
                                                                    bladder.
50782................  C....................  ...................  Reimplant ureter in   ...........  ...........  ...........  ...........  ...........
                                                                    bladder.
50783................  C....................  ...................  Reimplant ureter in   ...........  ...........  ...........  ...........  ...........
                                                                    bladder.
50785................  C....................  ...................  Reimplant ureter in   ...........  ...........  ...........  ...........  ...........
                                                                    bladder.
50800................  C....................  ...................  Implant ureter in     ...........  ...........  ...........  ...........  ...........
                                                                    bowel.
50810................  C....................  ...................  Fusion of ureter &    ...........  ...........  ...........  ...........  ...........
                                                                    bowel.
50815................  C....................  ...................  Urine shunt to        ...........  ...........  ...........  ...........  ...........
                                                                    intestine.
50820................  C....................  ...................  Construct bowel       ...........  ...........  ...........  ...........  ...........
                                                                    bladder.
50825................  C....................  ...................  Construct bowel       ...........  ...........  ...........  ...........  ...........
                                                                    bladder.
50830................  C....................  ...................  Revise urine flow...  ...........  ...........  ...........  ...........  ...........
50840................  C....................  ...................  Replace ureter by     ...........  ...........  ...........  ...........  ...........
                                                                    bowel.
50845................  C....................  ...................  Appendico-            ...........  ...........  ...........  ...........  ...........
                                                                    vesicostomy.
50860................  C....................  ...................  Transplant ureter to  ...........  ...........  ...........  ...........  ...........
                                                                    skin.
50900................  C....................  ...................  Repair of ureter....  ...........  ...........  ...........  ...........  ...........
50920................  C....................  ...................  Closure ureter/skin   ...........  ...........  ...........  ...........  ...........
                                                                    fistula.
50930................  C....................  ...................  Closure ureter/bowel  ...........  ...........  ...........  ...........  ...........
                                                                    fistula.
50940................  C....................  ...................  Release of ureter...  ...........  ...........  ...........  ...........  ...........
50945................  T....................  ...................  Laparoscopy                  0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    ureterolithotomy.
50947................  T....................  ...................  Laparo new ureter/           0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    bladder.
50948................  T....................  ...................  Laparo new ureter/           0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    bladder.
50949................  T....................  ...................  Laparoscope proc,            0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    ureter.
50951................  T....................  ...................  Endoscopy of ureter.         0160       6.8801      $375.39      $105.06       $75.08
50953................  T....................  ...................  Endoscopy of ureter.         0160       6.8801      $375.39      $105.06       $75.08
50955................  T....................  ...................  Ureter endoscopy &           0161      16.8407      $918.85      $249.36      $183.77
                                                                    biopsy.
50957................  T....................  ...................  Ureter endoscopy &           0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
50959................  T....................  ...................  Ureter endoscopy &           0161      16.8407      $918.85      $249.36      $183.77
                                                                    tracer.
50961................  T....................  ...................  Ureter endoscopy &           0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
50970................  T....................  ...................  Ureter endoscopy....         0160       6.8801      $375.39      $105.06       $75.08
50972................  T....................  ...................  Ureter endoscopy &           0160       6.8801      $375.39      $105.06       $75.08
                                                                    catheter.
50974................  T....................  ...................  Ureter endoscopy &           0161      16.8407      $918.85      $249.36      $183.77
                                                                    biopsy.
50976................  T....................  ...................  Ureter endoscopy &           0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
50978................  T....................  ...................  Ureter endoscopy &           0161      16.8407      $918.85      $249.36      $183.77
                                                                    tracer.
50980................  T....................  ...................  Ureter endoscopy &           0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
51000................  T....................  ...................  Drainage of bladder.         0164       1.2021       $65.59       $17.59       $13.12
51005................  T....................  ...................  Drainage of bladder.         0164       1.2021       $65.59       $17.59       $13.12
51010................  T....................  ...................  Drainage of bladder.         0165      14.6838      $801.16  ...........      $160.23
51020................  T....................  ...................  Incise & treat               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    bladder.
51030................  T....................  ...................  Incise & treat               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    bladder.
51040................  T....................  ...................  Incise & drain               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    bladder.
51045................  T....................  ...................  Incise bladder/drain         0160       6.8801      $375.39      $105.06       $75.08
                                                                    ureter.
51050................  T....................  ...................  Removal of bladder           0162      21.9098    $1,195.42  ...........      $239.08
                                                                    stone.
51060................  C....................  ...................  Removal of ureter     ...........  ...........  ...........  ...........  ...........
                                                                    stone.
51065................  T....................  ...................  Remove ureter                0162      21.9098    $1,195.42  ...........      $239.08
                                                                    calculus.
51080................  T....................  ...................  Drainage of bladder          0007      11.8633      $647.27  ...........      $129.45
                                                                    abscess.
51500................  T....................  ...................  Removal of bladder           0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    cyst.
51520................  T....................  ...................  Removal of bladder           0162      21.9098    $1,195.42  ...........      $239.08
                                                                    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.

[[Page 63544]]

 
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                0164       1.2021       $65.59       $17.59       $13.12
                                                                    bladder.
51701................  N....................  ...................  Insert bladder        ...........  ...........  ...........  ...........  ...........
                                                                    catheter.
51702................  N....................  ...................  Insert temp bladder   ...........  ...........  ...........  ...........  ...........
                                                                    cath.
51703................  N....................  ...................  Insert bladder cath,  ...........  ...........  ...........  ...........  ...........
                                                                    complex.
51705................  T....................  ...................  Change of bladder            0121       2.1189      $115.61       $43.80       $23.12
                                                                    tube.
51710................  T....................  ...................  Change of bladder            0122       8.8621      $483.53       $99.16       $96.71
                                                                    tube.
51715................  T....................  ...................  Endoscopic injection/        0167      30.0186    $1,637.84      $555.84      $327.57
                                                                    implant.
51720................  T....................  ...................  Treatment of bladder         0156       2.4747      $135.02       $40.52       $27.00
                                                                    lesion.
51725................  T....................  ...................  Simple                       0156       2.4747      $135.02       $40.52       $27.00
                                                                    cystometrogram.
51726................  T....................  ...................  Complex                      0156       2.4747      $135.02       $40.52       $27.00
                                                                    cystometrogram.
51736................  T....................  ...................  Urine flow                   0164       1.2021       $65.59       $17.59       $13.12
                                                                    measurement.
51741................  T....................  ...................  Electro-                     0164       1.2021       $65.59       $17.59       $13.12
                                                                    uroflowmetry, first.
51772................  T....................  ...................  Urethra pressure             0164       1.2021       $65.59       $17.59       $13.12
                                                                    profile.
51784................  T....................  ...................  Anal/urinary muscle          0164       1.2021       $65.59       $17.59       $13.12
                                                                    study.
51785................  T....................  ...................  Anal/urinary muscle          0164       1.2021       $65.59       $17.59       $13.12
                                                                    study.
51792................  T....................  ...................  Urinary reflex study         0164       1.2021       $65.59       $17.59       $13.12
51795................  T....................  ...................  Urine voiding                0164       1.2021       $65.59       $17.59       $13.12
                                                                    pressure study.
51797................  T....................  ...................  Intraabdominal               0164       1.2021       $65.59       $17.59       $13.12
                                                                    pressure test.
51798................  X....................  ...................  Us urine capacity            0340       0.6314       $34.45  ...........        $6.89
                                                                    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      21.9098    $1,195.42  ...........      $239.08
                                                                    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      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    suspension.
51992................  T....................  ...................  Laparo sling                 0132      57.2045    $3,121.13    $1,239.22      $624.23
                                                                    operation.
52000................  T....................  ...................  Cystoscopy..........         0160       6.8801      $375.39      $105.06       $75.08
52001................  T....................  ...................  Cystoscopy, removal          0160       6.8801      $375.39      $105.06       $75.08
                                                                    of clots.
52005................  T....................  ...................  Cystoscopy & ureter          0161      16.8407      $918.85      $249.36      $183.77
                                                                    catheter.
52007................  T....................  ...................  Cystoscopy and               0161      16.8407      $918.85      $249.36      $183.77
                                                                    biopsy.
52010................  T....................  ...................  Cystoscopy & duct            0160       6.8801      $375.39      $105.06       $75.08
                                                                    catheter.
52204................  T....................  ...................  Cystoscopy..........         0161      16.8407      $918.85      $249.36      $183.77
52214................  T....................  ...................  Cystoscopy and               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    treatment.
52224................  T....................  ...................  Cystoscopy and               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    treatment.
52234................  T....................  ...................  Cystoscopy and               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    treatment.
52235................  T....................  ...................  Cystoscopy and               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    treatment.
52240................  T....................  ...................  Cystoscopy and               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    treatment.
52250................  T....................  ...................  Cystoscopy and               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    radiotracer.
52260................  T....................  ...................  Cystoscopy and               0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
52265................  T....................  ...................  Cystoscopy and               0160       6.8801      $375.39      $105.06       $75.08
                                                                    treatment.
52270................  T....................  ...................  Cystoscopy & revise          0161      16.8407      $918.85      $249.36      $183.77
                                                                    urethra.
52275................  T....................  ...................  Cystoscopy & revise          0161      16.8407      $918.85      $249.36      $183.77
                                                                    urethra.
52276................  T....................  ...................  Cystoscopy and               0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
52277................  T....................  ...................  Cystoscopy and               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    treatment.
52281................  T....................  ...................  Cystoscopy and               0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
52282................  S....................  ...................  Cystoscopy, implant          0385      67.1530    $3,663.93  ...........      $732.79
                                                                    stent.
52283................  T....................  ...................  Cystoscopy and               0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
52285................  T....................  ...................  Cystoscopy and               0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
52290................  T....................  ...................  Cystoscopy and               0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
52300................  T....................  ...................  Cystoscopy and               0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
52301................  T....................  ...................  Cystoscopy and               0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
52305................  T....................  ...................  Cystoscopy and               0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
52310................  T....................  ...................  Cystoscopy and               0160       6.8801      $375.39      $105.06       $75.08
                                                                    treatment.
52315................  T....................  ...................  Cystoscopy and               0161      16.8407      $918.85      $249.36      $183.77
                                                                    treatment.
52317................  T....................  ...................  Remove bladder stone         0162      21.9098    $1,195.42  ...........      $239.08
52318................  T....................  ...................  Remove bladder stone         0162      21.9098    $1,195.42  ...........      $239.08
52320................  T....................  ...................  Cystoscopy and               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    treatment.

[[Page 63545]]

 
52325................  T....................  ...................  Cystoscopy, stone            0162      21.9098    $1,195.42  ...........      $239.08
                                                                    removal.
52327................  T....................  ...................  Cystoscopy, inject           0162      21.9098    $1,195.42  ...........      $239.08
                                                                    material.
52330................  T....................  ...................  Cystoscopy and               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    treatment.
52332................  T....................  ...................  Cystoscopy and               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    treatment.
52334................  T....................  ...................  Create passage to            0162      21.9098    $1,195.42  ...........      $239.08
                                                                    kidney.
52341................  T....................  ...................  Cysto w/ureter               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    stricture tx.
52342................  T....................  ...................  Cysto w/up stricture         0162      21.9098    $1,195.42  ...........      $239.08
                                                                    tx.
52343................  T....................  ...................  Cysto w/renal                0162      21.9098    $1,195.42  ...........      $239.08
                                                                    stricture tx.
52344................  T....................  ...................  Cysto/uretero, stone         0162      21.9098    $1,195.42  ...........      $239.08
                                                                    remove.
52345................  T....................  ...................  Cysto/uretero w/up           0162      21.9098    $1,195.42  ...........      $239.08
                                                                    stricture.
52346................  T....................  ...................  Cystouretero w/renal         0162      21.9098    $1,195.42  ...........      $239.08
                                                                    strict.
52347................  T....................  ...................  Cystoscopy, resect           0161      16.8407      $918.85      $249.36      $183.77
                                                                    ducts.
52351................  T....................  ...................  Cystouretero & or            0161      16.8407      $918.85      $249.36      $183.77
                                                                    pyeloscope.
52352................  T....................  ...................  Cystouretero w/stone         0162      21.9098    $1,195.42  ...........      $239.08
                                                                    remove.
52353................  T....................  ...................  Cystouretero w/              0163      33.8805    $1,848.55  ...........      $369.71
                                                                    lithotripsy.
52354................  T....................  ...................  Cystouretero w/              0162      21.9098    $1,195.42  ...........      $239.08
                                                                    biopsy.
52355................  T....................  ...................  Cystouretero w/              0162      21.9098    $1,195.42  ...........      $239.08
                                                                    excise tumor.
52400................  T....................  ...................  Cystouretero w/              0162      21.9098    $1,195.42  ...........      $239.08
                                                                    congen repr.
52450................  T....................  ...................  Incision of prostate         0162      21.9098    $1,195.42  ...........      $239.08
52500................  T....................  ...................  Revision of bladder          0162      21.9098    $1,195.42  ...........      $239.08
                                                                    neck.
52510................  T....................  ...................  Dilation prostatic           0161      16.8407      $918.85      $249.36      $183.77
                                                                    urethra.
52601................  T....................  ...................  Prostatectomy (TURP)         0163      33.8805    $1,848.55  ...........      $369.71
52606................  T....................  ...................  Control postop               0162      21.9098    $1,195.42  ...........      $239.08
                                                                    bleeding.
52612................  T....................  ...................  Prostatectomy, first         0163      33.8805    $1,848.55  ...........      $369.71
                                                                    stage.
52614................  T....................  ...................  Prostatectomy,               0163      33.8805    $1,848.55  ...........      $369.71
                                                                    second stage.
52620................  T....................  ...................  Remove residual              0163      33.8805    $1,848.55  ...........      $369.71
                                                                    prostate.
52630................  T....................  ...................  Remove prostate              0163      33.8805    $1,848.55  ...........      $369.71
                                                                    regrowth.
52640................  T....................  ...................  Relieve bladder              0162      21.9098    $1,195.42  ...........      $239.08
                                                                    contracture.
52647................  T....................  ...................  Laser surgery of             0163      33.8805    $1,848.55  ...........      $369.71
                                                                    prostate.
52648................  T....................  ...................  Laser surgery of             0163      33.8805    $1,848.55  ...........      $369.71
                                                                    prostate.
52700................  T....................  ...................  Drainage of prostate         0162      21.9098    $1,195.42  ...........      $239.08
                                                                    abscess.
53000................  T....................  ...................  Incision of urethra.         0166      16.7918      $916.18      $218.73      $183.24
53010................  T....................  ...................  Incision of urethra.         0166      16.7918      $916.18      $218.73      $183.24
53020................  T....................  ...................  Incision of urethra.         0166      16.7918      $916.18      $218.73      $183.24
53025................  T....................  ...................  Incision of urethra.         0166      16.7918      $916.18      $218.73      $183.24
53040................  T....................  ...................  Drainage of urethra          0167      30.0186    $1,637.84      $555.84      $327.57
                                                                    abscess.
53060................  T....................  ...................  Drainage of urethra          0166      16.7918      $916.18      $218.73      $183.24
                                                                    abscess.
53080................  T....................  ...................  Drainage of urinary          0166      16.7918      $916.18      $218.73      $183.24
                                                                    leakage.
53085................  C....................  ...................  Drainage of urinary   ...........  ...........  ...........  ...........  ...........
                                                                    leakage.
53200................  T....................  ...................  Biopsy of urethra...         0166      16.7918      $916.18      $218.73      $183.24
53210................  T....................  ...................  Removal of urethra..         0168      30.0147    $1,637.63      $405.60      $327.53
53215................  T....................  ...................  Removal of urethra..         0166      16.7918      $916.18      $218.73      $183.24
53220................  T....................  ...................  Treatment of urethra         0168      30.0147    $1,637.63      $405.60      $327.53
                                                                    lesion.
53230................  T....................  ...................  Removal of urethra           0168      30.0147    $1,637.63      $405.60      $327.53
                                                                    lesion.
53235................  T....................  ...................  Removal of urethra           0166      16.7918      $916.18      $218.73      $183.24
                                                                    lesion.
53240................  T....................  ...................  Surgery for urethra          0168      30.0147    $1,637.63      $405.60      $327.53
                                                                    pouch.
53250................  T....................  ...................  Removal of urethra           0166      16.7918      $916.18      $218.73      $183.24
                                                                    gland.
53260................  T....................  ...................  Treatment of urethra         0166      16.7918      $916.18      $218.73      $183.24
                                                                    lesion.
53265................  T....................  ...................  Treatment of urethra         0166      16.7918      $916.18      $218.73      $183.24
                                                                    lesion.
53270................  T....................  ...................  Removal of urethra           0167      30.0186    $1,637.84      $555.84      $327.57
                                                                    gland.
53275................  T....................  ...................  Repair of urethra            0166      16.7918      $916.18      $218.73      $183.24
                                                                    defect.
53400................  T....................  ...................  Revise urethra,              0168      30.0147    $1,637.63      $405.60      $327.53
                                                                    stage 1.
53405................  T....................  ...................  Revise urethra,              0168      30.0147    $1,637.63      $405.60      $327.53
                                                                    stage 2.
53410................  T....................  ...................  Reconstruction of            0168      30.0147    $1,637.63      $405.60      $327.53
                                                                    urethra.
53415................  C....................  ...................  Reconstruction of     ...........  ...........  ...........  ...........  ...........
                                                                    urethra.
53420................  T....................  ...................  Reconstruct urethra,         0168      30.0147    $1,637.63      $405.60      $327.53
                                                                    stage 1.
53425................  T....................  ...................  Reconstruct urethra,         0168      30.0147    $1,637.63      $405.60      $327.53
                                                                    stage 2.
53430................  T....................  ...................  Reconstruction of            0168      30.0147    $1,637.63      $405.60      $327.53
                                                                    urethra.
53431................  T....................  ...................  Reconstruct urethra/         0168      30.0147    $1,637.63      $405.60      $327.53
                                                                    bladder.
53440................  S....................  ...................  Correct bladder              0385      67.1530    $3,663.93  ...........      $732.79
                                                                    function.
53442................  T....................  ...................  Remove perineal              0167      30.0186    $1,637.84      $555.84      $327.57
                                                                    prosthesis.
53444................  S....................  ...................  Insert tandem cuff..         0385      67.1530    $3,663.93  ...........      $732.79
53445................  S....................  ...................  Insert uro/ves nck           0386     116.2382    $6,342.07  ...........    $1,268.41
                                                                    sphincter.
53446................  T....................  ...................  Remove uro sphincter         0168      30.0147    $1,637.63      $405.60      $327.53
53447................  S....................  ...................  Remove/replace ur            0386     116.2382    $6,342.07  ...........    $1,268.41
                                                                    sphincter.
53448................  C....................  ...................  Remov/replc ur        ...........  ...........  ...........  ...........  ...........
                                                                    sphinctr comp.
53449................  T....................  ...................  Repair uro sphincter         0168      30.0147    $1,637.63      $405.60      $327.53
53450................  T....................  ...................  Revision of urethra.         0168      30.0147    $1,637.63      $405.60      $327.53
53460................  T....................  ...................  Revision of urethra.         0166      16.7918      $916.18      $218.73      $183.24
53500................  T....................  NI.................  Urethrlys, transvag          0168      30.0147    $1,637.63      $405.60      $327.53
                                                                    w/ scope.
53502................  T....................  ...................  Repair of urethra            0166      16.7918      $916.18      $218.73      $183.24
                                                                    injury.
53505................  T....................  ...................  Repair of urethra            0167      30.0186    $1,637.84      $555.84      $327.57
                                                                    injury.
53510................  T....................  ...................  Repair of urethra            0166      16.7918      $916.18      $218.73      $183.24
                                                                    injury.
53515................  T....................  ...................  Repair of urethra            0168      30.0147    $1,637.63      $405.60      $327.53
                                                                    injury.
53520................  T....................  ...................  Repair of urethra            0168      30.0147    $1,637.63      $405.60      $327.53
                                                                    defect.

[[Page 63546]]

 
53600................  T....................  ...................  Dilate urethra               0156       2.4747      $135.02       $40.52       $27.00
                                                                    stricture.
53601................  T....................  ...................  Dilate urethra               0164       1.2021       $65.59       $17.59       $13.12
                                                                    stricture.
53605................  T....................  ...................  Dilate urethra               0161      16.8407      $918.85      $249.36      $183.77
                                                                    stricture.
53620................  T....................  ...................  Dilate urethra               0165      14.6838      $801.16  ...........      $160.23
                                                                    stricture.
53621................  T....................  ...................  Dilate urethra               0164       1.2021       $65.59       $17.59       $13.12
                                                                    stricture.
53660................  T....................  ...................  Dilation of urethra.         0164       1.2021       $65.59       $17.59       $13.12
53661................  T....................  ...................  Dilation of urethra.         0164       1.2021       $65.59       $17.59       $13.12
53665................  T....................  ...................  Dilation of urethra.         0166      16.7918      $916.18      $218.73      $183.24
53850................  T....................  ...................  Prostatic microwave          0675      49.3452    $2,692.32  ...........      $538.46
                                                                    thermotx.
53852................  T....................  ...................  Prostatic rf                 0675      49.3452    $2,692.32  ...........      $538.46
                                                                    thermotx.
53853................  T....................  ...................  Prostatic water              1550  ...........    $1,150.00  ...........      $230.00
                                                                    thermother.
53899................  T....................  ...................  Urology surgery              0164       1.2021       $65.59       $17.59       $13.12
                                                                    procedure.
54000................  T....................  ...................  Slitting of prepuce.         0166      16.7918      $916.18      $218.73      $183.24
54001................  T....................  ...................  Slitting of prepuce.         0166      16.7918      $916.18      $218.73      $183.24
54015................  T....................  ...................  Drain penis lesion..         0007      11.8633      $647.27  ...........      $129.45
54050................  T....................  ...................  Destruction, penis           0013       1.1272       $61.50       $14.20       $12.30
                                                                    lesion(s).
54055................  T....................  ...................  Destruction, penis           0017      16.3697      $893.15      $227.84      $178.63
                                                                    lesion(s).
54056................  T....................  ...................  Cryosurgery, penis           0012       0.7694       $41.98       $11.18        $8.40
                                                                    lesion(s).
54057................  T....................  ...................  Laser surg, penis            0017      16.3697      $893.15      $227.84      $178.63
                                                                    lesion(s).
54060................  T....................  ...................  Excision of penis            0017      16.3697      $893.15      $227.84      $178.63
                                                                    lesion(s).
54065................  T....................  ...................  Destruction, penis           0695      19.1849    $1,046.75      $266.59      $209.35
                                                                    lesion(s).
54100................  T....................  ...................  Biopsy of penis.....         0021      14.3594      $783.46      $219.48      $156.69
54105................  T....................  ...................  Biopsy of penis.....         0022      18.7932    $1,025.38      $354.45      $205.08
54110................  T....................  ...................  Treatment of penis           0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    lesion.
54111................  T....................  ...................  Treat penis lesion,          0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    graft.
54112................  T....................  ...................  Treat penis lesion,          0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    graft.
54115................  T....................  ...................  Treatment of penis           0008      19.4831    $1,063.02  ...........      $212.60
                                                                    lesion.
54120................  T....................  ...................  Partial removal of           0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    penis.
54125................  C....................  ...................  Removal of penis....  ...........  ...........  ...........  ...........  ...........
54130................  C....................  ...................  Remove penis & nodes  ...........  ...........  ...........  ...........  ...........
54135................  C....................  ...................  Remove penis & nodes  ...........  ...........  ...........  ...........  ...........
54150................  T....................  ...................  Circumcision........         0180      18.6176    $1,015.79      $304.87      $203.16
54152................  T....................  ...................  Circumcision........         0180      18.6176    $1,015.79      $304.87      $203.16
54160................  T....................  ...................  Circumcision........         0180      18.6176    $1,015.79      $304.87      $203.16
54161................  T....................  ...................  Circumcision........         0180      18.6176    $1,015.79      $304.87      $203.16
54162................  T....................  ...................  Lysis penil circumic         0180      18.6176    $1,015.79      $304.87      $203.16
                                                                    lesion.
54163................  T....................  ...................  Repair of                    0180      18.6176    $1,015.79      $304.87      $203.16
                                                                    circumcision.
54164................  T....................  ...................  Frenulotomy of penis         0180      18.6176    $1,015.79      $304.87      $203.16
54200................  T....................  ...................  Treatment of penis           0156       2.4747      $135.02       $40.52       $27.00
                                                                    lesion.
54205................  T....................  ...................  Treatment of penis           0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    lesion.
54220................  T....................  ...................  Treatment of penis           0156       2.4747      $135.02       $40.52       $27.00
                                                                    lesion.
54230................  N....................  ...................  Prepare penis study.  ...........  ...........  ...........  ...........  ...........
54231................  T....................  ...................  Dynamic                      0165      14.6838      $801.16  ...........      $160.23
                                                                    cavernosometry.
54235................  T....................  ...................  Penile injection....         0164       1.2021       $65.59       $17.59       $13.12
54240................  T....................  ...................  Penis study.........         0164       1.2021       $65.59       $17.59       $13.12
54250................  T....................  ...................  Penis study.........         0164       1.2021       $65.59       $17.59       $13.12
54300................  T....................  ...................  Revision of penis...         0181      29.4217    $1,605.28      $621.82      $321.06
54304................  T....................  ...................  Revision of penis...         0181      29.4217    $1,605.28      $621.82      $321.06
54308................  T....................  ...................  Reconstruction of            0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    urethra.
54312................  T....................  ...................  Reconstruction of            0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    urethra.
54316................  T....................  ...................  Reconstruction of            0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    urethra.
54318................  T....................  ...................  Reconstruction of            0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    urethra.
54322................  T....................  ...................  Reconstruction of            0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    urethra.
54324................  T....................  ...................  Reconstruction of            0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    urethra.
54326................  T....................  ...................  Reconstruction of            0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    urethra.
54328................  T....................  ...................  Revise penis/urethra         0181      29.4217    $1,605.28      $621.82      $321.06
54332................  C....................  ...................  Revise penis/urethra  ...........  ...........  ...........  ...........  ...........
54336................  C....................  ...................  Revise penis/urethra  ...........  ...........  ...........  ...........  ...........
54340................  T....................  ...................  Secondary urethral           0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    surgery.
54344................  T....................  ...................  Secondary urethral           0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    surgery.
54348................  T....................  ...................  Secondary urethral           0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    surgery.
54352................  T....................  ...................  Reconstruct urethra/         0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    penis.
54360................  T....................  ...................  Penis plastic                0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    surgery.
54380................  T....................  ...................  Repair penis........         0181      29.4217    $1,605.28      $621.82      $321.06
54385................  T....................  ...................  Repair penis........         0181      29.4217    $1,605.28      $621.82      $321.06
54390................  C....................  ...................  Repair penis and      ...........  ...........  ...........  ...........  ...........
                                                                    bladder.
54400................  S....................  ...................  Insert semi-rigid            0385      67.1530    $3,663.93  ...........      $732.79
                                                                    prosthesis.
54401................  S....................  ...................  Insert self-contd            0386     116.2382    $6,342.07  ...........    $1,268.41
                                                                    prosthesis.
54405................  S....................  ...................  Insert multi-comp            0386     116.2382    $6,342.07  ...........    $1,268.41
                                                                    penis pros.
54406................  T....................  ...................  Remove muti-comp             0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    penis pros.
54408................  T....................  ...................  Repair multi-comp            0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    penis pros.
54410................  S....................  ...................  Remove/replace penis         0386     116.2382    $6,342.07  ...........    $1,268.41
                                                                    prosth.
54411................  C....................  ...................  Remov/replc penis     ...........  ...........  ...........  ...........  ...........
                                                                    pros, comp.
54415................  T....................  ...................  Remove self-contd            0181      29.4217    $1,605.28      $621.82      $321.06
                                                                    penis pros.
54416................  S....................  ...................  Remv/repl penis              0385      67.1530    $3,663.93  ...........      $732.79
                                                                    contain pros.

[[Page 63547]]

 
54417................  C....................  ...................  Remv/replc penis      ...........  ...........  ...........  ...........  ...........
                                                                    pros, compl.
54420................  T....................  ...................  Revision of penis...         0181      29.4217    $1,605.28      $621.82      $321.06
54430................  C....................  ...................  Revision of penis...  ...........  ...........  ...........  ...........  ...........
54435................  T....................  ...................  Revision of penis...         0181      29.4217    $1,605.28      $621.82      $321.06
54440................  T....................  ...................  Repair of penis.....         0181      29.4217    $1,605.28      $621.82      $321.06
54450................  T....................  ...................  Preputial stretching         0156       2.4747      $135.02       $40.52       $27.00
54500................  T....................  ...................  Biopsy of testis....         0037       9.8921      $539.72      $237.45      $107.94
54505................  T....................  ...................  Biopsy of testis....         0183      21.6724    $1,182.47  ...........      $236.49
54512................  T....................  ...................  Excise lesion testis         0183      21.6724    $1,182.47  ...........      $236.49
54520................  T....................  ...................  Removal of testis...         0183      21.6724    $1,182.47  ...........      $236.49
54522................  T....................  ...................  Orchiectomy, partial         0183      21.6724    $1,182.47  ...........      $236.49
54530................  T....................  ...................  Removal of testis...         0154      26.9636    $1,471.16      $464.85      $294.23
54535................  C....................  ...................  Extensive testis      ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
54550................  T....................  ...................  Exploration for              0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    testis.
54560................  C....................  ...................  Exploration for       ...........  ...........  ...........  ...........  ...........
                                                                    testis.
54600................  T....................  ...................  Reduce testis                0183      21.6724    $1,182.47  ...........      $236.49
                                                                    torsion.
54620................  T....................  ...................  Suspension of testis         0183      21.6724    $1,182.47  ...........      $236.49
54640................  T....................  ...................  Suspension of testis         0154      26.9636    $1,471.16      $464.85      $294.23
54650................  C....................  ...................  Orchiopexy (Fowler-   ...........  ...........  ...........  ...........  ...........
                                                                    Stephens).
54660................  T....................  ...................  Revision of testis..         0183      21.6724    $1,182.47  ...........      $236.49
54670................  T....................  ...................  Repair testis injury         0183      21.6724    $1,182.47  ...........      $236.49
54680................  T....................  ...................  Relocation of                0183      21.6724    $1,182.47  ...........      $236.49
                                                                    testis(es).
54690................  T....................  ...................  Laparoscopy,                 0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    orchiectomy.
54692................  T....................  ...................  Laparoscopy,                 0132      57.2045    $3,121.13    $1,239.22      $624.23
                                                                    orchiopexy.
54699................  T....................  ...................  Laparoscope proc,            0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    testis.
54700................  T....................  ...................  Drainage of scrotum.         0183      21.6724    $1,182.47  ...........      $236.49
54800................  T....................  ...................  Biopsy of epididymis         0004       1.5882       $86.65       $22.36       $17.33
54820................  T....................  ...................  Exploration of               0183      21.6724    $1,182.47  ...........      $236.49
                                                                    epididymis.
54830................  T....................  ...................  Remove epididymis            0183      21.6724    $1,182.47  ...........      $236.49
                                                                    lesion.
54840................  T....................  ...................  Remove epididymis            0183      21.6724    $1,182.47  ...........      $236.49
                                                                    lesion.
54860................  T....................  ...................  Removal of                   0183      21.6724    $1,182.47  ...........      $236.49
                                                                    epididymis.
54861................  T....................  ...................  Removal of                   0183      21.6724    $1,182.47  ...........      $236.49
                                                                    epididymis.
54900................  T....................  ...................  Fusion of spermatic          0183      21.6724    $1,182.47  ...........      $236.49
                                                                    ducts.
54901................  T....................  ...................  Fusion of spermatic          0183      21.6724    $1,182.47  ...........      $236.49
                                                                    ducts.
55000................  T....................  ...................  Drainage of                  0004       1.5882       $86.65       $22.36       $17.33
                                                                    hydrocele.
55040................  T....................  ...................  Removal of hydrocele         0154      26.9636    $1,471.16      $464.85      $294.23
55041................  T....................  ...................  Removal of                   0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    hydroceles.
55060................  T....................  ...................  Repair of hydrocele.         0183      21.6724    $1,182.47  ...........      $236.49
55100................  T....................  ...................  Drainage of scrotum          0007      11.8633      $647.27  ...........      $129.45
                                                                    abscess.
55110................  T....................  ...................  Explore scrotum.....         0183      21.6724    $1,182.47  ...........      $236.49
55120................  T....................  ...................  Removal of scrotum           0183      21.6724    $1,182.47  ...........      $236.49
                                                                    lesion.
55150................  T....................  ...................  Removal of scrotum..         0183      21.6724    $1,182.47  ...........      $236.49
55175................  T....................  ...................  Revision of scrotum.         0183      21.6724    $1,182.47  ...........      $236.49
55180................  T....................  ...................  Revision of scrotum.         0183      21.6724    $1,182.47  ...........      $236.49
55200................  T....................  ...................  Incision of sperm            0183      21.6724    $1,182.47  ...........      $236.49
                                                                    duct.
55250................  T....................  ...................  Removal of sperm             0183      21.6724    $1,182.47  ...........      $236.49
                                                                    duct(s).                                                                 W
55300................  N....................  ...................  Prepare, sperm duct   ...........  ...........  ...........  ...........  ...........
                                                                    x-ray.
55400................  T....................  ...................  Repair of sperm duct         0183      21.6724    $1,182.47  ...........      $236.49
55450................  T....................  ...................  Ligation of sperm            0183      21.6724    $1,182.47  ...........      $236.49
                                                                    duct.
55500................  T....................  ...................  Removal of hydrocele         0183      21.6724    $1,182.47  ...........      $236.49
55520................  T....................  ...................  Removal of sperm             0183      21.6724    $1,182.47  ...........      $236.49
                                                                    cord lesion.
55530................  T....................  ...................  Revise spermatic             0183      21.6724    $1,182.47  ...........      $236.49
                                                                    cord veins.
55535................  T....................  ...................  Revise spermatic             0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    cord veins.
55540................  T....................  ...................  Revise hernia &              0154      26.9636    $1,471.16      $464.85      $294.23
                                                                    sperm veins.
55550................  T....................  ...................  Laparo ligate                0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    spermatic vein.
55559................  T....................  ...................  Laparo proc,                 0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    spermatic 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      21.6724    $1,182.47  ...........      $236.49
                                                                    lesion.
55700................  T....................  ...................  Biopsy of prostate..         0184       3.8995      $212.76       $96.27       $42.55
55705................  T....................  ...................  Biopsy of prostate..         0184       3.8995      $212.76       $96.27       $42.55
55720................  T....................  ...................  Drainage of prostate         0162      21.9098    $1,195.42  ...........      $239.08
                                                                    abscess.
55725................  T....................  ...................  Drainage of prostate         0162      21.9098    $1,195.42  ...........      $239.08
                                                                    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                0163      33.8805    $1,848.55  ...........      $369.71
                                                                    insert, pros.
55860................  T....................  ...................  Surgical exposure,           0165      14.6838      $801.16  ...........      $160.23
                                                                    prostate.

[[Page 63548]]

 
55862................  C....................  ...................  Extensive prostate    ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
55865................  C....................  ...................  Extensive prostate    ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
55866................  C....................  ...................  Laparo radical        ...........  ...........  ...........  ...........  ...........
                                                                    prostatectomy.
55870................  T....................  ...................  Vag hyst w/                  0197       4.8280      $263.42  ...........       $52.68
                                                                    enterocele repair.
55873................  T....................  ...................  Cryoablate prostate.         0674     119.9733    $6,545.86  ...........    $1,309.17
55899................  T....................  ...................  Genital surgery              0164       1.2021       $65.59       $17.59       $13.12
                                                                    procedure.
55970................  E....................  ...................  Sex transformation,   ...........  ...........  ...........  ...........  ...........
                                                                    M to F.
55980................  E....................  ...................  Sex transformation,   ...........  ...........  ...........  ...........  ...........
                                                                    F to M.
56405................  T....................  ...................  I & D of vulva/              0192       2.7121      $147.97       $39.11       $29.59
                                                                    perineum.
56420................  T....................  ...................  Drainage of gland            0192       2.7121      $147.97       $39.11       $29.59
                                                                    abscess.
56440................  T....................  ...................  Surgery for vulva            0194      18.4286    $1,005.48      $397.84      $201.10
                                                                    lesion.
56441................  T....................  ...................  Lysis of labial              0193      15.0453      $820.89      $171.13      $164.18
                                                                    lesion(s).
56501................  T....................  ...................  Destroy, vulva               0017      16.3697      $893.15      $227.84      $178.63
                                                                    lesions, sim.
56515................  T....................  ...................  Destroy vulva lesion/        0695      19.1849    $1,046.75      $266.59      $209.35
                                                                    s compl.
56605................  T....................  ...................  Biopsy of vulva/             0019       3.9493      $215.48       $71.87       $43.10
                                                                    perineum.
56606................  T....................  ...................  Biopsy of vulva/             0019       3.9493      $215.48       $71.87       $43.10
                                                                    perineum.
56620................  T....................  ...................  Partial removal of           0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    vulva.
56625................  T....................  ...................  Complete removal of          0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    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      18.4286    $1,005.48      $397.84      $201.10
                                                                    hymen.
56720................  T....................  ...................  Incision of hymen...         0193      15.0453      $820.89      $171.13      $164.18
56740................  T....................  ...................  Remove vagina gland          0194      18.4286    $1,005.48      $397.84      $201.10
                                                                    lesion.
56800................  T....................  ...................  Repair of vagina....         0194      18.4286    $1,005.48      $397.84      $201.10
56805................  T....................  ...................  Repair clitoris.....         0194      18.4286    $1,005.48      $397.84      $201.10
56810................  T....................  ...................  Repair of perineum..         0194      18.4286    $1,005.48      $397.84      $201.10
56820................  T....................  ...................  Exam of vulva w/             0188       1.1365       $62.01  ...........       $12.40
                                                                    scope.
56821................  T....................  ...................  Exam/biopsy of vulva         0189       1.4232       $77.65       $18.09       $15.53
                                                                    w/scope.
57000................  T....................  ...................  Exploration of               0194      18.4286    $1,005.48      $397.84      $201.10
                                                                    vagina.
57010................  T....................  ...................  Drainage of pelvic           0194      18.4286    $1,005.48      $397.84      $201.10
                                                                    abscess.
57020................  T....................  ...................  Drainage of pelvic           0192       2.7121      $147.97       $39.11       $29.59
                                                                    fluid.
57022................  T....................  ...................  I & d vaginal                0007      11.8633      $647.27  ...........      $129.45
                                                                    hematoma, pp.
57023................  T....................  ...................  I & d vag hematoma,          0007      11.8633      $647.27  ...........      $129.45
                                                                    non-ob.
57061................  T....................  ...................  Destroy vag lesions,         0194      18.4286    $1,005.48      $397.84      $201.10
                                                                    simple.
57065................  T....................  ...................  Destroy vag lesions,         0194      18.4286    $1,005.48      $397.84      $201.10
                                                                    complex.
57100................  T....................  ...................  Biopsy of vagina....         0192       2.7121      $147.97       $39.11       $29.59
57105................  T....................  ...................  Biopsy of vagina....         0194      18.4286    $1,005.48      $397.84      $201.10
57106................  T....................  ...................  Remove vagina wall,          0194      18.4286    $1,005.48      $397.84      $201.10
                                                                    partial.
57107................  T....................  ...................  Remove vagina                0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    tissue, part.
57109................  T....................  ...................  Vaginectomy partial          0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    w/nodes.
57110................  C....................  ...................  Remove vagina wall,   ...........  ...........  ...........  ...........  ...........
                                                                    complete.
57111................  C....................  ...................  Remove vagina         ...........  ...........  ...........  ...........  ...........
                                                                    tissue, compl.
57112................  C....................  ...................  Vaginectomy w/nodes,  ...........  ...........  ...........  ...........  ...........
                                                                    compl.
57120................  T....................  ...................  Closure of vagina...         0195      25.6950    $1,401.94      $483.80      $280.39
57130................  T....................  ...................  Remove vagina lesion         0194      18.4286    $1,005.48      $397.84      $201.10
57135................  T....................  ...................  Remove vagina lesion         0194      18.4286    $1,005.48      $397.84      $201.10
57150................  T....................  ...................  Treat vagina                 0191       0.1853       $10.11        $2.93        $2.02
                                                                    infection.
57155................  T....................  ...................  Insert uteri tandems/        0193      15.0453      $820.89      $171.13      $164.18
                                                                    ovoids.
57160................  T....................  ...................  Insert pessary/other         0188       1.1365       $62.01  ...........       $12.40
                                                                    device.
57170................  T....................  ...................  Fitting of diaphragm/        0191       0.1853       $10.11        $2.93        $2.02
                                                                    cap.
57180................  T....................  ...................  Treat vaginal                0192       2.7121      $147.97       $39.11       $29.59
                                                                    bleeding.
57200................  T....................  ...................  Repair of vagina....         0194      18.4286    $1,005.48      $397.84      $201.10
57210................  T....................  ...................  Repair vagina/               0194      18.4286    $1,005.48      $397.84      $201.10
                                                                    perineum.
57220................  T....................  ...................  Revision of urethra.         0195      25.6950    $1,401.94      $483.80      $280.39
57230................  T....................  ...................  Repair of urethral           0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    lesion.
57240................  T....................  ...................  Repair bladder &             0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    vagina.
57250................  T....................  ...................  Repair rectum &              0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    vagina.
57260................  T....................  ...................  Repair of vagina....         0195      25.6950    $1,401.94      $483.80      $280.39
57265................  T....................  ...................  Extensive repair of          0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    vagina.
57268................  T....................  ...................  Repair of bowel              0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    bulge.
57270................  C....................  ...................  Repair of bowel       ...........  ...........  ...........  ...........  ...........
                                                                    pouch.
57280................  C....................  ...................  Suspension of vagina  ...........  ...........  ...........  ...........  ...........
57282................  C....................  ...................  Repair of vaginal     ...........  ...........  ...........  ...........  ...........
                                                                    prolapse.
57284................  T....................  ...................  Repair paravaginal           0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    defect.
57287................  T....................  ...................  Revise/remove sling          0202      38.9821    $2,126.90    $1,042.18      $425.38
                                                                    repair.
57288................  T....................  ...................  Repair bladder               0202      38.9821    $2,126.90    $1,042.18      $425.38
                                                                    defect.
57289................  T....................  ...................  Repair bladder &             0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    vagina.
57291................  T....................  ...................  Construction of              0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    vagina.
57292................  C....................  ...................  Construct vagina      ...........  ...........  ...........  ...........  ...........
                                                                    with graft.
57300................  T....................  ...................  Repair rectum-vagina         0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    fistula.

[[Page 63549]]

 
57305................  C....................  ...................  Repair rectum-vagina  ...........  ...........  ...........  ...........  ...........
                                                                    fistula.
57307................  C....................  ...................  Fistula repair &      ...........  ...........  ...........  ...........  ...........
                                                                    colostomy.
57308................  C....................  ...................  Fistula repair,       ...........  ...........  ...........  ...........  ...........
                                                                    transperine.
57310................  T....................  ...................  Repair                       0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    urethrovaginal
                                                                    lesion.
57311................  C....................  ...................  Repair                ...........  ...........  ...........  ...........  ...........
                                                                    urethrovaginal
                                                                    lesion.
57320................  T....................  ...................  Repair bladder-              0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    vagina lesion.
57330................  T....................  ...................  Repair bladder-              0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    vagina lesion.
57335................  C....................  ...................  Repair vagina.......  ...........  ...........  ...........  ...........  ...........
57400................  T....................  ...................  Dilation of vagina..         0194      18.4286    $1,005.48      $397.84      $201.10
57410................  T....................  ...................  Pelvic examination..         0194      18.4286    $1,005.48      $397.84      $201.10
57415................  T....................  ...................  Remove vaginal               0194      18.4286    $1,005.48      $397.84      $201.10
                                                                    foreign body.
57420................  T....................  ...................  Exam of vagina w/            0192       2.7121      $147.97       $39.11       $29.59
                                                                    scope.
57421................  T....................  ...................  Exam/biopsy of vag w/        0192       2.7121      $147.97       $39.11       $29.59
                                                                    scope.
57425................  T....................  NI.................  Laparoscopy, surg,           0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    colpopexy.
57452................  T....................  ...................  Examination of               0189       1.4232       $77.65       $18.09       $15.53
                                                                    vagina.
57454................  T....................  ...................  Vagina examination &         0192       2.7121      $147.97       $39.11       $29.59
                                                                    biopsy.
57455................  T....................  ...................  Biopsy of cervix w/          0192       2.7121      $147.97       $39.11       $29.59
                                                                    scope.
57456................  T....................  ...................  Endocerv curettage w/        0192       2.7121      $147.97       $39.11       $29.59
                                                                    scope.
57460................  T....................  ...................  Cervix excision.....         0193      15.0453      $820.89      $171.13      $164.18
57461................  T....................  ...................  Conz of cervix w/            0194      18.4286    $1,005.48      $397.84      $201.10
                                                                    scope, leep.
57500................  T....................  ...................  Biopsy of cervix....         0192       2.7121      $147.97       $39.11       $29.59
57505................  T....................  ...................  Endocervical                 0192       2.7121      $147.97       $39.11       $29.59
                                                                    curettage.
57510................  T....................  ...................  Cauterization of             0193      15.0453      $820.89      $171.13      $164.18
                                                                    cervix.
57511................  T....................  ...................  Cryocautery of               0189       1.4232       $77.65       $18.09       $15.53
                                                                    cervix.
57513................  T....................  ...................  Laser surgery of             0193      15.0453      $820.89      $171.13      $164.18
                                                                    cervix.
57520................  T....................  ...................  Conization of cervix         0194      18.4286    $1,005.48      $397.84      $201.10
57522................  T....................  ...................  Conization of cervix         0195      25.6950    $1,401.94      $483.80      $280.39
57530................  T....................  ...................  Removal of cervix...         0195      25.6950    $1,401.94      $483.80      $280.39
57531................  C....................  ...................  Removal of cervix,    ...........  ...........  ...........  ...........  ...........
                                                                    radical.
57540................  C....................  ...................  Removal of residual   ...........  ...........  ...........  ...........  ...........
                                                                    cervix.
57545................  C....................  ...................  Remove cervix/repair  ...........  ...........  ...........  ...........  ...........
                                                                    pelvis.
57550................  T....................  ...................  Removal of residual          0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    cervix.
57555................  T....................  ...................  Remove cervix/repair         0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    vagina.
57556................  T....................  ...................  Remove cervix,               0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    repair bowel.
57700................  T....................  ...................  Revision of cervix..         0194      18.4286    $1,005.48      $397.84      $201.10
57720................  T....................  ...................  Revision of cervix..         0194      18.4286    $1,005.48      $397.84      $201.10
57800................  T....................  ...................  Dilation of cervical         0193      15.0453      $820.89      $171.13      $164.18
                                                                    canal.
57820................  T....................  ...................  D & c of residual            0196      16.1219      $879.63      $338.23      $175.93
                                                                    cervix.
58100................  T....................  ...................  Biopsy of uterus             0188       1.1365       $62.01  ...........       $12.40
                                                                    lining.
58120................  T....................  ...................  Dilation and                 0196      16.1219      $879.63      $338.23      $175.93
                                                                    curettage.
58140................  C....................  ...................  Removal of uterus     ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
58145................  T....................  ...................  Myomectomy vag               0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    method.
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.
58300................  E....................  ...................  Insert intrauterine   ...........  ...........  ...........  ...........  ...........
                                                                    device.
58301................  T....................  ...................  Remove intrauterine          0189       1.4232       $77.65       $18.09       $15.53
                                                                    device.
58321................  T....................  ...................  Artificial                   0197       4.8280      $263.42  ...........       $52.68
                                                                    insemination.
58322................  T....................  ...................  Artificial                   0197       4.8280      $263.42  ...........       $52.68
                                                                    insemination.
58323................  T....................  ...................  Sperm washing.......         0197       4.8280      $263.42  ...........       $52.68
58340................  N....................  ...................  Catheter for          ...........  ...........  ...........  ...........  ...........
                                                                    hysterography.
58345................  T....................  ...................  Reopen fallopian             0194      18.4286    $1,005.48      $397.84      $201.10
                                                                    tube.
58346................  T....................  ...................  Insert heyman uteri          0193      15.0453      $820.89      $171.13      $164.18
                                                                    capsule.
58350................  T....................  ...................  Reopen fallopian             0194      18.4286    $1,005.48      $397.84      $201.10
                                                                    tube.
58353................  T....................  ...................  Endometr ablate,             0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    thermal.
58400................  C....................  ...................  Suspension of uterus  ...........  ...........  ...........  ...........  ...........
58410................  C....................  ...................  Suspension of uterus  ...........  ...........  ...........  ...........  ...........
58520................  C....................  ...................  Repair of ruptured    ...........  ...........  ...........  ...........  ...........
                                                                    uterus.

[[Page 63550]]

 
58540................  C....................  ...................  Revision of uterus..  ...........  ...........  ...........  ...........  ...........
58545................  T....................  ...................  Laparoscopic                 0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    myomectomy.
58546................  T....................  ...................  Laparo-myomectomy,           0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    complex.
58550................  T....................  ...................  Laparo-asst vag              0132      57.2045    $3,121.13    $1,239.22      $624.23
                                                                    hysterectomy.
58552................  T....................  ...................  Laparo-vag hyst incl         0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    t/o.
58553................  T....................  ...................  Laparo-vag hyst,             0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    complex.
58554................  T....................  ...................  Laparo-vag hyst w/t/         0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    o, compl.
58555................  T....................  ...................  Hysteroscopy, dx,            0190      19.6922    $1,074.43      $424.28      $214.89
                                                                    sep proc.
58558................  T....................  ...................  Hysteroscopy, biopsy         0190      19.6922    $1,074.43      $424.28      $214.89
58559................  T....................  ...................  Hysteroscopy, lysis.         0190      19.6922    $1,074.43      $424.28      $214.89
58560................  T....................  ...................  Hysteroscopy, resect         0387      28.1480    $1,535.78      $655.55      $307.16
                                                                    septum.
58561................  T....................  ...................  Hysteroscopy, remove         0387      28.1480    $1,535.78      $655.55      $307.16
                                                                    myoma.
58562................  T....................  ...................  Hysteroscopy, remove         0190      19.6922    $1,074.43      $424.28      $214.89
                                                                    fb.
58563................  T....................  ...................  Hysteroscopy,                0387      28.1480    $1,535.78      $655.55      $307.16
                                                                    ablation.
58578................  T....................  ...................  Laparo proc, uterus.         0130      32.7724    $1,788.09      $659.53      $357.62
58579................  T....................  ...................  Hysteroscope                 0190      19.6922    $1,074.43      $424.28      $214.89
                                                                    procedure.
58600................  T....................  ...................  Division of                  0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    fallopian tube.
58605................  C....................  ...................  Division of           ...........  ...........  ...........  ...........  ...........
                                                                    fallopian tube.
58611................  C....................  ...................  Ligate oviduct(s)     ...........  ...........  ...........  ...........  ...........
                                                                    add-on.
58615................  T....................  ...................  Occlude fallopian            0194      18.4286    $1,005.48      $397.84      $201.10
                                                                    tube(s).
58660................  T....................  ...................  Laparoscopy, lysis..         0131      40.8064    $2,226.44    $1,001.89      $445.29
58661................  T....................  ...................  Laparoscopy, remove          0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    adnexa.
58662................  T....................  ...................  Laparoscopy, excise          0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    lesions.
58670................  T....................  ...................  Laparoscopy, tubal           0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    cautery.
58671................  T....................  ...................  Laparoscopy, tubal           0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    block.
58672................  T....................  ...................  Laparoscopy,                 0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    fimbrioplasty.
58673................  T....................  ...................  Laparoscopy,                 0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    salpingostomy.
58679................  T....................  ...................  Laparo proc, oviduct-        0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    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.
58800................  T....................  ...................  Drainage of ovarian          0193      15.0453      $820.89      $171.13      $164.18
                                                                    cyst(s).
58805................  C....................  ...................  Drainage of ovarian   ...........  ...........  ...........  ...........  ...........
                                                                    cyst(s).
58820................  T....................  ...................  Drain ovary abscess,         0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    open.
58822................  C....................  ...................  Drain ovary abscess,  ...........  ...........  ...........  ...........  ...........
                                                                    percut.
58823................  T....................  ...................  Drain pelvic                 0193      15.0453      $820.89      $171.13      $164.18
                                                                    abscess, percut.
58825................  C....................  ...................  Transposition,        ...........  ...........  ...........  ...........  ...........
                                                                    ovary(s).
58900................  T....................  ...................  Biopsy of ovary(s)..         0193      15.0453      $820.89      $171.13      $164.18
58920................  T....................  ...................  Partial removal of           0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    ovary(s).
58925................  T....................  ...................  Removal of ovarian           0195      25.6950    $1,401.94      $483.80      $280.39
                                                                    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      18.4286    $1,005.48      $397.84      $201.10
58974................  T....................  ...................  Transfer of embryo..         0197       4.8280      $263.42  ...........       $52.68
58976................  T....................  ...................  Transfer of embryo..         0197       4.8280      $263.42  ...........       $52.68
58999................  T....................  ...................  Genital surgery              0191       0.1853       $10.11        $2.93        $2.02
                                                                    procedure.
59000................  T....................  ...................  Amniocentesis,               0198       1.3578       $74.08       $32.19       $14.82
                                                                    diagnostic.
59001................  T....................  ...................  Amniocentesis,               0198       1.3578       $74.08       $32.19       $14.82
                                                                    therapeutic.
59012................  T....................  ...................  Fetal cord                   0198       1.3578       $74.08       $32.19       $14.82
                                                                    puncture,prenatal.
59015................  T....................  ...................  Chorion biopsy......         0198       1.3578       $74.08       $32.19       $14.82
59020................  T....................  ...................  Fetal contract               0198       1.3578       $74.08       $32.19       $14.82
                                                                    stress test.
59025................  T....................  ...................  Fetal non-stress             0198       1.3578       $74.08       $32.19       $14.82
                                                                    test.
59030................  T....................  ...................  Fetal scalp blood            0198       1.3578       $74.08       $32.19       $14.82
                                                                    sample.
59050................  E....................  ...................  Fetal monitor w/      ...........  ...........  ...........  ...........  ...........
                                                                    report.
59051................  B....................  ...................  Fetal monitor/        ...........  ...........  ...........  ...........  ...........
                                                                    interpret only.
59070................  T....................  NI.................  Transabdom                   0198       1.3578       $74.08       $32.19       $14.82
                                                                    amnioinfus w/ us.
59072................  T....................  NI.................  Umbilical cord               0198       1.3578       $74.08       $32.19       $14.82
                                                                    occlud w/ us.
59074................  T....................  NI.................  Fetal fluid drainage         0198       1.3578       $74.08       $32.19       $14.82
                                                                    w/ us.
59076................  T....................  NI.................  Fetal shunt                  0198       1.3578       $74.08       $32.19       $14.82
                                                                    placement, w/ us.
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.

[[Page 63551]]

 
59140................  C....................  ...................  Treat ectopic         ...........  ...........  ...........  ...........  ...........
                                                                    pregnancy.
59150................  T....................  ...................  Treat ectopic                0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    pregnancy.
59151................  T....................  ...................  Treat ectopic                0131      40.8064    $2,226.44    $1,001.89      $445.29
                                                                    pregnancy.
59160................  T....................  ...................  D & c after delivery         0196      16.1219      $879.63      $338.23      $175.93
59200................  T....................  ...................  Insert cervical              0189       1.4232       $77.65       $18.09       $15.53
                                                                    dilator.
59300................  T....................  ...................  Episiotomy or                0193      15.0453      $820.89      $171.13      $164.18
                                                                    vaginal repair.
59320................  T....................  ...................  Revision of cervix..         0194      18.4286    $1,005.48      $397.84      $201.10
59325................  C....................  ...................  Revision of cervix..  ...........  ...........  ...........  ...........  ...........
59350................  C....................  ...................  Repair of uterus....  ...........  ...........  ...........  ...........  ...........
59400................  B....................  ...................  Obstetrical care....  ...........  ...........  ...........  ...........  ...........
59409................  T....................  ...................  Obstetrical care....         0199      17.2831      $942.98  ...........      $188.60
59410................  B....................  ...................  Obstetrical care....  ...........  ...........  ...........  ...........  ...........
59412................  T....................  ...................  Antepartum                   0700       2.4306      $132.62       $37.13       $26.52
                                                                    manipulation.
59414................  T....................  ...................  Deliver placenta....         0199      17.2831      $942.98  ...........      $188.60
59425................  B....................  ...................  Antepartum care only  ...........  ...........  ...........  ...........  ...........
59426................  B....................  ...................  Antepartum care only  ...........  ...........  ...........  ...........  ...........
59430................  B....................  ...................  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      17.2831      $942.98  ...........      $188.60
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      16.8660      $920.23      $329.65      $184.05
                                                                    miscarriage.
59820................  T....................  ...................  Care of miscarriage.         0201      16.8660      $920.23      $329.65      $184.05
59821................  T....................  ...................  Treatment of                 0201      16.8660      $920.23      $329.65      $184.05
                                                                    miscarriage.
59830................  C....................  ...................  Treat uterus          ...........  ...........  ...........  ...........  ...........
                                                                    infection.
59840................  T....................  ...................  Abortion............         0200      17.9920      $981.66      $307.83      $196.33
59841................  T....................  ...................  Abortion............         0200      17.9920      $981.66      $307.83      $196.33
59850................  C....................  ...................  Abortion............  ...........  ...........  ...........  ...........  ...........
59851................  C....................  ...................  Abortion............  ...........  ...........  ...........  ...........  ...........
59852................  C....................  ...................  Abortion............  ...........  ...........  ...........  ...........  ...........
59855................  C....................  ...................  Abortion............  ...........  ...........  ...........  ...........  ...........
59856................  C....................  ...................  Abortion............  ...........  ...........  ...........  ...........  ...........
59857................  C....................  ...................  Abortion............  ...........  ...........  ...........  ...........  ...........
59866................  T....................  ...................  Abortion (mpr)......         0198       1.3578       $74.08       $32.19       $14.82
59870................  T....................  ...................  Evacuate mole of             0201      16.8660      $920.23      $329.65      $184.05
                                                                    uterus.
59871................  T....................  ...................  Remove cerclage              0194      18.4286    $1,005.48      $397.84      $201.10
                                                                    suture.
59897................  T....................  NI.................  Fetal invas px w/ us         0198       1.3578       $74.08       $32.19       $14.82
59898................  T....................  ...................  Laparo proc, ob care/        0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    deliver.
59899................  T....................  ...................  Maternity care               0198       1.3578       $74.08       $32.19       $14.82
                                                                    procedure.
60000................  T....................  ...................  Drain thyroid/tongue         0252       6.4469      $351.75      $113.41       $70.35
                                                                    cyst.
60001................  T....................  ...................  Aspirate/inject              0004       1.5882       $86.65       $22.36       $17.33
                                                                    thyriod cyst.
60100................  T....................  ...................  Biopsy of thyroid...         0004       1.5882       $86.65       $22.36       $17.33
60200................  T....................  ...................  Remove thyroid               0114      37.5963    $2,051.29      $485.91      $410.26
                                                                    lesion.
60210................  T....................  ...................  Partial thyroid              0114      37.5963    $2,051.29      $485.91      $410.26
                                                                    excision.
60212................  T....................  ...................  Partial thyroid              0114      37.5963    $2,051.29      $485.91      $410.26
                                                                    excision.
60220................  T....................  ...................  Partial removal of           0114      37.5963    $2,051.29      $485.91      $410.26
                                                                    thyroid.
60225................  T....................  ...................  Partial removal of           0114      37.5963    $2,051.29      $485.91      $410.26
                                                                    thyroid.
60240................  T....................  ...................  Removal of thyroid..         0114      37.5963    $2,051.29      $485.91      $410.26
60252................  T....................  ...................  Removal of thyroid..         0256      35.1548    $1,918.08  ...........      $383.62
60254................  C....................  ...................  Extensive thyroid     ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
60260................  T....................  ...................  Repeat thyroid               0256      35.1548    $1,918.08  ...........      $383.62
                                                                    surgery.
60270................  C....................  ...................  Removal of thyroid..  ...........  ...........  ...........  ...........  ...........
60271................  C....................  ...................  Removal of thyroid..  ...........  ...........  ...........  ...........  ...........
60280................  T....................  ...................  Remove thyroid duct          0114      37.5963    $2,051.29      $485.91      $410.26
                                                                    lesion.
60281................  T....................  ...................  Remove thyroid duct          0114      37.5963    $2,051.29      $485.91      $410.26
                                                                    lesion.
60500................  T....................  ...................  Explore parathyroid          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    glands.
60502................  C....................  ...................  Re-explore            ...........  ...........  ...........  ...........  ...........
                                                                    parathyroids.
60505................  C....................  ...................  Explore parathyroid   ...........  ...........  ...........  ...........  ...........
                                                                    glands.
60512................  T....................  ...................  Autotransplant               0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    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,                 0130      32.7724    $1,788.09      $659.53      $357.62
                                                                    endocrine.
60699................  T....................  ...................  Endocrine surgery            0114      37.5963    $2,051.29      $485.91      $410.26
                                                                    procedure.

[[Page 63552]]

 
61000................  T....................  ...................  Remove cranial               0212       2.9739      $162.26       $74.67       $32.45
                                                                    cavity fluid.
61001................  T....................  ...................  Remove cranial               0212       2.9739      $162.26       $74.67       $32.45
                                                                    cavity fluid.
61020................  T....................  ...................  Remove brain cavity          0212       2.9739      $162.26       $74.67       $32.45
                                                                    fluid.
61026................  T....................  ...................  Injection into brain         0212       2.9739      $162.26       $74.67       $32.45
                                                                    canal.
61050................  T....................  ...................  Remove brain canal           0212       2.9739      $162.26       $74.67       $32.45
                                                                    fluid.
61055................  T....................  ...................  Injection into brain         0212       2.9739      $162.26       $74.67       $32.45
                                                                    canal.
61070................  T....................  ...................  Brain canal shunt            0212       2.9739      $162.26       $74.67       $32.45
                                                                    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      34.1770    $1,864.73      $453.41      $372.95
                                                                    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.
61316................  C....................  ...................  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               0256      35.1548    $1,918.08  ...........      $383.62
                                                                    socket.
61332................  C....................  ...................  Explore/biopsy eye    ...........  ...........  ...........  ...........  ...........
                                                                    socket.
61333................  C....................  ...................  Explore orbit/remove  ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
61334................  C....................  ...................  Explore orbit/remove  ...........  ...........  ...........  ...........  ...........
                                                                    object.
61340................  C....................  ...................  Relieve cranial       ...........  ...........  ...........  ...........  ...........
                                                                    pressure.
61343................  C....................  ...................  Incise skull (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................  C....................  ...................  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.
61537................  C....................  NI.................  Removal of brain      ...........  ...........  ...........  ...........  ...........
                                                                    tissue.
61538................  C....................  ...................  Removal of brain      ...........  ...........  ...........  ...........  ...........
                                                                    tissue.
61539................  C....................  ...................  Removal of brain      ...........  ...........  ...........  ...........  ...........
                                                                    tissue.
61540................  C....................  NI.................  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.

[[Page 63553]]

 
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.
61566................  C....................  NI.................  Removal of brain      ...........  ...........  ...........  ...........  ...........
                                                                    tissue.
61567................  C....................  NI.................  Incision of brain     ...........  ...........  ...........  ...........  ...........
                                                                    tissue.
61570................  C....................  ...................  Remove foreign body,  ...........  ...........  ...........  ...........  ...........
                                                                    brain.
61571................  C....................  ...................  Incise skull for      ...........  ...........  ...........  ...........  ...........
                                                                    brain wound.
61575................  C....................  ...................  Skull base/brainstem  ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
61576................  C....................  ...................  Skull base/brainstem  ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
61580................  C....................  ...................  Craniofacial          ...........  ...........  ...........  ...........  ...........
                                                                    approach, skull.
61581................  C....................  ...................  Craniofacial          ...........  ...........  ...........  ...........  ...........
                                                                    approach, skull.
61582................  C....................  ...................  Craniofacial          ...........  ...........  ...........  ...........  ...........
                                                                    approach, skull.
61583................  C....................  ...................  Craniofacial          ...........  ...........  ...........  ...........  ...........
                                                                    approach, skull.
61584................  C....................  ...................  Orbitocranial         ...........  ...........  ...........  ...........  ...........
                                                                    approach/skull.
61585................  C....................  ...................  Orbitocranial         ...........  ...........  ...........  ...........  ...........
                                                                    approach/skull.
61586................  C....................  ...................  Resect nasopharynx,   ...........  ...........  ...........  ...........  ...........
                                                                    skull.
61590................  C....................  ...................  Infratemporal         ...........  ...........  ...........  ...........  ...........
                                                                    approach/skull.
61591................  C....................  ...................  Infratemporal         ...........  ...........  ...........  ...........  ...........
                                                                    approach/skull.
61592................  C....................  ...................  Orbitocranial         ...........  ...........  ...........  ...........  ...........
                                                                    approach/skull.
61595................  C....................  ...................  Transtemporal         ...........  ...........  ...........  ...........  ...........
                                                                    approach/skull.
61596................  C....................  ...................  Transcochlear         ...........  ...........  ...........  ...........  ...........
                                                                    approach/skull.
61597................  C....................  ...................  Transcondylar         ...........  ...........  ...........  ...........  ...........
                                                                    approach/skull.
61598................  C....................  ...................  Transpetrosal         ...........  ...........  ...........  ...........  ...........
                                                                    approach/skull.
61600................  C....................  ...................  Resect/excise         ...........  ...........  ...........  ...........  ...........
                                                                    cranial lesion.
61601................  C....................  ...................  Resect/excise         ...........  ...........  ...........  ...........  ...........
                                                                    cranial lesion.
61605................  C....................  ...................  Resect/excise         ...........  ...........  ...........  ...........  ...........
                                                                    cranial lesion.
61606................  C....................  ...................  Resect/excise         ...........  ...........  ...........  ...........  ...........
                                                                    cranial lesion.
61607................  C....................  ...................  Resect/excise         ...........  ...........  ...........  ...........  ...........
                                                                    cranial lesion.
61608................  C....................  ...................  Resect/excise         ...........  ...........  ...........  ...........  ...........
                                                                    cranial lesion.
61609................  C....................  ...................  Transect artery,      ...........  ...........  ...........  ...........  ...........
                                                                    sinus.
61610................  C....................  ...................  Transect artery,      ...........  ...........  ...........  ...........  ...........
                                                                    sinus.
61611................  C....................  ...................  Transect artery,      ...........  ...........  ...........  ...........  ...........
                                                                    sinus.
61612................  C....................  ...................  Transect artery,      ...........  ...........  ...........  ...........  ...........
                                                                    sinus.
61613................  C....................  ...................  Remove aneurysm,      ...........  ...........  ...........  ...........  ...........
                                                                    sinus.
61615................  C....................  ...................  Resect/excise         ...........  ...........  ...........  ...........  ...........
                                                                    lesion, skull.
61616................  C....................  ...................  Resect/excise         ...........  ...........  ...........  ...........  ...........
                                                                    lesion, skull.
61618................  C....................  ...................  Repair dura.........  ...........  ...........  ...........  ...........  ...........
61619................  C....................  ...................  Repair dura.........  ...........  ...........  ...........  ...........  ...........
61623................  T....................  ...................  Endovasc tempory             1555  ...........    $1,650.00  ...........      $330.00
                                                                    vessel occl.
61624................  C....................  ...................  Occlusion/            ...........  ...........  ...........  ...........  ...........
                                                                    embolization cath.
61626................  T....................  ...................  Transcath occlusion,         0081      35.0285    $1,911.19  ...........      $382.24
                                                                    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             0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
61791................  T....................  ...................  Treat trigeminal             0204       2.1711      $118.46       $40.13       $23.69
                                                                    tract.
61793................  E....................  ...................  Focus radiation beam  ...........  ...........  ...........  ...........  ...........
61795................  S....................  ...................  Brain surgery using          0302       6.3268      $345.20      $130.77       $69.04
                                                                    computer.
61850................  C....................  ...................  Implant               ...........  ...........  ...........  ...........  ...........
                                                                    neuroelectrodes.
61860................  C....................  ...................  Implant               ...........  ...........  ...........  ...........  ...........
                                                                    neuroelectrodes.
61862................  C....................  DG.................  Implant neurostimul,  ...........  ...........  ...........  ...........  ...........
                                                                    subcort.

[[Page 63554]]

 
61863................  C....................  NI.................  Implant               ...........  ...........  ...........  ...........  ...........
                                                                    neuroelectrode.
61864................  C....................  NI.................  Implant               ...........  ...........  ...........  ...........  ...........
                                                                    neuroelectrde,
                                                                    add'l.
61867................  C....................  NI.................  Implant               ...........  ...........  ...........  ...........  ...........
                                                                    neuroelectrode.
61868................  C....................  NI.................  Implant               ...........  ...........  ...........  ...........  ...........
                                                                    neuroelectrde,
                                                                    add'l.
61870................  C....................  ...................  Implant               ...........  ...........  ...........  ...........  ...........
                                                                    neuroelectrodes.
61875................  C....................  ...................  Implant               ...........  ...........  ...........  ...........  ...........
                                                                    neuroelectrodes.
61880................  T....................  ...................  Revise/remove                0687      20.4416    $1,115.31      $513.05      $223.06
                                                                    neuroelectrode.
61885................  S....................  ...................  Implant neurostim            0039     235.1866   $12,832.02  ...........    $2,566.40
                                                                    one array.
61886................  T....................  ...................  Implant neurostim            0222     232.2024   $12,669.20  ...........    $2,533.84
                                                                    arrays.
61888................  T....................  ...................  Revise/remove                0688      46.7347    $2,549.89    $1,249.45      $509.98
                                                                    neuroreceiver.
62000................  C....................  ...................  Treat skull fracture  ...........  ...........  ...........  ...........  ...........
62005................  C....................  ...................  Treat skull fracture  ...........  ...........  ...........  ...........  ...........
62010................  C....................  ...................  Treatment of head     ...........  ...........  ...........  ...........  ...........
                                                                    injury.
62100................  C....................  ...................  Repair brain fluid    ...........  ...........  ...........  ...........  ...........
                                                                    leakage.
62115................  C....................  ...................  Reduction of skull    ...........  ...........  ...........  ...........  ...........
                                                                    defect.
62116................  C....................  ...................  Reduction of skull    ...........  ...........  ...........  ...........  ...........
                                                                    defect.
62117................  C....................  ...................  Reduction of skull    ...........  ...........  ...........  ...........  ...........
                                                                    defect.
62120................  C....................  ...................  Repair skull cavity   ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
62121................  C....................  ...................  Incise skull repair.  ...........  ...........  ...........  ...........  ...........
62140................  C....................  ...................  Repair of skull       ...........  ...........  ...........  ...........  ...........
                                                                    defect.
62141................  C....................  ...................  Repair of skull       ...........  ...........  ...........  ...........  ...........
                                                                    defect.
62142................  C....................  ...................  Remove skull plate/   ...........  ...........  ...........  ...........  ...........
                                                                    flap.
62143................  C....................  ...................  Replace skull plate/  ...........  ...........  ...........  ...........  ...........
                                                                    flap.
62145................  C....................  ...................  Repair of skull &     ...........  ...........  ...........  ...........  ...........
                                                                    brain.
62146................  C....................  ...................  Repair of skull with  ...........  ...........  ...........  ...........  ...........
                                                                    graft.
62147................  C....................  ...................  Repair of skull with  ...........  ...........  ...........  ...........  ...........
                                                                    graft.
62148................  C....................  ...................  Retr bone flap to     ...........  ...........  ...........  ...........  ...........
                                                                    fix skull.
62160................  C....................  ...................  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       2.1189      $115.61       $43.80       $23.12
                                                                    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       8.8621      $483.53       $99.16       $96.71
                                                                    catheter.
62230................  T....................  ...................  Replace/revise brain         0224      34.1770    $1,864.73      $453.41      $372.95
                                                                    shunt.
62252................  S....................  ...................  Csf shunt reprogram.         0691       2.8066      $153.13       $76.56       $30.63
62256................  C....................  ...................  Remove brain cavity   ...........  ...........  ...........  ...........  ...........
                                                                    shunt.
62258................  C....................  ...................  Replace brain cavity  ...........  ...........  ...........  ...........  ...........
                                                                    shunt.
62263................  T....................  ...................  Lysis epidural               0203      11.5969      $632.74      $276.76      $126.55
                                                                    adhesions.
62264................  T....................  ...................  Epidural lysis on            0203      11.5969      $632.74      $276.76      $126.55
                                                                    single day.
62268................  T....................  ...................  Drain spinal cord            0212       2.9739      $162.26       $74.67       $32.45
                                                                    cyst.
62269................  T....................  ...................  Needle biopsy,               0005       3.2698      $178.40       $71.59       $35.68
                                                                    spinal cord.
62270................  T....................  ...................  Spinal fluid tap,            0206       5.2875      $288.49       $75.55       $57.70
                                                                    diagnostic.
62272................  T....................  ...................  Drain cerebro spinal         0206       5.2875      $288.49       $75.55       $57.70
                                                                    fluid.
62273................  T....................  ...................  Treat epidural spine         0206       5.2875      $288.49       $75.55       $57.70
                                                                    lesion.
62280................  T....................  ...................  Treat spinal cord            0207       6.4554      $352.21      $123.69       $70.44
                                                                    lesion.
62281................  T....................  ...................  Treat spinal cord            0207       6.4554      $352.21      $123.69       $70.44
                                                                    lesion.
62282................  T....................  ...................  Treat spinal canal           0207       6.4554      $352.21      $123.69       $70.44
                                                                    lesion.
62284................  N....................  ...................  Injection for         ...........  ...........  ...........  ...........  ...........
                                                                    myelogram.
62287................  T....................  ...................  Percutaneous                 0220      16.5554      $903.28  ...........      $180.66
                                                                    diskectomy.
62290................  N....................  ...................  Inject for spine      ...........  ...........  ...........  ...........  ...........
                                                                    disk x-ray.
62291................  N....................  ...................  Inject for spine      ...........  ...........  ...........  ...........  ...........
                                                                    disk x-ray.
62292................  T....................  ...................  Injection into disk          0212       2.9739      $162.26       $74.67       $32.45
                                                                    lesion.
62294................  T....................  ...................  Injection into               0212       2.9739      $162.26       $74.67       $32.45
                                                                    spinal artery.
62310................  T....................  ...................  Inject spine c/t....         0206       5.2875      $288.49       $75.55       $57.70
62311................  T....................  ...................  Inject spine l/s             0206       5.2875      $288.49       $75.55       $57.70
                                                                    (cd).
62318................  T....................  ...................  Inject spine w/cath,         0206       5.2875      $288.49       $75.55       $57.70
                                                                    c/t.
62319................  T....................  ...................  Inject spine w/cath          0206       5.2875      $288.49       $75.55       $57.70
                                                                    l/s (cd).
62350................  T....................  ...................  Implant spinal canal         0223      26.7610    $1,460.11  ...........      $292.02
                                                                    cath.
62351................  T....................  ...................  Implant spinal canal         0208      40.2830    $2,197.88  ...........      $439.58
                                                                    cath.
62355................  T....................  ...................  Remove spinal canal          0203      11.5969      $632.74      $276.76      $126.55
                                                                    catheter.
62360................  T....................  ...................  Insert spine                 0226     136.2989    $7,436.60  ...........    $1,487.32
                                                                    infusion device.
62361................  T....................  ...................  Implant spine                0227     160.8363    $8,775.39  ...........    $1,755.08
                                                                    infusion pump.
62362................  T....................  ...................  Implant spine                0227     160.8363    $8,775.39  ...........    $1,755.08
                                                                    infusion pump.
62365................  T....................  ...................  Remove spine                 0203      11.5969      $632.74      $276.76      $126.55
                                                                    infusion device.
62367................  S....................  ...................  Analyze spine                0691       2.8066      $153.13       $76.56       $30.63
                                                                    infusion pump.
62368................  S....................  ...................  Analyze spine                0691       2.8066      $153.13       $76.56       $30.63
                                                                    infusion pump.

[[Page 63555]]

 
63001................  T....................  ...................  Removal of spinal            0208      40.2830    $2,197.88  ...........      $439.58
                                                                    lamina.
63003................  T....................  ...................  Removal of spinal            0208      40.2830    $2,197.88  ...........      $439.58
                                                                    lamina.
63005................  T....................  ...................  Removal of spinal            0208      40.2830    $2,197.88  ...........      $439.58
                                                                    lamina.
63011................  T....................  ...................  Removal of spinal            0208      40.2830    $2,197.88  ...........      $439.58
                                                                    lamina.
63012................  T....................  ...................  Removal of spinal            0208      40.2830    $2,197.88  ...........      $439.58
                                                                    lamina.
63015................  T....................  ...................  Removal of spinal            0208      40.2830    $2,197.88  ...........      $439.58
                                                                    lamina.
63016................  T....................  ...................  Removal of spinal            0208      40.2830    $2,197.88  ...........      $439.58
                                                                    lamina.
63017................  T....................  ...................  Removal of spinal            0208      40.2830    $2,197.88  ...........      $439.58
                                                                    lamina.
63020................  T....................  ...................  Neck spine disk              0208      40.2830    $2,197.88  ...........      $439.58
                                                                    surgery.
63030................  T....................  ...................  Low back disk                0208      40.2830    $2,197.88  ...........      $439.58
                                                                    surgery.
63035................  T....................  ...................  Spinal disk surgery          0208      40.2830    $2,197.88  ...........      $439.58
                                                                    add-on.
63040................  T....................  ...................  Laminotomy, single           0208      40.2830    $2,197.88  ...........      $439.58
                                                                    cervical.
63042................  T....................  ...................  Laminotomy, single           0208      40.2830    $2,197.88  ...........      $439.58
                                                                    lumbar.
63043................  C....................  ...................  Laminotomy, add'l     ...........  ...........  ...........  ...........  ...........
                                                                    cervical.
63044................  C....................  ...................  Laminotomy, add'l     ...........  ...........  ...........  ...........  ...........
                                                                    lumbar.
63045................  T....................  ...................  Removal of spinal            0208      40.2830    $2,197.88  ...........      $439.58
                                                                    lamina.
63046................  T....................  ...................  Removal of spinal            0208      40.2830    $2,197.88  ...........      $439.58
                                                                    lamina.
63047................  T....................  ...................  Removal of spinal            0208      40.2830    $2,197.88  ...........      $439.58
                                                                    lamina.
63048................  T....................  ...................  Remove spinal lamina         0208      40.2830    $2,197.88  ...........      $439.58
                                                                    add-on.
63055................  T....................  ...................  Decompress spinal            0208      40.2830    $2,197.88  ...........      $439.58
                                                                    cord.
63056................  T....................  ...................  Decompress spinal            0208      40.2830    $2,197.88  ...........      $439.58
                                                                    cord.
63057................  T....................  ...................  Decompress spine             0208      40.2830    $2,197.88  ...........      $439.58
                                                                    cord add-on.
63064................  T....................  ...................  Decompress spinal            0208      40.2830    $2,197.88  ...........      $439.58
                                                                    cord.
63066................  T....................  ...................  Decompress spine             0208      40.2830    $2,197.88  ...........      $439.58
                                                                    cord add-on.
63075................  C....................  ...................  Neck spine disk       ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
63076................  C....................  ...................  Neck spine disk       ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
63077................  C....................  ...................  Spine disk surgery,   ...........  ...........  ...........  ...........  ...........
                                                                    thorax.
63078................  C....................  ...................  Spine disk surgery,   ...........  ...........  ...........  ...........  ...........
                                                                    thorax.
63081................  C....................  ...................  Removal of vertebral  ...........  ...........  ...........  ...........  ...........
                                                                    body.
63082................  C....................  ...................  Remove vertebral      ...........  ...........  ...........  ...........  ...........
                                                                    body add-on.
63085................  C....................  ...................  Removal of vertebral  ...........  ...........  ...........  ...........  ...........
                                                                    body.
63086................  C....................  ...................  Remove vertebral      ...........  ...........  ...........  ...........  ...........
                                                                    body add-on.
63087................  C....................  ...................  Removal of vertebral  ...........  ...........  ...........  ...........  ...........
                                                                    body.
63088................  C....................  ...................  Remove vertebral      ...........  ...........  ...........  ...........  ...........
                                                                    body add-on.
63090................  C....................  ...................  Removal of vertebral  ...........  ...........  ...........  ...........  ...........
                                                                    body.
63091................  C....................  ...................  Remove vertebral      ...........  ...........  ...........  ...........  ...........
                                                                    body add-on.
63101................  C....................  NI.................  Removal of vertebral  ...........  ...........  ...........  ...........  ...........
                                                                    body.
63102................  C....................  NI.................  Removal of vertebral  ...........  ...........  ...........  ...........  ...........
                                                                    body.
63103................  C....................  NI.................  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.

[[Page 63556]]

 
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      16.5554      $903.28  ...........      $180.66
                                                                    lesion.
63610................  T....................  ...................  Stimulation of               0220      16.5554      $903.28  ...........      $180.66
                                                                    spinal cord.
63615................  T....................  ...................  Remove lesion of             0220      16.5554      $903.28  ...........      $180.66
                                                                    spinal cord.
63650................  S....................  ...................  Implant                      0040      52.1002    $2,842.64  ...........      $568.53
                                                                    neuroelectrodes.
63655................  S....................  ...................  Implant                      0225     206.0034   $11,239.75  ...........    $2,247.95
                                                                    neuroelectrodes.
63660................  T....................  ...................  Revise/remove                0687      20.4416    $1,115.31      $513.05      $223.06
                                                                    neuroelectrode.
63685................  T....................  ...................  Implant                      0222     232.2024   $12,669.20  ...........    $2,533.84
                                                                    neuroreceiver.
63688................  T....................  ...................  Revise/remove                0688      46.7347    $2,549.89    $1,249.45      $509.98
                                                                    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      52.2880    $2,852.89      $639.03      $570.58
63744................  T....................  ...................  Revision of spinal           0228      52.2880    $2,852.89      $639.03      $570.58
                                                                    shunt.
63746................  T....................  ...................  Removal of spinal            0109       7.4705      $407.60      $131.49       $81.52
                                                                    shunt.
64400................  T....................  ...................  N block inj,                 0204       2.1711      $118.46       $40.13       $23.69
                                                                    trigeminal.
64402................  T....................  ...................  N block inj, facial.         0204       2.1711      $118.46       $40.13       $23.69
64405................  T....................  ...................  N block inj,                 0204       2.1711      $118.46       $40.13       $23.69
                                                                    occipital.
64408................  T....................  ...................  N block inj, vagus..         0204       2.1711      $118.46       $40.13       $23.69
64410................  T....................  ...................  N block inj, phrenic         0204       2.1711      $118.46       $40.13       $23.69
64412................  T....................  ...................  N block inj, spinal          0204       2.1711      $118.46       $40.13       $23.69
                                                                    accessor.
64413................  T....................  ...................  N block inj,                 0204       2.1711      $118.46       $40.13       $23.69
                                                                    cervical plexus.
64415................  T....................  ...................  Injection for nerve          0204       2.1711      $118.46       $40.13       $23.69
                                                                    block.
64416................  T....................  ...................  N block cont infuse,         0204       2.1711      $118.46       $40.13       $23.69
                                                                    b plex.
64417................  T....................  ...................  N block inj,                 0204       2.1711      $118.46       $40.13       $23.69
                                                                    axillary.
64418................  T....................  ...................  N block inj,                 0204       2.1711      $118.46       $40.13       $23.69
                                                                    suprascapular.
64420................  T....................  ...................  N block inj,                 0207       6.4554      $352.21      $123.69       $70.44
                                                                    intercost, sng.
64421................  T....................  ...................  N block inj,                 0207       6.4554      $352.21      $123.69       $70.44
                                                                    intercost, mlt.
64425................  T....................  ...................  N block inj ilio-ing/        0204       2.1711      $118.46       $40.13       $23.69
                                                                    hypogi.
64430................  T....................  ...................  N block inj,                 0204       2.1711      $118.46       $40.13       $23.69
                                                                    pudendal.
64435................  T....................  ...................  N block inj,                 0204       2.1711      $118.46       $40.13       $23.69
                                                                    paracervical.
64445................  T....................  ...................  Injection for nerve          0204       2.1711      $118.46       $40.13       $23.69
                                                                    block.
64446................  T....................  ...................  N blk inj, sciatic,          0204       2.1711      $118.46       $40.13       $23.69
                                                                    cont inf.
64447................  T....................  ...................  N block inj fem,             0204       2.1711      $118.46       $40.13       $23.69
                                                                    single.
64448................  T....................  ...................  N block inj fem,             0204       2.1711      $118.46       $40.13       $23.69
                                                                    cont inf.
64449................  T....................  NI.................  N block inj, lumbar          0204       2.1711      $118.46       $40.13       $23.69
                                                                    plexus.
64450................  T....................  ...................  N block, other               0204       2.1711      $118.46       $40.13       $23.69
                                                                    peripheral.
64470................  T....................  ...................  Inj paravertebral c/         0207       6.4554      $352.21      $123.69       $70.44
                                                                    t.
64472................  T....................  ...................  Inj paravertebral c/         0207       6.4554      $352.21      $123.69       $70.44
                                                                    t add-on.
64475................  T....................  ...................  Inj paravertebral l/         0207       6.4554      $352.21      $123.69       $70.44
                                                                    s.
64476................  T....................  ...................  Inj paravertebral l/         0207       6.4554      $352.21      $123.69       $70.44
                                                                    s add-on.
64479................  T....................  ...................  Inj foramen epidural         0207       6.4554      $352.21      $123.69       $70.44
                                                                    c/t.
64480................  T....................  ...................  Inj foramen epidural         0207       6.4554      $352.21      $123.69       $70.44
                                                                    add-on.
64483................  T....................  ...................  Inj foramen epidural         0207       6.4554      $352.21      $123.69       $70.44
                                                                    l/s.
64484................  T....................  ...................  Inj foramen epidural         0207       6.4554      $352.21      $123.69       $70.44
                                                                    add-on.
64505................  T....................  ...................  N block,                     0204       2.1711      $118.46       $40.13       $23.69
                                                                    spenopalatine gangl.
64508................  T....................  ...................  N block, carotid             0204       2.1711      $118.46       $40.13       $23.69
                                                                    sinus s/p.
64510................  T....................  ...................  N block, stellate            0207       6.4554      $352.21      $123.69       $70.44
                                                                    ganglion.
64517................  T....................  NI.................  N block inj, hypogas         0204       2.1711      $118.46       $40.13       $23.69
                                                                    plxs.
64520................  T....................  ...................  N block, lumbar/             0207       6.4554      $352.21      $123.69       $70.44
                                                                    thoracic.
64530................  T....................  ...................  N block inj, celiac          0207       6.4554      $352.21      $123.69       $70.44
                                                                    pelus.
64550................  A....................  ...................  Apply                 ...........  ...........  ...........  ...........  ...........
                                                                    neurostimulator.
64553................  S....................  ...................  Implant                      0225     206.0034   $11,239.75  ...........    $2,247.95
                                                                    neuroelectrodes.
64555................  S....................  ...................  Implant                      0040      52.1002    $2,842.64  ...........      $568.53
                                                                    neuroelectrodes.
64560................  S....................  ...................  Implant                      0040      52.1002    $2,842.64  ...........      $568.53
                                                                    neuroelectrodes.
64561................  S....................  ...................  Implant                      0040      52.1002    $2,842.64  ...........      $568.53
                                                                    neuroelectrodes.
64565................  S....................  ...................  Implant                      0040      52.1002    $2,842.64  ...........      $568.53
                                                                    neuroelectrodes.
64573................  S....................  ...................  Implant                      0225     206.0034   $11,239.75  ...........    $2,247.95
                                                                    neuroelectrodes.
64575................  S....................  ...................  Implant                      0040      52.1002    $2,842.64  ...........      $568.53
                                                                    neuroelectrodes.
64577................  S....................  ...................  Implant                      0225     206.0034   $11,239.75  ...........    $2,247.95
                                                                    neuroelectrodes.

[[Page 63557]]

 
64580................  S....................  ...................  Implant                      0225     206.0034   $11,239.75  ...........    $2,247.95
                                                                    neuroelectrodes.
64581................  S....................  ...................  Implant                      0040      52.1002    $2,842.64  ...........      $568.53
                                                                    neuroelectrodes.
64585................  T....................  ...................  Revise/remove                0687      20.4416    $1,115.31      $513.05      $223.06
                                                                    neuroelectrode.
64590................  T....................  ...................  Implant                      0222     232.2024   $12,669.20  ...........    $2,533.84
                                                                    neuroreceiver.
64595................  T....................  ...................  Revise/remove                0688      46.7347    $2,549.89    $1,249.45      $509.98
                                                                    neuroreceiver.
64600................  T....................  ...................  Injection treatment          0203      11.5969      $632.74      $276.76      $126.55
                                                                    of nerve.
64605................  T....................  ...................  Injection treatment          0203      11.5969      $632.74      $276.76      $126.55
                                                                    of nerve.
64610................  T....................  ...................  Injection treatment          0203      11.5969      $632.74      $276.76      $126.55
                                                                    of nerve.
64612................  T....................  ...................  Destroy nerve, face          0204       2.1711      $118.46       $40.13       $23.69
                                                                    muscle.
64613................  T....................  ...................  Destroy nerve, spine         0204       2.1711      $118.46       $40.13       $23.69
                                                                    muscle.
64614................  T....................  ...................  Destroy nerve,               0204       2.1711      $118.46       $40.13       $23.69
                                                                    extrem musc.
64620................  T....................  ...................  Injection treatment          0203      11.5969      $632.74      $276.76      $126.55
                                                                    of nerve.
64622................  T....................  ...................  Destr paravertebrl           0203      11.5969      $632.74      $276.76      $126.55
                                                                    nerve l/s.
64623................  T....................  ...................  Destr paravertebral          0203      11.5969      $632.74      $276.76      $126.55
                                                                    n add-on.
64626................  T....................  ...................  Destr paravertebrl           0203      11.5969      $632.74      $276.76      $126.55
                                                                    nerve c/t.
64627................  T....................  ...................  Destr paravertebral          0203      11.5969      $632.74      $276.76      $126.55
                                                                    n add-on.
64630................  T....................  ...................  Injection treatment          0207       6.4554      $352.21      $123.69       $70.44
                                                                    of nerve.
64640................  T....................  ...................  Injection treatment          0207       6.4554      $352.21      $123.69       $70.44
                                                                    of nerve.
64680................  T....................  ...................  Injection treatment          0203      11.5969      $632.74      $276.76      $126.55
                                                                    of nerve.
64681................  T....................  NI.................  Injection treatment          0203      11.5969      $632.74      $276.76      $126.55
                                                                    of nerve.
64702................  T....................  ...................  Revise finger/toe            0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
64704................  T....................  ...................  Revise hand/foot             0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
64708................  T....................  ...................  Revise arm/leg nerve         0220      16.5554      $903.28  ...........      $180.66
64712................  T....................  ...................  Revision of sciatic          0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
64713................  T....................  ...................  Revision of arm              0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve(s).
64714................  T....................  ...................  Revise low back              0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve(s).
64716................  T....................  ...................  Revision of cranial          0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
64718................  T....................  ...................  Revise ulnar nerve           0220      16.5554      $903.28  ...........      $180.66
                                                                    at elbow.
64719................  T....................  ...................  Revise ulnar nerve           0220      16.5554      $903.28  ...........      $180.66
                                                                    at wrist.
64721................  T....................  ...................  Carpal tunnel                0220      16.5554      $903.28  ...........      $180.66
                                                                    surgery.
64722................  T....................  ...................  Relieve pressure on          0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve(s).
64726................  T....................  ...................  Release foot/toe             0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
64727................  T....................  ...................  Internal nerve               0220      16.5554      $903.28  ...........      $180.66
                                                                    revision.
64732................  T....................  ...................  Incision of brow             0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
64734................  T....................  ...................  Incision of cheek            0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
64736................  T....................  ...................  Incision of chin             0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
64738................  T....................  ...................  Incision of jaw              0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
64740................  T....................  ...................  Incision of tongue           0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
64742................  T....................  ...................  Incision of facial           0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
64744................  T....................  ...................  Incise nerve, back           0220      16.5554      $903.28  ...........      $180.66
                                                                    of head.
64746................  T....................  ...................  Incise diaphragm             0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
64752................  C....................  ...................  Incision of vagus     ...........  ...........  ...........  ...........  ...........
                                                                    nerve.
64755................  C....................  ...................  Incision of stomach   ...........  ...........  ...........  ...........  ...........
                                                                    nerves.
64760................  C....................  ...................  Incision of vagus     ...........  ...........  ...........  ...........  ...........
                                                                    nerve.
64761................  T....................  ...................  Incision of pelvis           0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
64763................  C....................  ...................  Incise hip/thigh      ...........  ...........  ...........  ...........  ...........
                                                                    nerve.
64766................  C....................  ...................  Incise hip/thigh      ...........  ...........  ...........  ...........  ...........
                                                                    nerve.
64771................  T....................  ...................  Sever cranial nerve.         0220      16.5554      $903.28  ...........      $180.66
64772................  T....................  ...................  Incision of spinal           0220      16.5554      $903.28  ...........      $180.66
                                                                    nerve.
64774................  T....................  ...................  Remove skin nerve            0220      16.5554      $903.28  ...........      $180.66
                                                                    lesion.
64776................  T....................  ...................  Remove digit nerve           0220      16.5554      $903.28  ...........      $180.66
                                                                    lesion.
64778................  T....................  ...................  Digit nerve surgery          0220      16.5554      $903.28  ...........      $180.66
                                                                    add-on.
64782................  T....................  ...................  Remove limb nerve            0220      16.5554      $903.28  ...........      $180.66
                                                                    lesion.
64783................  T....................  ...................  Limb nerve surgery           0220      16.5554      $903.28  ...........      $180.66
                                                                    add-on.
64784................  T....................  ...................  Remove nerve lesion.         0220      16.5554      $903.28  ...........      $180.66
64786................  T....................  ...................  Remove sciatic nerve         0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    lesion.
64787................  T....................  ...................  Implant nerve end...         0220      16.5554      $903.28  ...........      $180.66
64788................  T....................  ...................  Remove skin nerve            0220      16.5554      $903.28  ...........      $180.66
                                                                    lesion.
64790................  T....................  ...................  Removal of nerve             0220      16.5554      $903.28  ...........      $180.66
                                                                    lesion.
64792................  T....................  ...................  Removal of nerve             0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    lesion.
64795................  T....................  ...................  Biopsy of nerve.....         0220      16.5554      $903.28  ...........      $180.66
64802................  T....................  ...................  Remove sympathetic           0220      16.5554      $903.28  ...........      $180.66
                                                                    nerves.
64804................  C....................  ...................  Remove sympathetic    ...........  ...........  ...........  ...........  ...........
                                                                    nerves.
64809................  C....................  ...................  Remove sympathetic    ...........  ...........  ...........  ...........  ...........
                                                                    nerves.
64818................  C....................  ...................  Remove sympathetic    ...........  ...........  ...........  ...........  ...........
                                                                    nerves.
64820................  T....................  ...................  Remove sympathetic           0220      16.5554      $903.28  ...........      $180.66
                                                                    nerves.
64821................  T....................  ...................  Remove sympathetic           0054      24.2456    $1,322.86  ...........      $264.57
                                                                    nerves.
64822................  T....................  ...................  Remove sympathetic           0054      24.2456    $1,322.86  ...........      $264.57
                                                                    nerves.
64823................  T....................  ...................  Remove sympathetic           0054      24.2456    $1,322.86  ...........      $264.57
                                                                    nerves.
64831................  T....................  ...................  Repair of digit              0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    nerve.
64832................  T....................  ...................  Repair nerve add-on.         0221      24.8875    $1,357.89      $463.62      $271.58
64834................  T....................  ...................  Repair of hand or            0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    foot nerve.
64835................  T....................  ...................  Repair of hand or            0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    foot nerve.
64836................  T....................  ...................  Repair of hand or            0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    foot nerve.
64837................  T....................  ...................  Repair nerve add-on.         0221      24.8875    $1,357.89      $463.62      $271.58

[[Page 63558]]

 
64840................  T....................  ...................  Repair of leg nerve.         0221      24.8875    $1,357.89      $463.62      $271.58
64856................  T....................  ...................  Repair/transpose             0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    nerve.
64857................  T....................  ...................  Repair arm/leg nerve         0221      24.8875    $1,357.89      $463.62      $271.58
64858................  T....................  ...................  Repair sciatic nerve         0221      24.8875    $1,357.89      $463.62      $271.58
64859................  T....................  ...................  Nerve surgery.......         0221      24.8875    $1,357.89      $463.62      $271.58
64861................  T....................  ...................  Repair of arm nerves         0221      24.8875    $1,357.89      $463.62      $271.58
64862................  T....................  ...................  Repair of low back           0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    nerves.
64864................  T....................  ...................  Repair of facial             0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    nerve.
64865................  T....................  ...................  Repair of facial             0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    nerve.
64866................  C....................  ...................  Fusion of facial/     ...........  ...........  ...........  ...........  ...........
                                                                    other nerve.
64868................  C....................  ...................  Fusion of facial/     ...........  ...........  ...........  ...........  ...........
                                                                    other nerve.
64870................  T....................  ...................  Fusion of facial/            0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    other nerve.
64872................  T....................  ...................  Subsequent repair of         0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    nerve.
64874................  T....................  ...................  Repair & revise              0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    nerve add-on.
64876................  T....................  ...................  Repair nerve/shorten         0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    bone.
64885................  T....................  ...................  Nerve graft, head or         0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    neck.
64886................  T....................  ...................  Nerve graft, head or         0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    neck.
64890................  T....................  ...................  Nerve graft, hand or         0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    foot.
64891................  T....................  ...................  Nerve graft, hand or         0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    foot.
64892................  T....................  ...................  Nerve graft, arm or          0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    leg.
64893................  T....................  ...................  Nerve graft, arm or          0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    leg.
64895................  T....................  ...................  Nerve graft, hand or         0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    foot.
64896................  T....................  ...................  Nerve graft, hand or         0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    foot.
64897................  T....................  ...................  Nerve graft, arm or          0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    leg.
64898................  T....................  ...................  Nerve graft, arm or          0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    leg.
64901................  T....................  ...................  Nerve graft add-on..         0221      24.8875    $1,357.89      $463.62      $271.58
64902................  T....................  ...................  Nerve graft add-on..         0221      24.8875    $1,357.89      $463.62      $271.58
64905................  T....................  ...................  Nerve pedicle                0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    transfer.
64907................  T....................  ...................  Nerve pedicle                0221      24.8875    $1,357.89      $463.62      $271.58
                                                                    transfer.
64999................  T....................  ...................  Nervous system               0204       2.1711      $118.46       $40.13       $23.69
                                                                    surgery.
65091................  T....................  ...................  Revise eye..........         0242      29.4294    $1,605.70      $597.36      $321.14
65093................  T....................  ...................  Revise eye with              0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    implant.
65101................  T....................  ...................  Removal of eye......         0242      29.4294    $1,605.70      $597.36      $321.14
65103................  T....................  ...................  Remove eye/insert            0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    implant.
65105................  T....................  ...................  Remove eye/attach            0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    implant.
65110................  T....................  ...................  Removal of eye......         0242      29.4294    $1,605.70      $597.36      $321.14
65112................  T....................  ...................  Remove eye/revise            0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    socket.
65114................  T....................  ...................  Remove eye/revise            0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    socket.
65125................  T....................  ...................  Revise ocular                0240      17.4535      $952.28      $315.31      $190.46
                                                                    implant.
65130................  T....................  ...................  Insert ocular                0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    implant.
65135................  T....................  ...................  Insert ocular                0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    implant.
65140................  T....................  ...................  Attach ocular                0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    implant.
65150................  T....................  ...................  Revise ocular                0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    implant.
65155................  T....................  ...................  Reinsert ocular              0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    implant.
65175................  T....................  ...................  Removal of ocular            0240      17.4535      $952.28      $315.31      $190.46
                                                                    implant.
65205................  S....................  ...................  Remove foreign body          0698       0.9599       $52.37       $18.72       $10.47
                                                                    from eye.
65210................  S....................  ...................  Remove foreign body          0231       2.1883      $119.40       $50.94       $23.88
                                                                    from eye.
65220................  S....................  ...................  Remove foreign body          0231       2.1883      $119.40       $50.94       $23.88
                                                                    from eye.
65222................  S....................  ...................  Remove foreign body          0231       2.1883      $119.40       $50.94       $23.88
                                                                    from eye.
65235................  T....................  ...................  Remove foreign body          0233      14.4205      $786.80      $266.33      $157.36
                                                                    from eye.
65260................  T....................  ...................  Remove foreign body          0236      18.6701    $1,018.66  ...........      $203.73
                                                                    from eye.
65265................  T....................  ...................  Remove foreign body          0236      18.6701    $1,018.66  ...........      $203.73
                                                                    from eye.
65270................  T....................  ...................  Repair of eye wound.         0240      17.4535      $952.28      $315.31      $190.46
65272................  T....................  ...................  Repair of eye wound.         0233      14.4205      $786.80      $266.33      $157.36
65273................  C....................  ...................  Repair of eye wound.  ...........  ...........  ...........  ...........  ...........
65275................  T....................  ...................  Repair of eye wound.         0233      14.4205      $786.80      $266.33      $157.36
65280................  T....................  ...................  Repair of eye wound.         0234      21.4631    $1,171.05      $511.31      $234.21
65285................  T....................  ...................  Repair of eye wound.         0234      21.4631    $1,171.05      $511.31      $234.21
65286................  T....................  ...................  Repair of eye wound.         0233      14.4205      $786.80      $266.33      $157.36
65290................  T....................  ...................  Repair of eye socket         0243      21.7323    $1,185.74      $431.39      $237.15
                                                                    wound.
65400................  T....................  ...................  Removal of eye               0233      14.4205      $786.80      $266.33      $157.36
                                                                    lesion.
65410................  T....................  ...................  Biopsy of cornea....         0233      14.4205      $786.80      $266.33      $157.36
65420................  T....................  ...................  Removal of eye               0233      14.4205      $786.80      $266.33      $157.36
                                                                    lesion.
65426................  T....................  ...................  Removal of eye               0234      21.4631    $1,171.05      $511.31      $234.21
                                                                    lesion.
65430................  S....................  ...................  Corneal smear.......         0230       0.7619       $41.57       $14.97        $8.31
65435................  T....................  ...................  Curette/treat cornea         0239       6.1331      $334.63  ...........       $66.93
65436................  T....................  ...................  Curette/treat cornea         0233      14.4205      $786.80      $266.33      $157.36
65450................  S....................  ...................  Treatment of corneal         0231       2.1883      $119.40       $50.94       $23.88
                                                                    lesion.
65600................  T....................  ...................  Revision of cornea..         0240      17.4535      $952.28      $315.31      $190.46
65710................  T....................  ...................  Corneal transplant..         0244      37.6284    $2,053.04      $803.26      $410.61
65730................  T....................  ...................  Corneal transplant..         0244      37.6284    $2,053.04      $803.26      $410.61
65750................  T....................  ...................  Corneal transplant..         0244      37.6284    $2,053.04      $803.26      $410.61
65755................  T....................  ...................  Corneal transplant..         0244      37.6284    $2,053.04      $803.26      $410.61
65760................  E....................  ...................  Revision of cornea..  ...........  ...........  ...........  ...........  ...........
65765................  E....................  ...................  Revision of cornea..  ...........  ...........  ...........  ...........  ...........

[[Page 63559]]

 
65767................  E....................  ...................  Corneal tissue        ...........  ...........  ...........  ...........  ...........
                                                                    transplant.
65770................  T....................  ...................  Revise cornea with           0244      37.6284    $2,053.04      $803.26      $410.61
                                                                    implant.
65771................  E....................  ...................  Radial keratotomy...  ...........  ...........  ...........  ...........  ...........
65772................  T....................  ...................  Correction of                0233      14.4205      $786.80      $266.33      $157.36
                                                                    astigmatism.
65775................  T....................  ...................  Correction of                0233      14.4205      $786.80      $266.33      $157.36
                                                                    astigmatism.
65780................  T....................  NI.................  Ocular reconst,              0244      37.6284    $2,053.04      $803.26      $410.61
                                                                    transplant.
65781................  T....................  NI.................  Ocular reconst,              0244      37.6284    $2,053.04      $803.26      $410.61
                                                                    transplant.
65782................  T....................  NI.................  Ocular reconst,              0244      37.6284    $2,053.04      $803.26      $410.61
                                                                    transplant.
65800................  T....................  ...................  Drainage of eye.....         0233      14.4205      $786.80      $266.33      $157.36
65805................  T....................  ...................  Drainage of eye.....         0233      14.4205      $786.80      $266.33      $157.36
65810................  T....................  ...................  Drainage of eye.....         0234      21.4631    $1,171.05      $511.31      $234.21
65815................  T....................  ...................  Drainage of eye.....         0234      21.4631    $1,171.05      $511.31      $234.21
65820................  T....................  ...................  Relieve inner eye            0232       4.9206      $268.47      $103.17       $53.69
                                                                    pressure.
65850................  T....................  ...................  Incision of eye.....         0234      21.4631    $1,171.05      $511.31      $234.21
65855................  T....................  ...................  Laser surgery of eye         0247       4.9482      $269.98      $104.31       $54.00
65860................  T....................  ...................  Incise inner eye             0247       4.9482      $269.98      $104.31       $54.00
                                                                    adhesions.
65865................  T....................  ...................  Incise inner eye             0233      14.4205      $786.80      $266.33      $157.36
                                                                    adhesions.
65870................  T....................  ...................  Incise inner eye             0234      21.4631    $1,171.05      $511.31      $234.21
                                                                    adhesions.
65875................  T....................  ...................  Incise inner eye             0234      21.4631    $1,171.05      $511.31      $234.21
                                                                    adhesions.
65880................  T....................  ...................  Incise inner eye             0233      14.4205      $786.80      $266.33      $157.36
                                                                    adhesions.
65900................  T....................  ...................  Remove eye lesion...         0233      14.4205      $786.80      $266.33      $157.36
65920................  T....................  ...................  Remove implant of            0233      14.4205      $786.80      $266.33      $157.36
                                                                    eye.
65930................  T....................  ...................  Remove blood clot            0234      21.4631    $1,171.05      $511.31      $234.21
                                                                    from eye.
66020................  T....................  ...................  Injection treatment          0233      14.4205      $786.80      $266.33      $157.36
                                                                    of eye.
66030................  T....................  ...................  Injection treatment          0233      14.4205      $786.80      $266.33      $157.36
                                                                    of eye.
66130................  T....................  ...................  Remove eye lesion...         0234      21.4631    $1,171.05      $511.31      $234.21
66150................  T....................  ...................  Glaucoma surgery....         0233      14.4205      $786.80      $266.33      $157.36
66155................  T....................  ...................  Glaucoma surgery....         0234      21.4631    $1,171.05      $511.31      $234.21
66160................  T....................  ...................  Glaucoma surgery....         0234      21.4631    $1,171.05      $511.31      $234.21
66165................  T....................  ...................  Glaucoma surgery....         0234      21.4631    $1,171.05      $511.31      $234.21
66170................  T....................  ...................  Glaucoma surgery....         0234      21.4631    $1,171.05      $511.31      $234.21
66172................  T....................  ...................  Incision of eye.....         0673      26.8390    $1,464.36      $649.56      $292.87
66180................  T....................  ...................  Implant eye shunt...         0673      26.8390    $1,464.36      $649.56      $292.87
66185................  T....................  ...................  Revise eye shunt....         0673      26.8390    $1,464.36      $649.56      $292.87
66220................  T....................  ...................  Repair eye lesion...         0236      18.6701    $1,018.66  ...........      $203.73
66225................  T....................  ...................  Repair/graft eye             0673      26.8390    $1,464.36      $649.56      $292.87
                                                                    lesion.
66250................  T....................  ...................  Follow-up surgery of         0233      14.4205      $786.80      $266.33      $157.36
                                                                    eye.
66500................  T....................  ...................  Incision of iris....         0232       4.9206      $268.47      $103.17       $53.69
66505................  T....................  ...................  Incision of iris....         0232       4.9206      $268.47      $103.17       $53.69
66600................  T....................  ...................  Remove iris and              0233      14.4205      $786.80      $266.33      $157.36
                                                                    lesion.
66605................  T....................  ...................  Removal of iris.....         0234      21.4631    $1,171.05      $511.31      $234.21
66625................  T....................  ...................  Removal of iris.....         0233      14.4205      $786.80      $266.33      $157.36
66630................  T....................  ...................  Removal of iris.....         0233      14.4205      $786.80      $266.33      $157.36
66635................  T....................  ...................  Removal of iris.....         0234      21.4631    $1,171.05      $511.31      $234.21
66680................  T....................  ...................  Repair iris &                0234      21.4631    $1,171.05      $511.31      $234.21
                                                                    ciliary body.
66682................  T....................  ...................  Repair iris &                0234      21.4631    $1,171.05      $511.31      $234.21
                                                                    ciliary body.
66700................  T....................  ...................  Destruction, ciliary         0233      14.4205      $786.80      $266.33      $157.36
                                                                    body.
66710................  T....................  ...................  Destruction, ciliary         0233      14.4205      $786.80      $266.33      $157.36
                                                                    body.
66720................  T....................  ...................  Destruction, ciliary         0233      14.4205      $786.80      $266.33      $157.36
                                                                    body.
66740................  T....................  ...................  Destruction, ciliary         0233      14.4205      $786.80      $266.33      $157.36
                                                                    body.
66761................  T....................  ...................  Revision of iris....         0247       4.9482      $269.98      $104.31       $54.00
66762................  T....................  ...................  Revision of iris....         0247       4.9482      $269.98      $104.31       $54.00
66770................  T....................  ...................  Removal of inner eye         0247       4.9482      $269.98      $104.31       $54.00
                                                                    lesion.
66820................  T....................  ...................  Incision, secondary          0232       4.9206      $268.47      $103.17       $53.69
                                                                    cataract.
66821................  T....................  ...................  After cataract laser         0247       4.9482      $269.98      $104.31       $54.00
                                                                    surgery.
66825................  T....................  ...................  Reposition                   0234      21.4631    $1,171.05      $511.31      $234.21
                                                                    intraocular lens.
66830................  T....................  ...................  Removal of lens              0232       4.9206      $268.47      $103.17       $53.69
                                                                    lesion.
66840................  T....................  ...................  Removal of lens              0245      12.2973      $670.95      $222.22      $134.19
                                                                    material.
66850................  T....................  ...................  Removal of lens              0249      27.7406    $1,513.55      $524.67      $302.71
                                                                    material.
66852................  T....................  ...................  Removal of lens              0249      27.7406    $1,513.55      $524.67      $302.71
                                                                    material.
66920................  T....................  ...................  Extraction of lens..         0249      27.7406    $1,513.55      $524.67      $302.71
66930................  T....................  ...................  Extraction of lens..         0249      27.7406    $1,513.55      $524.67      $302.71
66940................  T....................  ...................  Extraction of lens..         0245      12.2973      $670.95      $222.22      $134.19
66982................  T....................  ...................  Cataract surgery,            0246      22.9755    $1,253.57      $495.96      $250.71
                                                                    complex.
66983................  T....................  ...................  Cataract surg w/iol,         0246      22.9755    $1,253.57      $495.96      $250.71
                                                                    1 stage.
66984................  T....................  ...................  Cataract surg w/iol,         0246      22.9755    $1,253.57      $495.96      $250.71
                                                                    1 stage.
66985................  T....................  ...................  Insert lens                  0246      22.9755    $1,253.57      $495.96      $250.71
                                                                    prosthesis.
66986................  T....................  ...................  Exchange lens                0246      22.9755    $1,253.57      $495.96      $250.71
                                                                    prosthesis.
66990................  N....................  ...................  Ophthalmic endoscope  ...........  ...........  ...........  ...........  ...........
                                                                    add-on.
66999................  T....................  ...................  Eye surgery                  0232       4.9206      $268.47      $103.17       $53.69
                                                                    procedure.
67005................  T....................  ...................  Partial removal of           0237      34.1784    $1,864.81      $818.54      $372.96
                                                                    eye fluid.
67010................  T....................  ...................  Partial removal of           0237      34.1784    $1,864.81      $818.54      $372.96
                                                                    eye fluid.
67015................  T....................  ...................  Release of eye fluid         0237      34.1784    $1,864.81      $818.54      $372.96
67025................  T....................  ...................  Replace eye fluid...         0236      18.6701    $1,018.66  ...........      $203.73
67027................  T....................  ...................  Implant eye drug             0237      34.1784    $1,864.81      $818.54      $372.96
                                                                    system.

[[Page 63560]]

 
67028................  T....................  ...................  Injection eye drug..         0235       5.0749      $276.89       $72.04       $55.38
67030................  T....................  ...................  Incise inner eye             0236      18.6701    $1,018.66  ...........      $203.73
                                                                    strands.
67031................  T....................  ...................  Laser surgery, eye           0247       4.9482      $269.98      $104.31       $54.00
                                                                    strands.
67036................  T....................  ...................  Removal of inner eye         0237      34.1784    $1,864.81      $818.54      $372.96
                                                                    fluid.
67038................  T....................  ...................  Strip retinal                0237      34.1784    $1,864.81      $818.54      $372.96
                                                                    membrane.
67039................  T....................  ...................  Laser treatment of           0237      34.1784    $1,864.81      $818.54      $372.96
                                                                    retina.
67040................  T....................  ...................  Laser treatment of           0672      38.9476    $2,125.02      $988.43      $425.00
                                                                    retina.
67101................  T....................  ...................  Repair detached              0235       5.0749      $276.89       $72.04       $55.38
                                                                    retina.
67105................  T....................  ...................  Repair detached              0248       4.8223      $263.11       $95.08       $52.62
                                                                    retina.
67107................  T....................  ...................  Repair detached              0672      38.9476    $2,125.02      $988.43      $425.00
                                                                    retina.
67108................  T....................  ...................  Repair detached              0672      38.9476    $2,125.02      $988.43      $425.00
                                                                    retina.
67110................  T....................  ...................  Repair detached              0236      18.6701    $1,018.66  ...........      $203.73
                                                                    retina.
67112................  T....................  ...................  Rerepair detached            0672      38.9476    $2,125.02      $988.43      $425.00
                                                                    retina.
67115................  T....................  ...................  Release encircling           0236      18.6701    $1,018.66  ...........      $203.73
                                                                    material.
67120................  T....................  ...................  Remove eye implant           0236      18.6701    $1,018.66  ...........      $203.73
                                                                    material.
67121................  T....................  ...................  Remove eye implant           0237      34.1784    $1,864.81      $818.54      $372.96
                                                                    material.
67141................  T....................  ...................  Treatment of retina.         0235       5.0749      $276.89       $72.04       $55.38
67145................  T....................  ...................  Treatment of retina.         0248       4.8223      $263.11       $95.08       $52.62
67208................  T....................  ...................  Treatment of retinal         0235       5.0749      $276.89       $72.04       $55.38
                                                                    lesion.
67210................  T....................  ...................  Treatment of retinal         0248       4.8223      $263.11       $95.08       $52.62
                                                                    lesion.
67218................  T....................  ...................  Treatment of retinal         0236      18.6701    $1,018.66  ...........      $203.73
                                                                    lesion.
67220................  T....................  ...................  Treatment of choroid         0235       5.0749      $276.89       $72.04       $55.38
                                                                    lesion.
67221................  T....................  ...................  Ocular photodynamic          0235       5.0749      $276.89       $72.04       $55.38
                                                                    ther.
67225................  T....................  ...................  Eye photodynamic             0235       5.0749      $276.89       $72.04       $55.38
                                                                    ther add-on.
67227................  T....................  ...................  Treatment of retinal         0235       5.0749      $276.89       $72.04       $55.38
                                                                    lesion.
67228................  T....................  ...................  Treatment of retinal         0248       4.8223      $263.11       $95.08       $52.62
                                                                    lesion.
67250................  T....................  ...................  Reinforce eye wall..         0240      17.4535      $952.28      $315.31      $190.46
67255................  T....................  ...................  Reinforce/graft eye          0237      34.1784    $1,864.81      $818.54      $372.96
                                                                    wall.
67299................  T....................  ...................  Eye surgery                  0235       5.0749      $276.89       $72.04       $55.38
                                                                    procedure.
67311................  T....................  ...................  Revise eye muscle...         0243      21.7323    $1,185.74      $431.39      $237.15
67312................  T....................  ...................  Revise two eye               0243      21.7323    $1,185.74      $431.39      $237.15
                                                                    muscles.
67314................  T....................  ...................  Revise eye muscle...         0243      21.7323    $1,185.74      $431.39      $237.15
67316................  T....................  ...................  Revise two eye               0243      21.7323    $1,185.74      $431.39      $237.15
                                                                    muscles.
67318................  T....................  ...................  Revise eye muscle(s)         0243      21.7323    $1,185.74      $431.39      $237.15
67320................  T....................  ...................  Revise eye muscle(s)         0243      21.7323    $1,185.74      $431.39      $237.15
                                                                    add-on.
67331................  T....................  ...................  Eye surgery follow-          0243      21.7323    $1,185.74      $431.39      $237.15
                                                                    up add-on.
67332................  T....................  ...................  Rerevise eye muscles         0243      21.7323    $1,185.74      $431.39      $237.15
                                                                    add-on.
67334................  T....................  ...................  Revise eye muscle w/         0243      21.7323    $1,185.74      $431.39      $237.15
                                                                    suture.
67335................  T....................  ...................  Eye suture during            0243      21.7323    $1,185.74      $431.39      $237.15
                                                                    surgery.
67340................  T....................  ...................  Revise eye muscle            0243      21.7323    $1,185.74      $431.39      $237.15
                                                                    add-on.
67343................  T....................  ...................  Release eye tissue..         0243      21.7323    $1,185.74      $431.39      $237.15
67345................  T....................  ...................  Destroy nerve of eye         0238       3.1954      $174.34       $58.96       $34.87
                                                                    muscle.
67350................  T....................  ...................  Biopsy eye muscle...         0699       2.2303      $121.69       $47.46       $24.34
67399................  T....................  ...................  Eye muscle surgery           0243      21.7323    $1,185.74      $431.39      $237.15
                                                                    procedure.
67400................  T....................  ...................  Explore/biopsy eye           0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    socket.
67405................  T....................  ...................  Explore/drain eye            0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    socket.
67412................  T....................  ...................  Explore/treat eye            0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    socket.
67413................  T....................  ...................  Explore/treat eye            0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    socket.
67414................  T....................  ...................  Explr/decompress eye         0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    socket.
67415................  T....................  ...................  Aspiration, orbital          0239       6.1331      $334.63  ...........       $66.93
                                                                    contents.
67420................  T....................  ...................  Explore/treat eye            0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    socket.
67430................  T....................  ...................  Explore/treat eye            0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    socket.
67440................  T....................  ...................  Explore/drain eye            0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    socket.
67445................  T....................  ...................  Explr/decompress eye         0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    socket.
67450................  T....................  ...................  Explore/biopsy eye           0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    socket.
67500................  S....................  ...................  Inject/treat eye             0231       2.1883      $119.40       $50.94       $23.88
                                                                    socket.
67505................  T....................  ...................  Inject/treat eye             0238       3.1954      $174.34       $58.96       $34.87
                                                                    socket.
67515................  T....................  ...................  Inject/treat eye             0239       6.1331      $334.63  ...........       $66.93
                                                                    socket.
67550................  T....................  ...................  Insert eye socket            0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    implant.
67560................  T....................  ...................  Revise eye socket            0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    implant.
67570................  T....................  ...................  Decompress optic             0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    nerve.
67599................  T....................  ...................  Orbit surgery                0239       6.1331      $334.63  ...........       $66.93
                                                                    procedure.
67700................  T....................  ...................  Drainage of eyelid           0238       3.1954      $174.34       $58.96       $34.87
                                                                    abscess.
67710................  T....................  ...................  Incision of eyelid..         0239       6.1331      $334.63  ...........       $66.93
67715................  T....................  ...................  Incision of eyelid           0240      17.4535      $952.28      $315.31      $190.46
                                                                    fold.
67800................  T....................  ...................  Remove eyelid lesion         0238       3.1954      $174.34       $58.96       $34.87
67801................  T....................  ...................  Remove eyelid                0239       6.1331      $334.63  ...........       $66.93
                                                                    lesions.
67805................  T....................  ...................  Remove eyelid                0238       3.1954      $174.34       $58.96       $34.87
                                                                    lesions.
67808................  T....................  ...................  Remove eyelid                0240      17.4535      $952.28      $315.31      $190.46
                                                                    lesion(s).
67810................  T....................  ...................  Biopsy of eyelid....         0238       3.1954      $174.34       $58.96       $34.87
67820................  S....................  ...................  Revise eyelashes....         0698       0.9599       $52.37       $18.72       $10.47
67825................  T....................  ...................  Revise eyelashes....         0238       3.1954      $174.34       $58.96       $34.87
67830................  T....................  ...................  Revise eyelashes....         0239       6.1331      $334.63  ...........       $66.93
67835................  T....................  ...................  Revise eyelashes....         0240      17.4535      $952.28      $315.31      $190.46
67840................  T....................  ...................  Remove eyelid lesion         0239       6.1331      $334.63  ...........       $66.93

[[Page 63561]]

 
67850................  T....................  ...................  Treat eyelid lesion.         0239       6.1331      $334.63  ...........       $66.93
67875................  T....................  ...................  Closure of eyelid by         0239       6.1331      $334.63  ...........       $66.93
                                                                    suture.
67880................  T....................  ...................  Revision of eyelid..         0233      14.4205      $786.80      $266.33      $157.36
67882................  T....................  ...................  Revision of eyelid..         0240      17.4535      $952.28      $315.31      $190.46
67900................  T....................  ...................  Repair brow defect..         0240      17.4535      $952.28      $315.31      $190.46
67901................  T....................  ...................  Repair eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67902................  T....................  ...................  Repair eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67903................  T....................  ...................  Repair eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67904................  T....................  ...................  Repair eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67906................  T....................  ...................  Repair eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67908................  T....................  ...................  Repair eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67909................  T....................  ...................  Revise eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67911................  T....................  ...................  Revise eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67912................  T....................  NI.................  Correction eyelid w/         0239       6.1331      $334.63  ...........       $66.93
                                                                    implant.
67914................  T....................  ...................  Repair eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67915................  T....................  ...................  Repair eyelid defect         0239       6.1331      $334.63  ...........       $66.93
67916................  T....................  ...................  Repair eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67917................  T....................  ...................  Repair eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67921................  T....................  ...................  Repair eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67922................  T....................  ...................  Repair eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67923................  T....................  ...................  Repair eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67924................  T....................  ...................  Repair eyelid defect         0240      17.4535      $952.28      $315.31      $190.46
67930................  T....................  ...................  Repair eyelid wound.         0240      17.4535      $952.28      $315.31      $190.46
67935................  T....................  ...................  Repair eyelid wound.         0240      17.4535      $952.28      $315.31      $190.46
67938................  S....................  ...................  Remove eyelid                0698       0.9599       $52.37       $18.72       $10.47
                                                                    foreign body.
67950................  T....................  ...................  Revision of eyelid..         0240      17.4535      $952.28      $315.31      $190.46
67961................  T....................  ...................  Revision of eyelid..         0240      17.4535      $952.28      $315.31      $190.46
67966................  T....................  ...................  Revision of eyelid..         0240      17.4535      $952.28      $315.31      $190.46
67971................  T....................  ...................  Reconstruction of            0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    eyelid.
67973................  T....................  ...................  Reconstruction of            0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    eyelid.
67974................  T....................  ...................  Reconstruction of            0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    eyelid.
67975................  T....................  ...................  Reconstruction of            0240      17.4535      $952.28      $315.31      $190.46
                                                                    eyelid.
67999................  T....................  ...................  Revision of eyelid..         0240      17.4535      $952.28      $315.31      $190.46
68020................  T....................  ...................  Incise/drain eyelid          0240      17.4535      $952.28      $315.31      $190.46
                                                                    lining.
68040................  S....................  ...................  Treatment of eyelid          0698       0.9599       $52.37       $18.72       $10.47
                                                                    lesions.
68100................  T....................  ...................  Biopsy of eyelid             0232       4.9206      $268.47      $103.17       $53.69
                                                                    lining.
68110................  T....................  ...................  Remove eyelid lining         0699       2.2303      $121.69       $47.46       $24.34
                                                                    lesion.
68115................  T....................  ...................  Remove eyelid lining         0239       6.1331      $334.63  ...........       $66.93
                                                                    lesion.
68130................  T....................  ...................  Remove eyelid lining         0233      14.4205      $786.80      $266.33      $157.36
                                                                    lesion.
68135................  T....................  ...................  Remove eyelid lining         0239       6.1331      $334.63  ...........       $66.93
                                                                    lesion.
68200................  S....................  ...................  Treat eyelid by              0698       0.9599       $52.37       $18.72       $10.47
                                                                    injection.
68320................  T....................  ...................  Revise/graft eyelid          0240      17.4535      $952.28      $315.31      $190.46
                                                                    lining.
68325................  T....................  ...................  Revise/graft eyelid          0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    lining.
68326................  T....................  ...................  Revise/graft eyelid          0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    lining.
68328................  T....................  ...................  Revise/graft eyelid          0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    lining.
68330................  T....................  ...................  Revise eyelid lining         0233      14.4205      $786.80      $266.33      $157.36
68335................  T....................  ...................  Revise/graft eyelid          0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    lining.
68340................  T....................  ...................  Separate eyelid              0240      17.4535      $952.28      $315.31      $190.46
                                                                    adhesions.
68360................  T....................  ...................  Revise eyelid lining         0234      21.4631    $1,171.05      $511.31      $234.21
68362................  T....................  ...................  Revise eyelid lining         0234      21.4631    $1,171.05      $511.31      $234.21
68371................  T....................  NI.................  Harvest eye tissue,          0233      14.4205      $786.80      $266.33      $157.36
                                                                    alograft.
68399................  T....................  ...................  Eyelid lining                0239       6.1331      $334.63  ...........       $66.93
                                                                    surgery.
68400................  T....................  ...................  Incise/drain tear            0238       3.1954      $174.34       $58.96       $34.87
                                                                    gland.
68420................  T....................  ...................  Incise/drain tear            0240      17.4535      $952.28      $315.31      $190.46
                                                                    sac.
68440................  T....................  ...................  Incise tear duct             0238       3.1954      $174.34       $58.96       $34.87
                                                                    opening.
68500................  T....................  ...................  Removal of tear              0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    gland.
68505................  T....................  ...................  Partial removal,             0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    tear gland.
68510................  T....................  ...................  Biopsy of tear gland         0240      17.4535      $952.28      $315.31      $190.46
68520................  T....................  ...................  Removal of tear sac.         0241      22.1969    $1,211.09      $384.47      $242.22
68525................  T....................  ...................  Biopsy of tear sac..         0240      17.4535      $952.28      $315.31      $190.46
68530................  T....................  ...................  Clearance of tear            0240      17.4535      $952.28      $315.31      $190.46
                                                                    duct.
68540................  T....................  ...................  Remove tear gland            0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    lesion.
68550................  T....................  ...................  Remove tear gland            0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    lesion.
68700................  T....................  ...................  Repair tear ducts...         0241      22.1969    $1,211.09      $384.47      $242.22
68705................  T....................  ...................  Revise tear duct             0238       3.1954      $174.34       $58.96       $34.87
                                                                    opening.
68720................  T....................  ...................  Create tear sac              0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    drain.
68745................  T....................  ...................  Create tear duct             0241      22.1969    $1,211.09      $384.47      $242.22
                                                                    drain.
68750................  T....................  ...................  Create tear duct             0242      29.4294    $1,605.70      $597.36      $321.14
                                                                    drain.
68760................  S....................  ...................  Close tear duct              0698       0.9599       $52.37       $18.72       $10.47
                                                                    opening.
68761................  S....................  ...................  Close tear duct              0231       2.1883      $119.40       $50.94       $23.88
                                                                    opening.
68770................  T....................  ...................  Close tear system            0240      17.4535      $952.28      $315.31      $190.46
                                                                    fistula.
68801................  S....................  ...................  Dilate tear duct             0231       2.1883      $119.40       $50.94       $23.88
                                                                    opening.
68810................  T....................  ...................  Probe nasolacrimal           0699       2.2303      $121.69       $47.46       $24.34
                                                                    duct.
68811................  T....................  ...................  Probe nasolacrimal           0240      17.4535      $952.28      $315.31      $190.46
                                                                    duct.
68815................  T....................  ...................  Probe nasolacrimal           0240      17.4535      $952.28      $315.31      $190.46
                                                                    duct.

[[Page 63562]]

 
68840................  T....................  ...................  Explore/irrigate             0699       2.2303      $121.69       $47.46       $24.34
                                                                    tear ducts.
68850................  N....................  ...................  Injection for tear    ...........  ...........  ...........  ...........  ...........
                                                                    sac x-ray.
68899................  T....................  ...................  Tear duct system             0699       2.2303      $121.69       $47.46       $24.34
                                                                    surgery.
69000................  T....................  ...................  Drain external ear           0006       1.6527       $90.17       $23.26       $18.03
                                                                    lesion.
69005................  T....................  ...................  Drain external ear           0007      11.8633      $647.27  ...........      $129.45
                                                                    lesion.
69020................  T....................  ...................  Drain outer ear              0006       1.6527       $90.17       $23.26       $18.03
                                                                    canal lesion.
69090................  E....................  ...................  Pierce earlobes.....  ...........  ...........  ...........  ...........  ...........
69100................  T....................  ...................  Biopsy of external           0019       3.9493      $215.48       $71.87       $43.10
                                                                    ear.
69105................  T....................  ...................  Biopsy of external           0253      15.2249      $830.69      $282.29      $166.14
                                                                    ear canal.
69110................  T....................  ...................  Remove external ear,         0021      14.3594      $783.46      $219.48      $156.69
                                                                    partial.
69120................  T....................  ...................  Removal of external          0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    ear.
69140................  T....................  ...................  Remove ear canal             0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    lesion(s).
69145................  T....................  ...................  Remove ear canal             0021      14.3594      $783.46      $219.48      $156.69
                                                                    lesion(s).
69150................  T....................  ...................  Extensive ear canal          0252       6.4469      $351.75      $113.41       $70.35
                                                                    surgery.
69155................  C....................  ...................  Extensive ear/neck    ...........  ...........  ...........  ...........  ...........
                                                                    surgery.
69200................  X....................  ...................  Clear outer ear              0340       0.6314       $34.45  ...........        $6.89
                                                                    canal.
69205................  T....................  ...................  Clear outer ear              0022      18.7932    $1,025.38      $354.45      $205.08
                                                                    canal.
69210................  X....................  ...................  Remove impacted ear          0340       0.6314       $34.45  ...........        $6.89
                                                                    wax.
69220................  T....................  ...................  Clean out mastoid            0012       0.7694       $41.98       $11.18        $8.40
                                                                    cavity.
69222................  T....................  ...................  Clean out mastoid            0253      15.2249      $830.69      $282.29      $166.14
                                                                    cavity.
69300................  T....................  ...................  Revise external ear.         0254      21.8901    $1,194.35      $321.35      $238.87
69310................  T....................  ...................  Rebuild outer ear            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    canal.
69320................  T....................  ...................  Rebuild outer ear            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    canal.
69399................  T....................  ...................  Outer ear surgery            0251       1.7880       $97.56  ...........       $19.51
                                                                    procedure.
69400................  T....................  ...................  Inflate middle ear           0251       1.7880       $97.56  ...........       $19.51
                                                                    canal.
69401................  T....................  ...................  Inflate middle ear           0251       1.7880       $97.56  ...........       $19.51
                                                                    canal.
69405................  T....................  ...................  Catheterize middle           0252       6.4469      $351.75      $113.41       $70.35
                                                                    ear canal.
69410................  T....................  ...................  Inset middle ear             0251       1.7880       $97.56  ...........       $19.51
                                                                    (baffle).
69420................  T....................  ...................  Incision of eardrum.         0252       6.4469      $351.75      $113.41       $70.35
69421................  T....................  ...................  Incision of eardrum.         0253      15.2249      $830.69      $282.29      $166.14
69424................  T....................  ...................  Remove ventilating           0252       6.4469      $351.75      $113.41       $70.35
                                                                    tube.
69433................  T....................  ...................  Create eardrum               0252       6.4469      $351.75      $113.41       $70.35
                                                                    opening.
69436................  T....................  ...................  Create eardrum               0253      15.2249      $830.69      $282.29      $166.14
                                                                    opening.
69440................  T....................  ...................  Exploration of               0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    middle ear.
69450................  T....................  ...................  Eardrum revision....         0256      35.1548    $1,918.08  ...........      $383.62
69501................  T....................  ...................  Mastoidectomy.......         0256      35.1548    $1,918.08  ...........      $383.62
69502................  T....................  ...................  Mastoidectomy.......         0254      21.8901    $1,194.35      $321.35      $238.87
69505................  T....................  ...................  Remove mastoid               0256      35.1548    $1,918.08  ...........      $383.62
                                                                    structures.
69511................  T....................  ...................  Extensive mastoid            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    surgery.
69530................  T....................  ...................  Extensive mastoid            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    surgery.
69535................  C....................  ...................  Remove part of        ...........  ...........  ...........  ...........  ...........
                                                                    temporal bone.
69540................  T....................  ...................  Remove ear lesion...         0253      15.2249      $830.69      $282.29      $166.14
69550................  T....................  ...................  Remove ear lesion...         0256      35.1548    $1,918.08  ...........      $383.62
69552................  T....................  ...................  Remove ear lesion...         0256      35.1548    $1,918.08  ...........      $383.62
69554................  C....................  ...................  Remove ear lesion...  ...........  ...........  ...........  ...........  ...........
69601................  T....................  ...................  Mastoid surgery              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    revision.
69602................  T....................  ...................  Mastoid surgery              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    revision.
69603................  T....................  ...................  Mastoid surgery              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    revision.
69604................  T....................  ...................  Mastoid surgery              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    revision.
69605................  T....................  ...................  Mastoid surgery              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    revision.
69610................  T....................  ...................  Repair of eardrum...         0254      21.8901    $1,194.35      $321.35      $238.87
69620................  T....................  ...................  Repair of eardrum...         0254      21.8901    $1,194.35      $321.35      $238.87
69631................  T....................  ...................  Repair eardrum               0256      35.1548    $1,918.08  ...........      $383.62
                                                                    structures.
69632................  T....................  ...................  Rebuild eardrum              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    structures.
69633................  T....................  ...................  Rebuild eardrum              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    structures.
69635................  T....................  ...................  Repair eardrum               0256      35.1548    $1,918.08  ...........      $383.62
                                                                    structures.
69636................  T....................  ...................  Rebuild eardrum              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    structures.
69637................  T....................  ...................  Rebuild eardrum              0256      35.1548    $1,918.08  ...........      $383.62
                                                                    structures.
69641................  T....................  ...................  Revise middle ear &          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    mastoid.
69642................  T....................  ...................  Revise middle ear &          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    mastoid.
69643................  T....................  ...................  Revise middle ear &          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    mastoid.
69644................  T....................  ...................  Revise middle ear &          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    mastoid.
69645................  T....................  ...................  Revise middle ear &          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    mastoid.
69646................  T....................  ...................  Revise middle ear &          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    mastoid.
69650................  T....................  ...................  Release middle ear           0254      21.8901    $1,194.35      $321.35      $238.87
                                                                    bone.
69660................  T....................  ...................  Revise middle ear            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    bone.
69661................  T....................  ...................  Revise middle ear            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    bone.
69662................  T....................  ...................  Revise middle ear            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    bone.
69666................  T....................  ...................  Repair middle ear            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    structures.
69667................  T....................  ...................  Repair middle ear            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    structures.
69670................  T....................  ...................  Remove mastoid air           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    cells.
69676................  T....................  ...................  Remove middle ear            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    nerve.
69700................  T....................  ...................  Close mastoid                0256      35.1548    $1,918.08  ...........      $383.62
                                                                    fistula.
69710................  E....................  ...................  Implant/replace       ...........  ...........  ...........  ...........  ...........
                                                                    hearing aid.
69711................  T....................  ...................  Remove/repair                0256      35.1548    $1,918.08  ...........      $383.62
                                                                    hearing aid.

[[Page 63563]]

 
69714................  T....................  ...................  Implant temple bone          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    w/stimul.
69715................  T....................  ...................  Temple bne implnt w/         0256      35.1548    $1,918.08  ...........      $383.62
                                                                    stimulat.
69717................  T....................  ...................  Temple bone implant          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    revision.
69718................  T....................  ...................  Revise temple bone           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    implant.
69720................  T....................  ...................  Release facial nerve         0256      35.1548    $1,918.08  ...........      $383.62
69725................  T....................  ...................  Release facial nerve         0256      35.1548    $1,918.08  ...........      $383.62
69740................  T....................  ...................  Repair facial nerve.         0256      35.1548    $1,918.08  ...........      $383.62
69745................  T....................  ...................  Repair facial nerve.         0256      35.1548    $1,918.08  ...........      $383.62
69799................  T....................  ...................  Middle ear surgery           0253      15.2249      $830.69      $282.29      $166.14
                                                                    procedure.
69801................  T....................  ...................  Incise inner ear....         0256      35.1548    $1,918.08  ...........      $383.62
69802................  T....................  ...................  Incise inner ear....         0256      35.1548    $1,918.08  ...........      $383.62
69805................  T....................  ...................  Explore inner ear...         0256      35.1548    $1,918.08  ...........      $383.62
69806................  T....................  ...................  Explore inner ear...         0256      35.1548    $1,918.08  ...........      $383.62
69820................  T....................  ...................  Establish inner ear          0256      35.1548    $1,918.08  ...........      $383.62
                                                                    window.
69840................  T....................  ...................  Revise inner ear             0256      35.1548    $1,918.08  ...........      $383.62
                                                                    window.
69905................  T....................  ...................  Remove inner ear....         0256      35.1548    $1,918.08  ...........      $383.62
69910................  T....................  ...................  Remove inner ear &           0256      35.1548    $1,918.08  ...........      $383.62
                                                                    mastoid.
69915................  T....................  ...................  Incise inner ear             0256      35.1548    $1,918.08  ...........      $383.62
                                                                    nerve.
69930................  T....................  ...................  Implant cochlear             0259     392.8622   $21,434.95    $9,394.83    $4,286.99
                                                                    device.
69949................  T....................  ...................  Inner ear surgery            0253      15.2249      $830.69      $282.29      $166.14
                                                                    procedure.
69950................  C....................  ...................  Incise inner ear      ...........  ...........  ...........  ...........  ...........
                                                                    nerve.
69955................  T....................  ...................  Release facial nerve         0256      35.1548    $1,918.08  ...........      $383.62
69960................  T....................  ...................  Release inner ear            0256      35.1548    $1,918.08  ...........      $383.62
                                                                    canal.
69970................  C....................  ...................  Remove inner ear      ...........  ...........  ...........  ...........  ...........
                                                                    lesion.
69979................  T....................  ...................  Temporal bone                0251       1.7880       $97.56  ...........       $19.51
                                                                    surgery.
69990................  N....................  ...................  Microsurgery add-on.  ...........  ...........  ...........  ...........  ...........
70010................  S....................  ...................  Contrast x-ray of            0274       3.5931      $196.04       $93.63       $39.21
                                                                    brain.
70015................  S....................  ...................  Contrast x-ray of            0274       3.5931      $196.04       $93.63       $39.21
                                                                    brain.
70030................  X....................  ...................  X-ray eye for                0260       0.7802       $42.57       $21.28        $8.51
                                                                    foreign body.
70100................  X....................  ...................  X-ray exam of jaw...         0260       0.7802       $42.57       $21.28        $8.51
70110................  X....................  ...................  X-ray exam of jaw...         0260       0.7802       $42.57       $21.28        $8.51
70120................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    mastoids.
70130................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    mastoids.
70134................  X....................  ...................  X-ray exam of middle         0261       1.3176       $71.89  ...........       $14.38
                                                                    ear.
70140................  X....................  ...................  X-ray exam of facial         0260       0.7802       $42.57       $21.28        $8.51
                                                                    bones.
70150................  X....................  ...................  X-ray exam of facial         0260       0.7802       $42.57       $21.28        $8.51
                                                                    bones.
70160................  X....................  ...................  X-ray exam of nasal          0260       0.7802       $42.57       $21.28        $8.51
                                                                    bones.
70170................  X....................  ...................  X-ray exam of tear           0263       2.1883      $119.40       $43.58       $23.88
                                                                    duct.
70190................  X....................  ...................  X-ray exam of eye            0260       0.7802       $42.57       $21.28        $8.51
                                                                    sockets.
70200................  X....................  ...................  X-ray exam of eye            0260       0.7802       $42.57       $21.28        $8.51
                                                                    sockets.
70210................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    sinuses.
70220................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    sinuses.
70240................  X....................  ...................  X-ray exam,                  0260       0.7802       $42.57       $21.28        $8.51
                                                                    pituitary saddle.
70250................  X....................  ...................  X-ray exam of skull.         0260       0.7802       $42.57       $21.28        $8.51
70260................  X....................  ...................  X-ray exam of skull.         0261       1.3176       $71.89  ...........       $14.38
70300................  X....................  ...................  X-ray exam of teeth.         0262       0.7540       $41.14        $9.82        $8.23
70310................  X....................  ...................  X-ray exam of teeth.         0262       0.7540       $41.14        $9.82        $8.23
70320................  X....................  ...................  Full mouth x-ray of          0262       0.7540       $41.14        $9.82        $8.23
                                                                    teeth.
70328................  X....................  ...................  X-ray exam of jaw            0260       0.7802       $42.57       $21.28        $8.51
                                                                    joint.
70330................  X....................  ...................  X-ray exam of jaw            0260       0.7802       $42.57       $21.28        $8.51
                                                                    joints.
70332................  S....................  ...................  X-ray exam of jaw            0275       3.2775      $178.82       $69.09       $35.76
                                                                    joint.
70336................  S....................  ...................  Magnetic image, jaw          0335       6.3499      $346.46      $151.46       $69.29
                                                                    joint.
70350................  X....................  ...................  X-ray head for               0260       0.7802       $42.57       $21.28        $8.51
                                                                    orthodontia.
70355................  X....................  ...................  Panoramic x-ray of           0260       0.7802       $42.57       $21.28        $8.51
                                                                    jaws.
70360................  X....................  ...................  X-ray exam of neck..         0260       0.7802       $42.57       $21.28        $8.51
70370................  X....................  ...................  Throat x-ray &               0272       1.4166       $77.29       $38.36       $15.46
                                                                    fluoroscopy.
70371................  X....................  ...................  Speech evaluation,           0272       1.4166       $77.29       $38.36       $15.46
                                                                    complex.
70373................  X....................  ...................  Contrast x-ray of            0263       2.1883      $119.40       $43.58       $23.88
                                                                    larynx.
70380................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    salivary gland.
70390................  X....................  ...................  X-ray exam of                0264       3.0287      $165.25       $79.41       $33.05
                                                                    salivary duct.
70450................  S....................  ...................  Ct head/brain w/o            0332       3.3936      $185.16       $91.27       $37.03
                                                                    dye.
70460................  S....................  ...................  Ct head/brain w/dye.         0283       4.6543      $253.94      $126.27       $50.79
70470................  S....................  ...................  Ct head/brain w/o &          0333       5.4241      $295.94      $146.98       $59.19
                                                                    w/ dye.
70480................  S....................  ...................  Ct orbit/ear/fossa w/        0332       3.3936      $185.16       $91.27       $37.03
                                                                    o dye.
70481................  S....................  ...................  Ct orbit/ear/fossa w/        0283       4.6543      $253.94      $126.27       $50.79
                                                                    dye.
70482................  S....................  ...................  Ct orbit/ear/fossa w/        0333       5.4241      $295.94      $146.98       $59.19
                                                                    o&w dye.
70486................  S....................  ...................  Ct maxillofacial w/o         0332       3.3936      $185.16       $91.27       $37.03
                                                                    dye.
70487................  S....................  ...................  Ct maxillofacial w/          0283       4.6543      $253.94      $126.27       $50.79
                                                                    dye.
70488................  S....................  ...................  Ct maxillofacial w/o         0333       5.4241      $295.94      $146.98       $59.19
                                                                    & w dye.
70490................  S....................  ...................  Ct soft tissue neck          0332       3.3936      $185.16       $91.27       $37.03
                                                                    w/o dye.
70491................  S....................  ...................  Ct soft tissue neck          0283       4.6543      $253.94      $126.27       $50.79
                                                                    w/dye.
70492................  S....................  ...................  Ct sft tsue nck w/o          0333       5.4241      $295.94      $146.98       $59.19
                                                                    & w/dye.
70496................  S....................  ...................  Ct angiography, head         0662       5.8775      $320.68      $156.47       $64.14
70498................  S....................  ...................  Ct angiography, neck         0662       5.8775      $320.68      $156.47       $64.14
70540................  S....................  ...................  Mri orbit/face/neck          0336       6.3897      $348.63      $174.31       $69.73
                                                                    w/o dye.

[[Page 63564]]

 
70542................  S....................  ...................  Mri orbit/face/neck          0284       7.1165      $388.28      $194.13       $77.66
                                                                    w/dye.
70543................  S....................  ...................  Mri orbt/fac/nck w/o         0337       9.2075      $502.37      $240.77      $100.47
                                                                    & w dye.
70544................  S....................  ...................  Mr angiography head          0336       6.3897      $348.63      $174.31       $69.73
                                                                    w/o dye.
70545................  S....................  ...................  Mr angiography head          0284       7.1165      $388.28      $194.13       $77.66
                                                                    w/dye.
70546................  S....................  ...................  Mr angiograph head w/        0337       9.2075      $502.37      $240.77      $100.47
                                                                    o&w dye.
70547................  S....................  ...................  Mr angiography neck          0336       6.3897      $348.63      $174.31       $69.73
                                                                    w/o dye.
70548................  S....................  ...................  Mr angiography neck          0284       7.1165      $388.28      $194.13       $77.66
                                                                    w/dye.
70549................  S....................  ...................  Mr angiograph neck w/        0337       9.2075      $502.37      $240.77      $100.47
                                                                    o&w dye.
70551................  S....................  ...................  Mri brain w/o dye...         0336       6.3897      $348.63      $174.31       $69.73
70552................  S....................  ...................  Mri brain w/ dye....         0284       7.1165      $388.28      $194.13       $77.66
70553................  S....................  ...................  Mri brain w/o & w/           0337       9.2075      $502.37      $240.77      $100.47
                                                                    dye.
70557................  S....................  NI.................  Mri brain w/o dye...         0336       6.3897      $348.63      $174.31       $69.73
70558................  S....................  NI.................  Mri brain w/ dye....         0284       7.1165      $388.28      $194.13       $77.66
70559................  S....................  NI.................  Mri brain w/o & w/           0337       9.2075      $502.37      $240.77      $100.47
                                                                    dye.
71010................  X....................  ...................  Chest x-ray.........         0260       0.7802       $42.57       $21.28        $8.51
71015................  X....................  ...................  Chest x-ray.........         0260       0.7802       $42.57       $21.28        $8.51
71020................  X....................  ...................  Chest x-ray.........         0260       0.7802       $42.57       $21.28        $8.51
71021................  X....................  ...................  Chest x-ray.........         0260       0.7802       $42.57       $21.28        $8.51
71022................  X....................  ...................  Chest x-ray.........         0260       0.7802       $42.57       $21.28        $8.51
71023................  X....................  ...................  Chest x-ray and              0272       1.4166       $77.29       $38.36       $15.46
                                                                    fluoroscopy.
71030................  X....................  ...................  Chest x-ray.........         0260       0.7802       $42.57       $21.28        $8.51
71034................  X....................  ...................  Chest x-ray and              0272       1.4166       $77.29       $38.36       $15.46
                                                                    fluoroscopy.
71035................  X....................  ...................  Chest x-ray.........         0260       0.7802       $42.57       $21.28        $8.51
71040................  X....................  ...................  Contrast x-ray of            0263       2.1883      $119.40       $43.58       $23.88
                                                                    bronchi.
71060................  X....................  ...................  Contrast x-ray of            0264       3.0287      $165.25       $79.41       $33.05
                                                                    bronchi.
71090................  X....................  ...................  X-ray & pacemaker            0272       1.4166       $77.29       $38.36       $15.46
                                                                    insertion.
71100................  X....................  ...................  X-ray exam of ribs..         0260       0.7802       $42.57       $21.28        $8.51
71101................  X....................  ...................  X-ray exam of ribs/          0260       0.7802       $42.57       $21.28        $8.51
                                                                    chest.
71110................  X....................  ...................  X-ray exam of ribs..         0260       0.7802       $42.57       $21.28        $8.51
71111................  X....................  ...................  X-ray exam of ribs/          0261       1.3176       $71.89  ...........       $14.38
                                                                    chest.
71120................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    breastbone.
71130................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    breastbone.
71250................  S....................  ...................  Ct thorax w/o dye...         0332       3.3936      $185.16       $91.27       $37.03
71260................  S....................  ...................  Ct thorax w/dye.....         0283       4.6543      $253.94      $126.27       $50.79
71270................  S....................  ...................  Ct thorax w/o & w/           0333       5.4241      $295.94      $146.98       $59.19
                                                                    dye.
71275................  S....................  ...................  Ct angiography,              0662       5.8775      $320.68      $156.47       $64.14
                                                                    chest.
71550................  S....................  ...................  Mri chest w/o dye...         0336       6.3897      $348.63      $174.31       $69.73
71551................  S....................  ...................  Mri chest w/dye.....         0284       7.1165      $388.28      $194.13       $77.66
71552................  S....................  ...................  Mri chest w/o & w/           0337       9.2075      $502.37      $240.77      $100.47
                                                                    dye.
71555................  B....................  ...................  Mri angio chest w or  ...........  ...........  ...........  ...........  ...........
                                                                    w/o dye.
72010................  X....................  ...................  X-ray exam of spine.         0261       1.3176       $71.89  ...........       $14.38
72020................  X....................  ...................  X-ray exam of spine.         0260       0.7802       $42.57       $21.28        $8.51
72040................  X....................  ...................  X-ray exam of neck           0260       0.7802       $42.57       $21.28        $8.51
                                                                    spine.
72050................  X....................  ...................  X-ray exam of neck           0261       1.3176       $71.89  ...........       $14.38
                                                                    spine.
72052................  X....................  ...................  X-ray exam of neck           0261       1.3176       $71.89  ...........       $14.38
                                                                    spine.
72069................  X....................  ...................  X-ray exam of trunk          0260       0.7802       $42.57       $21.28        $8.51
                                                                    spine.
72070................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    thoracic spine.
72072................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    thoracic spine.
72074................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    thoracic spine.
72080................  X....................  ...................  X-ray exam of trunk          0260       0.7802       $42.57       $21.28        $8.51
                                                                    spine.
72090................  X....................  ...................  X-ray exam of trunk          0261       1.3176       $71.89  ...........       $14.38
                                                                    spine.
72100................  X....................  ...................  X-ray exam of lower          0260       0.7802       $42.57       $21.28        $8.51
                                                                    spine.
72110................  X....................  ...................  X-ray exam of lower          0261       1.3176       $71.89  ...........       $14.38
                                                                    spine.
72114................  X....................  ...................  X-ray exam of lower          0261       1.3176       $71.89  ...........       $14.38
                                                                    spine.
72120................  X....................  ...................  X-ray exam of lower          0260       0.7802       $42.57       $21.28        $8.51
                                                                    spine.
72125................  S....................  ...................  Ct neck spine w/o            0332       3.3936      $185.16       $91.27       $37.03
                                                                    dye.
72126................  S....................  ...................  Ct neck spine w/dye.         0283       4.6543      $253.94      $126.27       $50.79
72127................  S....................  ...................  Ct neck spine w/o &          0333       5.4241      $295.94      $146.98       $59.19
                                                                    w/dye.
72128................  S....................  ...................  Ct chest spine w/o           0332       3.3936      $185.16       $91.27       $37.03
                                                                    dye.
72129................  S....................  ...................  Ct chest spine w/dye         0283       4.6543      $253.94      $126.27       $50.79
72130................  S....................  ...................  Ct chest spine w/o &         0333       5.4241      $295.94      $146.98       $59.19
                                                                    w/dye.
72131................  S....................  ...................  Ct lumbar spine w/o          0332       3.3936      $185.16       $91.27       $37.03
                                                                    dye.
72132................  S....................  ...................  Ct lumbar spine w/           0283       4.6543      $253.94      $126.27       $50.79
                                                                    dye.
72133................  S....................  ...................  Ct lumbar spine w/o          0333       5.4241      $295.94      $146.98       $59.19
                                                                    & w/dye.
72141................  S....................  ...................  Mri neck spine w/o           0336       6.3897      $348.63      $174.31       $69.73
                                                                    dye.
72142................  S....................  ...................  Mri neck spine w/dye         0284       7.1165      $388.28      $194.13       $77.66
72146................  S....................  ...................  Mri chest spine w/o          0336       6.3897      $348.63      $174.31       $69.73
                                                                    dye.
72147................  S....................  ...................  Mri chest spine w/           0284       7.1165      $388.28      $194.13       $77.66
                                                                    dye.
72148................  S....................  ...................  Mri lumbar spine w/o         0336       6.3897      $348.63      $174.31       $69.73
                                                                    dye.
72149................  S....................  ...................  Mri lumbar spine w/          0284       7.1165      $388.28      $194.13       $77.66
                                                                    dye.
72156................  S....................  ...................  Mri neck spine w/o &         0337       9.2075      $502.37      $240.77      $100.47
                                                                    w/dye.
72157................  S....................  ...................  Mri chest spine w/o          0337       9.2075      $502.37      $240.77      $100.47
                                                                    & w/dye.
72158................  S....................  ...................  Mri lumbar spine w/o         0337       9.2075      $502.37      $240.77      $100.47
                                                                    & w/dye.
72159................  E....................  ...................  Mr angio spine w/o&w/ ...........  ...........  ...........  ...........  ...........
                                                                    dye.
72170................  X....................  ...................  X-ray exam of pelvis         0260       0.7802       $42.57       $21.28        $8.51

[[Page 63565]]

 
72190................  X....................  ...................  X-ray exam of pelvis         0260       0.7802       $42.57       $21.28        $8.51
72191................  S....................  ...................  Ct angiograph pelv w/        0662       5.8775      $320.68      $156.47       $64.14
                                                                    o&w/dye.
72192................  S....................  ...................  Ct pelvis w/o dye...         0332       3.3936      $185.16       $91.27       $37.03
72193................  S....................  ...................  Ct pelvis w/dye.....         0283       4.6543      $253.94      $126.27       $50.79
72194................  S....................  ...................  Ct pelvis w/o & w/           0333       5.4241      $295.94      $146.98       $59.19
                                                                    dye.
72195................  S....................  ...................  Mri pelvis w/o dye..         0336       6.3897      $348.63      $174.31       $69.73
72196................  S....................  ...................  Mri pelvis w/dye....         0284       7.1165      $388.28      $194.13       $77.66
72197................  S....................  ...................  Mri pelvis w/o & w/          0337       9.2075      $502.37      $240.77      $100.47
                                                                    dye.
72198................  E....................  ...................  Mr angio pelvis w/o   ...........  ...........  ...........  ...........  ...........
                                                                    & w/dye.
72200................  X....................  ...................  X-ray exam                   0260       0.7802       $42.57       $21.28        $8.51
                                                                    sacroiliac joints.
72202................  X....................  ...................  X-ray exam                   0260       0.7802       $42.57       $21.28        $8.51
                                                                    sacroiliac joints.
72220................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    tailbone.
72240................  S....................  ...................  Contrast x-ray of            0274       3.5931      $196.04       $93.63       $39.21
                                                                    neck spine.
72255................  S....................  ...................  Contrast x-ray,              0274       3.5931      $196.04       $93.63       $39.21
                                                                    thorax spine.
72265................  S....................  ...................  Contrast x-ray,              0274       3.5931      $196.04       $93.63       $39.21
                                                                    lower spine.
72270................  S....................  ...................  Contrast x-ray,              0274       3.5931      $196.04       $93.63       $39.21
                                                                    spine.
72275................  S....................  ...................  Epidurography.......         0274       3.5931      $196.04       $93.63       $39.21
72285................  S....................  ...................  X-ray c/t spine disk         0388      11.6347      $634.80      $303.19      $126.96
72295................  S....................  ...................  X-ray of lower spine         0388      11.6347      $634.80      $303.19      $126.96
                                                                    disk.
73000................  X....................  ...................  X-ray exam of collar         0260       0.7802       $42.57       $21.28        $8.51
                                                                    bone.
73010................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    shoulder blade.
73020................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    shoulder.
73030................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    shoulder.
73040................  S....................  ...................  Contrast x-ray of            0275       3.2775      $178.82       $69.09       $35.76
                                                                    shoulder.
73050................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    shoulders.
73060................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    humerus.
73070................  X....................  ...................  X-ray exam of elbow.         0260       0.7802       $42.57       $21.28        $8.51
73080................  X....................  ...................  X-ray exam of elbow.         0260       0.7802       $42.57       $21.28        $8.51
73085................  S....................  ...................  Contrast x-ray of            0275       3.2775      $178.82       $69.09       $35.76
                                                                    elbow.
73090................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    forearm.
73092................  X....................  ...................  X-ray exam of arm,           0260       0.7802       $42.57       $21.28        $8.51
                                                                    infant.
73100................  X....................  ...................  X-ray exam of wrist.         0260       0.7802       $42.57       $21.28        $8.51
73110................  X....................  ...................  X-ray exam of wrist.         0260       0.7802       $42.57       $21.28        $8.51
73115................  S....................  ...................  Contrast x-ray of            0275       3.2775      $178.82       $69.09       $35.76
                                                                    wrist.
73120................  X....................  ...................  X-ray exam of hand..         0260       0.7802       $42.57       $21.28        $8.51
73130................  X....................  ...................  X-ray exam of hand..         0260       0.7802       $42.57       $21.28        $8.51
73140................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    finger(s).
73200................  S....................  ...................  Ct upper extremity w/        0332       3.3936      $185.16       $91.27       $37.03
                                                                    o dye.
73201................  S....................  ...................  Ct upper extremity w/        0283       4.6543      $253.94      $126.27       $50.79
                                                                    dye.
73202................  S....................  ...................  Ct uppr extremity w/         0333       5.4241      $295.94      $146.98       $59.19
                                                                    o&w/dye.
73206................  S....................  ...................  Ct angio upr extrm w/        0662       5.8775      $320.68      $156.47       $64.14
                                                                    o&w/dye.
73218................  S....................  ...................  Mri upper extremity          0336       6.3897      $348.63      $174.31       $69.73
                                                                    w/o dye.
73219................  S....................  ...................  Mri upper extremity          0284       7.1165      $388.28      $194.13       $77.66
                                                                    w/dye.
73220................  S....................  ...................  Mri uppr extremity w/        0337       9.2075      $502.37      $240.77      $100.47
                                                                    o&w/dye.
73221................  S....................  ...................  Mri joint upr extrem         0336       6.3897      $348.63      $174.31       $69.73
                                                                    w/o dye.
73222................  S....................  ...................  Mri joint upr extrem         0284       7.1165      $388.28      $194.13       $77.66
                                                                    w/dye.
73223................  S....................  ...................  Mri joint upr extr w/        0337       9.2075      $502.37      $240.77      $100.47
                                                                    o&w/dye.
73225................  E....................  ...................  Mr angio upr extr w/  ...........  ...........  ...........  ...........  ...........
                                                                    o&w/dye.
73500................  X....................  ...................  X-ray exam of hip...         0260       0.7802       $42.57       $21.28        $8.51
73510................  X....................  ...................  X-ray exam of hip...         0260       0.7802       $42.57       $21.28        $8.51
73520................  X....................  ...................  X-ray exam of hips..         0260       0.7802       $42.57       $21.28        $8.51
73525................  S....................  ...................  Contrast x-ray of            0275       3.2775      $178.82       $69.09       $35.76
                                                                    hip.
73530................  X....................  ...................  X-ray exam of hip...         0261       1.3176       $71.89  ...........       $14.38
73540................  X....................  ...................  X-ray exam of pelvis         0260       0.7802       $42.57       $21.28        $8.51
                                                                    & hips.
73542................  S....................  ...................  X-ray exam,                  0275       3.2775      $178.82       $69.09       $35.76
                                                                    sacroiliac joint.
73550................  X....................  ...................  X-ray exam of thigh.         0260       0.7802       $42.57       $21.28        $8.51
73560................  X....................  ...................  X-ray exam of knee,          0260       0.7802       $42.57       $21.28        $8.51
                                                                    1 or 2.
73562................  X....................  ...................  X-ray exam of knee,          0260       0.7802       $42.57       $21.28        $8.51
                                                                    3.
73564................  X....................  ...................  X-ray exam, knee, 4          0260       0.7802       $42.57       $21.28        $8.51
                                                                    or more.
73565................  X....................  ...................  X-ray exam of knees.         0260       0.7802       $42.57       $21.28        $8.51
73580................  S....................  ...................  Contrast x-ray of            0275       3.2775      $178.82       $69.09       $35.76
                                                                    knee joint.
73590................  X....................  ...................  X-ray exam of lower          0260       0.7802       $42.57       $21.28        $8.51
                                                                    leg.
73592................  X....................  ...................  X-ray exam of leg,           0260       0.7802       $42.57       $21.28        $8.51
                                                                    infant.
73600................  X....................  ...................  X-ray exam of ankle.         0260       0.7802       $42.57       $21.28        $8.51
73610................  X....................  ...................  X-ray exam of ankle.         0260       0.7802       $42.57       $21.28        $8.51
73615................  S....................  ...................  Contrast x-ray of            0275       3.2775      $178.82       $69.09       $35.76
                                                                    ankle.
73620................  X....................  ...................  X-ray exam of foot..         0260       0.7802       $42.57       $21.28        $8.51
73630................  X....................  ...................  X-ray exam of foot..         0260       0.7802       $42.57       $21.28        $8.51
73650................  X....................  ...................  X-ray exam of heel..         0260       0.7802       $42.57       $21.28        $8.51
73660................  X....................  ...................  X-ray exam of toe(s)         0260       0.7802       $42.57       $21.28        $8.51
73700................  S....................  ...................  Ct lower extremity w/        0332       3.3936      $185.16       $91.27       $37.03
                                                                    o dye.
73701................  S....................  ...................  Ct lower extremity w/        0283       4.6543      $253.94      $126.27       $50.79
                                                                    dye.
73702................  S....................  ...................  Ct lwr extremity w/          0333       5.4241      $295.94      $146.98       $59.19
                                                                    o&w/dye.
73706................  S....................  ...................  Ct angio lwr extr w/         0662       5.8775      $320.68      $156.47       $64.14
                                                                    o&w/dye.
73718................  S....................  ...................  Mri lower extremity          0336       6.3897      $348.63      $174.31       $69.73
                                                                    w/o dye.

[[Page 63566]]

 
73719................  S....................  ...................  Mri lower extremity          0284       7.1165      $388.28      $194.13       $77.66
                                                                    w/dye.
73720................  S....................  ...................  Mri lwr extremity w/         0337       9.2075      $502.37      $240.77      $100.47
                                                                    o&w/dye.
73721................  S....................  ...................  Mri jnt of lwr extre         0336       6.3897      $348.63      $174.31       $69.73
                                                                    w/o dye.
73722................  S....................  ...................  Mri joint of lwr             0284       7.1165      $388.28      $194.13       $77.66
                                                                    extr w/dye.
73723................  S....................  ...................  Mri joint lwr extr w/        0337       9.2075      $502.37      $240.77      $100.47
                                                                    o&w/dye.
73725................  B....................  ...................  Mr ang lwr ext w or   ...........  ...........  ...........  ...........  ...........
                                                                    w/o dye.
74000................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    abdomen.
74010................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    abdomen.
74020................  X....................  ...................  X-ray exam of                0260       0.7802       $42.57       $21.28        $8.51
                                                                    abdomen.
74022................  X....................  ...................  X-ray exam series,           0261       1.3176       $71.89  ...........       $14.38
                                                                    abdomen.
74150................  S....................  ...................  Ct abdomen w/o dye..         0332       3.3936      $185.16       $91.27       $37.03
74160................  S....................  ...................  Ct abdomen w/dye....         0283       4.6543      $253.94      $126.27       $50.79
74170................  S....................  ...................  Ct abdomen w/o &w /          0333       5.4241      $295.94      $146.98       $59.19
                                                                    dye.
74175................  S....................  ...................  Ct angio abdom w/o &         0662       5.8775      $320.68      $156.47       $64.14
                                                                    w/dye.
74181................  S....................  ...................  Mri abdomen w/o dye.         0336       6.3897      $348.63      $174.31       $69.73
74182................  S....................  ...................  Mri abdomen w/dye...         0284       7.1165      $388.28      $194.13       $77.66
74183................  S....................  ...................  Mri abdomen w/o & w/         0337       9.2075      $502.37      $240.77      $100.47
                                                                    dye.
74185................  B....................  ...................  Mri angio, abdom w    ...........  ...........  ...........  ...........  ...........
                                                                    orw/o dye.
74190................  X....................  ...................  X-ray exam of                0263       2.1883      $119.40       $43.58       $23.88
                                                                    peritoneum.
74210................  S....................  ...................  Contrst x-ray exam           0276       1.5906       $86.78       $41.72       $17.36
                                                                    of throat.
74220................  S....................  ...................  Contrast x-ray,              0276       1.5906       $86.78       $41.72       $17.36
                                                                    esophagus.
74230................  S....................  ...................  Cine/vid x-ray,              0276       1.5906       $86.78       $41.72       $17.36
                                                                    throat/esoph.
74235................  S....................  ...................  Remove esophagus             0296       2.8635      $156.24       $69.20       $31.25
                                                                    obstruction.
74240................  S....................  ...................  X-ray exam, upper gi         0276       1.5906       $86.78       $41.72       $17.36
                                                                    tract.
74241................  S....................  ...................  X-ray exam, upper gi         0276       1.5906       $86.78       $41.72       $17.36
                                                                    tract.
74245................  S....................  ...................  X-ray exam, upper gi         0277       2.4444      $133.37       $60.47       $26.67
                                                                    tract.
74246................  S....................  ...................  Contrst x-ray uppr           0276       1.5906       $86.78       $41.72       $17.36
                                                                    gi tract.
74247................  S....................  ...................  Contrst x-ray uppr           0276       1.5906       $86.78       $41.72       $17.36
                                                                    gi tract.
74249................  S....................  ...................  Contrst x-ray uppr           0277       2.4444      $133.37       $60.47       $26.67
                                                                    gi tract.
74250................  S....................  ...................  X-ray exam of small          0276       1.5906       $86.78       $41.72       $17.36
                                                                    bowel.
74251................  S....................  ...................  X-ray exam of small          0277       2.4444      $133.37       $60.47       $26.67
                                                                    bowel.
74260................  S....................  ...................  X-ray exam of small          0277       2.4444      $133.37       $60.47       $26.67
                                                                    bowel.
74270................  S....................  ...................  Contrast x-ray exam          0276       1.5906       $86.78       $41.72       $17.36
                                                                    of colon.
74280................  S....................  ...................  Contrast x-ray exam          0277       2.4444      $133.37       $60.47       $26.67
                                                                    of colon.
74283................  S....................  ...................  Contrast x-ray exam          0276       1.5906       $86.78       $41.72       $17.36
                                                                    of colon.
74290................  S....................  ...................  Contrast x-ray,              0276       1.5906       $86.78       $41.72       $17.36
                                                                    gallbladder.
74291................  S....................  ...................  Contrast x-rays,             0276       1.5906       $86.78       $41.72       $17.36
                                                                    gallbladder.
74300................  X....................  ...................  X-ray bile ducts/            0263       2.1883      $119.40       $43.58       $23.88
                                                                    pancreas.
74301................  X....................  ...................  X-rays at surgery            0263       2.1883      $119.40       $43.58       $23.88
                                                                    add-on.
74305................  X....................  ...................  X-ray bile ducts/            0263       2.1883      $119.40       $43.58       $23.88
                                                                    pancreas.
74320................  X....................  ...................  Contrast x-ray of            0264       3.0287      $165.25       $79.41       $33.05
                                                                    bile ducts.
74327................  S....................  ...................  X-ray bile stone             0296       2.8635      $156.24       $69.20       $31.25
                                                                    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           0272       1.4166       $77.29       $38.36       $15.46
                                                                    tube.
74350................  X....................  ...................  X-ray guide, stomach         0263       2.1883      $119.40       $43.58       $23.88
                                                                    tube.
74355................  X....................  ...................  X-ray guide,                 0263       2.1883      $119.40       $43.58       $23.88
                                                                    intestinal tube.
74360................  S....................  ...................  X-ray guide, GI              0296       2.8635      $156.24       $69.20       $31.25
                                                                    dilation.
74363................  S....................  ...................  X-ray, bile duct             0297       7.7145      $420.91      $172.51       $84.18
                                                                    dilation.
74400................  S....................  ...................  Contrst x-ray,               0278       2.7012      $147.38       $66.07       $29.48
                                                                    urinary tract.
74410................  S....................  ...................  Contrst x-ray,               0278       2.7012      $147.38       $66.07       $29.48
                                                                    urinary tract.
74415................  S....................  ...................  Contrst x-ray,               0278       2.7012      $147.38       $66.07       $29.48
                                                                    urinary tract.
74420................  S....................  ...................  Contrst x-ray,               0278       2.7012      $147.38       $66.07       $29.48
                                                                    urinary tract.
74425................  S....................  ...................  Contrst x-ray,               0278       2.7012      $147.38       $66.07       $29.48
                                                                    urinary tract.
74430................  S....................  ...................  Contrast x-ray,              0278       2.7012      $147.38       $66.07       $29.48
                                                                    bladder.
74440................  S....................  ...................  X-ray, male genital          0278       2.7012      $147.38       $66.07       $29.48
                                                                    tract.
74445................  S....................  ...................  X-ray exam of penis.         0278       2.7012      $147.38       $66.07       $29.48
74450................  S....................  ...................  X-ray, urethra/              0278       2.7012      $147.38       $66.07       $29.48
                                                                    bladder.
74455................  S....................  ...................  X-ray, urethra/              0278       2.7012      $147.38       $66.07       $29.48
                                                                    bladder.
74470................  X....................  ...................  X-ray exam of kidney         0264       3.0287      $165.25       $79.41       $33.05
                                                                    lesion.
74475................  S....................  ...................  X-ray control, cath          0297       7.7145      $420.91      $172.51       $84.18
                                                                    insert.
74480................  S....................  ...................  X-ray control, cath          0296       2.8635      $156.24       $69.20       $31.25
                                                                    insert.
74485................  S....................  ...................  X-ray guide, GU              0296       2.8635      $156.24       $69.20       $31.25
                                                                    dilation.
74710................  X....................  ...................  X-ray measurement of         0260       0.7802       $42.57       $21.28        $8.51
                                                                    pelvis.
74740................  X....................  ...................  X-ray, female                0264       3.0287      $165.25       $79.41       $33.05
                                                                    genital tract.
74742................  X....................  ...................  X-ray, fallopian             0263       2.1883      $119.40       $43.58       $23.88
                                                                    tube.
74775................  S....................  ...................  X-ray exam of                0278       2.7012      $147.38       $66.07       $29.48
                                                                    perineum.
75552................  S....................  ...................  Heart mri for morph          0336       6.3897      $348.63      $174.31       $69.73
                                                                    w/o dye.
75553................  S....................  ...................  Heart mri for morph          0284       7.1165      $388.28      $194.13       $77.66
                                                                    w/dye.
75554................  S....................  ...................  Cardiac MRI/function         0335       6.3499      $346.46      $151.46       $69.29
75555................  S....................  ...................  Cardiac MRI/limited          0335       6.3499      $346.46      $151.46       $69.29
                                                                    study.
75556................  E....................  ...................  Cardiac MRI/flow      ...........  ...........  ...........  ...........  ...........
                                                                    mapping.
75600................  S....................  ...................  Contrast x-ray exam          0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    of aorta.
75605................  S....................  ...................  Contrast x-ray exam          0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    of aorta.

[[Page 63567]]

 
75625................  S....................  ...................  Contrast x-ray exam          0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    of aorta.
75630................  S....................  ...................  X-ray aorta, leg             0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    arteries.
75635................  S....................  ...................  Ct angio abdominal           0662       5.8775      $320.68      $156.47       $64.14
                                                                    arteries.
75650................  S....................  ...................  Artery x-rays, head          0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    & neck.
75658................  S....................  ...................  Artery x-rays, arm..         0280      19.1015    $1,042.20      $353.85      $208.44
75660................  S....................  ...................  Artery x-rays, head          0279      10.7073      $584.20      $174.57      $116.84
                                                                    & neck.
75662................  S....................  ...................  Artery x-rays, head          0279      10.7073      $584.20      $174.57      $116.84
                                                                    & neck.
75665................  S....................  ...................  Artery x-rays, head          0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    & neck.
75671................  S....................  ...................  Artery x-rays, head          0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    & neck.
75676................  S....................  ...................  Artery x-rays, neck.         0280      19.1015    $1,042.20      $353.85      $208.44
75680................  S....................  ...................  Artery x-rays, neck.         0280      19.1015    $1,042.20      $353.85      $208.44
75685................  S....................  ...................  Artery x-rays, spine         0279      10.7073      $584.20      $174.57      $116.84
75705................  S....................  ...................  Artery x-rays, spine         0279      10.7073      $584.20      $174.57      $116.84
75710................  S....................  ...................  Artery x-rays, arm/          0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    leg.
75716................  S....................  ...................  Artery x-rays, arms/         0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    legs.
75722................  S....................  ...................  Artery x-rays,               0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    kidney.
75724................  S....................  ...................  Artery x-rays,               0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    kidneys.
75726................  S....................  ...................  Artery x-rays,               0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    abdomen.
75731................  S....................  ...................  Artery x-rays,               0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    adrenal gland.
75733................  S....................  ...................  Artery x-rays,               0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    adrenals.
75736................  S....................  ...................  Artery x-rays,               0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    pelvis.
75741................  S....................  ...................  Artery x-rays, lung.         0279      10.7073      $584.20      $174.57      $116.84
75743................  S....................  ...................  Artery x-rays, lungs         0280      19.1015    $1,042.20      $353.85      $208.44
75746................  S....................  ...................  Artery x-rays, lung.         0279      10.7073      $584.20      $174.57      $116.84
75756................  S....................  ...................  Artery x-rays, chest         0279      10.7073      $584.20      $174.57      $116.84
75774................  S....................  ...................  Artery x-ray, each           0668      10.2660      $560.12      $237.76      $112.02
                                                                    vessel.
75790................  S....................  ...................  Visualize A-V shunt.         0281       6.6031      $360.27      $115.16       $72.05
75801................  X....................  ...................  Lymph vessel x-ray,          0264       3.0287      $165.25       $79.41       $33.05
                                                                    arm/leg.
75803................  X....................  ...................  Lymph vessel x-              0264       3.0287      $165.25       $79.41       $33.05
                                                                    ray,arms/legs.
75805................  X....................  ...................  Lymph vessel x-ray,          0264       3.0287      $165.25       $79.41       $33.05
                                                                    trunk.
75807................  X....................  ...................  Lymph vessel x-ray,          0264       3.0287      $165.25       $79.41       $33.05
                                                                    trunk.
75809................  X....................  ...................  Nonvascular shunt, x-        0263       2.1883      $119.40       $43.58       $23.88
                                                                    ray.
75810................  S....................  ...................  Vein x-ray, spleen/          0279      10.7073      $584.20      $174.57      $116.84
                                                                    liver.
75820................  S....................  ...................  Vein x-ray, arm/leg.         0281       6.6031      $360.27      $115.16       $72.05
75822................  S....................  ...................  Vein x-ray, arms/            0281       6.6031      $360.27      $115.16       $72.05
                                                                    legs.
75825................  S....................  ...................  Vein x-ray, trunk...         0279      10.7073      $584.20      $174.57      $116.84
75827................  S....................  ...................  Vein x-ray, chest...         0279      10.7073      $584.20      $174.57      $116.84
75831................  S....................  ...................  Vein x-ray, kidney..         0287       6.4923      $354.23      $111.33       $70.85
75833................  S....................  ...................  Vein x-ray, kidneys.         0279      10.7073      $584.20      $174.57      $116.84
75840................  S....................  ...................  Vein x-ray, adrenal          0287       6.4923      $354.23      $111.33       $70.85
                                                                    gland.
75842................  S....................  ...................  Vein x-ray, adrenal          0287       6.4923      $354.23      $111.33       $70.85
                                                                    glands.
75860................  S....................  ...................  Vein x-ray, neck....         0287       6.4923      $354.23      $111.33       $70.85
75870................  S....................  ...................  Vein x-ray, skull...         0287       6.4923      $354.23      $111.33       $70.85
75872................  S....................  ...................  Vein x-ray, skull...         0287       6.4923      $354.23      $111.33       $70.85
75880................  S....................  ...................  Vein x-ray, eye              0287       6.4923      $354.23      $111.33       $70.85
                                                                    socket.
75885................  S....................  ...................  Vein x-ray, liver...         0279      10.7073      $584.20      $174.57      $116.84
75887................  S....................  ...................  Vein x-ray, liver...         0280      19.1015    $1,042.20      $353.85      $208.44
75889................  S....................  ...................  Vein x-ray, liver...         0279      10.7073      $584.20      $174.57      $116.84
75891................  S....................  ...................  Vein x-ray, liver...         0279      10.7073      $584.20      $174.57      $116.84
75893................  N....................  ...................  Venous sampling by    ...........  ...........  ...........  ...........  ...........
                                                                    catheter.
75894................  S....................  ...................  X-rays, transcath            0297       7.7145      $420.91      $172.51       $84.18
                                                                    therapy.
75896................  S....................  ...................  X-rays, transcath            0297       7.7145      $420.91      $172.51       $84.18
                                                                    therapy.
75898................  X....................  ...................  Follow-up                    0264       3.0287      $165.25       $79.41       $33.05
                                                                    angiography.
75900................  C....................  ...................  Arterial catheter     ...........  ...........  ...........  ...........  ...........
                                                                    exchange.
75901................  X....................  ...................  Remove cva device            0264       3.0287      $165.25       $79.41       $33.05
                                                                    obstruct.
75902................  X....................  ...................  Remove cva lumen             0263       2.1883      $119.40       $43.58       $23.88
                                                                    obstruct.
75940................  X....................  ...................  X-ray placement,             0187       4.4288      $241.64       $90.71       $48.33
                                                                    vein filter.
75945................  S....................  ...................  Intravascular us....         0267       2.4586      $134.14       $65.52       $26.83
75946................  S....................  ...................  Intravascular us add-        0267       2.4586      $134.14       $65.52       $26.83
                                                                    on.
75952................  C....................  ...................  Endovasc repair       ...........  ...........  ...........  ...........  ...........
                                                                    abdom aorta.
75953................  C....................  ...................  Abdom aneurysm        ...........  ...........  ...........  ...........  ...........
                                                                    endovas rpr.
75954................  C....................  ...................  Iliac aneurysm        ...........  ...........  ...........  ...........  ...........
                                                                    endovas rpr.
75960................  S....................  ...................  Transcatheter intro,         0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    stent.
75961................  S....................  ...................  Retrieval, broken            0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    catheter.
75962................  S....................  ...................  Repair arterial              0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    blockage.
75964................  S....................  ...................  Repair artery                0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    blockage, each.
75966................  S....................  ...................  Repair arterial              0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    blockage.
75968................  S....................  ...................  Repair artery                0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    blockage, each.
75970................  S....................  ...................  Vascular biopsy.....         0280      19.1015    $1,042.20      $353.85      $208.44
75978................  S....................  ...................  Repair venous                0668      10.2660      $560.12      $237.76      $112.02
                                                                    blockage.
75980................  S....................  ...................  Contrast xray exam           0296       2.8635      $156.24       $69.20       $31.25
                                                                    bile duct.
75982................  S....................  ...................  Contrast xray exam           0297       7.7145      $420.91      $172.51       $84.18
                                                                    bile duct.
75984................  X....................  ...................  Xray control                 0264       3.0287      $165.25       $79.41       $33.05
                                                                    catheter change.
75989................  N....................  ...................  Abscess drainage      ...........  ...........  ...........  ...........  ...........
                                                                    under x-ray.
75992................  S....................  ...................  Atherectomy, x-ray           0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    exam.

[[Page 63568]]

 
75993................  S....................  ...................  Atherectomy, x-ray           0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    exam.
75994................  S....................  ...................  Atherectomy, x-ray           0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    exam.
75995................  S....................  ...................  Atherectomy, x-ray           0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    exam.
75996................  S....................  ...................  Atherectomy, x-ray           0280      19.1015    $1,042.20      $353.85      $208.44
                                                                    exam.
75998................  N....................  NI.................  Fluoroguide for vein  ...........  ...........  ...........  ...........  ...........
                                                                    device.
76000................  X....................  ...................  Fluoroscope                  0272       1.4166       $77.29       $38.36       $15.46
                                                                    examination.
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       0.7802       $42.57       $21.28        $8.51
76010................  X....................  ...................  X-ray, nose to               0260       0.7802       $42.57       $21.28        $8.51
                                                                    rectum.
76012................  S....................  ...................  Percut                       0274       3.5931      $196.04       $93.63       $39.21
                                                                    vertebroplasty
                                                                    fluor.
76013................  S....................  ...................  Percut                       0274       3.5931      $196.04       $93.63       $39.21
                                                                    vertebroplasty, ct.
76020................  X....................  ...................  X-rays for bone age.         0260       0.7802       $42.57       $21.28        $8.51
76040................  X....................  ...................  X-rays, bone                 0260       0.7802       $42.57       $21.28        $8.51
                                                                    evaluation.
76061................  X....................  ...................  X-rays, bone survey.         0261       1.3176       $71.89  ...........       $14.38
76062................  X....................  ...................  X-rays, bone survey.         0261       1.3176       $71.89  ...........       $14.38
76065................  X....................  ...................  X-rays, bone                 0261       1.3176       $71.89  ...........       $14.38
                                                                    evaluation.
76066................  X....................  ...................  Joint survey, single         0260       0.7802       $42.57       $21.28        $8.51
                                                                    view.
76070................  S....................  ...................  CT scan, bone                0288       1.2726       $69.43  ...........       $13.89
                                                                    density study.
76071................  S....................  ...................  Ct bone density,             0282       1.6834       $91.85       $44.51       $18.37
                                                                    peripheral.
76075................  S....................  ...................  Dexa, axial skeleton         0288       1.2726       $69.43  ...........       $13.89
                                                                    study.
76076................  S....................  ...................  Dexa, peripheral             0665       0.7257       $39.59  ...........        $7.92
                                                                    study.
76078................  X....................  ...................  Radiographic                 0261       1.3176       $71.89  ...........       $14.38
                                                                    absorptiometry.
76080................  X....................  ...................  X-ray exam of                0263       2.1883      $119.40       $43.58       $23.88
                                                                    fistula.
76082................  S....................  NI.................  Computer mammogram           0410       0.1523        $8.31  ...........        $1.66
                                                                    add-on.
76083................  A....................  NI.................  Computer mammogram    ...........  ...........  ...........  ...........  ...........
                                                                    add-on.
76085................  D....................  DNG................  Computer mammogram    ...........  ...........  ...........  ...........  ...........
                                                                    add-on.
76086................  X....................  ...................  X-ray of mammary             0263       2.1883      $119.40       $43.58       $23.88
                                                                    duct.
76088................  X....................  ...................  X-ray of mammary             0263       2.1883      $119.40       $43.58       $23.88
                                                                    ducts.
76090................  S....................  ...................  Mammogram, one               0271       0.6499       $35.46       $16.80        $7.09
                                                                    breast.
76091................  S....................  ...................  Mammogram, both              0271       0.6499       $35.46       $16.80        $7.09
                                                                    breasts.
76092................  A....................  ...................  Mammogram, screening  ...........  ...........  ...........  ...........  ...........
76093................  E....................  ...................  Magnetic image,       ...........  ...........  ...........  ...........  ...........
                                                                    breast.
76094................  E....................  ...................  Magnetic image, both  ...........  ...........  ...........  ...........  ...........
                                                                    breasts.
76095................  X....................  ...................  Stereotactic breast          0187       4.4288      $241.64       $90.71       $48.33
                                                                    biopsy.
76096................  X....................  ...................  X-ray of needle              0289       3.4900      $190.42       $44.80       $38.08
                                                                    wire, breast.
76098................  X....................  ...................  X-ray exam, breast           0260       0.7802       $42.57       $21.28        $8.51
                                                                    specimen.
76100................  X....................  ...................  X-ray exam of body           0261       1.3176       $71.89  ...........       $14.38
                                                                    section.
76101................  X....................  ...................  Complex body section         0264       3.0287      $165.25       $79.41       $33.05
                                                                    x-ray.
76102................  X....................  ...................  Complex body section         0264       3.0287      $165.25       $79.41       $33.05
                                                                    x-rays.
76120................  X....................  ...................  Cine/video x-rays...         0272       1.4166       $77.29       $38.36       $15.46
76125................  X....................  ...................  Cine/video x-rays            0260       0.7802       $42.57       $21.28        $8.51
                                                                    add-on.
76140................  E....................  ...................  X-ray consultation..  ...........  ...........  ...........  ...........  ...........
76150................  X....................  ...................  X-ray exam, dry              0260       0.7802       $42.57       $21.28        $8.51
                                                                    process.
76350................  N....................  ...................  Special x-ray         ...........  ...........  ...........  ...........  ...........
                                                                    contrast study.
76355................  S....................  ...................  Ct scan for                  0283       4.6543      $253.94      $126.27       $50.79
                                                                    localization.
76360................  S....................  ...................  Ct scan for needle           0283       4.6543      $253.94      $126.27       $50.79
                                                                    biopsy.
76362................  S....................  ...................  Ct guide for tissue          0332       3.3936      $185.16       $91.27       $37.03
                                                                    ablation.
76370................  S....................  ...................  Ct scan for therapy          0282       1.6834       $91.85       $44.51       $18.37
                                                                    guide.
76375................  S....................  ...................  3d/holograph                 0282       1.6834       $91.85       $44.51       $18.37
                                                                    reconstr add-on.
76380................  S....................  ...................  CAT scan follow-up           0282       1.6834       $91.85       $44.51       $18.37
                                                                    study.
76390................  E....................  ...................  Mr spectroscopy.....  ...........  ...........  ...........  ...........  ...........
76393................  S....................  ...................  Mr guidance for              0335       6.3499      $346.46      $151.46       $69.29
                                                                    needle place.
76394................  S....................  ...................  Mri for tissue               0335       6.3499      $346.46      $151.46       $69.29
                                                                    ablation.
76400................  S....................  ...................  Magnetic image, bone         0335       6.3499      $346.46      $151.46       $69.29
                                                                    marrow.
76490................  S....................  DG.................  Us for tissue                0268       1.3081       $71.37  ...........       $14.27
                                                                    ablation.
76496................  X....................  ...................  Fluoroscopic                 0272       1.4166       $77.29       $38.36       $15.46
                                                                    procedure.
76497................  S....................  ...................  Ct procedure........         0282       1.6834       $91.85       $44.51       $18.37
76498................  S....................  ...................  Mri procedure.......         0335       6.3499      $346.46      $151.46       $69.29
76499................  X....................  ...................  Radiographic                 0260       0.7802       $42.57       $21.28        $8.51
                                                                    procedure.
76506................  S....................  ...................  Echo exam of head...         0266       1.6117       $87.94       $43.97       $17.59
76511................  S....................  ...................  Echo exam of eye....         0266       1.6117       $87.94       $43.97       $17.59
76512................  S....................  ...................  Echo exam of eye....         0266       1.6117       $87.94       $43.97       $17.59
76513................  S....................  ...................  Echo exam of eye,            0265       1.0289       $56.14       $28.07       $11.23
                                                                    water bath.
76514................  S....................  NI.................  Echo exam of eye,            0265       1.0289       $56.14       $28.07       $11.23
                                                                    thickness.
76516................  S....................  ...................  Echo exam of eye....         0266       1.6117       $87.94       $43.97       $17.59
76519................  S....................  ...................  Echo exam of eye....         0266       1.6117       $87.94       $43.97       $17.59
76529................  S....................  ...................  Echo exam of eye....         0265       1.0289       $56.14       $28.07       $11.23
76536................  S....................  ...................  Us exam of head and          0266       1.6117       $87.94       $43.97       $17.59
                                                                    neck.
76604................  S....................  ...................  Us exam, chest, b-           0266       1.6117       $87.94       $43.97       $17.59
                                                                    scan.
76645................  S....................  ...................  Us exam, breast(s)..         0265       1.0289       $56.14       $28.07       $11.23
76700................  S....................  ...................  Us exam, abdom,              0266       1.6117       $87.94       $43.97       $17.59
                                                                    complete.
76705................  S....................  ...................  Echo exam of abdomen         0266       1.6117       $87.94       $43.97       $17.59
76770................  S....................  ...................  Us exam abdo back            0266       1.6117       $87.94       $43.97       $17.59
                                                                    wall, comp.

[[Page 63569]]

 
76775................  S....................  ...................  Us exam abdo back            0266       1.6117       $87.94       $43.97       $17.59
                                                                    wall, lim.
76778................  S....................  ...................  Us exam kidney               0266       1.6117       $87.94       $43.97       $17.59
                                                                    transplant.
76800................  S....................  ...................  Us exam, spinal              0266       1.6117       $87.94       $43.97       $17.59
                                                                    canal.
76801................  S....................  ...................  Ob us < 14 wks,              0265       1.0289       $56.14       $28.07       $11.23
                                                                    single fetus.
76802................  S....................  ...................  Ob us < 14 wks,              0265       1.0289       $56.14       $28.07       $11.23
                                                                    add'l fetus.
76805................  S....................  ...................  Us exam, pg uterus,          0266       1.6117       $87.94       $43.97       $17.59
                                                                    compl.
76810................  S....................  ...................  Us exam, pg uterus,          0265       1.0289       $56.14       $28.07       $11.23
                                                                    mult.
76811................  S....................  ...................  Ob us, detailed,             0267       2.4586      $134.14       $65.52       $26.83
                                                                    sngl fetus.
76812................  S....................  ...................  Ob us, detailed,             0266       1.6117       $87.94       $43.97       $17.59
                                                                    addl fetus.
76815................  S....................  ...................  Us exam, pg uterus           0265       1.0289       $56.14       $28.07       $11.23
                                                                    limit.
76816................  S....................  ...................  Us exam pg uterus            0265       1.0289       $56.14       $28.07       $11.23
                                                                    repeat.
76817................  S....................  ...................  Transvaginal us,             0265       1.0289       $56.14       $28.07       $11.23
                                                                    obstetric.
76818................  S....................  ...................  Fetal biophys                0266       1.6117       $87.94       $43.97       $17.59
                                                                    profile w/nst.
76819................  S....................  ...................  Fetal biophys profil         0266       1.6117       $87.94       $43.97       $17.59
                                                                    w/o nst.
76825................  S....................  ...................  Echo exam of fetal           0671       1.6384       $89.39       $44.69       $17.88
                                                                    heart.
76826................  S....................  ...................  Echo exam of fetal           0697       1.4415       $78.65       $39.32       $15.73
                                                                    heart.
76827................  S....................  ...................  Echo exam of fetal           0671       1.6384       $89.39       $44.69       $17.88
                                                                    heart.
76828................  S....................  ...................  Echo exam of fetal           0697       1.4415       $78.65       $39.32       $15.73
                                                                    heart.
76830................  S....................  ...................  Transvaginal us, non-        0266       1.6117       $87.94       $43.97       $17.59
                                                                    ob.
76831................  S....................  ...................  Echo exam, uterus...         0266       1.6117       $87.94       $43.97       $17.59
76856................  S....................  ...................  Us exam, pelvic,             0266       1.6117       $87.94       $43.97       $17.59
                                                                    complete.
76857................  S....................  ...................  Us exam, pelvic,             0265       1.0289       $56.14       $28.07       $11.23
                                                                    limited.
76870................  S....................  ...................  Us exam, scrotum....         0266       1.6117       $87.94       $43.97       $17.59
76872................  S....................  ...................  Us, transrectal.....         0266       1.6117       $87.94       $43.97       $17.59
76873................  S....................  ...................  Echograp trans r,            0266       1.6117       $87.94       $43.97       $17.59
                                                                    pros study.
76880................  S....................  ...................  Us exam, extremity..         0266       1.6117       $87.94       $43.97       $17.59
76885................  S....................  ...................  Us exam infant hips,         0266       1.6117       $87.94       $43.97       $17.59
                                                                    dynamic.
76886................  S....................  ...................  Us exam infant hips,         0266       1.6117       $87.94       $43.97       $17.59
                                                                    static.
76930................  S....................  ...................  Echo guide,                  0268       1.3081       $71.37  ...........       $14.27
                                                                    cardiocentesis.
76932................  S....................  ...................  Echo guide for heart         0268       1.3081       $71.37  ...........       $14.27
                                                                    biopsy.
76936................  S....................  ...................  Echo guide for               0268       1.3081       $71.37  ...........       $14.27
                                                                    artery repair.
76937................  N....................  NI.................  Us guide, vascular    ...........  ...........  ...........  ...........  ...........
                                                                    access.
76940................  S....................  NI.................  Us guide, tissue             0268       1.3081       $71.37  ...........       $14.27
                                                                    ablation.
76941................  S....................  ...................  Echo guide for               0268       1.3081       $71.37  ...........       $14.27
                                                                    transfusion.
76942................  S....................  ...................  Echo guide for               0268       1.3081       $71.37  ...........       $14.27
                                                                    biopsy.
76945................  S....................  ...................  Echo guide, villus           0268       1.3081       $71.37  ...........       $14.27
                                                                    sampling.
76946................  S....................  ...................  Echo guide for               0268       1.3081       $71.37  ...........       $14.27
                                                                    amniocentesis.
76948................  S....................  ...................  Echo guide, ova              0268       1.3081       $71.37  ...........       $14.27
                                                                    aspiration.
76950................  S....................  ...................  Echo guidance                0268       1.3081       $71.37  ...........       $14.27
                                                                    radiotherapy.
76965................  S....................  ...................  Echo guidance                0268       1.3081       $71.37  ...........       $14.27
                                                                    radiotherapy.
76970................  S....................  ...................  Ultrasound exam              0265       1.0289       $56.14       $28.07       $11.23
                                                                    follow-up.
76975................  S....................  ...................  GI endoscopic                0266       1.6117       $87.94       $43.97       $17.59
                                                                    ultrasound.
76977................  S....................  ...................  Us bone density              0340       0.6314       $34.45  ...........        $6.89
                                                                    measure.
76986................  S....................  ...................  Ultrasound guide             0266       1.6117       $87.94       $43.97       $17.59
                                                                    intraoper.
76999................  S....................  ...................  Echo examination             0265       1.0289       $56.14       $28.07       $11.23
                                                                    procedure.
77261................  E....................  ...................  Radiation therapy     ...........  ...........  ...........  ...........  ...........
                                                                    planning.
77262................  E....................  ...................  Radiation therapy     ...........  ...........  ...........  ...........  ...........
                                                                    planning.
77263................  E....................  ...................  Radiation therapy     ...........  ...........  ...........  ...........  ...........
                                                                    planning.
77280................  X....................  ...................  Set radiation                0304       1.6742       $91.35       $41.52       $18.27
                                                                    therapy field.
77285................  X....................  ...................  Set radiation                0305       3.6767      $200.60       $91.38       $40.12
                                                                    therapy field.
77290................  X....................  ...................  Set radiation                0305       3.6767      $200.60       $91.38       $40.12
                                                                    therapy field.
77295................  X....................  ...................  Set radiation                0310      13.7165      $748.39      $325.27      $149.68
                                                                    therapy field.
77299................  E....................  ...................  Radiation therapy     ...........  ...........  ...........  ...........  ...........
                                                                    planning.
77300................  X....................  ...................  Radiation therapy            0304       1.6742       $91.35       $41.52       $18.27
                                                                    dose plan.
77301................  S....................  ...................  Radiotherapy dose            1510  ...........      $850.00  ...........      $170.00
                                                                    plan, imrt.
77305................  X....................  ...................  Teletx isodose plan          0304       1.6742       $91.35       $41.52       $18.27
                                                                    simple.
77310................  X....................  ...................  Teletx isodose plan          0304       1.6742       $91.35       $41.52       $18.27
                                                                    intermed.
77315................  X....................  ...................  Teletx isodose plan          0305       3.6767      $200.60       $91.38       $40.12
                                                                    complex.
77321................  X....................  ...................  Special teletx port          0305       3.6767      $200.60       $91.38       $40.12
                                                                    plan.
77326................  X....................  ...................  Radiation therapy            0305       3.6767      $200.60       $91.38       $40.12
                                                                    dose plan.
77327................  X....................  ...................  Brachytx isodose             0305       3.6767      $200.60       $91.38       $40.12
                                                                    calc interm.
77328................  X....................  ...................  Brachytx isodose             0305       3.6767      $200.60       $91.38       $40.12
                                                                    plan compl.
77331................  X....................  ...................  Special radiation            0304       1.6742       $91.35       $41.52       $18.27
                                                                    dosimetry.
77332................  X....................  ...................  Radiation treatment          0303       2.8835      $157.33       $66.95       $31.47
                                                                    aid(s).
77333................  X....................  ...................  Radiation treatment          0303       2.8835      $157.33       $66.95       $31.47
                                                                    aid(s).
77334................  X....................  ...................  Radiation treatment          0303       2.8835      $157.33       $66.95       $31.47
                                                                    aid(s).
77336................  X....................  ...................  Radiation physics            0304       1.6742       $91.35       $41.52       $18.27
                                                                    consult.
77370................  X....................  ...................  Radiation physics            0305       3.6767      $200.60       $91.38       $40.12
                                                                    consult.
77399................  X....................  ...................  External radiation           0304       1.6742       $91.35       $41.52       $18.27
                                                                    dosimetry.
77401................  S....................  ...................  Radiation treatment          0300       1.4912       $81.36  ...........       $16.27
                                                                    delivery.
77402................  S....................  ...................  Radiation treatment          0300       1.4912       $81.36  ...........       $16.27
                                                                    delivery.
77403................  S....................  ...................  Radiation treatment          0300       1.4912       $81.36  ...........       $16.27
                                                                    delivery.
77404................  S....................  ...................  Radiation treatment          0300       1.4912       $81.36  ...........       $16.27
                                                                    delivery.
77406................  S....................  ...................  Radiation treatment          0300       1.4912       $81.36  ...........       $16.27
                                                                    delivery.
77407................  S....................  ...................  Radiation treatment          0300       1.4912       $81.36  ...........       $16.27
                                                                    delivery.

[[Page 63570]]

 
77408................  S....................  ...................  Radiation treatment          0300       1.4912       $81.36  ...........       $16.27
                                                                    delivery.
77409................  S....................  ...................  Radiation treatment          0300       1.4912       $81.36  ...........       $16.27
                                                                    delivery.
77411................  S....................  ...................  Radiation treatment          0300       1.4912       $81.36  ...........       $16.27
                                                                    delivery.
77412................  S....................  ...................  Radiation treatment          0301       2.1340      $116.43  ...........       $23.29
                                                                    delivery.
77413................  S....................  ...................  Radiation treatment          0301       2.1340      $116.43  ...........       $23.29
                                                                    delivery.
77414................  S....................  ...................  Radiation treatment          0301       2.1340      $116.43  ...........       $23.29
                                                                    delivery.
77416................  S....................  ...................  Radiation treatment          0301       2.1340      $116.43  ...........       $23.29
                                                                    delivery.
77417................  X....................  ...................  Radiology port               0260       0.7802       $42.57       $21.28        $8.51
                                                                    film(s).
77418................  S....................  ...................  Radiation tx                 0412       5.3904      $294.11  ...........       $58.82
                                                                    delivery, imrt.
77427................  E....................  ...................  Radiation tx          ...........  ...........  ...........  ...........  ...........
                                                                    management, x5.
77431................  E....................  ...................  Radiation therapy     ...........  ...........  ...........  ...........  ...........
                                                                    management.
77432................  E....................  ...................  Stereotactic          ...........  ...........  ...........  ...........  ...........
                                                                    radiation trmt.
77470................  S....................  ...................  Special radiation            0299       5.7618      $314.37  ...........       $62.87
                                                                    treatment.
77499................  E....................  ...................  Radiation therapy     ...........  ...........  ...........  ...........  ...........
                                                                    management.
77520................  S....................  ...................  Proton trmt, simple          0664       9.7295      $530.85  ...........      $106.17
                                                                    w/o comp.
77522................  S....................  ...................  Proton trmt, simple          0664       9.7295      $530.85  ...........      $106.17
                                                                    w/comp.
77523................  S....................  ...................  Proton trmt,                 1511  ...........      $950.00  ...........      $190.00
                                                                    intermediate.
77525................  S....................  ...................  Proton treatment,            1511  ...........      $950.00  ...........      $190.00
                                                                    complex.
77600................  S....................  ...................  Hyperthermia                 0314       4.6041      $251.20      $101.77       $50.24
                                                                    treatment.
77605................  S....................  ...................  Hyperthermia                 0314       4.6041      $251.20      $101.77       $50.24
                                                                    treatment.
77610................  S....................  ...................  Hyperthermia                 0314       4.6041      $251.20      $101.77       $50.24
                                                                    treatment.
77615................  S....................  ...................  Hyperthermia                 0314       4.6041      $251.20      $101.77       $50.24
                                                                    treatment.
77620................  S....................  ...................  Hyperthermia                 0314       4.6041      $251.20      $101.77       $50.24
                                                                    treatment.
77750................  S....................  ...................  Infuse radioactive           0300       1.4912       $81.36  ...........       $16.27
                                                                    materials.
77761................  S....................  ...................  Apply intrcav radiat         0312       3.6637      $199.90  ...........       $39.98
                                                                    simple.
77762................  S....................  ...................  Apply intrcav radiat         0312       3.6637      $199.90  ...........       $39.98
                                                                    interm.
77763................  S....................  ...................  Apply intrcav radiat         0312       3.6637      $199.90  ...........       $39.98
                                                                    compl.
77776................  S....................  ...................  Apply interstit              0312       3.6637      $199.90  ...........       $39.98
                                                                    radiat simpl.
77777................  S....................  ...................  Apply interstit              0312       3.6637      $199.90  ...........       $39.98
                                                                    radiat inter.
77778................  S....................  ...................  Apply interstit              0651      10.2314      $558.24  ...........      $111.65
                                                                    radiat compl.
77781................  S....................  ...................  High intensity               0313      16.2481      $886.51  ...........      $177.30
                                                                    brachytherapy.
77782................  S....................  ...................  High intensity               0313      16.2481      $886.51  ...........      $177.30
                                                                    brachytherapy.
77783................  S....................  ...................  High intensity               0313      16.2481      $886.51  ...........      $177.30
                                                                    brachytherapy.
77784................  S....................  ...................  High intensity               0313      16.2481      $886.51  ...........      $177.30
                                                                    brachytherapy.
77789................  S....................  ...................  Apply surface                0300       1.4912       $81.36  ...........       $16.27
                                                                    radiation.
77790................  N....................  ...................  Radiation handling..  ...........  ...........  ...........  ...........  ...........
77799................  S....................  ...................  Radium/radioisotope          0313      16.2481      $886.51  ...........      $177.30
                                                                    therapy.
78000................  S....................  ...................  Thyroid, single              0389       1.6328       $89.09       $44.54       $17.82
                                                                    uptake.
78001................  S....................  ...................  Thyroid, multiple            0389       1.6328       $89.09       $44.54       $17.82
                                                                    uptakes.
78003................  S....................  ...................  Thyroid suppress/            0389       1.6328       $89.09       $44.54       $17.82
                                                                    stimul.
78006................  S....................  ...................  Thyroid imaging with         0390       2.7907      $152.26       $76.13       $30.45
                                                                    uptake.
78007................  S....................  ...................  Thyroid image, mult          0391       3.1956      $174.36       $87.18       $34.87
                                                                    uptakes.
78010................  S....................  ...................  Thyroid imaging.....         0390       2.7907      $152.26       $76.13       $30.45
78011................  S....................  ...................  Thyroid imaging with         0390       2.7907      $152.26       $76.13       $30.45
                                                                    flow.
78015................  S....................  ...................  Thyroid met imaging.         0406       4.3955      $239.82      $119.91       $47.96
78016................  S....................  ...................  Thyroid met imaging/         0406       4.3955      $239.82      $119.91       $47.96
                                                                    studies.
78018................  S....................  ...................  Thyroid met imaging,         0406       4.3955      $239.82      $119.91       $47.96
                                                                    body.
78020................  S....................  ...................  Thyroid met uptake..         0399       1.5273       $83.33       $41.66       $16.67
78070................  S....................  ...................  Parathyroid nuclear          0391       3.1956      $174.36       $87.18       $34.87
                                                                    imaging.
78075................  S....................  ...................  Adrenal nuclear              0391       3.1956      $174.36       $87.18       $34.87
                                                                    imaging.
78099................  S....................  ...................  Endocrine nuclear            0390       2.7907      $152.26       $76.13       $30.45
                                                                    procedure.
78102................  S....................  ...................  Bone marrow imaging,         0400       3.8242      $208.65      $104.32       $41.73
                                                                    ltd.
78103................  S....................  ...................  Bone marrow imaging,         0400       3.8242      $208.65      $104.32       $41.73
                                                                    mult.
78104................  S....................  ...................  Bone marrow imaging,         0400       3.8242      $208.65      $104.32       $41.73
                                                                    body.
78110................  S....................  ...................  Plasma volume,               0393       4.4354      $242.00      $121.00       $48.40
                                                                    single.
78111................  S....................  ...................  Plasma volume,               0393       4.4354      $242.00      $121.00       $48.40
                                                                    multiple.
78120................  S....................  ...................  Red cell mass,               0393       4.4354      $242.00      $121.00       $48.40
                                                                    single.
78121................  S....................  ...................  Red cell mass,               0393       4.4354      $242.00      $121.00       $48.40
                                                                    multiple.
78122................  S....................  ...................  Blood volume........         0393       4.4354      $242.00      $121.00       $48.40
78130................  S....................  ...................  Red cell survival            0393       4.4354      $242.00      $121.00       $48.40
                                                                    study.
78135................  S....................  ...................  Red cell survival            0393       4.4354      $242.00      $121.00       $48.40
                                                                    kinetics.
78140................  S....................  ...................  Red cell                     0393       4.4354      $242.00      $121.00       $48.40
                                                                    sequestration.
78160................  S....................  ...................  Plasma iron turnover         0393       4.4354      $242.00      $121.00       $48.40
78162................  S....................  ...................  Radioiron absorption         0393       4.4354      $242.00      $121.00       $48.40
                                                                    exam.
78170................  S....................  ...................  Red cell iron                0393       4.4354      $242.00      $121.00       $48.40
                                                                    utilization.
78172................  S....................  ...................  Total body iron              0393       4.4354      $242.00      $121.00       $48.40
                                                                    estimation.
78185................  S....................  ...................  Spleen imaging......         0400       3.8242      $208.65      $104.32       $41.73
78190................  S....................  ...................  Platelet survival,           0389       1.6328       $89.09       $44.54       $17.82
                                                                    kinetics.
78191................  S....................  ...................  Platelet survival...         0389       1.6328       $89.09       $44.54       $17.82
78195................  S....................  ...................  Lymph system imaging         0400       3.8242      $208.65      $104.32       $41.73
78199................  S....................  ...................  Blood/lymph nuclear          0400       3.8242      $208.65      $104.32       $41.73
                                                                    exam.
78201................  S....................  ...................  Liver imaging.......         0394       4.3714      $238.51      $119.25       $47.70
78202................  S....................  ...................  Liver imaging with           0394       4.3714      $238.51      $119.25       $47.70
                                                                    flow.
78205................  S....................  ...................  Liver imaging (3D)..         0394       4.3714      $238.51      $119.25       $47.70
78206................  S....................  ...................  Liver image (3d)             0394       4.3714      $238.51      $119.25       $47.70
                                                                    with flow.

[[Page 63571]]

 
78215................  S....................  ...................  Liver and spleen             0394       4.3714      $238.51      $119.25       $47.70
                                                                    imaging.
78216................  S....................  ...................  Liver & spleen image/        0394       4.3714      $238.51      $119.25       $47.70
                                                                    flow.
78220................  S....................  ...................  Liver function study         0394       4.3714      $238.51      $119.25       $47.70
78223................  S....................  ...................  Hepatobiliary                0394       4.3714      $238.51      $119.25       $47.70
                                                                    imaging.
78230................  S....................  ...................  Salivary gland               0395       3.9536      $215.71      $107.85       $43.14
                                                                    imaging.
78231................  S....................  ...................  Serial salivary              0395       3.9536      $215.71      $107.85       $43.14
                                                                    imaging.
78232................  S....................  ...................  Salivary gland               0395       3.9536      $215.71      $107.85       $43.14
                                                                    function exam.
78258................  S....................  ...................  Esophageal motility          0395       3.9536      $215.71      $107.85       $43.14
                                                                    study.
78261................  S....................  ...................  Gastric mucosa               0395       3.9536      $215.71      $107.85       $43.14
                                                                    imaging.
78262................  S....................  ...................  Gastroesophageal             0395       3.9536      $215.71      $107.85       $43.14
                                                                    reflux exam.
78264................  S....................  ...................  Gastric emptying             0395       3.9536      $215.71      $107.85       $43.14
                                                                    study.
78267................  A....................  ...................  Breath tst attain/    ...........  ...........  ...........  ...........  ...........
                                                                    anal c-14.
78268................  A....................  ...................  Breath test           ...........  ...........  ...........  ...........  ...........
                                                                    analysis, c-14.
78270................  S....................  ...................  Vit B-12 absorption          0389       1.6328       $89.09       $44.54       $17.82
                                                                    exam.
78271................  S....................  ...................  Vit b-12 absrp exam,         0389       1.6328       $89.09       $44.54       $17.82
                                                                    int fac.
78272................  S....................  ...................  Vit B-12 absorp,             0389       1.6328       $89.09       $44.54       $17.82
                                                                    combined.
78278................  S....................  ...................  Acute GI blood loss          0395       3.9536      $215.71      $107.85       $43.14
                                                                    imaging.
78282................  S....................  ...................  GI protein loss exam         0395       3.9536      $215.71      $107.85       $43.14
78290................  S....................  ...................  Meckel's divert exam         0395       3.9536      $215.71      $107.85       $43.14
78291................  S....................  ...................  Leveen/shunt patency         0395       3.9536      $215.71      $107.85       $43.14
                                                                    exam.
78299................  S....................  ...................  GI nuclear procedure         0395       3.9536      $215.71      $107.85       $43.14
78300................  S....................  ...................  Bone imaging,                0396       4.1883      $228.52      $114.26       $45.70
                                                                    limited area.
78305................  S....................  ...................  Bone imaging,                0396       4.1883      $228.52      $114.26       $45.70
                                                                    multiple areas.
78306................  S....................  ...................  Bone imaging, whole          0396       4.1883      $228.52      $114.26       $45.70
                                                                    body.
78315................  S....................  ...................  Bone imaging, 3              0396       4.1883      $228.52      $114.26       $45.70
                                                                    phase.
78320................  S....................  ...................  Bone imaging (3D)...         0396       4.1883      $228.52      $114.26       $45.70
78350................  X....................  ...................  Bone mineral, single         0261       1.3176       $71.89  ...........       $14.38
                                                                    photon.
78351................  E....................  ...................  Bone mineral, dual    ...........  ...........  ...........  ...........  ...........
                                                                    photon.
78399................  S....................  ...................  Musculoskeletal              0396       4.1883      $228.52      $114.26       $45.70
                                                                    nuclear exam.
78414................  S....................  ...................  Non-imaging heart            0398       4.5091      $246.02      $123.01       $49.20
                                                                    function.
78428................  S....................  ...................  Cardiac shunt                0398       4.5091      $246.02      $123.01       $49.20
                                                                    imaging.
78445................  S....................  ...................  Vascular flow                0397       2.2183      $121.03       $60.51       $24.21
                                                                    imaging.
78455................  S....................  ...................  Venous thrombosis            0397       2.2183      $121.03       $60.51       $24.21
                                                                    study.
78456................  S....................  ...................  Acute venous                 0397       2.2183      $121.03       $60.51       $24.21
                                                                    thrombus image.
78457................  S....................  ...................  Venous thrombosis            0397       2.2183      $121.03       $60.51       $24.21
                                                                    imaging.
78458................  S....................  ...................  Ven thrombosis               0397       2.2183      $121.03       $60.51       $24.21
                                                                    images, bilat.
78459................  S....................  ...................  Heart muscle imaging         0285      14.1508      $772.08      $334.45      $154.42
                                                                    (PET).
78460................  S....................  ...................  Heart muscle blood,          0398       4.5091      $246.02      $123.01       $49.20
                                                                    single.
78461................  S....................  ...................  Heart muscle blood,          0377       6.8830      $375.54      $187.76       $75.11
                                                                    multiple.
78464................  S....................  ...................  Heart image (3d),            0398       4.5091      $246.02      $123.01       $49.20
                                                                    single.
78465................  S....................  ...................  Heart image (3d),            0377       6.8830      $375.54      $187.76       $75.11
                                                                    multiple.
78466................  S....................  ...................  Heart infarct image.         0398       4.5091      $246.02      $123.01       $49.20
78468................  S....................  ...................  Heart infarct image          0398       4.5091      $246.02      $123.01       $49.20
                                                                    (ef).
78469................  S....................  ...................  Heart infarct image          0398       4.5091      $246.02      $123.01       $49.20
                                                                    (3D).
78472................  S....................  ...................  Gated heart, planar,         0398       4.5091      $246.02      $123.01       $49.20
                                                                    single.
78473................  S....................  ...................  Gated heart,                 0376       4.4510      $242.85      $121.42       $48.57
                                                                    multiple.
78478................  S....................  ...................  Heart wall motion            0399       1.5273       $83.33       $41.66       $16.67
                                                                    add-on.
78480................  S....................  ...................  Heart function add-          0399       1.5273       $83.33       $41.66       $16.67
                                                                    on.
78481................  S....................  ...................  Heart first pass,            0398       4.5091      $246.02      $123.01       $49.20
                                                                    single.
78483................  S....................  ...................  Heart first pass,            0376       4.4510      $242.85      $121.42       $48.57
                                                                    multiple.
78491................  E....................  ...................  Heart image (pet),    ...........  ...........  ...........  ...........  ...........
                                                                    single.
78492................  E....................  ...................  Heart image (pet),    ...........  ...........  ...........  ...........  ...........
                                                                    multiple.
78494................  S....................  ...................  Heart image, spect..         0398       4.5091      $246.02      $123.01       $49.20
78496................  S....................  ...................  Heart first pass add-        0399       1.5273       $83.33       $41.66       $16.67
                                                                    on.
78499................  S....................  ...................  Cardiovascular               0398       4.5091      $246.02      $123.01       $49.20
                                                                    nuclear exam.
78580................  S....................  ...................  Lung perfusion               0401       3.3736      $184.07       $92.03       $36.81
                                                                    imaging.
78584................  S....................  ...................  Lung V/Q image               0378       5.4852      $299.28      $149.63       $59.86
                                                                    single breath.
78585................  S....................  ...................  Lung V/Q imaging....         0378       5.4852      $299.28      $149.63       $59.86
78586................  S....................  ...................  Aerosol lung image,          0401       3.3736      $184.07       $92.03       $36.81
                                                                    single.
78587................  S....................  ...................  Aerosol lung image,          0401       3.3736      $184.07       $92.03       $36.81
                                                                    multiple.
78588................  S....................  ...................  Perfusion lung image         0378       5.4852      $299.28      $149.63       $59.86
78591................  S....................  ...................  Vent image, 1                0401       3.3736      $184.07       $92.03       $36.81
                                                                    breath, 1 proj.
78593................  S....................  ...................  Vent image, 1 proj,          0401       3.3736      $184.07       $92.03       $36.81
                                                                    gas.
78594................  S....................  ...................  Vent image, mult             0401       3.3736      $184.07       $92.03       $36.81
                                                                    proj, gas.
78596................  S....................  ...................  Lung differential            0378       5.4852      $299.28      $149.63       $59.86
                                                                    function.
78599................  S....................  ...................  Respiratory nuclear          0401       3.3736      $184.07       $92.03       $36.81
                                                                    exam.
78600................  S....................  ...................  Brain imaging, ltd           0402       5.4063      $294.97      $147.48       $58.99
                                                                    static.
78601................  S....................  ...................  Brain imaging, ltd w/        0402       5.4063      $294.97      $147.48       $58.99
                                                                    flow.
78605................  S....................  ...................  Brain imaging,               0402       5.4063      $294.97      $147.48       $58.99
                                                                    complete.
78606................  S....................  ...................  Brain imaging, compl         0402       5.4063      $294.97      $147.48       $58.99
                                                                    w/flow.
78607................  S....................  ...................  Brain imaging (3D)..         0402       5.4063      $294.97      $147.48       $58.99
78608................  E....................  ...................  Brain imaging (PET).  ...........  ...........  ...........  ...........  ...........
78609................  E....................  ...................  Brain imaging (PET).  ...........  ...........  ...........  ...........  ...........
78610................  S....................  ...................  Brain flow imaging           0402       5.4063      $294.97      $147.48       $58.99
                                                                    only.
78615................  S....................  ...................  Cerebral vascular            0402       5.4063      $294.97      $147.48       $58.99
                                                                    flow image.

[[Page 63572]]

 
78630................  S....................  ...................  Cerebrospinal fluid          0403       3.8402      $209.53      $104.76       $41.91
                                                                    scan.
78635................  S....................  ...................  CSF ventriculography         0403       3.8402      $209.53      $104.76       $41.91
78645................  S....................  ...................  CSF shunt evaluation         0403       3.8402      $209.53      $104.76       $41.91
78647................  S....................  ...................  Cerebrospinal fluid          0403       3.8402      $209.53      $104.76       $41.91
                                                                    scan.
78650................  S....................  ...................  CSF leakage imaging.         0403       3.8402      $209.53      $104.76       $41.91
78660................  S....................  ...................  Nuclear exam of tear         0403       3.8402      $209.53      $104.76       $41.91
                                                                    flow.
78699................  S....................  ...................  Nervous system               0402       5.4063      $294.97      $147.48       $58.99
                                                                    nuclear exam.
78700................  S....................  ...................  Kidney imaging,              0404       3.7303      $203.53      $101.76       $40.71
                                                                    static.
78701................  S....................  ...................  Kidney imaging with          0404       3.7303      $203.53      $101.76       $40.71
                                                                    flow.
78704................  S....................  ...................  Imaging renogram....         0404       3.7303      $203.53      $101.76       $40.71
78707................  S....................  ...................  Kidney flow/function         0404       3.7303      $203.53      $101.76       $40.71
                                                                    image.
78708................  S....................  ...................  Kidney flow/function         0405       4.3432      $236.97      $118.48       $47.39
                                                                    image.
78709................  S....................  ...................  Kidney flow/function         0405       4.3432      $236.97      $118.48       $47.39
                                                                    image.
78710................  S....................  ...................  Kidney imaging (3D).         0404       3.7303      $203.53      $101.76       $40.71
78715................  S....................  ...................  Renal vascular flow          0404       3.7303      $203.53      $101.76       $40.71
                                                                    exam.
78725................  S....................  ...................  Kidney function              0389       1.6328       $89.09       $44.54       $17.82
                                                                    study.
78730................  S....................  ...................  Urinary bladder              0404       3.7303      $203.53      $101.76       $40.71
                                                                    retention.
78740................  S....................  ...................  Ureteral reflux              0404       3.7303      $203.53      $101.76       $40.71
                                                                    study.
78760................  S....................  ...................  Testicular imaging..         0404       3.7303      $203.53      $101.76       $40.71
78761................  S....................  ...................  Testicular imaging/          0404       3.7303      $203.53      $101.76       $40.71
                                                                    flow.
78799................  S....................  ...................  Genitourinary                0404       3.7303      $203.53      $101.76       $40.71
                                                                    nuclear exam.
78800................  S....................  ...................  Tumor imaging,               0406       4.3955      $239.82      $119.91       $47.96
                                                                    limited area.
78801................  S....................  ...................  Tumor imaging, mult          0406       4.3955      $239.82      $119.91       $47.96
                                                                    areas.
78802................  S....................  ...................  Tumor imaging, whole         0406       4.3955      $239.82      $119.91       $47.96
                                                                    body.
78803................  S....................  ...................  Tumor imaging (3D)..         0406       4.3955      $239.82      $119.91       $47.96
78804................  S....................  NI.................  Tumor imaging, whole         1508  ...........      $650.00  ...........      $130.00
                                                                    body.
78805................  S....................  ...................  Abscess imaging, ltd         0406       4.3955      $239.82      $119.91       $47.96
                                                                    area.
78806................  S....................  ...................  Abscess imaging,             0406       4.3955      $239.82      $119.91       $47.96
                                                                    whole body.
78807................  S....................  ...................  Nuclear localization/        0406       4.3955      $239.82      $119.91       $47.96
                                                                    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           0389       1.6328       $89.09       $44.54       $17.82
                                                                    exam.
79000................  S....................  ...................  Init hyperthyroid            0407       3.5841      $195.55       $97.77       $39.11
                                                                    therapy.
79001................  S....................  ...................  Repeat hyperthyroid          0407       3.5841      $195.55       $97.77       $39.11
                                                                    therapy.
79020................  S....................  ...................  Thyroid ablation....         0407       3.5841      $195.55       $97.77       $39.11
79030................  S....................  ...................  Thyroid ablation,            0407       3.5841      $195.55       $97.77       $39.11
                                                                    carcinoma.
79035................  S....................  ...................  Thyroid metastatic           0407       3.5841      $195.55       $97.77       $39.11
                                                                    therapy.
79100................  S....................  ...................  Hematopoetic nuclear         0407       3.5841      $195.55       $97.77       $39.11
                                                                    therapy.
79200................  S....................  ...................  Intracavitary                0407       3.5841      $195.55       $97.77       $39.11
                                                                    nuclear trmt.
79300................  S....................  ...................  Interstitial nuclear         0407       3.5841      $195.55       $97.77       $39.11
                                                                    therapy.
79400................  S....................  ...................  Nonhemato nuclear            0407       3.5841      $195.55       $97.77       $39.11
                                                                    therapy.
79403................  S....................  NI.................  Hematopoetic nuclear         1507  ...........      $550.00  ...........      $110.00
                                                                    therapy.
79420................  S....................  ...................  Intravascular                0407       3.5841      $195.55       $97.77       $39.11
                                                                    nuclear ther.
79440................  S....................  ...................  Nuclear joint                0407       3.5841      $195.55       $97.77       $39.11
                                                                    therapy.
79900................  N....................  ...................  Provide ther          ...........  ...........  ...........  ...........  ...........
                                                                    radiopharm(s).
79999................  S....................  ...................  Nuclear medicine             0407       3.5841      $195.55       $97.77       $39.11
                                                                    therapy.
80048................  A....................  ...................  Basic metabolic       ...........  ...........  ...........  ...........  ...........
                                                                    panel.
80050................  E....................  ...................  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.
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  ...........  ...........  ...........  ...........  ...........

[[Page 63573]]

 
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       0.4617       $25.19       $12.55        $5.04
                                                                    consultation.
80502................  X....................  ...................  Lab pathology                0342       0.2162       $11.80        $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  ...........  ...........  ...........  ...........  ...........
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.

[[Page 63574]]

 
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.
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.

[[Page 63575]]

 
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....................  ...................  Dehydroepiandrostero  ...........  ...........  ...........  ...........  ...........
                                                                    ne.
82627................  A....................  ...................  Dehydroepiandrostero  ...........  ...........  ...........  ...........  ...........
                                                                    ne.
82633................  A....................  ...................  Desoxycorticosterone  ...........  ...........  ...........  ...........  ...........
82634................  A....................  ...................  Deoxycortisol.......  ...........  ...........  ...........  ...........  ...........
82638................  A....................  ...................  Assay of dibucaine    ...........  ...........  ...........  ...........  ...........
                                                                    number.
82646................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    dihydrocodeinone.
82649................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    dihydromorphinone.
82651................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    dihydrotestosterone.
82652................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    dihydroxyvitamin d.
82654................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    dimethadione.
82657................  A....................  ...................  Enzyme cell activity  ...........  ...........  ...........  ...........  ...........
82658................  A....................  ...................  Enzyme cell           ...........  ...........  ...........  ...........  ...........
                                                                    activity, ra.
82664................  A....................  ...................  Electrophoretic test  ...........  ...........  ...........  ...........  ...........
82666................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    epiandrosterone.
82668................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    erythropoietin.
82670................  A....................  ...................  Assay of estradiol..  ...........  ...........  ...........  ...........  ...........
82671................  A....................  ...................  Assay of estrogens..  ...........  ...........  ...........  ...........  ...........
82672................  A....................  ...................  Assay of estrogen...  ...........  ...........  ...........  ...........  ...........
82677................  A....................  ...................  Assay of estriol....  ...........  ...........  ...........  ...........  ...........
82679................  A....................  ...................  Assay of estrone....  ...........  ...........  ...........  ...........  ...........
82690................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    ethchlorvynol.
82693................  A....................  ...................  Assay of ethylene     ...........  ...........  ...........  ...........  ...........
                                                                    glycol.
82696................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    etiocholanolone.
82705................  A....................  ...................  Fats/lipids, feces,   ...........  ...........  ...........  ...........  ...........
                                                                    qual.
82710................  A....................  ...................  Fats/lipids, feces,   ...........  ...........  ...........  ...........  ...........
                                                                    quant.
82715................  A....................  ...................  Assay of fecal fat..  ...........  ...........  ...........  ...........  ...........
82725................  A....................  ...................  Assay of blood fatty  ...........  ...........  ...........  ...........  ...........
                                                                    acids.
82726................  A....................  ...................  Long chain fatty      ...........  ...........  ...........  ...........  ...........
                                                                    acids.
82728................  A....................  ...................  Assay of ferritin...  ...........  ...........  ...........  ...........  ...........
82731................  A....................  ...................  Assay of fetal        ...........  ...........  ...........  ...........  ...........
                                                                    fibronectin.
82735................  A....................  ...................  Assay of fluoride...  ...........  ...........  ...........  ...........  ...........
82742................  A....................  ...................  Assay of flurazepam.  ...........  ...........  ...........  ...........  ...........
82746................  A....................  ...................  Blood folic acid      ...........  ...........  ...........  ...........  ...........
                                                                    serum.
82747................  A....................  ...................  Assay of folic acid,  ...........  ...........  ...........  ...........  ...........
                                                                    rbc.
82757................  A....................  ...................  Assay of semen        ...........  ...........  ...........  ...........  ...........
                                                                    fructose.
82759................  A....................  ...................  Assay of rbc          ...........  ...........  ...........  ...........  ...........
                                                                    galactokinase.
82760................  A....................  ...................  Assay of galactose..  ...........  ...........  ...........  ...........  ...........
82775................  A....................  ...................  Assay galactose       ...........  ...........  ...........  ...........  ...........
                                                                    transferase.
82776................  A....................  ...................  Galactose             ...........  ...........  ...........  ...........  ...........
                                                                    transferase test.
82784................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    gammaglobulin igm.
82785................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    gammaglobulin ige.
82787................  A....................  ...................  Igg 1, 2, 3 or 4,     ...........  ...........  ...........  ...........  ...........
                                                                    each.
82800................  A....................  ...................  Blood pH............  ...........  ...........  ...........  ...........  ...........
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.

[[Page 63576]]

 
82938................  A....................  ...................  Gastrin test........  ...........  ...........  ...........  ...........  ...........
82941................  A....................  ...................  Assay of gastrin....  ...........  ...........  ...........  ...........  ...........
82943................  A....................  ...................  Assay of glucagon...  ...........  ...........  ...........  ...........  ...........
82945................  A....................  ...................  Glucose other fluid.  ...........  ...........  ...........  ...........  ...........
82946................  A....................  ...................  Glucagon tolerance    ...........  ...........  ...........  ...........  ...........
                                                                    test.
82947................  A....................  ...................  Assay, glucose,       ...........  ...........  ...........  ...........  ...........
                                                                    blood quant.
82948................  A....................  ...................  Reagent strip/blood   ...........  ...........  ...........  ...........  ...........
                                                                    glucose.
82950................  A....................  ...................  Glucose test........  ...........  ...........  ...........  ...........  ...........
82951................  A....................  ...................  Glucose tolerance     ...........  ...........  ...........  ...........  ...........
                                                                    test (GTT).
82952................  A....................  ...................  GTT-added samples...  ...........  ...........  ...........  ...........  ...........
82953................  A....................  ...................  Glucose-tolbutamide   ...........  ...........  ...........  ...........  ...........
                                                                    test.
82955................  A....................  ...................  Assay of g6pd enzyme  ...........  ...........  ...........  ...........  ...........
82960................  A....................  ...................  Test for G6PD enzyme  ...........  ...........  ...........  ...........  ...........
82962................  A....................  ...................  Glucose blood test..  ...........  ...........  ...........  ...........  ...........
82963................  A....................  ...................  Assay of glucosidase  ...........  ...........  ...........  ...........  ...........
82965................  A....................  ...................  Assay of gdh enzyme.  ...........  ...........  ...........  ...........  ...........
82975................  A....................  ...................  Assay of glutamine..  ...........  ...........  ...........  ...........  ...........
82977................  A....................  ...................  Assay of GGT........  ...........  ...........  ...........  ...........  ...........
82978................  A....................  ...................  Assay of glutathione  ...........  ...........  ...........  ...........  ...........
82979................  A....................  ...................  Assay, rbc            ...........  ...........  ...........  ...........  ...........
                                                                    glutathione.
82980................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    glutethimide.
82985................  A....................  ...................  Glycated protein....  ...........  ...........  ...........  ...........  ...........
83001................  A....................  ...................  Gonadotropin (FSH)..  ...........  ...........  ...........  ...........  ...........
83002................  A....................  ...................  Gonadotropin (LH)...  ...........  ...........  ...........  ...........  ...........
83003................  A....................  ...................  Assay, growth         ...........  ...........  ...........  ...........  ...........
                                                                    hormone (hgh).
83008................  A....................  ...................  Assay of guanosine..  ...........  ...........  ...........  ...........  ...........
83010................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    haptoglobin, quant.
83012................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    haptoglobins.
83013................  A....................  ...................  H pylori analysis...  ...........  ...........  ...........  ...........  ...........
83014................  A....................  ...................  H pylori drug admin/  ...........  ...........  ...........  ...........  ...........
                                                                    collect.
83015................  A....................  ...................  Heavy metal screen..  ...........  ...........  ...........  ...........  ...........
83018................  A....................  ...................  Quantitative screen,  ...........  ...........  ...........  ...........  ...........
                                                                    metals.
83020................  A....................  ...................  Hemoglobin            ...........  ...........  ...........  ...........  ...........
                                                                    electrophoresis.
83021................  A....................  ...................  Hemoglobin            ...........  ...........  ...........  ...........  ...........
                                                                    chromotography.
83026................  A....................  ...................  Hemoglobin, copper    ...........  ...........  ...........  ...........  ...........
                                                                    sulfate.
83030................  A....................  ...................  Fetal hemoglobin,     ...........  ...........  ...........  ...........  ...........
                                                                    chemical.
83033................  A....................  ...................  Fetal hemoglobin      ...........  ...........  ...........  ...........  ...........
                                                                    assay, qual.
83036................  A....................  ...................  Glycated hemoglobin   ...........  ...........  ...........  ...........  ...........
                                                                    test.
83045................  A....................  ...................  Blood methemoglobin   ...........  ...........  ...........  ...........  ...........
                                                                    test.
83050................  A....................  ...................  Blood methemoglobin   ...........  ...........  ...........  ...........  ...........
                                                                    assay.
83051................  A....................  ...................  Assay of plasma       ...........  ...........  ...........  ...........  ...........
                                                                    hemoglobin.
83055................  A....................  ...................  Blood sulfhemoglobin  ...........  ...........  ...........  ...........  ...........
                                                                    test.
83060................  A....................  ...................  Blood sulfhemoglobin  ...........  ...........  ...........  ...........  ...........
                                                                    assay.
83065................  A....................  ...................  Assay of hemoglobin   ...........  ...........  ...........  ...........  ...........
                                                                    heat.
83068................  A....................  ...................  Hemoglobin stability  ...........  ...........  ...........  ...........  ...........
                                                                    screen.
83069................  A....................  ...................  Assay of urine        ...........  ...........  ...........  ...........  ...........
                                                                    hemoglobin.
83070................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    hemosiderin, qual.
83071................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    hemosiderin, quant.
83080................  A....................  ...................  Assay of b            ...........  ...........  ...........  ...........  ...........
                                                                    hexosaminidase.
83088................  A....................  ...................  Assay of histamine..  ...........  ...........  ...........  ...........  ...........
83090................  A....................  ...................  Assay of homocystine  ...........  ...........  ...........  ...........  ...........
83150................  A....................  ...................  Assay of for hva....  ...........  ...........  ...........  ...........  ...........
83491................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    corticosteroids.
83497................  A....................  ...................  Assay of 5-hiaa.....  ...........  ...........  ...........  ...........  ...........
83498................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    progesterone.
83499................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    progesterone.
83500................  A....................  ...................  Assay, free           ...........  ...........  ...........  ...........  ...........
                                                                    hydroxyproline.
83505................  A....................  ...................  Assay, total          ...........  ...........  ...........  ...........  ...........
                                                                    hydroxyproline.
83516................  A....................  ...................  Immunoassay,          ...........  ...........  ...........  ...........  ...........
                                                                    nonantibody.
83518................  A....................  ...................  Immunoassay,          ...........  ...........  ...........  ...........  ...........
                                                                    dipstick.
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..  ...........  ...........  ...........  ...........  ...........

[[Page 63577]]

 
83633................  A....................  ...................  Test urine for        ...........  ...........  ...........  ...........  ...........
                                                                    lactose.
83634................  A....................  ...................  Assay of urine for    ...........  ...........  ...........  ...........  ...........
                                                                    lactose.
83655................  A....................  ...................  Assay of lead.......  ...........  ...........  ...........  ...........  ...........
83661................  A....................  ...................  L/s ratio, fetal      ...........  ...........  ...........  ...........  ...........
                                                                    lung.
83662................  A....................  ...................  Foam stability,       ...........  ...........  ...........  ...........  ...........
                                                                    fetal lung.
83663................  A....................  ...................  Fluoro polarize,      ...........  ...........  ...........  ...........  ...........
                                                                    fetal lung.
83664................  A....................  ...................  Lamellar bdy, fetal   ...........  ...........  ...........  ...........  ...........
                                                                    lung.
83670................  A....................  ...................  Assay of lap enzyme.  ...........  ...........  ...........  ...........  ...........
83690................  A....................  ...................  Assay of lipase.....  ...........  ...........  ...........  ...........  ...........
83715................  A....................  ...................  Assay of blood        ...........  ...........  ...........  ...........  ...........
                                                                    lipoproteins.
83716................  A....................  ...................  Assay of blood        ...........  ...........  ...........  ...........  ...........
                                                                    lipoproteins.
83718................  A....................  ...................  Assay of lipoprotein  ...........  ...........  ...........  ...........  ...........
83719................  A....................  ...................  Assay of blood        ...........  ...........  ...........  ...........  ...........
                                                                    lipoprotein.
83721................  A....................  ...................  Assay of blood        ...........  ...........  ...........  ...........  ...........
                                                                    lipoprotein.
83727................  A....................  ...................  Assay of lrh hormone  ...........  ...........  ...........  ...........  ...........
83735................  A....................  ...................  Assay of magnesium..  ...........  ...........  ...........  ...........  ...........
83775................  A....................  ...................  Assay of md enzyme..  ...........  ...........  ...........  ...........  ...........
83785................  A....................  ...................  Assay of manganese..  ...........  ...........  ...........  ...........  ...........
83788................  A....................  ...................  Mass spectrometry     ...........  ...........  ...........  ...........  ...........
                                                                    qual.
83789................  A....................  ...................  Mass spectrometry     ...........  ...........  ...........  ...........  ...........
                                                                    quant.
83805................  A....................  ...................  Assay of meprobamate  ...........  ...........  ...........  ...........  ...........
83825................  A....................  ...................  Assay of mercury....  ...........  ...........  ...........  ...........  ...........
83835................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    metanephrines.
83840................  A....................  ...................  Assay of methadone..  ...........  ...........  ...........  ...........  ...........
83857................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    methemalbumin.
83858................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    methsuximide.
83864................  A....................  ...................  Mucopolysaccharides.  ...........  ...........  ...........  ...........  ...........
83866................  A....................  ...................  Mucopolysaccharides   ...........  ...........  ...........  ...........  ...........
                                                                    screen.
83872................  A....................  ...................  Assay synovial fluid  ...........  ...........  ...........  ...........  ...........
                                                                    mucin.
83873................  A....................  ...................  Assay of csf protein  ...........  ...........  ...........  ...........  ...........
83874................  A....................  ...................  Assay of myoglobin..  ...........  ...........  ...........  ...........  ...........
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.

[[Page 63578]]

 
84087................  A....................  ...................  Assay phosphohexose   ...........  ...........  ...........  ...........  ...........
                                                                    enzymes.
84100................  A....................  ...................  Assay of phosphorus.  ...........  ...........  ...........  ...........  ...........
84105................  A....................  ...................  Assay of urine        ...........  ...........  ...........  ...........  ...........
                                                                    phosphorus.
84106................  A....................  ...................  Test for              ...........  ...........  ...........  ...........  ...........
                                                                    porphobilinogen.
84110................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    porphobilinogen.
84119................  A....................  ...................  Test urine for        ...........  ...........  ...........  ...........  ...........
                                                                    porphyrins.
84120................  A....................  ...................  Assay of urine        ...........  ...........  ...........  ...........  ...........
                                                                    porphyrins.
84126................  A....................  ...................  Assay of feces        ...........  ...........  ...........  ...........  ...........
                                                                    porphyrins.
84127................  A....................  ...................  Assay of feces        ...........  ...........  ...........  ...........  ...........
                                                                    porphyrins.
84132................  A....................  ...................  Assay of serum        ...........  ...........  ...........  ...........  ...........
                                                                    potassium.
84133................  A....................  ...................  Assay of urine        ...........  ...........  ...........  ...........  ...........
                                                                    potassium.
84134................  A....................  ...................  Assay of prealbumin.  ...........  ...........  ...........  ...........  ...........
84135................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    pregnanediol.
84138................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    pregnanetriol.
84140................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    pregnenolone.
84143................  A....................  ...................  Assay of 17-          ...........  ...........  ...........  ...........  ...........
                                                                    hydroxypregneno.
84144................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    progesterone.
84146................  A....................  ...................  Assay of prolactin..  ...........  ...........  ...........  ...........  ...........
84150................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    prostaglandin.
84152................  A....................  ...................  Assay of psa,         ...........  ...........  ...........  ...........  ...........
                                                                    complexed.
84153................  A....................  ...................  Assay of psa, total.  ...........  ...........  ...........  ...........  ...........
84154................  A....................  ...................  Assay of psa, free..  ...........  ...........  ...........  ...........  ...........
84155................  A....................  ...................  Assay of protein,     ...........  ...........  ...........  ...........  ...........
                                                                    serum.
84156................  A....................  NI.................  Assay of protein,     ...........  ...........  ...........  ...........  ...........
                                                                    urine.
84157................  A....................  NI.................  Assay of protein,     ...........  ...........  ...........  ...........  ...........
                                                                    other.
84160................  A....................  ...................  Assay of protein,     ...........  ...........  ...........  ...........  ...........
                                                                    any source.
84165................  A....................  ...................  Electrophoreisis of   ...........  ...........  ...........  ...........  ...........
                                                                    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).

[[Page 63579]]

 
84466................  A....................  ...................  Assay of transferrin  ...........  ...........  ...........  ...........  ...........
84478................  A....................  ...................  Assay of              ...........  ...........  ...........  ...........  ...........
                                                                    triglycerides.
84479................  A....................  ...................  Assay of thyroid (t3  ...........  ...........  ...........  ...........  ...........
                                                                    or t4).
84480................  A....................  ...................  Assay,                ...........  ...........  ...........  ...........  ...........
                                                                    triiodothyronine
                                                                    (t3).
84481................  A....................  ...................  Free assay (FT-3)...  ...........  ...........  ...........  ...........  ...........
84482................  A....................  ...................  T3 reverse..........  ...........  ...........  ...........  ...........  ...........
84484................  A....................  ...................  Assay of troponin,    ...........  ...........  ...........  ...........  ...........
                                                                    quant.
84485................  A....................  ...................  Assay duodenal fluid  ...........  ...........  ...........  ...........  ...........
                                                                    trypsin.
84488................  A....................  ...................  Test feces for        ...........  ...........  ...........  ...........  ...........
                                                                    trypsin.
84490................  A....................  ...................  Assay of feces for    ...........  ...........  ...........  ...........  ...........
                                                                    trypsin.
84510................  A....................  ...................  Assay of tyrosine...  ...........  ...........  ...........  ...........  ...........
84512................  A....................  ...................  Assay of troponin,    ...........  ...........  ...........  ...........  ...........
                                                                    qual.
84520................  A....................  ...................  Assay of urea         ...........  ...........  ...........  ...........  ...........
                                                                    nitrogen.
84525................  A....................  ...................  Urea nitrogen semi-   ...........  ...........  ...........  ...........  ...........
                                                                    quant.
84540................  A....................  ...................  Assay of urine/urea-  ...........  ...........  ...........  ...........  ...........
                                                                    n.
84545................  A....................  ...................  Urea-N clearance      ...........  ...........  ...........  ...........  ...........
                                                                    test.
84550................  A....................  ...................  Assay of blood/uric   ...........  ...........  ...........  ...........  ...........
                                                                    acid.
84560................  A....................  ...................  Assay of urine/uric   ...........  ...........  ...........  ...........  ...........
                                                                    acid.
84577................  A....................  ...................  Assay of feces/       ...........  ...........  ...........  ...........  ...........
                                                                    urobilinogen.
84578................  A....................  ...................  Test urine            ...........  ...........  ...........  ...........  ...........
                                                                    urobilinogen.
84580................  A....................  ...................  Assay of urine        ...........  ...........  ...........  ...........  ...........
                                                                    urobilinogen.
84583................  A....................  ...................  Assay of urine        ...........  ...........  ...........  ...........  ...........
                                                                    urobilinogen.
84585................  A....................  ...................  Assay of urine vma..  ...........  ...........  ...........  ...........  ...........
84586................  A....................  ...................  Assay of vip........  ...........  ...........  ...........  ...........  ...........
84588................  A....................  ...................  Assay of vasopressin  ...........  ...........  ...........  ...........  ...........
84590................  A....................  ...................  Assay of vitamin a..  ...........  ...........  ...........  ...........  ...........
84591................  A....................  ...................  Assay of nos vitamin  ...........  ...........  ...........  ...........  ...........
84597................  A....................  ...................  Assay of vitamin k..  ...........  ...........  ...........  ...........  ...........
84600................  A....................  ...................  Assay of volatiles..  ...........  ...........  ...........  ...........  ...........
84620................  A....................  ...................  Xylose tolerance      ...........  ...........  ...........  ...........  ...........
                                                                    test.
84630................  A....................  ...................  Assay of zinc.......  ...........  ...........  ...........  ...........  ...........
84681................  A....................  ...................  Assay of c-peptide..  ...........  ...........  ...........  ...........  ...........
84702................  A....................  ...................  Chorionic             ...........  ...........  ...........  ...........  ...........
                                                                    gonadotropin test.
84703................  A....................  ...................  Chorionic             ...........  ...........  ...........  ...........  ...........
                                                                    gonadotropin assay.
84830................  A....................  ...................  Ovulation tests.....  ...........  ...........  ...........  ...........  ...........
84999................  A....................  ...................  Clinical chemistry    ...........  ...........  ...........  ...........  ...........
                                                                    test.
85002................  A....................  ...................  Bleeding time test..  ...........  ...........  ...........  ...........  ...........
85004................  A....................  ...................  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.
85055................  A....................  NI.................  Reticulated platelet  ...........  ...........  ...........  ...........  ...........
                                                                    assay.
85060................  X....................  ...................  Blood smear                  0342       0.2162       $11.80        $5.88        $2.36
                                                                    interpretation.
85097................  X....................  ...................  Bone marrow                  0343       0.4617       $25.19       $12.55        $5.04
                                                                    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.

[[Page 63580]]

 
85300................  A....................  ...................  Antithrombin III      ...........  ...........  ...........  ...........  ...........
                                                                    test.
85301................  A....................  ...................  Antithrombin III      ...........  ...........  ...........  ...........  ...........
                                                                    test.
85302................  A....................  ...................  Blood clot inhibitor  ...........  ...........  ...........  ...........  ...........
                                                                    antigen.
85303................  A....................  ...................  Blood clot inhibitor  ...........  ...........  ...........  ...........  ...........
                                                                    test.
85305................  A....................  ...................  Blood clot inhibitor  ...........  ...........  ...........  ...........  ...........
                                                                    assay.
85306................  A....................  ...................  Blood clot inhibitor  ...........  ...........  ...........  ...........  ...........
                                                                    test.
85307................  A....................  ...................  Assay activated       ...........  ...........  ...........  ...........  ...........
                                                                    protein c.
85335................  A....................  ...................  Factor inhibitor      ...........  ...........  ...........  ...........  ...........
                                                                    test.
85337................  A....................  ...................  Thrombomodulin......  ...........  ...........  ...........  ...........  ...........
85345................  A....................  ...................  Coagulation time....  ...........  ...........  ...........  ...........  ...........
85347................  A....................  ...................  Coagulation time....  ...........  ...........  ...........  ...........  ...........
85348................  A....................  ...................  Coagulation time....  ...........  ...........  ...........  ...........  ...........
85360................  A....................  ...................  Euglobulin lysis....  ...........  ...........  ...........  ...........  ...........
85362................  A....................  ...................  Fibrin degradation    ...........  ...........  ...........  ...........  ...........
                                                                    products.
85366................  A....................  ...................  Fibrinogen test.....  ...........  ...........  ...........  ...........  ...........
85370................  A....................  ...................  Fibrinogen test.....  ...........  ...........  ...........  ...........  ...........
85378................  A....................  ...................  Fibrin degradation..  ...........  ...........  ...........  ...........  ...........
85379................  A....................  ...................  Fibrin degradation,   ...........  ...........  ...........  ...........  ...........
                                                                    quant.
85380................  A....................  ...................  Fibrin degradation,   ...........  ...........  ...........  ...........  ...........
                                                                    vte.
85384................  A....................  ...................  Fibrinogen..........  ...........  ...........  ...........  ...........  ...........
85385................  A....................  ...................  Fibrinogen..........  ...........  ...........  ...........  ...........  ...........
85390................  A....................  ...................  Fibrinolysins screen  ...........  ...........  ...........  ...........  ...........
85396................  N....................  NI.................  Clotting assay,       ...........  ...........  ...........  ...........  ...........
                                                                    whole blood.
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).
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.

[[Page 63581]]

 
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....................  ...................  Counterimmunoelectro  ...........  ...........  ...........  ...........  ...........
                                                                    phoresis.
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,infectio  ...........  ...........  ...........  ...........  ...........
                                                                    us agent.
86318................  A....................  ...................  Immunoassay,infectio  ...........  ...........  ...........  ...........  ...........
                                                                    us agent.
86320................  A....................  ...................  Serum                 ...........  ...........  ...........  ...........  ...........
                                                                    immunoelectrophores
                                                                    is.
86325................  A....................  ...................  Other                 ...........  ...........  ...........  ...........  ...........
                                                                    immunoelectrophores
                                                                    is.
86327................  A....................  ...................  Immunoelectrophoresi  ...........  ...........  ...........  ...........  ...........
                                                                    s 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       0.1365        $7.45        $3.03        $1.49
86490................  X....................  ...................  Coccidioidomycosis           0341       0.1365        $7.45        $3.03        $1.49
                                                                    skin test.
86510................  X....................  ...................  Histoplasmosis skin          0341       0.1365        $7.45        $3.03        $1.49
                                                                    test.
86580................  X....................  ...................  TB intradermal test.         0341       0.1365        $7.45        $3.03        $1.49
86585................  X....................  ...................  TB tine test........         0341       0.1365        $7.45        $3.03        $1.49
86586................  X....................  ...................  Skin test, unlisted.         0341       0.1365        $7.45        $3.03        $1.49
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...  ...........  ...........  ...........  ...........  ...........

[[Page 63582]]

 
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.
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.

[[Page 63583]]

 
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       0.2550       $13.91        $3.10        $2.78
86860................  X....................  ...................  RBC antibody elution         0346       0.3866       $21.09        $5.32        $4.22
86870................  X....................  ...................  RBC antibody                 0346       0.3866       $21.09        $5.32        $4.22
                                                                    identification.
86880................  X....................  ...................  Coombs test, direct.         0409       0.1390        $7.58        $2.32        $1.52
86885................  X....................  ...................  Coombs test,                 0409       0.1390        $7.58        $2.32        $1.52
                                                                    indirect, qual.
86886................  X....................  ...................  Coombs test,                 0409       0.1390        $7.58        $2.32        $1.52
                                                                    indirect, titer.
86890................  X....................  ...................  Autologous blood             0347       0.9610       $52.43       $13.20       $10.49
                                                                    process.
86891................  X....................  ...................  Autologous blood, op         0345       0.2550       $13.91        $3.10        $2.78
                                                                    salvage.
86900................  X....................  ...................  Blood typing, ABO...         0409       0.1390        $7.58        $2.32        $1.52
86901................  X....................  ...................  Blood typing, Rh (D)         0409       0.1390        $7.58        $2.32        $1.52
86903................  X....................  ...................  Blood typing,                0345       0.2550       $13.91        $3.10        $2.78
                                                                    antigen screen.
86904................  X....................  ...................  Blood typing,                0345       0.2550       $13.91        $3.10        $2.78
                                                                    patient serum.
86905................  X....................  ...................  Blood typing, RBC            0345       0.2550       $13.91        $3.10        $2.78
                                                                    antigens.
86906................  X....................  ...................  Blood typing, Rh             0345       0.2550       $13.91        $3.10        $2.78
                                                                    phenotype.
86910................  E....................  ...................  Blood typing,         ...........  ...........  ...........  ...........  ...........
                                                                    paternity test.
86911................  E....................  ...................  Blood typing,         ...........  ...........  ...........  ...........  ...........
                                                                    antigen system.
86920................  X....................  ...................  Compatibility test..         0346       0.3866       $21.09        $5.32        $4.22
86921................  X....................  ...................  Compatibility test..         0345       0.2550       $13.91        $3.10        $2.78
86922................  X....................  ...................  Compatibility test..         0346       0.3866       $21.09        $5.32        $4.22
86927................  X....................  ...................  Plasma, fresh frozen         0346       0.3866       $21.09        $5.32        $4.22
86930................  X....................  ...................  Frozen blood prep...         0347       0.9610       $52.43       $13.20       $10.49
86931................  X....................  ...................  Frozen blood thaw...         0347       0.9610       $52.43       $13.20       $10.49
86932................  X....................  ...................  Frozen blood freeze/         0347       0.9610       $52.43       $13.20       $10.49
                                                                    thaw.
86940................  A....................  ...................  Hemolysins/           ...........  ...........  ...........  ...........  ...........
                                                                    agglutinins, auto.
86941................  A....................  ...................  Hemolysins/           ...........  ...........  ...........  ...........  ...........
                                                                    agglutinins.
86945................  X....................  ...................  Blood product/               0346       0.3866       $21.09        $5.32        $4.22
                                                                    irradiation.
86950................  X....................  ...................  Leukacyte                    0347       0.9610       $52.43       $13.20       $10.49
                                                                    transfusion.
86965................  X....................  ...................  Pooling blood                0346       0.3866       $21.09        $5.32        $4.22
                                                                    platelets.
86970................  X....................  ...................  RBC pretreatment....         0345       0.2550       $13.91        $3.10        $2.78
86971................  X....................  ...................  RBC pretreatment....         0345       0.2550       $13.91        $3.10        $2.78
86972................  X....................  ...................  RBC pretreatment....         0345       0.2550       $13.91        $3.10        $2.78
86975................  X....................  ...................  RBC pretreatment,            0345       0.2550       $13.91        $3.10        $2.78
                                                                    serum.
86976................  X....................  ...................  RBC pretreatment,            0345       0.2550       $13.91        $3.10        $2.78
                                                                    serum.
86977................  X....................  ...................  RBC pretreatment,            0345       0.2550       $13.91        $3.10        $2.78
                                                                    serum.
86978................  X....................  ...................  RBC pretreatment,            0345       0.2550       $13.91        $3.10        $2.78
                                                                    serum.
86985................  X....................  ...................  Split blood or               0347       0.9610       $52.43       $13.20       $10.49
                                                                    products.
86999................  X....................  ...................  Transfusion                  0345       0.2550       $13.91        $3.10        $2.78
                                                                    procedure.
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....................  ...................  Cultr bacteria,       ...........  ...........  ...........  ...........  ...........
                                                                    except blood.
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.

[[Page 63584]]

 
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....  ...........  ...........  ...........  ...........  ...........
87267................  A....................  ...................  Enterovirus           ...........  ...........  ...........  ...........  ...........
                                                                    antibody, dfa.
87269................  A....................  NI.................  Giardia ag, if......  ...........  ...........  ...........  ...........  ...........
87270................  A....................  ...................  Chlamydia             ...........  ...........  ...........  ...........  ...........
                                                                    trachomatis ag, if.
87271................  A....................  ...................  Cryptosporidum/       ...........  ...........  ...........  ...........  ...........
                                                                    gardia ag, if.
87272................  A....................  ...................  Cryptosporidium 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....................  ...................  Cryptosporidium ag,   ...........  ...........  ...........  ...........  ...........
                                                                    eia.
87329................  A....................  NI.................  Giardia 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.....  ...........  ...........  ...........  ...........  ...........

[[Page 63585]]

 
87449................  A....................  ...................  Ag detect nos, eia,   ...........  ...........  ...........  ...........  ...........
                                                                    mult.
87450................  A....................  ...................  Ag detect nos, eia,   ...........  ...........  ...........  ...........  ...........
                                                                    single.
87451................  A....................  ...................  Ag detect polyval,    ...........  ...........  ...........  ...........  ...........
                                                                    eia, mult.
87470................  A....................  ...................  Bartonella, dna, dir  ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87471................  A....................  ...................  Bartonella, dna, amp  ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87472................  A....................  ...................  Bartonella, dna,      ...........  ...........  ...........  ...........  ...........
                                                                    quant.
87475................  A....................  ...................  Lyme dis, dna, dir    ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87476................  A....................  ...................  Lyme dis, dna, amp    ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87477................  A....................  ...................  Lyme dis, dna, quant  ...........  ...........  ...........  ...........  ...........
87480................  A....................  ...................  Candida, dna, dir     ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87481................  A....................  ...................  Candida, dna, amp     ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87482................  A....................  ...................  Candida, dna, quant.  ...........  ...........  ...........  ...........  ...........
87485................  A....................  ...................  Chylmd pneum, dna,    ...........  ...........  ...........  ...........  ...........
                                                                    dir probe.
87486................  A....................  ...................  Chylmd pneum, dna,    ...........  ...........  ...........  ...........  ...........
                                                                    amp probe.
87487................  A....................  ...................  Chylmd pneum, dna,    ...........  ...........  ...........  ...........  ...........
                                                                    quant.
87490................  A....................  ...................  Chylmd trach, dna,    ...........  ...........  ...........  ...........  ...........
                                                                    dir probe.
87491................  A....................  ...................  Chylmd trach, dna,    ...........  ...........  ...........  ...........  ...........
                                                                    amp probe.
87492................  A....................  ...................  Chylmd trach, dna,    ...........  ...........  ...........  ...........  ...........
                                                                    quant.
87495................  A....................  ...................  Cytomeg, dna, dir     ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87496................  A....................  ...................  Cytomeg, dna, amp     ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87497................  A....................  ...................  Cytomeg, dna, quant.  ...........  ...........  ...........  ...........  ...........
87510................  A....................  ...................  Gardner vag, dna,     ...........  ...........  ...........  ...........  ...........
                                                                    dir probe.
87511................  A....................  ...................  Gardner vag, dna,     ...........  ...........  ...........  ...........  ...........
                                                                    amp probe.
87512................  A....................  ...................  Gardner vag, dna,     ...........  ...........  ...........  ...........  ...........
                                                                    quant.
87515................  A....................  ...................  Hepatitis b, dna,     ...........  ...........  ...........  ...........  ...........
                                                                    dir probe.
87516................  A....................  ...................  Hepatitis b, dna,     ...........  ...........  ...........  ...........  ...........
                                                                    amp probe.
87517................  A....................  ...................  Hepatitis b, dna,     ...........  ...........  ...........  ...........  ...........
                                                                    quant.
87520................  A....................  ...................  Hepatitis c, rna,     ...........  ...........  ...........  ...........  ...........
                                                                    dir probe.
87521................  A....................  ...................  Hepatitis c, rna,     ...........  ...........  ...........  ...........  ...........
                                                                    amp probe.
87522................  A....................  ...................  Hepatitis c, rna,     ...........  ...........  ...........  ...........  ...........
                                                                    quant.
87525................  A....................  ...................  Hepatitis g, dna,     ...........  ...........  ...........  ...........  ...........
                                                                    dir probe.
87526................  A....................  ...................  Hepatitis g, dna,     ...........  ...........  ...........  ...........  ...........
                                                                    amp probe.
87527................  A....................  ...................  Hepatitis g, dna,     ...........  ...........  ...........  ...........  ...........
                                                                    quant.
87528................  A....................  ...................  Hsv, dna, dir probe.  ...........  ...........  ...........  ...........  ...........
87529................  A....................  ...................  Hsv, dna, amp probe.  ...........  ...........  ...........  ...........  ...........
87530................  A....................  ...................  Hsv, dna, quant.....  ...........  ...........  ...........  ...........  ...........
87531................  A....................  ...................  Hhv-6, dna, dir       ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87532................  A....................  ...................  Hhv-6, dna, amp       ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87533................  A....................  ...................  Hhv-6, dna, quant...  ...........  ...........  ...........  ...........  ...........
87534................  A....................  ...................  Hiv-1, dna, dir       ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87535................  A....................  ...................  Hiv-1, dna, amp       ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87536................  A....................  ...................  Hiv-1, dna, quant...  ...........  ...........  ...........  ...........  ...........
87537................  A....................  ...................  Hiv-2, dna, dir       ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87538................  A....................  ...................  Hiv-2, dna, amp       ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87539................  A....................  ...................  Hiv-2, dna, quant...  ...........  ...........  ...........  ...........  ...........
87540................  A....................  ...................  Legion pneumo, dna,   ...........  ...........  ...........  ...........  ...........
                                                                    dir prob.
87541................  A....................  ...................  Legion pneumo, dna,   ...........  ...........  ...........  ...........  ...........
                                                                    amp prob.
87542................  A....................  ...................  Legion pneumo, dna,   ...........  ...........  ...........  ...........  ...........
                                                                    quant.
87550................  A....................  ...................  Mycobacteria, dna,    ...........  ...........  ...........  ...........  ...........
                                                                    dir probe.
87551................  A....................  ...................  Mycobacteria, dna,    ...........  ...........  ...........  ...........  ...........
                                                                    amp probe.
87552................  A....................  ...................  Mycobacteria, dna,    ...........  ...........  ...........  ...........  ...........
                                                                    quant.
87555................  A....................  ...................  M.tuberculo, dna,     ...........  ...........  ...........  ...........  ...........
                                                                    dir probe.
87556................  A....................  ...................  M.tuberculo, dna,     ...........  ...........  ...........  ...........  ...........
                                                                    amp probe.
87557................  A....................  ...................  M.tuberculo, dna,     ...........  ...........  ...........  ...........  ...........
                                                                    quant.
87560................  A....................  ...................  M.avium-intra, dna,   ...........  ...........  ...........  ...........  ...........
                                                                    dir prob.
87561................  A....................  ...................  M.avium-intra, dna,   ...........  ...........  ...........  ...........  ...........
                                                                    amp prob.
87562................  A....................  ...................  M.avium-intra, dna,   ...........  ...........  ...........  ...........  ...........
                                                                    quant.
87580................  A....................  ...................  M.pneumon, dna, dir   ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87581................  A....................  ...................  M.pneumon, dna, amp   ...........  ...........  ...........  ...........  ...........
                                                                    probe.
87582................  A....................  ...................  M.pneumon, dna,       ...........  ...........  ...........  ...........  ...........
                                                                    quant.
87590................  A....................  ...................  N.gonorrhoeae, dna,   ...........  ...........  ...........  ...........  ...........
                                                                    dir prob.
87591................  A....................  ...................  N.gonorrhoeae, dna,   ...........  ...........  ...........  ...........  ...........
                                                                    amp prob.
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.  ...........  ...........  ...........  ...........  ...........
87660................  A....................  NI.................  Trichomonas vagin,    ...........  ...........  ...........  ...........  ...........
                                                                    dir probe.
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.

[[Page 63586]]

 
87802................  A....................  ...................  Strep b assay w/      ...........  ...........  ...........  ...........  ...........
                                                                    optic.
87803................  A....................  ...................  Clostridium toxin a   ...........  ...........  ...........  ...........  ...........
                                                                    w/optic.
87804................  A....................  ...................  Influenza assay w/    ...........  ...........  ...........  ...........  ...........
                                                                    optic.
87810................  A....................  ...................  Chylmd trach assay w/ ...........  ...........  ...........  ...........  ...........
                                                                    optic.
87850................  A....................  ...................  N. gonorrhoeae assay  ...........  ...........  ...........  ...........  ...........
                                                                    w/optic.
87880................  A....................  ...................  Strep a assay w/      ...........  ...........  ...........  ...........  ...........
                                                                    optic.
87899................  A....................  ...................  Agent nos assay w/    ...........  ...........  ...........  ...........  ...........
                                                                    optic.
87901................  A....................  ...................  Genotype, dna, hiv    ...........  ...........  ...........  ...........  ...........
                                                                    reverse t.
87902................  A....................  ...................  Genotype, dna,        ...........  ...........  ...........  ...........  ...........
                                                                    hepatitis C.
87903................  A....................  ...................  Phenotype, dna hiv w/ ...........  ...........  ...........  ...........  ...........
                                                                    culture.
87904................  A....................  ...................  Phenotype, dna hiv w/ ...........  ...........  ...........  ...........  ...........
                                                                    clt add.
87999................  A....................  ...................  Microbiology          ...........  ...........  ...........  ...........  ...........
                                                                    procedure.
88000................  E....................  ...................  Autopsy (necropsy),   ...........  ...........  ...........  ...........  ...........
                                                                    gross.
88005................  E....................  ...................  Autopsy (necropsy),   ...........  ...........  ...........  ...........  ...........
                                                                    gross.
88007................  E....................  ...................  Autopsy (necropsy),   ...........  ...........  ...........  ...........  ...........
                                                                    gross.
88012................  E....................  ...................  Autopsy (necropsy),   ...........  ...........  ...........  ...........  ...........
                                                                    gross.
88014................  E....................  ...................  Autopsy (necropsy),   ...........  ...........  ...........  ...........  ...........
                                                                    gross.
88016................  E....................  ...................  Autopsy (necropsy),   ...........  ...........  ...........  ...........  ...........
                                                                    gross.
88020................  E....................  ...................  Autopsy (necropsy),   ...........  ...........  ...........  ...........  ...........
                                                                    complete.
88025................  E....................  ...................  Autopsy (necropsy),   ...........  ...........  ...........  ...........  ...........
                                                                    complete.
88027................  E....................  ...................  Autopsy (necropsy),   ...........  ...........  ...........  ...........  ...........
                                                                    complete.
88028................  E....................  ...................  Autopsy (necropsy),   ...........  ...........  ...........  ...........  ...........
                                                                    complete.
88029................  E....................  ...................  Autopsy (necropsy),   ...........  ...........  ...........  ...........  ...........
                                                                    complete.
88036................  E....................  ...................  Limited autopsy.....  ...........  ...........  ...........  ...........  ...........
88037................  E....................  ...................  Limited autopsy.....  ...........  ...........  ...........  ...........  ...........
88040................  E....................  ...................  Forensic autopsy      ...........  ...........  ...........  ...........  ...........
                                                                    (necropsy).
88045................  E....................  ...................  Coroner's autopsy     ...........  ...........  ...........  ...........  ...........
                                                                    (necropsy).
88099................  E....................  ...................  Necropsy (autopsy)    ...........  ...........  ...........  ...........  ...........
                                                                    procedure.
88104................  X....................  ...................  Cytopathology,               0343       0.4617       $25.19       $12.55        $5.04
                                                                    fluids.
88106................  X....................  ...................  Cytopathology,               0343       0.4617       $25.19       $12.55        $5.04
                                                                    fluids.
88107................  X....................  ...................  Cytopathology,               0343       0.4617       $25.19       $12.55        $5.04
                                                                    fluids.
88108................  X....................  ...................  Cytopath,                    0343       0.4617       $25.19       $12.55        $5.04
                                                                    concentrate tech.
88112................  X....................  NI.................  Cytopath, cell               0343       0.4617       $25.19       $12.55        $5.04
                                                                    enhance tech.
88125................  X....................  ...................  Forensic                     0342       0.2162       $11.80        $5.88        $2.36
                                                                    cytopathology.
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,              0342       0.2162       $11.80        $5.88        $2.36
                                                                    other source.
88161................  X....................  ...................  Cytopath smear,              0343       0.4617       $25.19       $12.55        $5.04
                                                                    other source.
88162................  X....................  ...................  Cytopath smear,              0343       0.4617       $25.19       $12.55        $5.04
                                                                    other 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           0343       0.4617       $25.19       $12.55        $5.04
                                                                    of fna.
88173................  X....................  ...................  Cytopath eval, fna,          0343       0.4617       $25.19       $12.55        $5.04
                                                                    report.
88174................  A....................  ...................  Cytopath, c/v auto,   ...........  ...........  ...........  ...........  ...........
                                                                    in fluid.
88175................  A....................  ...................  Cytopath c/v auto     ...........  ...........  ...........  ...........  ...........
                                                                    fluid redo.
88180................  X....................  ...................  Cell marker study...         0343       0.4617       $25.19       $12.55        $5.04
88182................  X....................  ...................  Cell marker study...         0344       0.6291       $34.32       $17.16        $6.86
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.

[[Page 63587]]

 
88269................  A....................  ...................  Chromosome analys,    ...........  ...........  ...........  ...........  ...........
                                                                    amniotic.
88271................  A....................  ...................  Cytogenetics, dna     ...........  ...........  ...........  ...........  ...........
                                                                    probe.
88272................  A....................  ...................  Cytogenetics, 3-5...  ...........  ...........  ...........  ...........  ...........
88273................  A....................  ...................  Cytogenetics, 10-30.  ...........  ...........  ...........  ...........  ...........
88274................  A....................  ...................  Cytogenetics, 25-99.  ...........  ...........  ...........  ...........  ...........
88275................  A....................  ...................  Cytogenetics, 100-    ...........  ...........  ...........  ...........  ...........
                                                                    300.
88280................  A....................  ...................  Chromosome karyotype  ...........  ...........  ...........  ...........  ...........
                                                                    study.
88283................  A....................  ...................  Chromosome banding    ...........  ...........  ...........  ...........  ...........
                                                                    study.
88285................  A....................  ...................  Chromosome count,     ...........  ...........  ...........  ...........  ...........
                                                                    additional.
88289................  A....................  ...................  Chromosome study,     ...........  ...........  ...........  ...........  ...........
                                                                    additional.
88291................  A....................  ...................  Cyto/molecular        ...........  ...........  ...........  ...........  ...........
                                                                    report.
88299................  X....................  ...................  Cytogenetic study...         0342       0.2162       $11.80        $5.88        $2.36
88300................  X....................  ...................  Surgical path, gross         0342       0.2162       $11.80        $5.88        $2.36
88302................  X....................  ...................  Tissue exam by               0342       0.2162       $11.80        $5.88        $2.36
                                                                    pathologist.
88304................  X....................  ...................  Tissue exam by               0343       0.4617       $25.19       $12.55        $5.04
                                                                    pathologist.
88305................  X....................  ...................  Tissue exam by               0343       0.4617       $25.19       $12.55        $5.04
                                                                    pathologist.
88307................  X....................  ...................  Tissue exam by               0344       0.6291       $34.32       $17.16        $6.86
                                                                    pathologist.
88309................  X....................  ...................  Tissue exam by               0344       0.6291       $34.32       $17.16        $6.86
                                                                    pathologist.
88311................  X....................  ...................  Decalcify tissue....         0342       0.2162       $11.80        $5.88        $2.36
88312................  X....................  ...................  Special stains......         0342       0.2162       $11.80        $5.88        $2.36
88313................  X....................  ...................  Special stains......         0342       0.2162       $11.80        $5.88        $2.36
88314................  X....................  ...................  Histochemical stain.         0342       0.2162       $11.80        $5.88        $2.36
88318................  X....................  ...................  Chemical                     0342       0.2162       $11.80        $5.88        $2.36
                                                                    histochemistry.
88319................  X....................  ...................  Enzyme                       0342       0.2162       $11.80        $5.88        $2.36
                                                                    histochemistry.
88321................  X....................  ...................  Microslide                   0342       0.2162       $11.80        $5.88        $2.36
                                                                    consultation.
88323................  X....................  ...................  Microslide                   0343       0.4617       $25.19       $12.55        $5.04
                                                                    consultation.
88325................  X....................  ...................  Comprehensive review         0344       0.6291       $34.32       $17.16        $6.86
                                                                    of data.
88329................  X....................  ...................  Path consult introp.         0342       0.2162       $11.80        $5.88        $2.36
88331................  X....................  ...................  Path consult                 0343       0.4617       $25.19       $12.55        $5.04
                                                                    intraop, 1 bloc.
88332................  X....................  ...................  Path consult                 0342       0.2162       $11.80        $5.88        $2.36
                                                                    intraop, add'l.
88342................  X....................  ...................  Immunohistochemistry         0344       0.6291       $34.32       $17.16        $6.86
88346................  X....................  ...................  Immunofluorescent            0343       0.4617       $25.19       $12.55        $5.04
                                                                    study.
88347................  X....................  ...................  Immunofluorescent            0344       0.6291       $34.32       $17.16        $6.86
                                                                    study.
88348................  X....................  ...................  Electron microscopy.         0661       3.2576      $177.74       $88.87       $35.55
88349................  X....................  ...................  Scanning electron            0661       3.2576      $177.74       $88.87       $35.55
                                                                    microscopy.
88355................  X....................  ...................  Analysis, skeletal           0344       0.6291       $34.32       $17.16        $6.86
                                                                    muscle.
88356................  X....................  ...................  Analysis, nerve.....         0344       0.6291       $34.32       $17.16        $6.86
88358................  X....................  ...................  Analysis, tumor.....         0344       0.6291       $34.32       $17.16        $6.86
88361................  X....................  NI.................  Immunohistochemistry         0344       0.6291       $34.32       $17.16        $6.86
                                                                    , tumor.
88362................  X....................  ...................  Nerve teasing                0344       0.6291       $34.32       $17.16        $6.86
                                                                    preparations.
88365................  X....................  ...................  Tissue hybridization         0344       0.6291       $34.32       $17.16        $6.86
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             ...........  ...........  ...........  ...........  ...........
                                                                    assessment, fecal.
89060................  A....................  ...................  Exam,synovial fluid   ...........  ...........  ...........  ...........  ...........
                                                                    crystals.
89100................  X....................  ...................  Sample intestinal            0360       1.7313       $94.46       $42.45       $18.89
                                                                    contents.
89105................  X....................  ...................  Sample intestinal            0360       1.7313       $94.46       $42.45       $18.89
                                                                    contents.
89125................  A....................  ...................  Specimen fat stain..  ...........  ...........  ...........  ...........  ...........
89130................  X....................  ...................  Sample stomach               0360       1.7313       $94.46       $42.45       $18.89
                                                                    contents.
89132................  X....................  ...................  Sample stomach               0360       1.7313       $94.46       $42.45       $18.89
                                                                    contents.
89135................  X....................  ...................  Sample stomach               0360       1.7313       $94.46       $42.45       $18.89
                                                                    contents.
89136................  X....................  ...................  Sample stomach               0360       1.7313       $94.46       $42.45       $18.89
                                                                    contents.
89140................  X....................  ...................  Sample stomach               0360       1.7313       $94.46       $42.45       $18.89
                                                                    contents.
89141................  X....................  ...................  Sample stomach               0360       1.7313       $94.46       $42.45       $18.89
                                                                    contents.
89160................  A....................  ...................  Exam feces for meat   ...........  ...........  ...........  ...........  ...........
                                                                    fibers.
89190................  A....................  ...................  Nasal smear for       ...........  ...........  ...........  ...........  ...........
                                                                    eosinophils.
89220................  X....................  NI.................  Sputum specimen              0343       0.4617       $25.19       $12.55        $5.04
                                                                    collection.
89225................  A....................  NI.................  Starch granules,      ...........  ...........  ...........  ...........  ...........
                                                                    feces.
89230................  X....................  NI.................  Collect sweat for            0344       0.6291       $34.32       $17.16        $6.86
                                                                    test.
89235................  A....................  NI.................  Water load test.....  ...........  ...........  ...........  ...........  ...........
89240................  A....................  NI.................  Pathology lab         ...........  ...........  ...........  ...........  ...........
                                                                    procedure.
89250................  X....................  ...................  Cultr oocyte/embryo          0348       0.8194       $44.71  ...........        $8.94
                                                                    <4 days.
89251................  X....................  ...................  Cultr oocyte/embryo          0348       0.8194       $44.71  ...........        $8.94
                                                                    <4 days.
89252................  X....................  DG.................  Assist oocyte                0348       0.8194       $44.71  ...........        $8.94
                                                                    fertilization.
89253................  X....................  ...................  Embryo hatching.....         0348       0.8194       $44.71  ...........        $8.94
89254................  X....................  ...................  Oocyte                       0348       0.8194       $44.71  ...........        $8.94
                                                                    identification.
89255................  X....................  ...................  Prepare embryo for           0348       0.8194       $44.71  ...........        $8.94
                                                                    transfer.
89256................  X....................  DG.................  Prepare                      0348       0.8194       $44.71  ...........        $8.94
                                                                    cryopreserved
                                                                    embryo.
89257................  X....................  ...................  Sperm identification         0348       0.8194       $44.71  ...........        $8.94
89258................  X....................  ...................  Cryopreservation;            0348       0.8194       $44.71  ...........        $8.94
                                                                    embryo(s).

[[Page 63588]]

 
89259................  X....................  ...................  Cryopreservation,            0348       0.8194       $44.71  ...........        $8.94
                                                                    sperm.
89260................  X....................  ...................  Sperm isolation,             0348       0.8194       $44.71  ...........        $8.94
                                                                    simple.
89261................  X....................  ...................  Sperm isolation,             0348       0.8194       $44.71  ...........        $8.94
                                                                    complex.
89264................  X....................  ...................  Identify sperm               0348       0.8194       $44.71  ...........        $8.94
                                                                    tissue.
89268................  X....................  NI.................  Insemination of              0348       0.8194       $44.71  ...........        $8.94
                                                                    oocytes.
89272................  X....................  NI.................  Extended culture of          0348       0.8194       $44.71  ...........        $8.94
                                                                    oocytes.
89280................  X....................  NI.................  Assist oocyte                0348       0.8194       $44.71  ...........        $8.94
                                                                    fertilization.
89281................  X....................  NI.................  Assist oocyte                0348       0.8194       $44.71  ...........        $8.94
                                                                    fertilization.
89290................  X....................  NI.................  Biopsy, oocyte polar         0348       0.8194       $44.71  ...........        $8.94
                                                                    body.
89291................  X....................  NI.................  Biopsy, oocyte polar         0348       0.8194       $44.71  ...........        $8.94
                                                                    body.
89300................  A....................  ...................  Semen analysis w/     ...........  ...........  ...........  ...........  ...........
                                                                    huhner.
89310................  A....................  ...................  Semen analysis......  ...........  ...........  ...........  ...........  ...........
89320................  A....................  ...................  Semen analysis,       ...........  ...........  ...........  ...........  ...........
                                                                    complete.
89321................  A....................  ...................  Semen analysis &      ...........  ...........  ...........  ...........  ...........
                                                                    motility.
89325................  A....................  ...................  Sperm antibody test.  ...........  ...........  ...........  ...........  ...........
89329................  A....................  ...................  Sperm evaluation      ...........  ...........  ...........  ...........  ...........
                                                                    test.
89330................  A....................  ...................  Evaluation, cervical  ...........  ...........  ...........  ...........  ...........
                                                                    mucus.
89335................  X....................  NI.................  Cryopreserve                 0348       0.8194       $44.71  ...........        $8.94
                                                                    testicular tiss.
89342................  X....................  NI.................  Storage/year;                0348       0.8194       $44.71  ...........        $8.94
                                                                    embryo(s).
89343................  X....................  NI.................  Storage/year; sperm/         0348       0.8194       $44.71  ...........        $8.94
                                                                    semen.
89344................  X....................  NI.................  Storage/year; reprod         0348       0.8194       $44.71  ...........        $8.94
                                                                    tissue.
89346................  X....................  NI.................  Storage/year; oocyte         0348       0.8194       $44.71  ...........        $8.94
89350................  X....................  DG.................  Sputum specimen              0343       0.4617       $25.19       $12.55        $5.04
                                                                    collection.
89352................  X....................  NI.................  Thawing                      0348       0.8194       $44.71  ...........        $8.94
                                                                    cryopresrved;
                                                                    embryo.
89353................  X....................  NI.................  Thawing                      0348       0.8194       $44.71  ...........        $8.94
                                                                    cryopresrved; sperm.
89354................  X....................  NI.................  Thaw cryoprsvrd;             0348       0.8194       $44.71  ...........        $8.94
                                                                    reprod tiss.
89355................  A....................  DG.................  Exam feces for        ...........  ...........  ...........  ...........  ...........
                                                                    starch.
89356................  X....................  NI.................  Thawing                      0348       0.8194       $44.71  ...........        $8.94
                                                                    cryopresrved;
                                                                    oocyte.
89360................  X....................  DG.................  Collect sweat for            0343       0.4617       $25.19       $12.55        $5.04
                                                                    test.
89365................  A....................  DG.................  Water load test.....  ...........  ...........  ...........  ...........  ...........
89399................  A....................  DG.................  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         0355       0.2749       $15.00  ...........        $3.00
90371................  E....................  ...................  Hep b ig, im........  ...........  ...........  ...........  ...........  ...........
90375................  K....................  ...................  Rabies ig, im/sc....         0356       0.7698       $42.00  ...........        $8.40
90376................  K....................  ...................  Rabies ig, heat              0356       0.7698       $42.00  ...........        $8.40
                                                                    treated.
90378................  E....................  ...................  Rsv ig, im, 50mg....  ...........  ...........  ...........  ...........  ...........
90379................  K....................  ...................  Rsv ig, iv..........         0356       0.7698       $42.00  ...........        $8.40
90384................  E....................  ...................  Rh ig, full-dose, im  ...........  ...........  ...........  ...........  ...........
90385................  K....................  ...................  Rh ig, minidose, im.         0356       0.7698       $42.00  ...........        $8.40
90386................  E....................  ...................  Rh ig, iv...........  ...........  ...........  ...........  ...........  ...........
90389................  N....................  ...................  Tetanus ig, im......  ...........  ...........  ...........  ...........  ...........
90393................  K....................  ...................  Vaccina ig, im......         0356       0.7698       $42.00  ...........        $8.40
90396................  K....................  ...................  Varicella-zoster ig,         0356       0.7698       $42.00  ...........        $8.40
                                                                    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.         0355       0.2749       $15.00  ...........        $3.00
90585................  N....................  ...................  Bcg vaccine, percut.  ...........  ...........  ...........  ...........  ...........
90586................  K....................  ...................  Bcg vaccine,                 0356       0.7698       $42.00  ...........        $8.40
                                                                    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,            0355       0.2749       $15.00  ...........        $3.00
                                                                    adult 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.
90655................  L....................  NI.................  Flu vaccine, 6-35     ...........  ...........  ...........  ...........  ...........
                                                                    mo, im.
90657................  L....................  ...................  Flu vaccine, 6-35     ...........  ...........  ...........  ...........  ...........
                                                                    mo, im.
90658................  L....................  ...................  Flu vaccine, 3 yrs,   ...........  ...........  ...........  ...........  ...........
                                                                    im.
90659................  L....................  DG.................  Flu vaccine, whole,   ...........  ...........  ...........  ...........  ...........
                                                                    im.
90660................  E....................  ...................  Flu vaccine, nasal..  ...........  ...........  ...........  ...........  ...........
90665................  N....................  ...................  Lyme disease          ...........  ...........  ...........  ...........  ...........
                                                                    vaccine, im.
90669................  E....................  ...................  Pneumococcal vacc,    ...........  ...........  ...........  ...........  ...........
                                                                    ped <5.
90675................  K....................  ...................  Rabies vaccine, im..         0356       0.7698       $42.00  ...........        $8.40
90676................  K....................  ...................  Rabies vaccine, id..         0356       0.7698       $42.00  ...........        $8.40

[[Page 63589]]

 
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,             0356       0.7698       $42.00  ...........        $8.40
                                                                    akd, sc.
90698................  N....................  NI.................  Dtap-hib-ip vaccine,  ...........  ...........  ...........  ...........  ...........
                                                                    im.
90700................  N....................  ...................  Dtap vaccine, im....  ...........  ...........  ...........  ...........  ...........
90701................  N....................  ...................  Dtp vaccine, im.....  ...........  ...........  ...........  ...........  ...........
90702................  N....................  ...................  Dt vaccine < 7, im..  ...........  ...........  ...........  ...........  ...........
90703................  N....................  ...................  Tetanus vaccine, im.  ...........  ...........  ...........  ...........  ...........
90704................  N....................  ...................  Mumps vaccine, sc...  ...........  ...........  ...........  ...........  ...........
90705................  N....................  ...................  Measles vaccine, sc.  ...........  ...........  ...........  ...........  ...........
90706................  N....................  ...................  Rubella vaccine, sc.  ...........  ...........  ...........  ...........  ...........
90707................  N....................  ...................  Mmr vaccine, sc.....  ...........  ...........  ...........  ...........  ...........
90708................  N....................  ...................  Measles-rubella       ...........  ...........  ...........  ...........  ...........
                                                                    vaccine, sc.
90710................  N....................  ...................  Mmrv vaccine, sc....  ...........  ...........  ...........  ...........  ...........
90712................  N....................  ...................  Oral poliovirus       ...........  ...........  ...........  ...........  ...........
                                                                    vaccine.
90713................  N....................  ...................  Poliovirus, ipv, sc.  ...........  ...........  ...........  ...........  ...........
90715................  N....................  NI.................  Tdap vaccine  7 im.
90716................  K....................  ...................  Chicken pox vaccine,         0355       0.2749       $15.00  ...........        $3.00
                                                                    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               0356       0.7698       $42.00  ...........        $8.40
                                                                    vaccine, im.
90725................  K....................  ...................  Cholera vaccine,             0355       0.2749       $15.00  ...........        $3.00
                                                                    injectable.
90727................  N....................  ...................  Plague vaccine, im..  ...........  ...........  ...........  ...........  ...........
90732................  L....................  ...................  Pneumococcal vaccine  ...........  ...........  ...........  ...........  ...........
90733................  N....................  ...................  Meningococcal         ...........  ...........  ...........  ...........  ...........
                                                                    vaccine, sc.
90734................  N....................  NI.................  Meningococcal         ...........  ...........  ...........  ...........  ...........
                                                                    vaccine, im.
90735................  N....................  ...................  Encephalitis          ...........  ...........  ...........  ...........  ...........
                                                                    vaccine, sc.
90740................  K....................  ...................  Hepb vacc, ill pat 3         0356       0.7698       $42.00  ...........        $8.40
                                                                    dose im.
90743................  K....................  ...................  Hep b vacc, adol, 2          0356       0.7698       $42.00  ...........        $8.40
                                                                    dose, im.
90744................  K....................  ...................  Hepb vacc ped/adol 3         0356       0.7698       $42.00  ...........        $8.40
                                                                    dose im.
90746................  K....................  ...................  Hep b vaccine,               0356       0.7698       $42.00  ...........        $8.40
                                                                    adult, im.
90747................  K....................  ...................  Hepb vacc, ill pat 4         0356       0.7698       $42.00  ...........        $8.40
                                                                    dose im.
90748................  K....................  ...................  Hep b/hib vaccine,           0355       0.2749       $15.00  ...........        $3.00
                                                                    im.
90749................  N....................  ...................  Vaccine toxoid......  ...........  ...........  ...........  ...........  ...........
90780................  B....................  ...................  IV infusion therapy,  ...........  ...........  ...........  ...........  ...........
                                                                    1 hour.
90781................  B....................  ...................  IV infusion,          ...........  ...........  ...........  ...........  ...........
                                                                    additional hour.
90782................  X....................  ...................  Injection, sc/im....         0353       0.3982       $21.73  ...........        $4.35
90783................  X....................  ...................  Injection, ia.......         0359       0.8000       $43.65  ...........        $8.73
90784................  X....................  ...................  Injection, iv.......         0359       0.8000       $43.65  ...........        $8.73
90788................  X....................  ...................  Injection of                 0359       0.8000       $43.65  ...........        $8.73
                                                                    antibiotic.
90799................  X....................  ...................  Ther/prophylactic/dx         0352       0.1230        $6.71  ...........        $1.34
                                                                    inject.
90801................  S....................  ...................  Psy dx interview....         0323       1.8689      $101.97       $21.26       $20.39
90802................  S....................  ...................  Intac psy dx                 0323       1.8689      $101.97       $21.26       $20.39
                                                                    interview.
90804................  S....................  ...................  Psytx, office, 20-30         0322       1.2802       $69.85  ...........       $13.97
                                                                    min.
90805................  S....................  ...................  Psytx, off, 20-30            0322       1.2802       $69.85  ...........       $13.97
                                                                    min w/e&m.
90806................  S....................  ...................  Psytx, off, 45-50            0323       1.8689      $101.97       $21.26       $20.39
                                                                    min.
90807................  S....................  ...................  Psytx, off, 45-50            0323       1.8689      $101.97       $21.26       $20.39
                                                                    min w/e&m.
90808................  S....................  ...................  Psytx, office, 75-80         0323       1.8689      $101.97       $21.26       $20.39
                                                                    min.
90809................  S....................  ...................  Psytx, off, 75-80, w/        0323       1.8689      $101.97       $21.26       $20.39
                                                                    e&m.
90810................  S....................  ...................  Intac psytx, off, 20-        0322       1.2802       $69.85  ...........       $13.97
                                                                    30 min.
90811................  S....................  ...................  Intac psytx, 20-30,          0322       1.2802       $69.85  ...........       $13.97
                                                                    w/e&m.
90812................  S....................  ...................  Intac psytx, off, 45-        0323       1.8689      $101.97       $21.26       $20.39
                                                                    50 min.
90813................  S....................  ...................  Intac psytx, 45-50           0323       1.8689      $101.97       $21.26       $20.39
                                                                    min w/e&m.
90814................  S....................  ...................  Intac psytx, off, 75-        0323       1.8689      $101.97       $21.26       $20.39
                                                                    80 min.
90815................  S....................  ...................  Intac psytx, 75-80 w/        0323       1.8689      $101.97       $21.26       $20.39
                                                                    e&m.
90816................  S....................  ...................  Psytx, hosp, 20-30           0322       1.2802       $69.85  ...........       $13.97
                                                                    min.
90817................  S....................  ...................  Psytx, hosp, 20-30           0322       1.2802       $69.85  ...........       $13.97
                                                                    min w/e&m.
90818................  S....................  ...................  Psytx, hosp, 45-50           0323       1.8689      $101.97       $21.26       $20.39
                                                                    min.
90819................  S....................  ...................  Psytx, hosp, 45-50           0323       1.8689      $101.97       $21.26       $20.39
                                                                    min w/e&m.
90821................  S....................  ...................  Psytx, hosp, 75-80           0323       1.8689      $101.97       $21.26       $20.39
                                                                    min.
90822................  S....................  ...................  Psytx, hosp, 75-80           0323       1.8689      $101.97       $21.26       $20.39
                                                                    min w/e&m.
90823................  S....................  ...................  Intac psytx, hosp,           0322       1.2802       $69.85  ...........       $13.97
                                                                    20-30 min.
90824................  S....................  ...................  Intac psytx, hsp 20-         0322       1.2802       $69.85  ...........       $13.97
                                                                    30 w/e&m.
90826................  S....................  ...................  Intac psytx, hosp,           0323       1.8689      $101.97       $21.26       $20.39
                                                                    45-50 min.
90827................  S....................  ...................  Intac psytx, hsp 45-         0323       1.8689      $101.97       $21.26       $20.39
                                                                    50 w/e&m.
90828................  S....................  ...................  Intac psytx, hosp,           0323       1.8689      $101.97       $21.26       $20.39
                                                                    75-80 min.
90829................  S....................  ...................  Intac psytx, hsp 75-         0323       1.8689      $101.97       $21.26       $20.39
                                                                    80 w/e&m.
90845................  S....................  ...................  Psychoanalysis......         0323       1.8689      $101.97       $21.26       $20.39
90846................  S....................  ...................  Family psytx w/o             0324       2.4473      $133.53  ...........       $26.71
                                                                    patient.
90847................  S....................  ...................  Family psytx w/              0324       2.4473      $133.53  ...........       $26.71
                                                                    patient.

[[Page 63590]]

 
90849................  S....................  ...................  Multiple family              0325       1.4865       $81.10       $18.27       $16.22
                                                                    group psytx.
90853................  S....................  ...................  Group psychotherapy.         0325       1.4865       $81.10       $18.27       $16.22
90857................  S....................  ...................  Intac group psytx...         0325       1.4865       $81.10       $18.27       $16.22
90862................  X....................  ...................  Medication                   0374       1.1252       $61.39  ...........       $12.28
                                                                    management.
90865................  S....................  ...................  Narcosynthesis......         0323       1.8689      $101.97       $21.26       $20.39
90870................  S....................  ...................  Electroconvulsive            0320       5.3785      $293.46       $80.06       $58.69
                                                                    therapy.
90871................  E....................  ...................  Electroconvulsive     ...........  ...........  ...........  ...........  ...........
                                                                    therapy.
90875................  E....................  ...................  Psychophysiological   ...........  ...........  ...........  ...........  ...........
                                                                    therapy.
90876................  E....................  ...................  Psychophysiological   ...........  ...........  ...........  ...........  ...........
                                                                    therapy.
90880................  S....................  ...................  Hypnotherapy........         0323       1.8689      $101.97       $21.26       $20.39
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       1.2802       $69.85  ...........       $13.97
                                                                    therapy.
90901................  A....................  ...................  Biofeedback train,    ...........  ...........  ...........  ...........  ...........
                                                                    any meth.
90911................  S....................  ...................  Biofeedback peri/uro/        0321       1.2387       $67.58       $21.78       $13.52
                                                                    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       5.9678      $325.61  ...........       $65.12
                                                                    evaluation.
90937................  E....................  ...................  Hemodialysis,         ...........  ...........  ...........  ...........  ...........
                                                                    repeated eval.
90939................  N....................  ...................  Hemodialysis study,   ...........  ...........  ...........  ...........  ...........
                                                                    transcut.
90940................  N....................  ...................  Hemodialysis access   ...........  ...........  ...........  ...........  ...........
                                                                    study.
90945................  S....................  ...................  Dialysis, one                0170       5.9678      $325.61  ...........       $65.12
                                                                    evaluation.
90947................  E....................  ...................  Dialysis, repeated    ...........  ...........  ...........  ...........  ...........
                                                                    eval.
90989................  B....................  ...................  Dialysis training,    ...........  ...........  ...........  ...........  ...........
                                                                    complete.
90993................  B....................  ...................  Dialysis training,    ...........  ...........  ...........  ...........  ...........
                                                                    incompl.
90997................  E....................  ...................  Hemoperfusion.......  ...........  ...........  ...........  ...........  ...........
90999................  B....................  ...................  Dialysis procedure..  ...........  ...........  ...........  ...........  ...........
91000................  X....................  ...................  Esophageal                   0361       3.5510      $193.75       $83.23       $38.75
                                                                    intubation.
91010................  X....................  ...................  Esophagus motility           0361       3.5510      $193.75       $83.23       $38.75
                                                                    study.
91011................  X....................  ...................  Esophagus motility           0361       3.5510      $193.75       $83.23       $38.75
                                                                    study.
91012................  X....................  ...................  Esophagus motility           0361       3.5510      $193.75       $83.23       $38.75
                                                                    study.
91020................  X....................  ...................  Gastric motility....         0361       3.5510      $193.75       $83.23       $38.75
91030................  X....................  ...................  Acid perfusion of            0361       3.5510      $193.75       $83.23       $38.75
                                                                    esophagus.
91032................  X....................  ...................  Esophagus, acid              0361       3.5510      $193.75       $83.23       $38.75
                                                                    reflux test.
91033................  X....................  ...................  Prolonged acid               0361       3.5510      $193.75       $83.23       $38.75
                                                                    reflux test.
91052................  X....................  ...................  Gastric analysis             0361       3.5510      $193.75       $83.23       $38.75
                                                                    test.
91055................  X....................  ...................  Gastric intubation           0360       1.7313       $94.46       $42.45       $18.89
                                                                    for smear.
91060................  X....................  ...................  Gastric saline load          0360       1.7313       $94.46       $42.45       $18.89
                                                                    test.
91065................  X....................  ...................  Breath hydrogen test         0360       1.7313       $94.46       $42.45       $18.89
91100................  X....................  ...................  Pass intestine               0360       1.7313       $94.46       $42.45       $18.89
                                                                    bleeding tube.
91105................  X....................  ...................  Gastric intubation           0360       1.7313       $94.46       $42.45       $18.89
                                                                    treatment.
91110................  S....................  NI.................  Gi tract capsule             1508  ...........      $650.00  ...........      $130.00
                                                                    endoscopy.
91122................  T....................  ...................  Anal pressure record         0156       2.4747      $135.02       $40.52       $27.00
91123................  N....................  ...................  Irrigate fecal        ...........  ...........  ...........  ...........  ...........
                                                                    impaction.
91132................  X....................  ...................  Electrogastrography.         0360       1.7313       $94.46       $42.45       $18.89
91133................  X....................  ...................  Electrogastrography          0360       1.7313       $94.46       $42.45       $18.89
                                                                    w/test.
91299................  X....................  ...................  Gastroenterology             0360       1.7313       $94.46       $42.45       $18.89
                                                                    procedure.
92002................  V....................  ...................  Eye exam, new                0601       0.9816       $53.56  ...........       $10.71
                                                                    patient.
92004................  V....................  ...................  Eye exam, new                0602       1.5041       $82.07  ...........       $16.41
                                                                    patient.
92012................  V....................  ...................  Eye exam established         0600       0.9278       $50.62  ...........       $10.12
                                                                    pat.
92014................  V....................  ...................  Eye exam & treatment         0602       1.5041       $82.07  ...........       $16.41
92015................  E....................  ...................  Refraction..........  ...........  ...........  ...........  ...........  ...........
92018................  T....................  ...................  New eye exam &               0699       2.2303      $121.69       $47.46       $24.34
                                                                    treatment.
92019................  S....................  ...................  Eye exam & treatment         0699       2.2303      $121.69       $47.46       $24.34
92020................  S....................  ...................  Special eye                  0230       0.7619       $41.57       $14.97        $8.31
                                                                    evaluation.
92060................  S....................  ...................  Special eye                  0230       0.7619       $41.57       $14.97        $8.31
                                                                    evaluation.
92065................  S....................  ...................  Orthoptic/pleoptic           0230       0.7619       $41.57       $14.97        $8.31
                                                                    training.
92070................  N....................  ...................  Fitting of contact    ...........  ...........  ...........  ...........  ...........
                                                                    lens.
92081................  S....................  ...................  Visual field                 0230       0.7619       $41.57       $14.97        $8.31
                                                                    examination(s).
92082................  S....................  ...................  Visual field                 0698       0.9599       $52.37       $18.72       $10.47
                                                                    examination(s).
92083................  S....................  ...................  Visual field                 0698       0.9599       $52.37       $18.72       $10.47
                                                                    examination(s).
92100................  N....................  ...................  Serial tonometry      ...........  ...........  ...........  ...........  ...........
                                                                    exam(s).
92120................  S....................  ...................  Tonography & eye             0230       0.7619       $41.57       $14.97        $8.31
                                                                    evaluation.
92130................  S....................  ...................  Water provocation            0698       0.9599       $52.37       $18.72       $10.47
                                                                    tonography.
92135................  S....................  ...................  Opthalmic dx imaging         0230       0.7619       $41.57       $14.97        $8.31
92136................  S....................  ...................  Ophthalmic biometry.         0230       0.7619       $41.57       $14.97        $8.31
92140................  S....................  ...................  Glaucoma provocative         0698       0.9599       $52.37       $18.72       $10.47
                                                                    tests.

[[Page 63591]]

 
92225................  S....................  ...................  Special eye exam,            0698       0.9599       $52.37       $18.72       $10.47
                                                                    initial.
92226................  S....................  ...................  Special eye exam,            0698       0.9599       $52.37       $18.72       $10.47
                                                                    subsequent.
92230................  T....................  ...................  Eye exam with photos         0699       2.2303      $121.69       $47.46       $24.34
92235................  T....................  ...................  Eye exam with photos         0699       2.2303      $121.69       $47.46       $24.34
92240................  S....................  ...................  Icg angiography.....         0231       2.1883      $119.40       $50.94       $23.88
92250................  S....................  ...................  Eye exam with photos         0230       0.7619       $41.57       $14.97        $8.31
92260................  S....................  ...................  Ophthalmoscopy/              0230       0.7619       $41.57       $14.97        $8.31
                                                                    dynamometry.
92265................  S....................  ...................  Eye muscle                   0231       2.1883      $119.40       $50.94       $23.88
                                                                    evaluation.
92270................  S....................  ...................  Electro-oculography.         0698       0.9599       $52.37       $18.72       $10.47
92275................  S....................  ...................  Electroretinography.         0231       2.1883      $119.40       $50.94       $23.88
92283................  S....................  ...................  Color vision                 0230       0.7619       $41.57       $14.97        $8.31
                                                                    examination.
92284................  S....................  ...................  Dark adaptation eye          0698       0.9599       $52.37       $18.72       $10.47
                                                                    exam.
92285................  S....................  ...................  Eye photography.....         0230       0.7619       $41.57       $14.97        $8.31
92286................  S....................  ...................  Internal eye                 0698       0.9599       $52.37       $18.72       $10.47
                                                                    photography.
92287................  S....................  ...................  Internal eye                 0231       2.1883      $119.40       $50.94       $23.88
                                                                    photography.
92310................  E....................  ...................  Contact lens fitting  ...........  ...........  ...........  ...........  ...........
92311................  X....................  ...................  Contact lens fitting         0362       2.6984      $147.23  ...........       $29.45
92312................  X....................  ...................  Contact lens fitting         0362       2.6984      $147.23  ...........       $29.45
92313................  X....................  ...................  Contact lens fitting         0362       2.6984      $147.23  ...........       $29.45
92314................  E....................  ...................  Prescription of       ...........  ...........  ...........  ...........  ...........
                                                                    contact lens.
92315................  X....................  ...................  Prescription of              0362       2.6984      $147.23  ...........       $29.45
                                                                    contact lens.
92316................  X....................  ...................  Prescription of              0362       2.6984      $147.23  ...........       $29.45
                                                                    contact lens.
92317................  X....................  ...................  Prescription of              0362       2.6984      $147.23  ...........       $29.45
                                                                    contact lens.
92325................  X....................  ...................  Modification of              0362       2.6984      $147.23  ...........       $29.45
                                                                    contact lens.
92326................  X....................  ...................  Replacement of               0362       2.6984      $147.23  ...........       $29.45
                                                                    contact lens.
92330................  S....................  ...................  Fitting of                   0230       0.7619       $41.57       $14.97        $8.31
                                                                    artificial 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       2.6984      $147.23  ...........       $29.45
                                                                    fitting.
92353................  X....................  ...................  Special spectacles           0362       2.6984      $147.23  ...........       $29.45
                                                                    fitting.
92354................  X....................  ...................  Special spectacles           0362       2.6984      $147.23  ...........       $29.45
                                                                    fitting.
92355................  X....................  ...................  Special spectacles           0362       2.6984      $147.23  ...........       $29.45
                                                                    fitting.
92358................  X....................  ...................  Eye prosthesis               0362       2.6984      $147.23  ...........       $29.45
                                                                    service.
92370................  E....................  ...................  Repair & adjust       ...........  ...........  ...........  ...........  ...........
                                                                    spectacles.
92371................  X....................  ...................  Repair & adjust              0362       2.6984      $147.23  ...........       $29.45
                                                                    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       0.7619       $41.57       $14.97        $8.31
                                                                    procedure.
92502................  T....................  ...................  Ear and throat               0251       1.7880       $97.56  ...........       $19.51
                                                                    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       0.8799       $48.01       $12.89        $9.60
92512................  X....................  ...................  Nasal function               0363       0.8641       $47.15       $17.44        $9.43
                                                                    studies.
92516................  X....................  ...................  Facial nerve                 0660       1.7353       $94.68       $30.66       $18.94
                                                                    function test.
92520................  X....................  ...................  Laryngeal function           0660       1.7353       $94.68       $30.66       $18.94
                                                                    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                  0363       0.8641       $47.15       $17.44        $9.43
                                                                    nystagmus test.
92542................  X....................  ...................  Positional nystagmus         0363       0.8641       $47.15       $17.44        $9.43
                                                                    test.
92543................  X....................  ...................  Caloric vestibular           0363       0.8641       $47.15       $17.44        $9.43
                                                                    test.
92544................  X....................  ...................  Optokinetic                  0363       0.8641       $47.15       $17.44        $9.43
                                                                    nystagmus test.
92545................  X....................  ...................  Oscillating tracking         0363       0.8641       $47.15       $17.44        $9.43
                                                                    test.
92546................  X....................  ...................  Sinusoidal                   0660       1.7353       $94.68       $30.66       $18.94
                                                                    rotational test.
92547................  X....................  ...................  Supplemental                 0363       0.8641       $47.15       $17.44        $9.43
                                                                    electrical test.
92548................  X....................  ...................  Posturography.......         0660       1.7353       $94.68       $30.66       $18.94
92551................  E....................  ...................  Pure tone hearing     ...........  ...........  ...........  ...........  ...........
                                                                    test, air.
92552................  X....................  ...................  Pure tone                    0364       0.4459       $24.33        $9.06        $4.87
                                                                    audiometry, air.
92553................  X....................  ...................  Audiometry, air &            0365       1.2132       $66.19       $18.95       $13.24
                                                                    bone.
92555................  X....................  ...................  Speech threshold             0364       0.4459       $24.33        $9.06        $4.87
                                                                    audiometry.
92556................  X....................  ...................  Speech audiometry,           0364       0.4459       $24.33        $9.06        $4.87
                                                                    complete.
92557................  X....................  ...................  Comprehensive                0365       1.2132       $66.19       $18.95       $13.24
                                                                    hearing test.
92559................  E....................  ...................  Group audiometric     ...........  ...........  ...........  ...........  ...........
                                                                    testing.
92560................  E....................  ...................  Bekesy audiometry,    ...........  ...........  ...........  ...........  ...........
                                                                    screen.

[[Page 63592]]

 
92561................  X....................  ...................  Bekesy audiometry,           0365       1.2132       $66.19       $18.95       $13.24
                                                                    diagnosis.
92562................  X....................  ...................  Loudness balance             0364       0.4459       $24.33        $9.06        $4.87
                                                                    test.
92563................  X....................  ...................  Tone decay hearing           0364       0.4459       $24.33        $9.06        $4.87
                                                                    test.
92564................  X....................  ...................  Sisi hearing test...         0364       0.4459       $24.33        $9.06        $4.87
92565................  X....................  ...................  Stenger test, pure           0364       0.4459       $24.33        $9.06        $4.87
                                                                    tone.
92567................  X....................  ...................  Tympanometry........         0364       0.4459       $24.33        $9.06        $4.87
92568................  X....................  ...................  Acoustic reflex              0364       0.4459       $24.33        $9.06        $4.87
                                                                    testing.
92569................  X....................  ...................  Acoustic reflex              0364       0.4459       $24.33        $9.06        $4.87
                                                                    decay test.
92571................  X....................  ...................  Filtered speech              0364       0.4459       $24.33        $9.06        $4.87
                                                                    hearing test.
92572................  X....................  ...................  Staggered spondaic           0364       0.4459       $24.33        $9.06        $4.87
                                                                    word test.
92573................  X....................  ...................  Lombard test........         0364       0.4459       $24.33        $9.06        $4.87
92575................  X....................  ...................  Sensorineural acuity         0365       1.2132       $66.19       $18.95       $13.24
                                                                    test.
92576................  X....................  ...................  Synthetic sentence           0364       0.4459       $24.33        $9.06        $4.87
                                                                    test.
92577................  X....................  ...................  Stenger test, speech         0365       1.2132       $66.19       $18.95       $13.24
92579................  X....................  ...................  Visual audiometry            0365       1.2132       $66.19       $18.95       $13.24
                                                                    (vra).
92582................  X....................  ...................  Conditioning play            0365       1.2132       $66.19       $18.95       $13.24
                                                                    audiometry.
92583................  X....................  ...................  Select picture               0364       0.4459       $24.33        $9.06        $4.87
                                                                    audiometry.
92584................  X....................  ...................  Electrocochleography         0660       1.7353       $94.68       $30.66       $18.94
92585................  S....................  ...................  Auditor evoke                0216       2.8535      $155.69       $67.98       $31.14
                                                                    potent, compre.
92586................  S....................  ...................  Auditor evoke                0218       1.1404       $62.22  ...........       $12.44
                                                                    potent, limit.
92587................  X....................  ...................  Evoked auditory test         0363       0.8641       $47.15       $17.44        $9.43
92588................  X....................  ...................  Evoked auditory test         0363       0.8641       $47.15       $17.44        $9.43
92589................  X....................  ...................  Auditory function            0364       0.4459       $24.33        $9.06        $4.87
                                                                    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       1.2132       $66.19       $18.95       $13.24
                                                                    evaluation.
92597................  A....................  ...................  Voice Prosthetic      ...........  ...........  ...........  ...........  ...........
                                                                    Evaluation.
92601................  X....................  NI.................  Cochlear implt f/up          0365       1.2132       $66.19       $18.95       $13.24
                                                                    exam < 7.
92602................  X....................  NI.................  Reprogram cochlear           0365       1.2132       $66.19       $18.95       $13.24
                                                                    implt < 7.
92603................  X....................  NI.................  Cochlear implt f/up          0365       1.2132       $66.19       $18.95       $13.24
                                                                    exam 7 .
92604................  X....................  NI.................  Reprogram cochlear           0365       1.2132       $66.19       $18.95       $13.24
                                                                    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/               0364       0.4459       $24.33        $9.06        $4.87
                                                                    service.
92950................  S....................  ...................  Heart/lung                   0094       2.6345      $143.74       $48.58       $28.75
                                                                    resuscitation cpr.
92953................  S....................  ...................  Temporary external           0094       2.6345      $143.74       $48.58       $28.75
                                                                    pacing.
92960................  S....................  ...................  Cardioversion                0679       5.4887      $299.47       $95.30       $59.89
                                                                    electric, ext.
92961................  S....................  ...................  Cardioversion,               0679       5.4887      $299.47       $95.30       $59.89
                                                                    electric, int.
92970................  C....................  ...................  Cardioassist,         ...........  ...........  ...........  ...........  ...........
                                                                    internal.
92971................  C....................  ...................  Cardioassist,         ...........  ...........  ...........  ...........  ...........
                                                                    external.
92973................  T....................  ...................  Percut coronary              1541  ...........      $250.00  ...........       $50.00
                                                                    thrombectomy.
92974................  T....................  ...................  Cath place, cardio           1559  ...........    $2,250.00  ...........      $450.00
                                                                    brachytx.
92975................  C....................  ...................  Dissolve clot, heart  ...........  ...........  ...........  ...........  ...........
                                                                    vessel.
92977................  T....................  ...................  Dissolve clot, heart         0676       2.7315      $149.03       $40.30       $29.81
                                                                    vessel.
92978................  S....................  ...................  Intravasc us, heart          0670      27.4483    $1,497.61      $542.37      $299.52
                                                                    add-on.
92979................  S....................  ...................  Intravasc us, heart          0670      27.4483    $1,497.61      $542.37      $299.52
                                                                    add-on.
92980................  T....................  ...................  Insert intracoronary         0104      82.6713    $4,510.63  ...........      $902.13
                                                                    stent.
92981................  T....................  ...................  Insert intracoronary         0104      82.6713    $4,510.63  ...........      $902.13
                                                                    stent.
92982................  T....................  ...................  Coronary artery              0083      59.2047    $3,230.27  ...........      $646.05
                                                                    dilation.
92984................  T....................  ...................  Coronary artery              0083      59.2047    $3,230.27  ...........      $646.05
                                                                    dilation.
92986................  T....................  ...................  Revision of aortic           0083      59.2047    $3,230.27  ...........      $646.05
                                                                    valve.
92987................  T....................  ...................  Revision of mitral           0083      59.2047    $3,230.27  ...........      $646.05
                                                                    valve.
92990................  T....................  ...................  Revision of                  0083      59.2047    $3,230.27  ...........      $646.05
                                                                    pulmonary valve.
92992................  C....................  ...................  Revision of heart     ...........  ...........  ...........  ...........  ...........
                                                                    chamber.
92993................  C....................  ...................  Revision of heart     ...........  ...........  ...........  ...........  ...........
                                                                    chamber.
92995................  T....................  ...................  Coronary atherectomy         0082     110.2196    $6,013.69    $1,293.59    $1,202.74
92996................  T....................  ...................  Coronary atherectomy         0082     110.2196    $6,013.69    $1,293.59    $1,202.74
                                                                    add-on.
92997................  T....................  ...................  Pul art balloon              0081      35.0285    $1,911.19  ...........      $382.24
                                                                    repr, percut.
92998................  T....................  ...................  Pul art balloon              0081      35.0285    $1,911.19  ...........      $382.24
                                                                    repr, percut.
93000................  B....................  ...................  Electrocardiogram,    ...........  ...........  ...........  ...........  ...........
                                                                    complete.

[[Page 63593]]

 
93005................  S....................  ...................  Electrocardiogram,           0099       0.3703       $20.20  ...........        $4.04
                                                                    tracing.
93010................  A....................  ...................  Electrocardiogram     ...........  ...........  ...........  ...........  ...........
                                                                    report.
93012................  N....................  ...................  Transmission of ecg.  ...........  ...........  ...........  ...........  ...........
93014................  B....................  ...................  Report on             ...........  ...........  ...........  ...........  ...........
                                                                    transmitted ecg.
93015................  B....................  ...................  Cardiovascular        ...........  ...........  ...........  ...........  ...........
                                                                    stress test.
93016................  B....................  ...................  Cardiovascular        ...........  ...........  ...........  ...........  ...........
                                                                    stress test.
93017................  X....................  ...................  Cardiovascular               0100       1.5862       $86.54       $41.44       $17.31
                                                                    stress test.
93018................  B....................  ...................  Cardiovascular        ...........  ...........  ...........  ...........  ...........
                                                                    stress test.
93024................  X....................  ...................  Cardiac drug stress          0100       1.5862       $86.54       $41.44       $17.31
                                                                    test.
93025................  X....................  ...................  Microvolt t-wave             0100       1.5862       $86.54       $41.44       $17.31
                                                                    assess.
93040................  B....................  ...................  Rhythm ECG with       ...........  ...........  ...........  ...........  ...........
                                                                    report.
93041................  S....................  ...................  Rhythm ECG, tracing.         0099       0.3703       $20.20  ...........        $4.04
93042................  B....................  ...................  Rhythm ECG, report..  ...........  ...........  ...........  ...........  ...........
93224................  B....................  ...................  ECG monitor/report,   ...........  ...........  ...........  ...........  ...........
                                                                    24 hrs.
93225................  X....................  ...................  ECG monitor/record,          0097       1.0635       $58.03       $23.80       $11.61
                                                                    24 hrs.
93226................  X....................  ...................  ECG monitor/report,          0097       1.0635       $58.03       $23.80       $11.61
                                                                    24 hrs.
93227................  B....................  ...................  ECG monitor/review,   ...........  ...........  ...........  ...........  ...........
                                                                    24 hrs.
93230................  B....................  ...................  ECG monitor/report,   ...........  ...........  ...........  ...........  ...........
                                                                    24 hrs.
93231................  X....................  ...................  Ecg monitor/record,          0097       1.0635       $58.03       $23.80       $11.61
                                                                    24 hrs.
93232................  X....................  ...................  ECG monitor/report,          0097       1.0635       $58.03       $23.80       $11.61
                                                                    24 hrs.
93233................  B....................  ...................  ECG monitor/review,   ...........  ...........  ...........  ...........  ...........
                                                                    24 hrs.
93235................  B....................  ...................  ECG monitor/report,   ...........  ...........  ...........  ...........  ...........
                                                                    24 hrs.
93236................  X....................  ...................  ECG monitor/report,          0097       1.0635       $58.03       $23.80       $11.61
                                                                    24 hrs.
93237................  B....................  ...................  ECG monitor/review,   ...........  ...........  ...........  ...........  ...........
                                                                    24 hrs.
93268................  B....................  ...................  ECG record/review...  ...........  ...........  ...........  ...........  ...........
93270................  X....................  ...................  ECG recording.......         0097       1.0635       $58.03       $23.80       $11.61
93271................  X....................  ...................  Ecg/monitoring and           0097       1.0635       $58.03       $23.80       $11.61
                                                                    analysis.
93272................  B....................  ...................  Ecg/review,           ...........  ...........  ...........  ...........  ...........
                                                                    interpret only.
93278................  S....................  ...................  ECG/signal-averaged.         0099       0.3703       $20.20  ...........        $4.04
93303................  S....................  ...................  Echo transthoracic..         0269       3.2309      $176.28       $87.24       $35.26
93304................  S....................  ...................  Echo transthoracic..         0697       1.4415       $78.65       $39.32       $15.73
93307................  S....................  ...................  Echo exam of heart..         0269       3.2309      $176.28       $87.24       $35.26
93308................  S....................  ...................  Echo exam of heart..         0697       1.4415       $78.65       $39.32       $15.73
93312................  S....................  ...................  Echo transesophageal         0270       5.8546      $319.43      $146.79       $63.89
93313................  S....................  ...................  Echo transesophageal         0270       5.8546      $319.43      $146.79       $63.89
93314................  N....................  ...................  Echo transesophageal  ...........  ...........  ...........  ...........  ...........
93315................  S....................  ...................  Echo transesophageal         0270       5.8546      $319.43      $146.79       $63.89
93316................  S....................  ...................  Echo transesophageal         0270       5.8546      $319.43      $146.79       $63.89
93317................  N....................  ...................  Echo transesophageal  ...........  ...........  ...........  ...........  ...........
93318................  S....................  ...................  Echo transesophageal         0270       5.8546      $319.43      $146.79       $63.89
                                                                    intraop.
93320................  S....................  ...................  Doppler echo exam,           0671       1.6384       $89.39       $44.69       $17.88
                                                                    heart.
93321................  S....................  ...................  Doppler echo exam,           0697       1.4415       $78.65       $39.32       $15.73
                                                                    heart.
93325................  S....................  ...................  Doppler color flow           0697       1.4415       $78.65       $39.32       $15.73
                                                                    add-on.
93350................  S....................  ...................  Echo transthoracic..         0269       3.2309      $176.28       $87.24       $35.26
93501................  T....................  ...................  Right heart                  0080      36.0160    $1,965.07      $838.92      $393.01
                                                                    catheterization.
93503................  T....................  ...................  Insert/place heart           0103      11.6202      $634.01      $223.63      $126.80
                                                                    catheter.
93505................  T....................  ...................  Biopsy of heart              0103      11.6202      $634.01      $223.63      $126.80
                                                                    lining.
93508................  T....................  ...................  Cath placement,              0080      36.0160    $1,965.07      $838.92      $393.01
                                                                    angiography.
93510................  T....................  ...................  Left heart                   0080      36.0160    $1,965.07      $838.92      $393.01
                                                                    catheterization.
93511................  T....................  ...................  Left heart                   0080      36.0160    $1,965.07      $838.92      $393.01
                                                                    catheterization.
93514................  T....................  ...................  Left heart                   0080      36.0160    $1,965.07      $838.92      $393.01
                                                                    catheterization.
93524................  T....................  ...................  Left heart                   0080      36.0160    $1,965.07      $838.92      $393.01
                                                                    catheterization.
93526................  T....................  ...................  Rt & Lt heart                0080      36.0160    $1,965.07      $838.92      $393.01
                                                                    catheters.
93527................  T....................  ...................  Rt & Lt heart                0080      36.0160    $1,965.07      $838.92      $393.01
                                                                    catheters.
93528................  T....................  ...................  Rt & Lt heart                0080      36.0160    $1,965.07      $838.92      $393.01
                                                                    catheters.
93529................  T....................  ...................  Rt, lt heart                 0080      36.0160    $1,965.07      $838.92      $393.01
                                                                    catheterization.
93530................  T....................  ...................  Rt heart cath,               0080      36.0160    $1,965.07      $838.92      $393.01
                                                                    congenital.
93531................  T....................  ...................  R & l heart cath,            0080      36.0160    $1,965.07      $838.92      $393.01
                                                                    congenital.
93532................  T....................  ...................  R & l heart cath,            0080      36.0160    $1,965.07      $838.92      $393.01
                                                                    congenital.
93533................  T....................  ...................  R & l heart cath,            0080      36.0160    $1,965.07      $838.92      $393.01
                                                                    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.

[[Page 63594]]

 
93600................  T....................  ...................  Bundle of His                0087      39.8161    $2,172.41  ...........      $434.48
                                                                    recording.
93602................  T....................  ...................  Intra-atrial                 0087      39.8161    $2,172.41  ...........      $434.48
                                                                    recording.
93603................  T....................  ...................  Right ventricular            0087      39.8161    $2,172.41  ...........      $434.48
                                                                    recording.
93609................  T....................  ...................  Map tachycardia, add-        0087      39.8161    $2,172.41  ...........      $434.48
                                                                    on.
93610................  T....................  ...................  Intra-atrial pacing.         0087      39.8161    $2,172.41  ...........      $434.48
93612................  T....................  ...................  Intraventricular             0087      39.8161    $2,172.41  ...........      $434.48
                                                                    pacing.
93613................  T....................  ...................  Electrophys map 3d,          0087      39.8161    $2,172.41  ...........      $434.48
                                                                    add-on.
93615................  T....................  ...................  Esophageal recording         0087      39.8161    $2,172.41  ...........      $434.48
93616................  T....................  ...................  Esophageal recording         0087      39.8161    $2,172.41  ...........      $434.48
93618................  T....................  ...................  Heart rhythm pacing.         0087      39.8161    $2,172.41  ...........      $434.48
93619................  T....................  ...................  Electrophysiology            0085      35.4126    $1,932.15      $426.25      $386.43
                                                                    evaluation.
93620................  T....................  ...................  Electrophysiology            0085      35.4126    $1,932.15      $426.25      $386.43
                                                                    evaluation.
93621................  T....................  ...................  Electrophysiology            0085      35.4126    $1,932.15      $426.25      $386.43
                                                                    evaluation.
93622................  T....................  ...................  Electrophysiology            0085      35.4126    $1,932.15      $426.25      $386.43
                                                                    evaluation.
93623................  T....................  ...................  Stimulation, pacing          0087      39.8161    $2,172.41  ...........      $434.48
                                                                    heart.
93624................  S....................  ...................  Electrophysiologic           0084      10.5226      $574.12  ...........      $114.82
                                                                    study.
93631................  T....................  ...................  Heart pacing,                0087      39.8161    $2,172.41  ...........      $434.48
                                                                    mapping.
93640................  S....................  ...................  Evaluation heart             0084      10.5226      $574.12  ...........      $114.82
                                                                    device.
93641................  S....................  ...................  Electrophysiology            0084      10.5226      $574.12  ...........      $114.82
                                                                    evaluation.
93642................  S....................  ...................  Electrophysiology            0084      10.5226      $574.12  ...........      $114.82
                                                                    evaluation.
93650................  T....................  ...................  Ablate heart                 0086      44.9389    $2,451.91      $833.33      $490.38
                                                                    dysrhythm focus.
93651................  T....................  ...................  Ablate heart                 0086      44.9389    $2,451.91      $833.33      $490.38
                                                                    dysrhythm focus.
93652................  T....................  ...................  Ablate heart                 0086      44.9389    $2,451.91      $833.33      $490.38
                                                                    dysrhythm focus.
93660................  S....................  ...................  Tilt table                   0101       4.4040      $240.29      $105.27       $48.06
                                                                    evaluation.
93662................  S....................  ...................  Intracardiac ecg             0670      27.4483    $1,497.61      $542.37      $299.52
                                                                    (ice).
93668................  E....................  ...................  Peripheral vascular   ...........  ...........  ...........  ...........  ...........
                                                                    rehab.
93701................  S....................  ...................  Bioimpedance,                0099       0.3703       $20.20  ...........        $4.04
                                                                    thoracic.
93720................  B....................  ...................  Total body            ...........  ...........  ...........  ...........  ...........
                                                                    plethysmography.
93721................  X....................  ...................  Plethysmography              0368       0.9319       $50.85       $25.42       $10.17
                                                                    tracing.
93722................  B....................  ...................  Plethysmography       ...........  ...........  ...........  ...........  ...........
                                                                    report.
93724................  S....................  ...................  Analyze pacemaker            0690       0.4074       $22.23       $10.63        $4.45
                                                                    system.
93727................  S....................  ...................  Analyze ilr system..         0690       0.4074       $22.23       $10.63        $4.45
93731................  S....................  ...................  Analyze pacemaker            0690       0.4074       $22.23       $10.63        $4.45
                                                                    system.
93732................  S....................  ...................  Analyze pacemaker            0690       0.4074       $22.23       $10.63        $4.45
                                                                    system.
93733................  S....................  ...................  Telephone analy,             0690       0.4074       $22.23       $10.63        $4.45
                                                                    pacemaker.
93734................  S....................  ...................  Analyze pacemaker            0690       0.4074       $22.23       $10.63        $4.45
                                                                    system.
93735................  S....................  ...................  Analyze pacemaker            0690       0.4074       $22.23       $10.63        $4.45
                                                                    system.
93736................  S....................  ...................  Telephonic analy,            0690       0.4074       $22.23       $10.63        $4.45
                                                                    pacemaker.
93740................  X....................  ...................  Temperature gradient         0367       0.5887       $32.12       $15.16        $6.42
                                                                    studies.
93741................  S....................  ...................  Analyze ht pace              0689       0.5533       $30.19  ...........        $6.04
                                                                    device sngl.
93742................  S....................  ...................  Analyze ht pace              0689       0.5533       $30.19  ...........        $6.04
                                                                    device sngl.
93743................  S....................  ...................  Analyze ht pace              0689       0.5533       $30.19  ...........        $6.04
                                                                    device dual.
93744................  S....................  ...................  Analyze ht pace              0689       0.5533       $30.19  ...........        $6.04
                                                                    device dual.
93760................  E....................  ...................  Cephalic thermogram.  ...........  ...........  ...........  ...........  ...........
93762................  E....................  ...................  Peripheral            ...........  ...........  ...........  ...........  ...........
                                                                    thermogram.
93770................  N....................  ...................  Measure venous        ...........  ...........  ...........  ...........  ...........
                                                                    pressure.
93784................  E....................  ...................  Ambulatory BP         ...........  ...........  ...........  ...........  ...........
                                                                    monitoring.
93786................  X....................  ...................  Ambulatory BP                0097       1.0635       $58.03       $23.80       $11.61
                                                                    recording.
93788................  E....................  ...................  Ambulatory BP         ...........  ...........  ...........  ...........  ...........
                                                                    analysis.
93790................  B....................  ...................  Review/report BP      ...........  ...........  ...........  ...........  ...........
                                                                    recording.
93797................  S....................  ...................  Cardiac rehab.......         0095       0.5994       $32.70       $16.35        $6.54
93798................  S....................  ...................  Cardiac rehab/               0095       0.5994       $32.70       $16.35        $6.54
                                                                    monitor.
93799................  S....................  ...................  Cardiovascular               0096       1.7176       $93.71       $46.85       $18.74
                                                                    procedure.
93875................  S....................  ...................  Extracranial study..         0096       1.7176       $93.71       $46.85       $18.74
93880................  S....................  ...................  Extracranial study..         0267       2.4586      $134.14       $65.52       $26.83
93882................  S....................  ...................  Extracranial study..         0267       2.4586      $134.14       $65.52       $26.83
93886................  S....................  ...................  Intracranial study..         0267       2.4586      $134.14       $65.52       $26.83
93888................  S....................  ...................  Intracranial study..         0266       1.6117       $87.94       $43.97       $17.59
93922................  S....................  ...................  Extremity study.....         0096       1.7176       $93.71       $46.85       $18.74
93923................  S....................  ...................  Extremity study.....         0096       1.7176       $93.71       $46.85       $18.74
93924................  S....................  ...................  Extremity study.....         0096       1.7176       $93.71       $46.85       $18.74
93925................  S....................  ...................  Lower extremity              0267       2.4586      $134.14       $65.52       $26.83
                                                                    study.
93926................  S....................  ...................  Lower extremity              0267       2.4586      $134.14       $65.52       $26.83
                                                                    study.
93930................  S....................  ...................  Upper extremity              0267       2.4586      $134.14       $65.52       $26.83
                                                                    study.
93931................  S....................  ...................  Upper extremity              0266       1.6117       $87.94       $43.97       $17.59
                                                                    study.
93965................  S....................  ...................  Extremity study.....         0096       1.7176       $93.71       $46.85       $18.74
93970................  S....................  ...................  Extremity study.....         0267       2.4586      $134.14       $65.52       $26.83
93971................  S....................  ...................  Extremity study.....         0267       2.4586      $134.14       $65.52       $26.83
93975................  S....................  ...................  Vascular study......         0267       2.4586      $134.14       $65.52       $26.83
93976................  S....................  ...................  Vascular study......         0267       2.4586      $134.14       $65.52       $26.83
93978................  S....................  ...................  Vascular study......         0267       2.4586      $134.14       $65.52       $26.83
93979................  S....................  ...................  Vascular study......         0267       2.4586      $134.14       $65.52       $26.83
93980................  S....................  ...................  Penile vascular              0267       2.4586      $134.14       $65.52       $26.83
                                                                    study.
93981................  S....................  ...................  Penile vascular              0267       2.4586      $134.14       $65.52       $26.83
                                                                    study.
93990................  S....................  ...................  Doppler flow testing         0267       2.4586      $134.14       $65.52       $26.83

[[Page 63595]]

 
94010................  X....................  ...................  Breathing capacity           0368       0.9319       $50.85       $25.42       $10.17
                                                                    test.
94014................  X....................  ...................  Patient recorded             0367       0.5887       $32.12       $15.16        $6.42
                                                                    spirometry.
94015................  X....................  ...................  Patient recorded             0369       2.4984      $136.32       $44.18       $27.26
                                                                    spirometry.
94016................  A....................  ...................  Review patient        ...........  ...........  ...........  ...........  ...........
                                                                    spirometry.
94060................  X....................  ...................  Evaluation of                0368       0.9319       $50.85       $25.42       $10.17
                                                                    wheezing.
94070................  X....................  ...................  Evaluation of                0369       2.4984      $136.32       $44.18       $27.26
                                                                    wheezing.
94150................  X....................  ...................  Vital capacity test.         0367       0.5887       $32.12       $15.16        $6.42
94200................  X....................  ...................  Lung function test           0367       0.5887       $32.12       $15.16        $6.42
                                                                    (MBC/MVV).
94240................  X....................  ...................  Residual lung                0368       0.9319       $50.85       $25.42       $10.17
                                                                    capacity.
94250................  X....................  ...................  Expired gas                  0367       0.5887       $32.12       $15.16        $6.42
                                                                    collection.
94260................  X....................  ...................  Thoracic gas volume.         0368       0.9319       $50.85       $25.42       $10.17
94350................  X....................  ...................  Lung nitrogen                0368       0.9319       $50.85       $25.42       $10.17
                                                                    washout curve.
94360................  X....................  ...................  Measure airflow              0367       0.5887       $32.12       $15.16        $6.42
                                                                    resistance.
94370................  X....................  ...................  Breath airway                0367       0.5887       $32.12       $15.16        $6.42
                                                                    closing volume.
94375................  X....................  ...................  Respiratory flow             0367       0.5887       $32.12       $15.16        $6.42
                                                                    volume loop.
94400................  X....................  ...................  CO2 breathing                0367       0.5887       $32.12       $15.16        $6.42
                                                                    response curve.
94450................  X....................  ...................  Hypoxia response             0367       0.5887       $32.12       $15.16        $6.42
                                                                    curve.
94620................  X....................  ...................  Pulmonary stress             0368       0.9319       $50.85       $25.42       $10.17
                                                                    test/simple.
94621................  X....................  ...................  Pulm stress test/            0369       2.4984      $136.32       $44.18       $27.26
                                                                    complex.
94640................  S....................  ...................  Airway inhalation            0077       0.2837       $15.48        $7.74        $3.10
                                                                    treatment.
94642................  S....................  ...................  Aerosol inhalation           0078       0.7917       $43.20       $14.55        $8.64
                                                                    treatment.
94656................  S....................  ...................  Initial ventilator           0079       2.1494      $117.27  ...........       $23.45
                                                                    mgmt.
94657................  S....................  ...................  Continued ventilator         0079       2.1494      $117.27  ...........       $23.45
                                                                    mgmt.
94660................  S....................  ...................  Pos airway pressure,         0068       1.0807       $58.96       $29.48       $11.79
                                                                    CPAP.
94662................  S....................  ...................  Neg press                    0079       2.1494      $117.27  ...........       $23.45
                                                                    ventilation, cnp.
94664................  S....................  ...................  Aerosol or vapor             0077       0.2837       $15.48        $7.74        $3.10
                                                                    inhalations.
94667................  S....................  ...................  Chest wall                   0077       0.2837       $15.48        $7.74        $3.10
                                                                    manipulation.
94668................  S....................  ...................  Chest wall                   0077       0.2837       $15.48        $7.74        $3.10
                                                                    manipulation.
94680................  X....................  ...................  Exhaled air                  0367       0.5887       $32.12       $15.16        $6.42
                                                                    analysis, o2.
94681................  X....................  ...................  Exhaled air                  0368       0.9319       $50.85       $25.42       $10.17
                                                                    analysis, o2/co2.
94690................  X....................  ...................  Exhaled air analysis         0367       0.5887       $32.12       $15.16        $6.42
94720................  X....................  ...................  Monoxide diffusing           0368       0.9319       $50.85       $25.42       $10.17
                                                                    capacity.
94725................  X....................  ...................  Membrane diffusion           0368       0.9319       $50.85       $25.42       $10.17
                                                                    capacity.
94750................  X....................  ...................  Pulmonary compliance         0367       0.5887       $32.12       $15.16        $6.42
                                                                    study.
94760................  N....................  ...................  Measure blood oxygen  ...........  ...........  ...........  ...........  ...........
                                                                    level.
94761................  N....................  ...................  Measure blood oxygen  ...........  ...........  ...........  ...........  ...........
                                                                    level.
94762................  N....................  ...................  Measure blood oxygen  ...........  ...........  ...........  ...........  ...........
                                                                    level.
94770................  X....................  ...................  Exhaled carbon               0367       0.5887       $32.12       $15.16        $6.42
                                                                    dioxide test.
94772................  X....................  ...................  Breath recording,            0369       2.4984      $136.32       $44.18       $27.26
                                                                    infant.
94799................  X....................  ...................  Pulmonary service/           0367       0.5887       $32.12       $15.16        $6.42
                                                                    procedure.
95004................  X....................  ...................  Percut allergy skin          0370       0.9185       $50.11       $11.58       $10.02
                                                                    tests.
95010................  X....................  ...................  Percut allergy               0370       0.9185       $50.11       $11.58       $10.02
                                                                    titrate test.
95015................  X....................  ...................  Id allergy titrate-          0370       0.9185       $50.11       $11.58       $10.02
                                                                    drug/bug.
95024................  X....................  ...................  Id allergy test,             0370       0.9185       $50.11       $11.58       $10.02
                                                                    drug/bug.
95027................  X....................  ...................  Skin end point               0370       0.9185       $50.11       $11.58       $10.02
                                                                    titration.
95028................  X....................  ...................  Id allergy test-             0370       0.9185       $50.11       $11.58       $10.02
                                                                    delayed type.
95044................  X....................  ...................  Allergy patch tests.         0370       0.9185       $50.11       $11.58       $10.02
95052................  X....................  ...................  Photo patch test....         0370       0.9185       $50.11       $11.58       $10.02
95056................  X....................  ...................  Photosensitivity             0370       0.9185       $50.11       $11.58       $10.02
                                                                    tests.
95060................  X....................  ...................  Eye allergy tests...         0370       0.9185       $50.11       $11.58       $10.02
95065................  X....................  ...................  Nose allergy test...         0370       0.9185       $50.11       $11.58       $10.02
95070................  X....................  ...................  Bronchial allergy            0369       2.4984      $136.32       $44.18       $27.26
                                                                    tests.
95071................  X....................  ...................  Bronchial allergy            0369       2.4984      $136.32       $44.18       $27.26
                                                                    tests.
95075................  X....................  ...................  Ingestion challenge          0361       3.5510      $193.75       $83.23       $38.75
                                                                    test.
95078................  X....................  ...................  Provocative testing.         0370       0.9185       $50.11       $11.58       $10.02
95115................  X....................  ...................  Immunotherapy, one           0352       0.1230        $6.71  ...........        $1.34
                                                                    injection.
95117................  X....................  ...................  Immunotherapy                0353       0.3982       $21.73  ...........        $4.35
                                                                    injections.
95120................  B....................  ...................  Immunotherapy, one    ...........  ...........  ...........  ...........  ...........
                                                                    injection.
95125................  B....................  ...................  Immunotherapy, many   ...........  ...........  ...........  ...........  ...........
                                                                    antigens.
95130................  B....................  ...................  Immunotherapy,        ...........  ...........  ...........  ...........  ...........
                                                                    insect venom.
95131................  B....................  ...................  Immunotherapy,        ...........  ...........  ...........  ...........  ...........
                                                                    insect venoms.
95132................  B....................  ...................  Immunotherapy,        ...........  ...........  ...........  ...........  ...........
                                                                    insect venoms.
95133................  B....................  ...................  Immunotherapy,        ...........  ...........  ...........  ...........  ...........
                                                                    insect venoms.
95134................  B....................  ...................  Immunotherapy,        ...........  ...........  ...........  ...........  ...........
                                                                    insect venoms.
95144................  X....................  ...................  Antigen therapy              0371       0.4105       $22.40  ...........        $4.48
                                                                    services.
95145................  X....................  ...................  Antigen therapy              0371       0.4105       $22.40  ...........        $4.48
                                                                    services.
95146................  X....................  ...................  Antigen therapy              0371       0.4105       $22.40  ...........        $4.48
                                                                    services.
95147................  X....................  ...................  Antigen therapy              0371       0.4105       $22.40  ...........        $4.48
                                                                    services.
95148................  X....................  ...................  Antigen therapy              0371       0.4105       $22.40  ...........        $4.48
                                                                    services.
95149................  X....................  ...................  Antigen therapy              0371       0.4105       $22.40  ...........        $4.48
                                                                    services.
95165................  X....................  ...................  Antigen therapy              0371       0.4105       $22.40  ...........        $4.48
                                                                    services.
95170................  X....................  ...................  Antigen therapy              0371       0.4105       $22.40  ...........        $4.48
                                                                    services.
95180................  X....................  ...................  Rapid                        0370       0.9185       $50.11       $11.58       $10.02
                                                                    desensitization.
95199................  X....................  ...................  Allergy immunology           0370       0.9185       $50.11       $11.58       $10.02
                                                                    services.
95250................  T....................  ...................  Glucose monitoring,          1540  ...........      $150.00  ...........       $30.00
                                                                    cont.

[[Page 63596]]

 
95805................  S....................  ...................  Multiple sleep               0209      11.5435      $629.82      $280.58      $125.96
                                                                    latency test.
95806................  S....................  ...................  Sleep study,                 0213       2.9055      $158.53       $65.74       $31.71
                                                                    unattended.
95807................  S....................  ...................  Sleep study,                 0209      11.5435      $629.82      $280.58      $125.96
                                                                    attended.
95808................  S....................  ...................  Polysomnography, 1-3         0209      11.5435      $629.82      $280.58      $125.96
95810................  S....................  ...................  Polysomnography, 4           0209      11.5435      $629.82      $280.58      $125.96
                                                                    or more.
95811................  S....................  ...................  Polysomnography w/           0209      11.5435      $629.82      $280.58      $125.96
                                                                    cpap.
95812................  S....................  ...................  Electroencephalogram         0213       2.9055      $158.53       $65.74       $31.71
                                                                    (EEG).
95813................  S....................  ...................  Eeg, over 1 hour....         0213       2.9055      $158.53       $65.74       $31.71
95816................  S....................  ...................  Electroencephalogram         0214       2.2176      $120.99       $58.12       $24.20
                                                                    (EEG).
95819................  S....................  ...................  Electroencephalogram         0214       2.2176      $120.99       $58.12       $24.20
                                                                    (EEG).
95822................  S....................  ...................  Sleep                        0214       2.2176      $120.99       $58.12       $24.20
                                                                    electroencephalogra
                                                                    m.
95824................  S....................  ...................  Eeg, cerebral death          0214       2.2176      $120.99       $58.12       $24.20
                                                                    only.
95827................  S....................  ...................  night                        0209      11.5435      $629.82      $280.58      $125.96
                                                                    electroencephalogra
                                                                    m.
95829................  S....................  ...................  Surgery                      0214       2.2176      $120.99       $58.12       $24.20
                                                                    electrocorticogram.
95830................  B....................  ...................  Insert electrodes     ...........  ...........  ...........  ...........  ...........
                                                                    for EEG.
95831................  A....................  ...................  Limb muscle testing,  ...........  ...........  ...........  ...........  ...........
                                                                    manual.
95832................  A....................  ...................  Hand muscle testing,  ...........  ...........  ...........  ...........  ...........
                                                                    manual.
95833................  A....................  ...................  Body muscle testing,  ...........  ...........  ...........  ...........  ...........
                                                                    manual.
95834................  A....................  ...................  Body muscle testing,  ...........  ...........  ...........  ...........  ...........
                                                                    manual.
95851................  A....................  ...................  Range of motion       ...........  ...........  ...........  ...........  ...........
                                                                    measurements.
95852................  A....................  ...................  Range of motion       ...........  ...........  ...........  ...........  ...........
                                                                    measurements.
95857................  S....................  ...................  Tensilon test.......         0218       1.1404       $62.22  ...........       $12.44
95858................  S....................  ...................  Tensilon test &              0215       0.6457       $35.23       $15.76        $7.05
                                                                    myogram.
95860................  S....................  ...................  Muscle test, one             0218       1.1404       $62.22  ...........       $12.44
                                                                    limb.
95861................  S....................  ...................  Muscle test, 2 limbs         0218       1.1404       $62.22  ...........       $12.44
95863................  S....................  ...................  Muscle test, 3 limbs         0218       1.1404       $62.22  ...........       $12.44
95864................  S....................  ...................  Muscle test, 4 limbs         0218       1.1404       $62.22  ...........       $12.44
95867................  S....................  ...................  Muscle test, head or         0218       1.1404       $62.22  ...........       $12.44
                                                                    neck.
95868................  S....................  ...................  Muscle test cran             0218       1.1404       $62.22  ...........       $12.44
                                                                    nerve bilat.
95869................  S....................  ...................  Muscle test, thor            0215       0.6457       $35.23       $15.76        $7.05
                                                                    paraspinal.
95870................  S....................  ...................  Muscle test,                 0215       0.6457       $35.23       $15.76        $7.05
                                                                    nonparaspinal.
95872................  S....................  ...................  Muscle test, one             0218       1.1404       $62.22  ...........       $12.44
                                                                    fiber.
95875................  S....................  ...................  Limb exercise test..         0215       0.6457       $35.23       $15.76        $7.05
95900................  S....................  ...................  Motor nerve                  0215       0.6457       $35.23       $15.76        $7.05
                                                                    conduction test.
95903................  S....................  ...................  Motor nerve                  0215       0.6457       $35.23       $15.76        $7.05
                                                                    conduction test.
95904................  S....................  ...................  Sense nerve                  0215       0.6457       $35.23       $15.76        $7.05
                                                                    conduction test.
95920................  S....................  ...................  Intraop nerve test           0216       2.8535      $155.69       $67.98       $31.14
                                                                    add-on.
95921................  S....................  ...................  Autonomic nerv               0218       1.1404       $62.22  ...........       $12.44
                                                                    function test.
95922................  S....................  ...................  Autonomic nerv               0218       1.1404       $62.22  ...........       $12.44
                                                                    function test.
95923................  S....................  ...................  Autonomic nerv               0215       0.6457       $35.23       $15.76        $7.05
                                                                    function test.
95925................  S....................  ...................  Somatosensory                0216       2.8535      $155.69       $67.98       $31.14
                                                                    testing.
95926................  S....................  ...................  Somatosensory                0216       2.8535      $155.69       $67.98       $31.14
                                                                    testing.
95927................  S....................  ...................  Somatosensory                0216       2.8535      $155.69       $67.98       $31.14
                                                                    testing.
95930................  S....................  ...................  Visual evoked                0218       1.1404       $62.22  ...........       $12.44
                                                                    potential test.
95933................  S....................  ...................  Blink reflex test...         0215       0.6457       $35.23       $15.76        $7.05
95934................  S....................  ...................  H-reflex test.......         0215       0.6457       $35.23       $15.76        $7.05
95936................  S....................  ...................  H-reflex test.......         0215       0.6457       $35.23       $15.76        $7.05
95937................  S....................  ...................  Neuromuscular                0218       1.1404       $62.22  ...........       $12.44
                                                                    junction test.
95950................  S....................  ...................  Ambulatory eeg               0213       2.9055      $158.53       $65.74       $31.71
                                                                    monitoring.
95951................  S....................  ...................  EEG monitoring/              0209      11.5435      $629.82      $280.58      $125.96
                                                                    videorecord.
95953................  S....................  ...................  EEG monitoring/              0209      11.5435      $629.82      $280.58      $125.96
                                                                    computer.
95954................  S....................  ...................  EEG monitoring/              0214       2.2176      $120.99       $58.12       $24.20
                                                                    giving drugs.
95955................  S....................  ...................  EEG during surgery..         0213       2.9055      $158.53       $65.74       $31.71
95956................  S....................  ...................  Eeg monitoring,              0214       2.2176      $120.99       $58.12       $24.20
                                                                    cable/radio.
95957................  S....................  ...................  EEG digital analysis         0214       2.2176      $120.99       $58.12       $24.20
95958................  S....................  ...................  EEG monitoring/              0213       2.9055      $158.53       $65.74       $31.71
                                                                    function test.
95961................  S....................  ...................  Electrode                    0216       2.8535      $155.69       $67.98       $31.14
                                                                    stimulation, brain.
95962................  S....................  ...................  Electrode stim,              0216       2.8535      $155.69       $67.98       $31.14
                                                                    brain 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            1511  ...........      $950.00  ...........      $190.00
                                                                    add'l.
95970................  S....................  ...................  Analyze neurostim,           0692       1.1057       $60.33       $30.16       $12.07
                                                                    no prog.
95971................  S....................  ...................  Analyze neurostim,           0692       1.1057       $60.33       $30.16       $12.07
                                                                    simple.
95972................  S....................  ...................  Analyze neurostim,           0692       1.1057       $60.33       $30.16       $12.07
                                                                    complex.
95973................  S....................  ...................  Analyze neurostim,           0692       1.1057       $60.33       $30.16       $12.07
                                                                    complex.
95974................  S....................  ...................  Cranial neurostim,           0692       1.1057       $60.33       $30.16       $12.07
                                                                    complex.
95975................  S....................  ...................  Cranial neurostim,           0692       1.1057       $60.33       $30.16       $12.07
                                                                    complex.
95990................  T....................  ...................  Spin/brain pump              0125       2.1606      $117.88  ...........       $23.58
                                                                    refil & main.
95991................  T....................  NI.................  Spin/brain pump              0125       2.1606      $117.88  ...........       $23.58
                                                                    refil & main.
95999................  S....................  ...................  Neurological                 0215       0.6457       $35.23       $15.76        $7.05
                                                                    procedure.
96000................  S....................  ...................  Motion analysis,             1503  ...........      $150.00  ...........       $30.00
                                                                    video/3d.
96001................  S....................  ...................  Motion test w/ft             1503  ...........      $150.00  ...........       $30.00
                                                                    press meas.
96002................  S....................  ...................  Dynamic surface emg.         1503  ...........      $150.00  ...........       $30.00
96003................  S....................  ...................  Dynamic fine wire            1503  ...........      $150.00  ...........       $30.00
                                                                    emg.
96004................  E....................  ...................  Phys review of        ...........  ...........  ...........  ...........  ...........
                                                                    motion tests.

[[Page 63597]]

 
96100................  X....................  ...................  Psychological                0373       2.0899      $114.03  ...........       $22.81
                                                                    testing.
96105................  A....................  ...................  Assessment of         ...........  ...........  ...........  ...........  ...........
                                                                    aphasia.
96110................  X....................  ...................  Developmental test,          0373       2.0899      $114.03  ...........       $22.81
                                                                    lim.
96111................  X....................  ...................  Developmental test,          0373       2.0899      $114.03  ...........       $22.81
                                                                    extend.
96115................  X....................  ...................  Neurobehavior status         0373       2.0899      $114.03  ...........       $22.81
                                                                    exam.
96117................  X....................  ...................  Neuropsych test              0373       2.0899      $114.03  ...........       $22.81
                                                                    battery.
96150................  S....................  ...................  Assess lth/behave,           0322       1.2802       $69.85  ...........       $13.97
                                                                    init.
96151................  S....................  ...................  Assess hlth/behave,          0322       1.2802       $69.85  ...........       $13.97
                                                                    subseq.
96152................  S....................  ...................  Intervene hlth/              0322       1.2802       $69.85  ...........       $13.97
                                                                    behave, indiv.
96153................  S....................  ...................  Intervene hlth/              0322       1.2802       $69.85  ...........       $13.97
                                                                    behave, group.
96154................  S....................  ...................  Interv hlth/behav,           0322       1.2802       $69.85  ...........       $13.97
                                                                    fam w/pt.
96155................  S....................  ...................  Interv hlth/behav            0322       1.2802       $69.85  ...........       $13.97
                                                                    fam no pt.
96400................  B....................  ...................  Chemotherapy, sc/im.  ...........  ...........  ...........  ...........  ...........
96405................  B....................  ...................  Intralesional chemo   ...........  ...........  ...........  ...........  ...........
                                                                    admin.
96406................  B....................  ...................  Intralesional chemo   ...........  ...........  ...........  ...........  ...........
                                                                    admin.
96408................  B....................  ...................  Chemotherapy, push    ...........  ...........  ...........  ...........  ...........
                                                                    technique.
96410................  B....................  ...................  Chemotherapy,infusio  ...........  ...........  ...........  ...........  ...........
                                                                    n method.
96412................  B....................  ...................  Chemo, infuse method  ...........  ...........  ...........  ...........  ...........
                                                                    add-on.
96414................  B....................  ...................  Chemo, infuse method  ...........  ...........  ...........  ...........  ...........
                                                                    add-on.
96420................  B....................  ...................  Chemotherapy, push    ...........  ...........  ...........  ...........  ...........
                                                                    technique.
96422................  B....................  ...................  Chemotherapy,infusio  ...........  ...........  ...........  ...........  ...........
                                                                    n method.
96423................  B....................  ...................  Chemo, infuse method  ...........  ...........  ...........  ...........  ...........
                                                                    add-on.
96425................  B....................  ...................  Chemotherapy,infusio  ...........  ...........  ...........  ...........  ...........
                                                                    n method.
96440................  B....................  ...................  Chemotherapy,         ...........  ...........  ...........  ...........  ...........
                                                                    intracavitary.
96445................  B....................  ...................  Chemotherapy,         ...........  ...........  ...........  ...........  ...........
                                                                    intracavitary.
96450................  B....................  ...................  Chemotherapy, into    ...........  ...........  ...........  ...........  ...........
                                                                    CNS.
96520................  T....................  ...................  Port pump refill &           0125       2.1606      $117.88  ...........       $23.58
                                                                    main.
96530................  T....................  ...................  Pump refilling,              0125       2.1606      $117.88  ...........       $23.58
                                                                    maintenance.
96542................  B....................  ...................  Chemotherapy          ...........  ...........  ...........  ...........  ...........
                                                                    injection.
96545................  B....................  ...................  Provide chemotherapy  ...........  ...........  ...........  ...........  ...........
                                                                    agent.
96549................  B....................  ...................  Chemotherapy,         ...........  ...........  ...........  ...........  ...........
                                                                    unspecified.
96567................  T....................  ...................  Photodynamic tx,             1540  ...........      $150.00  ...........       $30.00
                                                                    skin.
96570................  T....................  ...................  Photodynamic tx, 30          1541  ...........      $250.00  ...........       $50.00
                                                                    min.
96571................  T....................  ...................  Photodynamic tx,             1541  ...........      $250.00  ...........       $50.00
                                                                    addl 15 min.
96900................  S....................  ...................  Ultraviolet light            0001       0.4237       $23.12        $7.09        $4.62
                                                                    therapy.
96902................  N....................  ...................  Trichogram..........  ...........  ...........  ...........  ...........  ...........
96910................  S....................  ...................  Photochemotherapy            0001       0.4237       $23.12        $7.09        $4.62
                                                                    with UV-B.
96912................  S....................  ...................  Photochemotherapy            0001       0.4237       $23.12        $7.09        $4.62
                                                                    with UV-A.
96913................  S....................  ...................  Photochemotherapy,           0683       1.5489       $84.51       $30.42       $16.90
                                                                    UV-A or B.
96920................  T....................  ...................  Laser tx, skin < 250         0012       0.7694       $41.98       $11.18        $8.40
                                                                    sq cm.
96921................  T....................  ...................  Laser tx, skin 250-          0012       0.7694       $41.98       $11.18        $8.40
                                                                    500 sq cm.
96922................  T....................  ...................  Laser tx, skin  500 sq cm.
96999................  T....................  ...................  Dermatological               0010       0.6480       $35.36       $10.08        $7.07
                                                                    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.  ...........  ...........  ...........  ...........  ...........

[[Page 63598]]

 
97530................  A....................  ...................  Therapeutic           ...........  ...........  ...........  ...........  ...........
                                                                    activities.
97532................  A....................  ...................  Cognitive skills      ...........  ...........  ...........  ...........  ...........
                                                                    development.
97533................  A....................  ...................  Sensory integration.  ...........  ...........  ...........  ...........  ...........
97535................  A....................  ...................  Self care mngment     ...........  ...........  ...........  ...........  ...........
                                                                    training.
97537................  A....................  ...................  Community/work        ...........  ...........  ...........  ...........  ...........
                                                                    reintegration.
97542................  A....................  ...................  Wheelchair mngment    ...........  ...........  ...........  ...........  ...........
                                                                    training.
97545................  A....................  ...................  Work hardening......  ...........  ...........  ...........  ...........  ...........
97546................  A....................  ...................  Work hardening add-   ...........  ...........  ...........  ...........  ...........
                                                                    on.
97601................  A....................  ...................  Wound(s) care,        ...........  ...........  ...........  ...........  ...........
                                                                    selective.
97602................  N....................  ...................  Wound(s) care non-    ...........  ...........  ...........  ...........  ...........
                                                                    selective.
97703................  A....................  ...................  Prosthetic checkout.  ...........  ...........  ...........  ...........  ...........
97750................  A....................  ...................  Physical performance  ...........  ...........  ...........  ...........  ...........
                                                                    test.
97755................  A....................  NI.................  Assistive technology  ...........  ...........  ...........  ...........  ...........
                                                                    assess.
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       0.2788       $15.21  ...........        $3.04
                                                                    manipulation.
98926................  S....................  ...................  Osteopathic                  0060       0.2788       $15.21  ...........        $3.04
                                                                    manipulation.
98927................  S....................  ...................  Osteopathic                  0060       0.2788       $15.21  ...........        $3.04
                                                                    manipulation.
98928................  S....................  ...................  Osteopathic                  0060       0.2788       $15.21  ...........        $3.04
                                                                    manipulation.
98929................  S....................  ...................  Osteopathic                  0060       0.2788       $15.21  ...........        $3.04
                                                                    manipulation.
98940................  S....................  ...................  Chiropractic                 0060       0.2788       $15.21  ...........        $3.04
                                                                    manipulation.
98941................  S....................  ...................  Chiropractic                 0060       0.2788       $15.21  ...........        $3.04
                                                                    manipulation.
98942................  S....................  ...................  Chiropractic                 0060       0.2788       $15.21  ...........        $3.04
                                                                    manipulation.
98943................  E....................  ...................  Chiropractic          ...........  ...........  ...........  ...........  ...........
                                                                    manipulation.
99000................  B....................  ...................  Specimen handling...  ...........  ...........  ...........  ...........  ...........
99001................  B....................  ...................  Specimen handling...  ...........  ...........  ...........  ...........  ...........
99002................  E....................  ...................  Device handling.....  ...........  ...........  ...........  ...........  ...........
99024................  B....................  ...................  Postop follow-up      ...........  ...........  ...........  ...........  ...........
                                                                    visit.
99025................  B....................  DG.................  Initial surgical      ...........  ...........  ...........  ...........  ...........
                                                                    evaluation.
99026................  E....................  ...................  In-hospital on call   ...........  ...........  ...........  ...........  ...........
                                                                    service.
99027................  E....................  ...................  Out-of-hosp on call   ...........  ...........  ...........  ...........  ...........
                                                                    service.
99050................  B....................  ...................  Medical services      ...........  ...........  ...........  ...........  ...........
                                                                    after hrs.
99052................  B....................  ...................  Medical services at   ...........  ...........  ...........  ...........  ...........
                                                                    night.
99054................  B....................  ...................  Medical servcs,       ...........  ...........  ...........  ...........  ...........
                                                                    unusual hrs.
99056................  B....................  ...................  Non-office medical    ...........  ...........  ...........  ...........  ...........
                                                                    services.
99058................  B....................  ...................  Office emergency      ...........  ...........  ...........  ...........  ...........
                                                                    care.
99070................  B....................  ...................  Special supplies....  ...........  ...........  ...........  ...........  ...........
99071................  B....................  ...................  Patient education     ...........  ...........  ...........  ...........  ...........
                                                                    materials.
99075................  E....................  ...................  Medical testimony...  ...........  ...........  ...........  ...........  ...........
99078................  N....................  ...................  Group health          ...........  ...........  ...........  ...........  ...........
                                                                    education.
99080................  B....................  ...................  Special reports or    ...........  ...........  ...........  ...........  ...........
                                                                    forms.
99082................  B....................  ...................  Unusual physician     ...........  ...........  ...........  ...........  ...........
                                                                    travel.
99090................  B....................  ...................  Computer data         ...........  ...........  ...........  ...........  ...........
                                                                    analysis.
99091................  E....................  ...................  Collect/review data   ...........  ...........  ...........  ...........  ...........
                                                                    from pt.
99100................  B....................  ...................  Special anesthesia    ...........  ...........  ...........  ...........  ...........
                                                                    service.
99116................  B....................  ...................  Anesthesia with       ...........  ...........  ...........  ...........  ...........
                                                                    hypothermia.
99135................  B....................  ...................  Special anesthesia    ...........  ...........  ...........  ...........  ...........
                                                                    procedure.
99140................  E....................  ...................  Emergency anesthesia  ...........  ...........  ...........  ...........  ...........
99141................  N....................  ...................  Sedation, iv/im or    ...........  ...........  ...........  ...........  ...........
                                                                    inhalant.
99142................  N....................  ...................  Sedation, oral/       ...........  ...........  ...........  ...........  ...........
                                                                    rectal/nasal.
99170................  T....................  ...................  Anogenital exam,             0191       0.1853       $10.11        $2.93        $2.02
                                                                    child.
99172................  E....................  ...................  Ocular function       ...........  ...........  ...........  ...........  ...........
                                                                    screen.
99173................  E....................  ...................  Visual acuity screen  ...........  ...........  ...........  ...........  ...........
99175................  N....................  ...................  Induction of          ...........  ...........  ...........  ...........  ...........
                                                                    vomiting.
99183................  B....................  ...................  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       0.5607       $30.59       $10.09        $6.12
99199................  B....................  ...................  Special service/proc/ ...........  ...........  ...........  ...........  ...........
                                                                    report.
99201................  V....................  ...................  Office/outpatient            0600       0.9278       $50.62  ...........       $10.12
                                                                    visit, new.
99202................  V....................  ...................  Office/outpatient            0600       0.9278       $50.62  ...........       $10.12
                                                                    visit, new.
99203................  V....................  ...................  Office/outpatient            0601       0.9816       $53.56  ...........       $10.71
                                                                    visit, new.
99204................  V....................  ...................  Office/outpatient            0602       1.5041       $82.07  ...........       $16.41
                                                                    visit, new.
99205................  V....................  ...................  Office/outpatient            0602       1.5041       $82.07  ...........       $16.41
                                                                    visit, new.
99211................  V....................  ...................  Office/outpatient            0600       0.9278       $50.62  ...........       $10.12
                                                                    visit, est.
99212................  V....................  ...................  Office/outpatient            0600       0.9278       $50.62  ...........       $10.12
                                                                    visit, est.
99213................  V....................  ...................  Office/outpatient            0601       0.9816       $53.56  ...........       $10.71
                                                                    visit, est.
99214................  V....................  ...................  Office/outpatient            0602       1.5041       $82.07  ...........       $16.41
                                                                    visit, est.

[[Page 63599]]

 
99215................  V....................  ...................  Office/outpatient            0602       1.5041       $82.07  ...........       $16.41
                                                                    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       0.9278       $50.62  ...........       $10.12
99242................  V....................  ...................  Office consultation.         0600       0.9278       $50.62  ...........       $10.12
99243................  V....................  ...................  Office consultation.         0601       0.9816       $53.56  ...........       $10.71
99244................  V....................  ...................  Office consultation.         0602       1.5041       $82.07  ...........       $16.41
99245................  V....................  ...................  Office consultation.         0602       1.5041       $82.07  ...........       $16.41
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       0.9278       $50.62  ...........       $10.12
                                                                    consultation.
99272................  V....................  ...................  Confirmatory                 0600       0.9278       $50.62  ...........       $10.12
                                                                    consultation.
99273................  V....................  ...................  Confirmatory                 0601       0.9816       $53.56  ...........       $10.71
                                                                    consultation.
99274................  V....................  ...................  Confirmatory                 0602       1.5041       $82.07  ...........       $16.41
                                                                    consultation.
99275................  V....................  ...................  Confirmatory                 0602       1.5041       $82.07  ...........       $16.41
                                                                    consultation.
99281................  V....................  ...................  Emergency dept visit         0610       1.3691       $74.70       $19.57       $14.94
99282................  V....................  ...................  Emergency dept visit         0610       1.3691       $74.70       $19.57       $14.94
99283................  V....................  ...................  Emergency dept visit         0611       2.3967      $130.77       $36.16       $26.15
99284................  V....................  ...................  Emergency dept visit         0612       4.1476      $226.30       $54.12       $45.26
99285................  V....................  ...................  Emergency dept visit         0612       4.1476      $226.30       $54.12       $45.26
99288................  B....................  ...................  Direct advanced life  ...........  ...........  ...........  ...........  ...........
                                                                    support.
99289................  N....................  ...................  Pt transport, 30-74   ...........  ...........  ...........  ...........  ...........
                                                                    min.
99290................  N....................  ...................  Pt transport, addl    ...........  ...........  ...........  ...........  ...........
                                                                    30 min.
99291................  S....................  ...................  Critical care, first         0620       8.9992      $491.01      $142.30       $98.20
                                                                    hour.
99292................  N....................  ...................  Critical care, add'l  ...........  ...........  ...........  ...........  ...........
                                                                    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................  B....................  ...................  Nursing facility      ...........  ...........  ...........  ...........  ...........
                                                                    care.
99302................  B....................  ...................  Nursing facility      ...........  ...........  ...........  ...........  ...........
                                                                    care.
99303................  B....................  ...................  Nursing facility      ...........  ...........  ...........  ...........  ...........
                                                                    care.
99311................  B....................  ...................  Nursing fac care,     ...........  ...........  ...........  ...........  ...........
                                                                    subseq.
99312................  B....................  ...................  Nursing fac care,     ...........  ...........  ...........  ...........  ...........
                                                                    subseq.
99313................  B....................  ...................  Nursing fac care,     ...........  ...........  ...........  ...........  ...........
                                                                    subseq.
99315................  B....................  ...................  Nursing fac           ...........  ...........  ...........  ...........  ...........
                                                                    discharge day.
99316................  B....................  ...................  Nursing fac           ...........  ...........  ...........  ...........  ...........
                                                                    discharge day.
99321................  B....................  ...................  Rest home visit, new  ...........  ...........  ...........  ...........  ...........
                                                                    patient.
99322................  B....................  ...................  Rest home visit, new  ...........  ...........  ...........  ...........  ...........
                                                                    patient.
99323................  B....................  ...................  Rest home visit, new  ...........  ...........  ...........  ...........  ...........
                                                                    patient.
99331................  B....................  ...................  Rest home visit, est  ...........  ...........  ...........  ...........  ...........
                                                                    pat.
99332................  B....................  ...................  Rest home visit, est  ...........  ...........  ...........  ...........  ...........
                                                                    pat.
99333................  B....................  ...................  Rest home visit, est  ...........  ...........  ...........  ...........  ...........
                                                                    pat.
99341................  B....................  ...................  Home visit, new       ...........  ...........  ...........  ...........  ...........
                                                                    patient.
99342................  B....................  ...................  Home visit, new       ...........  ...........  ...........  ...........  ...........
                                                                    patient.
99343................  B....................  ...................  Home visit, new       ...........  ...........  ...........  ...........  ...........
                                                                    patient.
99344................  B....................  ...................  Home visit, new       ...........  ...........  ...........  ...........  ...........
                                                                    patient.
99345................  B....................  ...................  Home visit, new       ...........  ...........  ...........  ...........  ...........
                                                                    patient.
99347................  B....................  ...................  Home visit, est       ...........  ...........  ...........  ...........  ...........
                                                                    patient.
99348................  B....................  ...................  Home visit, est       ...........  ...........  ...........  ...........  ...........
                                                                    patient.
99349................  B....................  ...................  Home visit, est       ...........  ...........  ...........  ...........  ...........
                                                                    patient.
99350................  B....................  ...................  Home visit, est       ...........  ...........  ...........  ...........  ...........
                                                                    patient.
99354................  N....................  ...................  Prolonged service,    ...........  ...........  ...........  ...........  ...........
                                                                    office.
99355................  N....................  ...................  Prolonged service,    ...........  ...........  ...........  ...........  ...........
                                                                    office.

[[Page 63600]]

 
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................  B....................  ...................  Physician standby     ...........  ...........  ...........  ...........  ...........
                                                                    services.
99361................  E....................  ...................  Physician/team        ...........  ...........  ...........  ...........  ...........
                                                                    conference.
99362................  E....................  ...................  Physician/team        ...........  ...........  ...........  ...........  ...........
                                                                    conference.
99371................  B....................  ...................  Physician phone       ...........  ...........  ...........  ...........  ...........
                                                                    consultation.
99372................  B....................  ...................  Physician phone       ...........  ...........  ...........  ...........  ...........
                                                                    consultation.
99373................  B....................  ...................  Physician phone       ...........  ...........  ...........  ...........  ...........
                                                                    consultation.
99374................  B....................  ...................  Home health care      ...........  ...........  ...........  ...........  ...........
                                                                    supervision.
99377................  B....................  ...................  Hospice care          ...........  ...........  ...........  ...........  ...........
                                                                    supervision.
99379................  B....................  ...................  Nursing fac care      ...........  ...........  ...........  ...........  ...........
                                                                    supervision.
99380................  B....................  ...................  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       0.9278       $50.62  ...........       $10.12
                                                                    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                      0094       2.6345      $143.74       $48.58       $28.75
                                                                    resuscitation.
99450................  E....................  ...................  Life/disability       ...........  ...........  ...........  ...........  ...........
                                                                    evaluation.
99455................  B....................  ...................  Disability            ...........  ...........  ...........  ...........  ...........
                                                                    examination.
99456................  B....................  ...................  Disability            ...........  ...........  ...........  ...........  ...........
                                                                    examination.
99499................  B....................  ...................  Unlisted e&m service  ...........  ...........  ...........  ...........  ...........
99500................  E....................  ...................  Home visit, prenatal  ...........  ...........  ...........  ...........  ...........
99501................  E....................  ...................  Home visit,           ...........  ...........  ...........  ...........  ...........
                                                                    postnatal.
99502................  E....................  ...................  Home visit, nb care.  ...........  ...........  ...........  ...........  ...........
99503................  E....................  ...................  Home visit, resp      ...........  ...........  ...........  ...........  ...........
                                                                    therapy.
99504................  E....................  ...................  Home visit mech       ...........  ...........  ...........  ...........  ...........
                                                                    ventilator.
99505................  E....................  ...................  Home visit, stoma     ...........  ...........  ...........  ...........  ...........
                                                                    care.
99506................  E....................  ...................  Home visit, im        ...........  ...........  ...........  ...........  ...........
                                                                    injection.
99507................  E....................  ...................  Home visit, cath      ...........  ...........  ...........  ...........  ...........
                                                                    maintain.
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 for        ...........  ...........  ...........  ...........  ...........
                                                                    hemodialysis.
99551................  E....................  DG.................  Home infus, pain      ...........  ...........  ...........  ...........  ...........
                                                                    mgmt, iv/sc.
99552................  E....................  DG.................  Hm infus pain mgmt,   ...........  ...........  ...........  ...........  ...........
                                                                    epid/ith.
99553................  E....................  DG.................  Home infuse,          ...........  ...........  ...........  ...........  ...........
                                                                    tocolytic tx.
99554................  E....................  DG.................  Home infus, hormone/  ...........  ...........  ...........  ...........  ...........
                                                                    platelet.
99555................  E....................  DG.................  Home infuse,          ...........  ...........  ...........  ...........  ...........
                                                                    chemotheraphy.
99556................  E....................  DG.................  Home infus, antibio/  ...........  ...........  ...........  ...........  ...........
                                                                    fung/vir.
99557................  E....................  DG.................  Home infuse,          ...........  ...........  ...........  ...........  ...........
                                                                    anticoagulant.
99558................  E....................  DG.................  Home infuse,          ...........  ...........  ...........  ...........  ...........
                                                                    immunotherapy.
99559................  E....................  DG.................  Home infus, periton   ...........  ...........  ...........  ...........  ...........
                                                                    dialysis.
99560................  E....................  DG.................  Home infus, entero    ...........  ...........  ...........  ...........  ...........
                                                                    nutrition.
99561................  E....................  DG.................  Home infuse,          ...........  ...........  ...........  ...........  ...........
                                                                    hydration tx.
99562................  E....................  DG.................  Home infus, parent    ...........  ...........  ...........  ...........  ...........
                                                                    nutrition.
99563................  E....................  DG.................  Home admin,           ...........  ...........  ...........  ...........  ...........
                                                                    pentamidine.
99564................  E....................  DG.................  Hme infus,            ...........  ...........  ...........  ...........  ...........
                                                                    antihemophil agnt.
99565................  E....................  DG.................  Home infus,           ...........  ...........  ...........  ...........  ...........
                                                                    proteinase inhib.
99566................  E....................  DG.................  Home infuse, iv       ...........  ...........  ...........  ...........  ...........
                                                                    therapy.
99567................  E....................  DG.................  Home infuse, sympath  ...........  ...........  ...........  ...........  ...........
                                                                    agent.

[[Page 63601]]

 
99568................  E....................  DG.................  Home infus, misc      ...........  ...........  ...........  ...........  ...........
                                                                    drug, daily.
99569................  E....................  DG.................  Home infuse, each     ...........  ...........  ...........  ...........  ...........
                                                                    addl tx.
99600................  E....................  ...................  Home visit nos......  ...........  ...........  ...........  ...........  ...........
99601................  E....................  NI.................  Home infusion/visit,  ...........  ...........  ...........  ...........  ...........
                                                                    2 hrs.
99602................  E....................  NI.................  Home infusion, each   ...........  ...........  ...........  ...........  ...........
                                                                    addtl hr.
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.
A0800................  A....................  ...................  Amb trans 7pm-7am...  ...........  ...........  ...........  ...........  ...........
A0888................  E....................  ...................  Noncovered ambulance  ...........  ...........  ...........  ...........  ...........
                                                                    mileage.
A0999................  A....................  ...................  Unlisted ambulance    ...........  ...........  ...........  ...........  ...........
                                                                    service.
A4206................  A....................  ...................  1 CC sterile          ...........  ...........  ...........  ...........  ...........
                                                                    syringe&needle.
A4207................  A....................  ...................  2 CC sterile          ...........  ...........  ...........  ...........  ...........
                                                                    syringe&needle.
A4208................  A....................  ...................  3 CC sterile          ...........  ...........  ...........  ...........  ...........
                                                                    syringe&needle.
A4209................  E....................  ...................  5+ CC sterile         ...........  ...........  ...........  ...........  ...........
                                                                    syringe&needle.
A4210................  E....................  ...................  Nonneedle injection   ...........  ...........  ...........  ...........  ...........
                                                                    device.
A4211................  B....................  ...................  Supp for self-adm     ...........  ...........  ...........  ...........  ...........
                                                                    injections.
A4212................  B....................  ...................  Non coring needle or  ...........  ...........  ...........  ...........  ...........
                                                                    stylet.
A4213................  E....................  ...................  20+ CC syringe only.  ...........  ...........  ...........  ...........  ...........
A4214................  A....................  DG.................  30 CC sterile water/  ...........  ...........  ...........  ...........  ...........
                                                                    saline.
A4215................  E....................  ...................  Sterile needle......  ...........  ...........  ...........  ...........  ...........
A4216................  A....................  NI.................  Sterile water/        ...........  ...........  ...........  ...........  ...........
                                                                    saline, 10 ml.
A4217................  A....................  NI.................  Sterile water/        ...........  ...........  ...........  ...........  ...........
                                                                    saline, 500 ml.
A4220................  N....................  NI.................  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.
A4248................  N....................  ...................  Chlorhexidine         ...........  ...........  ...........  ...........  ...........
                                                                    antisept.
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.

[[Page 63602]]

 
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....................  DG.................  Sterile H2O           ...........  ...........  ...........  ...........  ...........
                                                                    irrigation solut.
A4320................  A....................  ...................  Irrigation tray.....  ...........  ...........  ...........  ...........  ...........
A4321................  A....................  ...................  Cath therapeutic      ...........  ...........  ...........  ...........  ...........
                                                                    irrig agent.
A4322................  A....................  ...................  Irrigation syringe..  ...........  ...........  ...........  ...........  ...........
A4323................  A....................  DG.................  Saline irrigation     ...........  ...........  ...........  ...........  ...........
                                                                    solution.
A4324................  A....................  ...................  Male ext cath w/adh   ...........  ...........  ...........  ...........  ...........
                                                                    coating.
A4325................  A....................  ...................  Male ext cath w/adh   ...........  ...........  ...........  ...........  ...........
                                                                    strip.
A4326................  A....................  ...................  Male external         ...........  ...........  ...........  ...........  ...........
                                                                    catheter.
A4327................  A....................  ...................  Fem urinary collect   ...........  ...........  ...........  ...........  ...........
                                                                    dev cup.
A4328................  A....................  ...................  Fem urinary collect   ...........  ...........  ...........  ...........  ...........
                                                                    pouch.
A4330................  A....................  ...................  Stool collection      ...........  ...........  ...........  ...........  ...........
                                                                    pouch.
A4331................  A....................  ...................  Extension drainage    ...........  ...........  ...........  ...........  ...........
                                                                    tubing.
A4332................  A....................  ...................  Lubricant for cath    ...........  ...........  ...........  ...........  ...........
                                                                    insertion.
A4333................  A....................  ...................  Urinary cath anchor   ...........  ...........  ...........  ...........  ...........
                                                                    device.
A4334................  A....................  ...................  Urinary cath leg      ...........  ...........  ...........  ...........  ...........
                                                                    strap.
A4335................  A....................  ...................  Incontinence supply.  ...........  ...........  ...........  ...........  ...........
A4338................  A....................  ...................  Indwelling catheter   ...........  ...........  ...........  ...........  ...........
                                                                    latex.
A4340................  A....................  ...................  Indwelling catheter   ...........  ...........  ...........  ...........  ...........
                                                                    special.
A4344................  A....................  ...................  Cath indw foley 2     ...........  ...........  ...........  ...........  ...........
                                                                    way silicn.
A4346................  A....................  ...................  Cath indw foley 3     ...........  ...........  ...........  ...........  ...........
                                                                    way.
A4347................  A....................  ...................  Male external         ...........  ...........  ...........  ...........  ...........
                                                                    catheter.
A4348................  A....................  ...................  Male ext cath         ...........  ...........  ...........  ...........  ...........
                                                                    extended wear.
A4351................  A....................  ...................  Straight tip urine    ...........  ...........  ...........  ...........  ...........
                                                                    catheter.
A4352................  A....................  ...................  Coude tip urinary     ...........  ...........  ...........  ...........  ...........
                                                                    catheter.
A4353................  A....................  ...................  Intermittent urinary  ...........  ...........  ...........  ...........  ...........
                                                                    cath.
A4354................  A....................  ...................  Cath insertion tray   ...........  ...........  ...........  ...........  ...........
                                                                    w/bag.
A4355................  A....................  ...................  Bladder irrigation    ...........  ...........  ...........  ...........  ...........
                                                                    tubing.
A4356................  A....................  ...................  Ext ureth clmp or     ...........  ...........  ...........  ...........  ...........
                                                                    compr dvc.
A4357................  A....................  ...................  Bedside drainage bag  ...........  ...........  ...........  ...........  ...........
A4358................  A....................  ...................  Urinary leg or        ...........  ...........  ...........  ...........  ...........
                                                                    abdomen bag.
A4359................  A....................  ...................  Urinary suspensory w/ ...........  ...........  ...........  ...........  ...........
                                                                    o leg b.
A4361................  A....................  ...................  Ostomy face plate...  ...........  ...........  ...........  ...........  ...........
A4362................  A....................  ...................  Solid skin barrier..  ...........  ...........  ...........  ...........  ...........
A4364................  A....................  ...................  Adhesive, liquid or   ...........  ...........  ...........  ...........  ...........
                                                                    equal.
A4365................  A....................  ...................  Adhesive remover      ...........  ...........  ...........  ...........  ...........
                                                                    wipes.
A4366................  A....................  ...................  Ostomy vent.........  ...........  ...........  ...........  ...........  ...........
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.

[[Page 63603]]

 
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[gE].
A4408................  A....................  ...................  Ext wear ost skn      ...........  ...........  ...........  ...........  ...........
                                                                    barr 4sq[gE].
A4409................  A....................  ...................  Ost skn barr w flng   ...........  ...........  ...........  ...........  ...........
                                                                    <=4 sq[gE].
A4410................  A....................  ...................  Ost skn barr w flng   ...........  ...........  ...........  ...........  ...........
                                                                    4sq[gE].
A4413................  A....................  ...................  2 pc drainable ost    ...........  ...........  ...........  ...........  ...........
                                                                    pouch.
A4414................  A....................  ...................  Ostomy sknbarr w      ...........  ...........  ...........  ...........  ...........
                                                                    flng <=4sq[gE].
A4415................  A....................  ...................  Ostomy skn barr w     ...........  ...........  ...........  ...........  ...........
                                                                    flng 4sq[gE].
A4416................  A....................  NI.................  Ost pch clsd w        ...........  ...........  ...........  ...........  ...........
                                                                    barrier/filtr.
A4417................  A....................  NI.................  Ost pch w bar/        ...........  ...........  ...........  ...........  ...........
                                                                    bltinconv/fltr.
A4418................  A....................  NI.................  Ost pch clsd w/o bar  ...........  ...........  ...........  ...........  ...........
                                                                    w filtr.
A4419................  A....................  NI.................  Ost pch for bar w     ...........  ...........  ...........  ...........  ...........
                                                                    flange/flt.
A4420................  A....................  NI.................  Ost pch clsd for bar  ...........  ...........  ...........  ...........  ...........
                                                                    w lk fl.
A4421................  A....................  ...................  Ostomy supply misc..  ...........  ...........  ...........  ...........  ...........
A4422................  A....................  ...................  Ost pouch absorbent   ...........  ...........  ...........  ...........  ...........
                                                                    material.
A4424................  A....................  NI.................  Ost pch drain w bar   ...........  ...........  ...........  ...........  ...........
                                                                    & filter.
A4425................  A....................  NI.................  Ost pch drain for     ...........  ...........  ...........  ...........  ...........
                                                                    barrier fl.
A4426................  A....................  NI.................  Ost pch drain 2       ...........  ...........  ...........  ...........  ...........
                                                                    piece system.
A4427................  A....................  NI.................  Ost pch drain/barr    ...........  ...........  ...........  ...........  ...........
                                                                    lk flng/f.
A4428................  A....................  NI.................  Urine ost pouch w     ...........  ...........  ...........  ...........  ...........
                                                                    faucet/tap.
A4429................  A....................  NI.................  Urine ost pch bar w   ...........  ...........  ...........  ...........  ...........
                                                                    lock fln.
A4430................  A....................  NI.................  Ost pch urine w lock  ...........  ...........  ...........  ...........  ...........
                                                                    flng/ft.
A4431................  A....................  NI.................  Urine ost pch bar w   ...........  ...........  ...........  ...........  ...........
                                                                    lock fln.
A4432................  A....................  NI.................  Ost pch urine w lock  ...........  ...........  ...........  ...........  ...........
                                                                    flng/ft.
A4433................  A....................  NI.................  Urine ost pch bar w   ...........  ...........  ...........  ...........  ...........
                                                                    lock fln.
A4434................  A....................  NI.................  Ost pch urine w lock  ...........  ...........  ...........  ...........  ...........
                                                                    flng/ft.
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.

[[Page 63604]]

 
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....................  ...................  Reusable diaper from  ...........  ...........  ...........  ...........  ...........
                                                                    dpr svc.
A4550................  B....................  ...................  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................  E....................  ...................  Splint..............  ...........  ...........  ...........  ...........  ...........
A4575................  E....................  ...................  Hyperbaric o2         ...........  ...........  ...........  ...........  ...........
                                                                    chamber disps.
A4580................  E....................  ...................  Cast supplies         ...........  ...........  ...........  ...........  ...........
                                                                    (plaster).
A4590................  E....................  ...................  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....................  DG.................  Tracheotomy mask or   ...........  ...........  ...........  ...........  ...........
                                                                    collar.
A4622................  A....................  DG.................  Tracheostomy or       ...........  ...........  ...........  ...........  ...........
                                                                    larngectomy.
A4623................  A....................  ...................  Tracheostomy inner    ...........  ...........  ...........  ...........  ...........
                                                                    cannula.
A4624................  A....................  ...................  Tracheal suction      ...........  ...........  ...........  ...........  ...........
                                                                    tube.
A4625................  A....................  ...................  Trach care kit for    ...........  ...........  ...........  ...........  ...........
                                                                    new trach.
A4626................  A....................  ...................  Tracheostomy          ...........  ...........  ...........  ...........  ...........
                                                                    cleaning brush.
A4627................  E....................  ...................  Spacer bag/reservoir  ...........  ...........  ...........  ...........  ...........
A4628................  A....................  ...................  Oropharyngeal         ...........  ...........  ...........  ...........  ...........
                                                                    suction cath.
A4629................  A....................  ...................  Tracheostomy care     ...........  ...........  ...........  ...........  ...........
                                                                    kit.
A4630................  A....................  ...................  Repl bat t.e.n.s.     ...........  ...........  ...........  ...........  ...........
                                                                    own by pt.
A4631................  A....................  DG.................  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.
A4638................  Y....................  NI.................  Repl batt pulse gen   ...........  ...........  ...........  ...........  ...........
                                                                    sys.
A4639................  A....................  ...................  Infrared ht sys       ...........  ...........  ...........  ...........  ...........
                                                                    replcmnt pad.
A4640................  A....................  ...................  Alternating pressure  ...........  ...........  ...........  ...........  ...........
                                                                    pad.
A4641................  N....................  ...................  Diagnostic imaging    ...........  ...........  ...........  ...........  ...........
                                                                    agent.
A4642................  K....................  ...................  Satumomab pendetide          0704       2.2811      $124.46  ...........       $24.89
                                                                    per dose.
A4643................  N....................  ...................  High dose contrast    ...........  ...........  ...........  ...........  ...........
                                                                    MRI.
A4644................  N....................  DG.................  Contrast 100-199 MGs  ...........  ...........  ...........  ...........  ...........
                                                                    iodine.
A4645................  N....................  DG.................  Contrast 200-299 MGs  ...........  ...........  ...........  ...........  ...........
                                                                    iodine.
A4646................  N....................  DG.................  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.
A4671................  E....................  NI.................  Disposable cycler     ...........  ...........  ...........  ...........  ...........
                                                                    set.
A4672................  E....................  NI.................  Drainage ext line,    ...........  ...........  ...........  ...........  ...........
                                                                    dialysis.
A4673................  E....................  NI.................  Ext line w easy lock  ...........  ...........  ...........  ...........  ...........
                                                                    connect.

[[Page 63605]]

 
A4674................  E....................  NI.................  Chem/antisept         ...........  ...........  ...........  ...........  ...........
                                                                    solution, 8oz.
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....................  DG.................  Sterile water inj     ...........  ...........  ...........  ...........  ...........
                                                                    per 10 ml.
A4714................  A....................  ...................  Treated water per     ...........  ...........  ...........  ...........  ...........
                                                                    gallon.
A4719................  A....................  ...................  [gE]Y set[gE] tubing  ...........  ...........  ...........  ...........  ...........
A4720................  A....................  ...................  Dialysat sol fld vol  ...........  ...........  ...........  ...........  ...........
                                                                     249cc.
A4721................  A....................  ...................  Dialysat sol fld vol  ...........  ...........  ...........  ...........  ...........
                                                                     999cc.
A4722................  A....................  ...................  Dialys sol fld vol    ...........  ...........  ...........  ...........  ...........
                                                                     1999cc.
A4723................  A....................  ...................  Dialys sol fld vol    ...........  ...........  ...........  ...........  ...........
                                                                     2999cc.
A4724................  A....................  ...................  Dialys sol fld vol    ...........  ...........  ...........  ...........  ...........
                                                                     3999cc.
A4725................  A....................  ...................  Dialys sol fld vol    ...........  ...........  ...........  ...........  ...........
                                                                     4999cc.
A4726................  A....................  ...................  Dialys sol fld vol    ...........  ...........  ...........  ...........  ...........
                                                                     5999cc.
A4728................  E....................  NI.................  Dialysate solution,   ...........  ...........  ...........  ...........  ...........
                                                                    non-dex.
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.
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.

[[Page 63606]]

 
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.
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.

[[Page 63607]]

 
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.
A6407................  A....................  NI.................  Packing strips, non-  ...........  ...........  ...........  ...........  ...........
                                                                    impreg.
A6410................  A....................  ...................  Sterile eye pad.....  ...........  ...........  ...........  ...........  ...........
A6411................  A....................  ...................  Non-sterile eye pad.  ...........  ...........  ...........  ...........  ...........
A6412................  E....................  ...................  Occlusive eye patch.  ...........  ...........  ...........  ...........  ...........
A6421................  A....................  DG.................  Pad bandage =3 <5in w /roll.
A6422................  A....................  DG.................  Conf bandage ns =3<5[gE]w/
                                                                    roll.
A6424................  A....................  DG.................  Conf bandage ns =5[gE]w /
                                                                    roll.
A6426................  A....................  DG.................  Conf bandage s =3<5[gE] w/
                                                                    roll.
A6428................  A....................  DG.................  Conf bandage s =5[gE] w /
                                                                    roll.
A6430................  A....................  DG.................  Lt compres bdg =3<5[gE]w /
                                                                    roll.
A6432................  A....................  DG.................  Lt compres bdg =5[gE]w /
                                                                    roll.
A6434................  A....................  DG.................  Mo compres bdg =3<5[gE]w /
                                                                    roll.
A6436................  A....................  DG.................  Hi compres bdg =3<5[gE]w /
                                                                    roll.
A6438................  A....................  DG.................  Self-adher bdg =3<5[gE]w /
                                                                    roll.
A6440................  A....................  DG.................  Zinc paste bdg =3<5[gE]w /
                                                                    roll.
A6441................  A....................  NI.................  Pad band w=3[gE] <5[gE]/yd.
A6442................  A....................  NI.................  Conform band n/s      ...........  ...........  ...........  ...........  ...........
                                                                    w<3[gE]/yd.
A6443................  A....................  NI.................  Conform band n/s      ...........  ...........  ...........  ...........  ...........
                                                                    w=3[gE]<
                                                                    5[gE]/yd.
A6444................  A....................  NI.................  Conform band n/s      ...........  ...........  ...........  ...........  ...........
                                                                    w=5[gE]/
                                                                    yd.
A6445................  A....................  NI.................  Conform band s w      ...........  ...........  ...........  ...........  ...........
                                                                    <3[gE]/yd.
A6446................  A....................  NI.................  Conform band s w=3[gE]
                                                                    <5[gE]/yd.
A6447................  A....................  NI.................  Conform band s w =5[gE]/yd.
A6448................  A....................  NI.................  Lt compres band       ...........  ...........  ...........  ...........  ...........
                                                                    <3[gE]/yd.
A6449................  A....................  NI.................  Lt compres band =3[gE]
                                                                    <5[gE]/yd.
A6450................  A....................  NI.................  Lt compres band =5[gE]/yd.
A6451................  A....................  NI.................  Mod compres band      ...........  ...........  ...........  ...........  ...........
                                                                    w=3[gE]<
                                                                    5[gE]/yd.
A6452................  A....................  NI.................  High compres band     ...........  ...........  ...........  ...........  ...........
                                                                    w=3[gE]<
                                                                    5[gE]yd.
A6453................  A....................  NI.................  Self-adher band w     ...........  ...........  ...........  ...........  ...........
                                                                    <3[gE]/yd.
A6454................  A....................  NI.................  Self-adher band w=3[gE]
                                                                    <5[gE]/yd.
A6455................  A....................  NI.................  Self-adher band =5[gE]/yd.
A6456................  A....................  NI.................  Zinc paste band w     ...........  ...........  ...........  ...........  ...........
                                                                    =3[gE]<5
                                                                    [gE]/yd.
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.
A6550................  Y....................  NI.................  Neg pres wound ther   ...........  ...........  ...........  ...........  ...........
                                                                    drsg set.
A6551................  Y....................  NI.................  Neg press wound ther  ...........  ...........  ...........  ...........  ...........
                                                                    canistr.
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....................  DG.................  Saline solution       ...........  ...........  ...........  ...........  ...........
                                                                    dispenser.
A7020................  A....................  DG.................  Sterile H2O or NSS w  ...........  ...........  ...........  ...........  ...........
                                                                    lgv neb.
A7025................  A....................  ...................  Replace chest         ...........  ...........  ...........  ...........  ...........
                                                                    compress vest.
A7026................  A....................  ...................  Replace chst cmprss   ...........  ...........  ...........  ...........  ...........
                                                                    sys hose.

[[Page 63608]]

 
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..  ...........  ...........  ...........  ...........  ...........
A7046................  Y....................  NI.................  Repl water chamber,   ...........  ...........  ...........  ...........  ...........
                                                                    PAP dev.
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.
A7520................  A....................  NI.................  Trach/laryn tube non- ...........  ...........  ...........  ...........  ...........
                                                                    cuffed.
A7521................  A....................  NI.................  Trach/laryn tube      ...........  ...........  ...........  ...........  ...........
                                                                    cuffed.
A7522................  A....................  NI.................  Trach/laryn tube      ...........  ...........  ...........  ...........  ...........
                                                                    stainless.
A7523................  A....................  NI.................  Tracheostomy shower   ...........  ...........  ...........  ...........  ...........
                                                                    protect.
A7524................  A....................  NI.................  Tracheostoma stent/   ...........  ...........  ...........  ...........  ...........
                                                                    stud/bttn.
A7525................  A....................  NI.................  Tracheostomy mask...  ...........  ...........  ...........  ...........  ...........
A7526................  A....................  NI.................  Tracheostomy tube     ...........  ...........  ...........  ...........  ...........
                                                                    collar.
A9150................  B....................  ...................  Misc/exper non-       ...........  ...........  ...........  ...........  ...........
                                                                    prescript dru.
A9270................  E....................  ...................  Non-covered item or   ...........  ...........  ...........  ...........  ...........
                                                                    service.
A9280................  E....................  NI.................  Alert device, noc...  ...........  ...........  ...........  ...........  ...........
A9300................  E....................  ...................  Exercise equipment..  ...........  ...........  ...........  ...........  ...........
A9500................  K....................  ...................  Technetium TC 99m            1600       1.1782       $64.28  ...........       $12.86
                                                                    sestamibi.
A9502................  K....................  ...................  Technetium TC99M             0705       1.0642       $58.06  ...........       $11.61
                                                                    tetrofosmin.
A9503................  N....................  ...................  Technetium TC 99m     ...........  ...........  ...........  ...........  ...........
                                                                    medronate.
A9504................  N....................  ...................  Technetium tc 99m     ...........  ...........  ...........  ...........  ...........
                                                                    apcitide.
A9505................  K....................  ...................  Thallous chloride TL         1603       0.3645       $19.89  ...........        $3.98
                                                                    201/mci.
A9507................  K....................  ...................  Indium/111 capromab          1604      12.6045      $687.71  ...........      $137.54
                                                                    pendetid.
A9508................  K....................  ...................  Iobenguane sulfate I-        1045       3.0392      $165.82  ...........       $33.16
                                                                    131, per 0.5 mCi.
A9510................  N....................  ...................  Technetium TC99m      ...........  ...........  ...........  ...........  ...........
                                                                    Disofenin.
A9511................  K....................  ...................  Technetium TC 99m            1095       0.6940       $37.87  ...........        $7.57
                                                                    depreotide.
A9512................  N....................  ...................  Technetiumtc99mperte  ...........  ...........  ...........  ...........  ...........
                                                                    chnetate.
A9513................  N....................  ...................  Technetium tc-99m     ...........  ...........  ...........  ...........  ...........
                                                                    mebrofenin.
A9514................  N....................  ...................  Technetiumtc99mpyrop  ...........  ...........  ...........  ...........  ...........
                                                                    hosphate.
A9515................  N....................  ...................  Technetium tc-99m     ...........  ...........  ...........  ...........  ...........
                                                                    pentetate.
A9516................  N....................  ...................  I-123 sodium iodide   ...........  ...........  ...........  ...........  ...........
                                                                    capsule.
A9517................  K....................  ...................  Th I131 so iodide            1064       0.1004        $5.48  ...........        $1.10
                                                                    cap millic.
A9518................  D....................  DNG................  I-131 sodium iodide   ...........  ...........  ...........  ...........  ...........
                                                                    solution.
A9519................  N....................  ...................  Technetiumtc-         ...........  ...........  ...........  ...........  ...........
                                                                    99mmacroag albu.
A9520................  N....................  ...................  Technetiumtc-99m      ...........  ...........  ...........  ...........  ...........
                                                                    sulfur clld.
A9521................  K....................  ...................  Technetiumtc-99m             1096       3.8609      $210.65  ...........       $42.13
                                                                    exametazine.
A9522................  B....................  ...................  Indium111ibritumomab  ...........  ...........  ...........  ...........  ...........
                                                                    tiuxetan.
A9523................  B....................  ...................  Yttrium90ibritumomab  ...........  ...........  ...........  ...........  ...........
                                                                    tiuxetan.
A9524................  K....................  ...................  Iodinated I-131              9100       0.0066        $0.36  ...........        $0.07
                                                                    serumalbumin, per
                                                                    5uci.
A9525................  N....................  NI.................  Low/iso-osmolar       ...........  ...........  ...........  ...........  ...........
                                                                    contrast mat.
A9526................  K....................  NI.................  Ammonia N-13, per            9025       2.6372      $143.89  ...........       $28.78
                                                                    dose.
A9527................  B....................  NI.................  I-131 tositumomab     ...........  ...........  ...........  ...........  ...........
                                                                    therapeut.
A9528................  K....................  NI.................  Dx I131 so iodide            1064       0.1004        $5.48  ...........        $1.10
                                                                    cap millic.
A9529................  K....................  NI.................  Dx I131 so iodide            1065       0.1189        $6.49  ...........        $1.30
                                                                    sol millic.
A9530................  K....................  NI.................  Th I131 so iodide            1065       0.1189        $6.49  ...........        $1.30
                                                                    sol millic.
A9531................  N....................  NI.................  Dx I131 so iodide     ...........  ...........  ...........  ...........  ...........
                                                                    microcurie.
A9532................  N....................  NI.................  I-125 serum albumin   ...........  ...........  ...........  ...........  ...........
                                                                    micro.
A9533................  B....................  NI.................  I-131 tositumomab     ...........  ...........  ...........  ...........  ...........
                                                                    diagnostic.
A9534................  B....................  NI.................  I-131 tositumomab     ...........  ...........  ...........  ...........  ...........
                                                                    therapeut.
A9600................  K....................  ...................  Strontium-89                 0701       7.3835      $402.85  ...........       $80.57
                                                                    chloride.
A9605................  K....................  ...................  Samarium sm153               0702      16.0268      $874.44  ...........      $174.89
                                                                    lexidronamm.
A9699................  N....................  ...................  Noc therapeutic       ...........  ...........  ...........  ...........  ...........
                                                                    radiopharm.
A9700................  E....................  ...................  Echocardiography             9202       2.1737      $118.60  ...........       $23.72
                                                                    Contrast.
A9900................  A....................  ...................  Supply/accessory/     ...........  ...........  ...........  ...........  ...........
                                                                    service.
A9901................  A....................  ...................  Delivery/set up/      ...........  ...........  ...........  ...........  ...........
                                                                    dispensing.
A9999................  Y....................  NI.................  DME supply or         ...........  ...........  ...........  ...........  ...........
                                                                    accessory, nos.
B4034................  A....................  ...................  Enter feed supkit     ...........  ...........  ...........  ...........  ...........
                                                                    syr by day.
B4035................  A....................  ...................  Enteral feed supp     ...........  ...........  ...........  ...........  ...........
                                                                    pump per d.

[[Page 63609]]

 
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.
B9999................  A....................  ...................  Parenteral supp not   ...........  ...........  ...........  ...........  ...........
                                                                    othrws c.
C1010................  K....................  DG.................  Blood, L/R, CMV-NEG.         1010  ...........      $121.78  ...........       $24.36
C1011................  K....................  DG.................  Platelets, HLA-m, L/         1011  ...........      $499.77  ...........       $99.95
                                                                    R, unit.
C1015................  K....................  DG.................  Plt, pher,L/R,CMV,           1020  ...........      $495.22  ...........       $99.04
                                                                    irrad.
C1016................  K....................  DG.................  BLOOD,L/R,FROZ/DEGLY/        1016  ...........      $301.68  ...........       $60.34
                                                                    Washed.
C1017................  K....................  DG.................  Plt, APH/PHER,L/             1017  ...........      $393.15  ...........       $78.63
                                                                    R,CMV-NEG.
C1018................  K....................  DG.................  Blood, L/R,                  1018  ...........      $132.40  ...........       $26.48
                                                                    IRRADIATED.
C1020................  K....................  DG.................  RBC, frz/deg/wsh, L/         1021  ...........      $336.04  ...........       $67.21
                                                                    R, irrad.
C1021................  K....................  DG.................  RBC, L/R, CMV neg,           1022  ...........      $201.12  ...........       $40.22
                                                                    irrad.
C1022................  K....................  DG.................  Plasma, frz within           0955  ...........       $95.00  ...........       $19.00
                                                                    24 hour.
C1079................  K....................  ...................  CO 57/58 per 0.5 uCi         1079       1.2556       $68.51  ...........       $13.70
C1080................  K....................  NI.................  I-131 tositumomab,           1080  ...........    $2,260.00  ...........      $452.00
                                                                    dx.
C1081................  K....................  NI.................  I-131 tositumomab,           1081  ...........   $19,565.00  ...........    $3,913.00
                                                                    tx.
C1082................  K....................  NF.................  In-111 ibritumomab           9118  ...........    $2,260.00  ...........      $452.00
                                                                    tiuxetan.
C1083................  K....................  NF.................  Yttrium 90                   9117  ...........   $19,565.00  ...........    $3,913.00
                                                                    ibritumomab
                                                                    tiuxetan.
C1088................  T....................  ...................  LASER OPTIC TR Sys..         1557  ...........    $1,850.00  ...........      $370.00
C1091................  K....................  ...................  IN111                        1091       4.1151      $224.52  ...........       $44.90
                                                                    oxyquinoline,per0.5
                                                                    mCi.
C1092................  K....................  ...................  IN 111 pentetate per         1092       3.9855      $217.45  ...........       $43.49
                                                                    0.5 mCi.
C1122................  K....................  ...................  Tc 99M ARCITUMOMAB           1122       9.8014      $534.77  ...........      $106.95
                                                                    PER VIAL.
C1166................  K....................  DG.................  CYTARABINE                   1166       5.1134      $278.99  ...........       $55.80
                                                                    LIPOSOMAL, 10 mg.
C1167................  K....................  DG.................  EPIRUBICIN HCL, 2 mg         1167       0.3744       $20.43  ...........        $4.09
C1178................  K....................  ...................  BUSULFAN IV, 6 Mg...         1178       5.4930      $299.70  ...........       $59.94
C1200................  K....................  ...................  TC 99M Sodium                1200       0.5550       $30.28  ...........        $6.06
                                                                    Glucoheptonat.
C1201................  K....................  ...................  TC 99M SUCCIMER, PER         1201       1.4706       $80.24  ...........       $16.05
                                                                    Vial.
C1300................  S....................  ...................  HYPERBARIC Oxygen...         0659       3.0228      $164.93  ...........       $32.99
C1305................  K....................  ...................  Apligraf............         1305      15.0691      $822.19  ...........      $164.44
C1713................  N....................  NF.................  Anchor/screw bn/      ...........  ...........  ...........  ...........  ...........
                                                                    bn,tis/bn.
C1714................  N....................  NF.................  Cath, trans           ...........  ...........  ...........  ...........  ...........
                                                                    atherectomy, dir.
C1715................  N....................  NF.................  Brachytherapy needle  ...........  ...........  ...........  ...........  ...........
C1716................  K....................  ...................  Brachytx source,             1716       1.3811       $75.35  ...........       $15.07
                                                                    Gold 198.
C1717................  N....................  NF.................  Brachytx source, HDR  ...........  ...........  ...........  ...........  ...........
                                                                    Ir-192.
C1718................  K....................  ...................  Brachytx source,             1718       0.6843       $37.34  ...........        $7.47
                                                                    Iodine 125.
C1719................  K....................  ...................  Brachytx sour,Non-           1719       0.3187       $17.39  ...........        $3.48
                                                                    HDR Ir-192.
C1720................  K....................  ...................  Brachytx sour,               1720       0.8187       $44.67  ...........        $8.93
                                                                    Palladium 103.
C1721................  N....................  NF.................  AICD, dual chamber..  ...........  ...........  ...........  ...........  ...........
C1722................  N....................  NF.................  AICD, single chamber  ...........  ...........  ...........  ...........  ...........
C1724................  N....................  NF.................  Cath, trans           ...........  ...........  ...........  ...........  ...........
                                                                    atherec,rotation.
C1725................  N....................  NF.................  Cath, translumin non- ...........  ...........  ...........  ...........  ...........
                                                                    laser.

[[Page 63610]]

 
C1726................  N....................  NF.................  Cath, bal dil, non-   ...........  ...........  ...........  ...........  ...........
                                                                    vascular.
C1727................  N....................  NF.................  Cath, bal tis dis,    ...........  ...........  ...........  ...........  ...........
                                                                    non-vas.
C1728................  N....................  NF.................  Cath, brachytx seed   ...........  ...........  ...........  ...........  ...........
                                                                    adm.
C1729................  N....................  NF.................  Cath, drainage......  ...........  ...........  ...........  ...........  ...........
C1730................  N....................  NF.................  Cath, EP, 19 or few   ...........  ...........  ...........  ...........  ...........
                                                                    elect.
C1731................  N....................  NF.................  Cath, EP, 20 or more  ...........  ...........  ...........  ...........  ...........
                                                                    elec.
C1732................  N....................  NF.................  Cath, EP, diag/abl,   ...........  ...........  ...........  ...........  ...........
                                                                    3D/vect.
C1733................  N....................  NF.................  Cath, EP, othr than   ...........  ...........  ...........  ...........  ...........
                                                                    cool-tip.
C1750................  N....................  NF.................  Cath,                 ...........  ...........  ...........  ...........  ...........
                                                                    hemodialysis,long-
                                                                    term.
C1751................  N....................  NF.................  Cath, inf, per/cent/  ...........  ...........  ...........  ...........  ...........
                                                                    midline.
C1752................  N....................  NF.................  Cath,hemodialysis,sh  ...........  ...........  ...........  ...........  ...........
                                                                    ort-term.
C1753................  N....................  NF.................  Cath, intravas        ...........  ...........  ...........  ...........  ...........
                                                                    ultrasound.
C1754................  N....................  NF.................  Catheter,             ...........  ...........  ...........  ...........  ...........
                                                                    intradiscal.
C1755................  N....................  NF.................  Catheter,             ...........  ...........  ...........  ...........  ...........
                                                                    intraspinal.
C1756................  N....................  NF.................  Cath, pacing,         ...........  ...........  ...........  ...........  ...........
                                                                    transesoph.
C1757................  N....................  NF.................  Cath, thrombectomy/   ...........  ...........  ...........  ...........  ...........
                                                                    embolect.
C1758................  N....................  NF.................  Catheter, ureteral..  ...........  ...........  ...........  ...........  ...........
C1759................  N....................  NF.................  Cath, intra           ...........  ...........  ...........  ...........  ...........
                                                                    echocardiography.
C1760................  N....................  NF.................  Closure dev, vasc...  ...........  ...........  ...........  ...........  ...........
C1762................  N....................  NF.................  Conn tiss, human(inc  ...........  ...........  ...........  ...........  ...........
                                                                    fascia).
C1763................  N....................  NF.................  Conn tiss, non-human  ...........  ...........  ...........  ...........  ...........
C1764................  N....................  NF.................  Event recorder,       ...........  ...........  ...........  ...........  ...........
                                                                    cardiac.
C1765................  N....................  ...................  Adhesion barrier....  ...........  ...........  ...........  ...........  ...........
C1766................  N....................  NF.................  Intro/                ...........  ...........  ...........  ...........  ...........
                                                                    sheath,strble,non-
                                                                    peel.
C1767................  N....................  NF.................  Generator,            ...........  ...........  ...........  ...........  ...........
                                                                    neurostim, imp.
C1768................  N....................  NF.................  Graft, vascular.....  ...........  ...........  ...........  ...........  ...........
C1769................  N....................  NF.................  Guide wire..........  ...........  ...........  ...........  ...........  ...........
C1770................  N....................  NF.................  Imaging coil, MR,     ...........  ...........  ...........  ...........  ...........
                                                                    insertable.
C1771................  N....................  NF.................  Rep dev, urinary, w/  ...........  ...........  ...........  ...........  ...........
                                                                    sling.
C1772................  N....................  NF.................  Infusion pump,        ...........  ...........  ...........  ...........  ...........
                                                                    programmable.
C1773................  N....................  NF.................  Ret dev, insertable.  ...........  ...........  ...........  ...........  ...........
C1774................  K....................  DG.................  Darbepoetin alfa, 1          0734  ...........        $3.24  ...........        $0.65
                                                                    mcg.
C1775................  K....................  ...................  FDG, per dose (4-40          1775       5.9471      $324.48  ...........       $64.90
                                                                    mCi/ml).
C1776................  N....................  NF.................  Joint device          ...........  ...........  ...........  ...........  ...........
                                                                    (implantable).
C1777................  N....................  NF.................  Lead, AICD, endo      ...........  ...........  ...........  ...........  ...........
                                                                    single coil.
C1778................  N....................  NF.................  Lead,                 ...........  ...........  ...........  ...........  ...........
                                                                    neurostimulator.
C1779................  N....................  NF.................  Lead, pmkr,           ...........  ...........  ...........  ...........  ...........
                                                                    transvenous VDD.
C1780................  N....................  NF.................  Lens, intraocular     ...........  ...........  ...........  ...........  ...........
                                                                    (new tech).
C1781................  N....................  NF.................  Mesh (implantable)..  ...........  ...........  ...........  ...........  ...........
C1782................  N....................  NF.................  Morcellator.........  ...........  ...........  ...........  ...........  ...........
C1783................  H....................  ...................  Ocular imp, aqueous          1783  ...........  ...........  ...........  ...........
                                                                    drain ev.
C1784................  N....................  NF.................  Ocular dev, intraop,  ...........  ...........  ...........  ...........  ...........
                                                                    det ret.
C1785................  N....................  NF.................  Pmkr, dual, rate-     ...........  ...........  ...........  ...........  ...........
                                                                    resp.
C1786................  N....................  NF.................  Pmkr, single, rate-   ...........  ...........  ...........  ...........  ...........
                                                                    resp.
C1787................  N....................  NF.................  Patient progr,        ...........  ...........  ...........  ...........  ...........
                                                                    neurostim.
C1788................  N....................  NF.................  Port, indwelling,     ...........  ...........  ...........  ...........  ...........
                                                                    imp.
C1789................  N....................  NF.................  Prosthesis, breast,   ...........  ...........  ...........  ...........  ...........
                                                                    imp.
C1813................  N....................  NF.................  Prosthesis, penile,   ...........  ...........  ...........  ...........  ...........
                                                                    inflatab.
C1814................  H....................  NF.................  Retinal tamp,                1814  ...........  ...........  ...........  ...........
                                                                    silicone oil.
C1815................  N....................  NF.................  Pros, urinary sph,    ...........  ...........  ...........  ...........  ...........
                                                                    imp.
C1816................  N....................  NF.................  Receiver/             ...........  ...........  ...........  ...........  ...........
                                                                    transmitter, neuro.
C1817................  N....................  NF.................  Septal defect imp     ...........  ...........  ...........  ...........  ...........
                                                                    sys.
C1818................  H....................  ...................  Integrated                   1818  ...........  ...........  ...........  ...........
                                                                    keratoprosthesis.
C1819................  H....................  NI.................  Tissue localization-         1819  ...........  ...........  ...........  ...........
                                                                    excision dev.
C1874................  N....................  NF.................  Stent, coated/cov w/  ...........  ...........  ...........  ...........  ...........
                                                                    del sys.
C1875................  N....................  NF.................  Stent, coated/cov w/  ...........  ...........  ...........  ...........  ...........
                                                                    o del sy.
C1876................  N....................  NF.................  Stent, non-coa/non-   ...........  ...........  ...........  ...........  ...........
                                                                    cov w/del.
C1877................  N....................  NF.................  Stent, non-coat/cov   ...........  ...........  ...........  ...........  ...........
                                                                    w/o del.
C1878................  N....................  NF.................  Matrl for vocal cord  ...........  ...........  ...........  ...........  ...........
C1879................  N....................  NF.................  Tissue marker,        ...........  ...........  ...........  ...........  ...........
                                                                    implantable.
C1880................  N....................  NF.................  Vena cava filter....  ...........  ...........  ...........  ...........  ...........
C1881................  N....................  NF.................  Dialysis access       ...........  ...........  ...........  ...........  ...........
                                                                    system.
C1882................  N....................  NF.................  AICD, other than      ...........  ...........  ...........  ...........  ...........
                                                                    sing/dual.
C1883................  N....................  NF.................  Adapt/ext, pacing/    ...........  ...........  ...........  ...........  ...........
                                                                    neuro lead.
C1884................  H....................  NI.................  Embolization Protect         1884  ...........  ...........  ...........  ...........
                                                                    syst.
C1885................  N....................  NF.................  Cath, translumin      ...........  ...........  ...........  ...........  ...........
                                                                    angio laser.
C1887................  N....................  NF.................  Catheter, guiding...  ...........  ...........  ...........  ...........  ...........
C1888................  H....................  ...................  Catheter, ablation,          1888  ...........  ...........  ...........  ...........
                                                                    non-cardiac,
                                                                    endovascular
                                                                    (implantable).
C1891................  N....................  NF.................  Infusion pump,non-    ...........  ...........  ...........  ...........  ...........
                                                                    prog, perm.
C1892................  N....................  NF.................  Intro/                ...........  ...........  ...........  ...........  ...........
                                                                    sheath,fixed,peel-
                                                                    away.
C1893................  N....................  NF.................  Intro/sheath,         ...........  ...........  ...........  ...........  ...........
                                                                    fixed,non-peel.
C1894................  N....................  NF.................  Intro/sheath, non-    ...........  ...........  ...........  ...........  ...........
                                                                    laser.
C1895................  N....................  NF.................  Lead, AICD, endo      ...........  ...........  ...........  ...........  ...........
                                                                    dual coil.
C1896................  N....................  NF.................  Lead, AICD, non sing/ ...........  ...........  ...........  ...........  ...........
                                                                    dual.

[[Page 63611]]

 
C1897................  N....................  NF.................  Lead, neurostim test  ...........  ...........  ...........  ...........  ...........
                                                                    kit.
C1898................  N....................  NF.................  Lead, pmkr, other     ...........  ...........  ...........  ...........  ...........
                                                                    than trans.
C1899................  N....................  NF.................  Lead, pmkr/AICD       ...........  ...........  ...........  ...........  ...........
                                                                    combination.
C1900................  H....................  ...................  Lead coronary venous         1900  ...........  ...........  ...........  ...........
C2614................  H....................  ...................  Probe, perc lumb             2614  ...........  ...........  ...........  ...........
                                                                    disc.
C2615................  N....................  NF.................  Sealant, pulmonary,   ...........  ...........  ...........  ...........  ...........
                                                                    liquid.
C2616................  K....................  ...................  Brachytx source,             2616     176.2339    $9,615.50  ...........    $1,923.10
                                                                    Yttrium-90.
C2617................  N....................  NF.................  Stent, non-cor, tem   ...........  ...........  ...........  ...........  ...........
                                                                    w/o del.
C2618................  N....................  ...................  Probe, cryoablation.  ...........  ...........  ...........  ...........  ...........
C2619................  N....................  NF.................  Pmkr, dual, non rate- ...........  ...........  ...........  ...........  ...........
                                                                    resp.
C2620................  N....................  NF.................  Pmkr, single, non     ...........  ...........  ...........  ...........  ...........
                                                                    rate-resp.
C2621................  N....................  NF.................  Pmkr, other than      ...........  ...........  ...........  ...........  ...........
                                                                    sing/dual.
C2622................  N....................  NF.................  Prosthesis, penile,   ...........  ...........  ...........  ...........  ...........
                                                                    non-inf.
C2625................  N....................  NF.................  Stent, non-cor, tem   ...........  ...........  ...........  ...........  ...........
                                                                    w/del sy.
C2626................  N....................  NF.................  Infusion pump, non-   ...........  ...........  ...........  ...........  ...........
                                                                    prog,temp.
C2627................  N....................  NF.................  Cath, suprapubic/     ...........  ...........  ...........  ...........  ...........
                                                                    cystoscopic.
C2628................  N....................  NF.................  Catheter, occlusion.  ...........  ...........  ...........  ...........  ...........
C2629................  N....................  NF.................  Intro/sheath, laser.  ...........  ...........  ...........  ...........  ...........
C2630................  N....................  NF.................  Cath, EP, cool-tip..  ...........  ...........  ...........  ...........  ...........
C2631................  N....................  NF.................  Rep dev, urinary, w/  ...........  ...........  ...........  ...........  ...........
                                                                    o sling.
C2632................  H....................  ...................  Brachytx sol, I-125,         2632  ...........  ...........  ...........  ...........
                                                                    per mCi.
C2633................  K....................  NI.................  Brachytx source,             2633       0.8187       $44.67  ...........        $8.93
                                                                    Cesium-131.
C8900................  S....................  ...................  MRA w/cont, abd.....         0284       7.1165      $388.28      $194.13       $77.66
C8901................  S....................  ...................  MRA w/o cont, abd...         0336       6.3897      $348.63      $174.31       $69.73
C8902................  S....................  ...................  MRA w/o fol w/cont,          0337       9.2075      $502.37      $240.77      $100.47
                                                                    abd.
C8903................  S....................  ...................  MRI w/cont, breast,          0284       7.1165      $388.28      $194.13       $77.66
                                                                    uni.
C8904................  S....................  ...................  MRI w/o cont,                0336       6.3897      $348.63      $174.31       $69.73
                                                                    breast, uni.
C8905................  S....................  ...................  MRI w/o fol w/cont,          0337       9.2075      $502.37      $240.77      $100.47
                                                                    brst, un.
C8906................  S....................  ...................  MRI w/cont, breast,          0284       7.1165      $388.28      $194.13       $77.66
                                                                    bi.
C8907................  S....................  ...................  MRI w/o cont,                0336       6.3897      $348.63      $174.31       $69.73
                                                                    breast, bi.
C8908................  S....................  ...................  MRI w/o fol w/cont,          0337       9.2075      $502.37      $240.77      $100.47
                                                                    breast,.
C8909................  S....................  ...................  MRA w/cont, chest...         0284       7.1165      $388.28      $194.13       $77.66
C8910................  S....................  ...................  MRA w/o cont, chest.         0336       6.3897      $348.63      $174.31       $69.73
C8911................  S....................  ...................  MRA w/o fol w/cont,          0337       9.2075      $502.37      $240.77      $100.47
                                                                    chest.
C8912................  S....................  ...................  MRA w/cont, lwr ext.         0284       7.1165      $388.28      $194.13       $77.66
C8913................  S....................  ...................  MRA w/o cont, lwr            0336       6.3897      $348.63      $174.31       $69.73
                                                                    ext.
C8914................  S....................  ...................  MRA w/o fol w/cont,          0337       9.2075      $502.37      $240.77      $100.47
                                                                    lwr ext.
C8918................  S....................  NF.................  MRA w/cont, pelvis..         0284       7.1165      $388.28      $194.13       $77.66
C8919................  S....................  NF.................  MRA w/o cont, pelvis         0336       6.3897      $348.63      $174.31       $69.73
C8920................  S....................  NF.................  MRA w/o fol w/cont,          0337       9.2075      $502.37      $240.77      $100.47
                                                                    pelvis.
C9000................  N....................  ...................  Na chromateCr51, per  ...........  ...........  ...........  ...........  ...........
                                                                    0.25mCi.
C9003................  K....................  ...................  Palivizumab, per 50          9003       6.3077      $344.15  ...........       $68.83
                                                                    mg.
C9007................  N....................  ...................  Baclofen Intrathecal  ...........  ...........  ...........  ...........  ...........
                                                                    kit-1am.
C9008................  K....................  ...................  Baclofen Refill Kit-         9008       0.1264        $6.90  ...........        $1.38
                                                                    500mcg.
C9009................  K....................  ...................  Baclofen Refill Kit-         9009       0.7499       $40.92  ...........        $8.18
                                                                    2000mcg.
C9010................  K....................  DG.................  Baclofen Refill Kit-         9010       0.7739       $42.22  ...........        $8.44
                                                                    4000mcg.
C9013................  K....................  ...................  Co 57 cobaltous              9013       1.0386       $56.67  ...........       $11.33
                                                                    chloride.
C9102................  N....................  ...................  51 Na Chromate,       ...........  ...........  ...........  ...........  ...........
                                                                    50mCi.
C9103................  N....................  ...................  Na Iothalamate I-     ...........  ...........  ...........  ...........  ...........
                                                                    125, 10 uCi.
C9105................  K....................  ...................  Hep B imm glob, per          9105       1.3074       $71.33  ...........       $14.27
                                                                    1 ml.
C9109................  K....................  ...................  Tirofiban hcl, 6.25          9109       2.1737      $118.60  ...........       $23.72
                                                                    mg.
C9111................  D....................  DNG................  Inj, bivalirudin,     ...........  ...........  ...........  ...........  ...........
                                                                    250mg vial.
C9112................  G....................  ...................  Perflutren lipid             9112  ...........      $148.20  ...........       $22.15
                                                                    micro, 2ml.
C9113................  G....................  ...................  Inj pantoprazole             9113  ...........       $25.08  ...........        $3.75
                                                                    sodium, via.
C9116................  D....................  DNG................  Ertapenem sodium,     ...........  ...........       $23.74  ...........  ...........
                                                                    per 1 gm.
C9119................  D....................  DNG................  Injection,            ...........  ...........  ...........  ...........  ...........
                                                                    pegfilgrastim.
C9120................  D....................  DNG................  Injection,            ...........  ...........  ...........  ...........  ...........
                                                                    fulvestrant.
C9121................  G....................  ...................  Injection,                   9121  ...........       $16.35  ...........        $2.44
                                                                    argatroban.
C9123................  G....................  NF.................  Transcyte, per 247           9123  ...........      $770.93  ...........      $115.23
                                                                    sq cm.
C9200................  G....................  ...................  Orcel, per 36 cm2...         9200  ...........    $1,135.25            $      $169.69
C9201................  G....................  ...................  Dermagraft, per 37.5         9201  ...........      $577.60  ...........       $86.34
                                                                    sq cm.
C9202................  K....................  NF.................  Octafluoropropane...         9202       2.1737      $118.60  ...........       $23.72
C9203................  G....................  NF.................  Perflexane lipid             9203  ...........      $142.50  ...........       $21.30
                                                                    micro.
C9204................  D....................  DNG................  Ziprasidone mesylate  ...........  ...........  ...........  ...........  ...........
C9205................  G....................  ...................  Oxaliplatin.........         9205  ...........       $94.46  ...........       $14.12
C9207................  G....................  NI.................  Injection,                   9207  ...........    $1,039.68  ...........      $155.40
                                                                    bortezomib.
C9208................  G....................  NF.................  Injection,                   9208  ...........      $123.78  ...........       $18.50
                                                                    agalsidase beta.
C9209................  G....................  NF.................  Injection,                   9209  ...........      $644.10  ...........       $96.28
                                                                    laronidase.
C9210................  G....................  NI.................  Injection,                   9210  ...........      $307.80  ...........       $46.01
                                                                    palonosetron HCL.
C9211................  G....................  NI.................  Inj, alefacept, IV..         9211  ...........      $665.00  ...........       $99.40
C9212................  G....................  NI.................  Inj, alefacept, IM..         9212  ...........      $472.63  ...........       $70.65
C9503................  K....................  DG.................  Fresh frozen plasma,         9503  ...........       $69.74  ...........       $13.95
                                                                    ea unit.
C9701................  T....................  ...................  Stretta System......         1557  ...........    $1,850.00  ...........      $370.00
C9703................  T....................  ...................  Bard Endoscopic              1555  ...........    $1,650.00  ...........      $330.00
                                                                    Suturing Sys.
C9704................  T....................  NI.................  Inj inert subs upper         1556  ...........    $1,750.00  ...........      $350.00
                                                                    GI.

[[Page 63612]]

 
C9711................  T....................  DG.................  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       0.5745       $31.35  ...........        $6.27
                                                                    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           0330       0.5745       $31.35  ...........        $6.27
                                                                    film.
D0250................  S....................  ...................  Extraoral first film         0330       0.5745       $31.35  ...........        $6.27
D0260................  S....................  ...................  Extraoral ea                 0330       0.5745       $31.35  ...........        $6.27
                                                                    additional film.
D0270................  S....................  ...................  Dental bitewing              0330       0.5745       $31.35  ...........        $6.27
                                                                    single film.
D0272................  S....................  ...................  Dental bitewings two         0330       0.5745       $31.35  ...........        $6.27
                                                                    films.
D0274................  S....................  ...................  Dental bitewings             0330       0.5745       $31.35  ...........        $6.27
                                                                    four films.
D0277................  S....................  ...................  Vert bitewings-sev           0330       0.5745       $31.35  ...........        $6.27
                                                                    to eight.
D0290................  E....................  ...................  Dental film skull/    ...........  ...........  ...........  ...........  ...........
                                                                    facial bon.
D0310................  E....................  ...................  Dental saliography..  ...........  ...........  ...........  ...........  ...........
D0320................  E....................  ...................  Dental tmj            ...........  ...........  ...........  ...........  ...........
                                                                    arthrogram incl i.
D0321................  E....................  ...................  Dental other tmj      ...........  ...........  ...........  ...........  ...........
                                                                    films.
D0322................  E....................  ...................  Dental tomographic    ...........  ...........  ...........  ...........  ...........
                                                                    survey.
D0330................  E....................  ...................  Dental panoramic      ...........  ...........  ...........  ...........  ...........
                                                                    film.
D0340................  E....................  ...................  Dental cephalometric  ...........  ...........  ...........  ...........  ...........
                                                                    film.
D0350................  E....................  ...................  Oral/facial images..  ...........  ...........  ...........  ...........  ...........
D0415................  E....................  ...................  Bacteriologic study.  ...........  ...........  ...........  ...........  ...........
D0425................  E....................  ...................  Caries                ...........  ...........  ...........  ...........  ...........
                                                                    susceptibility test.
D0460................  S....................  ...................  Pulp vitality test..         0330       0.5745       $31.35  ...........        $6.27
D0470................  E....................  ...................  Diagnostic casts....  ...........  ...........  ...........  ...........  ...........
D0472................  S....................  ...................  Gross exam, prep &           0330       0.5745       $31.35  ...........        $6.27
                                                                    report.
D0473................  S....................  ...................  Micro exam, prep &           0330       0.5745       $31.35  ...........        $6.27
                                                                    report.
D0474................  S....................  ...................  Micro w exam of surg         0330       0.5745       $31.35  ...........        $6.27
                                                                    margins.
D0480................  S....................  ...................  Cytopath smear prep          0330       0.5745       $31.35  ...........        $6.27
                                                                    & report.
D0502................  S....................  ...................  Other oral pathology         0330       0.5745       $31.35  ...........        $6.27
                                                                    procedu.
D0999................  S....................  ...................  Unspecified                  0330       0.5745       $31.35  ...........        $6.27
                                                                    diagnostic 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       0.5745       $31.35  ...........        $6.27
                                                                    unilat.
D1515................  S....................  ...................  Fixed bilat space            0330       0.5745       $31.35  ...........        $6.27
                                                                    maintainer.
D1520................  S....................  ...................  Remove unilat space          0330       0.5745       $31.35  ...........        $6.27
                                                                    maintain.
D1525................  S....................  ...................  Remove bilat space           0330       0.5745       $31.35  ...........        $6.27
                                                                    maintain.
D1550................  S....................  ...................  Recement space               0330       0.5745       $31.35  ...........        $6.27
                                                                    maintainer.
D2140................  E....................  ...................  Amalgam one surface   ...........  ...........  ...........  ...........  ...........
                                                                    permanen.
D2150................  E....................  ...................  Amalgam two surfaces  ...........  ...........  ...........  ...........  ...........
                                                                    permane.
D2160................  E....................  ...................  Amalgam three         ...........  ...........  ...........  ...........  ...........
                                                                    surfaces perma.
D2161................  E....................  ...................  Amalgam 4 or  surfaces perm.
D2330................  E....................  ...................  Resin one surface-    ...........  ...........  ...........  ...........  ...........
                                                                    anterior.
D2331................  E....................  ...................  Resin two surfaces-   ...........  ...........  ...........  ...........  ...........
                                                                    anterior.
D2332................  E....................  ...................  Resin three surfaces- ...........  ...........  ...........  ...........  ...........
                                                                    anterio.
D2335................  E....................  ...................  Resin 4/   ...........  ...........  ...........  ...........  ...........
                                                                    surf or w incis an.
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.

[[Page 63613]]

 
D2642................  E....................  ...................  Dental onlay          ...........  ...........  ...........  ...........  ...........
                                                                    porcelin 2 surf.
D2643................  E....................  ...................  Dental onlay          ...........  ...........  ...........  ...........  ...........
                                                                    porcelin 3 surf.
D2644................  E....................  ...................  Dental onlay porc 4/  ...........  ...........  ...........  ...........  ...........
                                                                    more sur.
D2650................  E....................  ...................  Inlay composite/      ...........  ...........  ...........  ...........  ...........
                                                                    resin one su.
D2651................  E....................  ...................  Inlay composite/      ...........  ...........  ...........  ...........  ...........
                                                                    resin two su.
D2652................  E....................  ...................  Dental inlay resin 3/ ...........  ...........  ...........  ...........  ...........
                                                                    mre sur.
D2662................  E....................  ...................  Dental onlay resin 2  ...........  ...........  ...........  ...........  ...........
                                                                    surface.
D2663................  E....................  ...................  Dental onlay resin 3  ...........  ...........  ...........  ...........  ...........
                                                                    surface.
D2664................  E....................  ...................  Dental onlay resin 4/ ...........  ...........  ...........  ...........  ...........
                                                                    mre sur.
D2710................  E....................  ...................  Crown resin           ...........  ...........  ...........  ...........  ...........
                                                                    laboratory.
D2720................  E....................  ...................  Crown resin w/ high   ...........  ...........  ...........  ...........  ...........
                                                                    noble me.
D2721................  E....................  ...................  Crown resin w/ base   ...........  ...........  ...........  ...........  ...........
                                                                    metal.
D2722................  E....................  ...................  Crown resin w/ noble  ...........  ...........  ...........  ...........  ...........
                                                                    metal.
D2740................  E....................  ...................  Crown porcelain/      ...........  ...........  ...........  ...........  ...........
                                                                    ceramic subs.
D2750................  E....................  ...................  Crown porcelain w/ h  ...........  ...........  ...........  ...........  ...........
                                                                    noble m.
D2751................  E....................  ...................  Crown porcelain       ...........  ...........  ...........  ...........  ...........
                                                                    fused base m.
D2752................  E....................  ...................  Crown porcelain w/    ...........  ...........  ...........  ...........  ...........
                                                                    noble met.
D2780................  E....................  ...................  Crown 3/4 cast hi     ...........  ...........  ...........  ...........  ...........
                                                                    noble met.
D2781................  E....................  ...................  Crown 3/4 cast base   ...........  ...........  ...........  ...........  ...........
                                                                    metal.
D2782................  E....................  ...................  Crown 3/4 cast noble  ...........  ...........  ...........  ...........  ...........
                                                                    metal.
D2783................  E....................  ...................  Crown 3/4 porcelain/  ...........  ...........  ...........  ...........  ...........
                                                                    ceramic.
D2790................  E....................  ...................  Crown full cast high  ...........  ...........  ...........  ...........  ...........
                                                                    noble m.
D2791................  E....................  ...................  Crown full cast base  ...........  ...........  ...........  ...........  ...........
                                                                    metal.
D2792................  E....................  ...................  Crown full cast       ...........  ...........  ...........  ...........  ...........
                                                                    noble metal.
D2799................  E....................  ...................  Provisional crown...  ...........  ...........  ...........  ...........  ...........
D2910................  E....................  ...................  Dental recement       ...........  ...........  ...........  ...........  ...........
                                                                    inlay.
D2920................  E....................  ...................  Dental recement       ...........  ...........  ...........  ...........  ...........
                                                                    crown.
D2930................  E....................  ...................  Prefab stnlss steel   ...........  ...........  ...........  ...........  ...........
                                                                    crwn pri.
D2931................  E....................  ...................  Prefab stnlss steel   ...........  ...........  ...........  ...........  ...........
                                                                    crown pe.
D2932................  E....................  ...................  Prefabricated resin   ...........  ...........  ...........  ...........  ...........
                                                                    crown.
D2933................  E....................  ...................  Prefab stainless      ...........  ...........  ...........  ...........  ...........
                                                                    steel crown.
D2940................  E....................  ...................  Dental sedative       ...........  ...........  ...........  ...........  ...........
                                                                    filling.
D2950................  E....................  ...................  Core build-up incl    ...........  ...........  ...........  ...........  ...........
                                                                    any pins.
D2951................  E....................  ...................  Tooth pin retention.  ...........  ...........  ...........  ...........  ...........
D2952................  E....................  ...................  Post and core cast +  ...........  ...........  ...........  ...........  ...........
                                                                    crown.
D2953................  E....................  ...................  Each addtnl cast      ...........  ...........  ...........  ...........  ...........
                                                                    post.
D2954................  E....................  ...................  Prefab post/core +    ...........  ...........  ...........  ...........  ...........
                                                                    crown.
D2955................  E....................  ...................  Post removal........  ...........  ...........  ...........  ...........  ...........
D2957................  E....................  ...................  Each addtnl prefab    ...........  ...........  ...........  ...........  ...........
                                                                    post.
D2960................  E....................  ...................  Laminate labial       ...........  ...........  ...........  ...........  ...........
                                                                    veneer.
D2961................  E....................  ...................  Lab labial veneer     ...........  ...........  ...........  ...........  ...........
                                                                    resin.
D2962................  E....................  ...................  Lab labial veneer     ...........  ...........  ...........  ...........  ...........
                                                                    porcelain.
D2970................  S....................  ...................  Temporary- fractured         0330       0.5745       $31.35  ...........        $6.27
                                                                    tooth.
D2980................  E....................  ...................  Crown repair........  ...........  ...........  ...........  ...........  ...........
D2999................  S....................  ...................  Dental unspec                0330       0.5745       $31.35  ...........        $6.27
                                                                    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                   0330       0.5745       $31.35  ...........        $6.27
                                                                    endosseous 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       0.5745       $31.35  ...........        $6.27

[[Page 63614]]

 
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       0.5745       $31.35  ...........        $6.27
                                                                    quadrant.
D4261................  E....................  ...................  Osseous surgl-        ...........  ...........  ...........  ...........  ...........
                                                                    3teethperquad.
D4263................  S....................  ...................  Bone replce graft            0330       0.5745       $31.35  ...........        $6.27
                                                                    first site.
D4264................  S....................  ...................  Bone replce graft            0330       0.5745       $31.35  ...........        $6.27
                                                                    each 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       0.5745       $31.35  ...........        $6.27
                                                                    procedure.
D4270................  S....................  ...................  Pedicle soft tissue          0330       0.5745       $31.35  ...........        $6.27
                                                                    graft pr.
D4271................  S....................  ...................  Free soft tissue             0330       0.5745       $31.35  ...........        $6.27
                                                                    graft proc.
D4273................  S....................  ...................  Subepithelial tissue         0330       0.5745       $31.35  ...........        $6.27
                                                                    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                   0330       0.5745       $31.35  ...........        $6.27
                                                                    debridement.
D4381................  S....................  ...................  Localized chemo              0330       0.5745       $31.35  ...........        $6.27
                                                                    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.
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.

[[Page 63615]]

 
D5899................  E....................  ...................  Removable             ...........  ...........  ...........  ...........  ...........
                                                                    prosthodontic proc.
D5911................  S....................  ...................  Facial moulage               0330       0.5745       $31.35  ...........        $6.27
                                                                    sectional.
D5912................  S....................  ...................  Facial moulage               0330       0.5745       $31.35  ...........        $6.27
                                                                    complete.
D5913................  E....................  ...................  Nasal prosthesis....  ...........  ...........  ...........  ...........  ...........
D5914................  E....................  ...................  Auricular prosthesis  ...........  ...........  ...........  ...........  ...........
D5915................  E....................  ...................  Orbital prosthesis..  ...........  ...........  ...........  ...........  ...........
D5916................  E....................  ...................  Ocular prosthesis...  ...........  ...........  ...........  ...........  ...........
D5919................  E....................  ...................  Facial prosthesis...  ...........  ...........  ...........  ...........  ...........
D5922................  E....................  ...................  Nasal septal          ...........  ...........  ...........  ...........  ...........
                                                                    prosthesis.
D5923................  E....................  ...................  Ocular prosthesis     ...........  ...........  ...........  ...........  ...........
                                                                    interim.
D5924................  E....................  ...................  Cranial prosthesis..  ...........  ...........  ...........  ...........  ...........
D5925................  E....................  ...................  Facial augmentation   ...........  ...........  ...........  ...........  ...........
                                                                    implant.
D5926................  E....................  ...................  Replacement nasal     ...........  ...........  ...........  ...........  ...........
                                                                    prosthesis.
D5927................  E....................  ...................  Auricular             ...........  ...........  ...........  ...........  ...........
                                                                    replacement.
D5928................  E....................  ...................  Orbital replacement.  ...........  ...........  ...........  ...........  ...........
D5929................  E....................  ...................  Facial replacement..  ...........  ...........  ...........  ...........  ...........
D5931................  E....................  ...................  Surgical obturator..  ...........  ...........  ...........  ...........  ...........
D5932................  E....................  ...................  Postsurgical          ...........  ...........  ...........  ...........  ...........
                                                                    obturator.
D5933................  E....................  ...................  Refitting of          ...........  ...........  ...........  ...........  ...........
                                                                    obturator.
D5934................  E....................  ...................  Mandibular flange     ...........  ...........  ...........  ...........  ...........
                                                                    prosthesis.
D5935................  E....................  ...................  Mandibular denture    ...........  ...........  ...........  ...........  ...........
                                                                    prosth.
D5936................  E....................  ...................  Temp obturator        ...........  ...........  ...........  ...........  ...........
                                                                    prosthesis.
D5937................  E....................  ...................  Trismus appliance...  ...........  ...........  ...........  ...........  ...........
D5951................  E....................  ...................  Feeding aid.........  ...........  ...........  ...........  ...........  ...........
D5952................  E....................  ...................  Pediatric speech aid  ...........  ...........  ...........  ...........  ...........
D5953................  E....................  ...................  Adult speech aid....  ...........  ...........  ...........  ...........  ...........
D5954................  E....................  ...................  Superimposed          ...........  ...........  ...........  ...........  ...........
                                                                    prosthesis.
D5955................  E....................  ...................  Palatal lift          ...........  ...........  ...........  ...........  ...........
                                                                    prosthesis.
D5958................  E....................  ...................  Intraoral con def     ...........  ...........  ...........  ...........  ...........
                                                                    inter plt.
D5959................  E....................  ...................  Intraoral con def     ...........  ...........  ...........  ...........  ...........
                                                                    mod palat.
D5960................  E....................  ...................  Modify speech aid     ...........  ...........  ...........  ...........  ...........
                                                                    prosthesis.
D5982................  E....................  ...................  Surgical stent......  ...........  ...........  ...........  ...........  ...........
D5983................  S....................  ...................  Radiation applicator         0330       0.5745       $31.35  ...........        $6.27
D5984................  S....................  ...................  Radiation shield....         0330       0.5745       $31.35  ...........        $6.27
D5985................  S....................  ...................  Radiation cone               0330       0.5745       $31.35  ...........        $6.27
                                                                    locator.
D5986................  E....................  ...................  Fluoride applicator.  ...........  ...........  ...........  ...........  ...........
D5987................  S....................  ...................  Commissure splint...         0330       0.5745       $31.35  ...........        $6.27
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...  ...........  ...........  ...........  ...........  ...........

[[Page 63616]]

 
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.
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       0.5745       $31.35  ...........        $6.27
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       0.5745       $31.35  ...........        $6.27
                                                                    deciduous t.
D7140................  S....................  ...................  Extraction erupted           0330       0.5745       $31.35  ...........        $6.27
                                                                    tooth/exr.
D7210................  S....................  ...................  Rem imp tooth w              0330       0.5745       $31.35  ...........        $6.27
                                                                    mucoper flp.
D7220................  S....................  ...................  Impact tooth remov           0330       0.5745       $31.35  ...........        $6.27
                                                                    soft tiss.
D7230................  S....................  ...................  Impact tooth remov           0330       0.5745       $31.35  ...........        $6.27
                                                                    part bony.
D7240................  S....................  ...................  Impact tooth remov           0330       0.5745       $31.35  ...........        $6.27
                                                                    comp bony.
D7241................  S....................  ...................  Impact tooth rem             0330       0.5745       $31.35  ...........        $6.27
                                                                    bony w/comp.
D7250................  S....................  ...................  Tooth root removal..         0330       0.5745       $31.35  ...........        $6.27
D7260................  S....................  ...................  Oral antral fistula          0330       0.5745       $31.35  ...........        $6.27
                                                                    closure.
D7261................  S....................  ...................  Primary closure              0330       0.5745       $31.35  ...........        $6.27
                                                                    sinus 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.

[[Page 63617]]

 
D7287................  E....................  ...................  Cytology sample       ...........  ...........  ...........  ...........  ...........
                                                                    collection.
D7290................  E....................  ...................  Repositioning of      ...........  ...........  ...........  ...........  ...........
                                                                    teeth.
D7291................  S....................  ...................  Transseptal                  0330       0.5745       $31.35  ...........        $6.27
                                                                    fiberotomy.
D7310................  E....................  ...................  Alveoplasty w/        ...........  ...........  ...........  ...........  ...........
                                                                    extraction.
D7320................  E....................  ...................  Alveoplasty w/o       ...........  ...........  ...........  ...........  ...........
                                                                    extraction.
D7340................  E....................  ...................  Vestibuloplasty       ...........  ...........  ...........  ...........  ...........
                                                                    ridge extens.
D7350................  E....................  ...................  Vestibuloplasty       ...........  ...........  ...........  ...........  ...........
                                                                    exten graft.
D7410................  E....................  ...................  Rad exc lesion up to  ...........  ...........  ...........  ...........  ...........
                                                                    1.25 cm.
D7411................  E....................  ...................  Excision benign       ...........  ...........  ...........  ...........  ...........
                                                                    lesion1.
                                                                    25c.
D7412................  E....................  ...................  Excision benign       ...........  ...........  ...........  ...........  ...........
                                                                    lesion compl.
D7413................  E....................  ...................  Excision malig        ...........  ...........  ...........  ...........  ...........
                                                                    lesion<=1.25c.
D7414................  E....................  ...................  Excision malig        ...........  ...........  ...........  ...........  ...........
                                                                    lesion1.
                                                                    25cm.
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.
D7912................  E....................  ...................  Suture complicate     ...........  ...........  ...........  ...........  ...........
                                                                    wnd  5
                                                                    cm.
D7920................  E....................  ...................  Dental skin graft...  ...........  ...........  ...........  ...........  ...........
D7940................  S....................  ...................  Reshaping bone               0330       0.5745       $31.35  ...........        $6.27
                                                                    orthognathic.

[[Page 63618]]

 
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/                 0330       0.5745       $31.35  ...........        $6.27
                                                                    medicaments.
D9910................  E....................  ...................  Dent appl             ...........  ...........  ...........  ...........  ...........
                                                                    desensitizing med.
D9911................  E....................  ...................  Appl desensitizing    ...........  ...........  ...........  ...........  ...........
                                                                    resin.
D9920................  E....................  ...................  Behavior management.  ...........  ...........  ...........  ...........  ...........
D9930................  S....................  ...................  Treatment of                 0330       0.5745       $31.35  ...........        $6.27
                                                                    complications.
D9940................  S....................  ...................  Dental occlusal              0330       0.5745       $31.35  ...........        $6.27
                                                                    guard.
D9941................  E....................  ...................  Fabrication athletic  ...........  ...........  ...........  ...........  ...........
                                                                    guard.
D9950................  S....................  ...................  Occlusion analysis..         0330       0.5745       $31.35  ...........        $6.27
D9951................  S....................  ...................  Limited occlusal             0330       0.5745       $31.35  ...........        $6.27
                                                                    adjustment.
D9952................  S....................  ...................  Complete occlusal            0330       0.5745       $31.35  ...........        $6.27
                                                                    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.

[[Page 63619]]

 
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.
E0118................  E....................  NI.................  Crutch substitute...  ...........  ...........  ...........  ...........  ...........
E0130................  A....................  ...................  Walker rigid adjust/  ...........  ...........  ...........  ...........  ...........
                                                                    fixed ht.
E0135................  A....................  ...................  Walker folding        ...........  ...........  ...........  ...........  ...........
                                                                    adjust/fixed.
E0140................  Y....................  NI.................  Walker w trunk        ...........  ...........  ...........  ...........  ...........
                                                                    support.
E0141................  A....................  ...................  Rigid walker wheeled  ...........  ...........  ...........  ...........  ...........
                                                                    wo seat.
E0142................  A....................  DG.................  Walker rigid wheeled  ...........  ...........  ...........  ...........  ...........
                                                                    with se.
E0143................  A....................  ...................  Walker folding        ...........  ...........  ...........  ...........  ...........
                                                                    wheeled w/o s.
E0144................  A....................  ...................  Enclosed walker w     ...........  ...........  ...........  ...........  ...........
                                                                    rear seat.
E0145................  A....................  DG.................  Walker whled seat/    ...........  ...........  ...........  ...........  ...........
                                                                    crutch att.
E0146................  A....................  DG.................  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....................  DG.................  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.
E0190................  E....................  NI.................  Positioning cushion.  ...........  ...........  ...........  ...........  ...........
E0191................  A....................  ...................  Protector heel or     ...........  ...........  ...........  ...........  ...........
                                                                    elbow.
E0192................  A....................  ...................  Pad wheelchr low      ...........  ...........  ...........  ...........  ...........
                                                                    press/posit.
E0193................  A....................  ...................  Powered air           ...........  ...........  ...........  ...........  ...........
                                                                    flotation bed.
E0194................  A....................  ...................  Air fluidized bed...  ...........  ...........  ...........  ...........  ...........
E0196................  A....................  ...................  Gel pressure          ...........  ...........  ...........  ...........  ...........
                                                                    mattress.
E0197................  A....................  ...................  Air pressure pad for  ...........  ...........  ...........  ...........  ...........
                                                                    mattres.
E0198................  A....................  ...................  Water pressure pad    ...........  ...........  ...........  ...........  ...........
                                                                    for mattr.
E0199................  A....................  ...................  Dry pressure pad for  ...........  ...........  ...........  ...........  ...........
                                                                    mattres.
E0200................  A....................  ...................  Heat lamp without     ...........  ...........  ...........  ...........  ...........
                                                                    stand.
E0202................  A....................  ...................  Phototherapy light w/ ...........  ...........  ...........  ...........  ...........
                                                                     photom.
E0203................  A....................  ...................  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...  ...........  ...........  ...........  ...........  ...........

[[Page 63620]]

 
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.
E0240................  E....................  NI.................  Bath/shower chair...  ...........  ...........  ...........  ...........  ...........
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.
E0247................  E....................  NI.................  Trans bench w/wo      ...........  ...........  ...........  ...........  ...........
                                                                    comm open.
E0248................  E....................  NI.................  HDtrans bench w/wo    ...........  ...........  ...........  ...........  ...........
                                                                    comm open.
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.
E0300................  Y....................  NI.................  Enclosed ped crib     ...........  ...........  ...........  ...........  ...........
                                                                    hosp grade.
E0301................  Y....................  NI.................  HD hosp bed, 350-600  ...........  ...........  ...........  ...........  ...........
                                                                    lbs.
E0302................  Y....................  NI.................  Ex hd hosp bed  600 lbs.
E0303................  Y....................  NI.................  Hosp bed hvy dty      ...........  ...........  ...........  ...........  ...........
                                                                    xtra wide.
E0304................  Y....................  NI.................  Hosp bed xtra hvy     ...........  ...........  ...........  ...........  ...........
                                                                    dty x wide.
E0305................  A....................  ...................  Rails bed side half   ...........  ...........  ...........  ...........  ...........
                                                                    length.
E0310................  A....................  ...................  Rails bed side full   ...........  ...........  ...........  ...........  ...........
                                                                    length.
E0315................  E....................  ...................  Bed accessory brd/    ...........  ...........  ...........  ...........  ...........
                                                                    tbl/supprt.
E0316................  A....................  ...................  Bed safety enclosure  ...........  ...........  ...........  ...........  ...........
E0325................  A....................  ...................  Urinal male jug-type  ...........  ...........  ...........  ...........  ...........
E0326................  A....................  ...................  Urinal female jug-    ...........  ...........  ...........  ...........  ...........
                                                                    type.
E0350................  E....................  ...................  Control unit bowel    ...........  ...........  ...........  ...........  ...........
                                                                    system.
E0352................  E....................  ...................  Disposable pack w/    ...........  ...........  ...........  ...........  ...........
                                                                    bowel syst.
E0370................  E....................  ...................  Air elevator for      ...........  ...........  ...........  ...........  ...........
                                                                    heel.
E0371................  A....................  ...................  Nonpower mattress     ...........  ...........  ...........  ...........  ...........
                                                                    overlay.
E0372................  A....................  ...................  Powered air mattress  ...........  ...........  ...........  ...........  ...........
                                                                    overlay.
E0373................  A....................  ...................  Nonpowered pressure   ...........  ...........  ...........  ...........  ...........
                                                                    mattress.
E0424................  A....................  ...................  Stationary            ...........  ...........  ...........  ...........  ...........
                                                                    compressed gas 02.
E0425................  E....................  ...................  Gas system            ...........  ...........  ...........  ...........  ...........
                                                                    stationary compre.
E0430................  E....................  ...................  Oxygen system gas     ...........  ...........  ...........  ...........  ...........
                                                                    portable.
E0431................  A....................  ...................  Portable gaseous 02.  ...........  ...........  ...........  ...........  ...........
E0434................  A....................  ...................  Portable liquid 02..  ...........  ...........  ...........  ...........  ...........
E0435................  E....................  ...................  Oxygen system liquid  ...........  ...........  ...........  ...........  ...........
                                                                    portabl.
E0439................  A....................  ...................  Stationary liquid 02  ...........  ...........  ...........  ...........  ...........
E0440................  E....................  ...................  Oxygen system liquid  ...........  ...........  ...........  ...........  ...........
                                                                    station.
E0441................  A....................  ...................  Oxygen contents,      ...........  ...........  ...........  ...........  ...........
                                                                    gaseous.
E0442................  A....................  ...................  Oxygen contents,      ...........  ...........  ...........  ...........  ...........
                                                                    liquid.
E0443................  A....................  ...................  Portable 02           ...........  ...........  ...........  ...........  ...........
                                                                    contents, gas.
E0444................  A....................  ...................  Portable 02           ...........  ...........  ...........  ...........  ...........
                                                                    contents, liquid.
E0445................  A....................  ...................  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.........  ...........  ...........  ...........  ...........  ...........

[[Page 63621]]

 
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.
E0470................  Y....................  NI.................  RAD w/o backup non-   ...........  ...........  ...........  ...........  ...........
                                                                    inv intfc.
E0471................  Y....................  NI.................  RAD w/backup non inv  ...........  ...........  ...........  ...........  ...........
                                                                    intrfc.
E0472................  Y....................  NI.................  RAD w backup          ...........  ...........  ...........  ...........  ...........
                                                                    invasive intrfc.
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.
E0561................  Y....................  NI.................  Humidifier nonheated  ...........  ...........  ...........  ...........  ...........
                                                                    w PAP.
E0562................  Y....................  NI.................  Humidifier heated     ...........  ...........  ...........  ...........  ...........
                                                                    used w PAP.
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.
E0637................  Y....................  NI.................  Sit-stand w seatlift  ...........  ...........  ...........  ...........  ...........
                                                                    wheeled.
E0638................  Y....................  NI.................  Standing frame sys    ...........  ...........  ...........  ...........  ...........
                                                                    wheeled.
E0650................  A....................  ...................  Pneuma compresor non- ...........  ...........  ...........  ...........  ...........
                                                                    segment.
E0651................  A....................  ...................  Pneum compressor      ...........  ...........  ...........  ...........  ...........
                                                                    segmental.
E0652................  A....................  ...................  Pneum compres w/cal   ...........  ...........  ...........  ...........  ...........
                                                                    pressure.
E0655................  A....................  ...................  Pneumatic appliance   ...........  ...........  ...........  ...........  ...........
                                                                    half arm.
E0660................  A....................  ...................  Pneumatic appliance   ...........  ...........  ...........  ...........  ...........
                                                                    full leg.
E0665................  A....................  ...................  Pneumatic appliance   ...........  ...........  ...........  ...........  ...........
                                                                    full arm.
E0666................  A....................  ...................  Pneumatic appliance   ...........  ...........  ...........  ...........  ...........
                                                                    half leg.
E0667................  A....................  ...................  Seg pneumatic appl    ...........  ...........  ...........  ...........  ...........
                                                                    full leg.
E0668................  A....................  ...................  Seg pneumatic appl    ...........  ...........  ...........  ...........  ...........
                                                                    full arm.
E0669................  A....................  ...................  Seg pneumatic appli   ...........  ...........  ...........  ...........  ...........
                                                                    half leg.
E0671................  A....................  ...................  Pressure pneum appl   ...........  ...........  ...........  ...........  ...........
                                                                    full leg.
E0672................  A....................  ...................  Pressure pneum appl   ...........  ...........  ...........  ...........  ...........
                                                                    full arm.
E0673................  A....................  ...................  Pressure pneum appl   ...........  ...........  ...........  ...........  ...........
                                                                    half leg.
E0675................  Y....................  NI.................  Pneumatic             ...........  ...........  ...........  ...........  ...........
                                                                    compression device.
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......  ...........  ...........  ...........  ...........  ...........

[[Page 63622]]

 
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....................  DG.................  Cervical pillow.....  ...........  ...........  ...........  ...........  ...........
E0944................  A....................  ...................  Pelvic belt/harness/  ...........  ...........  ...........  ...........  ...........
                                                                    boot.
E0945................  A....................  ...................  Belt/harness          ...........  ...........  ...........  ...........  ...........
                                                                    extremity.
E0946................  A....................  ...................  Fracture frame dual   ...........  ...........  ...........  ...........  ...........
                                                                    w cross.
E0947................  A....................  ...................  Fracture frame        ...........  ...........  ...........  ...........  ...........
                                                                    attachmnts pe.
E0948................  A....................  ...................  Fracture frame        ...........  ...........  ...........  ...........  ...........
                                                                    attachmnts ce.
E0950................  E....................  ...................  Tray................  ...........  ...........  ...........  ...........  ...........
E0951................  E....................  ...................  Loop heel...........  ...........  ...........  ...........  ...........  ...........
E0952................  E....................  ...................  Toe loop/holder,      ...........  ...........  ...........  ...........  ...........
                                                                    each.
E0953................  E....................  ...................  Pneumatic tire......  ...........  ...........  ...........  ...........  ...........
E0954................  E....................  ...................  Wheelchair semi-      ...........  ...........  ...........  ...........  ...........
                                                                    pneumatic ca.
E0955................  Y....................  NI.................  Cushioned headrest..  ...........  ...........  ...........  ...........  ...........
E0956................  Y....................  NI.................  W/c lateral trunk/    ...........  ...........  ...........  ...........  ...........
                                                                    hip suppor.
E0957................  Y....................  NI.................  W/c medial thigh      ...........  ...........  ...........  ...........  ...........
                                                                    support.
E0958................  A....................  ...................  Whlchr att- conv 1    ...........  ...........  ...........  ...........  ...........
                                                                    arm drive.
E0959................  B....................  ...................  Amputee adapter.....  ...........  ...........  ...........  ...........  ...........
E0960................  Y....................  NI.................  W/c shoulder harness/ ...........  ...........  ...........  ...........  ...........
                                                                    straps.
E0961................  B....................  ...................  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................  B....................  ...................  Wheelchair head rest  ...........  ...........  ...........  ...........  ...........
                                                                    extensi.
E0967................  B....................  ...................  Wheelchair hand rims  ...........  ...........  ...........  ...........  ...........
E0968................  A....................  ...................  Wheelchair commode    ...........  ...........  ...........  ...........  ...........
                                                                    seat.
E0969................  B....................  ...................  Wheelchair narrowing  ...........  ...........  ...........  ...........  ...........
                                                                    device.
E0970................  B....................  ...................  Wheelchair no. 2      ...........  ...........  ...........  ...........  ...........
                                                                    footplates.
E0971................  B....................  ...................  Wheelchair anti-      ...........  ...........  ...........  ...........  ...........
                                                                    tipping devi.
E0972................  A....................  ...................  Transfer board or     ...........  ...........  ...........  ...........  ...........
                                                                    device.
E0973................  B....................  ...................  Wheelchair adjustabl  ...........  ...........  ...........  ...........  ...........
                                                                    height.
E0974................  B....................  ...................  Wheelchair grade-aid  ...........  ...........  ...........  ...........  ...........

[[Page 63623]]

 
E0975................  B....................  DG.................  Wheelchair            ...........  ...........  ...........  ...........  ...........
                                                                    reinforced seat u.
E0976................  B....................  DG.................  Wheelchair            ...........  ...........  ...........  ...........  ...........
                                                                    reinforced back u.
E0977................  B....................  ...................  Wheelchair wedge      ...........  ...........  ...........  ...........  ...........
                                                                    cushion.
E0978................  B....................  ...................  Wheelchair belt w/    ...........  ...........  ...........  ...........  ...........
                                                                    airplane b.
E0979................  B....................  DG.................  Wheelchair belt with  ...........  ...........  ...........  ...........  ...........
                                                                    velcro.
E0980................  B....................  ...................  Wheelchair safety     ...........  ...........  ...........  ...........  ...........
                                                                    vest.
E0981................  Y....................  NI.................  Seat upholstery,      ...........  ...........  ...........  ...........  ...........
                                                                    replacement.
E0982................  Y....................  NI.................  Back upholstery,      ...........  ...........  ...........  ...........  ...........
                                                                    replacement.
E0983................  Y....................  NI.................  Add pwr joystick....  ...........  ...........  ...........  ...........  ...........
E0984................  Y....................  NI.................  Add pwr tiller......  ...........  ...........  ...........  ...........  ...........
E0985................  Y....................  NI.................  W/c seat lift         ...........  ...........  ...........  ...........  ...........
                                                                    mechanism.
E0986................  Y....................  NI.................  Man w/c push-rim pow  ...........  ...........  ...........  ...........  ...........
                                                                    assist.
E0990................  B....................  ...................  Whellchair elevating  ...........  ...........  ...........  ...........  ...........
                                                                    leg res.
E0991................  B....................  DG.................  Wheelchair upholstry  ...........  ...........  ...........  ...........  ...........
                                                                    seat.
E0992................  B....................  ...................  Wheelchair solid      ...........  ...........  ...........  ...........  ...........
                                                                    seat insert.
E0993................  B....................  DG.................  Wheelchair back       ...........  ...........  ...........  ...........  ...........
                                                                    upholstery.
E0994................  B....................  ...................  Wheelchair arm rest.  ...........  ...........  ...........  ...........  ...........
E0995................  B....................  ...................  Wheelchair calf rest  ...........  ...........  ...........  ...........  ...........
E0996................  B....................  ...................  Wheelchair tire       ...........  ...........  ...........  ...........  ...........
                                                                    solid.
E0997................  B....................  ...................  Wheelchair caster w/  ...........  ...........  ...........  ...........  ...........
                                                                    a fork.
E0998................  B....................  ...................  Wheelchair caster w/  ...........  ...........  ...........  ...........  ...........
                                                                    o a fork.
E0999................  B....................  ...................  Wheelchr pneumatic    ...........  ...........  ...........  ...........  ...........
                                                                    tire w/wh.
E1000................  B....................  ...................  Wheelchair tire       ...........  ...........  ...........  ...........  ...........
                                                                    pneumatic ca.
E1001................  B....................  ...................  Wheelchair wheel....  ...........  ...........  ...........  ...........  ...........
E1002................  Y....................  NI.................  Pwr seat tilt.......  ...........  ...........  ...........  ...........  ...........
E1003................  Y....................  NI.................  Pwr seat recline....  ...........  ...........  ...........  ...........  ...........
E1004................  Y....................  NI.................  Pwr seat recline      ...........  ...........  ...........  ...........  ...........
                                                                    mech.
E1005................  Y....................  NI.................  Pwr seat recline pwr  ...........  ...........  ...........  ...........  ...........
E1006................  Y....................  NI.................  Pwr seat combo w/o    ...........  ...........  ...........  ...........  ...........
                                                                    shear.
E1007................  Y....................  NI.................  Pwr seat combo w/     ...........  ...........  ...........  ...........  ...........
                                                                    shear.
E1008................  Y....................  NI.................  Pwr seat combo pwr    ...........  ...........  ...........  ...........  ...........
                                                                    shear.
E1009................  Y....................  NI.................  Add mech leg          ...........  ...........  ...........  ...........  ...........
                                                                    elevation.
E1010................  Y....................  NI.................  Add pwr leg           ...........  ...........  ...........  ...........  ...........
                                                                    elevation.
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.
E1019................  Y....................  NI.................  HD feature power      ...........  ...........  ...........  ...........  ...........
                                                                    seat.
E1020................  A....................  ...................  Residual limb         ...........  ...........  ...........  ...........  ...........
                                                                    support system.
E1021................  Y....................  NI.................  Ex hd feature power   ...........  ...........  ...........  ...........  ...........
                                                                    seat.
E1025................  A....................  ...................  Pedwc lat/thor sup    ...........  ...........  ...........  ...........  ...........
                                                                    nocontour.
E1026................  A....................  ...................  Pedwc contoured lat/  ...........  ...........  ...........  ...........  ...........
                                                                    thor sup.
E1027................  A....................  ...................  Ped wc lat/ant        ...........  ...........  ...........  ...........  ...........
                                                                    support.
E1028................  Y....................  NI.................  W/c manual swingaway  ...........  ...........  ...........  ...........  ...........
E1029................  Y....................  NI.................  W/c vent tray fixed.  ...........  ...........  ...........  ...........  ...........
E1030................  Y....................  NI.................  W/c vent tray         ...........  ...........  ...........  ...........  ...........
                                                                    gimbaled.
E1031................  A....................  ...................  Rollabout chair with  ...........  ...........  ...........  ...........  ...........
                                                                    casters.
E1035................  B....................  ...................  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................  B....................  ...................  Wheelchair power      ...........  ...........  ...........  ...........  ...........
                                                                    attachment.
E1066................  B....................  DG.................  Wheelchair battery    ...........  ...........  ...........  ...........  ...........
                                                                    charger.
E1069................  B....................  DG.................  Wheelchair deep       ...........  ...........  ...........  ...........  ...........
                                                                    cycle batter.
E1070................  A....................  ...................  Wheelchair            ...........  ...........  ...........  ...........  ...........
                                                                    detachable foot r.
E1083................  A....................  ...................  Hemi-wheelchair       ...........  ...........  ...........  ...........  ...........
                                                                    fixed arms.
E1084................  A....................  ...................  Hemi-wheelchair       ...........  ...........  ...........  ...........  ...........
                                                                    detachable a.
E1085................  A....................  ...................  Hemi-wheelchair       ...........  ...........  ...........  ...........  ...........
                                                                    fixed arms.
E1086................  A....................  ...................  Hemi-wheelchair       ...........  ...........  ...........  ...........  ...........
                                                                    detachable a.
E1087................  A....................  ...................  Wheelchair lightwt    ...........  ...........  ...........  ...........  ...........
                                                                    fixed arm.
E1088................  A....................  ...................  Wheelchair            ...........  ...........  ...........  ...........  ...........
                                                                    lightweight det a.
E1089................  A....................  ...................  Wheelchair lightwt    ...........  ...........  ...........  ...........  ...........
                                                                    fixed arm.
E1090................  A....................  ...................  Wheelchair            ...........  ...........  ...........  ...........  ...........
                                                                    lightweight det a.
E1091................  D....................  DNG................  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.

[[Page 63624]]

 
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................  B....................  ...................  W/ch access anti-     ...........  ...........  ...........  ...........  ...........
                                                                    rollback.
E1227................  B....................  ...................  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.  ...........  ...........  ...........  ...........  ...........
E1391................  Y....................  NI.................  Oxygen concentrator,  ...........  ...........  ...........  ...........  ...........
                                                                    dual.
E1399................  N....................  NI.................  Durable medical       ...........  ...........  ...........  ...........  ...........
                                                                    equipment mi.
E1405................  A....................  ...................  O2/water vapor        ...........  ...........  ...........  ...........  ...........
                                                                    enrich w/heat.
E1406................  A....................  ...................  O2/water vapor        ...........  ...........  ...........  ...........  ...........
                                                                    enrich w/o he.
E1500................  A....................  ...................  Centrifuge..........  ...........  ...........  ...........  ...........  ...........
E1510................  A....................  ...................  Kidney dialysate      ...........  ...........  ...........  ...........  ...........
                                                                    delivry sys.
E1520................  A....................  ...................  Heparin infusion      ...........  ...........  ...........  ...........  ...........
                                                                    pump.
E1530................  A....................  ...................  Replacement air       ...........  ...........  ...........  ...........  ...........
                                                                    bubble detec.
E1540................  A....................  ...................  Replacement pressure  ...........  ...........  ...........  ...........  ...........
                                                                    alarm.
E1550................  A....................  ...................  Bath conductivity     ...........  ...........  ...........  ...........  ...........
                                                                    meter.
E1560................  A....................  ...................  Replace blood leak    ...........  ...........  ...........  ...........  ...........
                                                                    detector.
E1570................  A....................  ...................  Adjustable chair for  ...........  ...........  ...........  ...........  ...........
                                                                    esrd pt.
E1575................  A....................  ...................  Transducer protect/   ...........  ...........  ...........  ...........  ...........
                                                                    fld bar.
E1580................  A....................  ...................  Unipuncture control   ...........  ...........  ...........  ...........  ...........
                                                                    system.
E1590................  A....................  ...................  Hemodialysis machine  ...........  ...........  ...........  ...........  ...........
E1592................  A....................  ...................  Auto interm           ...........  ...........  ...........  ...........  ...........
                                                                    peritoneal dialy.
E1594................  A....................  ...................  Cycler dialysis       ...........  ...........  ...........  ...........  ...........
                                                                    machine.
E1600................  A....................  ...................  Deli/install chrg     ...........  ...........  ...........  ...........  ...........
                                                                    hemo equip.
E1610................  A....................  ...................  Reverse osmosis h2o   ...........  ...........  ...........  ...........  ...........
                                                                    puri sys.
E1615................  A....................  ...................  Deionizer H2O puri    ...........  ...........  ...........  ...........  ...........
                                                                    system.
E1620................  A....................  ...................  Replacement blood     ...........  ...........  ...........  ...........  ...........
                                                                    pump.
E1625................  A....................  ...................  Water softening       ...........  ...........  ...........  ...........  ...........
                                                                    system.
E1630................  A....................  ...................  Reciprocating         ...........  ...........  ...........  ...........  ...........
                                                                    peritoneal dia.
E1632................  A....................  ...................  Wearable artificial   ...........  ...........  ...........  ...........  ...........
                                                                    kidney.
E1634................  E....................  NI.................  Peritoneal dialysis   ...........  ...........  ...........  ...........  ...........
                                                                    clamp.

[[Page 63625]]

 
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.
E2120................  Y....................  NI.................  Pulse gen sys tx      ...........  ...........  ...........  ...........  ...........
                                                                    endolymp fl.
E2201................  Y....................  NI.................  Man w/ch acc seat     ...........  ...........  ...........  ...........  ...........
                                                                    w=20[gE]
                                                                    <24[gE].
E2202................  Y....................  NI.................  Seat width 24-27 in.  ...........  ...........  ...........  ...........  ...........
E2203................  Y....................  NI.................  Frame depth less      ...........  ...........  ...........  ...........  ...........
                                                                    than 22 in.
E2204................  Y....................  NI.................  Frame depth 22 to 25  ...........  ...........  ...........  ...........  ...........
                                                                    in.
E2300................  Y....................  NI.................  Pwr seat elevation    ...........  ...........  ...........  ...........  ...........
                                                                    sys.
E2301................  Y....................  NI.................  Pwr standing........  ...........  ...........  ...........  ...........  ...........
E2310................  Y....................  NI.................  Electro connect btw   ...........  ...........  ...........  ...........  ...........
                                                                    control.
E2311................  Y....................  NI.................  Electro connect btw   ...........  ...........  ...........  ...........  ...........
                                                                    2 sys.
E2320................  Y....................  NI.................  Hand chin control...  ...........  ...........  ...........  ...........  ...........
E2321................  Y....................  NI.................  Hand interface        ...........  ...........  ...........  ...........  ...........
                                                                    joystick.
E2322................  Y....................  NI.................  Mult mech switches..  ...........  ...........  ...........  ...........  ...........
E2323................  Y....................  NI.................  Special joystick      ...........  ...........  ...........  ...........  ...........
                                                                    handle.
E2324................  Y....................  NI.................  Chin cup interface..  ...........  ...........  ...........  ...........  ...........
E2325................  Y....................  NI.................  Sip and puff          ...........  ...........  ...........  ...........  ...........
                                                                    interface.
E2326................  Y....................  NI.................  Breath tube kit.....  ...........  ...........  ...........  ...........  ...........
E2327................  Y....................  NI.................  Head control          ...........  ...........  ...........  ...........  ...........
                                                                    interface mech.
E2328................  Y....................  NI.................  Head/extremity        ...........  ...........  ...........  ...........  ...........
                                                                    control inter.
E2329................  Y....................  NI.................  Head control          ...........  ...........  ...........  ...........  ...........
                                                                    nonproportional.
E2330................  Y....................  NI.................  Head control          ...........  ...........  ...........  ...........  ...........
                                                                    proximity switc.
E2331................  Y....................  NI.................  Attendant control...  ...........  ...........  ...........  ...........  ...........
E2340................  Y....................  NI.................  W/c wdth 20-23 in     ...........  ...........  ...........  ...........  ...........
                                                                    seat frame.
E2341................  Y....................  NI.................  W/c wdth 24-27 in     ...........  ...........  ...........  ...........  ...........
                                                                    seat frame.
E2342................  Y....................  NI.................  W/c dpth 20-21 in     ...........  ...........  ...........  ...........  ...........
                                                                    seat frame.
E2343................  Y....................  NI.................  W/c dpth 22-25 in     ...........  ...........  ...........  ...........  ...........
                                                                    seat frame.
E2350................  Y....................  NI.................  W/c hd pt wt  250 lbs.
E2351................  Y....................  NI.................  Electronic SGD        ...........  ...........  ...........  ...........  ...........
                                                                    interface.
E2360................  Y....................  NI.................  22nf nonsealed        ...........  ...........  ...........  ...........  ...........
                                                                    leadacid.
E2361................  Y....................  NI.................  22nf sealed leadacid  ...........  ...........  ...........  ...........  ...........
                                                                    battery.
E2362................  Y....................  NI.................  Gr24 nonsealed        ...........  ...........  ...........  ...........  ...........
                                                                    leadacid.
E2363................  Y....................  NI.................  Gr24 sealed leadacid  ...........  ...........  ...........  ...........  ...........
                                                                    battery.
E2364................  Y....................  NI.................  U1nonsealed leadacid  ...........  ...........  ...........  ...........  ...........
                                                                    battery.
E2365................  Y....................  NI.................  U1 sealed leadacid    ...........  ...........  ...........  ...........  ...........
                                                                    battery.
E2366................  Y....................  NI.................  Battery charger,      ...........  ...........  ...........  ...........  ...........
                                                                    single mode.
E2367................  Y....................  NI.................  Battery charger,      ...........  ...........  ...........  ...........  ...........
                                                                    dual mode.
E2399................  Y....................  NI.................  Noc interface.......  ...........  ...........  ...........  ...........  ...........
E2402................  Y....................  NI.................  Neg press wound       ...........  ...........  ...........  ...........  ...........
                                                                    therapy pump.
E2500................  Y....................  NI.................  SGD digitized pre-    ...........  ...........  ...........  ...........  ...........
                                                                    rec <=8min.
E2502................  Y....................  NI.................  SGD prerec msg 8min <=20min.
E2504................  Y....................  NI.................  SGD prerec msg20min
                                                                    <=40min.
E2506................  Y....................  NI.................  SGD prerec msg  40 min.
E2508................  Y....................  NI.................  SGD spelling phys     ...........  ...........  ...........  ...........  ...........
                                                                    contact.
E2510................  Y....................  NI.................  SGD w multi methods   ...........  ...........  ...........  ...........  ...........
                                                                    msg/accs.
E2511................  Y....................  NI.................  SGD sftwre prgrm for  ...........  ...........  ...........  ...........  ...........
                                                                    PC/PDA.
E2512................  Y....................  NI.................  SGD accessory,        ...........  ...........  ...........  ...........  ...........
                                                                    mounting sys.
E2599................  Y....................  NI.................  SGD accessory noc...  ...........  ...........  ...........  ...........  ...........
G0001................  A....................  ...................  Drawing blood for     ...........  ...........  ...........  ...........  ...........
                                                                    specimen.
G0008................  L....................  ...................  Admin influenza       ...........  ...........  ...........  ...........  ...........
                                                                    virus vac.

[[Page 63626]]

 
G0009................  L....................  ...................  Admin pneumococcal    ...........  ...........  ...........  ...........  ...........
                                                                    vaccine.
G0010................  K....................  ...................  Admin hepatitis b            0355       0.2749       $15.00  ...........        $3.00
                                                                    vaccine.
G0025................  D....................  DNG................  Collagen skin test    ...........  ...........  ...........  ...........  ...........
                                                                    kit.
G0027................  A....................  NI.................  Semen analysis......  ...........  ...........  ...........  ...........  ...........
G0030................  S....................  ...................  PET imaging prev PET         0285      14.1508      $772.08      $334.45      $154.42
                                                                    single.
G0031................  S....................  ...................  PET imaging prev PET         0285      14.1508      $772.08      $334.45      $154.42
                                                                    multple.
G0032................  S....................  ...................  PET follow SPECT             0285      14.1508      $772.08      $334.45      $154.42
                                                                    78464 singl.
G0033................  S....................  ...................  PET follow SPECT             0285      14.1508      $772.08      $334.45      $154.42
                                                                    78464 mult.
G0034................  S....................  ...................  PET follow SPECT             0285      14.1508      $772.08      $334.45      $154.42
                                                                    76865 singl.
G0035................  S....................  ...................  PET follow SPECT             0285      14.1508      $772.08      $334.45      $154.42
                                                                    78465 mult.
G0036................  S....................  ...................  PET follow cornry            0285      14.1508      $772.08      $334.45      $154.42
                                                                    angio sing.
G0037................  S....................  ...................  PET follow cornry            0285      14.1508      $772.08      $334.45      $154.42
                                                                    angio mult.
G0038................  S....................  ...................  PET follow myocard           0285      14.1508      $772.08      $334.45      $154.42
                                                                    perf sing.
G0039................  S....................  ...................  PET follow myocard           0285      14.1508      $772.08      $334.45      $154.42
                                                                    perf mult.
G0040................  S....................  ...................  PET follow stress            0285      14.1508      $772.08      $334.45      $154.42
                                                                    echo singl.
G0041................  S....................  ...................  PET follow stress            0285      14.1508      $772.08      $334.45      $154.42
                                                                    echo mult.
G0042................  S....................  ...................  PET follow                   0285      14.1508      $772.08      $334.45      $154.42
                                                                    ventriculogm sing.
G0043................  S....................  ...................  PET follow                   0285      14.1508      $772.08      $334.45      $154.42
                                                                    ventriculogm mult.
G0044................  S....................  ...................  PET following rest           0285      14.1508      $772.08      $334.45      $154.42
                                                                    ECG singl.
G0045................  S....................  ...................  PET following rest           0285      14.1508      $772.08      $334.45      $154.42
                                                                    ECG mult.
G0046................  S....................  ...................  PET follow stress            0285      14.1508      $772.08      $334.45      $154.42
                                                                    ECG singl.
G0047................  S....................  ...................  PET follow stress            0285      14.1508      $772.08      $334.45      $154.42
                                                                    ECG mult.
G0101................  V....................  ...................  CA screen;pelvic/            0600       0.9278       $50.62  ...........       $10.12
                                                                    breast exam.
G0102................  N....................  ...................  Prostate ca           ...........  ...........  ...........  ...........  ...........
                                                                    screening; dre.
G0103................  A....................  ...................  Psa, total screening  ...........  ...........  ...........  ...........  ...........
G0104................  S....................  ...................  CA screen;flexi              0159       2.7823      $151.81  ...........       $37.95
                                                                    sigmoidscope.
G0105................  T....................  ...................  Colorectal scrn; hi          0158       7.4244      $405.08  ...........      $101.27
                                                                    risk ind.
G0106................  S....................  ...................  Colon CA                     0157       2.5693      $140.18  ...........       $28.04
                                                                    screen;barium enema.
G0107................  A....................  ...................  CA screen; fecal      ...........  ...........  ...........  ...........  ...........
                                                                    blood test.
G0108................  A....................  ...................  Diab manage trn per   ...........  ...........  ...........  ...........  ...........
                                                                    indiv.
G0109................  A....................  ...................  Diab manage trn ind/  ...........  ...........  ...........  ...........  ...........
                                                                    group.
G0110................  A....................  DG.................  Nett pulm-rehab       ...........  ...........  ...........  ...........  ...........
                                                                    educ; ind.
G0111................  A....................  DG.................  Nett pulm-rehab       ...........  ...........  ...........  ...........  ...........
                                                                    educ; group.
G0112................  A....................  DG.................  Nett;nutrition guid,  ...........  ...........  ...........  ...........  ...........
                                                                    initial.
G0113................  A....................  DG.................  Nett;nutrition        ...........  ...........  ...........  ...........  ...........
                                                                    guid,subseqnt.
G0114................  A....................  DG.................  Nett; psychosocial    ...........  ...........  ...........  ...........  ...........
                                                                    consult.
G0115................  A....................  DG.................  Nett; psychological   ...........  ...........  ...........  ...........  ...........
                                                                    testing.
G0116................  A....................  DG.................  Nett; psychosocial    ...........  ...........  ...........  ...........  ...........
                                                                    counsel.
G0117................  S....................  ...................  Glaucoma scrn hgh            0230       0.7619       $41.57       $14.97        $8.31
                                                                    risk direc.
G0118................  S....................  ...................  Glaucoma scrn hgh            0230       0.7619       $41.57       $14.97        $8.31
                                                                    risk direc.
G0120................  S....................  ...................  Colon ca scrn;               0157       2.5693      $140.18  ...........       $28.04
                                                                    barium enema.
G0121................  T....................  ...................  Colon ca scrn not hi         0158       7.4244      $405.08  ...........      $101.27
                                                                    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             1516  ...........    $1,450.00  ...........      $290.00
                                                                    pulm ring.
G0127................  T....................  ...................  Trim nail(s)........         0009       0.6652       $36.29        $8.34        $7.26
G0128................  B....................  ...................  CORF skilled nursing  ...........  ...........  ...........  ...........  ...........
                                                                    service.
G0129................  P....................  ...................  Partial hosp prog            0033       5.2569      $286.82  ...........       $57.36
                                                                    service.
G0130................  X....................  ...................  Single energy x-ray          0260       0.7802       $42.57       $21.28        $8.51
                                                                    study.
G0141................  E....................  ...................  Scr c/v cyto,autosys  ...........  ...........  ...........  ...........  ...........
                                                                    and md.
G0143................  A....................  ...................  Scr c/v               ...........  ...........  ...........  ...........  ...........
                                                                    cyto,thinlayer,resc
                                                                    r.
G0144................  A....................  ...................  Scr c/v               ...........  ...........  ...........  ...........  ...........
                                                                    cyto,thinlayer,resc
                                                                    r.
G0145................  A....................  ...................  Scr c/v               ...........  ...........  ...........  ...........  ...........
                                                                    cyto,thinlayer,resc
                                                                    r.
G0147................  A....................  ...................  Scr c/v cyto,         ...........  ...........  ...........  ...........  ...........
                                                                    automated sys.
G0148................  A....................  ...................  Scr c/v cyto,         ...........  ...........  ...........  ...........  ...........
                                                                    autosys, rescr.
G0151................  B....................  ...................  HHCP-serv of pt,ea    ...........  ...........  ...........  ...........  ...........
                                                                    15 min.
G0152................  B....................  ...................  HHCP-serv of ot,ea    ...........  ...........  ...........  ...........  ...........
                                                                    15 min.
G0153................  B....................  ...................  HHCP-svs of s/l       ...........  ...........  ...........  ...........  ...........
                                                                    path,ea 15mn.
G0154................  B....................  ...................  HHCP-svs of rn,ea 15  ...........  ...........  ...........  ...........  ...........
                                                                    min.
G0155................  B....................  ...................  HHCP-svs of csw,ea    ...........  ...........  ...........  ...........  ...........
                                                                    15 min.
G0156................  B....................  ...................  HHCP-svs of aide,ea   ...........  ...........  ...........  ...........  ...........
                                                                    15 min.
G0166................  T....................  ...................  Extrnl counterpulse,         0678       2.0659      $112.72  ...........       $22.54
                                                                    per tx.
G0167................  B....................  DG.................  Hyperbaric oz tx;no   ...........  ...........  ...........  ...........  ...........
                                                                    md reqrd.
G0168................  X....................  ...................  Wound closure by             0340       0.6314       $34.45  ...........        $6.89
                                                                    adhesive.
G0173................  S....................  ...................  Stereo                       1528  ...........    $5,250.00  ...........    $1,050.00
                                                                    radoisurgery,comple
                                                                    te.
G0175................  V....................  ...................  OPPS Service,sched           0602       1.5041       $82.07  ...........       $16.41
                                                                    team conf.
G0176................  P....................  ...................  OPPS/PHP;activity            0033       5.2569      $286.82  ...........       $57.36
                                                                    therapy.
G0177................  P....................  ...................  OPPS/PHP; train &            0033       5.2569      $286.82  ...........       $57.36
                                                                    educ 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           0235       5.0749      $276.89       $72.04       $55.38
                                                                    vssl tech.
G0202................  A....................  ...................  Screeningmammography  ...........  ...........  ...........  ...........  ...........
                                                                    digital.

[[Page 63627]]

 
G0204................  S....................  ...................  Diagnosticmammograph         0669       0.9009       $49.15  ...........        $9.83
                                                                    ydigital.
G0206................  S....................  ...................  Diagnosticmammograph         0669       0.9009       $49.15  ...........        $9.83
                                                                    ydigital.
G0210................  S....................  ...................  PET img whbd ring            1516  ...........    $1,450.00  ...........      $290.00
                                                                    dxlung ca.
G0211................  S....................  ...................  PET img whbd ring            1516  ...........    $1,450.00  ...........      $290.00
                                                                    init 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            1516  ...........    $1,450.00  ...........      $290.00
                                                                    init colre.
G0215................  S....................  ...................  PET img whbd restag          1516  ...........    $1,450.00  ...........      $290.00
                                                                    col.
G0216................  S....................  ...................  PET img whbd ring dx         1516  ...........    $1,450.00  ...........      $290.00
                                                                    melanom.
G0217................  S....................  ...................  PET img whbd ring            1516  ...........    $1,450.00  ...........      $290.00
                                                                    init 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            1516  ...........    $1,450.00  ...........      $290.00
                                                                    init lymph.
G0222................  S....................  ...................  PET img whbd ring            1516  ...........    $1,450.00  ...........      $290.00
                                                                    resta lymp.
G0223................  S....................  ...................  PET img whbd reg             1516  ...........    $1,450.00  ...........      $290.00
                                                                    ring 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              1516  ...........    $1,450.00  ...........      $290.00
                                                                    esophag.
G0227................  S....................  ...................  PET img whbd ring            1516  ...........    $1,450.00  ...........      $290.00
                                                                    ini esopha.
G0228................  S....................  ...................  PET img whbd ring            1516  ...........    $1,450.00  ...........      $290.00
                                                                    restg esop.
G0229................  S....................  ...................  PET img metabolic            1516  ...........    $1,450.00  ...........      $290.00
                                                                    brain ring.
G0230................  S....................  ...................  PET myocard                  1516  ...........    $1,450.00  ...........      $290.00
                                                                    viability ring.
G0231................  S....................  ...................  PET WhBD colorec;            1516  ...........    $1,450.00  ...........      $290.00
                                                                    gamma 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................  D....................  DNG................  Digital film convert  ...........  ...........  ...........  ...........  ...........
                                                                    diag ma.
G0237................  S....................  ...................  Therapeutic procd            0411       0.4367       $23.83  ...........        $4.77
                                                                    strg endur.
G0238................  S....................  ...................  Oth resp proc, indiv         0411       0.4367       $23.83  ...........        $4.77
G0239................  S....................  ...................  Oth resp proc, group         0411       0.4367       $23.83  ...........        $4.77
G0242................  S....................  ...................  Multisource photon           1516  ...........    $1,450.00  ...........      $290.00
                                                                    ster plan.
G0243................  S....................  ...................  Multisour photon             1528  ...........    $5,250.00  ...........    $1,050.00
                                                                    stero treat.
G0244................  S....................  ...................  Observ care by               0339       3.8356      $209.27  ...........       $41.85
                                                                    facility topt.
G0245................  V....................  ...................  Initial Foot Exam            0600       0.9278       $50.62  ...........       $10.12
                                                                    PTLOPS.
G0246................  V....................  ...................  Follow-up Eval of            0600       0.9278       $50.62  ...........       $10.12
                                                                    Foot PTLOPS.
G0247................  T....................  ...................  Routine footcare w           0009       0.6652       $36.29        $8.34        $7.26
                                                                    LOPS.
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             1513  ...........    $1,150.00  ...........      $230.00
                                                                    stero radio.
G0252................  E....................  ...................  PET imaging initial   ...........  ...........  ...........  ...........  ...........
                                                                    dx.
G0253................  S....................  ...................  PET image brst               1516  ...........    $1,450.00  ...........      $290.00
                                                                    dection recur.
G0254................  S....................  ...................  PET image brst eval          1516  ...........    $1,450.00  ...........      $290.00
                                                                    to tx.
G0255................  E....................  ...................  Current percep        ...........  ...........  ...........  ...........  ...........
                                                                    threshold tst.
G0256................  D....................  DNG................  Prostate brachy w     ...........  ...........  ...........  ...........  ...........
                                                                    palladium.
G0257................  S....................  ...................  Unsched dialysis             0170       5.9678      $325.61  ...........       $65.12
                                                                    ESRD pt hos.
G0259................  N....................  ...................  Inject for            ...........  ...........  ...........  ...........  ...........
                                                                    sacroiliac joint.
G0260................  T....................  ...................  Inj for sacroiliac           0204       2.1711      $118.46       $40.13       $23.69
                                                                    jt anesth.
G0261................  D....................  DNG................  Prostate brachy w     ...........  ...........  ...........  ...........  ...........
                                                                    iodine see.
G0262................  S....................  DG.................  Sm intestinal image          1508  ...........      $650.00  ...........      $130.00
                                                                    capsule.
G0263................  N....................  ...................  Adm with CHF, CP,     ...........  ...........  ...........  ...........  ...........
                                                                    asthma.
G0264................  V....................  ...................  Assmt otr CHF, CP,           0600       0.9278       $50.62  ...........       $10.12
                                                                    asthma.
G0265................  A....................  ...................  Cryopresevation       ...........  ...........  ...........  ...........  ...........
                                                                    Freeze+stora.
G0266................  A....................  ...................  Thawing + expansion   ...........  ...........  ...........  ...........  ...........
                                                                    froz cel.
G0267................  S....................  ...................  Bone marrow or psc           0110       3.6718      $200.34  ...........       $40.07
                                                                    harvest.
G0268................  X....................  ...................  Removal of impacted          0340       0.6314       $34.45  ...........        $6.89
                                                                    wax 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....................  DG.................  Naso/oro gastric             0272       1.4166       $77.29       $38.36       $15.46
                                                                    tube pl MD.
G0273................  D....................  DNG................  Pretx planning, non-  ...........  ...........  ...........  ...........  ...........
                                                                    Hodgkins.
G0274................  D....................  DNG................  Radiopharm tx, non-   ...........  ...........  ...........  ...........  ...........
                                                                    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 pre &         1506  ...........      $450.00  ...........       $90.00
                                                                    post sug.
G0289................  N....................  ...................  Arthro, loose body +  ...........  ...........  ...........  ...........  ...........
                                                                    chondro.
G0290................  T....................  ...................  Drug-eluting stents,         0656     103.4907    $5,646.56  ...........    $1,129.31
                                                                    single.
G0291................  T....................  ...................  Drug-eluting                 0656     103.4907    $5,646.56  ...........    $1,129.31
                                                                    stents,each add.
G0292................  S....................  ...................  Adm exp                      1503  ...........      $150.00  ...........       $30.00
                                                                    drugs,clinical
                                                                    trial.

[[Page 63628]]

 
G0293................  S....................  ...................  Non-cov surg                 1505  ...........      $350.00  ...........       $70.00
                                                                    proc,clin trial.
G0294................  S....................  ...................  Non-cov proc,                1502  ...........       $75.00  ...........       $15.00
                                                                    clinical trial.
G0295................  E....................  ...................  Electromagnetic       ...........  ...........  ...........  ...........  ...........
                                                                    therapy onc.
G0296................  S....................  NF.................  PET imge restag              1516  ...........    $1,450.00  ...........      $290.00
                                                                    thyrod cance.
G0297................  T....................  NF.................  Insert single                0107     337.1304   $18,394.17    $3,699.14    $3,678.83
                                                                    chamber/cd.
G0298................  T....................  NF.................  Insert dual chamber/         0107     337.1304   $18,394.17    $3,699.14    $3,678.83
                                                                    cd.
G0299................  T....................  NF.................  Inser/repos single           0108     433.2998   $23,641.27  ...........    $4,728.25
                                                                    icd+leads.
G0300................  T....................  NF.................  Insert reposit lead          0108     433.2998   $23,641.27  ...........    $4,728.25
                                                                    dual+gen.
G0302................  S....................  NI.................  Pre-op service LVRS          1509  ...........      $750.00  ...........      $150.00
                                                                    complete.
G0303................  S....................  NI.................  Pre-op service LVRS          1507  ...........      $550.00  ...........      $110.00
                                                                    10-15dos.
G0304................  S....................  NI.................  Pre-op service LVRS          1504  ...........      $250.00  ...........       $50.00
                                                                    1-9 dos.
G0305................  S....................  NI.................  Post op service LVRS         1504  ...........      $250.00  ...........       $50.00
                                                                    min 6.
G0306................  A....................  NI.................  CBC/diffwbc w/o       ...........  ...........  ...........  ...........  ...........
                                                                    platelet.
G0307................  A....................  NI.................  CBC without platelet  ...........  ...........  ...........  ...........  ...........
G0323................  A....................  NI.................  ESRD related svs      ...........  ...........  ...........  ...........  ...........
                                                                    home mo 20+.
G0324................  A....................  NI.................  ESRD related svs      ...........  ...........  ...........  ...........  ...........
                                                                    home/dy/2y.
G0325................  A....................  NI.................  ESRD relate home/dy   ...........  ...........  ...........  ...........  ...........
                                                                    2-11yr.
G0326................  A....................  NI.................  ESRD relate home/dy   ...........  ...........  ...........  ...........  ...........
                                                                    12-19y.
G0327................  A....................  NI.................  ESRD relate home/dy   ...........  ...........  ...........  ...........  ...........
                                                                    20+yrs.
G0338................  S....................  NI.................  Linear accelerator           1516  ...........    $1,450.00  ...........      $290.00
                                                                    stero pln.
G0339................  S....................  NI.................  Robot lin-radsurg            1528  ...........    $5,250.00  ...........    $1,050.00
                                                                    com, first.
G0340................  S....................  NI.................  Robot lin-radsurg            1525  ...........    $3,750.00  ...........      $750.00
                                                                    fractx 2-5.
G3001................  S....................  NI.................  Admin + supply,              1522  ...........    $2,250.00  ...........      $450.00
                                                                    tositumomab.
G9001................  B....................  ...................  MCCD, initial rate..  ...........  ...........  ...........  ...........  ...........
G9002................  B....................  ...................  MCCD,maintenance      ...........  ...........  ...........  ...........  ...........
                                                                    rate.
G9003................  B....................  ...................  MCCD, risk adj hi,    ...........  ...........  ...........  ...........  ...........
                                                                    initial.
G9004................  B....................  ...................  MCCD, risk adj lo,    ...........  ...........  ...........  ...........  ...........
                                                                    initial.
G9005................  B....................  ...................  MCCD, risk adj,       ...........  ...........  ...........  ...........  ...........
                                                                    maintenance.
G9006................  B....................  ...................  MCCD, Home            ...........  ...........  ...........  ...........  ...........
                                                                    monitoring.
G9007................  B....................  ...................  MCCD, sch team conf.  ...........  ...........  ...........  ...........  ...........
G9008................  B....................  ...................  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................  E....................  ...................  Demo-smoking          ...........  ...........  ...........  ...........  ...........
                                                                    cessation coun.
J0120................  N....................  ...................  Tetracyclin           ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J0130................  K....................  ...................  Abciximab injection.         1605       5.3048      $289.44  ...........       $57.89
J0150................  K....................  ...................  Injection adenosine          0379       0.2078       $11.34  ...........        $2.27
                                                                    6 MG.
J0151................  D....................  DNG................  Adenosine injection.  ...........  ...........  ...........  ...........  ...........
J0152................  K....................  NI.................  Adenosine injection.         0917       1.0393       $56.71  ...........       $11.34
J0170................  N....................  ...................  Adrenalin epinephrin  ...........  ...........  ...........  ...........  ...........
                                                                    inject.
J0190................  N....................  ...................  Inj biperiden         ...........  ...........  ...........  ...........  ...........
                                                                    lactate/5 mg.
J0200................  N....................  ...................  Alatrofloxacin        ...........  ...........  ...........  ...........  ...........
                                                                    mesylate.
J0205................  K....................  ...................  Alglucerase                  0900  ...........       $37.13  ...........        $7.43
                                                                    injection.
J0207................  K....................  ...................  Amifostine..........         7000       5.3041      $289.40  ...........       $57.88
J0210................  N....................  ...................  Methyldopate hcl      ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J0215................  B....................  ...................  Alefacept...........  ...........  ...........  ...........  ...........  ...........
J0256................  K....................  ...................  Alpha 1 proteinase           0901  ...........        $3.43  ...........        $0.69
                                                                    inhibitor.
J0270................  B....................  ...................  Alprostadil for       ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J0275................  B....................  ...................  Alprostadil urethral  ...........  ...........  ...........  ...........  ...........
                                                                    suppos.
J0280................  N....................  ...................  Aminophyllin 250 MG   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J0282................  N....................  ...................  Amiodarone HCl......  ...........  ...........  ...........  ...........  ...........
J0285................  N....................  ...................  Amphotericin B......  ...........  ...........  ...........  ...........  ...........
J0287................  K....................  ...................  Amphotericin b lipid         9024       0.3823       $20.86  ...........        $4.17
                                                                    complex.
J0288................  K....................  ...................  Ampho b cholesteryl          9024       0.3823       $20.86  ...........        $4.17
                                                                    sulfate.
J0289................  K....................  ...................  Amphotericin b               9024       0.3823       $20.86  ...........        $4.17
                                                                    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                    1606      27.7939    $1,516.46  ...........      $303.29
                                                                    anistreplase 30 u.
J0360................  N....................  ...................  Hydralazine hcl       ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J0380................  N....................  ...................  Inj metaraminol       ...........  ...........  ...........  ...........  ...........
                                                                    bitartrate.
J0390................  N....................  ...................  Chloroquine           ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J0395................  N....................  ...................  Arbutamine HCl        ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J0456................  N....................  ...................  Azithromycin........  ...........  ...........  ...........  ...........  ...........
J0460................  N....................  ...................  Atropine sulfate      ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J0470................  N....................  ...................  Dimecaprol injection  ...........  ...........  ...........  ...........  ...........
J0475................  N....................  ...................  Baclofen 10 MG        ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J0476................  B....................  ...................  Baclofen intrathecal  ...........  ...........  ...........  ...........  ...........
                                                                    trial.
J0500................  N....................  ...................  Dicyclomine           ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J0515................  N....................  ...................  Inj benztropine       ...........  ...........  ...........  ...........  ...........
                                                                    mesylate.
J0520................  N....................  ...................  Bethanechol chloride  ...........  ...........  ...........  ...........  ...........
                                                                    inject.
J0530................  N....................  ...................  Penicillin g          ...........  ...........  ...........  ...........  ...........
                                                                    benzathine inj.

[[Page 63629]]

 
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.
J0583................  G....................  NI.................  Bivalirudin.........         9111  ...........        $1.60  ...........        $0.04
J0585................  K....................  ...................  Botulinum toxin a            0902       0.0588        $3.21  ...........        $0.64
                                                                    per unit.
J0587................  K....................  ...................  Botulinum toxin type         9018       0.1279        $6.98  ...........        $1.40
                                                                    B.
J0592................  N....................  ...................  Buprenorphine         ...........  ...........  ...........  ...........  ...........
                                                                    hydrochloride.
J0595................  N....................  NI.................  Butorphanol tartrate  ...........  ...........  ...........  ...........  ...........
                                                                    1 mg.
J0600................  N....................  ...................  Edetate calcium       ...........  ...........  ...........  ...........  ...........
                                                                    disodium inj.
J0610................  N....................  ...................  Calcium gluconate     ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J0620................  N....................  ...................  Calcium glycer &      ...........  ...........  ...........  ...........  ...........
                                                                    lact/10 ML.
J0630................  N....................  ...................  Calcitonin salmon     ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J0636................  N....................  ...................  Inj calcitriol per    ...........  ...........  ...........  ...........  ...........
                                                                    0.1 mcg.
J0637................  K....................  ...................  Caspofungin acetate.         9019       0.5432       $29.64  ...........        $5.93
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          0903       5.3368      $291.18  ...........       $58.24
                                                                    IV /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                 ...........  ...........  ...........  ...........  ...........
                                                                    contraceptiveinject
                                                                    ion.
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       2.0616      $112.48  ...........       $22.50
                                                                    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................  K....................  ...................  Dipyridamole                 0380       0.2525       $13.78  ...........        $2.76
                                                                    injection.
J1250................  N....................  ...................  Inj dobutamine HCL/   ...........  ...........  ...........  ...........  ...........
                                                                    250 mg.
J1260................  N....................  ...................  Dolasetron mesylate.  ...........  ...........  ...........  ...........  ...........

[[Page 63630]]

 
J1270................  N....................  ...................  Injection,            ...........  ...........  ...........  ...........  ...........
                                                                    doxercalciferol.
J1320................  N....................  ...................  Amitriptyline         ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J1325................  N....................  ...................  Epoprostenol          ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J1327................  K....................  ...................  Eptifibatide                 1607       0.1465        $7.99  ...........        $1.60
                                                                    injection.
J1330................  N....................  ...................  Ergonovine maleate    ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J1335................  G....................  NI.................  Ertapenem injection.         9116  ...........       $23.74  ...........        $3.55
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................  K....................  ...................  Etanercept injection         1608       1.8762      $102.37  ...........       $20.47
J1440................  K....................  ...................  Filgrastim 300 mcg           0728       2.2631      $123.48  ...........       $24.70
                                                                    injection.
J1441................  K....................  ...................  Filgrastim 480 mcg           7049       3.2251      $175.96  ...........       $35.19
                                                                    injection.
J1450................  N....................  ...................  Fluconazole.........  ...........  ...........  ...........  ...........  ...........
J1452................  N....................  ...................  Intraocular           ...........  ...........  ...........  ...........  ...........
                                                                    Fomivirsen na.
J1455................  N....................  ...................  Foscarnet sodium      ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J1460................  N....................  ...................  Gamma globulin 1 CC   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J1470................  B....................  ...................  Gamma globulin 2 CC   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J1480................  B....................  ...................  Gamma globulin 3 CC   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J1490................  B....................  ...................  Gamma globulin 4 CC   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J1500................  B....................  ...................  Gamma globulin 5 CC   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J1510................  B....................  ...................  Gamma globulin 6 CC   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J1520................  B....................  ...................  Gamma globulin 7 CC   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J1530................  B....................  ...................  Gamma globulin 8 CC   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J1540................  B....................  ...................  Gamma globulin 9 CC   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J1550................  B....................  ...................  Gamma globulin 10 CC  ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J1560................  B....................  ...................  Gamma globulin  10 CC inj.
J1563................  K....................  ...................  Immune globulin, 1 g         0905       0.8057       $43.96  ...........        $8.79
J1564................  K....................  ...................  Immune globulin 10           9021       0.0080        $0.44  ...........        $0.09
                                                                    mg.
J1565................  K....................  ...................  RSV-ivig............         0906       0.8910       $48.61  ...........        $9.72
J1570................  K....................  ...................  Ganciclovir sodium           0907       0.5918       $32.29  ...........        $6.46
                                                                    injection.
J1580................  N....................  ...................  Garamycin gentamicin  ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J1590................  N....................  ...................  Gatifloxacin          ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J1595................  N....................  ...................  Injection glatiramer  ...........  ...........  ...........  ...........  ...........
                                                                    acetate.
J1600................  N....................  ...................  Gold sodium           ...........  ...........  ...........  ...........  ...........
                                                                    thiomaleate inj.
J1610................  N....................  ...................  Glucagon              ...........  ...........  ...........  ...........  ...........
                                                                    hydrochloride/1 MG.
J1620................  N....................  ...................  Gonadorelin hydroch/  ...........  ...........  ...........  ...........  ...........
                                                                    100 mcg.
J1626................  K....................  ...................  Granisetron HCl              0764       0.1044        $5.70  ...........        $1.14
                                                                    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       0.7122       $38.86  ...........        $7.77
J1750................  N....................  ...................  Iron dextran........  ...........  ...........  ...........  ...........  ...........
J1756................  N....................  ...................  Iron sucrose          ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J1785................  K....................  ...................  Injection                    0916  ...........        $3.71  ...........        $0.74
                                                                    imiglucerase /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       3.3868      $184.79  ...........       $36.96
J1830................  K....................  ...................  Interferon beta-1b /         0910       1.8421      $100.51  ...........       $20.10
                                                                    .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....................  DG.................  Kutapressin           ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J1940................  N....................  ...................  Furosemide injection  ...........  ...........  ...........  ...........  ...........
J1950................  K....................  ...................  Leuprolide acetate /         0800       3.3525      $182.92  ...........       $36.58
                                                                    3.75 MG.
J1955................  B....................  ...................  Inj levocarnitine     ...........  ...........  ...........  ...........  ...........
                                                                    per 1 gm.
J1956................  N....................  ...................  Levofloxacin          ...........  ...........  ...........  ...........  ...........
                                                                    injection.

[[Page 63631]]

 
J1960................  N....................  ...................  Levorphanol tartrate  ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J1980................  N....................  ...................  Hyoscyamine sulfate   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J1990................  N....................  ...................  Chlordiazepoxide      ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J2000................  N....................  DG.................  Lidocaine injection.  ...........  ...........  ...........  ...........  ...........
J2001................  N....................  NI.................  Lidocaine injection.  ...........  ...........  ...........  ...........  ...........
J2010................  N....................  ...................  Lincomycin injection  ...........  ...........  ...........  ...........  ...........
J2020................  K....................  ...................  Linezolid injection.         9001       0.2771       $15.12  ...........        $3.02
J2060................  N....................  ...................  Lorazepam injection.  ...........  ...........  ...........  ...........  ...........
J2150................  N....................  ...................  Mannitol injection..  ...........  ...........  ...........  ...........  ...........
J2175................  N....................  ...................  Meperidine hydrochl / ...........  ...........  ...........  ...........  ...........
                                                                    100 MG.
J2180................  N....................  ...................  Meperidine/           ...........  ...........  ...........  ...........  ...........
                                                                    promethazine inj.
J2185................  N....................  NI.................  Meropenem...........  ...........  ...........  ...........  ...........  ...........
J2210................  N....................  ...................  Methylergonovin       ...........  ...........  ...........  ...........  ...........
                                                                    maleate inj.
J2250................  N....................  ...................  Inj midazolam         ...........  ...........  ...........  ...........  ...........
                                                                    hydrochloride.
J2260................  K....................  ...................  Inj milrinone                7007       0.2129       $11.62  ...........        $2.32
                                                                    lactate, per 5 mg.
J2270................  N....................  ...................  Morphine sulfate      ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J2271................  N....................  ...................  Morphine so4          ...........  ...........  ...........  ...........  ...........
                                                                    injection 100mg.
J2275................  N....................  ...................  Morphine sulfate      ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J2280................  N....................  NI.................  Inj, moxifloxacin     ...........  ...........  ...........  ...........  ...........
                                                                    100 mg.
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          9114  ...........      $151.62  ...........       $22.66
                                                                    mg vial.
J2352................  D....................  DNG................  Octreotide acetate    ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J2353................  K....................  NI.................  Octreotide                   1207       1.2049       $65.74  ...........       $13.15
                                                                    injection, depot.
J2354................  K....................  NI.................  Octreotide inj, non-         7031       0.0264        $1.44  ...........        $0.29
                                                                    depot.
J2355................  K....................  ...................  Oprelvekin injection         7011  ...........      $248.16  ...........       $49.63
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       3.1949      $174.32  ...........       $34.86
                                                                    /30 MG.
J2440................  N....................  ...................  Papaverin hcl         ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J2460................  N....................  ...................  Oxytetracycline       ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J2501................  N....................  ...................  Paricalcitol........  ...........  ...........  ...........  ...........  ...........
J2505................  G....................  NI.................  Injection,                   9119  ...........    $2,802.50  ...........      $418.90
                                                                    pegfilgrastim 6mg.
J2510................  N....................  ...................  Penicillin g          ...........  ...........  ...........  ...........  ...........
                                                                    procaine inj.
J2515................  N....................  ...................  Pentobarbital sodium  ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J2540................  N....................  ...................  Penicillin g          ...........  ...........  ...........  ...........  ...........
                                                                    potassium inj.
J2543................  N....................  ...................  Piperacillin/         ...........  ...........  ...........  ...........  ...........
                                                                    tazobactam.
J2545................  Y....................  ...................  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.
J2783................  N....................  NI.................  Rasburicase.........  ...........  ...........  ...........  ...........  ...........
J2788................  K....................  ...................  Rho d immune                 9023       0.0310        $1.69  ...........        $0.34
                                                                    globulin 50 mcg.
J2790................  K....................  ...................  Rho d immune                 0884       0.1863       $10.16  ...........        $2.03
                                                                    globulin inj.
J2792................  K....................  ...................  Rho(D) immune                1609       0.1789        $9.76  ...........        $1.95
                                                                    globulin h, sd.
J2795................  N....................  ...................  Ropivacaine HCl       ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J2800................  N....................  ...................  Methocarbamol         ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J2810................  N....................  ...................  Inj theophylline per  ...........  ...........  ...........  ...........  ...........
                                                                    40 MG.
J2820................  K....................  ...................  Sargramostim                 0731       0.2991       $16.32  ...........        $3.26
                                                                    injection.
J2910................  N....................  ...................  Aurothioglucose       ...........  ...........  ...........  ...........  ...........
                                                                    injeciton.
J2912................  N....................  ...................  Sodium chloride       ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J2916................  N....................  ...................  Na ferric gluconate   ...........  ...........  ...........  ...........  ...........
                                                                    complex.
J2920................  N....................  ...................  Methylprednisolone    ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J2930................  N....................  ...................  Methylprednisolone    ...........  ...........  ...........  ...........  ...........
                                                                    injection.

[[Page 63632]]

 
J2940................  N....................  ...................  Somatrem injection..  ...........  ...........  ...........  ...........  ...........
J2941................  K....................  ...................  Somatropin injection         7034       0.7547       $41.18  ...........        $8.24
J2950................  N....................  ...................  Promazine hcl         ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J2993................  K....................  ...................  Reteplase injection.         9005      10.4165      $568.33  ...........      $113.67
J2995................  K....................  ...................  Inj streptokinase /          0911       1.5733       $85.84  ...........       $17.17
                                                                    250000 IU.
J2997................  K....................  ...................  Alteplase                    7048       0.2856       $15.58  ...........        $3.12
                                                                    recombinant.
J3000................  N....................  ...................  Streptomycin          ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J3010................  N....................  ...................  Fentanyl citrate      ...........  ...........  ...........  ...........  ...........
                                                                    injeciton.
J3030................  N....................  ...................  Sumatriptan           ...........  ...........  ...........  ...........  ...........
                                                                    succinate / 6 MG.
J3070................  N....................  ...................  Pentazocine hcl       ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J3100................  K....................  ...................  Tenecteplase                 9002      23.7669    $1,296.75  ...........      $259.35
                                                                    injection.
J3105................  N....................  ...................  Terbutaline sulfate   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J3120................  N....................  ...................  Testosterone          ...........  ...........  ...........  ...........  ...........
                                                                    enanthate inj.
J3130................  N....................  ...................  Testosterone          ...........  ...........  ...........  ...........  ...........
                                                                    enanthate inj.
J3140................  N....................  ...................  Testosterone          ...........  ...........  ...........  ...........  ...........
                                                                    suspension inj.
J3150................  N....................  ...................  Testosteron           ...........  ...........  ...........  ...........  ...........
                                                                    propionate inj.
J3230................  N....................  ...................  Chlorpromazine hcl    ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J3240................  K....................  ...................  Thyrotropin                  9108  ...........      $572.00  ...........      $114.40
                                                                    injection.
J3245................  K....................  ...................  Tirofiban                    7041        4.176      $227.85  ...........       $45.57
                                                                    hydrochloride.
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       1.1246       $61.36  ...........       $12.27
                                                                    glucoronate.
J3310................  N....................  ...................  Perphenazine          ...........  ...........  ...........  ...........  ...........
                                                                    injeciton.
J3315................  G....................  ...................  Triptorelin pamoate.         9122  ...........      $398.62  ...........       $59.58
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       3.7855      $206.54  ...........       $41.31
                                                                    inj.
J3370................  N....................  ...................  Vancomycin hcl        ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J3395................  K....................  ...................  Verteporfin                  1203      16.4439      $897.20  ...........      $179.44
                                                                    injection.
J3400................  N....................  ...................  Triflupromazine hcl   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J3410................  N....................  ...................  Hydroxyzine hcl       ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J3411................  N....................  NI.................  Thiamine hcl 100 mg.  ...........  ...........  ...........  ...........  ...........
J3415................  N....................  NI.................  Pyridoxine hcl 100    ...........  ...........  ...........  ...........  ...........
                                                                    mg.
J3420................  N....................  ...................  Vitamin b12           ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J3430................  N....................  ...................  Vitamin k             ...........  ...........  ...........  ...........  ...........
                                                                    phytonadione inj.
J3465................  N....................  NI.................  Injection,            ...........  ...........  ...........  ...........  ...........
                                                                    voriconazole.
J3470................  N....................  ...................  Hyaluronidase         ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J3475................  N....................  ...................  Inj magnesium         ...........  ...........  ...........  ...........  ...........
                                                                    sulfate.
J3480................  N....................  ...................  Inj potassium         ...........  ...........  ...........  ...........  ...........
                                                                    chloride.
J3485................  N....................  ...................  Zidovudine..........  ...........  ...........  ...........  ...........  ...........
J3486................  G....................  NI.................  Ziprasidone mesylate         9204  ...........       $20.79  ...........        $3.11
J3487................  G....................  ...................  Zoledronic acid.....         9115  ...........      $217.43  ...........       $32.50
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.
J7190................  K....................  ...................  Factor viii.........         0925  ...........        $0.51  ...........        $0.10
J7191................  K....................  ...................  Factor VIII                  0926  ...........        $1.52  ...........        $0.30
                                                                    (porcine).
J7192................  K....................  ...................  Factor viii                  0927  ...........        $1.01  ...........        $0.20
                                                                    recombinant.
J7193................  K....................  ...................  Factor IX non-               0931  ...........        $0.51  ...........        $0.10
                                                                    recombinant.
J7194................  K....................  ...................  Factor ix complex...         0928  ...........        $0.51  ...........        $0.10
J7195................  K....................  ...................  Factor IX                    0932  ...........        $1.01  ...........        $0.20
                                                                    recombinant.
J7197................  N....................  ...................  Antithrombin iii      ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J7198................  K....................  ...................  Anti-inhibitor......         0929  ...........        $1.01  ...........        $0.20
J7199................  B....................  ...................  Hemophilia clot       ...........  ...........  ...........  ...........  ...........
                                                                    factor noc.

[[Page 63633]]

 
J7300................  E....................  ...................  Intraut copper        ...........  ...........  ...........  ...........  ...........
                                                                    contraceptive.
J7302................  E....................  ...................  Levonorgestrel iu     ...........  ...........  ...........  ...........  ...........
                                                                    contracept.
J7303................  E....................  NI.................  Contraceptive         ...........  ...........  ...........  ...........  ...........
                                                                    vaginal ring.
J7308................  N....................  ...................  Aminolevulinic acid   ...........  ...........  ...........  ...........  ...........
                                                                    hcl top.
J7310................  K....................  ...................  Ganciclovir long act         0913       1.5861       $86.54  ...........       $17.31
                                                                    implant.
J7317................  K....................  ...................  Sodium hyaluronate           7316       2.5436      $138.78  ...........       $27.76
                                                                    injection.
J7320................  K....................  ...................  Hylan G-F 20                 1611       2.2628      $123.46  ...........       $24.69
                                                                    injection.
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            0888       0.0470        $2.56  ...........        $0.51
                                                                    100 mg.
J7504................  K....................  ...................  Lymphocyte immune            0890       2.3439      $127.89  ...........       $25.58
                                                                    globulin.
J7505................  K....................  ...................  Monoclonal                   7038       5.8803      $320.84  ...........       $64.17
                                                                    antibodies.
J7506................  N....................  ...................  Prednisone oral.....  ...........  ...........  ...........  ...........  ...........
J7507................  K....................  ...................  Tacrolimus oral per          0891       0.0246        $1.34  ...........        $0.27
                                                                    1 MG.
J7508................  B....................  DG.................  Tacrolimus oral per   ...........  ...........  ...........  ...........  ...........
                                                                    5 MG.
J7509................  N....................  ...................  Methylprednisolone    ...........  ...........  ...........  ...........  ...........
                                                                    oral.
J7510................  N....................  ...................  Prednisolone oral     ...........  ...........  ...........  ...........  ...........
                                                                    per 5 mg.
J7511................  K....................  ...................  Antithymocyte                9104       2.9978      $163.56  ...........       $32.71
                                                                    globuln rabbit.
J7513................  K....................  ...................  Daclizumab,                  1612  ...........      $393.78  ...........       $78.76
                                                                    parenteral.
J7515................  N....................  ...................  Cyclosporine oral 25  ...........  ...........  ...........  ...........  ...........
                                                                    mg.
J7516................  N....................  ...................  Cyclosporin           ...........  ...........  ...........  ...........  ...........
                                                                    parenteral 250mg.
J7517................  K....................  ...................  Mycophenolate                9015       0.0374        $2.04  ...........        $0.41
                                                                    mofetil oral.
J7520................  K....................  ...................  Sirolimus, oral.....         9020       0.0529        $2.89  ...........        $0.58
J7525................  K....................  ...................  Tacrolimus injection         9006       0.1048        $5.72  ...........        $1.14
J7599................  N....................  ...................  Immunosuppressive     ...........  ...........  ...........  ...........  ...........
                                                                    drug noc.
J7608................  Y....................  ...................  Acetylcysteine inh    ...........  ...........  ...........  ...........  ...........
                                                                    sol u d.
J7618................  Y....................  ...................  Albuterol inh sol     ...........  ...........  ...........  ...........  ...........
                                                                    con.
J7619................  Y....................  ...................  Albuterol inh sol u   ...........  ...........  ...........  ...........  ...........
                                                                    d.
J7621................  Y....................  NI.................  (Levo)albuterol/Ipra- ...........  ...........  ...........  ...........  ...........
                                                                    bromide.
J7622................  A....................  ...................  Beclomethasone        ...........  ...........  ...........  ...........  ...........
                                                                    inhalatn sol.
J7624................  A....................  ...................  Betamethasone         ...........  ...........  ...........  ...........  ...........
                                                                    inhalation sol.
J7626................  A....................  ...................  Budesonide            ...........  ...........  ...........  ...........  ...........
                                                                    inhalation sol.
J7628................  Y....................  ...................  Bitolterol mes inhal  ...........  ...........  ...........  ...........  ...........
                                                                    sol con.
J7629................  Y....................  ...................  Bitolterol mes inh    ...........  ...........  ...........  ...........  ...........
                                                                    sol u d.
J7631................  Y....................  ...................  Cromolyn sodium inh   ...........  ...........  ...........  ...........  ...........
                                                                    sol u d.
J7633................  N....................  ...................  Budesonide            ...........  ...........  ...........  ...........  ...........
                                                                    concentrated sol.
J7635................  Y....................  ...................  Atropine inhal sol    ...........  ...........  ...........  ...........  ...........
                                                                    con.
J7636................  Y....................  ...................  Atropine inhal sol    ...........  ...........  ...........  ...........  ...........
                                                                    unit dose.
J7637................  Y....................  ...................  Dexamethasone inhal   ...........  ...........  ...........  ...........  ...........
                                                                    sol con.
J7638................  Y....................  ...................  Dexamethasone inhal   ...........  ...........  ...........  ...........  ...........
                                                                    sol u d.
J7639................  Y....................  ...................  Dornase alpha inhal   ...........  ...........  ...........  ...........  ...........
                                                                    sol u d.
J7641................  A....................  ...................  Flunisolide,          ...........  ...........  ...........  ...........  ...........
                                                                    inhalation sol.
J7642................  Y....................  ...................  Glycopyrrolate inhal  ...........  ...........  ...........  ...........  ...........
                                                                    sol con.
J7643................  Y....................  ...................  Glycopyrrolate inhal  ...........  ...........  ...........  ...........  ...........
                                                                    sol u d.
J7644................  Y....................  ...................  Ipratropium brom inh  ...........  ...........  ...........  ...........  ...........
                                                                    sol u d.
J7648................  Y....................  ...................  Isoetharine hcl inh   ...........  ...........  ...........  ...........  ...........
                                                                    sol con.
J7649................  Y....................  ...................  Isoetharine hcl inh   ...........  ...........  ...........  ...........  ...........
                                                                    sol u d.
J7658................  Y....................  ...................  Isoproterenolhcl inh  ...........  ...........  ...........  ...........  ...........
                                                                    sol con.
J7659................  Y....................  ...................  Isoproterenol hcl     ...........  ...........  ...........  ...........  ...........
                                                                    inh sol ud.
J7668................  Y....................  ...................  Metaproterenol inh    ...........  ...........  ...........  ...........  ...........
                                                                    sol con.
J7669................  Y....................  ...................  Metaproterenol inh    ...........  ...........  ...........  ...........  ...........
                                                                    sol u d.
J7680................  Y....................  ...................  Terbutaline so4 inh   ...........  ...........  ...........  ...........  ...........
                                                                    sol con.
J7681................  Y....................  ...................  Terbutaline so4 inh   ...........  ...........  ...........  ...........  ...........
                                                                    sol u d.
J7682................  Y....................  ...................  Tobramycin            ...........  ...........  ...........  ...........  ...........
                                                                    inhalation sol.
J7683................  Y....................  ...................  Triamcinolone inh     ...........  ...........  ...........  ...........  ...........
                                                                    sol con.
J7684................  Y....................  ...................  Triamcinolone inh     ...........  ...........  ...........  ...........  ...........
                                                                    sol u d.
J7699................  Y....................  ...................  Inhalation solution   ...........  ...........  ...........  ...........  ...........
                                                                    for DME.
J7799................  Y....................  ...................  Non-inhalation drug   ...........  ...........  ...........  ...........  ...........
                                                                    for DME.
J8499................  E....................  ...................  Oral prescrip drug    ...........  ...........  ...........  ...........  ...........
                                                                    non chemo.
J8510................  K....................  ...................  Oral busulfan.......         7015       0.0288        $1.57  ...........        $0.31
J8520................  K....................  ...................  Capecitabine, oral,          7042       0.0302        $1.65  ...........        $0.33
                                                                    150 mg.
J8521................  E....................  ...................  Capecitabine, oral,   ...........  ...........  ...........  ...........  ...........
                                                                    500 mg.
J8530................  N....................  ...................  Cyclophosphamide      ...........  ...........  ...........  ...........  ...........
                                                                    oral 25 MG.
J8560................  K....................  ...................  Etoposide oral 50 MG         0802       0.5016       $27.37  ...........        $5.47
J8600................  N....................  ...................  Melphalan oral 2 MG.  ...........  ...........  ...........  ...........  ...........
J8610................  N....................  ...................  Methotrexate oral     ...........  ...........  ...........  ...........  ...........
                                                                    2.5 MG.
J8700................  K....................  ...................  Temozolmide.........         1086       0.0690        $3.76  ...........        $0.75
J8999................  B....................  ...................  Oral prescription     ...........  ...........  ...........  ...........  ...........
                                                                    drug chemo.
J9000................  K....................  ...................  Doxorubic hcl 10 MG          0847       0.1212        $6.61  ...........        $1.32
                                                                    vl chemo.
J9001................  K....................  ...................  Doxorubicin hcl              7046       4.6982      $256.34  ...........       $51.27
                                                                    liposome inj.
J9010................  K....................  ...................  Alemtuzumab                  9110       7.7873      $424.88  ...........       $84.98
                                                                    injection.

[[Page 63634]]

 
J9015................  K....................  ...................  Aldesleukin/single           0807  ...........      $680.35  ...........      $136.07
                                                                    use vial.
J9017................  K....................  ...................  Arsenic trioxide....         9012       0.4933       $26.91  ...........        $5.38
J9020................  K....................  ...................  Asparaginase                 0814       0.2957       $16.13  ...........        $3.23
                                                                    injection.
J9031................  K....................  ...................  Bcg live                     0809       1.9015      $103.75  ...........       $20.75
                                                                    intravesical vac.
J9040................  K....................  ...................  Bleomycin sulfate            0857       2.9427      $160.56  ...........       $32.11
                                                                    injection.
J9045................  K....................  ...................  Carboplatin                  0811       1.5849       $86.47  ...........       $17.29
                                                                    injection.
J9050................  N....................  ...................  Carmus bischl nitro   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J9060................  K....................  ...................  Cisplatin 10 MG              0813       0.3985       $21.74  ...........        $4.35
                                                                    injection.
J9062................  B....................  ...................  Cisplatin 50 MG       ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J9065................  K....................  ...................  Inj cladribine per 1         0858       0.6931       $37.82  ...........        $7.56
                                                                    MG.
J9070................  K....................  ...................  Cyclophosphamide 100         0815       0.0868        $4.74  ...........        $0.95
                                                                    MG inj.
J9080................  B....................  ...................  Cyclophosphamide 200  ...........  ...........  ...........  ...........  ...........
                                                                    MG inj.
J9090................  B....................  ...................  Cyclophosphamide 500  ...........  ...........  ...........  ...........  ...........
                                                                    MG inj.
J9091................  B....................  ...................  Cyclophosphamide 1.0  ...........  ...........  ...........  ...........  ...........
                                                                    grm inj.
J9092................  B....................  ...................  Cyclophosphamide 2.0  ...........  ...........  ...........  ...........  ...........
                                                                    grm inj.
J9093................  K....................  ...................  Cyclophosphamide             0816       0.0825        $4.50  ...........        $0.90
                                                                    lyophilized.
J9094................  B....................  ...................  Cyclophosphamide      ...........  ...........  ...........  ...........  ...........
                                                                    lyophilized.
J9095................  B....................  ...................  Cyclophosphamide      ...........  ...........  ...........  ...........  ...........
                                                                    lyophilized.
J9096................  B....................  ...................  Cyclophosphamide      ...........  ...........  ...........  ...........  ...........
                                                                    lyophilized.
J9097................  B....................  ...................  Cyclophosphamide      ...........  ...........  ...........  ...........  ...........
                                                                    lyophilized.
J9098................  K....................  NI.................  Cytarabine liposome.         1166       5.1134      $278.99  ...........       $55.80
J9100................  K....................  ...................  Cytarabine hcl 100           0817       0.0930        $5.07  ...........        $1.01
                                                                    MG inj.
J9110................  B....................  ...................  Cytarabine hcl 500    ...........  ...........  ...........  ...........  ...........
                                                                    MG inj.
J9120................  N....................  ...................  Dactinomycin          ...........  ...........  ...........  ...........  ...........
                                                                    actinomycin d.
J9130................  K....................  ...................  Dacarbazine 100 mg           0819       0.0974        $5.31  ...........        $1.06
                                                                    inj.
J9140................  B....................  ...................  Dacarbazine 200 MG    ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J9150................  K....................  ...................  Daunorubicin........         0820       1.3557       $73.97  ...........       $14.79
J9151................  K....................  ...................  Daunorubicin citrate         0821       2.9976      $163.55  ...........       $32.71
                                                                    liposom.
J9160................  K....................  ...................  Denileukin diftitox,         1084  ...........    $1,232.88  ...........      $246.58
                                                                    300 mcg.
J9165................  N....................  ...................  Diethylstilbestrol    ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J9170................  K....................  ...................  Docetaxel...........         0823       4.0499      $220.97  ...........       $44.19
J9178................  K....................  NI.................  Inj, epirubicin hcl,         1167       0.3744       $20.43  ...........        $4.09
                                                                    2 mg.
J9180................  B....................  DG.................  Epirubicin HCl        ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J9181................  K....................  ...................  Etoposide 10 MG inj.         0824       0.0836        $4.56  ...........        $0.91
J9182................  B....................  ...................  Etoposide 100 MG inj  ...........  ...........  ...........  ...........  ...........
J9185................  K....................  ...................  Fludarabine                  0842       3.7708      $205.74  ...........       $41.15
                                                                    phosphate inj.
J9190................  N....................  ...................  Fluorouracil          ...........  ...........  ...........  ...........  ...........
                                                                    injection.
J9200................  K....................  ...................  Floxuridine                  0827       2.0928      $114.19  ...........       $22.84
                                                                    injection.
J9201................  K....................  ...................  Gemcitabine HCl.....         0828       1.4742       $80.43  ...........       $16.09
J9202................  K....................  ...................  Goserelin acetate            0810       5.2265      $285.16  ...........       $57.03
                                                                    implant.
J9206................  K....................  ...................  Irinotecan injection         0830       1.8428      $100.55  ...........       $20.11
J9208................  K....................  ...................  Ifosfomide injection         0831       1.9435      $106.04  ...........       $21.21
J9209................  K....................  ...................  Mesna injection.....         0732       0.5211       $28.43  ...........        $5.69
J9211................  K....................  ...................  Idarubicin hcl               0832       3.2663      $178.21  ...........       $35.64
                                                                    injection.
J9212................  N....................  ...................  Interferon alfacon-1  ...........  ...........  ...........  ...........  ...........
J9213................  K....................  ...................  Interferon alfa-2a           0834       0.3777       $20.61  ...........        $4.12
                                                                    inj.
J9214................  K....................  ...................  Interferon alfa-2b           0836       0.2003       $10.93  ...........        $2.19
                                                                    inj.
J9215................  K....................  ...................  Interferon alfa-n3           0865       1.4598       $79.65  ...........       $15.93
                                                                    inj.
J9216................  K....................  ...................  Interferon gamma 1-b         0838  ...........      $180.15  ...........       $36.03
                                                                    inj.
J9217................  K....................  ...................  Leuprolide acetate           9217       5.7252      $312.37  ...........       $62.47
                                                                    suspnsion.
J9218................  K....................  ...................  Leuprolide acetate           0861       0.7991       $43.60  ...........        $8.72
                                                                    injeciton.
J9219................  K....................  ...................  Leuprolide acetate           7051      67.2039    $3,666.71  ...........      $733.34
                                                                    implant.
J9230................  N....................  ...................  Mechlorethamine hcl   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J9245................  K....................  ...................  Inj melphalan                0840       4.6719      $254.90  ...........       $50.98
                                                                    hydrochl 50 MG.
J9250................  N....................  ...................  Methotrexate sodium   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J9260................  B....................  ...................  Methotrexate sodium   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J9263................  B....................  NI.................  Oxaliplatin.........  ...........  ...........  ...........  ...........  ...........
J9265................  K....................  ...................  Paclitaxel injection         0863       2.0553      $112.14  ...........       $22.43
J9266................  N....................  ...................  Pegaspargase/singl    ...........  ...........  ...........  ...........  ...........
                                                                    dose vial.
J9268................  K....................  ...................  Pentostatin                  0844      17.7045      $965.98  ...........      $193.20
                                                                    injection.
J9270................  K....................  ...................  Plicamycin                   0860       0.2826       $15.42  ...........        $3.08
                                                                    (mithramycin) inj.
J9280................  K....................  ...................  Mitomycin 5 MG inj..         0862       0.9719       $53.03  ...........       $10.61
J9290................  B....................  ...................  Mitomycin 20 MG inj.  ...........  ...........  ...........  ...........  ...........
J9291................  B....................  ...................  Mitomycin 40 MG inj.  ...........  ...........  ...........  ...........  ...........
J9293................  K....................  ...................  Mitoxantrone                 0864       3.1832      $173.68  ...........       $34.74
                                                                    hydrochl / 5 MG.
J9300................  K....................  ...................  Gemtuzumab                   9004  ...........    $2,022.90  ...........      $404.58
                                                                    ozogamicin.
J9310................  K....................  ...................  Rituximab cancer             0849       5.6158      $306.40  ...........       $61.28
                                                                    treatment.
J9320................  K....................  ...................  Streptozocin                 0850       1.1948       $65.19  ...........       $13.04
                                                                    injection.
J9340................  K....................  ...................  Thiotepa injection..         0851       1.0984       $59.93  ...........       $11.99
J9350................  K....................  ...................  Topotecan...........         0852       7.9435      $433.41  ...........       $86.68
J9355................  K....................  ...................  Trastuzumab.........         1613       0.7434       $40.56  ...........        $8.11
J9357................  K....................  ...................  Valrubicin, 200 mg..         1614       8.4635      $461.78  ...........       $92.36
J9360................  N....................  ...................  Vinblastine sulfate   ...........  ...........  ...........  ...........  ...........
                                                                    inj.
J9370................  N....................  ...................  Vincristine sulfate   ...........  ...........  ...........  ...........  ...........
                                                                    1 MG inj.
J9375................  B....................  ...................  Vincristine sulfate   ...........  ...........  ...........  ...........  ...........
                                                                    2 MG inj.

[[Page 63635]]

 
J9380................  B....................  ...................  Vincristine sulfate   ...........  ...........  ...........  ...........  ...........
                                                                    5 MG inj.
J9390................  K....................  ...................  Vinorelbine tartrate/        0855       1.1874       $64.79  ...........       $12.96
                                                                    10 mg.
J9395................  G....................  NI.................  Injection,                   9120  ...........       $87.58  ...........       $87.58
                                                                    Fulvestrant.
J9600................  K....................  ...................  Porfimer sodium.....         0856      29.2205    $1,594.30  ...........      $318.86
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....................  DG.................  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....................  DG.................  Reinforced back       ...........  ...........  ...........  ...........  ...........
                                                                    upholstery.
K0023................  A....................  ...................  Planr back insrt      ...........  ...........  ...........  ...........  ...........
                                                                    foam w/strp.
K0024................  A....................  ...................  Plnr back insrt foam  ...........  ...........  ...........  ...........  ...........
                                                                    w/hrdwr.
K0025................  A....................  DG.................  Hook-on headrest      ...........  ...........  ...........  ...........  ...........
                                                                    extension.
K0026................  A....................  DG.................  Back upholst lgtwt    ...........  ...........  ...........  ...........  ...........
                                                                    whlchr.
K0027................  A....................  DG.................  Back upholst other    ...........  ...........  ...........  ...........  ...........
                                                                    whlchr.
K0028................  A....................  DG.................  Manual fully          ...........  ...........  ...........  ...........  ...........
                                                                    reclining back.
K0029................  A....................  DG.................  Reinforced seat       ...........  ...........  ...........  ...........  ...........
                                                                    upholstery.
K0030................  A....................  DG.................  Solid plnr seat sngl  ...........  ...........  ...........  ...........  ...........
                                                                    dnsfoam.
K0031................  A....................  DG.................  Safety belt/pelvic    ...........  ...........  ...........  ...........  ...........
                                                                    strap.
K0032................  A....................  DG.................  Seat uphols lgtwt     ...........  ...........  ...........  ...........  ...........
                                                                    whlchr.
K0033................  A....................  DG.................  Seat upholstery       ...........  ...........  ...........  ...........  ...........
                                                                    other whlchr.
K0035................  A....................  DG.................  Heel loop with ankle  ...........  ...........  ...........  ...........  ...........
                                                                    strap.
K0036................  A....................  DG.................  Toe loop each.......  ...........  ...........  ...........  ...........  ...........
K0037................  A....................  ...................  High mount flip-up    ...........  ...........  ...........  ...........  ...........
                                                                    footrest.
K0038................  A....................  ...................  Leg strap each......  ...........  ...........  ...........  ...........  ...........
K0039................  A....................  ...................  Leg strap h style     ...........  ...........  ...........  ...........  ...........
                                                                    each.
K0040................  A....................  ...................  Adjustable angle      ...........  ...........  ...........  ...........  ...........
                                                                    footplate.
K0041................  A....................  ...................  Large size footplate  ...........  ...........  ...........  ...........  ...........
                                                                    each.
K0042................  A....................  ...................  Standard size         ...........  ...........  ...........  ...........  ...........
                                                                    footplate each.
K0043................  A....................  ...................  Ftrst lower           ...........  ...........  ...........  ...........  ...........
                                                                    extension tube.
K0044................  A....................  ...................  Ftrst upper hanger    ...........  ...........  ...........  ...........  ...........
                                                                    bracket.
K0045................  A....................  ...................  Footrest complete     ...........  ...........  ...........  ...........  ...........
                                                                    assembly.
K0046................  A....................  ...................  Elevat legrst low     ...........  ...........  ...........  ...........  ...........
                                                                    extension.
K0047................  A....................  ...................  Elevat legrst up      ...........  ...........  ...........  ...........  ...........
                                                                    hangr brack.
K0048................  A....................  DG.................  Elevate legrest       ...........  ...........  ...........  ...........  ...........
                                                                    complete.
K0049................  A....................  DG.................  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....................  DG.................  Seat wdth 10-12/15/   ...........  ...........  ...........  ...........  ...........
                                                                    17/20 wc.
K0055................  A....................  DG.................  Seat dpth 15/17/18    ...........  ...........  ...........  ...........  ...........
                                                                    ltwt wc.
K0056................  A....................  ...................  Seat ht 17 or 21      ...........  ...........  ...........  ...........  ...........
                                                                    ltwt wc.
K0057................  A....................  DG.................  Seat wdth 19/20 hvy   ...........  ...........  ...........  ...........  ...........
                                                                    dty wc.
K0058................  A....................  DG.................  Seat dpth 17/18       ...........  ...........  ...........  ...........  ...........
                                                                    power wc.
K0059................  A....................  ...................  Plastic coated        ...........  ...........  ...........  ...........  ...........
                                                                    handrim each.
K0060................  A....................  ...................  Steel handrim each..  ...........  ...........  ...........  ...........  ...........
K0061................  A....................  ...................  Aluminum handrim      ...........  ...........  ...........  ...........  ...........
                                                                    each.
K0062................  A....................  DG.................  Handrim 8-10 vert/    ...........  ...........  ...........  ...........  ...........
                                                                    obliq proj.
K0063................  A....................  DG.................  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.

[[Page 63636]]

 
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....................  DG.................  Wheel lock extension  ...........  ...........  ...........  ...........  ...........
                                                                    pair.
K0080................  A....................  DG.................  Anti-rollback device  ...........  ...........  ...........  ...........  ...........
                                                                    pair.
K0081................  A....................  ...................  Wheel lock assembly   ...........  ...........  ...........  ...........  ...........
                                                                    complete.
K0082................  A....................  DG.................  22 nf deep cycl acid  ...........  ...........  ...........  ...........  ...........
                                                                    battery.
K0083................  A....................  DG.................  22 nf gel cell        ...........  ...........  ...........  ...........  ...........
                                                                    battery each.
K0084................  A....................  DG.................  Grp 24 deep cycl      ...........  ...........  ...........  ...........  ...........
                                                                    acid battry.
K0085................  A....................  DG.................  Group 24 gel cell     ...........  ...........  ...........  ...........  ...........
                                                                    battery.
K0086................  A....................  DG.................  U-1 lead acid         ...........  ...........  ...........  ...........  ...........
                                                                    battery each.
K0087................  A....................  DG.................  U-1 gel cell battery  ...........  ...........  ...........  ...........  ...........
                                                                    each.
K0088................  A....................  DG.................  Battry chrgr acid/    ...........  ...........  ...........  ...........  ...........
                                                                    gel cell.
K0089................  A....................  DG.................  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....................  DG.................  Amputee adapter pair  ...........  ...........  ...........  ...........  ...........
K0102................  A....................  ...................  Crutch and cane       ...........  ...........  ...........  ...........  ...........
                                                                    holder.
K0103................  A....................  DG.................  Transfer board <      ...........  ...........  ...........  ...........  ...........
                                                                    25[gE].
K0104................  A....................  ...................  Cylinder tank         ...........  ...........  ...........  ...........  ...........
                                                                    carrier.
K0105................  A....................  ...................  Iv hanger...........  ...........  ...........  ...........  ...........  ...........
K0106................  A....................  ...................  Arm trough each.....  ...........  ...........  ...........  ...........  ...........
K0107................  A....................  DG.................  Wheelchair tray.....  ...........  ...........  ...........  ...........  ...........
K0108................  A....................  ...................  W/c component-        ...........  ...........  ...........  ...........  ...........
                                                                    accessory NOS.
K0112................  A....................  DG.................  Trunk vest supprt     ...........  ...........  ...........  ...........  ...........
                                                                    innr frame.
K0113................  A....................  DG.................  Trunk vest suprt w/o  ...........  ...........  ...........  ...........  ...........
                                                                    inr frm.
K0114................  A....................  ...................  Whlchr back suprt     ...........  ...........  ...........  ...........  ...........
                                                                    inr frame.
K0115................  A....................  ...................  Back module orthotic  ...........  ...........  ...........  ...........  ...........
                                                                    system.
K0116................  A....................  ...................  Back & seat modul     ...........  ...........  ...........  ...........  ...........
                                                                    orthot sys.
K0195................  A....................  ...................  Elevating whlchair    ...........  ...........  ...........  ...........  ...........
                                                                    leg rests.
K0268................  A....................  DG.................  Humidifier nonheated  ...........  ...........  ...........  ...........  ...........
                                                                    w PAP.
K0415................  B....................  ...................  RX antiemetic drg,    ...........  ...........  ...........  ...........  ...........
                                                                    oral NOS.
K0416................  B....................  ...................  Rx antiemetic         ...........  ...........  ...........  ...........  ...........
                                                                    drg,rectal NOS.
K0452................  A....................  ...................  Wheelchair bearings.  ...........  ...........  ...........  ...........  ...........
K0455................  A....................  ...................  Pump uninterrupted    ...........  ...........  ...........  ...........  ...........
                                                                    infusion.
K0460................  A....................  DG.................  WC power add-on       ...........  ...........  ...........  ...........  ...........
                                                                    joystick.
K0461................  A....................  DG.................  WC power add-on       ...........  ...........  ...........  ...........  ...........
                                                                    tiller cntrl.
K0462................  A....................  ...................  Temporary             ...........  ...........  ...........  ...........  ...........
                                                                    replacement eqpmnt.
K0531................  A....................  DG.................  Heated humidifier     ...........  ...........  ...........  ...........  ...........
                                                                    used w pap.
K0532................  A....................  DG.................  Noninvasive assist    ...........  ...........  ...........  ...........  ...........
                                                                    wo backup.
K0533................  A....................  DG.................  Noninvasive assist w  ...........  ...........  ...........  ...........  ...........
                                                                    backup.
K0534................  A....................  DG.................  Invasive assist w     ...........  ...........  ...........  ...........  ...........
                                                                    backup.
K0538................  A....................  DG.................  Neg pressure wnd      ...........  ...........  ...........  ...........  ...........
                                                                    thrpy pump.
K0539................  A....................  DG.................  Neg pres wnd thrpy    ...........  ...........  ...........  ...........  ...........
                                                                    dsg set.
K0540................  A....................  DG.................  Neg pres wnd thrp     ...........  ...........  ...........  ...........  ...........
                                                                    canister.
K0541................  A....................  DG.................  SGD prerecorded msg   ...........  ...........  ...........  ...........  ...........
                                                                    <= 8 min.
K0542................  A....................  DG.................  SGD prerecorded msg   ...........  ...........  ...........  ...........  ...........
                                                                     8 min.
K0543................  A....................  DG.................  SGD msg formed by     ...........  ...........  ...........  ...........  ...........
                                                                    spelling.
K0544................  A....................  DG.................  SGD w multi methods   ...........  ...........  ...........  ...........  ...........
                                                                    msg/accs.
K0545................  A....................  DG.................  SGD sftwre prgrm for  ...........  ...........  ...........  ...........  ...........
                                                                    PC/PDA.
K0546................  A....................  DG.................  SGD                   ...........  ...........  ...........  ...........  ...........
                                                                    accessory,mounting
                                                                    systm.
K0547................  A....................  DG.................  SGD accessory NOC...  ...........  ...........  ...........  ...........  ...........
K0548................  N....................  NI.................  Insulin lispro......  ...........  ...........  ...........  ...........  ...........
K0549................  A....................  DG.................  Hosp bed hvy dty      ...........  ...........  ...........  ...........  ...........
                                                                    xtra wide.
K0550................  A....................  DG.................  Hosp bed xtra hvy     ...........  ...........  ...........  ...........  ...........
                                                                    dty x wide.
K0552................  Y....................  NF.................  Supply/Ext inf pump   ...........  ...........  ...........  ...........  ...........
                                                                    syr type.
K0556................  A....................  DG.................  Socket insert w lock  ...........  ...........  ...........  ...........  ...........
                                                                    mech.
K0557................  A....................  DG.................  Socket insert w/o     ...........  ...........  ...........  ...........  ...........
                                                                    lock mech.
K0558................  A....................  DG.................  Intl custm cong/atyp  ...........  ...........  ...........  ...........  ...........
                                                                    insert.
K0559................  A....................  DG.................  Initial custom        ...........  ...........  ...........  ...........  ...........
                                                                    socket insert.
K0560................  N....................  DG.................  Mcp joint 2-piece     ...........  ...........  ...........  ...........  ...........
                                                                    for implant.
K0581................  A....................  DG.................  Ost pch clsd w        ...........  ...........  ...........  ...........  ...........
                                                                    barrier/filtr.
K0582................  A....................  DG.................  Ost pch w bar/        ...........  ...........  ...........  ...........  ...........
                                                                    bltinconv/fltr.
K0583................  A....................  DG.................  Ost pch clsd w/o bar  ...........  ...........  ...........  ...........  ...........
                                                                    w filtr.
K0584................  A....................  DG.................  Ost pch for bar w     ...........  ...........  ...........  ...........  ...........
                                                                    flange/flt.
K0585................  A....................  DG.................  Ost pch clsd for bar  ...........  ...........  ...........  ...........  ...........
                                                                    w lk fl.

[[Page 63637]]

 
K0586................  A....................  DG.................  Ost pch for bar w lk  ...........  ...........  ...........  ...........  ...........
                                                                    fl/fltr.
K0587................  A....................  DG.................  Ost pch drain w bar   ...........  ...........  ...........  ...........  ...........
                                                                    & filter.
K0588................  A....................  DG.................  Ost pch drain for     ...........  ...........  ...........  ...........  ...........
                                                                    barrier fl.
K0589................  A....................  DG.................  Ost pch drain 2       ...........  ...........  ...........  ...........  ...........
                                                                    piece system.
K0590................  A....................  DG.................  Ost pch drain/barr    ...........  ...........  ...........  ...........  ...........
                                                                    lk flng/f.
K0591................  A....................  DG.................  Urine ost pouch w     ...........  ...........  ...........  ...........  ...........
                                                                    faucet/tap.
K0592................  A....................  DG.................  Urine ost pouch w     ...........  ...........  ...........  ...........  ...........
                                                                    bltinconv.
K0593................  A....................  DG.................  Ost urine pch w b/    ...........  ...........  ...........  ...........  ...........
                                                                    bltin conv.
K0594................  A....................  DG.................  Ost pch urine w       ...........  ...........  ...........  ...........  ...........
                                                                    barrier/tapv.
K0595................  A....................  DG.................  Os pch urine w bar/   ...........  ...........  ...........  ...........  ...........
                                                                    fange/tap.
K0596................  A....................  DG.................  Urine ost pch bar w   ...........  ...........  ...........  ...........  ...........
                                                                    lock fln.
K0597................  A....................  DG.................  Ost pch urine w lock  ...........  ...........  ...........  ...........  ...........
                                                                    flng/ft.
K0600................  Y....................  NF.................  Functional            ...........  ...........  ...........  ...........  ...........
                                                                    neuromuscular stim.
K0601................  Y....................  NF.................  Repl batt silver      ...........  ...........  ...........  ...........  ...........
                                                                    oxide 1.5 v.
K0602................  Y....................  NF.................  Repl batt silver      ...........  ...........  ...........  ...........  ...........
                                                                    oxide 3 v.
K0603................  Y....................  NF.................  Repl batt alkaline    ...........  ...........  ...........  ...........  ...........
                                                                    1.5 v.
K0604................  Y....................  NF.................  Repl batt lithium     ...........  ...........  ...........  ...........  ...........
                                                                    3.6 v.
K0605................  Y....................  NF.................  Repl batt lithium     ...........  ...........  ...........  ...........  ...........
                                                                    4.5 v.
K0606................  Y....................  NF.................  AED garment w/elec    ...........  ...........  ...........  ...........  ...........
                                                                    analysis.
K0607................  Y....................  NF.................  Repl batt for AED     ...........  ...........  ...........  ...........  ...........
                                                                    device.
K0608................  Y....................  NF.................  Repl garment for AED  ...........  ...........  ...........  ...........  ...........
K0609................  Y....................  NF.................  Repl electrode for    ...........  ...........  ...........  ...........  ...........
                                                                    AED.
K0610................  E....................  DG.................  Peritoneal dialysis   ...........  ...........  ...........  ...........  ...........
                                                                    clamp.
K0611................  E....................  DG.................  Disposable cycler     ...........  ...........  ...........  ...........  ...........
                                                                    set.
K0612................  E....................  DG.................  Drainage ext line,    ...........  ...........  ...........  ...........  ...........
                                                                    dialysis.
K0613................  E....................  DG.................  Ext line w/easy lock  ...........  ...........  ...........  ...........  ...........
                                                                    connect.
K0614................  E....................  DG.................  Chem/antiseptic       ...........  ...........  ...........  ...........  ...........
                                                                    solution, 8oz.
K0615................  Y....................  DG.................  SGD prerec mes 8min <20min.
K0616................  Y....................  DG.................  SGD prerec mes 20min <40min.
K0617................  Y....................  DG.................  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....................  DG.................  Gauze, non-impreg     ...........  ...........  ...........  ...........  ...........
                                                                    pack strip.
K0622................  A....................  DG.................  Confrm band non str   ...........  ...........  ...........  ...........  ...........
                                                                    <3in/rol.
K0623................  A....................  DG.................  Confrm band sterl3in/roll.
K0624................  A....................  DG.................  Lite compress         ...........  ...........  ...........  ...........  ...........
                                                                    wdth<3in/roll.
K0625................  A....................  DG.................  Self adher wdth <3    ...........  ...........  ...........  ...........  ...........
                                                                    in, roll.
K0626................  A....................  DG.................  Self adher wdth =5 in, roll.
L0100................  A....................  ...................  Cranial orthosis/     ...........  ...........  ...........  ...........  ...........
                                                                    helmet mold.
L0110................  A....................  ...................  Cranial orthosis/     ...........  ...........  ...........  ...........  ...........
                                                                    helmet nonm.
L0112................  A....................  NI.................  Cranial cervical      ...........  ...........  ...........  ...........  ...........
                                                                    orthosis.
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.

[[Page 63638]]

 
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.
L0861................  A....................  NI.................  Halo repl liner/      ...........  ...........  ...........  ...........  ...........
                                                                    interface.
L0960................  A....................  ...................  Post surgical         ...........  ...........  ...........  ...........  ...........
                                                                    support pads.
L0970................  A....................  ...................  Tlso corset front...  ...........  ...........  ...........  ...........  ...........
L0972................  A....................  ...................  Lso corset front....  ...........  ...........  ...........  ...........  ...........
L0974................  A....................  ...................  Tlso full corset....  ...........  ...........  ...........  ...........  ...........
L0976................  A....................  ...................  Lso full corset.....  ...........  ...........  ...........  ...........  ...........
L0978................  A....................  ...................  Axillary crutch       ...........  ...........  ...........  ...........  ...........
                                                                    extension.
L0980................  A....................  ...................  Peroneal straps pair  ...........  ...........  ...........  ...........  ...........
L0982................  A....................  ...................  Stocking supp grips   ...........  ...........  ...........  ...........  ...........
                                                                    set of f.
L0984................  A....................  ...................  Protective body sock  ...........  ...........  ...........  ...........  ...........
                                                                    each.
L0999................  A....................  ...................  Add to spinal         ...........  ...........  ...........  ...........  ...........
                                                                    orthosis NOS.
L1000................  A....................  ...................  Ctlso milwauke        ...........  ...........  ...........  ...........  ...........
                                                                    initial model.
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.

[[Page 63639]]

 
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.
L1831................  A....................  NI.................  Knee orth pos         ...........  ...........  ...........  ...........  ...........
                                                                    locking joint.
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.
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....................  DG.................  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.
L1907................  A....................  NI.................  AFO supramalleolar    ...........  ...........  ...........  ...........  ...........
                                                                    custom.
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.
L1951................  A....................  NI.................  AFO spiral            ...........  ...........  ...........  ...........  ...........
                                                                    prefabricated.
L1960................  A....................  ...................  Afo pos solid ank     ...........  ...........  ...........  ...........  ...........
                                                                    plastic mo.
L1970................  A....................  ...................  Afo plastic molded w/ ...........  ...........  ...........  ...........  ...........
                                                                    ankle j.
L1971................  A....................  NI.................  AFO w/ankle joint,    ...........  ...........  ...........  ...........  ...........
                                                                    prefab.
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....................  DG.................  Afo tibial fx cast    ...........  ...........  ...........  ...........  ...........
                                                                    plstr mol.
L2104................  E....................  DG.................  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....................  DG.................  Kafo fem fx cast      ...........  ...........  ...........  ...........  ...........
                                                                    plaster mol.
L2124................  E....................  DG.................  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.

[[Page 63640]]

 
L2136................  A....................  ...................  Kafo femoral fx cast  ...........  ...........  ...........  ...........  ...........
                                                                    rigid.
L2180................  A....................  ...................  Plas shoe insert w    ...........  ...........  ...........  ...........  ...........
                                                                    ank joint.
L2182................  A....................  ...................  Drop lock knee......  ...........  ...........  ...........  ...........  ...........
L2184................  A....................  ...................  Limited motion knee   ...........  ...........  ...........  ...........  ...........
                                                                    joint.
L2186................  A....................  ...................  Adj motion knee jnt   ...........  ...........  ...........  ...........  ...........
                                                                    lerman t.
L2188................  A....................  ...................  Quadrilateral brim..  ...........  ...........  ...........  ...........  ...........
L2190................  A....................  ...................  Waist belt..........  ...........  ...........  ...........  ...........  ...........
L2192................  A....................  ...................  Pelvic band & belt    ...........  ...........  ...........  ...........  ...........
                                                                    thigh fla.
L2200................  A....................  ...................  Limited ankle motion  ...........  ...........  ...........  ...........  ...........
                                                                    ea jnt.
L2210................  A....................  ...................  Dorsiflexion assist   ...........  ...........  ...........  ...........  ...........
                                                                    each joi.
L2220................  A....................  ...................  Dorsi & plantar flex  ...........  ...........  ...........  ...........  ...........
                                                                    ass/res.
L2230................  A....................  ...................  Split flat caliper    ...........  ...........  ...........  ...........  ...........
                                                                    stirr & p.
L2240................  A....................  ...................  Round caliper and     ...........  ...........  ...........  ...........  ...........
                                                                    plate atta.
L2250................  A....................  ...................  Foot plate molded     ...........  ...........  ...........  ...........  ...........
                                                                    stirrup at.
L2260................  A....................  ...................  Reinforced solid      ...........  ...........  ...........  ...........  ...........
                                                                    stirrup.
L2265................  A....................  ...................  Long tongue stirrup.  ...........  ...........  ...........  ...........  ...........
L2270................  A....................  ...................  Varus/valgus strap    ...........  ...........  ...........  ...........  ...........
                                                                    padded/li.
L2275................  A....................  ...................  Plastic mod low ext   ...........  ...........  ...........  ...........  ...........
                                                                    pad/line.
L2280................  A....................  ...................  Molded inner boot...  ...........  ...........  ...........  ...........  ...........
L2300................  A....................  ...................  Abduction bar         ...........  ...........  ...........  ...........  ...........
                                                                    jointed adjust.
L2310................  A....................  ...................  Abduction bar-        ...........  ...........  ...........  ...........  ...........
                                                                    straight.
L2320................  A....................  ...................  Non-molded lacer....  ...........  ...........  ...........  ...........  ...........
L2330................  A....................  ...................  Lacer molded to       ...........  ...........  ...........  ...........  ...........
                                                                    patient mode.
L2335................  A....................  ...................  Anterior swing band.  ...........  ...........  ...........  ...........  ...........
L2340................  A....................  ...................  Pre-tibial shell      ...........  ...........  ...........  ...........  ...........
                                                                    molded to p.
L2350................  A....................  ...................  Prosthetic type       ...........  ...........  ...........  ...........  ...........
                                                                    socket molde.
L2360................  A....................  ...................  Extended steel shank  ...........  ...........  ...........  ...........  ...........
L2370................  A....................  ...................  Patten bottom.......  ...........  ...........  ...........  ...........  ...........
L2375................  A....................  ...................  Torsion ank & half    ...........  ...........  ...........  ...........  ...........
                                                                    solid sti.
L2380................  A....................  ...................  Torsion straight      ...........  ...........  ...........  ...........  ...........
                                                                    knee joint.
L2385................  A....................  ...................  Straight knee joint   ...........  ...........  ...........  ...........  ...........
                                                                    heavy du.
L2390................  A....................  ...................  Offset knee joint     ...........  ...........  ...........  ...........  ...........
                                                                    each.
L2395................  A....................  ...................  Offset knee joint     ...........  ...........  ...........  ...........  ...........
                                                                    heavy duty.
L2397................  A....................  ...................  Suspension sleeve     ...........  ...........  ...........  ...........  ...........
                                                                    lower ext.
L2405................  A....................  ...................  Knee joint drop lock  ...........  ...........  ...........  ...........  ...........
                                                                    ea jnt.
L2415................  A....................  ...................  Knee joint cam lock   ...........  ...........  ...........  ...........  ...........
                                                                    each joi.
L2425................  A....................  ...................  Knee disc/dial lock/  ...........  ...........  ...........  ...........  ...........
                                                                    adj flex.
L2430................  A....................  ...................  Knee jnt ratchet      ...........  ...........  ...........  ...........  ...........
                                                                    lock ea jnt.
L2435................  A....................  ...................  Knee joint            ...........  ...........  ...........  ...........  ...........
                                                                    polycentric joint.
L2492................  A....................  ...................  Knee lift loop drop   ...........  ...........  ...........  ...........  ...........
                                                                    lock rin.
L2500................  A....................  ...................  Thi/glut/ischia wgt   ...........  ...........  ...........  ...........  ...........
                                                                    bearing.
L2510................  A....................  ...................  Th/wght bear quad-    ...........  ...........  ...........  ...........  ...........
                                                                    lat brim m.
L2520................  A....................  ...................  Th/wght bear quad-    ...........  ...........  ...........  ...........  ...........
                                                                    lat brim c.
L2525................  A....................  ...................  Th/wght bear nar m-l  ...........  ...........  ...........  ...........  ...........
                                                                    brim mo.
L2526................  A....................  ...................  Th/wght bear nar m-l  ...........  ...........  ...........  ...........  ...........
                                                                    brim cu.
L2530................  A....................  ...................  Thigh/wght bear       ...........  ...........  ...........  ...........  ...........
                                                                    lacer non-mo.
L2540................  A....................  ...................  Thigh/wght bear       ...........  ...........  ...........  ...........  ...........
                                                                    lacer molded.
L2550................  A....................  ...................  Thigh/wght bear high  ...........  ...........  ...........  ...........  ...........
                                                                    roll cu.
L2570................  A....................  ...................  Hip clevis type 2     ...........  ...........  ...........  ...........  ...........
                                                                    posit jnt.
L2580................  A....................  ...................  Pelvic control        ...........  ...........  ...........  ...........  ...........
                                                                    pelvic sling.
L2600................  A....................  ...................  Hip clevis/thrust     ...........  ...........  ...........  ...........  ...........
                                                                    bearing fr.
L2610................  A....................  ...................  Hip clevis/thrust     ...........  ...........  ...........  ...........  ...........
                                                                    bearing lo.
L2620................  A....................  ...................  Pelvic control hip    ...........  ...........  ...........  ...........  ...........
                                                                    heavy dut.
L2622................  A....................  ...................  Hip joint adjustable  ...........  ...........  ...........  ...........  ...........
                                                                    flexion.
L2624................  A....................  ...................  Hip adj flex ext      ...........  ...........  ...........  ...........  ...........
                                                                    abduct cont.
L2627................  A....................  ...................  Plastic mold recipro  ...........  ...........  ...........  ...........  ...........
                                                                    hip & c.
L2628................  A....................  ...................  Metal frame recipro   ...........  ...........  ...........  ...........  ...........
                                                                    hip & ca.
L2630................  A....................  ...................  Pelvic control band   ...........  ...........  ...........  ...........  ...........
                                                                    & belt u.
L2640................  A....................  ...................  Pelvic control band   ...........  ...........  ...........  ...........  ...........
                                                                    & belt b.
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.

[[Page 63641]]

 
L2840................  A....................  ...................  Tibial length sock    ...........  ...........  ...........  ...........  ...........
                                                                    fx or equ.
L2850................  A....................  ...................  Femoral lgth sock fx  ...........  ...........  ...........  ...........  ...........
                                                                    or equa.
L2860................  A....................  ...................  Torsion mechanism     ...........  ...........  ...........  ...........  ...........
                                                                    knee/ankle.
L2999................  A....................  ...................  Lower extremity       ...........  ...........  ...........  ...........  ...........
                                                                    orthosis NOS.
L3000................  B....................  ...................  Ft insert ucb         ...........  ...........  ...........  ...........  ...........
                                                                    berkeley shell.
L3001................  B....................  ...................  Foot insert remov     ...........  ...........  ...........  ...........  ...........
                                                                    molded spe.
L3002................  B....................  ...................  Foot insert           ...........  ...........  ...........  ...........  ...........
                                                                    plastazote or eq.
L3003................  B....................  ...................  Foot insert silicone  ...........  ...........  ...........  ...........  ...........
                                                                    gel eac.
L3010................  B....................  ...................  Foot longitudinal     ...........  ...........  ...........  ...........  ...........
                                                                    arch suppo.
L3020................  B....................  ...................  Foot longitud/        ...........  ...........  ...........  ...........  ...........
                                                                    metatarsal sup.
L3030................  B....................  ...................  Foot arch support     ...........  ...........  ...........  ...........  ...........
                                                                    remov prem.
L3031................  E....................  NI.................  Foot lamin/prepreg    ...........  ...........  ...........  ...........  ...........
                                                                    composite.
L3040................  B....................  ...................  Ft arch suprt         ...........  ...........  ...........  ...........  ...........
                                                                    premold longit.
L3050................  B....................  ...................  Foot arch supp        ...........  ...........  ...........  ...........  ...........
                                                                    premold metat.
L3060................  B....................  ...................  Foot arch supp        ...........  ...........  ...........  ...........  ...........
                                                                    longitud/meta.
L3070................  B....................  ...................  Arch suprt att to     ...........  ...........  ...........  ...........  ...........
                                                                    sho longit.
L3080................  B....................  ...................  Arch supp att to      ...........  ...........  ...........  ...........  ...........
                                                                    shoe metata.
L3090................  B....................  ...................  Arch supp att to      ...........  ...........  ...........  ...........  ...........
                                                                    shoe long/m.
L3100................  B....................  ...................  Hallus-valgus nght    ...........  ...........  ...........  ...........  ...........
                                                                    dynamic s.
L3140................  B....................  ...................  Abduction rotation    ...........  ...........  ...........  ...........  ...........
                                                                    bar shoe.
L3150................  B....................  ...................  Abduct rotation bar   ...........  ...........  ...........  ...........  ...........
                                                                    w/o shoe.
L3160................  B....................  ...................  Shoe styled           ...........  ...........  ...........  ...........  ...........
                                                                    positioning dev.
L3170................  B....................  ...................  Foot plastic heel     ...........  ...........  ...........  ...........  ...........
                                                                    stabilizer.
L3201................  B....................  ...................  Oxford w supinat/     ...........  ...........  ...........  ...........  ...........
                                                                    pronat inf.
L3202................  B....................  ...................  Oxford w/ supinat/    ...........  ...........  ...........  ...........  ...........
                                                                    pronator c.
L3203................  B....................  ...................  Oxford w/ supinator/  ...........  ...........  ...........  ...........  ...........
                                                                    pronator.
L3204................  B....................  ...................  Hightop w/ supp/      ...........  ...........  ...........  ...........  ...........
                                                                    pronator inf.
L3206................  B....................  ...................  Hightop w/ supp/      ...........  ...........  ...........  ...........  ...........
                                                                    pronator chi.
L3207................  B....................  ...................  Hightop w/ supp/      ...........  ...........  ...........  ...........  ...........
                                                                    pronator jun.
L3208................  B....................  ...................  Surgical boot each    ...........  ...........  ...........  ...........  ...........
                                                                    infant.
L3209................  B....................  ...................  Surgical boot each    ...........  ...........  ...........  ...........  ...........
                                                                    child.
L3211................  B....................  ...................  Surgical boot each    ...........  ...........  ...........  ...........  ...........
                                                                    junior.
L3212................  B....................  ...................  Benesch boot pair     ...........  ...........  ...........  ...........  ...........
                                                                    infant.
L3213................  B....................  ...................  Benesch boot pair     ...........  ...........  ...........  ...........  ...........
                                                                    child.
L3214................  B....................  ...................  Benesch boot pair     ...........  ...........  ...........  ...........  ...........
                                                                    junior.
L3215................  B....................  ...................  Orthopedic ftwear     ...........  ...........  ...........  ...........  ...........
                                                                    ladies oxf.
L3216................  B....................  ...................  Orthoped ladies       ...........  ...........  ...........  ...........  ...........
                                                                    shoes dpth i.
L3217................  B....................  ...................  Ladies shoes hightop  ...........  ...........  ...........  ...........  ...........
                                                                    depth i.
L3219................  B....................  ...................  Orthopedic mens       ...........  ...........  ...........  ...........  ...........
                                                                    shoes oxford.
L3221................  B....................  ...................  Orthopedic mens       ...........  ...........  ...........  ...........  ...........
                                                                    shoes dpth i.
L3222................  B....................  ...................  Mens shoes hightop    ...........  ...........  ...........  ...........  ...........
                                                                    depth inl.
L3224................  A....................  ...................  Woman's shoe oxford   ...........  ...........  ...........  ...........  ...........
                                                                    brace.
L3225................  A....................  ...................  Man's shoe oxford     ...........  ...........  ...........  ...........  ...........
                                                                    brace.
L3230................  B....................  ...................  Custom shoes depth    ...........  ...........  ...........  ...........  ...........
                                                                    inlay.
L3250................  B....................  ...................  Custom mold shoe      ...........  ...........  ...........  ...........  ...........
                                                                    remov prost.
L3251................  B....................  ...................  Shoe molded to pt     ...........  ...........  ...........  ...........  ...........
                                                                    silicone s.
L3252................  B....................  ...................  Shoe molded           ...........  ...........  ...........  ...........  ...........
                                                                    plastazote cust.
L3253................  B....................  ...................  Shoe molded           ...........  ...........  ...........  ...........  ...........
                                                                    plastazote cust.
L3254................  B....................  ...................  Orth foot non-        ...........  ...........  ...........  ...........  ...........
                                                                    stndard size/w.
L3255................  B....................  ...................  Orth foot non-        ...........  ...........  ...........  ...........  ...........
                                                                    standard size/.
L3257................  B....................  ...................  Orth foot add charge  ...........  ...........  ...........  ...........  ...........
                                                                    split s.
L3260................  B....................  ...................  Ambulatory surgical   ...........  ...........  ...........  ...........  ...........
                                                                    boot eac.
L3265................  B....................  ...................  Plastazote sandal     ...........  ...........  ...........  ...........  ...........
                                                                    each.
L3300................  B....................  ...................  Sho lift taper to     ...........  ...........  ...........  ...........  ...........
                                                                    metatarsal.
L3310................  B....................  ...................  Shoe lift elev heel/  ...........  ...........  ...........  ...........  ...........
                                                                    sole neo.
L3320................  B....................  ...................  Shoe lift elev heel/  ...........  ...........  ...........  ...........  ...........
                                                                    sole cor.
L3330................  B....................  ...................  Lifts elevation       ...........  ...........  ...........  ...........  ...........
                                                                    metal extens.
L3332................  B....................  ...................  Shoe lifts tapered    ...........  ...........  ...........  ...........  ...........
                                                                    to one-ha.
L3334................  B....................  ...................  Shoe lifts elevation  ...........  ...........  ...........  ...........  ...........
                                                                    heel /i.
L3340................  B....................  ...................  Shoe wedge sach.....  ...........  ...........  ...........  ...........  ...........
L3350................  E....................  ...................  Shoe heel wedge.....  ...........  ...........  ...........  ...........  ...........
L3360................  B....................  ...................  Shoe sole wedge       ...........  ...........  ...........  ...........  ...........
                                                                    outside sole.
L3370................  B....................  ...................  Shoe sole wedge       ...........  ...........  ...........  ...........  ...........
                                                                    between sole.
L3380................  B....................  ...................  Shoe clubfoot wedge.  ...........  ...........  ...........  ...........  ...........
L3390................  B....................  ...................  Shoe outflare wedge.  ...........  ...........  ...........  ...........  ...........
L3400................  B....................  ...................  Shoe metatarsal bar   ...........  ...........  ...........  ...........  ...........
                                                                    wedge ro.
L3410................  B....................  ...................  Shoe metatarsal bar   ...........  ...........  ...........  ...........  ...........
                                                                    between.
L3420................  B....................  ...................  Full sole/heel wedge  ...........  ...........  ...........  ...........  ...........
                                                                    btween.
L3430................  B....................  ...................  Sho heel count plast  ...........  ...........  ...........  ...........  ...........
                                                                    reinfor.
L3440................  B....................  ...................  Heel leather          ...........  ...........  ...........  ...........  ...........
                                                                    reinforced.
L3450................  B....................  ...................  Shoe heel sach        ...........  ...........  ...........  ...........  ...........
                                                                    cushion type.
L3455................  B....................  ...................  Shoe heel new         ...........  ...........  ...........  ...........  ...........
                                                                    leather standa.
L3460................  B....................  ...................  Shoe heel new rubber  ...........  ...........  ...........  ...........  ...........
                                                                    standar.
L3465................  B....................  ...................  Shoe heel thomas      ...........  ...........  ...........  ...........  ...........
                                                                    with wedge.
L3470................  B....................  ...................  Shoe heel thomas      ...........  ...........  ...........  ...........  ...........
                                                                    extend to b.

[[Page 63642]]

 
L3480................  B....................  ...................  Shoe heel pad &       ...........  ...........  ...........  ...........  ...........
                                                                    depress for.
L3485................  B....................  ...................  Shoe heel pad         ...........  ...........  ...........  ...........  ...........
                                                                    removable for.
L3500................  B....................  ...................  Ortho shoe add        ...........  ...........  ...........  ...........  ...........
                                                                    leather insol.
L3510................  B....................  ...................  Orthopedic shoe add   ...........  ...........  ...........  ...........  ...........
                                                                    rub insl.
L3520................  B....................  ...................  O shoe add felt w     ...........  ...........  ...........  ...........  ...........
                                                                    leath insl.
L3530................  B....................  ...................  Ortho shoe add half   ...........  ...........  ...........  ...........  ...........
                                                                    sole.
L3540................  B....................  ...................  Ortho shoe add full   ...........  ...........  ...........  ...........  ...........
                                                                    sole.
L3550................  B....................  ...................  O shoe add standard   ...........  ...........  ...........  ...........  ...........
                                                                    toe tap.
L3560................  B....................  ...................  O shoe add horseshoe  ...........  ...........  ...........  ...........  ...........
                                                                    toe tap.
L3570................  B....................  ...................  O shoe add instep     ...........  ...........  ...........  ...........  ...........
                                                                    extension.
L3580................  B....................  ...................  O shoe add instep     ...........  ...........  ...........  ...........  ...........
                                                                    velcro clo.
L3590................  B....................  ...................  O shoe convert to     ...........  ...........  ...........  ...........  ...........
                                                                    sof counte.
L3595................  B....................  ...................  Ortho shoe add march  ...........  ...........  ...........  ...........  ...........
                                                                    bar.
L3600................  B....................  ...................  Trans shoe calip      ...........  ...........  ...........  ...........  ...........
                                                                    plate exist.
L3610................  B....................  ...................  Trans shoe caliper    ...........  ...........  ...........  ...........  ...........
                                                                    plate new.
L3620................  B....................  ...................  Trans shoe solid      ...........  ...........  ...........  ...........  ...........
                                                                    stirrup exi.
L3630................  B....................  ...................  Trans shoe solid      ...........  ...........  ...........  ...........  ...........
                                                                    stirrup new.
L3640................  B....................  ...................  Shoe dennis browne    ...........  ...........  ...........  ...........  ...........
                                                                    splint bo.
L3649................  B....................  ...................  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................  B....................  ...................  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.
L3916................  A....................  ...................  Whfo wrist extens w/  ...........  ...........  ...........  ...........  ...........
                                                                    outrigg.
L3917................  A....................  NI.................  Prefab metacarpl fx   ...........  ...........  ...........  ...........  ...........
                                                                    orthosis.
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........  ...........  ...........  ...........  ...........  ...........

[[Page 63643]]

 
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.
L5000................  A....................  ...................  Sho insert w arch     ...........  ...........  ...........  ...........  ...........
                                                                    toe filler.
L5010................  A....................  ...................  Mold socket ank hgt   ...........  ...........  ...........  ...........  ...........
                                                                    w/ toe f.
L5020................  A....................  ...................  Tibial tubercle hgt   ...........  ...........  ...........  ...........  ...........
                                                                    w/ toe f.
L5050................  A....................  ...................  Ank symes mold sckt   ...........  ...........  ...........  ...........  ...........
                                                                    sach ft.
L5060................  A....................  ...................  Symes met fr leath    ...........  ...........  ...........  ...........  ...........
                                                                    socket ar.
L5100................  A....................  ...................  Molded socket shin    ...........  ...........  ...........  ...........  ...........
                                                                    sach foot.
L5105................  A....................  ...................  Plast socket jts/     ...........  ...........  ...........  ...........  ...........
                                                                    thgh lacer.
L5150................  A....................  ...................  Mold sckt ext knee    ...........  ...........  ...........  ...........  ...........
                                                                    shin sach.
L5160................  A....................  ...................  Mold socket bent      ...........  ...........  ...........  ...........  ...........
                                                                    knee shin s.
L5200................  A....................  ...................  Kne sing axis fric    ...........  ...........  ...........  ...........  ...........
                                                                    shin sach.
L5210................  A....................  ...................  No knee/ankle joints  ...........  ...........  ...........  ...........  ...........
                                                                    w/ ft b.
L5220................  A....................  ...................  No knee joint with    ...........  ...........  ...........  ...........  ...........
                                                                    artic ali.
L5230................  A....................  ...................  Fem focal defic       ...........  ...........  ...........  ...........  ...........
                                                                    constant fri.
L5250................  A....................  ...................  Hip canad sing axi    ...........  ...........  ...........  ...........  ...........
                                                                    cons fric.
L5270................  A....................  ...................  Tilt table locking    ...........  ...........  ...........  ...........  ...........
                                                                    hip sing.
L5280................  A....................  ...................  Hemipelvect canad     ...........  ...........  ...........  ...........  ...........
                                                                    sing axis.
L5301................  A....................  ...................  BK mold socket SACH   ...........  ...........  ...........  ...........  ...........
                                                                    ft endo.
L5311................  A....................  ...................  Knee disart, SACH     ...........  ...........  ...........  ...........  ...........
                                                                    ft, endo.
L5321................  A....................  ...................  AK open end SACH....  ...........  ...........  ...........  ...........  ...........
L5331................  A....................  ...................  Hip disart canadian   ...........  ...........  ...........  ...........  ...........
                                                                    SACH ft.
L5341................  A....................  ...................  Hemipelvectomy        ...........  ...........  ...........  ...........  ...........
                                                                    canadian SACH.
L5400................  A....................  ...................  Postop dress & 1      ...........  ...........  ...........  ...........  ...........
                                                                    cast chg bk.

[[Page 63644]]

 
L5410................  A....................  ...................  Postop dsg bk ea add  ...........  ...........  ...........  ...........  ...........
                                                                    cast ch.
L5420................  A....................  ...................  Postop dsg & 1 cast   ...........  ...........  ...........  ...........  ...........
                                                                    chg ak/d.
L5430................  A....................  ...................  Postop dsg ak ea add  ...........  ...........  ...........  ...........  ...........
                                                                    cast ch.
L5450................  A....................  ...................  Postop app non-wgt    ...........  ...........  ...........  ...........  ...........
                                                                    bear dsg.
L5460................  A....................  ...................  Postop app non-wgt    ...........  ...........  ...........  ...........  ...........
                                                                    bear dsg.
L5500................  A....................  ...................  Init bk ptb plaster   ...........  ...........  ...........  ...........  ...........
                                                                    direct.
L5505................  A....................  ...................  Init ak ischal plstr  ...........  ...........  ...........  ...........  ...........
                                                                    direct.
L5510................  A....................  ...................  Prep BK ptb plaster   ...........  ...........  ...........  ...........  ...........
                                                                    molded.
L5520................  A....................  ...................  Perp BK ptb           ...........  ...........  ...........  ...........  ...........
                                                                    thermopls direct.
L5530................  A....................  ...................  Prep BK ptb           ...........  ...........  ...........  ...........  ...........
                                                                    thermopls molded.
L5535................  A....................  ...................  Prep BK ptb open end  ...........  ...........  ...........  ...........  ...........
                                                                    socket.
L5540................  A....................  ...................  Prep BK ptb           ...........  ...........  ...........  ...........  ...........
                                                                    laminated socket.
L5560................  A....................  ...................  Prep AK ischial       ...........  ...........  ...........  ...........  ...........
                                                                    plast molded.
L5570................  A....................  ...................  Prep AK ischial       ...........  ...........  ...........  ...........  ...........
                                                                    direct form.
L5580................  A....................  ...................  Prep AK ischial       ...........  ...........  ...........  ...........  ...........
                                                                    thermo mold.
L5585................  A....................  ...................  Prep AK ischial open  ...........  ...........  ...........  ...........  ...........
                                                                    end.
L5590................  A....................  ...................  Prep AK ischial       ...........  ...........  ...........  ...........  ...........
                                                                    laminated.
L5595................  A....................  ...................  Hip disartic sach     ...........  ...........  ...........  ...........  ...........
                                                                    thermopls.
L5600................  A....................  ...................  Hip disart sach       ...........  ...........  ...........  ...........  ...........
                                                                    laminat mold.
L5610................  A....................  ...................  Above knee            ...........  ...........  ...........  ...........  ...........
                                                                    hydracadence.
L5611................  A....................  ...................  Ak 4 bar link w/fric  ...........  ...........  ...........  ...........  ...........
                                                                    swing.
L5613................  A....................  ...................  Ak 4 bar ling w/      ...........  ...........  ...........  ...........  ...........
                                                                    hydraul swig.
L5614................  A....................  ...................  4-bar link above      ...........  ...........  ...........  ...........  ...........
                                                                    knee w/swng.
L5616................  A....................  ...................  Ak univ multiplex     ...........  ...........  ...........  ...........  ...........
                                                                    sys frict.
L5617................  A....................  ...................  AK/BK self-aligning   ...........  ...........  ...........  ...........  ...........
                                                                    unit ea.
L5618................  A....................  ...................  Test socket symes...  ...........  ...........  ...........  ...........  ...........
L5620................  A....................  ...................  Test socket below     ...........  ...........  ...........  ...........  ...........
                                                                    knee.
L5622................  A....................  ...................  Test socket knee      ...........  ...........  ...........  ...........  ...........
                                                                    disarticula.
L5624................  A....................  ...................  Test socket above     ...........  ...........  ...........  ...........  ...........
                                                                    knee.
L5626................  A....................  ...................  Test socket hip       ...........  ...........  ...........  ...........  ...........
                                                                    disarticulat.
L5628................  A....................  ...................  Test socket           ...........  ...........  ...........  ...........  ...........
                                                                    hemipelvectomy.
L5629................  A....................  ...................  Below knee acrylic    ...........  ...........  ...........  ...........  ...........
                                                                    socket.
L5630................  A....................  ...................  Syme typ expandabl    ...........  ...........  ...........  ...........  ...........
                                                                    wall sckt.
L5631................  A....................  ...................  Ak/knee disartic      ...........  ...........  ...........  ...........  ...........
                                                                    acrylic soc.
L5632................  A....................  ...................  Symes type ptb brim   ...........  ...........  ...........  ...........  ...........
                                                                    design s.
L5634................  A....................  ...................  Symes type poster     ...........  ...........  ...........  ...........  ...........
                                                                    opening so.
L5636................  A....................  ...................  Symes type medial     ...........  ...........  ...........  ...........  ...........
                                                                    opening so.
L5637................  A....................  ...................  Below knee total      ...........  ...........  ...........  ...........  ...........
                                                                    contact.
L5638................  A....................  ...................  Below knee leather    ...........  ...........  ...........  ...........  ...........
                                                                    socket.
L5639................  A....................  ...................  Below knee wood       ...........  ...........  ...........  ...........  ...........
                                                                    socket.
L5640................  A....................  ...................  Knee disarticulat     ...........  ...........  ...........  ...........  ...........
                                                                    leather so.
L5642................  A....................  ...................  Above knee leather    ...........  ...........  ...........  ...........  ...........
                                                                    socket.
L5643................  A....................  ...................  Hip flex inner        ...........  ...........  ...........  ...........  ...........
                                                                    socket ext fr.
L5644................  A....................  ...................  Above knee wood       ...........  ...........  ...........  ...........  ...........
                                                                    socket.
L5645................  A....................  ...................  Bk flex inner socket  ...........  ...........  ...........  ...........  ...........
                                                                    ext fra.
L5646................  A....................  ...................  Below knee air        ...........  ...........  ...........  ...........  ...........
                                                                    cushion socke.
L5647................  A....................  ...................  Below knee suction    ...........  ...........  ...........  ...........  ...........
                                                                    socket.
L5648................  A....................  ...................  Above knee air        ...........  ...........  ...........  ...........  ...........
                                                                    cushion socke.
L5649................  A....................  ...................  Isch containmt/       ...........  ...........  ...........  ...........  ...........
                                                                    narrow m-l so.
L5650................  A....................  ...................  Tot contact ak/knee   ...........  ...........  ...........  ...........  ...........
                                                                    disart s.
L5651................  A....................  ...................  Ak flex inner socket  ...........  ...........  ...........  ...........  ...........
                                                                    ext fra.
L5652................  A....................  ...................  Suction susp ak/knee  ...........  ...........  ...........  ...........  ...........
                                                                    disart.
L5653................  A....................  ...................  Knee disart expand    ...........  ...........  ...........  ...........  ...........
                                                                    wall sock.
L5654................  A....................  ...................  Socket insert symes.  ...........  ...........  ...........  ...........  ...........
L5655................  A....................  ...................  Socket insert below   ...........  ...........  ...........  ...........  ...........
                                                                    knee.
L5656................  A....................  ...................  Socket insert knee    ...........  ...........  ...........  ...........  ...........
                                                                    articulat.
L5658................  A....................  ...................  Socket insert above   ...........  ...........  ...........  ...........  ...........
                                                                    knee.
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.
L5673................  A....................  NI.................  Socket insert w lock  ...........  ...........  ...........  ...........  ...........
                                                                    mech.
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  ...........  ...........  ...........  ...........  ...........
L5679................  A....................  NI.................  Socket insert w/o     ...........  ...........  ...........  ...........  ...........
                                                                    lock mech.
L5680................  A....................  ...................  Bk thigh lacer non-   ...........  ...........  ...........  ...........  ...........
                                                                    molded.
L5681................  A....................  NI.................  Intl custm cong/      ...........  ...........  ...........  ...........  ...........
                                                                    latyp insert.
L5682................  A....................  ...................  Bk thigh lacer glut/  ...........  ...........  ...........  ...........  ...........
                                                                    ischia m.
L5683................  A....................  NI.................  Initial custom        ...........  ...........  ...........  ...........  ...........
                                                                    socket insert.

[[Page 63645]]

 
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.
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.

[[Page 63646]]

 
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.
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/extension     ...........  ...........  ...........  ...........  ...........
                                                                    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.

[[Page 63647]]

 
L6686................  A....................  ...................  Suction socket......  ...........  ...........  ...........  ...........  ...........
L6687................  A....................  ...................  Frame typ socket bel  ...........  ...........  ...........  ...........  ...........
                                                                    elbow/w.
L6688................  A....................  ...................  Frame typ sock above  ...........  ...........  ...........  ...........  ...........
                                                                    elb/dis.
L6689................  A....................  ...................  Frame typ socket      ...........  ...........  ...........  ...........  ...........
                                                                    shoulder di.
L6690................  A....................  ...................  Frame typ sock        ...........  ...........  ...........  ...........  ...........
                                                                    interscap-tho.
L6691................  A....................  ...................  Removable insert      ...........  ...........  ...........  ...........  ...........
                                                                    each.
L6692................  A....................  ...................  Silicone gel insert   ...........  ...........  ...........  ...........  ...........
                                                                    or equal.
L6693................  A....................  ...................  Lockingelbow forearm  ...........  ...........  ...........  ...........  ...........
                                                                    cntrbal.
L6700................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model 3.
L6705................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model 5.
L6710................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model 5x.
L6715................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model 5xa.
L6720................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model 6.
L6725................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model 7.
L6730................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model 7lo.
L6735................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model 8.
L6740................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model 8x.
L6745................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model 88x.
L6750................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model 10p.
L6755................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model 10x.
L6765................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model 12p.
L6770................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model 99x.
L6775................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model555.
L6780................  A....................  ...................  Terminal device       ...........  ...........  ...........  ...........  ...........
                                                                    model ss555.
L6790................  A....................  ...................  Hooks-accu hook or    ...........  ...........  ...........  ...........  ...........
                                                                    equal.
L6795................  A....................  ...................  Hooks-2 load or       ...........  ...........  ...........  ...........  ...........
                                                                    equal.
L6800................  A....................  ...................  Hooks-aprl vc or      ...........  ...........  ...........  ...........  ...........
                                                                    equal.
L6805................  A....................  ...................  Modifier wrist        ...........  ...........  ...........  ...........  ...........
                                                                    flexion unit.
L6806................  A....................  ...................  Trs grip vc or equal  ...........  ...........  ...........  ...........  ...........
L6807................  A....................  ...................  Term device grip1/2   ...........  ...........  ...........  ...........  ...........
                                                                    or equal.
L6808................  A....................  ...................  Term device infant    ...........  ...........  ...........  ...........  ...........
                                                                    or child.
L6809................  A....................  ...................  Trs super sport       ...........  ...........  ...........  ...........  ...........
                                                                    passive.
L6810................  A....................  ...................  Pincher tool otto     ...........  ...........  ...........  ...........  ...........
                                                                    bock or eq.
L6825................  A....................  ...................  Hands dorrance vo...  ...........  ...........  ...........  ...........  ...........
L6830................  A....................  ...................  Hand aprl vc........  ...........  ...........  ...........  ...........  ...........
L6835................  A....................  ...................  Hand sierra vo......  ...........  ...........  ...........  ...........  ...........
L6840................  A....................  ...................  Hand becker imperial  ...........  ...........  ...........  ...........   W= 40.
R0070................  N....................  ...................  Transport portable x- ...........  ...........  ...........  ...........  ...........
                                                                    ray.
R0075................  N....................  ...................  Transport port x-ray  ...........  ...........  ...........  ...........  ...........
                                                                    multipl.
R0076................  N....................  ...................  Transport portable    ...........  ...........  ...........  ...........  ...........
                                                                    EKG.
V2020................  A....................  ...................  Vision svcs frames    ...........  ...........  ...........  ...........  ...........
                                                                    purchases.
V2025................  E....................  ...................  Eyeglasses delux      ...........  ...........  ...........  ...........  ...........
                                                                    frames.
V2100................  A....................  ...................  Lens spher single     ...........  ...........  ...........  ...........  ...........
                                                                    plano 4.00.
V2101................  A....................  ...................  Single visn sphere    ...........  ...........  ...........  ...........  ...........
                                                                    4.12-7.00.
V2102................  A....................  ...................  Singl visn sphere     ...........  ...........  ...........  ...........  ...........
                                                                    7.12-20.00.
V2103................  A....................  ...................  Spherocylindr 4.00d/  ...........  ...........  ...........  ...........  ...........
                                                                    12-2.00d.
V2104................  A....................  ...................  Spherocylindr 4.00d/  ...........  ...........  ...........  ...........  ...........
                                                                    2.12-4d.
V2105................  A....................  ...................  Spherocylinder 4.00d/ ...........  ...........  ...........  ...........  ...........
                                                                    4.25-6d.
V2106................  A....................  ...................  Spherocylinder 4.00d/ ...........  ...........  ...........  ...........  ...........
                                                                    6.00d.
V2107................  A....................  ...................  Spherocylinder 4.25d/ ...........  ...........  ...........  ...........  ...........
                                                                    12-2d.
V2108................  A....................  ...................  Spherocylinder 4.25d/ ...........  ...........  ...........  ...........  ...........
                                                                    2.12-4d.
V2109................  A....................  ...................  Spherocylinder 4.25d/ ...........  ...........  ...........  ...........  ...........
                                                                    4.25-6d.
V2110................  A....................  ...................  Spherocylinder 4.25d/ ...........  ...........  ...........  ...........  ...........
                                                                    over 6d.
V2111................  A....................  ...................  Spherocylindr 7.25d/  ...........  ...........  ...........  ...........  ...........
                                                                    .25-2.25.
V2112................  A....................  ...................  Spherocylindr 7.25d/  ...........  ...........  ...........  ...........  ...........
                                                                    2.25-4d.
V2113................  A....................  ...................  Spherocylindr 7.25d/  ...........  ...........  ...........  ...........  ...........
                                                                    4.25-6d.
V2114................  A....................  ...................  Spherocylinder over   ...........  ...........  ...........  ...........  ...........
                                                                    12.00d.
V2115................  A....................  ...................  Lens lenticular       ...........  ...........  ...........  ...........  ...........
                                                                    bifocal.
V2116................  A....................  DG.................  Nonaspheric lens      ...........  ...........  ...........  ...........  ...........
                                                                    bifocal.
V2117................  A....................  DG.................  Aspheric lens         ...........  ...........  ...........  ...........  ...........
                                                                    bifocal.
V2118................  A....................  ...................  Lens aniseikonic      ...........  ...........  ...........  ...........  ...........
                                                                    single.
V2121................  A....................  NI.................  Lenticular lens,      ...........  ...........  ...........  ...........  ...........
                                                                    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....................  DG.................  Lens lenticular       ...........  ...........  ...........  ...........  ...........
                                                                    nonaspheric.
V2217................  A....................  DG.................  Lens lenticular       ...........  ...........  ...........  ...........  ...........
                                                                    aspheric bif.
V2218................  A....................  ...................  Lens aniseikonic      ...........  ...........  ...........  ...........  ...........
                                                                    bifocal.
V2219................  A....................  ...................  Lens bifocal seg      ...........  ...........  ...........  ...........  ...........
                                                                    width over.
V2220................  A....................  ...................  Lens bifocal add      ...........  ...........  ...........  ...........  ...........
                                                                    over 3.25d.
V2221................  A....................  NI.................  Lenticular lens,      ...........  ...........  ...........  ...........  ...........
                                                                    bifocal.
V2299................  A....................  ...................  Lens bifocal          ...........  ...........  ...........  ...........  ...........
                                                                    speciality.
V2300................  A....................  ...................  Lens sphere trifocal  ...........  ...........  ...........  ...........  ...........
                                                                    4.00d.

[[Page 63653]]

 
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....................  DG.................  Lens lenticular       ...........  ...........  ...........  ...........  ...........
                                                                    nonaspheric.
V2317................  A....................  DG.................  Lens lenticular       ...........  ...........  ...........  ...........  ...........
                                                                    aspheric tri.
V2318................  A....................  ...................  Lens aniseikonic      ...........  ...........  ...........  ...........  ...........
                                                                    trifocal.
V2319................  A....................  ...................  Lens trifocal seg     ...........  ...........  ...........  ...........  ...........
                                                                    width 
                                                                    28.
V2320................  A....................  ...................  Lens trifocal add     ...........  ...........  ...........  ...........  ...........
                                                                    over 3.25d.
V2321................  A....................  NI.................  Lenticular lens,      ...........  ...........  ...........  ...........  ...........
                                                                    trifocal.
V2399................  A....................  ...................  Lens trifocal         ...........  ...........  ...........  ...........  ...........
                                                                    speciality.
V2410................  A....................  ...................  Lens variab           ...........  ...........  ...........  ...........  ...........
                                                                    asphericity sing.
V2430................  A....................  ...................  Lens variable         ...........  ...........  ...........  ...........  ...........
                                                                    asphericity bi.
V2499................  A....................  ...................  Variable asphericity  ...........  ...........  ...........  ...........  ...........
                                                                    lens.
V2500................  A....................  ...................  Contact lens pmma     ...........  ...........  ...........  ...........  ...........
                                                                    spherical.
V2501................  A....................  ...................  Cntct lens pmma-      ...........  ...........  ...........  ...........  ...........
                                                                    toric/prism.
V2502................  A....................  ...................  Contact lens pmma     ...........  ...........  ...........  ...........  ...........
                                                                    bifocal.
V2503................  A....................  ...................  Cntct lens pmma       ...........  ...........  ...........  ...........  ...........
                                                                    color vision.
V2510................  A....................  ...................  Cntct gas permeable   ...........  ...........  ...........  ...........  ...........
                                                                    sphericl.
V2511................  A....................  ...................  Cntct toric prism     ...........  ...........  ...........  ...........  ...........
                                                                    ballast.
V2512................  A....................  ...................  Cntct lens gas        ...........  ...........  ...........  ...........  ...........
                                                                    permbl bifocl.
V2513................  A....................  ...................  Contact lens          ...........  ...........  ...........  ...........  ...........
                                                                    extended wear.
V2520................  A....................  ...................  Contact lens          ...........  ...........  ...........  ...........  ...........
                                                                    hydrophilic.
V2521................  A....................  ...................  Cntct lens            ...........  ...........  ...........  ...........  ...........
                                                                    hydrophilic toric.
V2522................  A....................  ...................  Cntct lens hydrophil  ...........  ...........  ...........  ...........  ...........
                                                                    bifocl.
V2523................  A....................  ...................  Cntct lens hydrophil  ...........  ...........  ...........  ...........  ...........
                                                                    extend.
V2530................  A....................  ...................  Contact lens gas      ...........  ...........  ...........  ...........  ...........
                                                                    impermeable.
V2531................  A....................  ...................  Contact lens gas      ...........  ...........  ...........  ...........  ...........
                                                                    permeable.
V2599................  A....................  ...................  Contact lens/es       ...........  ...........  ...........  ...........  ...........
                                                                    other type.
V2600................  A....................  ...................  Hand held low vision  ...........  ...........  ...........  ...........  ...........
                                                                    aids.
V2610................  A....................  ...................  Single lens           ...........  ...........  ...........  ...........  ...........
                                                                    spectacle mount.
V2615................  A....................  ...................  Telescop/othr         ...........  ...........  ...........  ...........  ...........
                                                                    compound lens.
V2623................  A....................  ...................  Plastic eye prosth    ...........  ...........  ...........  ...........  ...........
                                                                    custom.
V2624................  A....................  ...................  Polishing artifical   ...........  ...........  ...........  ...........  ...........
                                                                    eye.
V2625................  A....................  ...................  Enlargemnt of eye     ...........  ...........  ...........  ...........  ...........
                                                                    prosthesis.
V2626................  A....................  ...................  Reduction of eye      ...........  ...........  ...........  ...........  ...........
                                                                    prosthesis.
V2627................  A....................  ...................  Scleral cover shell.  ...........  ...........  ...........  ...........  ...........
V2628................  A....................  ...................  Fabrication &         ...........  ...........  ...........  ...........  ...........
                                                                    fitting.
V2629................  A....................  ...................  Prosthetic eye other  ...........  ...........  ...........  ...........  ...........
                                                                    type.
V2630................  N....................  ...................  Anter chamber         ...........  ...........  ...........  ...........  ...........
                                                                    intraocul lens.
V2631................  N....................  ...................  Iris support          ...........  ...........  ...........  ...........  ...........
                                                                    intraoclr lens.
V2632................  N....................  ...................  Post chmbr            ...........  ...........  ...........  ...........  ...........
                                                                    intraocular lens.
V2700................  A....................  ...................  Balance lens........  ...........  ...........  ...........  ...........  ...........
V2710................  A....................  ...................  Glass/plastic slab    ...........  ...........  ...........  ...........  ...........
                                                                    off prism.
V2715................  A....................  ...................  Prism lens/es.......  ...........  ...........  ...........  ...........  ...........
V2718................  A....................  ...................  Fresnell prism press- ...........  ...........  ...........  ...........  ...........
                                                                    on lens.
V2730................  A....................  ...................  Special base curve..  ...........  ...........  ...........  ...........  ...........
V2740................  A....................  DG.................  Rose tint plastic...  ...........  ...........  ...........  ...........  ...........
V2741................  A....................  DG.................  Non-rose tint         ...........  ...........  ...........  ...........  ...........
                                                                    plastic.
V2742................  A....................  DG.................  Rose tint glass.....  ...........  ...........  ...........  ...........  ...........
V2743................  A....................  DG.................  Non-rose tint glass.  ...........  ...........  ...........  ...........  ...........
V2744................  A....................  ...................  Tint photochromatic   ...........  ...........  ...........  ...........  ...........
                                                                    lens/es.
V2745................  A....................  NI.................  Tint, any color/      ...........  ...........  ...........  ...........  ...........
                                                                    solid/grad.
V2750................  A....................  ...................  Anti-reflective       ...........  ...........  ...........  ...........  ...........
                                                                    coating.
V2755................  A....................  ...................  UV lens/es..........  ...........  ...........  ...........  ...........  ...........
V2756................  E....................  NI.................  Eye glass case......  ...........  ...........  ...........  ...........  ...........
V2760................  A....................  ...................  Scratch resistant     ...........  ...........  ...........  ...........  ...........
                                                                    coating.
V2761................  E....................  NI.................  Mirror coating......  ...........  ...........  ...........  ...........  ...........
V2762................  A....................  NI.................  Polarization, any     ...........  ...........  ...........  ...........  ...........
                                                                    lens.
V2770................  A....................  ...................  Occluder lens/es....  ...........  ...........  ...........  ...........  ...........
V2780................  A....................  ...................  Oversize lens/es....  ...........  ...........  ...........  ...........  ...........
V2781................  B....................  ...................  Progressive lens per  ...........  ...........  ...........  ...........  ...........
                                                                    lens.
V2782................  A....................  NI.................  Lens, 1.54-1.65 p/    ...........  ...........  ...........  ...........  ...........
                                                                    1.60-1.79g.
V2783................  A....................  NI.................  Lens, =    ...........  ...........  ...........  ...........  ...........
                                                                    1.66 p/=1.80 g.

[[Page 63654]]

 
V2784................  A....................  NI.................  Lens polycarb or      ...........  ...........  ...........  ...........  ...........
                                                                    equal.
V2785................  F....................  ...................  Corneal tissue        ...........  ...........  ...........  ...........  ...........
                                                                    processing.
V2786................  A....................  NI.................  Occupational          ...........  ...........  ...........  ...........  ...........
                                                                    multifocal lens.
V2790................  N....................  ...................  Amniotic membrane...  ...........  ...........  ...........  ...........  ...........
V2797................  A....................  NI.................  Vis item/svc in       ...........  ...........  ...........  ...........  ...........
                                                                    other code.
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.
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................  B....................  ...................  Hearing service.....  ...........  ...........  ...........  ...........  ...........
V5336................  E....................  ...................  Repair communication  ...........  ...........  ...........  ...........  ...........
                                                                    device.
V5362................  E....................  ...................  Speech screening....  ...........  ...........  ...........  ...........  ...........
V5363................  E....................  ...................  Language screening..  ...........  ...........  ...........  ...........  ...........

[[Page 63655]]

 
V5364................  E....................  ...................  Dysphagia screening.  ...........  ...........  ...........  ...........  ...........
--------------------------------------------------------------------------------------------------------------------------------------------------------
CPT codes and descriptions only are copyright American Medical Association. All Rights Reserved. Applicable FARS/DFARS Apply.
Copyright American Dental Association. All rights reserved.






  Federal Register / Vol. 68, No. 216 / Friday, November 7, 2003 / 
Rules and Regulations  

[[Page 63655]]




[[Page 63656]]



   Addendum D1.--Payment Status Indicators for the Hospital Outpatient
                       Prospective Payment System
------------------------------------------------------------------------
     Indicator          Item/code/service                Status
------------------------------------------------------------------------
A.................  Services furnished to a    Not paid under OPPS. Paid
                     Hospital Outpatient that   by Intermediaries under
                     are paid under a Fee       a Fee Schedule/Payment
                     Schedule/Payment System    System other than OPPS.
                     other than OPPS, e.g.:
                    [sbull] Ambulance
                     Services.
                    [sbull] Clinical
                     Diagnostic Laboratory
                     Services.
                    [sbull] Non-Implantable
                     Prosthetic and Orthotic
                     Devices.
                    [sbull] EPO for ESRD
                     Patients.
                    [sbull] Physical,
                     Occupational, and Speech
                     Therapy.
                    [sbull] Routine Dialysis
                     Services for ESRD
                     Patients Provided in a
                     Certified Dialysis Unit
                     of a Hospital.
                    [sbull] Screening
                     Mammography.
B.................  Codes that are not         Not paid under OPPS.
                     recognized by OPPS when   [sbull] May be paid by
                     submitted on an            Intermediaries when
                     Outpatient Hospital Part   submitted on a different
                     B bill type (12x, 13x,     bill type, e.g., 75x
                     and 14x).                  (CORF), but not paid
                                                under OPPS.
                                               [sbull] An alternate code
                                                that is recognized by
                                                OPPS when submitted on
                                                an Outpatient Hospital
                                                Part B bill type (12x,
                                                13x, and 14x) may be
                                                available.
C.................  Inpatient Procedures.....  Not paid under OPPS.
                                                Admit patient; Bill as
                                                Inpatient.
D.................  Deleted Codes............  Not paid under OPPS. Not
                                                paid under Medicare.
E.................  Items, Codes, and          Not paid under OPPS.
                     Services:.
                    [sbull] That are not
                     covered by Medicare
                     based on Statutory
                     Exclusion.
                    [sbull] That are not
                     covered by Medicare for
                     reasons other than
                     Statutory Exclusion.
                    [sbull] That are not
                     recognized by Medicare
                     but for which an
                     alternate code for the
                     same item or service may
                     be available.
                    [sbull] For which
                     separate payment is not
                     provided by Medicare.
F.................  Corneal Tissue             Not paid under OPPS. Paid
                     Acquisition; Certain       at reasonable cost.
                     CRNA Services.
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 Drugs     Paid under OPPS; Separate
                     and Biologicals;           APC payment.
                     Radiopharmaceutical
                     Agents; Certain
                     Brachytherapy Sources.
L.................  Influenza Vaccine;         Not paid under OPPS. Paid
                     Pneumococcal Pneumonia     at reasonable cost; Not
                     Vaccine.                   subject to deductible or
                                                coinsurance.
N.................  Items and Services         Paid under OPPS. However,
                     packaged into APC Rates.   payment is packaged into
                                                payment for other
                                                services, including
                                                Outliers. Therefore,
                                                there is no separate APC
                                                payment.
P.................  Partial Hospitalization..  Paid under OPPS; Per diem
                                                APC payment.
S.................  Significant Procedure,     Paid under OPPS; Separate
                     Not Discounted when        APC payment.
                     Multiple.
T.................  Significant Procedure,     Paid under OPPS; Separate
                     Multiple Procedure         APC payment.
                     Reduction Applies.
V.................  Clinic or Emergency        Paid under OPPS; Separate
                     Department Visit.          APC payment.
Y.................  Non-Implantable Durable    Not paid under OPPS. All
                     Medical Equipment.         institutional providers
                                                other than Home Health
                                                Agencies bill to DMERC.
X.................  Ancillary Service........  Paid under OPPS; Separate
                                                APC payment.
------------------------------------------------------------------------


                      Addendum D2.--Code Conditions
------------------------------------------------------------------------
        Code  condition                        Descriptor
------------------------------------------------------------------------
DG............................  Deleted code with a grace period;
                                 Payment will be made under the deleted
                                 code during the 90-day grace period.
DNG...........................  Deleted code with no grace period;
                                 Payment will not be made under the
                                 deleted code after December 31, 2003.
NF............................  New code final APC assignment; Comments
                                 were accepted on a proposed APC
                                 assignment in the Proposed Rule; APC
                                 assignment is no longer open to
                                 comment.
NI............................  New code interim APC assignment;
                                 Comments will be accepted on the
                                 interim APC assignment for the new
                                 code.
------------------------------------------------------------------------

    --------------------
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 63656]]



                     Addendum E.--CPT Codes Which Would Be Paid Only As Inpatient Procedures
                                              [Calendar Year 2004]
----------------------------------------------------------------------------------------------------------------
               CPT/HCPCS                           NPRM SI                            Description
----------------------------------------------------------------------------------------------------------------
0001T.................................  C...........................  Endovas repr abdo ao aneurys
0001T.................................  C...........................  Endovas repr abdo ao aneurys
0005T.................................  C...........................  Perc cath stent/brain cv art

[[Page 63657]]

 
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)
0048T.................................  C...........................  Implant ventricular device
0049T.................................  C...........................  External circulation assist
0050T.................................  C...........................  Removal circulation assist
0051T.................................  C...........................  Implant total heart system
00524.................................  C...........................  Anesth, chest drainage
0052T.................................  C...........................  Replace component heart syst
0053T.................................  C...........................  Replace component heart syst
00540.................................  C...........................  Anesth, chest surgery
00542.................................  C...........................  Anesth, release of lung
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
01272.................................  C...........................  Anesth, femoral artery surg
01274.................................  C...........................  Anesth, femoral embolectomy
01402.................................  C...........................  Anesth, knee arthroplasty
01404.................................  C...........................  Anesth, amputation at knee

[[Page 63658]]

 
01442.................................  C...........................  Anesth, knee artery surg
01444.................................  C...........................  Anesth, knee artery repair
01486.................................  C...........................  Anesth, ankle replacement
01502.................................  C...........................  Anesth, lwr leg embolectomy
01632.................................  C...........................  Anesth, surgery of shoulder
01634.................................  C...........................  Anesth, shoulder joint amput
01636.................................  C...........................  Anesth, forequarter amput
01638.................................  C...........................  Anesth, shoulder replacement
01652.................................  C...........................  Anesth, shoulder vessel surg
01654.................................  C...........................  Anesth, shoulder vessel surg
01656.................................  C...........................  Anesth, arm-leg vessel surg
01756.................................  C...........................  Anesth, radical humerus surg
01990.................................  C...........................  Support for organ donor
15756.................................  C...........................  Free muscle flap, microvasc
15757.................................  C...........................  Free skin flap, microvasc
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
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

[[Page 63659]]

 
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
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

[[Page 63660]]

 
22326.................................  C...........................  Treat neck spine fracture
22327.................................  C...........................  Treat thorax spine fracture
22328.................................  C...........................  Treat each add spine fx
22532.................................  C...........................  Lat thorax spine fusion
22533.................................  C...........................  Lat lumbar spine fusion
22534.................................  C...........................  Lat thor/lumb, add'l seg
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
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

[[Page 63661]]

 
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
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

[[Page 63662]]

 
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
27715.................................  C...........................  Revision of lower leg
27720.................................  C...........................  Repair of tibia
27722.................................  C...........................  Repair/graft of tibia
27724.................................  C...........................  Repair/graft of tibia
27725.................................  C...........................  Repair of lower leg
27727.................................  C...........................  Repair of lower leg
27880.................................  C...........................  Amputation of lower leg
27881.................................  C...........................  Amputation of lower leg
27882.................................  C...........................  Amputation of lower leg
27886.................................  C...........................  Amputation follow-up surgery
27888.................................  C...........................  Amputation of foot at ankle
28800.................................  C...........................  Amputation of midfoot
28805.................................  C...........................  Amputation thru metatarsal
31225.................................  C...........................  Removal of upper jaw
31230.................................  C...........................  Removal of upper jaw
31290.................................  C...........................  Nasal/sinus endoscopy, surg
31291.................................  C...........................  Nasal/sinus endoscopy, surg
31292.................................  C...........................  Nasal/sinus endoscopy, surg
31293.................................  C...........................  Nasal/sinus endoscopy, surg
31294.................................  C...........................  Nasal/sinus endoscopy, surg
31360.................................  C...........................  Removal of larynx
31365.................................  C...........................  Removal of larynx

[[Page 63663]]

 
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
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

[[Page 63664]]

 
32662.................................  C...........................  Thoracoscopy, surgical
32663.................................  C...........................  Thoracoscopy, surgical
32664.................................  C...........................  Thoracoscopy, surgical
32665.................................  C...........................  Thoracoscopy, surgical
32800.................................  C...........................  Repair lung hernia
32810.................................  C...........................  Close chest after drainage
32815.................................  C...........................  Close bronchial fistula
32820.................................  C...........................  Reconstruct injured chest
32850.................................  C...........................  Donor pneumonectomy
32851.................................  C...........................  Lung transplant, single
32852.................................  C...........................  Lung transplant with bypass
32853.................................  C...........................  Lung transplant, double
32854.................................  C...........................  Lung transplant with bypass
32900.................................  C...........................  Removal of rib(s)
32905.................................  C...........................  Revise & repair chest wall
32906.................................  C...........................  Revise & repair chest wall
32940.................................  C...........................  Revision of lung
32997.................................  C...........................  Total lung lavage
33015.................................  C...........................  Incision of heart sac
33020.................................  C...........................  Incision of heart sac
33025.................................  C...........................  Incision of heart sac
33030.................................  C...........................  Partial removal of heart sac
33031.................................  C...........................  Partial removal of heart sac
33050.................................  C...........................  Removal of heart sac lesion
33120.................................  C...........................  Removal of heart lesion
33130.................................  C...........................  Removal of heart lesion
33140.................................  C...........................  Heart revascularize (tmr)
33141.................................  C...........................  Heart tmr w/other procedure
33200.................................  C...........................  Insertion of heart pacemaker
33201.................................  C...........................  Insertion of heart pacemaker
33236.................................  C...........................  Remove electrode/thoracotomy
33237.................................  C...........................  Remove electrode/thoracotomy
33238.................................  C...........................  Remove electrode/thoracotomy
33243.................................  C...........................  Remove eltrd/thoracotomy
33245.................................  C...........................  Insert epic eltrd pace-defib
33246.................................  C...........................  Insert epic eltrd/generator
33250.................................  C...........................  Ablate heart dysrhythm focus
33251.................................  C...........................  Ablate heart dysrhythm focus
33253.................................  C...........................  Reconstruct atria
33261.................................  C...........................  Ablate heart dysrhythm focus
33300.................................  C...........................  Repair of heart wound
33305.................................  C...........................  Repair of heart wound
33310.................................  C...........................  Exploratory heart surgery
33315.................................  C...........................  Exploratory heart surgery
33320.................................  C...........................  Repair major blood vessel(s)
33321.................................  C...........................  Repair major vessel
33322.................................  C...........................  Repair major blood vessel(s)
33330.................................  C...........................  Insert major vessel graft
33332.................................  C...........................  Insert major vessel graft
33335.................................  C...........................  Insert major vessel graft
33400.................................  C...........................  Repair of aortic valve
33401.................................  C...........................  Valvuloplasty, open
33403.................................  C...........................  Valvuloplasty, w/cp bypass
33404.................................  C...........................  Prepare heart-aorta conduit
33405.................................  C...........................  Replacement of aortic valve
33406.................................  C...........................  Replacement of aortic valve
33410.................................  C...........................  Replacement of aortic valve
33411.................................  C...........................  Replacement of aortic valve
33412.................................  C...........................  Replacement of aortic valve
33413.................................  C...........................  Replacement of aortic valve
33414.................................  C...........................  Repair of aortic valve
33415.................................  C...........................  Revision, subvalvular tissue
33416.................................  C...........................  Revise ventricle muscle
33417.................................  C...........................  Repair of aortic valve
33420.................................  C...........................  Revision of mitral valve
33422.................................  C...........................  Revision of mitral valve

[[Page 63665]]

 
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
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

[[Page 63666]]

 
33697.................................  C...........................  Repair of heart defects
33702.................................  C...........................  Repair of heart defects
33710.................................  C...........................  Repair of heart defects
33720.................................  C...........................  Repair of heart defect
33722.................................  C...........................  Repair of heart defect
33730.................................  C...........................  Repair heart-vein defect(s)
33732.................................  C...........................  Repair heart-vein defect
33735.................................  C...........................  Revision of heart chamber
33736.................................  C...........................  Revision of heart chamber
33737.................................  C...........................  Revision of heart chamber
33750.................................  C...........................  Major vessel shunt
33755.................................  C...........................  Major vessel shunt
33762.................................  C...........................  Major vessel shunt
33764.................................  C...........................  Major vessel shunt & graft
33766.................................  C...........................  Major vessel shunt
33767.................................  C...........................  Major vessel shunt
33770.................................  C...........................  Repair great vessels defect
33771.................................  C...........................  Repair great vessels defect
33774.................................  C...........................  Repair great vessels defect
33775.................................  C...........................  Repair great vessels defect
33776.................................  C...........................  Repair great vessels defect
33777.................................  C...........................  Repair great vessels defect
33778.................................  C...........................  Repair great vessels defect
33779.................................  C...........................  Repair great vessels defect
33780.................................  C...........................  Repair great vessels defect
33781.................................  C...........................  Repair great vessels defect
33786.................................  C...........................  Repair arterial trunk
33788.................................  C...........................  Revision of pulmonary artery
33800.................................  C...........................  Aortic suspension
33802.................................  C...........................  Repair vessel defect
33803.................................  C...........................  Repair vessel defect
33813.................................  C...........................  Repair septal defect
33814.................................  C...........................  Repair septal defect
33820.................................  C...........................  Revise major vessel
33822.................................  C...........................  Revise major vessel
33824.................................  C...........................  Revise major vessel
33840.................................  C...........................  Remove aorta constriction
33845.................................  C...........................  Remove aorta constriction
33851.................................  C...........................  Remove aorta constriction
33852.................................  C...........................  Repair septal defect
33853.................................  C...........................  Repair septal defect
33860.................................  C...........................  Ascending aortic graft
33861.................................  C...........................  Ascending aortic graft
33863.................................  C...........................  Ascending aortic graft
33870.................................  C...........................  Transverse aortic arch graft
33875.................................  C...........................  Thoracic aortic graft
33877.................................  C...........................  Thoracoabdominal graft
33910.................................  C...........................  Remove lung artery emboli
33915.................................  C...........................  Remove lung artery emboli
33916.................................  C...........................  Surgery of great vessel
33917.................................  C...........................  Repair pulmonary artery
33918.................................  C...........................  Repair pulmonary atresia
33919.................................  C...........................  Repair pulmonary atresia
33920.................................  C...........................  Repair pulmonary atresia
33922.................................  C...........................  Transect pulmonary artery
33924.................................  C...........................  Remove pulmonary shunt
33930.................................  C...........................  Removal of donor heart/lung
33935.................................  C...........................  Transplantation, heart/lung
33940.................................  C...........................  Removal of donor heart
33945.................................  C...........................  Transplantation of heart
33960.................................  C...........................  External circulation assist
33961.................................  C...........................  External circulation assist
33967.................................  C...........................  Insert ia percut device
33968.................................  C...........................  Remove aortic assist device
33970.................................  C...........................  Aortic circulation assist
33971.................................  C...........................  Aortic circulation assist

[[Page 63667]]

 
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
34805.................................  C...........................  Endovasc abdo repair w/pros
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
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

[[Page 63668]]

 
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
35510.................................  C...........................  Artery bypass graft
35511.................................  C...........................  Artery bypass graft
35512.................................  C...........................  Artery bypass graft
35515.................................  C...........................  Artery bypass graft
35516.................................  C...........................  Artery bypass graft
35518.................................  C...........................  Artery bypass graft
35521.................................  C...........................  Artery bypass graft
35522.................................  C...........................  Artery bypass graft
35525.................................  C...........................  Artery bypass graft
35526.................................  C...........................  Artery bypass graft
35531.................................  C...........................  Artery bypass graft
35533.................................  C...........................  Artery bypass graft
35536.................................  C...........................  Artery bypass graft
35541.................................  C...........................  Artery bypass graft
35546.................................  C...........................  Artery bypass graft
35548.................................  C...........................  Artery bypass graft
35549.................................  C...........................  Artery bypass graft
35551.................................  C...........................  Artery bypass graft
35556.................................  C...........................  Artery bypass graft
35558.................................  C...........................  Artery bypass graft
35560.................................  C...........................  Artery bypass graft
35563.................................  C...........................  Artery bypass graft
35565.................................  C...........................  Artery bypass graft
35566.................................  C...........................  Artery bypass graft
35571.................................  C...........................  Artery bypass graft
35582.................................  C...........................  Vein bypass graft
35583.................................  C...........................  Vein bypass graft
35585.................................  C...........................  Vein bypass graft
35587.................................  C...........................  Vein bypass graft
35600.................................  C...........................  Harvest artery for cabg
35601.................................  C...........................  Artery bypass graft
35606.................................  C...........................  Artery bypass graft
35612.................................  C...........................  Artery bypass graft
35616.................................  C...........................  Artery bypass graft
35621.................................  C...........................  Artery bypass graft
35623.................................  C...........................  Bypass graft, not vein
35626.................................  C...........................  Artery bypass graft
35631.................................  C...........................  Artery bypass graft
35636.................................  C...........................  Artery bypass graft
35641.................................  C...........................  Artery bypass graft

[[Page 63669]]

 
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
35697.................................  C...........................  Reimplant artery each
35700.................................  C...........................  Reoperation, bypass graft
35701.................................  C...........................  Exploration, carotid artery
35721.................................  C...........................  Exploration, femoral artery
35741.................................  C...........................  Exploration popliteal artery
35800.................................  C...........................  Explore neck vessels
35820.................................  C...........................  Explore chest vessels
35840.................................  C...........................  Explore abdominal vessels
35870.................................  C...........................  Repair vessel graft defect
35901.................................  C...........................  Excision, graft, neck
35905.................................  C...........................  Excision, graft, thorax
35907.................................  C...........................  Excision, graft, abdomen
36510.................................  C...........................  Insertion of catheter, vein
36660.................................  C...........................  Insertion catheter, artery
36822.................................  C...........................  Insertion of cannula(s)
36823.................................  C...........................  Insertion of cannula(s)
37140.................................  C...........................  Revision of circulation
37145.................................  C...........................  Revision of circulation
37160.................................  C...........................  Revision of circulation
37180.................................  C...........................  Revision of circulation
37181.................................  C...........................  Splice spleen/kidney veins
37182.................................  C...........................  Insert hepatic shunt (tips)
37183.................................  C...........................  Remove hepatic shunt (tips)
37195.................................  C...........................  Thrombolytic therapy, stroke
37616.................................  C...........................  Ligation of chest artery
37617.................................  C...........................  Ligation of abdomen artery
37618.................................  C...........................  Ligation of extremity artery
37660.................................  C...........................  Revision of major vein
37788.................................  C...........................  Revascularization, penis
38100.................................  C...........................  Removal of spleen, total
38101.................................  C...........................  Removal of spleen, partial
38102.................................  C...........................  Removal of spleen, total
38115.................................  C...........................  Repair of ruptured spleen
38380.................................  C...........................  Thoracic duct procedure
38381.................................  C...........................  Thoracic duct procedure
38382.................................  C...........................  Thoracic duct procedure
38562.................................  C...........................  Removal, pelvic lymph nodes
38564.................................  C...........................  Removal, abdomen lymph nodes
38724.................................  C...........................  Removal of lymph nodes, neck
38746.................................  C...........................  Remove thoracic lymph nodes
38747.................................  C...........................  Remove abdominal lymph nodes
38765.................................  C...........................  Remove groin lymph nodes
38770.................................  C...........................  Remove pelvis lymph nodes
38780.................................  C...........................  Remove abdomen lymph nodes
39000.................................  C...........................  Exploration of chest
39010.................................  C...........................  Exploration of chest

[[Page 63670]]

 
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
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

[[Page 63671]]

 
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
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

[[Page 63672]]

 
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
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

[[Page 63673]]

 
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
47140.................................  C...........................  Partial removal, donor liver
47141.................................  C...........................  Partial removal, donor liver
47142.................................  C...........................  Partial removal, donor liver
47360.................................  C...........................  Repair liver wound
47361.................................  C...........................  Repair liver wound
47362.................................  C...........................  Repair liver wound
47380.................................  C...........................  Open ablate liver tumor rf
47381.................................  C...........................  Open ablate liver tumor cryo
47400.................................  C...........................  Incision of liver duct
47420.................................  C...........................  Incision of bile duct
47425.................................  C...........................  Incision of bile duct
47460.................................  C...........................  Incise bile duct sphincter
47480.................................  C...........................  Incision of gallbladder
47550.................................  C...........................  Bile duct endoscopy add-on
47570.................................  C...........................  Laparo cholecystoenterostomy
47600.................................  C...........................  Removal of gallbladder
47605.................................  C...........................  Removal of gallbladder
47610.................................  C...........................  Removal of gallbladder
47612.................................  C...........................  Removal of gallbladder
47620.................................  C...........................  Removal of gallbladder
47700.................................  C...........................  Exploration of bile ducts
47701.................................  C...........................  Bile duct revision
47711.................................  C...........................  Excision of bile duct tumor
47712.................................  C...........................  Excision of bile duct tumor
47715.................................  C...........................  Excision of bile duct cyst
47716.................................  C...........................  Fusion of bile duct cyst
47720.................................  C...........................  Fuse gallbladder & bowel
47721.................................  C...........................  Fuse upper gi structures
47740.................................  C...........................  Fuse gallbladder & bowel
47741.................................  C...........................  Fuse gallbladder & bowel
47760.................................  C...........................  Fuse bile ducts and bowel
47765.................................  C...........................  Fuse liver ducts & bowel
47780.................................  C...........................  Fuse bile ducts and bowel
47785.................................  C...........................  Fuse bile ducts and bowel
47800.................................  C...........................  Reconstruction of bile ducts
47801.................................  C...........................  Placement, bile duct support
47802.................................  C...........................  Fuse liver duct & intestine
47900.................................  C...........................  Suture bile duct injury
48000.................................  C...........................  Drainage of abdomen
48001.................................  C...........................  Placement of drain, pancreas
48005.................................  C...........................  Resect/debride pancreas

[[Page 63674]]

 
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
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

[[Page 63675]]

 
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
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

[[Page 63676]]

 
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
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

[[Page 63677]]

 
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
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

[[Page 63678]]

 
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
61316.................................  C...........................  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
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.................................  C...........................  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

[[Page 63679]]

 
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
61537.................................  C...........................  Removal of brain tissue
61538.................................  C...........................  Removal of brain tissue
61539.................................  C...........................  Removal of brain tissue
61540.................................  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
61566.................................  C...........................  Removal of brain tissue
61567.................................  C...........................  Incision of brain tissue
61570.................................  C...........................  Remove foreign body, brain
61571.................................  C...........................  Incise skull for brain wound
61575.................................  C...........................  Skull base/brainstem surgery
61576.................................  C...........................  Skull base/brainstem surgery
61580.................................  C...........................  Craniofacial approach, skull
61581.................................  C...........................  Craniofacial approach, skull
61582.................................  C...........................  Craniofacial approach, skull
61583.................................  C...........................  Craniofacial approach, skull
61584.................................  C...........................  Orbitocranial approach/skull
61585.................................  C...........................  Orbitocranial approach/skull
61586.................................  C...........................  Resect nasopharynx, skull
61590.................................  C...........................  Infratemporal approach/skull
61591.................................  C...........................  Infratemporal approach/skull
61592.................................  C...........................  Orbitocranial approach/skull
61595.................................  C...........................  Transtemporal approach/skull
61596.................................  C...........................  Transcochlear approach/skull
61597.................................  C...........................  Transcondylar approach/skull
61598.................................  C...........................  Transpetrosal approach/skull
61600.................................  C...........................  Resect/excise cranial lesion
61601.................................  C...........................  Resect/excise cranial lesion
61605.................................  C...........................  Resect/excise cranial lesion
61606.................................  C...........................  Resect/excise cranial lesion
61607.................................  C...........................  Resect/excise cranial lesion
61608.................................  C...........................  Resect/excise cranial lesion
61609.................................  C...........................  Transect artery, sinus
61610.................................  C...........................  Transect artery, sinus
61611.................................  C...........................  Transect artery, sinus
61612.................................  C...........................  Transect artery, sinus
61613.................................  C...........................  Remove aneurysm, sinus
61615.................................  C...........................  Resect/excise lesion, skull
61616.................................  C...........................  Resect/excise lesion, skull
61618.................................  C...........................  Repair dura
61619.................................  C...........................  Repair dura
61624.................................  C...........................  Occlusion/embolization cath
61680.................................  C...........................  Intracranial vessel surgery
61682.................................  C...........................  Intracranial vessel surgery

[[Page 63680]]

 
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
61863.................................  C...........................  Implant neuroelectrode
61864.................................  C...........................  Implant neuroelectrde, add'l
61867.................................  C...........................  Implant neuroelectrode
61868.................................  C...........................  Implant neuroelectrde, add'l
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
62148.................................  C...........................  Retr bone flap to fix skull
62161.................................  C...........................  Dissect brain w/scope
62162.................................  C...........................  Remove colloid cyst w/scope
62163.................................  C...........................  Neuroendoscopy w/fb removal
62164.................................  C...........................  Remove brain tumor w/scope
62165.................................  C...........................  Remove pituit tumor w/scope
62180.................................  C...........................  Establish brain cavity shunt
62190.................................  C...........................  Establish brain cavity shunt
62192.................................  C...........................  Establish brain cavity shunt
62200.................................  C...........................  Establish brain cavity shunt
62201.................................  C...........................  Establish brain cavity shunt
62220.................................  C...........................  Establish brain cavity shunt
62223.................................  C...........................  Establish brain cavity shunt
62256.................................  C...........................  Remove brain cavity shunt
62258.................................  C...........................  Replace brain cavity shunt
63043.................................  C...........................  Laminotomy, addl cervical
63044.................................  C...........................  Laminotomy, addl lumbar
63075.................................  C...........................  Neck spine disk surgery
63076.................................  C...........................  Neck spine disk surgery
63077.................................  C...........................  Spine disk surgery, thorax
63078.................................  C...........................  Spine disk surgery, thorax
63081.................................  C...........................  Removal of vertebral body
63082.................................  C...........................  Remove vertebral body add-on

[[Page 63681]]

 
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
63101.................................  C...........................  Removal of vertebral body
63102.................................  C...........................  Removal of vertebral body
63103.................................  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
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

[[Page 63682]]

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






  Federal Register / Vol. 68, No. 216 / Friday, November 7, 2003 / 
Rules and Regulations  

[[Page 63682]]




                 Addendum H--Wage Index for Urban Areas
------------------------------------------------------------------------
                                                                  Wage
               Urban area (constituent counties)                  index
------------------------------------------------------------------------
0040 \2\ Abilene, TX..........................................    0.7780
  Taylor, TX
0060 Aguadilla, PR............................................    0.4306
  Aguada, PR
  Aguadilla, PR
  Moca, PR
0080 Akron, OH................................................    0.9442
  Portage, OH
  Summit, OH
0120 Albany, GA...............................................    1.0863
  Dougherty, GA
  Lee, GA
0160 \2\ Albany-Schenectady-Troy, NY..........................    0.8526
  Albany, NY
  Montgomery, NY
  Rensselaer, NY
  Saratoga, NY
  Schenectady, NY
  Schoharie, NY
0200 Albuquerque, NM..........................................    0.9300
  Bernalillo, NM
  Sandoval, NM
  Valencia, NM
0220 Alexandria, LA...........................................    0.8037
  Rapides, LA
0240 Allentown-Bethlehem-Easton, PA...........................    0.9721
  Carbon, PA
  Lehigh, PA
  Northampton, PA
0280 Altoona, PA..............................................    0.8827
  Blair, PA
0320 Amarillo, TX.............................................    0.8986
  Potter, TX
  Randall, TX
0380 Anchorage, AK............................................    1.2351
  Anchorage, AK
0440 Ann Arbor, MI............................................    1.1074
  Lenawee, MI
  Livingston, MI
  Washtenaw, MI
0450 Anniston, AL.............................................    0.8090
  Calhoun, AL
0460 \2\ Appleton-Oshkosh-Neenah, WI..........................    0.9304
  Calumet, WI
  Outagamie, WI
  Winnebago, WI
0470 Arecibo, PR..............................................    0.4155
  Arecibo, PR
  Camuy, PR

[[Page 63683]]

 
  Hatillo, PR
0480 Asheville, NC............................................    0.9720
  Buncombe, NC
  Madison, NC
0500 Athens, GA...............................................    0.9818
  Clarke, GA
  Madison, GA
  Oconee, GA
0520 \1\ Atlanta, GA..........................................    1.0130
  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....................................    1.0795
  Atlantic, NJ
  Cape May, NJ
0580 Auburn-Opelika, AL.......................................    0.8494
  Lee, AL
0600 Augusta-Aiken, GA-SC.....................................    0.9625
  Columbia, GA
  McDuffie, GA
  Richmond, GA
  Aiken, SC
  Edgefield, SC
0640 \1\ Austin-San Marcos, TX................................    0.9609
  Bastrop, TX
  Caldwell, TX
  Hays, TX
  Travis, TX
  Williamson, TX
0680 \2\ Bakersfield, CA......................................    0.9967
  Kern, CA
0720 \1\ Baltimore, MD........................................    0.9919
  Anne Arundel, MD
  Baltimore, MD
  Baltimore City, MD
  Carroll, MD
  Harford, MD
  Howard, MD
  Queen Anne's, MD
0733 Bangor, ME...............................................    0.9904
  Penobscot, ME
0743 Barnstable-Yarmouth, MA..................................    1.2956
  Barnstable, MA
0760 Baton Rouge, LA..........................................    0.8406
  Ascension, LA
  East Baton Rouge, LA
  Livingston, LA
  West Baton Rouge, LA
0840 Beaumont-Port Arthur, TX.................................    0.8424
  Hardin, TX
  Jefferson, TX
  Orange, TX
0860 Bellingham, WA...........................................    1.1757
  Whatcom, WA
0870 Benton Harbor, MI........................................    0.8935
  Berrien, MI
0875 \1\ Bergen-Passaic, NJ...................................    1.1731
  Bergen, NJ
  Passaic, NJ
0880 Billings, MT.............................................    0.8961
  Yellowstone, MT
0920 Biloxi-Gulfport-Pascagoula, MS...........................    0.9029
  Hancock, MS
  Harrison, MS
  Jackson, MS
0960 \2\ Binghamton, NY.......................................    0.8526
  Broome, NY
  Tioga, NY1000 Birmingham, AL                                    0.9212
  Blount, AL
  Jefferson, AL
  St. Clair, AL
  Shelby, AL1010 Bismarck, ND                                     0.8033
  Burleigh, ND
  Morton, ND
1020 \2\ Bloomington, IN......................................    0.8824
  Monroe, IN
1040 Bloomington-Normal, IL...................................    0.8832
  McLean, IL
1080 Boise City, ID...........................................    0.9232
  Ada, ID
  Canyon, ID
1123 \1\ Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH.....    1.1233
  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.....................................    1.0049
  Boulder, CO
1145 Brazoria, TX.............................................    0.8137
  Brazoria, TX
1150 Bremerton, WA............................................    1.0580
  Kitsap, WA
1240 Brownsville-Harlingen-San Benito, TX.....................    1.0303
  Cameron, TX
1260 Bryan-College Station, TX................................    0.9019
  Brazos, TX
1280 \1\ Buffalo-Niagara Falls, NY............................    0.9604
  Erie, NY
  Niagara, NY
1303 Burlington, VT...........................................    0.9704
  Chittenden, VT
  Franklin, VT
  Grand Isle, VT
1310 Caguas, PR...............................................    0.4201
  Caguas, PR
  Cayey, PR
  Cidra, PR
  Gurabo, PR
  San Lorenzo, PR
1320 Canton-Massillon, OH.....................................    0.9071
  Carroll, OH
  Stark, OH
1350 Casper, WY...............................................    0.9209
  Natrona, WY
1360 Cedar Rapids, IA.........................................    0.8874
  Linn, IA
1400 Champaign-Urbana, IL.....................................    0.9907
  Champaign, IL
1440 Charleston-North Charleston, SC..........................    0.9332
  Berkeley, SC
  Charleston, SC
  Dorchester, SC
1480 Charleston, WV...........................................    0.8880
  Kanawha, WV
  Putnam, WV
1520 \1\ Charlotte-Gastonia-Rock Hill, NC-SC..................    0.9730
  Cabarrus, NC
  Gaston, NC
  Lincoln, NC
  Mecklenburg, NC
  Rowan, NC
  Stanly, NC
  Union, NC
  York, SC
1540 Charlottesville, VA......................................    1.0025
  Albemarle, VA
  Charlottesville City, VA
  Fluvanna, VA
  Greene, VA
1560 Chattanooga, TN-GA.......................................    0.9086
  Catoosa, GA
  Dade, GA
  Walker, GA
  Hamilton, TN
  Marion, TN
1580 \2\ Cheyenne, WY.........................................    0.9110
  Laramie, WY
1600 \1\ Chicago, IL..........................................    1.0892
  Cook, IL
  DeKalb, IL
  DuPage, IL
  Grundy, IL
  Kane, IL
  Kendall, IL
  Lake, IL
  McHenry, IL
  Will, IL
1620 Chico-Paradise, CA.......................................    1.0193
  Butte, CA
1640 \1\ Cincinnati, OH-KY-IN.................................    0.9413
  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..........................    0.8354
  Christian, KY
  Montgomery, TN
1680 \1\ Cleveland-Lorain-Elyria, OH..........................    0.9671
  Ashtabula, OH
  Cuyahoga, OH
  Geauga, OH

[[Page 63684]]

 
  Lake, OH
  Lorain, OH
  Medina, OH
1720 Colorado Springs, CO.....................................    0.9833
  El Paso, CO
1740 Columbia, MO.............................................    0.8695
  Boone, MO
1760 Columbia, SC.............................................    0.8902
  Lexington, SC
  Richland, SC
1800 Columbus, GA-AL..........................................    0.8694
  Russell, AL
  Chattahoochee, GA
  Harris, GA
  Muscogee, GA
1840 \1\ Columbus, OH.........................................    0.9648
  Delaware, OH
  Fairfield, OH
  Franklin, OH
  Licking, OH
  Madison, OH
  Pickaway, OH
1880 Corpus Christi, TX.......................................    0.8521
  Nueces, TX
  San Patricio, TX
1890 Corvallis, OR............................................    1.1516
  Benton, OR
1900 \2\ Cumberland, MD-WV (MD Hospitals).....................    0.9125
  Allegany, MD
  Mineral, WV
1900 Cumberland, MD-WV (WV Hospitals).........................    0.8200
  Allegany, MD
  Mineral, WV
1920 \1\ Dallas, TX...........................................    0.9974
  Collin, TX
  Dallas, TX
  Denton, TX
  Ellis, TX
  Henderson, TX
  Hunt, TX
  Kaufman, TX
  Rockwall, TX
1950 Danville, VA.............................................
  Danville City, VA
  Pittsylvania, VA                                                0.9035
1960 Davenport-Moline-Rock Island, IA-IL......................    0.8985
  Scott, IA
  Henry, IL
  Rock Island, IL
2000 Dayton-Springfield, OH...................................    0.9529
  Clark, OH
  Greene, OH
  Miami, OH
  Montgomery, OH
2020 Daytona Beach, FL........................................    0.9060
  Flagler, FL
  Volusia, FL
2030 Decatur, AL..............................................    0.8828
  Lawrence, AL
  Morgan, AL
2040 \2\ Decatur, IL..........................................    0.8254
  Macon, IL
2080 \1\ Denver, CO...........................................    1.0837
  Adams, CO
  Arapahoe, CO
  Broomfield, CO
  Denver, CO
  Douglas, CO
  Jefferson, CO
2120 Des Moines, IA...........................................    0.9106
  Dallas, IA
  Polk, IA
  Warren, IA
2160 \1\ Detroit, MI..........................................    1.0101
  Lapeer, MI
  Macomb, MI
  Monroe, MI
  Oakland, MI
  St. Clair, MI
  Wayne, MI
2180 Dothan, AL...............................................    0.7765
  Dale, AL
  Houston, AL
2190 Dover, DE................................................    0.9805
  Kent, DE
2200 Dubuque, IA..............................................    0.8886
  Dubuque, IA
2240 Duluth-Superior, MN-WI...................................    1.0171
  St. Louis, MN
  Douglas, WI
2281 Dutchess County, NY......................................    1.0934
  Dutchess, NY
2290 \2\ Eau Claire, WI.......................................    0.9304
  Chippewa, WI
  Eau Claire, WI
2320 El Paso, TX..............................................    0.9196
  El Paso, TX
2330 Elkhart-Goshen, IN.......................................    0.9783
  Elkhart, IN
2335 \2\ Elmira, NY...........................................    0.8526
  Chemung, NY
2340 Enid, OK.................................................    0.8559
  Garfield, OK
2360 Erie, PA.................................................    0.8601
  Erie, PA
2400 Eugene-Springfield, OR...................................    1.1456
  Lane, OR
2440 \2\ Evansville-Henderson, IN-KY (IN Hospitals)...........    0.8824
  Posey, IN
  Vanderburgh, IN
  Warrick, IN
  Henderson, KY
2440 Evansville-Henderson, IN-KY (KY Hospitals)...............    0.8429
  Posey, IN
  Vanderburgh, IN
  Warrick, IN
  Henderson, KY
2520 Fargo-Moorhead, ND-MN....................................    0.9797
  Clay, MN
  Cass, ND
2560 Fayetteville, NC.........................................    0.8986
  Cumberland, NC
2580 Fayetteville-Springdale-Rogers, AR.......................    0.8396
  Benton, AR
  Washington, AR
2620 Flagstaff, AZ-UT.........................................    1.1333
  Coconino, AZ
  Kane, UT
2640 Flint, MI................................................    1.0858
  Genesee, MI
2650 Florence, AL.............................................    0.7797
  Colbert, AL
  Lauderdale, AL
2655 Florence, SC.............................................    0.8709
  Florence, SC
2670 Fort Collins-Loveland, CO................................    1.0148
  Larimer, CO
2680 \1\ Ft. Lauderdale, FL...................................    1.0479
  Broward, FL
2700 Fort Myers-Cape Coral, FL................................    0.9816
  Lee, FL
2710 Fort Pierce-Port St. Lucie, FL...........................    1.0124
  Martin, FL
  St. Lucie, FL
2720 Fort Smith, AR-OK........................................    0.8424
  Crawford, AR
  Sebastian, AR
  Sequoyah, OK
2750 Fort Walton Beach, FL....................................    0.8966
  Okaloosa, FL
2760 Fort Wayne, IN...........................................    0.9585
  Adams, IN
  Allen, IN
  De Kalb, IN
  Huntington, IN
  Wells, IN
  Whitley, IN
2800 \1\ Forth Worth-Arlington, TX............................    0.9359
  Hood, TX
  Johnson, TX
  Parker, TX
  Tarrant, TX
2840 Fresno, CA...............................................    1.0142
  Fresno, CA
  Madera, CA
2880 Gadsden, AL..............................................    0.8229
  Etowah, AL
2900 Gainesville, FL..........................................    0.9693
  Alachua, FL
2920 Galveston-Texas City, TX.................................    0.9279
  Galveston, TX
2960 Gary, IN.................................................    0.9410
  Lake, IN
  Porter, IN
2975 \2\ Glens Falls, NY......................................    0.8526
  Warren, NY
  Washington, NY
2980 Goldsboro, NC............................................    0.8622
  Wayne, NC
2985 Grand Forks, ND-MN (ND Hospitals)........................    0.8636
  Polk, MN
  Grand Forks, ND
2985 \2\ Grand Forks, ND-MN (MN Hospitals)....................    0.9345
  Polk, MN
  Grand Forks, ND
2995 Grand Junction, CO.......................................    0.9921
  Mesa, CO
3000 \1\ Grand Rapids-Muskegon-Holland, MI....................    0.9469
  Allegan, MI
  Kent, MI
  Muskegon, MI
  Ottawa, MI
3040 Great Falls, MT..........................................    0.8918
  Cascade, MT
3060 Greeley, CO..............................................    0.9453
  Weld, CO
3080 Green Bay, WI............................................    0.9518
  Brown, WI
3120 \1\ Greensboro-Winston-Salem-High Point, NC..............    0.9166

[[Page 63685]]

 
  Alamance, NC
  Davidson, NC
  Davie, NC
  Forsyth, NC
  Guilford, NC
  Randolph, NC
  Stokes, NC
  Yadkin, NC
3150 Greenville, NC...........................................    0.9167
  Pitt, NC
3160 Greenville-Spartanburg-Anderson, SC......................    0.9335
  Anderson, SC
  Cherokee, SC
  Greenville, SC
  Pickens, SC
  Spartanburg, SC
3180 Hagerstown, MD...........................................    0.9172
  Washington, MD
3200 Hamilton-Middletown, OH..................................    0.9214
  Butler, OH
3240 Harrisburg-Lebanon-Carlisle, PA..........................    0.9164
  Cumberland, PA
  Dauphin, PA
  Lebanon, PA
  Perry, PA
3283 \1\ \2\ Hartford, CT.....................................    1.2183
  Hartford, CT
  Litchfield, CT
  Middlesex, CT
  Tolland, CT
3285 \2\ Hattiesburg, MS......................................    0.7778
  Forrest, MS
  Lamar, MS
3290 Hickory-Morganton-Lenoir, NC.............................    0.9242
  Alexander, NC
  Burke, NC
  Caldwell, NC
  Catawba, NC
3320 Honolulu, HI.............................................    1.1116
  Honolulu, HI
3350 Houma, LA................................................    0.7771
  Lafourche, LA
  Terrebonne, LA
3360 \1\ Houston, TX..........................................    0.9834
  Chambers, TX
  Fort Bend, TX
  Harris, TX
  Liberty, TX
  Montgomery, TX
  Waller, TX
3400 Huntington-Ashland, WV-KY-OH.............................    0.9595
  Boyd, KY
  Carter, KY
  Greenup, KY
  Lawrence, OH
  Cabell, WV
  Wayne, WV
3440 Huntsville, AL...........................................    0.9245
  Limestone, AL
  Madison, AL
3480 \1\ Indianapolis, IN.....................................    0.9916
  Boone, IN
  Hamilton, IN
  Hancock, IN
  Hendricks, IN
  Johnson, IN
  Madison, IN
  Marion, IN
  Morgan, IN
  Shelby, IN
3500 Iowa City, IA............................................    0.9548
  Johnson, IA
3520 Jackson, MI..............................................    0.8986
  Jackson, MI
3560 Jackson, MS..............................................    0.8399
  Hinds, MS
  Madison, MS
  Rankin, MS
3580 Jackson, TN..............................................    0.8984
  Madison, TN
  Chester, TN
3600 \1\ Jacksonville, FL.....................................    0.9563
  Clay, FL
  Duval, FL
  Nassau, FL
  St. Johns, FL
3605 Jacksonville, NC.........................................    0.8544
  Onslow, NC
3610 \2\ Jamestown, NY........................................    0.8526
  Chautauqua, NY
3620 \2\ Janesville-Beloit, WI................................    0.9304
  Rock, WI
3640 Jersey City, NJ..........................................    1.1115
  Hudson, NJ
3660 Johnson City-Kingsport-Bristol, TN-VA (TN Hospitals).....    0.8256
  Carter, TN
  Hawkins, TN
  Sullivan, TN
  Unicoi, TN
  Washington, TN
  Bristol City, VA
  Scott, VA
  Washington, VA
3660 \2\ Johnson City-Kingsport-Bristol, TN-VA (VA Hospitals).    0.8498
  Carter, TN
  Hawkins, TN
  Sullivan, TN
  Unicoi, TN
  Washington, TN
  Bristol City, VA
  Scott, VA
  Washington, VA
3680 \2\ Johnstown, PA........................................    0.8378
  Cambria, PA
  Somerset, PA
3700 Jonesboro, AR............................................    0.7809
  Craighead, AR
3710 Joplin, MO...............................................    0.8681
  Jasper, MO
  Newton, MO
3720 Kalamazoo-Battlecreek, MI................................    1.0500
  Calhoun, MI
  Kalamazoo, MI
  Van Buren, MI
3740 Kankakee, IL.............................................    1.0419
  Kankakee, IL
3760 \1\ Kansas City, KS-MO...................................    0.9715
  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..............................................    0.9761
  Kenosha, WI
3810 Killeen-Temple, TX.......................................    0.9159
  Bell, TX
  Coryell, TX
3840 Knoxville, TN............................................    0.8820
  Anderson, TN
  Blount, TN
  Knox, TN
  Loudon, TN
  Sevier, TN
  Union, TN
3850 Kokomo, IN...............................................    0.9045
  Howard, IN
  Tipton, IN
3870 \2\ La Crosse, WI-MN.....................................    0.9304
  Houston, MN
  La Crosse, WI
3880 Lafayette, LA............................................    0.8225
  Acadia, LA
  Lafayette, LA
  St. Landry, LA
  St. Martin, LA
3920 \2\ Lafayette, IN........................................    0.8824
  Clinton, IN
  Tippecanoe, IN
3960 Lake Charles, LA.........................................    0.7841
  Calcasieu, LA
3980 \2\ Lakeland-Winter Haven, FL............................    0.8855
  Polk, FL
4000 Lancaster, PA............................................    0.9282
  Lancaster, PA
4040 Lansing-East Lansing, MI.................................    0.9714
  Clinton, MI
  Eaton, MI
  Ingham, MI
4080 Laredo, TX...............................................    0.8091
  Webb, TX
4100 Las Cruces, NM...........................................    0.8688
  Dona Ana, NM
4120 \1\ Las Vegas, NV-AZ.....................................    1.1528
  Mohave, AZ
  Clark, NV
  Nye, NV
4150 \2\ Lawrence, KS.........................................    0.8074
  Douglas, KS
4200 Lawton, OK...............................................    0.8267
  Comanche, OK
4243 Lewiston-Auburn, ME......................................    0.9383
  Androscoggin, ME
4280 Lexington, KY............................................    0.8685
  Bourbon, KY
  Clark, KY
  Fayette, KY
  Jessamine, KY
  Madison, KY
  Scott, KY
  Woodford, KY
4320 Lima, OH.................................................    0.9522
  Allen, OH
  Auglaize, OH
4360 Lincoln, NE..............................................    1.0033
  Lancaster, NE
4400 Little Rock-North Little Rock, AR........................    0.8923

[[Page 63686]]

 
  Faulkner, AR
  Lonoke, AR
  Pulaski, AR
  Saline, AR
4420 Longview-Marshall, TX....................................    0.9113
  Gregg, TX
  Harrison, TX
  Upshur, TX
4480 \1\ Los Angeles-Long Beach, CA...........................    1.1832
  Los Angeles, CA
4520 \1\ Louisville, KY-IN....................................    0.9242
  Clark, IN
  Floyd, IN
  Harrison, IN
  Scott, IN
  Bullitt, KY
  Jefferson, KY
  Oldham, KY
4600 Lubbock, TX..............................................    0.8272
  Lubbock, TX
4640 Lynchburg, VA............................................    0.9134
  Amherst, VA
  Bedford, VA
  Bedford City, VA
  Campbell, VA
  Lynchburg City, VA
4680 Macon, GA................................................    0.8975
  Bibb, GA
  Houston, GA
  Jones, GA
  Peach, GA
  Twiggs, GA
4720 Madison, WI..............................................    1.0264
  Dane, WI
4800 Mansfield, OH............................................    0.9180
  Crawford, OH
  Richland, OH
4840 Mayaguez, PR.............................................    0.4795
  Anasco, PR
  Cabo Rojo, PR
  Hormigueros, PR
  Mayaguez, PR
  Sabana Grande, PR
  San German, PR
4880 McAllen-Edinburg-Mission, TX.............................    0.8381
  Hidalgo, TX
4890 Medford-Ashland, OR......................................    1.0772
  Jackson, OR
4900 Melbourne-Titusville-Palm Bay, FL........................    0.9776
  Brevard, Fl
4920 \1\ Memphis, TN-AR-MS....................................    0.9009
  Crittenden, AR
  DeSoto, MS
  Fayette, TN
  Shelby, TN
  Tipton, TN
4940 \2\ Merced, CA...........................................    0.9967
  Merced, CA
5000 \1\ Miami, FL............................................    0.9894
  Dade, FL
5015 \1\ Middlesex-Somerset-Hunterdon, NJ.....................    1.1366
  Hunterdon, NJ
  Middlesex, NJ
  Somerset, NJ
5080 \1\ Milwaukee-Waukesha, WI...............................    0.9988
  Milwaukee, WI
  Ozaukee, WI
  Washington, WI
  Waukesha, WI
5120 \1\ Minneapolis-St. Paul, MN-WI..........................    1.1001
  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.............................................    0.8884
  Missoula, MT
5160 Mobile, AL...............................................    0.7994
  Baldwin, AL
  Mobile, AL
5170 Modesto, CA..............................................    1.1275
  Stanislaus, CA
5190 \1\ Monmouth-Ocean, NJ...................................    1.1083
  Monmouth, NJ
  Ocean, NJ
5200 Monroe, LA...............................................    0.7922
  Ouachita, LA
5240 Montgomery, AL...........................................    0.7907
  Autauga, AL
  Elmore, AL
  Montgomery, AL
5280 \2\ Muncie, IN...........................................    0.8824
  Delaware, IN
5330 Myrtle Beach, SC.........................................    0.9112
  Horry, SC
5345 Naples, FL...............................................    0.9790
  Collier, FL
5360 \1\ Nashville, TN........................................    0.9855
  Cheatham, TN
  Davidson, TN
  Dickson, TN
  Robertson, TN
  Rutherford TN
  Sumner, TN
  Williamson, TN
  Wilson, TN
5380 \1\ Nassau-Suffolk, NY...................................    1.3140
  Nassau, NY
  Suffolk, NY
5483 \1\ New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT..    1.2468
  Fairfield, CT
  New Haven, CT
5523 \2\ New London-Norwich, CT...............................    1.2183
  New London, CT
5560 \1\ New Orleans, LA......................................    0.9174
  Jefferson, LA
  Orleans, LA
  Plaquemines, LA
  St. Bernard, LA
  St. Charles, LA
  St. James, LA
  St. John The Baptist, LA
  St. Tammany, LA
5600 \1\ New York, NY.........................................    1.4018
  Bronx, NY
  Kings, NY
  New York, NY
  Putnam, NY
  Queens, NY
  Richmond, NY
  Rockland, NY
  Westchester, NY
5640 \1\ Newark, NJ...........................................    1.1518
  Essex, NJ
  Morris, NJ
  Sussex, NJ
  Union, NJ
  Warren, NJ
5660 Newburgh, NY-PA..........................................    1.1509
  Orange, NY
  Pike, PA
5720 \1\ Norfolk-Virginia Beach-Newport News, VA-NC...........    0.8619
  Currituck, NC
  Chesapeake City, VA
  Gloucester, VA
  Hampton City, VA
  Isle of Wight, VA
  James City, VA
  Mathews, VA
  Newport News City, VA
  Norfolk City, VA
  Poquoson City, VA
  Portsmouth City, VA
  Suffolk City, VA
  Virginia Beach City VA
  Williamsburg City, VA
  York, VA
5775 \1\ Oakland, CA..........................................    1.5119
  Alameda, CA
  Contra Costa, CA
5790 Ocala, FL................................................    0.9728
  Marion, FL
5800 Odessa-Midland, TX.......................................    0.9327
  Ector, TX
  Midland, TX
5880 \1\ Oklahoma City, OK....................................    0.8984
  Canadian, OK
  Cleveland, OK
  Logan, OK
  McClain, OK
  Oklahoma, OK
  Pottawatomie, OK
5910 Olympia, WA..............................................    1.0963
  Thurston, WA
5920 Omaha, NE-IA.............................................    0.9745
  Pottawattamie, IA
  Cass, NE
  Douglas, NE
  Sarpy, NE
  Washington, NE
5945 \1\ Orange County, CA....................................    1.1492
  Orange, CA
5960 \1\ Orlando, FL..........................................    0.9654
  Lake, FL
  Orange, FL
  Osceola, FL
  Seminole, FL
5990 Owensboro, KY............................................    0.8374
  Daviess, KY
6015 \2\ Panama City, FL......................................    0.8855
  Bay, FL
6020 Parkersburg-Marietta, WV-OH (WV Hospitals)...............    0.8039
  Washington, OH

[[Page 63687]]

 
  Wood, WV
6020 \2\ Parkersburg-Marietta, WV-OH (OH Hospitals)...........    0.8820
  Washington, OH
  Wood, WV
6080 \2\ Pensacola, FL........................................    0.8855
  Escambia, FL
  Santa Rosa, FL
6120 Peoria-Pekin, IL.........................................    0.8734
  Peoria, IL
  Tazewell, IL
  Woodford, IL
6160 \1\ Philadelphia, PA-NJ..................................    1.0883
  Burlington, NJ
  Camden, NJ
  Gloucester, NJ
  Salem, NJ
  Bucks, PA
  Chester, PA
  Delaware, PA
  Montgomery, PA
  Philadelphia, PA
6200 \1\ Phoenix-Mesa, AZ.....................................    1.0129
  Maricopa, AZ
  Pinal, AZ
6240 Pine Bluff, AR...........................................    0.7865
  Jefferson, AR
6280 \1\ Pittsburgh, PA.......................................    0.8901
  Allegheny, PA
  Beaver, PA
  Butler, PA
  Fayette, PA
  Washington, PA
  Westmoreland, PA
6323 \2\ Pittsfield, MA.......................................    1.0432
  Berkshire, MA
6340 Pocatello, ID............................................    0.9249
  Bannock, ID
6360 Ponce, PR................................................    0.4708
  Guayanilla, PR
  Juana Diaz, PR
  Penuelas, PR
  Ponce, PR
  Villalba, PR
  Yauco, PR
6403 Portland, ME.............................................    0.9949
  Cumberland, ME
  Sagadahoc, ME
  York, ME
6440 \1\ Portland-Vancouver, OR-WA............................    1.1213
  Clackamas, OR
  Columbia, OR
  Multnomah, OR
  Washington, OR
  Yamhill, OR
  Clark, WA
6483 \1\ Providence-Warwick-Pawtucket, RI.....................    1.0977
  Bristol, RI
  Kent, RI
  Newport, RI
  Providence, RI
  Washington, RI
6520 Provo-Orem, UT...........................................    0.9976
  Utah, UT
6560 \2\ Pueblo, CO...........................................    0.9328
  Pueblo, CO
6580 Punta Gorda, FL..........................................    0.9510
  Charlotte, FL
6600 \2\ Racine, WI...........................................    0.9304
  Racine, WI
6640 \1\ Raleigh-Durham-Chapel Hill, NC.......................    0.9959
  Chatham, NC
  Durham, NC
  Franklin, NC
  Johnston, NC
  Orange, NC
  Wake, NC
6660 Rapid City, SD...........................................    0.8806
  Pennington, SD
6680 Reading, PA..............................................    0.9133
  Berks, PA
6690 Redding, CA..............................................    1.1352
  Shasta, CA
6720 Reno, NV.................................................    1.0682
  Washoe, NV
6740 Richland-Kennewick-Pasco, WA.............................    1.0609
  Benton, WA
  Franklin, WA
6760 Richmond-Petersburg, VA..................................    0.9349
  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 \1\ Riverside-San Bernardino, CA.........................    1.1348
  Riverside, CA
  San Bernardino, CA
6800 Roanoke, VA..............................................    0.8700
  Botetourt, VA
  Roanoke, VA
  Roanoke City, VA
  Salem City, VA
6820 Rochester, MN............................................    1.1739
  Olmsted, MN
6840 \1\ Rochester, NY........................................    0.9430
  Genesee, NY
  Livingston, NY
  Monroe, NY
  Ontario, NY
  Orleans, NY
  Wayne, NY
6880 Rockford, IL.............................................    0.9666
  Boone, IL
  Ogle, IL
  Winnebago, IL
6895 Rocky Mount, NC..........................................    0.9076
  Edgecombe, NC
  Nash, NC
6920 \1\ Sacramento, CA.......................................    1.1845
  El Dorado, CA
  Placer, CA
  Sacramento, CA
6960 Saginaw-Bay City-Midland, MI.............................    1.0032
  Bay, MI
  Midland, MI
  Saginaw, MI
6980 St. Cloud, MN............................................    0.9679
  Benton, MN
  Stearns, MN
7000 \2\ St. Joseph, MO.......................................    0.8056
  Andrew, MO
  Buchanan, MO
7040 \1\ St. Louis, MO-IL.....................................    0.9033
  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................................................    1.0482
  Marion, OR
  Polk, OR
7120 Salinas, CA..............................................    1.4339
  Monterey, CA
7160 \1\ Salt Lake City-Ogden, UT.............................    0.9913
  Davis, UT
  Salt Lake, UT
  Weber, UT
7200 San Angelo, TX...........................................    0.8535
  Tom Green, TX
7240 \1\ San Antonio, TX......................................    0.8870
  Bexar, TX
  Comal, TX
  Guadalupe, TX
  Wilson, TX
7320 \1\ San Diego, CA........................................    1.1147
  San Diego, CA
7360 \1\ San Francisco, CA....................................    1.4514
  Marin, CA
  San Francisco, CA
  San Mateo, CA
7400 \1\ San Jose, CA.........................................    1.4626
  Santa Clara, CA
7440 \1\ San Juan-Bayamon, PR.................................    0.4909
  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

[[Page 63688]]

 
  Trujillo Alto, PR
  Vega Alta, PR
  Vega Baja, PR
  Yabucoa, PR
7460 San Luis Obispo-Atascadero-Paso Robles, CA...............    1.1429
  San Luis Obispo, CA
7480 Santa Barbara-Santa Maria-Lompoc, CA.....................    1.0441
  Santa Barbara, CA
7485 Santa Cruz-Watsonville, CA...............................    1.2942
  Santa Cruz, CA
7490 Santa Fe, NM.............................................    1.0653
  Los Alamos, NM
  Santa Fe, NM
7500 Santa Rosa, CA...........................................    1.2877
  Sonoma, CA
7510 Sarasota-Bradenton, FL...................................    0.9971
  Manatee, FL
  Sarasota, FL
7520 Savannah, GA.............................................    0.9488
  Bryan, GA
  Chatham, GA
  Effingham, GA
7560 Scranton--Wilkes-Barre--Hazleton, PA.....................    0.8412
  Columbia, PA
  Lackawanna, PA
  Luzerne, PA
  Wyoming, PA
7600 \1\ Seattle-Bellevue-Everett, WA.........................    1.1562
  Island, WA
  King, WA
  Snohomish, WA
7610 \2\ Sharon, PA...........................................    0.8378
  Mercer, PA
7620 \2\ Sheboygan, WI........................................    0.9304
  Sheboygan, WI
7640 Sherman-Denison, TX......................................    0.9700
  Grayson, TX
7680 Shreveport-Bossier City, LA..............................    0.9083
  Bossier, LA
  Caddo, LA
  Webster, LA
7720 Sioux City, IA-NE........................................    0.8993
  Woodbury, IA
  Dakota, NE
7760 Sioux Falls, SD..........................................    0.9309
  Lincoln, SD
  Minnehaha, SD
7800 South Bend, IN...........................................    0.9821
  St. Joseph, IN
7840 Spokane, WA..............................................    1.0901
  Spokane, WA
7880 Springfield, IL..........................................    0.8944
  Menard, IL
  Sangamon, IL
7920 Springfield, MO..........................................    0.8457
  Christian, MO
  Greene, MO
  Webster, MO
8003 Springfield, MA..........................................    1.0543
  Hampden, MA
  Hampshire, MA
8050 State College, PA........................................    0.8740
  Centre, PA
8080 \2\ Steubenville-Weirton, OH-WV (OH Hospitals)...........    0.8820
  Jefferson, OH
  Brooke, WV
  Hancock, WV
8080 Steubenville-Weirton, OH-WV (WV Hospitals)...............    0.8398
  Jefferson, OH
  Brooke, WV
  Hancock, WV
8120 Stockton-Lodi, CA........................................    1.0404
  San Joaquin, CA
8140 \2\ Sumter, SC...........................................    0.8498
  Sumter, SC
8160 Syracuse, NY.............................................    0.9412
  Cayuga, NY
  Madison, NY
  Onondaga, NY
  Oswego, NY
8200 Tacoma, WA...............................................    1.1116
  Pierce, WA
8240 \2\ Tallahassee, FL......................................    0.8855
  Gadsden, FL
  Leon, FL
8280 \1\ Tampa-St. Petersburg-Clearwater, FL..................    0.9103
  Hernando, FL
  Hillsborough, FL
  Pasco, FL
  Pinellas, FL
8320 \2\ Terre Haute, IN......................................    0.8824
  Clay, IN
  Vermillion, IN
  Vigo, IN
8360 Texarkana, AR-Texarkana, TX..............................    0.8150
  Miller, AR
  Bowie, TX
8400 Toledo, OH...............................................    0.9397
  Fulton, OH
  Lucas, OH
  Wood, OH
8440 Topeka, KS...............................................    0.9108
  Shawnee, KS
8480 Trenton, NJ..............................................    1.0517
  Mercer, NJ
8520 \2\ Tucson, AZ...........................................    0.9270
  Pima, AZ
8560 Tulsa, OK................................................
  Creek, OK
  Osage, OK
  Rogers, OK
  Tulsa, OK
  Wagoner, OK                                                     0.9185
8600 Tuscaloosa, AL...........................................    0.8212
  Tuscaloosa, AL
8640 Tyler, TX................................................    0.9404
  Smith, TX
8680 \2\ Utica-Rome, NY.......................................    0.8526
  Herkimer, NY
  Oneida, NY
8720 Vallejo-Fairfield-Napa, CA...............................    1.3425
  Napa, CA
  Solano, CA
8735 Ventura, CA..............................................    1.1064
  Ventura, CA
8750 Victoria, TX.............................................    0.8184
  Victoria, TX
8760 Vineland-Millville-Bridgeton, NJ.........................    1.0405
  Cumberland, NJ
8780 \2\ Visalia-Tulare-Porterville, CA.......................    0.9967
  Tulare, CA
8800 Waco, TX.................................................    0.8394
  McLennan, TX
8840 \1\ Washington, DC-MD-VA-WV..............................    1.0904
  District of Columbia, DC
  Calvert, MD
  Charles, MD
  Frederick, MD
  Montgomery, MD
  Prince Georges, MD
  Alexandria City, VA
  Arlington, VA
  Clarke, VA
  Culpeper, VA
  Fairfax, VA
  Fairfax City, VA
  Falls Church City, VA
  Fauquier, VA
  Fredericksburg City, VA
  King George, VA
  Loudoun, VA
  Manassas City, VA
  Manassas Park City, VA
  Prince William, VA
  Spotsylvania, VA
  Stafford, VA
  Warren, VA
  Berkeley, WV
  Jefferson, WV
8920 \2\ Waterloo-Cedar Falls, IA.............................    0.8416
  Black Hawk, IA
8940 Wausau, WI...............................................    0.9783
  Marathon, WI
8960 \1\ West Palm Beach-Boca Raton, FL.......................    0.9798
  Palm Beach, FL
9000 \2\ Wheeling, WV-OH (WV Hospitals).......................    0.8018
  Belmont, OH
  Marshall, WV
  Ohio, WV
9000 \2\ Wheeling, WV-OH (OH Hospitals).......................    0.8820
  Belmont, OH
  Marshall, WV
  Ohio, WV
9040 Wichita, KS..............................................    0.9238
  Butler, KS
  Harvey, KS
  Sedgwick, KS
9080 Wichita Falls, TX........................................    0.8341
  Archer, TX
  Wichita, TX
9140 \2\ Williamsport, PA.....................................    0.8378
  Lycoming, PA
9160 Wilmington-Newark, DE-MD.................................    1.0882
  New Castle, DE
  Cecil, MD
9200 Wilmington, NC...........................................    0.9563
  New Hanover, NC
  Brunswick, NC
9260 \2\ Yakima, WA...........................................    1.0388
  Yakima, WA
9270 \2\ Yolo, CA.............................................    0.9967
  Yolo, CA
9280 York, PA.................................................    0.9119
  York, PA
9320 Youngstown-Warren, OH....................................    0.9214
  Columbiana, OH

[[Page 63689]]

 
  Mahoning, OH
  Trumbull, OH
9340 Yuba City, CA............................................    1.0196
  Sutter, CA
  Yuba, CA
9360 \2\ Yuma, AZ.............................................    0.9270
  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
------------------------------------------------------------------------
Alabama.......................................................    0.7492
Alaska........................................................    1.1886
Arizona.......................................................    0.9270
Arkansas......................................................    0.7734
California....................................................    0.9967
Colorado......................................................    0.9328
Connecticut...................................................    1.2183
Delaware......................................................    0.9595
Florida.......................................................    0.8855
Georgia.......................................................    0.8595
Hawaii........................................................    0.9958
Idaho.........................................................    0.8974
Illinois......................................................    0.8254
Indiana.......................................................    0.8824
Iowa..........................................................    0.8416
Kansas........................................................    0.8074
Kentucky......................................................    0.7974
Louisiana.....................................................    0.7467
Maine.........................................................    0.8812
Maryland......................................................    0.9125
Massachusetts.................................................    1.0432
Michigan......................................................    0.8877
Minnesota.....................................................    0.9345
Mississippi...................................................    0.7778
Missouri......................................................    0.8056
Montana.......................................................    0.8800
Nebraska......................................................    0.8822
Nevada........................................................    0.9806
New Hampshire.................................................    1.0030
New Jersey \1\................................................  ........
New Mexico....................................................    0.8270
New York......................................................    0.8526
North Carolina................................................    0.8456
North Dakota..................................................    0.7778
Ohio..........................................................    0.8820
Oklahoma......................................................    0.7537
Oregon........................................................    0.9994
Pennsylvania..................................................    0.8378
Puerto Rico...................................................    0.4018
Rhode Island \1\..............................................  ........
South Carolina................................................    0.8498
South Dakota..................................................    0.8195
Tennessee.....................................................    0.7886
Texas.........................................................    0.7780
Utah..........................................................    0.8974
Vermont.......................................................    0.9534
Virginia......................................................    0.8498
Washington....................................................    1.0388
West Virginia.................................................    0.8018
Wisconsin.....................................................    0.9304
Wyoming.......................................................    0.9110
------------------------------------------------------------------------
\1\ All counties within the State are classified as urban.


       Addendum J.--Wage Index for Hospitals That Are Reclassified
------------------------------------------------------------------------
                                                                  Wage
                             Area                                 index
------------------------------------------------------------------------
Akron, OH.....................................................    0.9442
Albany, GA....................................................    1.0664
Albuquerque, NM (NM hospitals)................................    0.9300
Albuquerque, NM (CO hospitals)................................    0.9328
Alexandria, LA................................................    0.8037
Allentown-Bethlehem-Easton, PA................................    0.9721
Altoona, PA...................................................    0.8827
Amarillo, TX..................................................    0.8858
Anchorage, AK.................................................    1.2351
Ann Arbor, MI.................................................    1.0846
Anniston, AL..................................................    0.7975
Asheville, NC.................................................    0.9477
Athens, GA....................................................    0.9564
Atlanta, GA...................................................    0.9990
Atlantic-Cape May, NJ.........................................    1.0531
Augusta-Aiken, GA-SC..........................................    0.9433
Austin-San Marcos, TX.........................................    0.9609
Bangor, ME....................................................    0.9904
Barnstable-Yarmouth, MA.......................................    1.2720
Baton Rouge, LA...............................................    0.8406
Bellingham, WA................................................    1.1305
Benton Harbor, MI.............................................    0.8935
Bergen-Passaic, NJ............................................    1.1731
Billings, MT..................................................    0.8961
Biloxi-Gulfport-Pascagoula, MS................................    0.8407
Binghamton, NY................................................    0.8428
Birmingham, AL................................................    0.9212
Bismarck, ND..................................................    0.8033
Bloomington-Normal, IL........................................    0.8832
Boise City, ID................................................    0.9232
Boston-Worcester-Lawrence-Lowell-Brockton, MA-NH..............    1.1233
Burlington, VT................................................    0.9332
Caguas, PR....................................................    0.4201
Casper, WY....................................................    0.9209
Champaign-Urbana, IL..........................................    0.9460
Charleston-North Charleston, SC...............................    0.9332
Charleston, WV (WV Hospitals).................................    0.8568
Charleston, WV (OH Hospitals).................................    0.8820
Charlotte-Gastonia-Rock Hill, NC-SC...........................    0.9730
Charlottesville, VA...........................................    0.9877
Chattanooga, TN-GA............................................    0.9086
Chicago, IL...................................................    1.0752
Cincinnati, OH-KY-IN..........................................    0.9413
Clarksville-Hopkinsville, TN-KY...............................    0.8354
Cleveland-Lorain-Elyria, OH...................................    0.9671
Columbia, MO..................................................    0.8557
Columbia, SC..................................................    0.8902
Columbus, GA-AL...............................................    0.8595
Columbus, OH..................................................    0.9648
Corpus Christi, TX............................................    0.8521
Corvallis, OR.................................................    1.1241
Dallas, TX....................................................    0.9974
Davenport-Moline-Rock Island, IA-IL...........................    0.8985
Dayton-Springfield, OH........................................    0.9529
Decatur, AL...................................................    0.8580
Denver, CO....................................................    1.0664
Des Moines, IA................................................    0.9106
Detroit, MI...................................................    1.0101
Dothan, AL....................................................    0.7765
Duluth-Superior, MN-WI........................................    1.0171
Elkhart-Goshen, IN............................................    0.9554
Erie, PA......................................................    0.8526
Eugene-Springfield, OR........................................    1.0977
Fargo-Moorhead, ND-MN.........................................    0.9501
Fayetteville, NC..............................................    0.8817
Flagstaff, AZ-UT..............................................    1.1079
Flint, MI.....................................................    1.0703
Florence, AL..................................................    0.7797
Fort Collins-Loveland, CO.....................................    1.0148
Ft. Lauderdale, FL............................................    1.0479
Fort Pierce-Port St. Lucie, FL................................    1.0124
Fort Smith, AR-OK.............................................    0.8077
Fort Walton Beach, FL.........................................    0.8804
Forth Worth-Arlington, TX.....................................    0.9359
Gadsden, AL...................................................    0.8229
Gainesville, FL...............................................    0.9693
Grand Forks, ND-MN............................................    0.8636
Grand Junction, CO............................................    0.9921
Grand Rapids-Muskegon-Holland, MI.............................    0.9469
Great Falls, MT...............................................    0.8918
Greeley, CO...................................................    0.9453
Green Bay, WI.................................................    0.9518
Greensboro-Winston-Salem-High Point, NC.......................    0.9058
Greenville, NC................................................    0.9167
Hamilton-Middletown, OH.......................................    0.9214
Harrisburg-Lebanon-Carlisle, PA...............................    0.9164
Hartford, CT..................................................    1.1359
Hickory-Morganton-Lenoir, NC..................................    0.9113
Honolulu, HI..................................................    1.1116
Houston, TX...................................................    0.9834
Huntington-Ashland, WV-KY-OH..................................    0.9076
Huntsville, AL................................................    0.9120
Indianapolis, IN..............................................    0.9916
Iowa City, IA.................................................    0.9404
Jackson, MS...................................................    0.8399
Jackson, TN...................................................    0.8819
Jacksonville, FL..............................................    0.9563
Johnson City-Kingsport-Bristol, TN-VA (VA Hospitals)..........    0.8498
Johnson City-Kingsport-Bristol, TN-VA (KY Hospitals)..........    0.8256
Jonesboro, AR (AR Hospitals)..................................    0.7809
Jonesboro, AR (MO Hospitals)..................................    0.8056
Joplin, MO....................................................    0.8558
Kalamazoo-Battlecreek, MI.....................................    1.0500
Kansas City, KS-MO............................................    0.9715
Knoxville, TN.................................................    0.8820
Kokomo, IN....................................................    0.9045
Lafayette, LA.................................................    0.8225
Lakeland-Winter Haven, FL.....................................    0.8855
Las Vegas, NV-AZ..............................................    1.1401
Lawton, OK....................................................    0.8140
Lexington, KY.................................................    0.8475
Lima, OH......................................................    0.9522
Lincoln, NE...................................................    0.9597
Little Rock-North Little Rock, AR.............................    0.8923
Longview-Marshall, TX.........................................    0.8943
Los Angeles-Long Beach, CA....................................    1.1832
Louisville, KY-IN.............................................    0.9118
Lubbock, TX...................................................    0.8272
Lynchburg, VA.................................................    0.8941
Macon, GA.....................................................    0.8975
Madison, WI...................................................    1.0117

[[Page 63690]]

 
Medford-Ashland, OR...........................................    1.0425
Melbourne-Titusville-Palm Bay, FL.............................    0.9776
Memphis, TN-AR-MS.............................................    0.8786
Miami, FL.....................................................    0.9894
Milwaukee-Waukesha, WI........................................    0.9829
Minneapolis-St. Paul, MN-WI...................................    1.1001
Missoula, MT..................................................    0.8884
Mobile, AL....................................................    0.7994
Modesto, CA...................................................    1.1148
Monmouth-Ocean, NJ............................................    1.1083
Monroe, LA....................................................    0.7922
Montgomery, AL................................................    0.7907
Nashville, TN.................................................    0.9591
New Haven-Bridgeport-Stamford-Waterbury-Danbury, CT...........    1.2468
New Orleans, LA...............................................    0.9174
New York, NY..................................................    1.4018
Newark, NJ....................................................    1.1518
Newburgh, NY-PA...............................................    1.1048
Oakland, CA...................................................    1.5119
Odessa-Midland, TX............................................    0.9076
Oklahoma City, OK.............................................    0.8984
Olympia, WA...................................................    1.0963
Omaha, NE-IA..................................................    0.9745
Orange County, CA.............................................    1.1492
Orlando, FL...................................................    0.9654
Peoria-Pekin, IL..............................................    0.8734
Philadelphia, PA-NJ...........................................    1.0883
Phoenix-Mesa, AZ..............................................    1.0129
Pittsburgh, PA................................................    0.8901
Pittsfield, MA................................................    0.9795
Pocatello, ID.................................................    0.9249
Portland, ME..................................................    0.9658
Portland-Vancouver, OR-WA.....................................    1.1213
Provo-Orem, UT................................................    0.9976
Raleigh-Durham-Chapel Hill, NC................................    0.9725
Rapid City, SD................................................    0.8806
Reading, PA...................................................    0.8998
Redding, CA...................................................    1.1352
Reno, NV......................................................    1.0682
Richland-Kennewick-Pasco, WA (WA Hospitals)...................    1.0388
Richland-Kennewick-Pasco, WA (ID Hospitals)...................    1.0215
Richmond-Petersburg, VA.......................................    0.9349
Roanoke, VA...................................................    0.8700
Rochester, MN.................................................    1.1739
Rockford, IL..................................................    0.9441
Sacramento, CA................................................    1.1845
Saginaw-Bay City-Midland, MI..................................    0.9751
St. Cloud, MN.................................................    0.9679
St. Joseph, MO................................................    0.8578
St. Louis, MO-IL..............................................    0.9033
Salinas, CA...................................................    1.4339
Salt Lake City-Ogden, UT......................................    0.9913
San Antonio, TX...............................................    0.8870
Santa Fe, NM..................................................    0.9524
Santa Rosa, CA................................................    1.2877
Sarasota-Bradenton, FL........................................    0.9971
Savannah, GA..................................................    0.9488
Seattle-Bellevue-Everett, WA..................................    1.1562
Sherman-Denison, TX...........................................    0.9203
Shreveport-Bossier City, LA...................................    0.8937
Sioux City, IA-NE (NE Hospitals)..............................    0.8822
Sioux City, IA-NE (SD Hospitals)..............................    0.8785
Sioux Falls, SD...............................................    0.9184
South Bend, IN................................................    0.9715
Spokane, WA...................................................    1.0717
Springfield, IL...............................................    0.8944
Springfield, MO...............................................    0.8259
Syracuse, NY..................................................    0.9412
Tampa-St. Petersburg-Clearwater, FL...........................    0.9103
Texarkana, AR-Texarkana, TX...................................    0.7969
Toledo, OH....................................................    0.9397
Topeka, KS....................................................    0.9108
Tucson, AZ....................................................    0.9270
Tulsa, OK.....................................................    0.8938
Tuscaloosa, AL................................................    0.8101
Tyler, TX.....................................................    0.9155
Vallejo-Fairfield-Napa, CA....................................    1.3425
Victoria, TX..................................................    0.8184
Waco, TX......................................................    0.8394
Washington, DC-MD-VA-WV.......................................    1.0904
Waterloo-Cedar Falls, IA......................................    0.8416
Wausau, WI....................................................    0.9783
West Palm Beach-Boca Raton, FL................................    0.9798
Wichita, KS...................................................    0.9004
Wichita Falls, TX.............................................    0.8341
Wilmington-Newark, DE-MD......................................    1.0710
Wilmington, NC................................................    0.9424
Youngstown-Warren, OH.........................................    0.9214
Rural Florida.................................................    0.8699
Rural Illinois (IA Hospitals).................................    0.8416
Rural Illinois (MO Hospitals).................................    0.8254
Rural Kentucky................................................    0.7974
Rural Louisiana...............................................    0.7467
Rural Minnesota...............................................    0.9345
Rural Missouri................................................    0.8056
Rural Nebraska................................................    0.8822
Rural Nevada..................................................    0.9276
Rural New Hampshire...........................................    1.0030
Rural Texas...................................................    0.7780
Rural Washington..............................................    1.0388
Rural Wyoming.................................................    0.8984
------------------------------------------------------------------------

[FR Doc. 03-27791 Filed 10-31-03; 11:55 am]
BILLING CODE 4120-01-P